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1 | |
The most common form of dementia in older adults is: |
| | A) | Lewy body dementia |
| | B) | Vascular dementia |
| | C) | Alzheimer’s disease |
| | D) | Organic brain syndrome |
| | E) | Frontotemporal dementia |
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2 | |
Genetic susceptibility to late-onset Alzheimer’s disease (AD) is primarily linked to: |
| | A) | Apolipoprotein E4 genotype |
| | B) | Presenilin gene mutations |
| | C) | Amyloid precursor protein mutations |
| | D) | Apolipoprotein E2 genotype |
| | E) | Angiotensin-converting enzyme gene mutations |
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3 | |
Environmental risk factors for AD include: |
| | A) | Low educational level |
| | B) | Advanced age |
| | C) | Reduced mental and physical activity |
| | D) | Head injury |
| | E) | All of the above |
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4 | |
Which of the following statements is true regarding the pathophysiology of Alzheimer’s disease? |
| | A) | Alzheimer’s disease is caused by neuritic plaques |
| | B) | Alzheimer’s disease is caused by neurofibrillary tangles |
| | C) | Alzheimer’s disease is caused by inflammatory processes in the brain |
| | D) | Alzheimer’s disease is caused by oxidative stress |
| | E) | The cause of Alzheimer’s disease is unknown |
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5 | |
Is the following statement true or false? Diabetes increases the risk of Alzheimer’s disease. |
| | A) | True |
| | B) | False |
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6 | |
The diagnostic workup for Alzheimer disease should include: |
| | A) | A spinal tap to test the cerebrospinal fluid for the presence of ß-amyloid peptide fragments |
| | B) | A CT scan to visualize neuritic plaques in the brain |
| | C) | Thyroid function tests to rule out hypothyroidism |
| | D) | Blood tests to rule out vitamin D deficiency |
| | E) | Biopsy of brain tissue to visualize neurofibrillary tangles |
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7 | |
J.F. is an 87-year-old man who was recently diagnosed with probable Alzheimer’s disease. His Mini Mental Status Examination (MMSE) score is 22, and his symptoms became noticeable approximately 1 year prior to the diagnosis. J.F.’s chief complaint is difficulty with his memory. He is able to perform all activities of daily living, and his care is not a burden to his wife. He exhibits no behavioral disturbances but does seem depressed. For patients such as J.F., which of the following drugs or drug combinations have been shown in multiple double-blind, placebo-control trials to be effective therapy for Alzheimer’s disease? |
| | A) | Vitamin E 1,000 international unit twice daily |
| | B) | Donepezil 10 mg at bedtime |
| | C) | Selegiline 5 mg twice daily |
| | D) | Rivastigmine 6 mg twice daily plus vitamin E 400 international unit twice daily |
| | E) | Galantamine 12 mg twice daily plus selegiline 5 mg twice daily |
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8 | |
J.F. is an 87-year-old man who was recently diagnosed with probable Alzheimer’s disease. His Mini Mental Status Examination (MMSE) score is 22, and his symptoms became noticeable approximately 1 year prior to the diagnosis. J.F.’s chief complaint is difficulty with his memory. He is able to perform all activities of daily living, and his care is not a burden to his wife. He exhibits no behavioral disturbances but does seem depressed. In clinical situations similar to that of J.F., what should patients and families be told about clinical expectations from cholinesterase inhibitor therapy? |
| | A) | Drug therapy will usually halt disease progression, and memory should significantly improve |
| | B) | The time to reach significant functional decline can be delayed, but behavioral disturbances usually worsen |
| | C) | The time to reach significant functional decline can be delayed, but the disease will continue to progress |
| | D) | Memantine is more effective than cholinesterase inhibitors for patients with mild to moderate Alzheimer’s disease |
| | E) | The risk of adverse events from cholinesterase inhibitors outweighs their usefulness in mild disease, and drug therapy should be delayed until the disease is moderately severe |
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9 | |
