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Continuum Postreading Test 28(3) June 2022 (Dementia)

Continuum Postreading Test 28(3) June 2022 (Dementia)

Learning Objectives

Upon completion of this Continuum: Lifelong Learning in Neurology Dementia issue, participants will be able to:
◆ Discuss the most common patterns of symptoms in Alzheimer disease and recent advances in the molecular biomarker tools available for the diagnosis of Alzheimer disease
◆ Discuss the diagnosis and management of atypical Alzheimer disease
◆ Discuss the clinical, neuropsychologic, biofluid, genetic, and neuroimaging features characteristic of and management strategies for behavioral variant frontotemporal dementia and the neuropathologic disorders that can manifest as behavioral variant frontotemporal dementia
◆ Discuss the extensive overlap between cognitive and movement clinical presentations, especially within the realm of neurodegenerative diseases, to better diagnose and manage such conditions
◆ Develop an approach to evaluating patients with suspected vascular cognitive impairment and dementia, understand the vascular risk factors that contribute to vascular cognitive impairment and dementia, differentiate vascular cognitive impairment and dementia from other neurodegenerative dementias, and appropriately manage vascular cognitive impairment and dementia
◆ Describe when neuropsychological evaluation would be an important adjunct to the workup of dementia, the neuropsychological characteristics of different clinical dementia syndromes, and the likely neuropathologic associations of those syndromes and differentiate between neuropsychological profiles characterized by deficits in episodic memory, reasoning, language, visuospatial abilities and social-comportmental behaviors
◆Discuss the role of quantitative columetric brain MRI and positron emission tomography (PET) for dementia diagnosis.
◆Discuss the uses of CSF and blood-based biomarkers in the evaluation of dementia
◆ Discuss the common brain pathologies in Alzheimer disease and related dementias and the importance of mixed pathologies and resilience
◆ Describe the spectrum of genetic risk in Alzheimer disease and identify cases in which genetic testing would be appropriate in the clinic setting
◆ Discuss health disparities associated with Alzheimer disease and related dementias in the United States and apply principles of culturally appropriate care to address health disparities in the context of diverse patients
◆ Describe a structured approach to managing patients following a diagnosis of dementia, including medical management, nonpharmacologic strategies, safety interventions, caregiver support, mobilization of community resources, and advanced care planning
◆ Implement a practical approach to the evaluation of patients with rapidly progressive dementia that includes an efficient diagnostic assessment to promote early recognition and treatment of potentially reversible causes
◆ Discuss the medicolegal issues for physicians when considering whether to prescribe a complex medication with potential risks around which no consensus of clinical efficacy has been reached

Core Competencies

This Continuum: Lifelong Learning in Neurology Dementia issue covers the following core competencies:
◆ Patient Care
◆ Medical Knowledge
◆ Practice-Based Learning and Improvement
◆ Interpersonal and Communication Skills
◆ Professionalism
◆ Systems-Based Practice

Contributorsa

John C. Morris, MD, FAAN, Guest Editor
Distinguished Professor of Neurology, Washington University School of Medicine, St. Louis, Missouri
Relationship Disclosure: Dr Morris has received personal compensation in the range of $500 to $4999 for serving on a scientific advisory or data safety monitoring board for CBR International, the Cure Alzheimer’s Fund, and the LEADS Steering Committee. Dr Morris has received intellectual property interests from a discovery or technology relating to health care. The institution of Dr Morris has received research support from the National Institutes of Health. The blood-based amyloid test is licensed by C2N and was cofounded by colleagues of Dr Morris. Washington University will receive royalties from this test, but Dr Morris will not receive personal compensation from it.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Morris reports no disclosure.

