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Chapter 29: Age-Associated Cognitive Disorders & Dementia

Which of the following reversible causes of cognitive impairment should you screen for in a patient with mild cognitive impairment?

A. Depression

B. Hypothyroidism

C. Vitamin B12 deficiency

D. B and C

E. All of the above

E. Depression commonly presents with cognitive symptoms, especially in older people. Hypothyroidism and vitamin B12 deficiency are both reversible causes of cognitive impairment, and screening for these abnormalities is standard of care for a dementia evaluation.

Which of the following medications is most likely to be associated with cognitive impairment?

A. Carvedilol

B. Hydrochlorothiazide

C. Lisinopril

D. Atorvastatin

E. Diphenhydramine

E. Anticholinergics such as diphenhydramine are the drugs most commonly associated with adverse cognitive effects.

Which of the following is the best choice for initial management of a patient with mild Alzheimer disease (AD)?

A. N-methyl-D-aspartate (NMDA) receptor antagonist (eg, memantine)

B. Peripherally acting cholinesterase inhibitor (eg, pyridostigmine)

C. Ginkgo biloba

D. Centrally acting cholinesterase inhibitor (eg, donepezil)

E. Selective serotonin reuptake inhibitor (eg, fluoxetine)

D. First-line treatment for Alzheimer disease is a centrally acting cholinesterase inhibitor. Memantine is indicated in later stages of the disease. Selective serotonin reuptake inhibitors can be used as adjuncts. There is no evidence for the effectiveness of Ginkgo biloba. Peripherally acting cholinesterase inhibitors would have no effect on cerebral function.

Variations in the nucleotide sequence of which of the following genes is most closely associated with the development of late-onset AD?

A. LRRK2

B. Progranulin (GRN)

C. Presenilin-1 (PSEN1)

D. APOE

E. Amyloid precursor protein (APP)

D. The ε4 polymorphism in APOE is the strongest genetic risk factor for late-onset Alzheimer disease (AD). Mutations in presenilin or amyloid precursor protein (APP) cause early-onset AD. LRRK2 mutations cause Parkinson disease, and progranulin mutations cause frontotemporal dementia.

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