Which of the following scales can be used to record the behavioural and psychological features associated with dementia in elderly people?
A. The Neuropsychiatric inventory (NPI) can be used to measure behavioural and psychological features of dementia in elderly people. It was created by Cummings et al. It evaluates 10–12 neuropsychiatric disturbances common to dementia using frequency, severity and the carer’s distress as indices. The Bristol scale is used to measure activities of daily living; the Cornell depression scale is used to assess depression in demented patients. The abbreviated mental test is a quick and easily administered test that is used as a screening tool for dementia.
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Which of the following diagnostic tests has been most widely used to monitor treatment response in anticholinesterase trials for dementia?
C. The ADAS-Cog is used as the de facto standard primary outcome neuropsychological measure for dementia trials. It measures several cognitive domains, including memory, language, and praxis with total scores ranging from 0 to 70. A four-point change on the ADAS-Cog at 6 months after starting anti-dementia drugs has been used as an arbitrary cut-off point indicating a clinically important difference. This pharmaceutical cut-off on ADAS-Cog must be interpreted in the context of overall response when it is translated to clinical practice. MMSE is not as sensitive to change as ADAS-Cog; hence, it is rarely used as a primary outcome measure in dementia trials. An MRI brain scan currently has no role in monitoring treatment response.
The average annual decline on the (Mini-Mental State Examination) MMSE scores for patients with a natural course of Alzheimer’s dementia is:
B. Alzheimer’s dementia is associated with an annual decline on the MMSE of 3–4 points. Similarly using the ADAS-Cog scale, the natural disease progression averages a 7-point decline per year. But the average change on ADAS-Cog when using anti-dementia drugs is about 2.7 points. Thus cholinesterase inhibitors are considered to delay this progression by 6 months on average. MMSE is a reasonable tool for monitoring disease progression in a clinical setting, but the occurrence of functional impairment is more likely to be relevant to the patient and their carers than MMSE scores. Performance in instrumental activities of daily living such as telephone use, taking own medication, handling finances, and transport correlates well with cognitive impairment.
Hyponatraemia is a troublesome side-effect of treating depression in elderly people.
All of the following are true with regard to the above except:
A. Generally, a high level of suspicion is needed to detect hyponatraemia in a depressed patient who does not undergo regular blood tests for electrolytes. The symptoms of hyponatraemia overlap with those of depression, making it hard to diagnose. Hyponatraemia due to selective serotonin reuptake inhibitors (SSRIs) or other antidepressant use is often linked to the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Increased age, female gender and co-prescription of diuretics are notable risk factors. Symptoms usually occur when the blood serum level falls below 130 mmol/L. These include lethargy, fatigue, muscle cramps, and headaches.
Presenilin mutations that are associated with early-onset Alzheimer’s dementia are proposed to affect which of the following enzymes?
E. Plaques seen in the brain of patients with Alzheimer’s dementia are insoluble extracellular deposits composed mainly of Aβ peptides. These Aβ peptides are derived from a transmembrane protein called B-amyloid precursor protein (APP) through proteolytic processing. APP is generally cleaved by β-secretase or α-secretase enzymes followed by γ -secretase. Aβ peptides are generated when APP is cleaved by β-secretase followed by γ -secretase. This pathway is amyloidogenic and forms the major metabolic pathway of APP in brain tissue; the non-amyloidogenic α-secretase pathway is the major pathway in other tissues. Presenilins are necessary for proteolytic activity of γ –secretase. PS/ γ -secretase complex is widely considered as a potential target for developing therapies against Alzheimer’s disease.
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