Dementia and Mvmt Disorders Flashcards
delirium sx
acute onset (over hours)
worse at night
what is a common medical condition that causes delirium?
organ failure
multi - young; one - older
what are some common drugs that cause delirium?
anticholinergic drugs
benzodiazepines
opiates
steroids
(also antihistamines, muscle relaxants, antibiotics)
what is the main treatment for delirium?
eliminate the underlying cause
how is normal aging different than dementia?
dementia interferes with normal IADLs
dementia is diagnosed by the presence of 2 of the following: impaired…
- learning and short-term memory
- handling of complex tasks
- reasoning ability (abstract thinking)
- spatial ability & orientation
(constructional ability and agnosia) - language (aphasia)
what other factors must be present for dementia diagnosis?
- significant impairment in social and occupational functioning
- decline from previous level of function
- not due to delirium or major psy illness
memory is mainly controlled by the ____ lobe
temporal
spatial awareness is mainly controlled by the ____ lobe
parietal
reasoning and complex tasks is mainly controlled by the ____ lobe
frontal
what is the triad of sx for normal pressure hydrocephalus?
memory problems
gait problems - magnetic
incontinence
what are cognitive assessments used to rule in or out dementia?
mini mental status exam (MMSE)
Montreal Cognitive Assessment (MOCA)
SLUMS exam
clock drawing
neuropsych tests (visual perception spatial function, executive function)
which test is harder: MMSE or MOCA?
MOCA
Alzheimer’s mainly effects _____ which leads to memory issues
hippocampus
which domains does clock drawing test assess?
visuospatial
executive
attention
memory
what are predictors of rapid progression in mild cognitive impairment (MCI)?
medial temporal lobe atrophy (MRI)
hypometabolic pattern (FDG-PET)
T/F: there is no drug effective for MCI
T
how does initial stage Alzheimer’s present?
short term memory loss
word finding difficulties
mild executive dysfunction
mild visuospatial deficits
how does later stage Alzheimer’s present?
all aspects of memory impaired
fluctuating behavioral changes
disturbed sleep and appetite
hallucinations
how does end stage Alzheimer’s present?
mute
aspiration risk
bed bound
incontinent
which lobe(s) does Alzheimer’s usually effect?
temporal and parietal
(memory & visuospatial)
what is the most common neurodegenerative disorder?
Alzheimer’s
early onset Alzheimer’s is when it occurs in _____ years old
<60
main theories of Alzheimer’s pathology (biomarkers)
neurofibillary tangles tau protein
senile plaques - amyloid
what is the lobe progression of Alzheimer’s?
hippocampus/temporal
parietal
frontal
global
what are the deficits in vascular dementia?
attention and concentration
(ex: remember words to recall with hints)
two main types of vascular dementia
multi-infarct
subcortical
which portions of the MOCA will vascular dementia pts have trouble with?
visuospatial
recall
cholinergic deficiency (in Alzheimer’s) results from degeneration of the
nucleus basalis of Meynert
which med is for more severe Alzheimer’s?
NMDA partial antagonist
(Memantine (Namenda))
meds for Alzheimer’s
cholinesterase inhibitor:
- donepezil (Aricept)
- galantamine (Razadyne)
- rivastigmine (Exelon)
antipsychotics
benzodiazepines
what meds are used to clear out amyloid for Alzheimer’s?
LECANEMAB (effective)
Aduhelm (no effect shown yet)
what is a concerning side effect of Lecanemab?
brain bleeding
when can Lecanemab be administered?
EARLY stage ONLY
Lewy Body dementia is involvement of ____ and ____ lobes
parietal and occipital
(not temporal like traditional)
what is a suspected if a person acts out their dreams and has Parkinsonism?
Lewy Body dementia
Lewy Body dementia probs
attention
executive function
visuospatial
which dementia has less memory issues?
Lewy Body dementia
Lewy Body dementia have 2 or more of …
fluctuations
recurrent visual hallucinations
spontaneous parkinsonism
REM sleep behavior disorder
meds of Lewy Body dementia
acetylcholinesterase inhibitor (rivastigmine) - hallucinations
levodopa-carbidopa - parkinsonism
antipsychotics (w/ caution)
which med should be avoided with Lewy Body dementia?
haldol (antipsychotic)
what is the 2nd most common cause of early onset dementia?
frontotemporal lobe degeneration (FTD)
if a younger person (45-60) has signs of dementia, which type is suspected?
frontotemporal lobe degeneration (FTD)
what is different about frontotemporal lobe degeneration (FTD)?
memory is OK
massive personality changes
pt thinks they’re fine
50% of all frontotemporal lobe degeneration (FTD) is
behavioral variant (bcFTD)
pathology of behavioral variant (bcFTD)
frontal and temporal lobe atrophy
NO amyloid collection
gradual onset of behavioral changes
meds for behavioral variant (bcFTD)
antidepressants
antipsychotics
cholinesterase inhibitors (less effective)
movement disorders are generally due to pathology of _____
basal ganglia (or cerebellum)
movement disorders are unrelated to ____ and ____
weakness and spasticity
extrapyramidal system main function
fine tuning
extrapyramidal system components
susbstantia nigra
red nucleus
subthalamic nucleus
difference between hypokinesia and bradykinesia
hypo - decreased amplitude (smaller mvmts)
brady - slower
what is chorea?
