Dementia and Tremor Flashcards
Resting Tremor
Occurs in body part that is relaxed and supported against gravity, enhanced by mental stress or movement of another body part (walking), and is diminished or alleviated by voluntary motion of the affected body part.
Action tremor
Postural- tremor with maintaining a position against gravity
Isometric- muscle contraction against a rigid stationary object (making a fist, holding a plank)
Kinetic tremor- associated with voluntary movement and includes intention tremor (produced with a target-directed movement)
Enhanced Physiologic Tremor
Everybody has this, low amplitude, high frequency bot at rest and during activity, usually noticed in times of stress, anxiety, use of medications, and with metabolic conditions (like hypoglycemia) Also common with caffeine over-consumption or fatigue
Essential Tremor
MOST COMMON pathological tremor
95% of these are kinetic and not postural
Most common in hands and feet but can affect voice, head, and LEs
Usually bilateral, interferes with activities, can be inherited, progresses with age
Caffeine and fatigue exacerbate the issue, while alcohol suppresses it
Parkinsonism
Clinical syndrome: classic pill-rolling tremor, 70% of patients have a resting tremor that can improve with action, bradykinesia, reduced arm swing, micrographia, difficulty rising from seated position
Causes of Parkinsonism
Various medications can cause Parkinsonism by blocking or depleting dopamine
Most common cause is idiopathy Parkinson Disease (prevalence of 1%)
Cerebellar Tremor (ataxia)
Low-frequency, slow-intension or postural tremor that is typically caused by multiple sclerosis with cerebellar plaques, stroke, or brainstem tumors
Psychogenic Tremors
Abrupt onset, spontaneous remission, changing characteristics (locations and frequency) and decrease or disappear with distraction
Often seen in employees of allied health professions, especially those in litigation
What history of obtain for tremor?
FHx of neuro disease or tremor? Onset? Gradual onset in elderly patient suggests PD. Sudden onset more likely psychogenic or in v rare circumstances, brain tumor
Patient complaints consistent with PD
Resting tremor, decreased sense of smell, sleep disturbance, subtle decrease in dexterity, decreased facial expression, depression, anhedonia, slowness in thinking, shuffling gait, and soft voice
Cognitive Domains Affected by Dementia
Complex Attention, Executive Function, Language, Learning and Memory, Preceptual-motor, Social Cognition
DSM-5 Major Diagnostic Criteria for Major and Minor Neurocognitive disorders
Major: Significant cognitive decline in at least 1 domain interfering with activities of daily living
Minor: Modest cognitive decline that does NOT interfere with daily living
History for suspected dementia?
Timeline of symptoms presentation and speed of progression (if sudden issue, more likely stroke or delirium), medication review (Beers criteria), risk factors for cardiometabolic issues? Infection?
Mini-cog test
Scoring?
Pt asked to repeat three unrelated words, perform a clock drawing test, then repeat the three words
Sensitivity is very high, specificity 54-85% for detecting cognitive impairment
Scoring: 1 point for each word remembered, 2 points for normal clock. Scores of 3, 4, or 5 indicates a lower likelihood of dementia, but doesn’t exclude some element of cognitive impairment
8-item Informant Questionairre
Screen for major and minor neurocognitive disorders
Sensitivity 85%, specificity 86%
Score of 2 or more “yes” answers indicates some cognitive impairment
What do you use to test the DEGREE of neurologic impairment?
Mini-Mental State Exam (MMSE), Montreal Cognitive Assessment (MOCA), and ST. Louis University Mental Status Examination
What test rules out psuedodementia?
Geriatric Depression Scale
What else do you do to rule out reversible causes of dementia?
Lab eval and Neuroimaging
