Depression

Depression US Medical PG Question 1: Which of the following neuroanatomical areas is/are considered to be involved in the etiology of depression?

• A. Striatum
• B. Amygdala
• C. Hippocampus
• D. All of the options (Correct Answer)

Depression Explanation: ***All of the options*** - The **amygdala**, **hippocampus**, and **striatum** are all part of complex neural circuits that have been implicated in the pathophysiology of depression. - Dysregulation in these areas can lead to emotional processing deficits, memory impairments, and anhedonia, which are core symptoms of depression. *Amygdala* - The **amygdala** is primarily involved in processing emotions, particularly fear and anxiety, and shows increased activity in depressed individuals, contributing to negative mood. - While significant, it is just one component of a broader network involved in depression. *Hippocampus* - The **hippocampus** plays a crucial role in memory and mood regulation, and studies often show reduced volume and function in depressed patients, affecting learning and emotional context. - Although it is significantly affected, depression involves multiple brain regions, not solely the hippocampus. *Striatum* - The **striatum**, particularly the **ventral striatum**, is vital for reward processing, motivation, and motor control, and its dysfunction can contribute to anhedonia and lack of motivation in depression. - While critical for reward pathways, the striatum is part of a larger interconnected system implicated in this condition.

Depression US Medical PG Question 2: A 38-year-old professor with depression requests you to prescribe an antidepressant that would be least likely to cause sexual dysfunction. Which of the following drugs would you prescribe?

• A. Bupropion (Correct Answer)
• B. Venlafaxine
• C. Fluoxetine
• D. Escitalopram

Depression Explanation: ***Bupropion***- Bupropion is a **norepinephrine-dopamine reuptake inhibitor (NDRI)** that differs structurally and mechanically from SSRIs and SNRIs. - It is known for its relatively neutral effect on sexual function, often having the **lowest incidence** of sexual side effects among commonly prescribed antidepressants, and is sometimes used to treat SSRI-induced sexual dysfunction.*Escitalopram*- As a **selective serotonin reuptake inhibitor (SSRI)**, escitalopram frequently causes sexual side effects such as decreased libido, delayed orgasm, and anorgasmia.- This class of drugs elevates **serotonin levels**, which is strongly implicated in causing sexual dysfunction.*Venlafaxine*- Venlafaxine is a **serotonin-norepinephrine reuptake inhibitor (SNRI)**, and its serotonergic component carries a medium-to-high risk of causing sexual dysfunction.- The common sexual side effects include **erectile dysfunction** in men and reduced arousal in women.*Fluoxetine*- Fluoxetine is a commonly prescribed **SSRI** with a significant association with sexual side effects, including inhibited orgasm and reduced libido.- Its long half-life means that these adverse effects, if they occur, can persist following **discontinuation**.

Depression US Medical PG Question 3: All are required to diagnose major depression except?

• A. Depressed mood
• B. Decreased concentration
• C. Nihilistic ideas (Correct Answer)
• D. Insomnia

Depression Explanation: ***Nihilistic ideas*** - While nihilistic ideas (e.g., belief that life is meaningless or that nothing matters) can occur in severe depression, they are **not a mandatory diagnostic criterion** for major depressive disorder (MDD). - The diagnosis of MDD requires a specific number of core symptoms, and nihilistic ideation is not listed as one of them in diagnostic manuals like the DSM-5. *Depressed mood* - A **depressed mood** for most of the day, nearly every day, is one of the two **cardinal symptoms** required for a diagnosis of major depressive disorder. - The other cardinal symptom is anhedonia (loss of interest or pleasure). *Insomnia* - **Insomnia** (difficulty falling or staying asleep) or hypersomnia (sleeping excessively) is a common neurovegetative symptom of major depressive disorder and is one of the **nine diagnostic criteria**. - At least 5 of these 9 criteria must be present for a diagnosis, including at least one of the two cardinal symptoms. *Decreased concentration* - **Diminished ability to think or concentrate**, or indecisiveness, is another of the **nine diagnostic criteria** for major depressive disorder. - This cognitive symptom highlights the impact of depression on mental function beyond mood.

