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Neuro MSK > Dementia and Mvmt Disorders > Flashcards

Dementia and Mvmt Disorders Flashcards

1
Q

delirium sx

A

acute onset (over hours)
worse at night

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2
Q

what is a common medical condition that causes delirium?

A

organ failure
multi - young; one - older

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3
Q

what are some common drugs that cause delirium?

A

anticholinergic drugs
benzodiazepines
opiates
steroids
(also antihistamines, muscle relaxants, antibiotics)

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4
Q

what is the main treatment for delirium?

A

eliminate the underlying cause

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5
Q

how is normal aging different than dementia?

A

dementia interferes with normal IADLs

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6
Q

dementia is diagnosed by the presence of 2 of the following: impaired…

A
  • learning and short-term memory
  • handling of complex tasks
  • reasoning ability (abstract thinking)
  • spatial ability & orientation
    (constructional ability and agnosia)
  • language (aphasia)
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7
Q

what other factors must be present for dementia diagnosis?

A
  • significant impairment in social and occupational functioning
  • decline from previous level of function
  • not due to delirium or major psy illness
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8
Q

memory is mainly controlled by the ____ lobe

A

temporal

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9
Q

spatial awareness is mainly controlled by the ____ lobe

A

parietal

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10
Q

reasoning and complex tasks is mainly controlled by the ____ lobe

A

frontal

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11
Q

what is the triad of sx for normal pressure hydrocephalus?

A

memory problems
gait problems - magnetic
incontinence

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12
Q

what are cognitive assessments used to rule in or out dementia?

A

mini mental status exam (MMSE)
Montreal Cognitive Assessment (MOCA)
SLUMS exam
clock drawing
neuropsych tests (visual perception spatial function, executive function)

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13
Q

which test is harder: MMSE or MOCA?

A

MOCA

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14
Q

Alzheimer’s mainly effects _____ which leads to memory issues

A

hippocampus

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15
Q

which domains does clock drawing test assess?

A

visuospatial
executive
attention
memory

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16
Q

what are predictors of rapid progression in mild cognitive impairment (MCI)?

A

medial temporal lobe atrophy (MRI)
hypometabolic pattern (FDG-PET)

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17
Q

T/F: there is no drug effective for MCI

A

T

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18
Q

how does initial stage Alzheimer’s present?

A

short term memory loss
word finding difficulties
mild executive dysfunction
mild visuospatial deficits

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19
Q

how does later stage Alzheimer’s present?

A

all aspects of memory impaired
fluctuating behavioral changes
disturbed sleep and appetite
hallucinations

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20
Q

how does end stage Alzheimer’s present?

A

mute
aspiration risk
bed bound
incontinent

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21
Q

which lobe(s) does Alzheimer’s usually effect?

A

temporal and parietal
(memory & visuospatial)

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22
Q

what is the most common neurodegenerative disorder?

A

Alzheimer’s

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23
Q

early onset Alzheimer’s is when it occurs in _____ years old

A

<60

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24
Q

main theories of Alzheimer’s pathology (biomarkers)

A

neurofibillary tangles tau protein
senile plaques - amyloid

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25
Q

what is the lobe progression of Alzheimer’s?

A

hippocampus/temporal
parietal
frontal
global

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26
Q

what are the deficits in vascular dementia?

A

attention and concentration
(ex: remember words to recall with hints)

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27
Q

two main types of vascular dementia

A

multi-infarct
subcortical

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28
Q

which portions of the MOCA will vascular dementia pts have trouble with?

A

visuospatial
recall

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29
Q

cholinergic deficiency (in Alzheimer’s) results from degeneration of the

A

nucleus basalis of Meynert

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30
Q

which med is for more severe Alzheimer’s?

A

NMDA partial antagonist
(Memantine (Namenda))

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31
Q

meds for Alzheimer’s

A

cholinesterase inhibitor:
- donepezil (Aricept)
- galantamine (Razadyne)
- rivastigmine (Exelon)
antipsychotics
benzodiazepines

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32
Q

what meds are used to clear out amyloid for Alzheimer’s?

