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Neuroconditions 2022 > Dementia and HD > Flashcards

Dementia and HD Flashcards

1
Q

What is dementia

A

cognitive impairment that affects the ability to think, remeber, and reason

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2
Q

what is dementia typically characterized by?

A

memory impairment, as well as difficulty in the domains fo language, motor activity, object recognition, and distrubance of executive function

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3
Q

What is executive function?

A

ability to plan, organize, and abstract

reasoning, problem solving, judgment and cognitive flexibility

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4
Q

What is memory cognitive domain ?

A

retain information and utilize it later for adaptive purposes

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5
Q

What is cognitve domain language ?

A

execute verbal function including spontaneous speeh, speech reptition and comprehension, naming, reading, writing

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6
Q

What is the cognitive domain visuospatial?

A

accurately perceive and understand the visual relationships between objects and space

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7
Q

What is cognitive domain attention

A

focus on specific piece of information for a sustained period of time while suppressing awaareness of other competing distractions

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8
Q

What are the signs and symptoms of dementia?

A

memory loss that disrupts daily life
challenges in planning or solving problems
difficulty completing familiar tasks
confusion with time or place
trouble understanding visual images and spatial relationships
new problems with words in speaking or writing
misplacing things, inability to retrace steps
decreased poor judegement
withdrawal from work or social activities
changesin mood and personality

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9
Q

What are the behavior and psychological symptoms of dementia?

A

aggression, agitation, apathy, deoression, dis-inhibition, mood lability, repetive questioning, sleep distrubances, socially inappropriate behaviors, wandering

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10
Q

What are the AD Risk factors?

A

genetics, hypertension, high cholesterol, dietary, cultural factors

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11
Q

What are AD protective factors?

A 
regular physical activity
fruits and vegetables
intellectually stimulation activites
leisure time physical activity at midlife is assoicated with a decreased risk of dementai and AD later in life
vitamin C, coenzyme Q10, and folate
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12
Q

What is the definition of delerium

A

acute onset, cognitive flucutuations over hours or days
impaired consciousness and attention
altered sleep cycles

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13
Q

What is the definition of cognitively impaired, no dementia (CIND)?

A

clinical syndrome with deficits in memory or other cognitive abilities that have minimal impact on day to day functioning and does not meet criteria for dementia

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14
Q

What is mild cognitive impairment (MCi)

A

clinical subsyndrome of CIND. Amnestic or nonamnestic

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15
Q

What is Alzheimer dementia

A

dementia syndrome that has gradual onset and slow progression and is best explained as caused by Alzheimer disease

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16
Q

What is Alzheimer disease?

A

brain disease characterized by plaques, tangles, and neuronal loss

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17
Q

What are the subcortical types of dementia?

A

dementia with Lewy bodies (DLB)

Huntington’s disease

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18
Q

What is dementia with lewy bodies (DLB(

A

Lewy body proteins are present in the brain stem, depleting dopamin, causing PD symptoms

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19
Q

What is Huntington’s disease

A

hereditary disorder that causes degeneration in the brain resulting in movement disorder and cognitive delcine

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20
Q

What are the cortical dementiates?

A 
Azheimers
vacular dementia
frontotemporal dementa
wernicke-Korsakofff's syndrome 
pugilistic dementia (CTE)
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21
Q

What is frontotemporal dementia?

A

degeneration of nerve cells in the frontal or temporal lobes of the brain
those with ALS typically develop this type in mid to late stage

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22
Q

What is vascular dementia

A

caused by stroke or partially blocked blood flow

2nd most common type

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23
Q

What defines Alzheimer’s dementia

A

neurofibrillary tangels and neuritic plaques with amyloid

60-80% of dementias

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24
Q

What is chronic traumatic encephalopathy (CTE)

A

progressive neuro degeneration caused by
history of repetitive hits to the head
length of exposure to head impacts
CTE can only be diagnosed after death through brain tissue analysis

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25
Q

How many people are diagnosed with MCI each year?

A

10-12%

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26
Q

How many times likely are AA to have Alzheimer’s as white americans?

A

twice as likey

27
Q

At what age is early onset AD?

A

prior to age 65, many in their 40s and 50s

28
Q

When was AD discovered?

A

1901

29
Q

What is the pathology of AD?

A

abnormal amounts of beta-amyloid are cleaved from the amyloid precurosr protein (APP) and released into the circulation
beta-amyloid fragments come together in clumps to form plaques that attach to the neuorn
microglia react to the plaque, and an inflammatory response results

30
Q

What are neurofibrillary tangles?

A

tau proteins provide structural suppport for the neuron microtubules.
chemical changes in the neuron produce structural changes in tau proteins
this results in twisting and tangling

31
Q

What is the symptom triad of normal pressure hydrocephalus (NPH)?

A

Difficulty walking
decline in thinking skills
loss of bladder control

32
Q

What is the mechanism for NPH?

A

excess CF accumulates in the brain’s ventricles
despite excess fluid, CSF pressure as measuresd during a spinal tap is often nronal
some benefits from shunt placement

33
Q

What are cholinesterarse inhibitors

A

acetrucholine– important brain neurotrans.– helps neurons communicate

Donepezil (Ariccept)
Rivastigmine (Exelon)
Galantamine (Reminyl)

34
Q

What is the total score and average score and AD score for the Montreal Cognitive Assessment (MOCA)

A

total score= 30
26-30 = normal
6.2= AD

35
Q

What are the ranges for the mini-mental state exam (MMSE)

A

total score= 30
20-24= mild dementia
13-19= moderate dementia
<13 severe dementia

36
Q

What is memantine medical intervention for AD?

