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Neuromuscular Exam and Rehab Exam 1 > Arousal, Cognition, Attention, Dementia > Flashcards

Arousal, Cognition, Attention, Dementia Flashcards

1
Q

What is the neurological screen used for?

A

to screen patients presenting to therapy to determine if further neurological evaluation is appropriate and determing body regions that have deficits

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2
Q

What are we screening for with our neuro screen?

A

red flags, referral potential, differential diagnosis, and baseline

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3
Q

What is mental status observed by?

A

patient history
- note behavior, language, attention, affect
Orientation
- person, place, time, situation
alert
- arousal, attention, consciousness
Behavior
Cognitive Status
Memory

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4
Q

What is a quick mental status check?

A

3 words to remember

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5
Q

What is normal arousal?

A

consciousness

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6
Q

What is hypoarousal?

A

lethargic, obtund, stupor, coma, minimally conscious vegitative state, persistent vegetative state

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7
Q

What is hyper aroused?

A

restless, agitated, irritable, unable to self console, hyperactive

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8
Q

What is lethargy?

A

mildly depressed level of consciousness

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9
Q

What is obtund?

A

significantly diminished, will respond to noxious stimulus but may be confused

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10
Q

What is stupor?

A

minimal arousal and requires vigerous noxious stimulus and minimal arousal

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11
Q

What is coma?

A

no arousal, inability to make purposeful response

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12
Q

What is a minimally concious vegetative state?

A

conscious but unaware of their environment and no purposful attention

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13
Q

What is a persistent vegetative state?

A

in state for 1 year or longer after TBI

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14
Q

How do we assess arousal?

A

response to stimulus

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15
Q

What is the gold standard to test arousal in acute brain injury?

A

Glasgow Coma Scale

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16
Q

What are stimuli we can use to assess response?

A

verbal, pain, light, touch

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17
Q

What kind of response are we looking for when testing arousal?

A
  • eye opening
  • motor response
  • verbal response
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18
Q

What survery is stroke specific for arousal?

A

NIHSS

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19
Q

What does section 1 of the NIHSS examine?

A

the patients level of conciousness and arousal

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20
Q

When is the Glasgow Coma Scale used?

A

immediately following a head injury in the acute phases

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21
Q

What does the Glasgow coma scale measure?

A

change following injury in arousal and neurologic function

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22
Q

What does the Glasgow Coma Scale examine?

A
  • eye opening
  • motor response
  • verbal response
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23
Q

What is the scoring of the Glasgow Coma Scale?

A

mild: 12-15
moderate: 9-11
severe: 3-8

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24
Q

What are physical touch ways to stimulate and improve arousal?

A
  • hand over hand
  • rubbing
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25
Q

What are noxious stimuli ways to stimulate and improve arousal?

A
  • sternal rub
  • nailbed pressure
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26
Q

What are some sensory stimulation ways to stimulate and improve arousal?

A
  • cold or wet towel
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27
Q

What are some vestibular stimulationways to stimulate and improve arousal?

A

movement

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28
Q

What are some environemental ways to stimulate and improve arousal?

A

lights, sound

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29
Q

What is attention necessary for?

A

to perform a conscious task

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30
Q

What are the 5 categories of attention?

A
  • focused
  • sustained
  • selective
  • alternating
  • divided
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31
Q

What is focused attention?

A

process specific information

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32
Q

What is sustained attention?

A

continuously over time

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33
Q

What is selective attention?

A

being able to perform with distractions

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34
Q

What is alternating attention?

A

shifting attention back and forth

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35
Q

What is divided attention?

A

respond to multiple stimuli simultaesously simultaneously

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36
Q

What is MARS?

A

Moss Attention Rating Scale

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37
Q

What is MARS for?

A

outcome measures for attention, characterized behavioural responses after brain injury

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38
Q

What is MARS made up of?

A
  • 22 questions that therapist is rating of person they are examining
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39
Q

What are the ratings for MARS?

A

1= definitely false
2= false for the most part
3= sometimes true sometimes false
4= true for the most part
5= definitely true

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40
Q

What is affect?

A

behaviors that describe mood or emotional state

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41
Q

WHat is pseudobulbar affect?

A

emotional dysregulation, uncontrolled and exaggerated laughing or crying

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42
Q

What is apathy?

A

shallow or blunted emotional response

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43
Q

What is euphoria?

A

exaggerated feelings of well being

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44
Q

What is depression?

A

poor perception of self and environment

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45
Q

What is cognition?

A

the ability to sort, retrieve and manipulate information

46
Q

What does a cognitive assessment determine?

A

if a patient may have a limitation in pOC or need further referral (speech?)

47
Q

What kind of patient is more likely to fall?

A

patients with dementia and cognitive impairment

48
Q

What does a cognitive assessment help a PT determine related to POC?

A

discharge plan

49
Q

When is attention, arousal and orientation done?

A

bedside and in subjective assessment

50
Q

What are some cognitive assessment objective tests and outcome measures?

A
  • clock drawing
  • reasoning
  • recall
  • animal fluency
  • mini-mental mental state exam (MMSE)
  • Montreal cognitive assessment (MOCA)
  • St. Louis University Mental Status Exam (SLUMS)
51
Q

What is animal fluency?

A

give patient 1 minute to name as many animals as possible

> 65 yo = 12 animals
< 65 = 18 animals

52
Q

What is clock drawing and how is it helpful?

A

blank sheet of paper and have patient draw a clock with numbers 1 - 12
- ask patient to draw hands to indicate a time (any time)

53
Q

How can we test reasoning?

A

say a phrase to a patient and ask them to interpret
- “you reap what you sew”

54
Q

How do we test retention?

A
  • give the patient a list of words for them to remember and have them repeat them to you
55
Q

How do we test recall?

A

ask later in the screen for the patient to repeat the words back to you

56
Q

What is the mini mental state exam?

A
  • used if cognitive issues is expected but undiagnosed
  • measures orientation, recall, short term verbal memory, calculation, language and construct ability
  • LICENCE MUST BE REQUESTED TO ADMINISTER
57
Q

What is the max score of MMSE? What indicates a cognitive impairement?

A
  • 30/30 max
  • less than 24 = cognitive impairment
58
Q

What is the scoring of MOCA?

A
  • less than 26/30 is indicative of dementia and further testing is required
59
Q

What is the scoring of SLUMS?

A
  • less than 25 indicates cognitive dysfunction
60
Q

What does SLUMS contain more of?

A

memory, attention and executive function questions

61
Q

Which test is more sensitive for identifying dementia?

A

SLUMS

62
Q

Where should our interventions start?

A
  • address mobility, strength and fall risk
63
Q

Interventions need to be _____________ based instead of explicit

A

PROCEDURAL

64
Q

Even if patients cant remember they can develop …

A

habits

65
Q

Patients can learn by ____ rather than remembering

A

doing

66
Q

The less explicit information and talking, the ______ ability to learn the task

A

better

67
Q

What are the 3 Ds?

A
  • delirium
  • depression
  • dementia
68
Q

What is delirium?

A

disrupted consciousness, cognition, or perception that is common in hospitalized older adults

69
Q

Is delirium common?

A

YES - occurs in 80% of those in the UCY

70
Q

How long does it take delirium to develop?

A

SHORT PERIOD OF TIME

71
Q

What are the symptoms of delirium?

A

fluctuate throughout day and night
- can be hyperactive, hypoactive or mixed

72
Q

What is dementia?

A

clinical syndrome of cognitive and functional decline

73
Q

What is the prognosis of dementia?

A

chronic and progressive in nature (NOT SUDDEN)

74
Q

How is dementia diagnosed?

A

by a careful history, medial and neurological exam and neurocognitive testing

75
Q

With dementia, what are the deficits?

A

cause impaired occupational or social functioning and represent a decline from previous level of function

76
Q

What are the 4 common types of dementia?

A
  • Alzheimer’s disease
  • vascular dementia
  • dementia with Lewy Bodies
  • Frontotemporal dementia
77
Q

What is a mild cognitive impairment?

A

altered cognition that fills the gap between normal and dementia

78
Q

What are the characteristics of a mild cognitive impairment?

