Problem:

I represent pharmaceutical company Easy Times Roll (ETR), and I want you to invest in my IPO. This company is marketing an agent to be utilized in patients with dementia (cognitive decline). These patients have clinical evidence of dementia and their CT/MRI shows the brain to be shrunken with marked enlargement of ventricles and CSF spaces. Neuropsychological testing confirms diagnosis of dementia and mini-mental status exam score is 23. Diagnostic testing reveals no etiology for the cognitive decline. CBF is markedly and significantly reduced as measured by PET and SPECT. Our drug "Mardi Gras Magic", which is derived from the Louisiana Oyster causes significant increase in cerebral blood flow. Slight headache, dizziness, and facial flushing are the only side effects. Neuropsychological testing shows 25% of patients show moderate cognitive improvement after one week, and 10% at six years of therapy as measured by the company doctors and psychologists. There is no control group. Based upon your knowledge of neuroscience, do you invest and why?

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1. Assuming this is "quackery", explain the initial 25% response rate.
   
   
2. If you're asked to examine 100 patients with early and moderate stage dementiabut only given 10 minutes, how could you determine who has Alzheimer's disease as contrasted with other types of dementia?
   
   
3. How could you determine which of the demented patients had "bad blood" and what does "bad blood" mean?
   
   
4. Which of the demented patients should have VP shunt?
   
   
5. If a demented patient appears "fidgety" what diagnosis does this suggest?
   
   
6. Define "vascular dementia". Is the MMSE more or less useful for making this diagnosis?  What is multi-infarct dementia and why is the term of vascular congitive impairment a more inclusive term.
   
   
7. What is pseudodementia?
   
   
8. What does this CT show?
   
   
9. What blood tests are warranted?
   
   
10. Does this patient need an LP?
    
    
11. Does "metabolism drive cerebral blood flow" or does "CBF drive brain metabolism"?
    
    
12. Could this patient have herpes simplex encephalitis?
    
    
13. Define aphasia and the common clinical patterns.

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Films C-6 Revised 6/27/2005