Dementia and Cognitive Disorders — MCQs

10 questions

All are true regarding Fronto-temporal dementia except:

The web-based IT system for case-based surveillance under National Tuberculosis Elimination Programme (NTEP, formerly RNTCP) is

Which of the following is a key distinguishing feature of delirium compared to dementia?

What is the possible cause of irreversible dementia?

Which one of the following is a subcortical dementia?

False regarding Alzheimer's disease (AD) is:

All of the following are features of dementia, EXCEPT:

Which of the following non-memory cognitive symptoms can be associated with Alzheimer's disease (AD)?

Q10

Dementia is present in all except:

Dementia and Cognitive Disorders Indian Medical PG Practice Questions and MCQs

Question 1: All are true regarding Fronto-temporal dementia except:

A. Affective symptoms
B. Age less than 65 years
C. Insight present (Correct Answer)
D. Stereotypic behavior

Explanation: ***Insight present*** - In Fronto-temporal dementia (FTD), **insight is typically lost** or severely impaired, particularly in the behavioral variant (bvFTD). Patients often exhibit a profound lack of awareness regarding their behavioral changes and their impact on others. - The presence of insight would argue against a diagnosis of FTD, as it is a hallmark feature of the disease's progression. *Affective symptoms* - **Affective symptoms** such as apathy, anhedonia, and dysphoria are very common in FTD, especially in the behavioral variant. These are often early and prominent features. - Patients may appear emotionally blunted or show inappropriate emotional responses. *Age less than 65 years* - FTD is a relatively common cause of **early-onset dementia**, often manifesting before the age of 65 years. - It frequently affects individuals in their 50s and early 60s, distinguishing it from Alzheimer's disease which typically presents later. *Stereotypic behavior* - **Repetitive, ritualistic, or stereotypic behaviors** are characteristic features of behavioral variant FTD. - Examples include repetitive gestures, ritualistic daily routines, or preoccupation with certain activities or foods.

Question 2: The web-based IT system for case-based surveillance under National Tuberculosis Elimination Programme (NTEP, formerly RNTCP) is

A. NIKSHAY (Correct Answer)
B. E-TB Tracker
C. SURAKSHA
D. SAFETY-NET

Explanation: ***NIKSHAY*** - **NIKSHAY** is the official web-based IT system used by the National Tuberculosis Elimination Programme (NTEP, formerly RNTCP) in India for **case-based surveillance** and monitoring of TB cases. - Launched in 2012, it facilitates **real-time data entry**, tracking of patient outcomes, drug logistics management, and program monitoring, significantly improving the efficiency of TB control efforts. - It enables **notification of all TB cases**, both from public and private sectors, ensuring comprehensive surveillance. *E-TB Tracker* - **E-TB Tracker** is not the designated IT system for TB surveillance under NTEP in India. - This term may refer to other electronic tracking systems used in different contexts, but NIKSHAY remains the official platform for India's TB programme. *SURAKSHA* - **SURAKSHA** means safety or protection in Hindi and is not associated with any specific web-based IT system for TB surveillance under NTEP. - This is not a recognized TB surveillance platform in the Indian context. *SAFETY-NET* - **SAFETY-NET** is a generic term referring to social protection programs or health support systems. - There is no specific NTEP initiative for TB surveillance identified by this name.

Question 3: Which of the following is a key distinguishing feature of delirium compared to dementia?

A. Visual hallucinations
B. Gradual memory loss
C. Acute onset of confusion and disorientation (Correct Answer)
D. Difficulty in recognizing familiar people

Explanation: ***Acute onset of confusion and disorientation*** - Delirium is characterized by a **sudden (acute) onset** of mental status changes, including fluctuations in attention, awareness, and cognition, often presenting as **confusion and disorientation**. - Its symptoms typically develop over hours to days, contrasting sharply with the more chronic and insidious progression of dementia. *Gradual memory loss* - **Gradual memory loss** is a hallmark symptom of **dementia**, a neurocognitive disorder characterized by a progressive decline in cognitive function over months to years. - While memory impairment can occur in delirium, its onset is rapid and associated with a fluctuating course, not a steady decline. *Visual hallucinations* - While visual hallucinations can occur in **delirium**, they are not its most unique distinguishing feature from **dementia**, as they can also be prominent in certain types of dementia, such as **Lewy body dementia**. - The acute, fluctuating nature of **cognitive impairment** is a more defining characteristic of delirium. *Difficulty in recognizing familiar people* - **Prosopagnosia** or the inability to recognize familiar faces, is a symptom that can manifest in advanced stages of **dementia** due to widespread brain atrophy. - While patients with delirium might appear confused or disoriented to the point of not recognizing familiar individuals, this is usually part of a global, acute cognitive impairment and not a primary, isolated deficit.

Question 4: What is the possible cause of irreversible dementia?