Depression US Medical PG Question 4: A 33-year-old man visits his psychiatrist with feelings of sadness on most days of the week for the past 4 weeks. He says that he is unable to participate in his daily activities and finds it hard to get out of bed on most days. If he has nothing scheduled for the day, he sometimes sleeps for 10–12 hours at a stretch. He has also noticed that on certain days, his legs feel heavy and he finds it difficult to walk, as though there are bricks tied to his feet. However, he is still able to attend social events and also enjoys playing with his children when he comes home from work. Other than these simple pleasures, he has lost interest in most of the activities he previously enjoyed. Another troubling fact is that he had gained weight over the past month, mainly because he eats so much when overcome by these feelings of depression. His is prescribed a medication to treat his symptoms. Which of the following is the mechanism of action of the drug he was most likely prescribed?

• A. Activates the γ-aminobutyric acid receptors
• B. Inhibit the uptake of serotonin and norepinephrine at the presynaptic cleft (Correct Answer)
• C. Works as an antagonist at the dopamine and serotonin receptors
• D. Non-selectively inhibits monoamine oxidase A and B
• E. Stimulates the release of norepinephrine and dopamine in the presynaptic cleft

Depression Explanation: ***Inhibit the uptake of serotonin and norepinephrine at the presynaptic cleft*** - The patient presents with symptoms characteristic of **atypical depression**, including increased sleep (**hypersomnia**), increased appetite leading to weight gain, **leaden paralysis** (heavy feelings in the limbs), and **mood reactivity** (enjoying social events/playing with children). - For initial treatment of atypical depression, **SSRIs** (e.g., fluoxetine, sertraline) and **SNRIs** (e.g., venlafaxine, duloxetine) are considered **first-line therapies** due to their favorable safety profile and efficacy. - **SNRIs** address both serotonin and norepinephrine imbalances and are effective for atypical depression, particularly when there is significant fatigue or pain. *Activates the γ-aminobutyric acid receptors* - This mechanism describes **benzodiazepines** or other GABAergic drugs, which are typically used for anxiety, insomnia, or acute agitation. - While they can provide symptomatic relief for anxiety associated with depression, they do not target the core depressive symptoms, lack antidepressant efficacy, and carry risk of dependence. *Works as an antagonist at the dopamine and serotonin receptors* - This mechanism describes **second-generation antipsychotics** (e.g., quetiapine, aripiprazole), which are primarily used to treat psychotic disorders or as adjuncts in severe depression with psychotic features or treatment-resistant depression. - The patient's symptoms do not suggest psychotic features, and antipsychotics are not first-line treatment for uncomplicated atypical depression. *Non-selectively inhibits monoamine oxidase A and B* - This describes **non-selective MAOIs** (e.g., phenelzine, tranylcypromine), which are considered the **most effective** antidepressants for atypical depression based on clinical trials. - However, MAOIs are typically reserved for **treatment-resistant depression** due to their significant side effect profile, dietary restrictions (tyramine-free diet to prevent **hypertensive crisis**), and drug interaction risks. - Given this is an initial presentation without treatment failure, MAOIs would not be the first-line choice despite their superior efficacy. *Stimulates the release of norepinephrine and dopamine in the presynaptic cleft* - This mechanism could describe **amphetamines** or certain **wake-promoting agents**, which are not standard antidepressant treatments. - **Bupropion** (an antidepressant) inhibits reuptake of norepinephrine and dopamine but does not directly stimulate their release. - Stimulants are occasionally used as adjuncts for treatment-resistant depression but are not first-line monotherapy due to abuse potential and limited evidence for long-term efficacy in depression.

Depression US Medical PG Question 5: A 60-year-old woman with treatment-resistant depression has been referred for electroconvulsive therapy (ECT) after failing adequate trials of four different antidepressants including augmentation strategies. She has severe depression with psychomotor retardation, significant weight loss, and pervasive guilt. Her family is concerned about potential cognitive side effects of ECT. They ask about factors that might be modified to minimise cognitive adverse effects while maintaining treatment efficacy. Which modification would most effectively reduce cognitive side effects while preserving antidepressant efficacy?