A.Y. is a 69-year-old white male who was recently diagnosed with Alzheimer’s disease by his primary care physician. A.Y. also suffers from hypertension and hypercholesterolemia and has received treatment for these conditions for more than 5 years. A.Y.’s wife brought him in to see the primary care physician because he was becoming increasingly forgetful and suspicious. He experienced several bouts of agitation with aggressive behavior during the month before he was diagnosed with dementia. His primary care physician initiated galantamine therapy at the usual starting dose of 4 mg twice a day with food. Important counseling points for patients such as A.Y. starting cholinesterase inhibitors include: |
| | A) | Therapy is usually short-term until the symptoms are controlled |
| | B) | A slow dose titration over 4 to 6 weeks is necessary to minimize side effects |
| | C) | The most common side effect of cholinesterase inhibitors is dry mouth |
| | D) | Significant improvement in memory is expected with galantamine therapy |
| | E) | Galantamine is expected to worsen A.Y.’s agitation |
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10 | |
A.Y. is a 69-year-old white male who was recently diagnosed with Alzheimer’s disease by his primary care physician. A.Y. also suffers from hypertension and hypercholesterolemia and has received treatment for these conditions for more than 5 years. A.Y.’s wife brought him in to see the primary care physician because he was becoming increasingly forgetful and suspicious. He experienced several bouts of agitation with aggressive behavior during the month before he was diagnosed with dementia. His primary care physician initiated galantamine therapy at the usual starting dose of 4 mg twice a day with food. A.Y.’s wife asks about using acetaminophen-diphenhydramine (Tylenol PM) to help her husband sleep. What recommendations should you give A.S. concerning the use of Tylenol PM? |
| | A) | Diphendydramine is preferred over prescription medications to treat insomnia in the elderly |
| | B) | Diphenhydramine should be avoided because it is anticholinergic and can counteract the effects of galantamine |
| | C) | Diphenhydramine should be avoided because it increases blood sugar in the elderly |
| | D) | A.Y. should take diphenhydramine nightly until the symptoms of insomnia resolve |
| | E) | Diphenhydramine can enhance the effects of galantamine, so concurrent use should be avoided |
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11 | |
What is the preferred initial treatment for most behavioral disturbances in Alzheimer’s disease? |
| | A) | Benzodiazepines |
| | B) | Anticonvulsants |
| | C) | Antipsychotics |
| | D) | Antidepressants |
| | E) | Nonpharmacologic behavioral therapies |
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12 | |
K.L. is an 88-year-old woman who was diagnosed with Alzheimer’s disease 8 years ago. She has been treated with donepezil 10 mg/day since she was first diagnosed. Her MMSE score today is 10, and her memory has declined significantly in the last 3 months. Appropriate therapy recommendations for KL include: |
| | A) | The dose of donepezil should be increased to 20 mg/day |
| | B) | Galantamine should be added to her current therapy |
| | C) | Addition of memantine to her current therapy should be considered |
| | D) | Donepezil is no longer effective and should be discontinued |
| | E) | No changes should be made in her drug therapy |
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13 | |
Which of the following statements is true regarding use of antipsychotics in patients with Alzheimer’s disease? |
| | A) | Antipsychotics have a labeled indication for the treatment of behavioral disturbances in patients with Alzheimer’s disease |
| | B) | Antipsychotics are associated with an increased risk of death in dementia patients |
| | C) | Antipsychotics are first-line treatment for memory enhancement in patients with Alzheimer’s disease |
| | D) | Management of wandering behavior in Alzheimer’s patients frequently requires the use of antipsychotics |
| | E) | Antipsychotics are never indicated in the management of behavioral disturbances in patients with Alzheimer’s disease |
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14 | |
Is the following statement true or false? Cholinesterase inhibitors are indicated for the treatment of mild cognitive impairment. |
| | A) | True |
| | B) | False |
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15 | |
Gingko biloba: |
| | A) | Is one of the most commonly used dietary supplements for the treatment of Alzheimer’s disease |
| | B) | Should be taken with vitamin E for optimal efficacy |
| | C) | Is recommended for use primarily in the late stage of Alzheimer’s disease |
| | D) | Is safe for use in patients with vascular dementia and atrial fibrillation taking warfarin |
| | E) | Products are standardized with regard to content and consistency |
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