A. Vitamin B12 deficiency
B. NPH
C. Hypothyroid
D. Lewy body (Correct Answer)

Explanation: ***Lewy body*** - **Lewy body dementia** is a progressive, irreversible neurodegenerative disorder characterized by the abnormal accumulation of **alpha-synuclein proteins** within neurons [1]. - It presents with fluctuating cognition, recurrent visual hallucinations, and spontaneous **parkinsonism**, eventually leading to severe and irreversible cognitive decline [1]. *Vitamin B12 deficiency* - **Vitamin B12 deficiency** can cause cognitive impairment and dementia-like symptoms, but these are often **reversible** with appropriate B12 supplementation [2]. - Symptoms include **anemia**, peripheral neuropathy, and psychiatric changes, which can improve with treatment. *NPH* - **Normal Pressure Hydrocephalus (NPH)** presents with a classic triad of gait disturbance, urinary incontinence, and dementia [2]. - While it causes dementia, it is often **reversible** with surgical placement of a **ventriculoperitoneal shunt** to drain excess CSF [2]. *Hypothyroid* - **Hypothyroidism** can lead to cognitive slowing, memory impairment, and confusion, resembling dementia. - These symptoms are typically **reversible** and improve significantly with **thyroid hormone replacement therapy**.

Question 5: Which one of the following is a subcortical dementia?

A. Vit B12 deficiency
B. Huntington's chorea (Correct Answer)
C. Normal pressure Hydrocephalus
D. Alzheimer's disease

Explanation: ***Huntington's chorea*** - **Huntington's disease** is a classic example of a **subcortical dementia**, characterized by prominent motor symptoms (chorea) along with cognitive decline [3]. - The pathology primarily affects the **basal ganglia**, a subcortical structure, leading to its distinctive clinical presentation [3]. *Vit B12 deficiency* - While **Vitamin B12 deficiency** can cause cognitive impairment and dementia-like symptoms, these are typically categorized as **reversible dementias** or **metabolic encephalopathies**, rather than a subcortical dementia [2]. - Its effects are widespread and not localized to subcortical structures in the primary sense of a neurodegenerative subcortical dementia. *Normal pressure Hydrocephalus* - **Normal pressure hydrocephalus (NPH)** is characterized by the triad of gait disturbance, urinary incontinence, and cognitive decline, and is often considered a **reversible cause of dementia** [2]. - Although it involves ventriculomegaly and affects white matter tracts, it is not classified as a subcortical dementia in the same neurodegenerative context as Huntington's or Parkinson's. *Alzheimer's disease* - **Alzheimer's disease** is the most common cause of **cortical dementia**, primarily affecting the cerebral cortex [1]. - It is characterized by significant deficits in memory, language, and executive functions due to cortical atrophy and neuronal loss [1].

Question 6: False regarding Alzheimer's disease (AD) is:

A. Number of neurofibrillary tangles is associated with the severity of dementia
B. Number of senile (neuritic) plaques correlates (increases) with age
C. Presence of tau protein suggest neurodegeneration
D. Extracellular inclusion (lesion) can occur in the absence of intracellular inclusions to make pathological diagnosis of AD (Correct Answer)

Explanation: ***Extracellular inclusion (lesion) can occur in the absence of intracellular inclusions to make pathological diagnosis of AD*** - A definitive pathological diagnosis of **Alzheimer's disease** requires both the presence of **extracellular amyloid plaques** and **intracellular neurofibrillary tangles** [1]. - Neither inclusion type alone is sufficient for the diagnosis, as amyloid plaques can be found in non-demented elderly individuals [1]. *Number of neurofibrillary tangles is associated with the severity of dementia* - The **density and distribution of neurofibrillary tangles** (NFTs) directly correlate with the severity of cognitive impairment and **dementia** in AD [1]. - Tangles are composed of hyperphosphorylated **tau protein** and disrupt neuronal function, leading to neurodegeneration [2]. *Number of senile (neuritic) plaques correlates (increases) with age* - The accumulation of **senile (neuritic) plaques**, composed primarily of **beta-amyloid protein**, generally increases with age, even in cognitively normal individuals [1]. - While plaques are a hallmark of AD, their mere presence is not always diagnostic of clinical dementia [1]. *Presence of tau protein suggest neurodegeneration* - The presence of **hyperphosphorylated tau protein**, especially when forming **neurofibrillary tangles**, is a strong indicator of **neurodegeneration** [2]. - **Tauopathy** is a key pathological feature in AD and other neurodegenerative diseases [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1292-1294. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 721-722.

Question 7: All of the following are features of dementia, EXCEPT:

A. Clouding of consciousness present (Correct Answer)
B. Insidious in onset
C. Visual hallucinations may occur
D. Usually irreversible

Explanation: ***Clouding of consciousness present*** - **Clouding of consciousness** is a hallmark feature of **delirium**, not dementia. Delirium is characterized by an acute, fluctuating disturbance of attention and cognition. - In dementia, consciousness typically remains clear until the very late stages of the disease, even as cognitive functions decline significantly. *Insidious in onset* - Dementia typically has an **insidious onset**, meaning symptoms develop gradually over months or years, often unnoticed initially by the patient or family. - This contrasts with the sudden or acute onset often seen in conditions like delirium or stroke. *Visual hallucinations may occur* - **Visual hallucinations** can occur in various forms of dementia, particularly in **dementia with Lewy bodies** and Parkinson's disease dementia. - While not universally present, their occurrence is a recognized potential feature of the disease. *Usually irreversible* - Most types of dementia, including **Alzheimer's disease**, **vascular dementia**, and **dementia with Lewy bodies**, are progressive and **irreversible**. - There are some treatable causes of cognitive impairment that can mimic dementia, but true dementia conditions generally do not resolve.

Question 8: Match the following drugs in Column A with their contraindications in Column B. | Column A | Column B | | :-- | :-- | | 1. Morphine | 1. QT prolongation | | 2. Amiodarone | 2. Thromboembolism | | 3. Vigabatrin | 3. Pregnancy | | 4. Estrogen preparations | 4. Head injury |

A. A-1, B-3, C-2, D-4
B. A-4, B-1, C-3, D-2 (Correct Answer)
C. A-3, B-2, C-4, D-1
D. A-2, B-4, C-1, D-3

Explanation: ***A-4, B-1, C-3, D-2*** - **Morphine** is contraindicated in **head injury** as it can increase intracranial pressure and mask neurological symptoms. - **Amiodarone** is contraindicated in patients with **QT prolongation** due to its risk of inducing more severe arrhythmias like Torsades de Pointes. - **Vigabatrin** is contraindicated during **pregnancy** due to its potential for teratogenicity and adverse effects on fetal development. - **Estrogen preparations** are contraindicated in patients with a history of **thromboembolism** due to their increased risk of blood clot formation. *A-1, B-3, C-2, D-4* - This option incorrectly matches **Morphine** with QT prolongation and **Estrogen preparations** with head injury, which are not their primary contraindications. - It also incorrectly links **Vigabatrin** with thromboembolism and **Amiodarone** with pregnancy. *A-3, B-2, C-4, D-1* - This choice incorrectly associates **Morphine** with pregnancy and **Vigabatrin** with head injury, which are not the most critical or direct contraindications. - It also misaligns **Amiodarone** with thromboembolism and **Estrogen preparations** with QT prolongation. *A-2, B-4, C-1, D-3* - This option incorrectly matches **Morphine** with thromboembolism and **Amiodarone** with head injury, which are not their most significant contraindications. - It also incorrectly links **Vigabatrin** with QT prolongation and **Estrogen preparations** with pregnancy.

Question 9: Which of the following non-memory cognitive symptoms can be associated with Alzheimer's disease (AD)?

A. Aphasia
B. Apraxia
C. Agnosia
D. All of the options (Correct Answer)

Explanation: ***All of the options*** - Alzheimer's disease is characterized by a decline in various cognitive domains, extending beyond memory impairment to include **aphasia**, **apraxia**, and **agnosia**. - These non-memory symptoms become increasingly prominent as the disease progresses and are essential for a comprehensive diagnostic evaluation. *Aphasia* - **Aphasia**, or difficulty with language production or comprehension, is a common non-memory cognitive symptom in AD. - Patients may struggle to find words, understand spoken or written language, or produce coherent sentences. *Apraxia* - **Apraxia**, the inability to perform learned motor movements despite intact motor function and comprehension, is frequently observed in AD. - This can manifest as difficulty with activities of daily living, such as dressing, eating, or using tools. *Agnosia* - **Agnosia**, the inability to recognize objects, people, sounds, shapes, or smells despite intact sensory function, is another non-memory cognitive deficit seen in AD. - Patients may not recognize familiar faces or common household items.

Question 10: Dementia is present in all except:

A. Lewy body dementia
B. Pick's disease
C. Ganser syndrome (Correct Answer)
D. Alzheimer's disease

Explanation: ***Ganser syndrome*** - Ganser syndrome is a **factitious disorder** characterized by approximate answers, not true dementia. - Patients with Ganser syndrome often present with dramatic, but ultimately **nonsensical responses** to simple questions, without a clear underlying organic cause of cognitive decline. *Lewy body* - **Lewy body dementia** is characterized by fluctuating cognition, recurrent visual hallucinations, and spontaneous parkinsonism. - It involves the presence of **Lewy bodies** in cortical and subcortical regions leading to progressive cognitive decline. *Pick's disease* - Pick's disease, a type of frontotemporal dementia, is characterized by language and **behavioral changes** due to neuronal loss. - It results in progressive **atrophy of the frontal and temporal lobes**, leading to profound cognitive deficits over time. *Alzheimer's disease* - **Alzheimer's disease** is the most common cause of dementia, characterized by progressive memory loss and cognitive impairment. - It is pathologically defined by the presence of **amyloid plaques** and **neurofibrillary tangles** in the brain.

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