• A. Using unilateral electrode placement on the non-dominant hemisphere rather than bilateral placement (Correct Answer)
• B. Reducing the electrical dose to just above seizure threshold regardless of electrode placement
• C. Extending the interval between treatments from twice weekly to once weekly throughout the course
• D. Using ultra-brief pulse width stimulation with bilateral electrode placement
• E. Limiting the total number of ECT sessions to a maximum of 6 treatments

Depression Explanation: ***Using unilateral electrode placement on the non-dominant hemisphere rather than bilateral placement*** - **Right-unilateral (RUL) ECT** is consistently associated with significantly fewer **cognitive adverse effects**, particularly regarding verbal memory and orientation, compared to **bilateral ECT**. - While bilateral placement is generally faster-acting, RUL ECT maintains comparable **antidepressant efficacy** provided the electrical dose is sufficiently higher (typically 6 times) than the **seizure threshold**. *Reducing the electrical dose to just above seizure threshold regardless of electrode placement* - While lower doses minimize cognitive side effects, using a dose just above the **seizure threshold** in unilateral ECT is often **ineffective** for treating depression. - To ensure efficacy in RUL placement, the dose must be significantly above threshold; therefore, reducing it too low risks a non-therapeutic response. *Extending the interval between treatments from twice weekly to once weekly throughout the course* - Reducing treatment frequency to **once weekly** may slow the rate of cognitive decline but significantly delays the **speed of remission** and clinical improvement. - **Twice-weekly sessions** are the standard of care to balance clinical response time with the risk of cumulative cognitive impairment. *Using ultra-brief pulse width stimulation with bilateral electrode placement* - **Ultra-brief pulse (0.3ms)** stimulation reduces cognitive side effects compared to standard brief pulse, but the benefits are most established when combined with **unilateral placement**. - Combining ultra-brief pulses with **bilateral placement** still poses a higher risk of cognitive deficits compared to the unilateral alternative. *Limiting the total number of ECT sessions to a maximum of 6 treatments* - Arbitrarily limiting sessions may result in **incomplete remission** or early relapse, as many patients require 8 to 12 sessions for a full therapeutic response. - Treatment course length should be determined by **clinical response** and recovery from symptoms like psychomotor retardation, rather than a fixed number of treatments.

Depression US Medical PG Question 6: A 52-year-old man presents with a 1-month history of a depressed mood. He says that he has been “feeling low” on most days of the week. He also says he has been having difficulty sleeping, feelings of being worthless, difficulty performing at work, and decreased interest in reading books (his hobby). He has no significant past medical history. The patient denies any history of smoking, alcohol use, or recreational drug use. A review of systems is significant for a 7% unintentional weight gain over the past month. The patient is afebrile and his vital signs are within normal limits. A physical examination is unremarkable. The patient is prescribed sertraline 50 mg daily. On follow-up 4 weeks later, the patient says he is slightly improved but is still not feeling 100%. Which of the following is the best next step in the management of this patient?

• A. Switch to a different SSRI
• B. Continue sertraline (Correct Answer)
• C. Add buspirone
• D. Switch to an MAOI
• E. Add aripiprazole

Depression Explanation: ***Continue sertraline*** - Many antidepressants, including SSRIs like sertraline, require **4-6 weeks at a therapeutic dose** to achieve their full effect. Since the patient reports slight improvement after 4 weeks, continuing the current medication allows more time for optimal response. - The goal is for the patient to feel "100%", which often takes longer than one month. **Gradual improvement** after initial therapy suggests the medication is working, but needs more time. *Switch to a different SSRI* - Switching to another SSRI is typically considered if there is **no improvement or significant intolerance** after an adequate trial (at least 4-6 weeks) at a therapeutic dose of the initial SSRI. - This patient has shown *slight improvement*, indicating that sertraline may still be effective with more time. *Add buspirone* - Buspirone is an **anxiolytic medication** sometimes used as an augmentation strategy for depression, particularly if anxiety is a prominent symptom. - However, it's generally added *after* an initial antidepressant has failed to achieve a full response, and typically *after* optimizing the dose and duration of the primary antidepressant. *Switch to an MAOI* - **Monoamine oxidase inhibitors (MAOIs)** are older antidepressants with a more challenging side effect profile and significant drug-drug and drug-food interactions. - They are typically reserved for patients who have **failed multiple trials of other antidepressants** due to their safety concerns. *Add aripiprazole* - Aripiprazole, an **atypical antipsychotic**, is sometimes used as an augmentation strategy for **treatment-resistant depression**. - This approach is usually considered when trials of several different antidepressant classes have failed or when the depression has not responded adequately to optimized antidepressant therapy.