A

LECANEMAB (effective)
Aduhelm (no effect shown yet)

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33
Q

what is a concerning side effect of Lecanemab?

A

brain bleeding

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34
Q

when can Lecanemab be administered?

A

EARLY stage ONLY

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35
Q

Lewy Body dementia is involvement of ____ and ____ lobes

A

parietal and occipital
(not temporal like traditional)

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36
Q

what is a suspected if a person acts out their dreams and has Parkinsonism?

A

Lewy Body dementia

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37
Q

Lewy Body dementia probs

A

attention
executive function
visuospatial

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38
Q

which dementia has less memory issues?

A

Lewy Body dementia

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39
Q

Lewy Body dementia have 2 or more of …

A

fluctuations
recurrent visual hallucinations
spontaneous parkinsonism
REM sleep behavior disorder

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40
Q

meds of Lewy Body dementia

A

acetylcholinesterase inhibitor (rivastigmine) - hallucinations
levodopa-carbidopa - parkinsonism
antipsychotics (w/ caution)

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41
Q

which med should be avoided with Lewy Body dementia?

A

haldol (antipsychotic)

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42
Q

what is the 2nd most common cause of early onset dementia?

A

frontotemporal lobe degeneration (FTD)

43
Q

if a younger person (45-60) has signs of dementia, which type is suspected?

A

frontotemporal lobe degeneration (FTD)

44
Q

what is different about frontotemporal lobe degeneration (FTD)?

A

memory is OK
massive personality changes
pt thinks they’re fine

45
Q

50% of all frontotemporal lobe degeneration (FTD) is

A

behavioral variant (bcFTD)

46
Q

pathology of behavioral variant (bcFTD)

A

frontal and temporal lobe atrophy
NO amyloid collection
gradual onset of behavioral changes

47
Q

meds for behavioral variant (bcFTD)

A

antidepressants
antipsychotics
cholinesterase inhibitors (less effective)

48
Q

movement disorders are generally due to pathology of _____

A

basal ganglia (or cerebellum)

49
Q

movement disorders are unrelated to ____ and ____

A

weakness and spasticity

50
Q

extrapyramidal system main function

A

fine tuning

51
Q

extrapyramidal system components

A

susbstantia nigra
red nucleus
subthalamic nucleus

52
Q

difference between hypokinesia and bradykinesia

A

hypo - decreased amplitude (smaller mvmts)
brady - slower

53
Q

what is chorea?

A

ongoing RANDOM involuntary movements
(dance-like)

54
Q

what is a rhythmic oscillatory movement around an axis (predictable)?

A

tremor

55
Q

what prevents stable posture?

A

athetosis

56
Q

what is violent movement at a joint?

A

ballism

57
Q

what is dystonia?

A

involuntary SUSTAINED or intermittent contractions cause twisting/repetitive movements or abnormal postures

58
Q

what is repeated NON-RHYTHMIC BRIEF shock-like jerks?

A

myoclonus

59
Q

what is movement with an urge that is relieved with the movement?

A

tic

60
Q

what is repetitive simple movements that CAN BE SURPRESSED?

A

stereotypy

61
Q

postural tremor is revealed by _____ing a limb against gravity

A

extending

62
Q

type of tremor?
big handwriting
small handwriting

A

big - essential tremor
small - Parkinson’s

63
Q

essential tremor:
location
position
direction
frequency
amplitude

A

location: bilateral
position: action, posture
direction: flexion-extension
frequency: faster
amplitude: high or low

64
Q

Parkinson’s tremor
location
position
direction
frequency
amplitude

A

location: unilateral then bilaterla
position: rest
direction: pronation-supination
frequency: slower
amplitude: high or low

65
Q

meds for essential tremor

A

primidone (antiepileptic)
propranolol (beta-blocker)
topirimate (antiepileptic)

66
Q

location progression of essential tremor

A

hands –> head –> speech, chin, tongue, trunk, legs

67
Q

Parkinson’s has a loss of ___ cells in the ____

A

dopaminergic cells
substantia nigra

68
Q

what is the 2nd most common neurological disease?

