dementia/CP Flashcards
Dementia definition and progression
Loss of the ability to problem solve significant enough to affect the patient’s activities of daily living
Chronic slowly progressive loss of function
Alzheimer’s Disease is the most common cause making up about 75% of all dementias
Brain injury
Lewy body dementia
Vascular dementia
Non reversible causes of dementia
Alzheimer’s Disease is what % of all dementias
75%
Hypothyroidism Vitamin B12 deficiency Lyme disease Neurosyphilis Hydrocephalus
Reversible causes of dementia
dementia is 2 out of what spheres
language, memory, visuospatial skills, emotional behavior, personality, cognition
most significant risk factor for alzheimers
3 other factors
old age
other: FH, education level, female
alzheimers prevelance
doubles every 5 years in the older population.
reaching 30%-50% at age 85 yrs
what chromosomes for alzheimers
1, 14, 19, 21
alzheimers tx
Psychological Therapies Medication Acetylcholinesterase inhibitors – Donepezil(improve memory function and delay d/s progression) Antipsychotic drugs Antidepressants
improve memory function and delay d/s progression
Acetylcholinesterase inhibitors – Donepezil
multi-infarct dementia
- gender
- assoc with what
men
HTN with or w/out hx of TIA or stroke
vascular dementia symptoms
forgetfulness in the absence of depression and inattentiveness
speech difficulty, trouble performing routine tasks, sensory interpretation difficulty, confusion, amnesia, executive dysfunction
cortical symptoms of vascular dementia
gait problems, urinary difficulties, motor deficits, personality changes
subcortical symptoms of vascular dementia
syndrome secondary to degeneration of the frontal lobe and may include the temporal lobe
frontotemporal dementia
frontal lobe symptoms
behavioral- euphoria, apathy, dishibition; and
compulsive disorders
frontal release signs
palmomental, palmar grasp, rooting reflexes
MRI of frontotemporal dementia
atrophy to lobe in late cases
what other test for frontotemporal dementia
PET: show hypometabolism- to differentiate alzheimer from biparietal hypometabolism
seen with psychiatric illness who appear to be demented; seen with what illness
pseudodementia; seen with major depressive episode
complain of memory problems but attention span and concentration appear intact while appearing upset or distressed
pseudodementia
in true dementia… you see what
pt will often give wrong answers, have poor attention and concentration, and appear indifferent or unconcerned
pseudodementia tx
antidepressant with SSRI first line; no acetylcholinesterase inhibitors
Change in mental status Seizures Loss of bowel or bladder function Poor Balance Falling Difficulty walking Fainting Lightheadedness Weakness in the face, arms and legs
altered level of consciousness
Levels of consciousness Conscious Confused Delirious Somnolent Obtunded Stuporous Comatose
Levels of consciousness
Conscious – Normal
Confused – Disoriented / Impaired
Delirious – Disoriented, restless, hallucinations, and delusions may occur
Somnolent – Sleepy
Obtunded – Decreased alertness and slowed response
Stuporous –Respond only to severe pain
Comatose – Non-arousable, Non-responsive to stimuli
Levels of consciousness
– Normal
– Disoriented / Impaired
– Disoriented, restless, hallucinations, and delusions may occur
– Sleepy
– Decreased alertness and slowed response
–Respond only to severe pain
– Non-arousable, Non-responsive to stimuli
Levels of consciousness
Conscious – Normal
Confused – Disoriented / Impaired
Delirious – Disoriented, restless, hallucinations, and delusions may occur
Somnolent – Sleepy
Obtunded – Decreased alertness and slowed response
Stuporous –Respond only to severe pain
Comatose – Non-arousable, Non-responsive to stimuli
altered level of consciousness tx
Maintain patent airway and monitor circulatory status
Medications
Dextrose – for hypoglycemia
Naloxone
Thiamine
Lumbar puncture – if meningitis is suspected
Cerebral Palsy
- progressive?
- Evident when?
Cerebral Palsy
Things you should know
Lifelong physical disability due to damage of the developing brain. This is not progressive.
Evident in the first 12 to 18 months
- Risk Factors 4 CP
About 50% of CP patients are born premature
Low birth weight
Infection of the mother in early pregnancy
Prolonged loss of oxygen during the pregnancy or birthing process
Musculoskeletal CP
- muscle tone and control
- unable to hold what up
- 75% have what
- walk when
- talk when
- reflexs
Low muscle tone
Unable to hold head up
75% of patients present with spasticity and contractures. This is often found on one side of the body.
Poor muscle control
Unable to walk at 12 to 18 month
Language delay – Inability to speak simple sentences by 24 months
hyporeflexia
Physical Exam: Slow motor movement Tight or floppy muscle tone Contractures & spasticity Missed developmental milestones CT or MRI – may show what?
CP
CP in pregnancy
Preventative measures
Carry baby to term
Magnesium Sulphate – Is used to help prevent preterm labor
Medical treatment CP
Benzodiazepines -help with muscle spasms
Diazepam
Botulinum toxin type A injection – administered IM for muscles with spasticity
Antiepileptic medication – to minimize seizures
surgery for CP
Fasciotomy
Muscle lengthening
Joint replacement
What is the #1 risk factor for a child having CP?
Prematurity