Depression US Medical PG Question 7: A 27-year-old man presents to his physician for a checkup. At presentation, he complains of anxiety and persistent mood changes. The patient's comorbidities include chronic gastritis treated with Helicobacter pylori eradication therapy, and chronic pyelonephritis with stage 1 chronic kidney disease. His grandfather who was a heavy smoker just passed away due to metastatic lung cancer. The patient has an 8-year-history of smoking, and he is concerned about consequences of his habit. He says that he tried to quit several times with nicotine patches, but he is unsuccessful because of the unpleasant symptoms and returning anxiety. Moreover, his tobacco use increased for the past 12 months due to increased anxiety due to his job and family problems, which could not be relieved by previous consumption levels. He still wants to stop smoking due to the health concerns. The patient's vital signs and physical examination are unremarkable. The physician considers prescribing the patient a partial nicotine agonist, and conducts a further testing to see whether the patient is eligible for this medication. Which of the following tests is required to be performed prior to prescribing this medication to the presented patient?

• A. Echocardiography
• B. Creatinine assessment
• C. Esophagogastroduodenoscopy
• D. Mini mental state examination
• E. 9-item patient health questionnaire (Correct Answer)

Depression Explanation: ***9-item patient health questionnaire*** - This patient is on a **partial nicotine agonist** (likely **varenicline**) and has a history of anxiety, mood changes, and chronic kidney disease, which requires a psychiatric assessment. - Varenicline has been associated with **neuropsychiatric effects**, including mood changes and suicidal ideation, making baseline assessment of mental health crucial. *Echocardiography* - This test is primarily used to assess **cardiac function** and structure. - Although smoking is a risk factor for cardiovascular disease, there is no indication for an echocardiogram based on the patient's current symptoms or the intended medication. *Creatinine assessment* - While the patient has **stage 1 chronic kidney disease**, the medication in question (varenicline) is primarily renally cleared. A **creatinine assessment** would be relevant for dose adjustment, but it is not typically a prerequisite for *eligibility* itself since the medication can be used in patients with kidney disease with dose modification. - The medication can be used but usually needs **dose adjustments** for patients with kidney impairment (creatinine clearance below 30 mL/min); therefore, it is often done, but mainly for dose modification, not for eligibility given stage 1 CKD. *Esophagogastroduodenoscopy* - This procedure is relevant for evaluating the upper gastrointestinal tract and is indicated for conditions like **chronic gastritis** or suspected peptic ulcer disease. - While the patient has a history of chronic gastritis, there is no current indication for an EGD related to the intended **smoking cessation medication.** *Mini mental state examination* - The **MMSE** assesses **global cognitive function** and screens for conditions like dementia. - The patient's symptoms of anxiety and mood changes do not primarily suggest cognitive impairment, and a psychiatric questionnaire is more appropriate for evaluating his specific mental health concerns.

Depression US Medical PG Question 8: A 50-year-old woman presents to her family physician 6 months after the death of her husband, who died following a car accident. She is crying inconsolably and reports that she no longer enjoys doing the things she and her husband once did together. She feels guilty for the time she wasted arguing with him in the past. She finds herself sleeping on most mornings, but still lacks the energy and concentration needed at work. The physical examination is normal. Based on a well-known hypothesis, which of the following combinations of neurotransmitter abnormalities most likely exist in this patient?

• A. ↑ Norepinephrine, ↑ Serotonin, ↑ Dopamine
• B. ↓ Norepinephrine, ↓ Serotonin, ↓ Dopamine (Correct Answer)
• C. Normal Norepinephrine, ↓ Serotonin, Normal Dopamine
• D. Normal Norepinephrine, Normal Serotonin, ↑ Dopamine
• E. Normal Norepinephrine, Normal Serotonin, ↓ Dopamine

