Dementia & Mmt Disorders Flashcards
Cognitive Screens for Dementia
-mini mental status exam
-Montreal cognitive assessment
-referral of neurophysiological testing
Benefits:
-cueing, instructions, education, documentation
Limitations:
-can be demeaning, only a screen
Outcome Measures for Dementia
-TUG
-QoL
-Depression
-Anxiety
-caregiver burden
-Berg
-6MWT
Test Selection: Dementia
-should be obvious
-short instructions
-short duration
Tips:
-clear speech
-friendly facial expressions
-eye contact
-remove distractions
Aerobic Ex for Dementia
-lessens cognitive impairments and dementia risk
-neuroprotective
-reduces agitation
-moderations brain atrophy
Strength Training Recommendations @ Old Age
-2x week major muscle groups
-mod to high intensity
Balance Training @ Old Age
-3x week
-fall rpevention
Home Exercise Program (Dementia)
-practice
-clear language
-big print
-increase self efficacy
Maintaining Personhood
-person’s growth in coping skills
-focus on independence
-subjective experience of illness
Remaining Cognitive Strengths
-reading simple words
-emotional and procedural memory
-L/R orientation
tie in to movement/exercise
LEAD Rehabilitation Framework
Leveraging
Existing
Abilities In
Dementia
-developing an underlying knowledge
-integrate communication, cognition, coping
Communication Strategies
-approach from front on their level
-remove distractions
-eye contact
-smiling
-explain
-invite to participate; allow to time to respond w/ repetition
-K.I.S.S: keep it short and simple
-ask questions based on currrent, not short term memory
-cues
-narrow choices
Cognition/Education Strategies
Errorless learning
-with feedback
Modeling
- to utilize procedural memory (motor tasks, for language deficits)
Spaced Retreval
-builds on implicit or procedural memory
-retaining info by recalling
-learining without intention
External Memory Aids
-ABLED
-memory books
-planners/signs/calendars
Cognitive Task Analysis
-breaking down a task into simplest cognitive components
ABLED
-accessible: easily seen
-bright
-legible: large
-explicit: simple
-done: able to cross off
Coping Strategies
Reframing
-changing thinking and descalating
Re-Evaluating Expectation
-reasonable goals to the person
Substituting Behaviors
-replacing undesirable behaviors with others
Adjusting the Environment
Pearls of Wisdom
-patient centered care
-Match patient and appropriate clinician
-Have back up plans
-know how much communication
-be creative
Delirium
-acute confusional state
-short period of time
-worse at night
-80% of elderly in ICU
-15-50% of all hostpital pts
S/s:
-disrupted sleep
-disordered thinking
-delusion
-hallucinations
-restlessness
Causes:
-vascular
-Trauma/surgery
-Metabolic/infection
-Tumors/seizures
-Drugs
Treatment:
-reoreintation
-out of bed
-less noise at night
-solve underlying issues
Dementia
-progressive loss of congitive functions that interfere activites
S/s;
-Impaired learning and memoy (temporal)
-impaired complex tasking and reasoning (frontal)
-impaired orientation (pareital)
-aphasia (temportal and parietal)
-changes in social
-decline from previous
Causes:
-alzheimers
-vascular
-parkinsons
-huntingtons
-alcohol
-CTE
-HIV/infections
-Meds
Normal Pressure Hydrocephalus
-memory problems, gait (magnetic), incontinence
Imaging: large ventricles
Treatment: VP shunt
Evaluation of Dementia
HX:
-impairement
-onset
-progression
-prior level of function
Exam:
-observstion
-mental status
-neuro
Labs:
-HIV/syphilis
-thyroid/liver/kidney
-B12/folate
-Lupus test
Imaging:
-MRI
-PET/Amyloid PET (ARIA-E)
Mild Cognitive Impairement
-pre dementia
-impairement in 1 or more domain w/o dementia or ADL involvement
-12-18% of ppl >60
Predicitors:
-medial lobe attrophy
Tx:
-exercise (no drugs)
Alzheimer Disease
-progressive cognitive, fucntiona behavior deficits
-MC neurodegenerative disorder
-6th MC cause of death in USA
-70% of dementia
S/s:
Early: short term mem loss, word finding difficulties, mild deficits of executive funtion
Later: all memory inpaired, behavior, sleep, appetite
End: mute, aspiration, bed bound, incontinent
RK:
-woman
-genertics
-education
-head trauma
-health
Alzheimer Cause
-brain atrophy (temporal and parietal MC) with neuron loss
-Neurofibrilary tangle tau protein and Senile plaques from amyloid beta protein
Vascular Dementia
-more issues with executive function, attention and recall
Multi-infarct Dementia:
-progressive
-step wise; stable then multiple strokes decline memory
