Pregunta 1
Pregunta
Normal advancing age can result in a number of neurophysiological changes. Select the change that is abnormal/not due to aging.
Pregunta 2
Pregunta
Subjective Cognitive Decline
• This is a title given to individuals who [blank_start]report[blank_end] experiencing cognitive change-most typically [blank_start]memory[blank_end] deficits.
• No impairment shown on cognitive [blank_start]testing[blank_end].
• There is increasing evidence that this subjectively experienced decline is associated with an [blank_start]increased[blank_end] risk of these patients experiencing [blank_start]future[blank_end] cognitive decline - and having biomarker abnormalities.
Respuesta
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report
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memory
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testing
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increased
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future
Pregunta 3
Pregunta
The DSM-V classifies MCI as “Mild Neurocognitive Disorder”. Their criteria are:
A. Evidence of modest cognitive decline from a previous level of performance in [blank_start]one or more[blank_end] cognitive domains (e.g. complex attention, executive function, learning and memory, language, perceptual motor, or social cognition) based
on:
1. Concern of the [blank_start]individual[blank_end], a knowledgeable informant, or the [blank_start]clinician[blank_end] that there has been a mild decline in functioning; and
2. A modest impairment in cognitive performance, [blank_start]preferably[blank_end] documented by standardised neuropsychological testing (usually 1-2 standard deviations below the expected range-between the 3rd and 16th percentiles).
B. The cognitive deficits do not interfere with capacity for [blank_start]independence[blank_end] in
everyday activities (but greater [blank_start]effort[blank_end], compensatory strategies, or accommodation may be required).
C. The cognitive deficits do not occur exclusively in the context of a [blank_start]delirium[blank_end]
D. The cognitive deficits are not better explained by another [blank_start]mental disorder[blank_end]
Respuesta
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one or more
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individual
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clinician
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preferably
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independence
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effort
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delirium
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mental disorder
Pregunta 4
Pregunta
What’s the difference between MCI and Dementia?
• In MCI there is a preservation of the person’s [blank_start]independence[blank_end] in functional abilities, and [blank_start]lack[blank_end] of significant impairment in [blank_start]occupational or social[blank_end] functioning.
• A person with a dementia or Major Neurocognitive Disorder (DSM-IV) will display more significant deficits on their cognitive tests (>[blank_start]2 SD from the mean[blank_end]) and their functioning will have [blank_start]significantly[blank_end] declined.
Respuesta
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independence
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lack
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occupational or social
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2 SD from the mean
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significantly
Pregunta 5
Pregunta
Risk factors for developing MCI:
• Age
• Male
• Lower [blank_start]educational[blank_end] level
• Presence of [blank_start]apolipoprotein E[blank_end] allele
• Family [blank_start]history[blank_end] of cognitive impairment
• Presence of [blank_start]vascular[blank_end] risk factors (hypertension, hyperlipidaemia, coronary artery disease, and stroke)
• [blank_start]Chronic[blank_end] health conditions e.g. hypertension, hyperlipidaemia, coronary artery disease, osteoarthritis, chronic obstructive pulmonary disease, depression, diabetes mellitus.
• Those that are cognitively or physically [blank_start]sedentary[blank_end]
Respuesta
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educational
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apolipoprotein E
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history
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vascular
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Chronic
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sedentary
Pregunta 6
Pregunta
Not all cases of MCI are precursors to dementia and not all are [blank_start]progressive[blank_end]. Studies have found quite high [blank_start]reversal[blank_end] rates, with [blank_start]30% to 50%[blank_end] of patients originally diagnosed with MCI reverting back to “normal cognition” or remaining [blank_start]stable[blank_end] at follow-up assessments.
SOME reversible Causes of MCI:
• [blank_start]Poly[blank_end]pharmacy
• Hypotension/Orthostatic [blank_start]Hyper[blank_end]tension
• Depression
• [blank_start]Hypo[blank_end]thyroidism
• Vitamin [blank_start]B12[blank_end] Deficiency
• Hypo/hyper[blank_start]glycemia[blank_end]
• De[blank_start]hydration[blank_end]
Respuesta
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progressive
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reversal
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30% to 50%
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stable
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Poly
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Hyper
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Hypo
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B12
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glycemia
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hydration
Pregunta 7
Pregunta
Screening for MCI: MoCA (Montreal Cognitive Assessment)
- Developed in 2005 as a brief [blank_start]screening[blank_end] instrument, not for diagnosis
- Takes 10 [blank_start]minutes[blank_end] to administer and is scored out of [blank_start]30[blank_end] points. Initial norms recommended a cut off score of 26/25 (<[blank_start]25[blank_end] suspected of having MCI) but studies have shown that a cut off of 23/30 may be better as it allows fewer [blank_start]falsepositives[blank_end].
- Assesses multiple cognitive domains including attention, concentration, executive functioning, memory, language, visuospatial skills, abstraction, calculation and orientation.
- The MoCA has excellent [blank_start]sensitivity[blank_end] in identifying MCI and AD (90% and 100% respectively). [blank_start]Specificity[blank_end] = 87% ([blank_start]true positive[blank_end] rate).
Respuesta
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screening
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minutes
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30
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25
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false positives
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sensitivity
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Specificity
-
true positive
Pregunta 8
Pregunta
Choose the incorrect statement.
Respuesta
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Currently there are no pharmacologic treatments that are approved for treatment of MCI.
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Pharmacologic treatments have been found to be useful at delaying the onset of dementia.
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There is no evidence to suggest that vitamins and various supplements help (unless there is a clear vitamin deficiency).
Pregunta 9
Pregunta
Treatments tend to focus on lifestyle modification:
• Vascular [blank_start]risk[blank_end] factor control
• Withdrawing and simplifying [blank_start]medication[blank_end] regimes may help
• Physical [blank_start]exercise[blank_end] is highly protective
• Engaging in meaningful mental [blank_start]stimulation[blank_end] and intellectual activity
• Socialising
• Maximising [blank_start]hearing[blank_end]
• Ensure people with [blank_start]sleep[blank_end] disorders are assessed and treated
• Management of depression and/or anxiety
• Education around [blank_start]external memory aids[blank_end] e.g. diary, calendar, keeping keys/purse in the [blank_start]same[blank_end] spot, reminder notes
• Trying to minimize risk:
- driving assessments, [blank_start]occupational therapy assessment[blank_end] around safety in the home, etc
• Family education