Liana G. Apostolova, MD, MSc, FAAN
Distinguished Professor of Neurology; Barbara and Peer Baekgaard Professor in Alzheimer's Disease Research; Professor of Radiology, Medical and Molecular Genetics; Indiana University School of Medicine, Indianapolis, Indiana
Relationship Disclosure: Dr Apostolova has received personal compensation in the range of $500 to $4999 for serving as a consultant for the Florida Department of Health; GE Healthcare; Lilly; the National Institutes of Health, and the National Institutes of Health NeuroBioBank and for serving on a scientific advisory of data safety moniotoring board for Eisai Co, Ltd; IQVIA, Inc; and TwoLabs, LLC. Dr Apostolova has received personal compensation in the range of $5000 to $9999 for serving as a consultant on a scientific advisory or data safety monitoring board for Biogen. Dr Apostolova has received personal compensation in the range of $10,000 to $49,999 for serving as an editor, associate editor, or editorial advisory board member for the Alzheimer’s Association. An immediate family member of Dr Apostolova has stock in Cassava Sciences, Inc; Golden Seeds; and Semiring. The instituion of Dr Apostolova has received research support from the Alzheimer’s Association, Avid Radiopharmaceuticals, F. Hoffman-La Roche Ltd, Life Molecular Imaging, and the National Institute on Aging (U01 AG057195).
Unlabeled Use of Products/Investigational Use Disclosure: Dr Apostolova discusses the unlabeled/investigational use of psychotropic medications for the management of behavioral symptoms in atypical Alzheimer disease.

Ganesh M. Babulal, PhD, OTD, MSCI, MOT
Assistant Professor of Neurology, Knight Alzheimer Disease Research Center Investigator, Institute for Public Health Faculty Scholar, Washington University School of Medicine, St. Louis, Missouri; Department of Psychology Research Associate, University of Johannesburg, South Africa; Adjunct Associate Professor, The George Washington University, Washington, DC
Relationship Disclosure: The blood-based amyloid test is licensed by C2N and was cofounded by colleagues of Dr Babulal. Washington University will receive royalties from this test, but Dr Babulal will not receive personal compensation from it.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Babulal reports no disclosure.

Joyce (Joy) E. Balls-Berry, PhD, MPE
Associate Professor of Neurology; Inaugural Lead, Health Disparities and Equity Core in the Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, Missouri
Relationship Disclosure: Dr Balls-Berry has received personal compensation for serving on a patient advisory board for Dartmouth College. The blood-based amyloid test is licensed by C2N and was cofounded by colleagues of Dr Balls-Berry. Washington University will receive royalties from this test, but Dr Balls-Berry will not receive personal compensation from it.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Balls-Berry reports no disclosure.

Tammie L. S. Benzinger, MD, PhD
Professor of Radiology and Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
Relationship Disclosure: Dr Benzinger has received personal compensation in the range of $5000 to $9999 for serving as a consultant, on a scientific advisory or data safety monitoring board, and on a speakers bureau for Biogen. Dr Benzinger has noncompensated relationships as a consultant for Siemens and Eisai Co, Ltd that are relevant to American Academy of Neurology interests or activities. The blood-based amyloid test is licensed by C2N and was cofounded by colleagues of Dr Benzinger. Washington University will receive royalties from this test, but Dr Benzinger will not receive personal compensation from it.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Benzinger discusses unlabeled/investigational uses of amyloid and tau positron emission tomography for the diagnosis of dementia.

Bradley F. Boeve, MD, FAAN
Professor of Neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
Relationship Disclosure: Dr Boeve has received personal compensation in the range of $10,000 to $49,999 for serving as an officer or member of the scientific advisory board of the Rainwater Charitable Foundation. Dr Boeve has received publishing royalties from a publication relating to health care. The institution of Dr Boeve has received research/ grant support from Alector, Inc; Biogen; EIP Pharma, Inc; GE Healthcare; and the National Institutes of Health.The institution of Dr Boeve has received research/grant support from Alector, Inc; Biogen; EIP Pharma, Inc;. and GE Healthcare. Dr Boeve has received publishing royalties from a publication relating to health care.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Boeve discusses the unlabeled/investigational use of antiseizure medications, atypical antipsychotics, cholinesterase inhibitors, memantine, oxytocin, psychostimulants, selective serotonin reuptake inhibitors/serotonin norepinephrine reuptake inhibitors, and trazodone for treating symptoms related to frontotemporal dementia, none of which are approved by the US Food and Drug Administration.

