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NMSK I > Arousal, Cognition, Attention, Dementia > Flashcards

Arousal, Cognition, Attention, Dementia Flashcards

1
Q

What is a neurological screen used for?

A

Used for patients presenting to physical therapy, this will determine if further neurological examination is needed. It also helps to find deficits in the body regions.

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2
Q

What do you want to MOST importantly screen for?

A

RED FLAGS, differential diagnosis, possible referral out, and a baseline

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3
Q

A neurological screen includes what factors? Name as many as you can.

A
  1. Cognitive Status
  2. Active ROM
  3. Sensation
  4. Proprioception
  5. Gross muscle testing
  6. Tone
  7. Cranial Nerves
  8. Coordination Screen
  9. DTRs
  10. Static and Dynamic Balance
  11. Gait
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4
Q

Mental Status is observed by…?

A

Patient history
Orientation
Alertness
Behavior
Cognitive Status
Memory

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5
Q

When screening a patient’s mental status, the patient history should focus on what?

A

behavior, language, attention, affect

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6
Q

When screening a patient’s mental status, orientation should focus on what?

A

Person
place
time
situation

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7
Q

__________ + __________ + ______ = alertness

A

Arousal
Attention
Consciousness

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8
Q

_______: level of excitability, response to sensory stimuli

A

Arousal

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9
Q

_________: direction of consciousness needed to complete a task

A

Attention

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10
Q

_________: state of arousal and attention to environment

A

Consciousness

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11
Q

What’s a quick memory test?

A

3 words

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12
Q

With normal arousal, the patient is ________

A

conscious

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13
Q

If a patient is lethargic, obtund, stupor, coma, minimal conscious vegetative state, persistent vegetative state, what is their arousal status?

A

Hypoaroused

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14
Q

If a patient is restless, agitated, irritable, unable to self console, and hyperactive, what is their arousal status?

A

HYPERaroused

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15
Q

________: mildly depressed level of consciousness

A

Lethargic

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16
Q

________: significantly diminished, will respond to noxious stimuli but may be confused

A

Obtund

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17
Q

_______: minimal arousal and requires vigorous noxious stimulus

A

Stupor

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18
Q

_______: no arousal, inability to make a purposeful response

A

Coma

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19
Q

________ _________ _______ state: conscious but unaware of their environment and no purposeful attention

A

Minimally conscious vegetative

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20
Q

__________ _______ state: in this state for 1 year or longer after TBI

A

Persistent vegetative

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21
Q

What are the 3 ways to assess arousal?

A

Response to stimulus
Glasgow Coma Scale
NIHSS

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22
Q

What are the 3 responses to stimulus (verbal, pain, light, touch)?

A

Eye opening
Motor response
Verbal response

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23
Q

The _______ _______ ______ is the gold standard assessment for an acute brain injury and arousal

A

Glasgow Coma Scale

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24
Q

The NIHSS measures the outcome for?

A

stroke severity

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25
Q

Section 1 of the NIHSS examines a patient’s level of _______ and _______

A

consciousness; arousal

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26
Q

With the GCS, _______ number is worse, ________ number is better

A

lower
higher

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27
Q

The GCS ranges from ___-____

A

3, 15

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28
Q

Mild range for GCS?

A

12-15

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29
Q

Moderate range for GCS?

A

9-11

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30
Q

Severe range for GCS?

A

3-8

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31
Q

Fill this out

A
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32
Q

What are ways to stimulate and improve arousal?

A

Physical touch
Noxious Stimuli
Sensory stimulation
Vestibular stimulation
Environment

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33
Q

If you are trying to improve a patient’s stimulation and arousal, you should create _______ _______!

A

daily routines

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34
Q

With physical touch to help improve a patient’s arousal and stimulation, you should perform…?

A

hand over hand, or hand rubbing

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35
Q

2 common ways to perform/tests noxious stimulation?

A

Sternal rub
Nailbed pressure

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36
Q

With sensory stimulation, you can use…?

A

a warm or wet towel

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37
Q

Vestibular stimulation involves ______

A

movement

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38
Q

Lights and sounds would be a part of the ________ to help improve and stimulate arousal

A

environment

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39
Q

Attention is necessary to…?
It gives us direction of _______

A

perform a task
awareness

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40
Q

What are the 5 directions of attention?

A

Focused
Sustained
Selective
Alternating
Divided

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41
Q

_________ attention helps process specific information

A

Focused

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42
Q

_______ attention is being able to perform without distractions

A

Selective

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43
Q

_________ attention is continuously over time

A

Sustained

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44
Q

_________ attention responds to multiple stimuli simultaneously (dual task)

A

Divided

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45
Q

_________ attention shifts backs and forth

A

Alternating

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46
Q

MARS: outcome measure for _______

A

attention

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47
Q

With MARS, there are _____ questions that the therapist is rating of the person they are examining

A

22

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48
Q

What does rate 1-5 mean with MARS?
1. ?
2. ?
3. ?
4. ?
5. ?