A
  • more memory loss than normal for those their age
  • symptoms not as severe as those with Alzheimer’s
  • Function is largely preserved and they are able to do normal daily activities
79
Q

What are signs of a mild cognitive impairement?

A
  • losing things, forgetting appointments, and trouble finding words, increased forgetfulness of recent events
80
Q

What is the most common form of dementia?

A

Alzheimer’s

81
Q

What is the dx of alzheimer’s associated with?

A

advanced age

82
Q

What is the predominant and earliest sign of alzheimer’s?

A

Memory decline

83
Q

What are later symptoms of alzheimer’s?

A

impaired communication, mobility, judgement, swallowing, speaking, behavior, and disorientation

84
Q

What are the pathological changes that cause alzheimer’s?

A

amyloid plaques and neurofibrillary tangles

85
Q

What area has atrophy with dementia?

A

inferior prefrontal cortex

86
Q

What are there inadequate levels of with alzheimer’s?

A

acetylcholine causes reduced synaptic activity and density

87
Q

What is vascular dementia?

A

mental disorder with the main feature of underlying cardiovascular disease

88
Q

What also comes with vascular dementia often times?

A

ALzheimer’s and Lewy Body Dementia

89
Q

What has the same risk factors as vascular dementia?

A

cardiovascular disease

90
Q

What can result from vascular strokes?

A

BRAIN DAMAGE

91
Q

What can vascular dementia also be?

A

multi infarct dementia which is a result of multiple large or small infarcts that cause brain loss

92
Q

What is the rate of cognitive decline like with vascular dementia?

A

similar to alzheimer’s disease but LIFE EXPECTANCY IS SHORTER

93
Q

What are some symptoms of vascular dementia?

A

slow processing speed, impaired judgment, and impaired ability to make decisions and plan are the first symptoms

94
Q

What physical symptoms are associated with vascular dementia?

A

slow gait and poor balance depending on where the ischemia is happening

95
Q

What is Lewy Body dementia?

A
  • similar to Alzheimer’s disease but has early sleep disturbance and hallucinations
  • have more imbalance and PKD type movement along with visuospatial impairment
96
Q

What causes Lewy Body dementia ?

A

the build-up of Lewy bodies inside the neurons in the cortex that control memory and motor control

97
Q

What are lewy bodies also linked to?

A

parkinsons and multi-system atrophy

98
Q

What makes lewy body different from parkinsons?

A
  • PKD is marked by motor symptoms and lewy body is marked by cognitive impairments first
99
Q

What is frontotemporal lobe dementia?

A
  • progressive nerve cell loss in the brains frontal and temporal lobe
100
Q

What does frontotemporal lobe dementia cause?

A

deteriation in behavior, personality, language and alterations in motor and muscle function

101
Q

Frontotemporal lobe dementia is the ___ mot ccommon cause of dementia

A

2nd

102
Q

How does frontotemporal lobe dementia differ from alzheimers?

A

frontotemporal dementia people are less disoriented than AD but have more difficult with executive function and problem solving

103
Q

What is perserved with frontotemproal dementia?

A

memory and spatial orientation

104
Q

What do those with frontotemporal dementia have less trouble with?

A

negotiating a familiar environment

105
Q

What can be profound with frontotemporal dementia?

A

lack of insight

106
Q

What is the MOST COMMON mental health disorder in adults 65 and older?

A

depression

107
Q

What can contribute to depression in older adults?

A

any medical diagnosis but stroke, cancer, chronic pain, MS are all highly correlated

108
Q

What are signs of depression?

A

sadness, irritability, cognitive alterations, decreased appetite, self-esteem, and energy, loss of interest, anxiety and reduced concentration

109
Q

What is a good tool to catch depression in an older population?

A

Geriatric Depression Scale

110
Q

What can we do for patients with depression?

A

choose activities that are engaging and interesting to them

111
Q

What are the normal vital sign ranges for adults (BP, RR, HR, O2)?

A

BP: 120/80
RR: 12-20 breaths per minute
HR: 60-100 bpm, avg 60
O2: 100%

Neuromuscular Exam and Rehab Exam 1 (11 decks)

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