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Neuromuscular > Dementia & Mmt Disorders > Flashcards

Dementia & Mmt Disorders Flashcards

1
Q

Cognitive Screens for Dementia

A

-mini mental status exam
-Montreal cognitive assessment
-referral of neurophysiological testing

Benefits:
-cueing, instructions, education, documentation

Limitations:
-can be demeaning, only a screen

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2
Q

Outcome Measures for Dementia

A

-TUG
-QoL
-Depression
-Anxiety
-caregiver burden
-Berg
-6MWT

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3
Q

Test Selection: Dementia

A

-should be obvious
-short instructions
-short duration

Tips:
-clear speech
-friendly facial expressions
-eye contact
-remove distractions

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4
Q

Aerobic Ex for Dementia

A

-lessens cognitive impairments and dementia risk
-neuroprotective
-reduces agitation
-moderations brain atrophy

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5
Q

Strength Training Recommendations @ Old Age

A

-2x week major muscle groups
-mod to high intensity

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6
Q

Balance Training @ Old Age

A

-3x week
-fall rpevention

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7
Q

Home Exercise Program (Dementia)

A

-practice
-clear language
-big print
-increase self efficacy

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8
Q

Maintaining Personhood

A

-person’s growth in coping skills
-focus on independence
-subjective experience of illness

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9
Q

Remaining Cognitive Strengths

A

-reading simple words
-emotional and procedural memory
-L/R orientation

tie in to movement/exercise

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10
Q

LEAD Rehabilitation Framework

A

Leveraging
Existing
Abilities In
Dementia

-developing an underlying knowledge
-integrate communication, cognition, coping

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11
Q

Communication Strategies

A

-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

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12
Q

Cognition/Education Strategies

A

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

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13
Q

ABLED

A

-accessible: easily seen
-bright
-legible: large
-explicit: simple
-done: able to cross off

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14
Q

Coping Strategies

A

Reframing
-changing thinking and descalating

Re-Evaluating Expectation
-reasonable goals to the person

Substituting Behaviors
-replacing undesirable behaviors with others

Adjusting the Environment

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15
Q

Pearls of Wisdom

A

-patient centered care
-Match patient and appropriate clinician
-Have back up plans
-know how much communication
-be creative

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16
Q

Delirium

A

-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

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17
Q

Dementia

A

-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

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18
Q

Normal Pressure Hydrocephalus

A

-memory problems, gait (magnetic), incontinence

Imaging: large ventricles

Treatment: VP shunt

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19
Q

Evaluation of Dementia

A

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)

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20
Q

Mild Cognitive Impairement

A

-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)

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21
Q

Alzheimer Disease

A

-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

22
Q

Alzheimer Cause

A

-brain atrophy (temporal and parietal MC) with neuron loss
-Neurofibrilary tangle tau protein and Senile plaques from amyloid beta protein

23
Q

Vascular Dementia

A

-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

24
Q

Alzheimer’s Treatment

A

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

25
Q

Parkinson’s Dementia

A

-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

26
Q

Frontotemporal Lobe Degeneration

A

-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

27
Q

Movement Disorders

A

-neurological syndromes with excess of movement
-basal ganglia
-no weakness or spasticity
-sudden onset
-Entrainment: sync up
-improves with distraction (parkinsons)

28
Q

Pyramidal System

A

-Cortex
-internal capsule
-brainstem
-medullary pyramids
-corticospinal tractts
-anterior horn of SC

29
Q

Extrapyramidal System

A

-fine tuning motor control
-basal ganglia
-substantia nigra
-red nuc
-subthalamic nuc

30
Q

Dyskinesia

A

-abnormal mmt

31
Q

Akinesia

A

-loss of mmt

32
Q

Tremor

A

-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

33
Q

Chorea

A

-random involuntary mmt
-can be incorporated into mmt
-dance-like

34
Q

Athetosis

A

-prevents stable posture
-slow writhing mmts

35
Q

Ballism

A

-more violent mmt at a joint
-proximal

36
Q

Dystonia

A

-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

37
Q

Myoclonus

A

-repeated non rhythmic breif shock like jerks
-everyone has

38
Q

Tic

A

-mmt with an urge that is relieved by mmt (feel urge)
-brief rapid mmt/sound
-can be supressed

39
Q

Stereotypy

A

-repetitive simple mmt that can be supressed
Ex: restless leg

40
Q

Parkinsonian Tremor

A

-unilateral to bilateral
-hands/leg/chin
-rest
-pronation to supination
-slower

41
Q

Essential Tremor

A

-bilateral
-fast (5-8hz)
-flx/ext
-large writing
-slow progression
-hands>head>speech

42
Q

Parkinson Disease

A

-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

43
Q

Progressive Supranuclear Palsy

A

-Atypical parkinsonism disorder
-inability to look up or down
-axial rigidity
-early falls

44
Q

Corticobasal Degeneration

A

-alien limb
-ataxia

45
Q

Multisystem Atrophy

A

-ortho hypo
-hyperreflexia

46
Q

Vascular Parkinsonism

A

-lower body parkinsonism
-normal UE
-extensive subcortical white mattter ischemic disease
-step deterioration

47
Q

Huntington Disease

A

-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

48
Q

Wilson Disease

A

-treatable/ auto recessive
-copper metabolism issues
-tremor

S/s:
-behavior
-dysarthria
-ataxia
-abnormal mmts
-liver cirrhosis

Tx:
-chelation with penicillamine

49
Q

Toruette Syndrome

A

-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

50
Q

Functional Neurological Disorders

A

-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

Neuromuscular (21 decks)

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