A

definitely false
false, for most part
sometimes true, somewhat false
true, most part
definitely true

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49
Q

_________ are behaviors that describe mood or emotional state

A

Affect

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50
Q

What are the 4 types of affect?

A

Pseudobulbar
Apathy
Euphoria
Depression

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51
Q

_________ affect: emotional dysregulation, uncontrolled laughing or crying

A

Pseudobulbar

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52
Q

_______: shallow or blunt emotional response

A

Apathy

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53
Q

________: exaggerated feelings of well being

A

Euphoria

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54
Q

_______: poor perception of self environment

A

depression

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55
Q

What are the 3 D’s in cognitive assessment?

A

Delirium
Dementia
Depression

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56
Q

________ is being able to sort, retrieve, and manipulate information

A

Cognition

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57
Q

A cognitive assessment helps to determine if there is a limitation in ______ or further _______ needed

A

POC, referral

58
Q

A cognitive assessment helps determine _____ ______

A

fall risk

59
Q

Patients with dementia or cognitive impairment are more likely to _____

A

fall

60
Q

Cognitive assessment helps determine ______ plan

A

discharge

61
Q

Attention, Arousal, and Orientation are done at _______ and in the _______ assessment

A

bedside
subjective

62
Q

_________ _______ is higher order cognitive planning

A

Executive function

63
Q

________ ________ helps us plan, manipulate, solve problems, recognize errors, and think abstract

A

Executive Function

64
Q

What are some Objective Tests and Outcome Measures for cognition?

A

Clock drawing
Reasoning
Recall
Animal Fluency
MMSE
MOCA
SLUMS

65
Q

Animal Fluency:
If the patient is > 65, they should be able to name ___ animals

If the patient is < 65, they should be able to name ____ animals

A

18
12

66
Q

How do you perform the Animal Fluency cognitive test?

A

Give patient 1 minute to name as many animals as possible

67
Q

How do you perform the Clock Drawing cognitive test?

A

Blank sheet of paper and have the pt. draw a clock with numbers 1-12, ask them to draw hands to indicate a time

68
Q

Saying a common phrase to a patient and ask them to interpret is called ?

A

Reasoning

69
Q

Reasoning grade scale
__-___ not understanding
__ complete understanding

A

0; 2
2

70
Q

Giving a patient a list of words for them to remember and have them repeat them back to you is called?

A

Retention

71
Q

Later in the session, you ask the patient to repeat the 3 words back to you, this is called ?

A

Recall

72
Q

Mini Mental State Exam (MMSE)
is used if _______ issues are expected but not diagnosed

A

cognitive

73
Q

The _________ measures orientation, recall, short term verbal memory, calculation, language, and construct ability

A

MMSE

74
Q

What is required to administer the MMSE?

A

license

75
Q

MMSE
Max score of ____/_____
Less than _____ indicates cognitive impairment

A

30; 30
24

76
Q

MOCA:
Less than ____/_____ is indicative of dementia (further testing needed)

A

26; 30

77
Q

SLUMS similar to MOCA and MMSE, but used for what kind of patients?

A

lower level cognitive patients

78
Q

With SLUMS, less than ______ indicates cognitive dysfunction

A

25

79
Q

SLUMS focuses on more ______, _______, and _______ function

A

memory
attention
executive

80
Q

Which cognitive test is more sensitive for identifying dementia?

A

SLUMS

81
Q

As therapists we can’t diagnose dementia, but we can diagnose what?

A

cognitive impairments

82
Q

What are some interventions to address for cognition?

A

mobility
strength
fall risk

83
Q

Interventions for cognitive impairments should be ______ based instead of _____

A

procedural; explicit

84
Q

With interventions for cognitive impairments, even if patients can’t remember, they can _____ ______

A

develop habits

85
Q

With interventions for cognitive impairments, patients can learn by….?

A

doing rather than remembering

86
Q

With interventions for cognitive impairments, it’s better to use _______ practice and practice in actual _______

A

blocked; context

87
Q

With interventions for cognitive impairments, less explicit information and talking, the better…?

A

ability to learn the task

88
Q

Facts, events, and recall are all examples of ________ memory (explicit)

A

declarative

89
Q

Delirium is disrupted _________, ________, or _______ that is common in hospitalized older adults

A

consciousness, cognition, perception

90
Q

Delirium is a common occurrence postoperatively in _______ ______ and occurs in 80% of those in the ______

A

older adults; ICU

91
Q

Delirium develops in a ______ period of time

A

short

92
Q

Delirium symptoms and severity _______ throughout day and night

A

fluctuate

93
Q

Delirium can be _______, _______, or _______

A

hypoactive
hyperactive
mixed

94
Q

________ active delirium: restlessness, agitation, rapid mood change

A

HYPER

95
Q

_______active delirium: inactivity or reduced motor activity

A

HYPO

96
Q

_________activity with delirium is most often mistaken for dementia

A

HYPO

97
Q

Dementia is the clinical syndrome of ________ and ________ decline

A

cognitive
functional

98
Q

Dementia is _______ and ______ in nature (not sudden)

A

chronic
progressive

99
Q

Dementia is diagnosed by a _______ ______, ______ and _______ exam, and ________ testing

A

careful history
medical; neurological
neurocognitive

100
Q

With dementia, deficits are sufficient enough to cause impaired ________ or _______ functioning and represent a ______ from previous level of functional

A

occupational
social
decline

101
Q

What are the 4 common types of dementia?