Depression Explanation: ***↓ Norepinephrine, ↓ Serotonin, ↓ Dopamine*** - The patient's symptoms (anhedonia, guilt, fatigue, poor concentration, sleep disturbance) are classic for **major depressive disorder**. - According to the **monoamine hypothesis of depression**, an imbalance of monoamine neurotransmitters (norepinephrine, serotonin, and dopamine) is implicated, with a **decrease** in their levels or activity leading to depressive symptoms. *↑ Norepinephrine, ↑ Serotonin, ↑ Dopamine* - **Elevated levels** of these neurotransmitters are typically associated with conditions like **mania** or **anxiety disorders**, not depression. - This pattern would lead to increased energy, euphoria, or agitation, which are contrary to the patient's presentation. *Normal Norepinephrine, ↓ Serotonin, Normal Dopamine* - While **decreased serotonin** is a key component of the monoamine hypothesis of depression and often targeted by SSRIs, depression typically involves a broader dysregulation of monoamines. - The patient's significant symptoms of fatigue and lack of concentration also suggest involvement of **norepinephrine** and **dopamine** deficiencies. *Normal Norepinephrine, Normal Serotonin, ↑ Dopamine* - An **increase in dopamine** is generally associated with conditions like **psychosis** or **reward-seeking behavior**, and would not explain the patient's anhedonia and low energy. - Normal levels of serotonin and norepinephrine would also not fully account for the scope of the patient's depressive symptoms. *Normal Norepinephrine, Normal Serotonin, ↓ Dopamine* - While **decreased dopamine** can contribute to anhedonia and lack of motivation, a diagnosis of major depressive disorder, especially with guilt and severe fatigue, is typically linked to a more widespread deficiency in *all three monoamines*. - Normal levels of norepinephrine and serotonin would be unlikely given the severity and range of the patient's depressive symptoms.

Depression US Medical PG Question 9: A 43-year-old woman is brought to the physician by her daughter because she has been intermittently crying for 6 hours and does not want to get out of bed. Her symptoms started after she was fired yesterday from her job of 20 years. She says she feels sad and does not understand what she will do with her life now. She uses an over-the-counter inhaler as needed for exercise-induced asthma, and recently started oral isotretinoin for acne. She used to smoke a pack of cigarettes per day, but for the last year she has decreased to 2 cigarettes daily. She appears sad and very upset. Her temperature is 37°C (98.6°F), pulse is 110/min, respirations are 20/min, and blood pressure is 140/80 mm Hg. Physical examination shows no other abnormalities. On mental status examination, she is oriented to person, place, and time. She maintains eye contact and follows instructions. She denies suicidal ideation. Which of the following is the most likely explanation for this finding?

• A. Drug-related depression
• B. Acute stress disorder
• C. Adjustment disorder
• D. Major depressive disorder
• E. Normal stress reaction (Correct Answer)

Depression Explanation: ***Normal stress reaction*** - The patient's symptoms (crying, sadness, not wanting to get out of bed) are a direct, understandable emotional response to a significant recent stressor (being fired from a 20-year job). This type of reaction is **expected and transient** in response to acute life changes. - The duration of symptoms is short (6 hours), and there is **no evidence of significant functional impairment** beyond the initial emotional distress, nor does she meet criteria for a mental disorder. *Drug-related depression* - While **isotretinoin has been associated with mood changes**, including depression, the acute onset and direct temporal relationship to a significant psychosocial stressor make a drug-related cause less likely as the primary explanation. - There are no other features pointing to drug-induced etiology, and her symptoms are clearly linked to the job loss. *Acute stress disorder* - Acute stress disorder symptoms (e.g., intrusive thoughts, negative mood, dissociation, avoidance, arousal) typically involve exposure to an **actual or threatened traumatic event**, such as death or serious injury, which is not the case here. - The symptom duration for acute stress disorder is also typically 3 days to 1 month, and the patient's symptoms are of much shorter duration and less severe. *Adjustment disorder* - Adjustment disorder involves significant emotional or behavioral symptoms in response to an identifiable stressor, but these symptoms must cause **marked distress in excess of what would be expected** or significant impairment in social or occupational functioning. - Given the magnitude of the stressor (losing a 20-year job), the patient's reaction is within the range of a normal and expected emotional response, rather than excessive or impairing functionality long-term. *Major depressive disorder* - Major depressive disorder requires a cluster of specific symptoms (e.g., anhedonia, sleep disturbance, appetite changes, low energy, feelings of worthlessness) lasting for at least **two weeks**, causing clinically significant distress or impairment. - The patient's symptoms are acute (6 hours), directly linked to an external event, and do not yet meet the duration or full criteria for a major depressive episode.