Cynthia M. Carlsson, MD, MS

Professor of Medicine, Department of Medicine, Division of Geriatrics and Gerontology, University of Wisconsin School of Medicine and Public Health; US Department of Veterans Affairs Staff Physician, Madison VA Geriatric Research Education and Clinical Center, Madison, Wisconsin
Relationship Disclosure:Dr Carlsson has received personal compensation in the range of $500 to $4999 for serving as a study section reviewer and clinical task force member with National Institutes of Health/National Institute on Aging. Dr Carlsson has a noncompensated relationship as a chair of the Advisory Council on Alzheimer's Research, Care, and Services with the US Health and Human Services that is relevant to American Academy of Neurology interests or activities. The institution of Dr Carlsson has received research/grant support from the Alzheimer’s Association; the Department of Veterans Affairs; the National Institutes of Health/Eisai Co, Ltd; the National Institutes of Health/Lilly; the National Institutes of Health/National Institute on Aging; and the University of Wisconsin Department of Medicine.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Carlsson discusses the unlabeled/investigational use of acetylcholinesterase inhibitors for the treatment of Lewy body disease and vascular dementia and of memantine in mild Alzheimer dementia for patients who cannot tolerate an acetylcholinesterase inhibitor.

Helena Chang Chui, MD

Raymond and Betty McCarron Professor, Chair of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California
Relationship Disclosure: The institution of Dr Chui has received research support from the National Institute on Aging.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Chui discusses the unlabeled/investigational use of donepezil for the treatment of vascular cognitive impairment and dementia and mixed vascular cognitive impairment and dementia/Alzheimer disease.

Gregory S. Day, MD, MSc, MSCI, FAAN

Assistant Professor of Neurology, Senior Associate Consultant, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
Relationship Disclosure: Dr Day has received personal compensation in the range of $500 to $4999 for serving as an editor, associate editor, or editorial advisory board member for DynaMed (EBSCO Industries, Inc), as a presenter at the Annual Meeting (CME) of the American Academy of Neurology, as a grant reviewer (honorarium) with the Pennsylvania Department of Health, and for CME content and delivery for PeerView and Continuing Education Inc. Dr Day has received personal compensation in the range of $5000 to $9999 for serving as a consultant for Parabon NanoLabs, Inc and personal compensation in the range of $10,000 to $49,999 for serving as an expert witness for Barrow Law. Dr Day has a noncompensated relationship as a clinical director for the Anti–NMDA Receptor Encephalitis Foundation Inc that is relevant to American Academy of Neurology interests or activities. Dr Day’s institution has received research support from the Alzheimer’s Association, the Chan Zuckerberg Initiative, the National Institutes of Health/National Institute on Aging, and the National Institutes of Health/National Institute of Neurological Disorders and Stroke.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Day reports no disclosure.

Jennifer G. Goldman, MD, MS, FAAN
Section Chief, Parkinson’s Disease and Movement Disorders; Professor, Departments of Physical Medicine and Rehabilitation and Neurology, Shirley Ryan AbilityLab and Northwestern University Feinberg School of Medicine, Chicago, Illinois
Relationship Disclosure: Dr Goldman has received personal compensation in the range of $500 to $4999 for serving as an officer or member of the board of directors for the Parkinson's Foundation Scientific Advisory Board. The institution of Dr Goldman has received research/grant support from Acadia Pharmaceuticals, the American Parkinson’s Disease Association, Lewy Body Dementia Association Research Center of Excellence, Michael J. Fox Foundation for Parkinson’s Research, and the Parkinson's Foundation.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Goldman discusses the unlabeled/investigational use of medications for the treatment of mood, behavioral, and cognitive symptoms, including donepezil, memantine, and rivastigmine as cognition-enhancing medications.

Samantha K. Holden, MD, MS
Assistant Professor of Neurology, University of Colorado School of Medicine, Aurora, Colorado
Relationship Disclosure: The institution of Dr Holden has received research support from Michael J. Fox Foundation for Parkinson's Research.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Holden discusses the unlabeled/investigational use of medications for the treatment of mood, behavioral, and cognitive symptoms, including donepezil, memantine, and rivastigmine as cognition-enhancing medications.

Suman Jayadev, MD
Associate Professor of Neurology, University of Washington, Seattle, Washington
Relationship Disclosure: Dr Jayadev reports no disclosure.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Jayadev reports no disclosure.

Joseph S. Kass, MD, JD, FAAN
Professor of Neurology, Psychiatry, and Medical Ethics, Baylor College of Medicine Houston, Texas
Relationship Disclosure: Dr Kass has received personal compensation in the range of $5000 to $9999 for serving as an editor, associate editor, or editorial advisory board member for American the Academy of Neurology and Elsevier. Dr Kass has served on an advisory board for Eisai Co, Ltd.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Kass reports no disclosure.

Eric M. McDade, DO
Associate Professor of Neurology, Washington University School of Medicine, St. Louis, Missouri
Relationship Disclosure: Dr McDade has received personal compensation in the range of $500 to $4999 for serving as a consultant for Lilly and for serving on a scientific advisory or data safety monitoring board for Alector, Inc and Lilly. Dr McDade has received personal compensation in the range of $5000 to $9999 for serving on a scientific advisory or data safety monitoring board for Fondation Alzheimer and in the range of $10,000 to $49,999 for serving on a scientifi c advisory or data safety monitoring board for Alzamend Neuro Inc. Dr McDade has received intellectual property interests from a discovery or technology relating to health care and publishing royalties from a publication relating to health care. The institution of Dr McDade has received research/grant support from F. Hoffmann-LaRoche, Lilly, and the National Institute on Aging. The blood-based amyloid test is licensed by C2N and was cofounded by colleagues of Dr McDade. Washington University will receive royalties from this test, but Dr McDade will not receive personal compensation from it.
Unlabeled Use of Products/Investigational Use Disclosure: Dr McDade discusses the unlabeled/investigational use of atypical antipsychotics for the treatment of behavioral symptoms of dementia.

Angelina J. Polsinelli, PhD
Assistant Professor of Clinical Neurology, Indiana University School of Medicine, Indianapolis, Indiana
Relationship Disclosure: Dr Polsinelli receives research/grant support from the Alzheimer’s Association, the Kessler Foundation, and the National Institute on Aging.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Polsinelli discusses the unlabeled/investigational use of psychotropic medications for the management of behavioral symptoms in atypical Alzheimer disease.

Cyrus A. Raji, MD, PhD
Assistant Professor of Radiology and Neurology, Director of Neuromagnetic Resonance Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
Relationship Disclosure: Dr Raji has received personal compensation in the range of $10,000 to $49,999 for serving as a consultant for Brainreader A/S, on a scientific advisory or data safety monitoring board for Apollo Health, and as an expert witness for Neurevolution Medicine, LLC. The blood-based amyloid test is licensed by C2N and was cofounded by colleagues of Dr Raji. Washington University will receive royalties from this test, but Dr Raji will not receive personal compensation from it.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Raji discusses unlabeled/investigational uses of amyloid and tau positron emission tomography for the diagnosis of dementia.

Rachel V. Rose, JD, MBA

Attorney, Rachel V. Rose Attorney at Law, PLLC; Affiliated Faculty, Baylor College of Medicine, Houston, Texas
Relationship Disclosure: Ms Rose serves on the editorial board of BC Advantage and received book royalities from the American Bar Association.
Unlabeled Use of Products/Investigational Use Disclosure: Ms Rose reports no disclosure.