A

helps with symptoms related to glutamate

blocks glutatmate and acts on the NMDA receptor

37
Q

What does the Huntington protein cause?

A

causes neuronal degeneration and eventual neuronal death
results in higher concentrations of dopamin and norepinephrine, disrupting the complex balance of excitation and inhibition between the thalamus and theBG for smooth, coordinated movement

38
Q

What does autosomal dominant trat mean?

A

everyone who inherits the genetic mutation will develop the disease
if parent has mutation, there is a 50/50 chance
number of CAG repears ais a more sophisticated measure of risk

39
Q

What is CAG repeat and what is normal

A

DNA nucleotide triplet of Cytosine, Adenine, Guanine (CAG)
normal number of repeats is <26
27-35– will not develop HD but will pass risk to children
36-39, some will develop HD
40+ all will develop HD and children will have a 50% risk
>50 repeats –juvenile onset

40
Q

How do you diagnose HD?

A 
histroy 
clinical signs: movement, cogntive, psychiatric 
postive family history 
imaging 
genetic testing
41
Q

What areas of the brain are most affected in HD?

A

cerebral cortex and basal ganglia
cortical pyramidal nneurons from motor and premotor areas
indirect pathway is affected earlier in the disease, causing chorea and involuntary movements
direct pathway is affected later in the disease and causes rigidity and bradykinesia
striatonigral pathways are affecte later in the disease

42
Q

What are the motor symptoms for adult onset HD?

A

choreiform movements
apraxia
cerebellar signs: ataxic gait, decreased force control
motor impersistene– inability to maintain a constant vountray contraction – results in dropping object, incomplete chewing, inconsistent driving speeds
dystonia– mainfests as arm elevation while walking, tilting of trunk, internal shoulder rotation, sustained fist clenching, excessive knee flexion, foot PF and INV

43
Q

What are the cognitive/behavioral symptoms for adult onset HD?

A 
decreased judgement 
loss of meomory 
deterioration of speech and writing 
depression 
hostility 
feelings of incompetence
decrease in IQ
changes in social behavior
44
Q

What are the juvenile onset differences from adult HD

A

initail more sever cog-beh problems
gait difficulty
speech and swallow problems
choreiform movements
rigidity soone
seizures– myocloinc type in 25% of children
later stages– ataxia and other cerebellar signs, severs dystonia

45
Q

What is the most common psychiatric condition for HD

A

depression
25% of patients attempt suicide once
6% of deaths

46
Q

What is the prognosis for disease life span for HD

A

15-20 years after onset of symptoms

47
Q

What are the pharmaclogical treatments for HD

A

dopamine antagonists decrease chorea – slows movement

antisense oligonucleotide is disease modifying – reduces Huntington messenger RNA

anticonvulsants, antipsychotics, antidepressants for symptom management

48
Q

What is chronic tardive dyskinesia

A

involuntary movements of face, tongue, lips

49
Q

What is Unifed Huntington’s disease rating scale (UHDRS)

A 
1. motor assessment 
2 cognitive assessment 
3 behavioral
4 independence scale 
5 functional assessment 
6 total functional capacity
50
Q

What defines the early stage of HD

A

stage 1: able to perform ADLS, live at home, work

stage 2: able to perform ADLs, live at home, work at lower level, needs assistance for finances

51
Q

What defines the middle stage of HD

A

stage 3: needs minA for ADLs, cannot do IADLs, unable to work, can live at home with support

52
Q

What defines the late stae of HD

A

Stage 4: needs MODA, may live in care facility

stage 5: needs maxA for ADLs, likely total care facility

53
Q

What are common abnormalities in eye movements in HD

A

Saccades: decreased velocity, undershooting of target, latency in initiation of movement
gaze fixation abnormalities
visual tracking has saccadic tracking of smooth pursuit
visual distractibility

54
Q

What can falls be attritbuted to in 30% of people with AD?

A

lack of perception of where their bodies are in space and their inability to move around objects

55
Q

> What does the GEMS: brain change model focus on

A

rather than focusing on person’s loss when there is brain change, seeing individuals as persons, unique, and capable encourages a care partnership and is cor of this model

56
Q

What does saphire GEM stand for

A

not experiencing dementia

57
Q

What does diamonds stand for

A

Clear, sharp, rigid, inflexible and likes a habited routin

58
Q

What does emerald GEM

A

not clear and shar
direction and tim frame is off
think they are fin
increased mistakes

59
Q

What does Amber

A

caught in a moment of time, no caution, no safety, inconsistenct behavior
low high sensory needs

60
Q

What does Ruby stand for

A

no fine motor, but gross strength is still there

61
Q

What does pearl stand for

A

lose gross motor, ruled by reflexes

62
Q

What doe sphysical activity do for dementia?

A

at least twice per week is associated with reduced risk of dementia
physical activity may alter Tau accumulation, synaptic function and number, restore neurogenesis, increase neurotrophin levels, positively alter inflammation and immunity, affect circadian rhyths, and improve cognition in those with AD

63
Q

What is a behavioral strategy for those with dementia?

A

redirection

validation

64
Q

What are the four Ps of PT managment

A

prevention
predcition
plasticity
participation

Neuroconditions 2022 (14 decks)

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