Depression US Medical PG Question 10: A 22-year-old female presents to your clinic for evaluation of "skin problems." She complains of severe acne and "spots" all over her face that have persisted for the last 8 years, despite innumerable creams and lotions. She reports spending several hours every morning using make-up just to go outside. She wishes to learn about cosmetic procedures or surgeries that could solve her problem. While you perceive her concern for her skin to be genuine, upon examination, you note a healthy-appearing, well-nourished female with a normal complexion, minimal acne and sparse freckles on the nasal bridge. You calculate her BMI to be 21. In addition to making a diagnosis, this patient should be screened for which other disorder?

• A. Major depressive disorder (Correct Answer)
• B. Anorexia
• C. Malingering
• D. Munchausen's syndrome
• E. Trichotillomania

Depression Explanation: **Major depressive disorder** * This patient's symptoms are suggestive of **body dysmorphic disorder (BDD)**, which has a high comorbidity with major depressive disorder. * **Depressive symptoms** like poor self-esteem, social isolation due to perceived flaws, and a focus on physical appearance often co-occur with BDD. *Anorexia* * **Anorexia** involves an extreme preoccupation with body weight and shape, leading to severe calorie restriction and a significantly low body weight (BMI < 17.5). * This patient has a normal BMI of 21 and her primary preoccupation is with perceived skin flaws rather than weight. *Malingering* * **Malingering** is the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding work or obtaining financial compensation. * The patient genuinely believes in her severe skin problems and is seeking treatment for them, not external gain. *Munchausen's syndrome* * **Munchausen's syndrome** (Factitious Disorder Imposed on Self) involves intentionally feigning or inducing illness to assume the sick role, without obvious external incentives. * While the patient's perception of her skin problems is distorted, she is not intentionally creating symptoms or fabricating illness for attention. *Trichotillomania* * **Trichotillomania** is an impulse control disorder characterized by recurrent, irresistible urges to pull out one's own hair. * This patient's primary complaint is severe acne and "spots" on her face, with no mention of hair pulling.

Depression Flashcard 1 of 9

Question: depression

Answer:

Extra Information: early morning awakening incompletedecreased: NE, dopamine, serotonin

Depression Flashcard 2 of 9

Question: When major depression fails to respond to an initial SSRI, patients can be switched to what other first-line antidepressants? _____

Answer: Different SSRI SNRI Bupropion Mirtazapine Serotonin modulators (e.g. vilazodone)

Extra Information:  https://onlinemeded.org/spa/psychiatry?ref=anki 

Depression Flashcard 3 of 9

Question: Depression is characterized by _____ serotonin

Answer: decreased

Depression Flashcard 4 of 9

Question: What is the first-line treatment for atypical depression? _____

Answer: CBT and SSRIs

Depression Flashcard 5 of 9

Question: serotonin

Answer: raphe nucleus

Depression Flashcard 6 of 9

Question: A woman status post mastectomy says she feels ugly when she undresses.

Answer: Find out why the patient feels that way. Do not offer false reassurance or anything that could be interpreted as flirtation. (e.g. You still look great!)

Depression Flashcard 7 of 9

Question: What changes in sleep patterns are often seen in depressed patients?

Answer: 1. less delta-wave sleep 2. more REM sleep 3. more/earlier awakenings (decreased delta-wave sleep (stage N3) decreased REM latency increased REM early in sleep cycle increased total time in REM repeated nighttime awakenings early-morning awakening)

Depression Flashcard 8 of 9

Question: Major depressive disorder with seasonal pattern is most associated with what season? _____

Answer: Winter

Extra Information:  https://onlinemeded.org/spa/psychiatry/mood-disorders/acquire?ref=anki 

Depression Flashcard 9 of 9

Question: Huntington disease presents with chorea that can progress to _____ and dementia; also may have aggression

Answer: depression

Extra Information:   Watch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons Disease [https://dashboard.sketchy.com/study/medical/courses/medical-pathophysiology/units/medical-pathophysiology-neuro/videos/medical-pathophysiology-neuro-neurodegenerative-creutzfeldt-jakob-disease-parkinsons-disease-and-huntingtons-disease?utm_source=anki&utm_medium=partnership&utm_campaign=february_update&utm_content=medical]Watch associated Bootcamp video [https://app.bootcamp.com/med-school/neurology/videos/dementia?index=8] https://onlinemeded.org/spa/genetics?ref=anki Atlas: