ACGME Core Competencies
- Patient care (a)
- Medical knowledge (b)
- Practice-based learning (c)
- Interpersonal and communication skills (d)
- Professionalism (e)
- Systems-based practice (f)
Course Objectives
(core competencies in parentheses)
- Discuss the definition of dementia, as used by clinicians (a,b,c,d).
- Differentiate dementia from mild cognitive impairment (MCI) or cognitive impairment, not demented (CIND) (a,b,c,d)
- Discuss the typical neuropsychological profile in “memory-impaired” MCI
- Discuss the role and implications of neuropsychological testing in MCI
- Differentiate the major clinical presentation (clinical history, exam findings) for several common dementia syndromes (a,b,c,d):
- Alzheimer’s disease
- Frontotemporal dementia
- Semantic dementia
- Progressive non-fluent aphasia
- Progressive supranuclear palsy
- Corticobasal degeneration
- Diffuse Lewy body dementia
- Creutzfeldt-Jakob disease
- Huntington’s disease
- Discuss and identify, using microscopy, the pathologic hallmarks or major pathologic findings in each of the above dementia syndromes (a,b,c,d).
- Differentiate the major domains of cognitive function relevant to dementia and discuss how impairment in each domain would present clinically (a,b,c,d):
- Executive dysfunction
- Memory dysfunction (recent, remote)
- Semantic memory impairment
- Visuospatial dysfunction (“what” and “where” pathways)
- Expressive language impairment, including speech apraxia
- Receptive language impairment
- Apraxia
- Differentiate the major domains of behavioral function relevant to dementia and discuss how impairment in each domain would present clinically (a,b,c,d):
- Apathy
- Disinhibition
- Agitation, irritability
- Delusions
- Hallucinations
- Eating disorders
- Obsessive/compulsive behaviors
- Sleep disorders
- Depression
- Discuss which cognitive domains are associated with which major anatomical structures in the brain (a,b,c,d).
- Identify the well-established neuroanatomical associations with behavioral dysfunction (a,b,c,d).
- Differentiate the major lobes of the brain on an MRI, and the hippocampi and the basal ganglia (a,b,c,d).
- Discuss the role that neuropsychological testing can play in the evaluation of cognitive domains (a,b,c,d).
- Perform the MMSE and bedside evaluation of other cognitive domains (a,b,c,d,e,f).
- Discuss two neuropsychological tasks that explore the following functions (in some cases, the same tests may tap into multiple systems; must explain how the outcome would be different if a different system failure is causing the deficit on testing) (a,b,c,d,e,f):
- Frontal lobe generative abilities
- Executive functions
- Working memory
- Episodic memory (verbal and visual)
- Semantic memory
- Visuospatial dysfunction (“what” and “where” pathways)
- Expressive language, including speech apraxia
- Receptive language
- Apraxia
- Perform an examination to elicit the major exam findings in typical Parkinson’s disease and atypical parkinsonian disorders (a,b,c,d,e).
- Perform an examination to identify useful findings in eye movements for the diagnosis of parkinsonian dementias (a,b,c,d,e).
- Recommend laboratory testing for the evaluation of dementia (a,b,c,d,e,f).
- What blood tests?
- Brain imaging? What kind?
- Differentiate typical and “rapidly progressive” dementia (a,b,c,d).
- Generate a reasonable differential diagnosis for entities causing rapidly progressive dementia (a,b,c,d,e,f).
- Recommend at least two effective medications or treatment strategies for the following symptoms in dementia (a,b,c,d,e,f).
- Memory dysfunction
- Agitation, aggression
- Depression
- Parkinsonism
- Discuss the important genetic associations for common dementia syndromes (a,b,c,d).
- Alzheimer’s disease
- Frontotemporal dementia
- Huntington’s disease
- Lewy body disease
- Creutzfeldt-Jakob disease
- Discuss how genetic factors affect clinical presentation (when this is known) in these disorders (a,b,c,d).
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