Suzanne E. Schindler, MD, PhD
Associate Professor of Neurology, Washington University School of Medicine, St. Louis, Missouri
Relationship Disclosure: Dr Schindler has received personal compensation in the range of $0 to $499 for serving as a member of the Biospecimen Review Committee with the National Centralized Repository for Alzheimer Disease and in the range of $500 to $4999 for serving as a member of the Alzheimer Disease Center Clinical Task Force with the University of Washington and as a presenter/panelist with the University of Wisconsin. Dr Schindler has a noncompensated relationship as a board member with the Greater Missouri Alzheimer's Association that is relevant to AAN interests or activities. The institution of Dr Schindler has received research support from the National Institute on Aging. Dr Schindler has analyzed blood-based biomarker data provided by C2N Diagnostics to Washington University. The blood-based amyloid test is licensed by C2N and was cofounded by colleagues of Dr Schindler. Washington University will receive royalties from this test, but Dr Schindler will not receive personal compensation from it.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Schindler discusses the unlabeled/investigational use of CSF and blood tests for the diagnosis of dementia.

Julie A. Schneider, MD, MS
The Deborah R. and Edgar D. Jannotta Presidential Professor of Pathology and Neurological Sciences; Associate Director, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois

Relationship Disclosure: Dr Schneider has received personal compensation in the range of $500 to $4999 for serving as a consultant for Lilly; on a scientific advisory or data safety monitoring board for Apellis Pharmaceuticals, Inc; and as a scientific advisor with Fondation Alzheimer. Dr Schneider has received personal compensation in the range of $5000 to $9999 for serving on a scientific advisory or data safety monitoring board for Alnylam Pharmaceuticals, Inc, and as an expert witness for the National Hockey League. The institution of Dr Schneider has received research support from the National Institutes of Health.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Schneider reports no disclosure.

Sandra Weintraub, PhD, ABCN/ABPP, FAAN
Professor of Psychiatry and Behavioral Sciences, Associate Director Northwestern Alzheimer’s Disease Center, Northwestern Feinberg School of Medicine, Chicago, Illinois
Relationship Disclosure: Dr Weintraub reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Weintraub reports no disclosure.

Ellen Chang Wong, MD
Assistant Professor, Keck School of Medicine, University of Southern California, Los Angeles, California; Physician Specialist, Rancho Los Amigos National Rehabilitation Center, Downey, California

Relationship Disclosure: Dr Wong has received research support from the National Institute on Aging.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Wong discusses the unlabeled/investigational use of donepezil for the treatment of vascular cognitive impairment and dementia and mixed vascular cognitive impairment and dementia/Alzheimer disease.

Self-Assessment and CME Test Writers

Nuri Jacoby, MD
Associate Professor of Neurology, SUNY Downstate Health Sciences University; Attending Neurologist, Maimonides Medical Center, Brooklyn, New York

Relationship Disclosure: Dr Jacoby has received personal compensation in the range of $500 to $4999 for serving as a multiple-choice question writer for Continuum with the American Academy of Neurology and on a scientific advisory or data safety monitoring board for Alexion Pharmaceuticals, Inc and in the range of $5000 to $9999 for serving as an expert witness. The institution of Dr Jacoby has received research support from the American Board of Psychiatry and Neurology.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Jacoby reports no disclosure.

Douglas J. Gelb, MD, PhD, FAAN
Professor of Neurology, University of Michigan, Ann Arbor, Michigan

Relationship Disclosure: Dr Gelb has received publishing royalties from a publication relating to health care and personal compensation in the range of $500 to $4999 for serving as a multiple-choice question writer for Continuum with the American Academy of Neurology.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Gelb reports no disclosure.

AAll relevant financial relationships have been mitigated.

Accreditation

Accreditation Statement: The American Academy of Neurology Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME for physicians. For information on Continuum Audio CME, please visitcontinuum.audio-digest.org.

AMA Credit: The American Academy of Neurology Institute designates this enduring material for a maximum of 20 AMA PRA Category1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Methods of Participation and Instructions for Use

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills. In Continuum, the process of absorbing, integrating, and applying the material presented is as important as, if not more important than, the material itself.

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The review articles emphasize clinical issues emerging in the field in recent years. Case reports and vignettes are used liberally, as are tables and illustrations. Audio interviews with the authors of Continuum articles are published alongside each article, and video material relating to the issue topic accompanies issues when applicable.

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