ongoing RANDOM involuntary movements
(dance-like)
what is a rhythmic oscillatory movement around an axis (predictable)?
tremor
what prevents stable posture?
athetosis
what is violent movement at a joint?
ballism
what is dystonia?
involuntary SUSTAINED or intermittent contractions cause twisting/repetitive movements or abnormal postures
what is repeated NON-RHYTHMIC BRIEF shock-like jerks?
myoclonus
what is movement with an urge that is relieved with the movement?
tic
what is repetitive simple movements that CAN BE SURPRESSED?
stereotypy
postural tremor is revealed by _____ing a limb against gravity
extending
type of tremor?
big handwriting
small handwriting
big - essential tremor
small - Parkinson’s
essential tremor:
location
position
direction
frequency
amplitude
location: bilateral
position: action, posture
direction: flexion-extension
frequency: faster
amplitude: high or low
Parkinson’s tremor
location
position
direction
frequency
amplitude
location: unilateral then bilaterla
position: rest
direction: pronation-supination
frequency: slower
amplitude: high or low
meds for essential tremor
primidone (antiepileptic)
propranolol (beta-blocker)
topirimate (antiepileptic)
location progression of essential tremor
hands –> head –> speech, chin, tongue, trunk, legs
Parkinson’s has a loss of ___ cells in the ____
dopaminergic cells
substantia nigra
what is the 2nd most common neurological disease?
Parkinson’s
features of Parkinson’s
rest tremor
rigidity
bradykinesia
loss of postural reflexes
freezing
flexed posture of trunk, neck, & limbs
meds for Parkinson’s
levodopa (motor)
dopamine agonist (motor)
COMT inhibitor (advanced Parkinson’s)
MAO inhibitor (advanced Parkinson’s)
anticholinergics (tremor)
amantadine (dyskinesias)
deep brain stimulation (advanced Parkinson’s)
most common med for Parkinson’s
levodopa
tx for advanced Parkinson’s that does not have side effects
deep brain stimulation
at __% dopamine loss, motor symptoms begin
70%
the toxic level of dopamine window ____ as Parkinson’s progresses
decreases
surgical tx of Parkinson’s
thalamotomy (contra tremor & rigidity)
pallidotomy (tremor, rigidity, bradykinesia)
deep brain stimulation
atypical parkinsonism disorders
Lewy Body Dementia
Progressive supranuclear palsy (PSP)
Corticobasal degeneration (CBD)
Multisystem atrophy (MSA)
sx of Progressive supranuclear palsy (PSP)
inability to look up or down
axial rigidity
early falls (first sx)
sx of Corticobasal degeneration (CBD)
alien limb/apraxia
sx of Multisystem atrophy (MSA)
orthostatic hypotension
hyperreflexia
which parkinsonism is known as lower body parkinsonism?
vascular parkinsonism
MRI changes in vascular parkinsonism
extensive subcortical white matter ischemic disease
main drugs that cause rest tremor
dopamine blocking (antipsychotics)
metoclopramide
which chromosome is faulty with Huntington’s Disease?
4 (autosomal dominantly inherited)
main neuronal loss in Huntington’s Disease is in the ___ and ____
caudate and putamen
sx of Huntington’s Disease
personality changes
dementia
CHOREA
athetosis
what is athetosis?
slow, nearly continuous writhing movements of the distal extremities
what is the main tx for chorea?
tetrabenazine
what is Wilson Disease?
treatable disease of copper metabolism
can present with tremor
sx of Wilson Disease
behavioral and personality changes
dysarthria
ATAXIA
ABNORMAL MOVEMENTS
chorea, athetosis, tremor, rigidity
tx for Wilson Disease
chelation with D-penicillamine
Wilson Disease is common in what age group?
young (20-30s)
dystonia is initiated or worsened with
voluntary movement
what can help relieve dystonia?
sensory tricks - gentle touch to affected area
what body parts does focal dystonia effect?
head, neck, or limb muscles
focal dystonia age group
generalized dystonia age group
focal - adults
general - kids
med for dystonia
botox
dx requirements for Tourette Syndrome
> 1 motor tic
1 vocal tic
fluctuating course
present >1 year
onset must be before 21 yo
Tourette Syndrome peaks during
puberty
meds for Tourette Syndrome
neuroleptics (Haldol, pimozide)
clonidine
what disorder is caused by a problem with the functioning of the NS not a structural issue?
Functional Neurological Disorder (FND)
characteristics of epileptic seizures
open eyes
hypoventilation
lack of memory
1-2 min duration
GTC or tonic
sudden onset
unilateral shaking
what helps suppress movement disorders?
distraction (esp. Parkinson’s)
test used for discriminating weakness and movement disorders?
Hoover sign