-asymmetrical
Diffuse White Matter Disease:
-chronic/progressive
-global
Subcortical:
-attention and concentration decline with psychomotor slowing
Alzheimer’s Treatment
Cholingeric deficiency:
-results from degeneration fo Nucleus Basalis of Meynert
-inhibitors slow progression a little
Amyloid:
-aducanunab/lecanemab makes antibodies to clear out amyloid in the brain
-slows decline by 27%
-must get it early/expensive/bleeding
Parkinson’s Dementia
-Lewy Body Dementia
-15-30% of dementia
Dementia:
-before parkinsons
-attention/executive/memory
2+:
-fluctuations
-visual hallucinations
-spontaneous parkinsons
-REM sleep behavior disorder (night terrors)
Suggestive Features:
-neuroleptic sensitivity
Supportive Features:
-falls/syncope
-autonomic dysfunction
-hallucinations
-depression
-perserved medial temporal lobe
Tx:
-Rivastigmine for hallucinations
-Levodopa-Carbidopa for motor parkinsons
-Haldol Avoided for increase deterioration
Frontotemporal Lobe Degeneration
-2nd MC cuase of early onset dementia
-45-64yr old
-aren’t aware they have a problem (unlike alzheimer’s)
Subtypes:
-Behavioral variant: 50%, atrophy in frontal and temporal; tau; disinhibition/loss of empathy/apathy/increased sex drive
-Primary progressive aphasia
-Motor neuron disease
Movement Disorders
-neurological syndromes with excess of movement
-basal ganglia
-no weakness or spasticity
-sudden onset
-Entrainment: sync up
-improves with distraction (parkinsons)
Pyramidal System
-Cortex
-internal capsule
-brainstem
-medullary pyramids
-corticospinal tractts
-anterior horn of SC
Extrapyramidal System
-fine tuning motor control
-basal ganglia
-substantia nigra
-red nuc
-subthalamic nuc
Dyskinesia
-abnormal mmt
Akinesia
-loss of mmt
Tremor
-rhythmic oscillatory mmt around an axis
-predictable contractions
-Resting
-Postural: reveal by extending limb against grav
-Intention: moving a limb tto and from a target
Chorea
-random involuntary mmt
-can be incorporated into mmt
-dance-like
Athetosis
-prevents stable posture
-slow writhing mmts
Ballism
-more violent mmt at a joint
-proximal
Dystonia
-involuntary sustained or intermittent contractions cause abnormal postures and mmts
-worsened by voluntary mmt
-head, neck, limbs
ex: torticolis, club foot
Tx:
-sensory tricks with gentle touch
-botox
-contracture prevention
Myoclonus
-repeated non rhythmic breif shock like jerks
-everyone has
Tic
-mmt with an urge that is relieved by mmt (feel urge)
-brief rapid mmt/sound
-can be supressed
Stereotypy
-repetitive simple mmt that can be supressed
Ex: restless leg
Parkinsonian Tremor
-unilateral to bilateral
-hands/leg/chin
-rest
-pronation to supination
-slower
Essential Tremor
-bilateral
-fast (5-8hz)
-flx/ext
-large writing
-slow progression
-hands>head>speech
Parkinson Disease
-progressive, loss of dopaminergic cells within substantia nigra
-2nd MC neurodegenerative disease
-5th and 6th decades
S/s:
-Masked face
-Bradykinesia: decreased blink, soft speech, loss of inflection, small writing, shuffling
-Stooped posture
-Rigidity: cog wheeling
-Rest tremor: pill rolling/slower
-loss of reflexes
-freezing
-Flexed posture
Tx:
-Meds
-Deep brain stimulation
-Thalamotomy: improves contra tremor, rigidity
-Pallidotomy: globis palladis; improves tremor, bradykinesia, rigidity
Progressive Supranuclear Palsy
-Atypical parkinsonism disorder
-inability to look up or down
-axial rigidity
-early falls
Corticobasal Degeneration
-alien limb
-ataxia
Multisystem Atrophy
-ortho hypo
-hyperreflexia
Vascular Parkinsonism
-lower body parkinsonism
-normal UE
-extensive subcortical white mattter ischemic disease
-step deterioration
Huntington Disease
-autodomal dom, chrom 4
-35-42
-lifespan after diagnosis 17y
-neuronal loss in the caudate and putamen
S/s:
-personality/dementia
-chorea
-athetosis: slow continuous writhing movements of distal extremities
-enlarge lat venticles
Tx:
-Tetrabenazine: depletes dopamine
Wilson Disease
-treatable/ auto recessive
-copper metabolism issues
-tremor
S/s:
-behavior
-dysarthria
-ataxia
-abnormal mmts
-liver cirrhosis
Tx:
-chelation with penicillamine
Toruette Syndrome
-genetic disorder; auto dom
-ass with OCD and ADHD 50%
Dx:
->1 motor tic
-1 vocal tic
-flucuating
->1 yr
-beore 21yrs
Tx:
-haldol, clonidine
Functional Neurological Disorders
-15-30% referrals to neuro
-neuro s/s caused by problem in NS, not due to damage
-must explain it is real
Dx:
-no inattention tremor (goes away)
-might be psychological