A

Parkinson’s

69
Q

features of Parkinson’s

A

rest tremor
rigidity
bradykinesia
loss of postural reflexes
freezing
flexed posture of trunk, neck, & limbs

70
Q

meds for Parkinson’s

A

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)

71
Q

most common med for Parkinson’s

A

levodopa

72
Q

tx for advanced Parkinson’s that does not have side effects

A

deep brain stimulation

73
Q

at __% dopamine loss, motor symptoms begin

A

70%

74
Q

the toxic level of dopamine window ____ as Parkinson’s progresses

A

decreases

75
Q

surgical tx of Parkinson’s

A

thalamotomy (contra tremor & rigidity)
pallidotomy (tremor, rigidity, bradykinesia)
deep brain stimulation

76
Q

atypical parkinsonism disorders

A

Lewy Body Dementia
Progressive supranuclear palsy (PSP)
Corticobasal degeneration (CBD)
Multisystem atrophy (MSA)

77
Q

sx of Progressive supranuclear palsy (PSP)

A

inability to look up or down
axial rigidity
early falls (first sx)

78
Q

sx of Corticobasal degeneration (CBD)

A

alien limb/apraxia

79
Q

sx of Multisystem atrophy (MSA)

A

orthostatic hypotension
hyperreflexia

80
Q

which parkinsonism is known as lower body parkinsonism?

A

vascular parkinsonism

81
Q

MRI changes in vascular parkinsonism

A

extensive subcortical white matter ischemic disease

82
Q

main drugs that cause rest tremor

A

dopamine blocking (antipsychotics)
metoclopramide

83
Q

which chromosome is faulty with Huntington’s Disease?

A

4 (autosomal dominantly inherited)

84
Q

main neuronal loss in Huntington’s Disease is in the ___ and ____

A

caudate and putamen

85
Q

sx of Huntington’s Disease

A

personality changes
dementia
CHOREA
athetosis

86
Q

what is athetosis?

A

slow, nearly continuous writhing movements of the distal extremities

87
Q

what is the main tx for chorea?

A

tetrabenazine

88
Q

what is Wilson Disease?

A

treatable disease of copper metabolism
can present with tremor

89
Q

sx of Wilson Disease

A

behavioral and personality changes
dysarthria
ATAXIA
ABNORMAL MOVEMENTS
chorea, athetosis, tremor, rigidity

90
Q

tx for Wilson Disease

A

chelation with D-penicillamine

91
Q

Wilson Disease is common in what age group?

A

young (20-30s)

92
Q

dystonia is initiated or worsened with

A

voluntary movement

93
Q

what can help relieve dystonia?

A

sensory tricks - gentle touch to affected area

94
Q

what body parts does focal dystonia effect?

A

head, neck, or limb muscles

95
Q

focal dystonia age group
generalized dystonia age group

A

focal - adults
general - kids

96
Q

med for dystonia

A

botox

97
Q

dx requirements for Tourette Syndrome

A

> 1 motor tic
1 vocal tic
fluctuating course
present >1 year
onset must be before 21 yo

98
Q

Tourette Syndrome peaks during

A

puberty

99
Q

meds for Tourette Syndrome

A

neuroleptics (Haldol, pimozide)
clonidine

100
Q

what disorder is caused by a problem with the functioning of the NS not a structural issue?

A

Functional Neurological Disorder (FND)

101
Q

characteristics of epileptic seizures

A

open eyes
hypoventilation
lack of memory
1-2 min duration
GTC or tonic
sudden onset
unilateral shaking

102
Q

what helps suppress movement disorders?

A

distraction (esp. Parkinson’s)

103
Q

test used for discriminating weakness and movement disorders?

A

Hoover sign

Neuro MSK (15 decks)

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