Dementia MCQs

Ans.B. Alzheimer's disease Subcortical dementia is seen in parkinsonism, Huntington's disease, wilson's disease, progressive supranuclear palsy, idiopathic basal ganglion calcification (Fahr's disease), thalamic lesions, multiple sclerosis, HIV associated dementia and multisYstem atroPhY. Alzheimer's disease causes cortical dementia.

Marchiafava-Bignami Disease should be considered in patients with chronic alcohol abuse or malnutrition who present with certain neurological symptoms. These symptoms include Dementia Altered mental status Personality change Spasticity Dysarthria Ataxia Gait abnormalities Seizures Other reported clinical findings include desynchronization of bilateral symmetric movements and unilateral signs of agraphia, apraxia, dyspraxia and anomia. Marchiafava-Bignami disease(MBD) is a very rare disorder of demyelination/necrosis of the corpus callosum and the near subcortical white matter that is especially predominant in ill-fed alcoholics. Vitamin supplementation is usually helpful. Reference: https://www.ncbi.nlm.nih.gov/books/NBK526007/

Explanation: Vitamin B12 deficiency is a common cause of cognitive impairment in the elderly. It can result in memory loss, confusion, and even dementia if left untreated. The deficiency disrupts myelin synthesis, leading to demyelination and neuronal dysfunction. Explanation for other options: Vitamin C (Option A): Deficiency causes scurvy, characterized by symptoms like bleeding gums and weakness, but it is not associated with cognitive decline. Vitamin B6 (Option C): Deficiency may cause irritability, depression, and confusion but is less frequently linked to significant cognitive impairment in older adults. Vitamin B1 (Thiamine) (Option D): Deficiency leads to Wernicke's encephalopathy and Korsakoff's syndrome, which are less common causes of cognitive impairment in the general elderly population compared to vitamin B12 deficiency.

Explanation: Sundowner syndrome is characterised by drowsiness, confusion, ataxia, and accidental falls. It occurs in older people who are overly sedated and in patients with dementia who react adversely to even a small dose of a psychoactive drug. The syndrome also occurs in demented patients when external stimuli, such as light and interpersonal orienting cues, are diminished.

Kraepelin translated the term 'démence précoce' into dementia praecox. (OPTION D) Kraepelin coined the term ' dementia praecox' . He distinguished between manic depression and dementia praecox, which was later named schizophrenia. Adolf Meyer was the founder of psychobiology . (OPTION A) Reference: Synopsis of Psychiatry, eleventh edition, chapter 7, page no. 301

Explanation: Tacrine is an older acetylcholinesterase inhibitor that's rarely used now. The main reason for the decline in its usage is the significant risk of hepatotoxicity it poses.

Rivastigmine is the correct choice because it is available as both an oral medication and a transdermal patch. The patch is particularly useful in elderly patients who have difficulty swallowing. Incorrect options: (A): Donepezil is only available in an oral form and would not be appropriate for a patient who cannot tolerate oral medications. (B): Memantine is not an acetylcholinesterase inhibitor. It is an NMDA receptor antagonist used in Alzheimer's disease, but it is not suitable for this question. (C): Galantamine is another acetylcholinesterase inhibitor but is also only available in oral form. Key Takeaways: Rivastigmine can be used in patients who cannot tolerate oral medications, as it comes in a transdermal patch form. Donepezil and Galantamine are available only in oral form. Memantine works differently from acetylcholinesterase inhibitors and is not used in this context.

In 1984, Jules Falret described the condition associated with alternating moods of depression and mania. He called it ' folie circulaire' . ( OPTION B ) It was Hippocrates who used the terms such as ' mania' and ' melancholia' to describe mental illness. ( OPTION A ) Kahlbaum used the term ' cyclothymia' . ( OPTION C ) Kraepelin coined the term ' dementia praecox' . ( OPTION D ) Reference: Synopsis of Psychiatry, eleventh edition, chapter 8, page no. 347