A

Alzheimer’s Disease
Lewy Body Disease
Frontotemporal Dementia
Vascular Dementia

102
Q

Mild cognitive impairment is altered cognition that fills the gap between ______ and _______

A

normal; dementia

103
Q

With mild cognitive impairment, they have more _______ _______ than normal for those their age

A

memory loss

104
Q

With mild cognitive impairment, symptoms are not as severe as _________

A

Alzheimer’s

105
Q

With mild cognitive impairment, function is largely ______ and they are able to do normal _______ ________

A

preserved
daily activities

106
Q

If a patient is losing things, forgetting appointments, trouble finding words, increased forgetfulness of events… this could be signs for what?

A

mild cognitive impairment

107
Q

Which condition is associated with sundowning?

A

Alzheimer’s

108
Q

What is the most common form of dementia and associated with advanced age?
(may start 20 years before symptoms)

A

Alzheimer’s

109
Q

What is the predominant symptom and earliest sign of Alzheimer’s?

A

Memory decline

110
Q

Some later symptoms of Alzheimer’s includes impaired….?

A

Communication
mobility
judgment
swallowing
speaking
behavior
disorientation

111
Q

With Alzheimer’s, ________ ________ and _________ _________ are the pathologic changes in the brain

A

amyloid plaques, neurofibrillary tangles

112
Q

_________ ________ are protein fragments known as B amyloid peptides mixed with other proteins

A

Amyloid plaques

113
Q

__________ ________ are abnormal collections of proteins known as tau

Tau is normal in the brain, but with AD, it clumps on the ______ and _______

A

Neurofibrillary tangles
neurons, dies

114
Q

With Alzheimer’s there is ______ in the _________ _________ cortex of the brain

A

atrophy
inferior prefrontal

115
Q

With Alzheimer’s, inadequate levels of _________ causes reduced synaptic activity and density

A

acetylcholine

116
Q

With _________ dementia, blood is not profusing like it used to and slows down blood flow to the brain

A

vascular

117
Q

_________ dementia is a mental disorder with the main feature of underlying vascular disease

A

Vascular

118
Q

_________ dementia is often present with AD and LBD

A

Vascular

119
Q

Some risk factors for VD?

A

Hypertension
hypercholesterol
smoking
DM

120
Q

With VD, brain damage results from ______ strokes

A

vascular

121
Q

VD can also be ____-_______ dementia, which is a result of multiple large or small infarcts that cause ________ ______

A

multi infarct
brain loss

122
Q

With VD, the first noted symptoms are:
they have a slow ________ speed, impaired _______, impaired ability to _______ ________ and plan

A

speed
judgement
make decisions

123
Q

slow ______ and poor _______ are associated with VD depending on where the ischemia occurred

A

slow gait
balance

124
Q

Which dementia is Parkinson’s in reverse?

A

LBD

125
Q

_______ _______: accumulated bits of alpha-synuclein proteins

A

Lewy Body

126
Q

LBD is similar to AD but instead patients have early _________ ________ and __________

A

sleep disturbances
hallucinations

127
Q

With LBD, they have more _______ and ________ type movement, along with __________ impairment

A

imbalance
Parkinson’s
visuospatial

128
Q

LBD is caused by the build up of _____ ______ inside the neurons in the cortex that controls ______ and ______ control

A

Lewy bodies
memory
motor

129
Q

Alpha-synuclein are also linked to _____ and ______ _______ atrophy

A

PD
multi system

130
Q

PD is marked by _______ symptoms
LBD is marked by _______ impairments 1st

A

motor
cognitive

131
Q

Frontotemporal Lobe Dementia is progressive _____ ______ ______ in the brain’s frontal and temporal lobes

A

nerve cell loss

132
Q

FTLD causes deterioration in ________, ________, _______, and alterations in ______ and ______ function

A

behavior, personality, language
motor, muscle

133
Q

What is the 2nd most common cause of dementia after AD?

A

FTLD

134
Q

With FTLD, people are less disoriented than AD but have more difficulty with _________ function and _______ solving

A

executive
problem

135
Q

Patients with FTLD usually have preserved _______ and _________ orientation

A

memory
spatial

136
Q

With FTLD, lack of _______ can be profound but have less trouble negotiating a _______ environment

A

insight
familiar

137
Q

What is the most common mental health disorder in adults 65 and older?

A

Depression

138
Q

These conditions are highly correlated with depression?

A

stroke
MS
cancer
chronic pain

139
Q

What are some signs of depression?

A

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

140
Q

The ______ _______ scale is a good tool to catch depression and those at risk

A

Geriatric Depression

141
Q

With depressive patients, you want to choose activities that are ______ and that they ______ !

A

engaging, enjoy

142
Q

S&S with depression can affect the rehab process which can affect…?

A

outcomes

NMSK I (9 decks)

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