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NEUROMUSCULAR > lecture 7: dementia and movenet disorders > Flashcards

lecture 7: dementia and movenet disorders Flashcards

1
Q

what is delirium

A

actue confusion state

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2
Q

what is the progressive loss of cognitive functions which interfere with work or usual social activities

A

dementia

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3
Q

what is an onset over a short period of time (typically over hours ) , worse at nights and has associated features of

– Disrupted sleep wake cycle
– Disorganized thinking
– Inattention
– Drowsiness
– Restlessness/agitation/combativeness – Delusions
– Hallucinations

A

delirium

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4
Q

is delirium or dementia common in the hospital

A

delirium

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5
Q

what drugs can causes ddelirum

A

-anticholinergic
-benzo
-opiates
-steroids

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6
Q

what is the treatment for delirium

A

-eliminate the cause
- frequent re orientation with white boards w th days date and schedule
- out of bed during the day w blinds open
-reduce noise at night

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7
Q

An 83-year-old man was evaluated for 2 years of progressive cognitive decline. He reported increasing problems remembering the names of distant acquaintances, thinking of words, and learning to use new devices. He started keeping a detailed to-do list and daily calendar because he had missed several medical appointments. His wife agreed that he had become more forgetful in the previous 2 years and commented that he now repeated himself in daily conversations. He remained active in local community organizations and was fully independent with all instrumental activities of daily living. His medical history was notable for well-controlled hypertension. He had been taking diphenhydramine at bedtime for many years for insomnia

would u think dementia ??

A

no just normla aging

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8
Q

• Decrease in attention span and ability to learn new information with age.
• Mild and do not affect normal IADLs

what does this describe

A

normla aging

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9
Q

Dementia?
A 73-year-old woman presented for evaluation of 3 years of progressive memory loss. Her husband reported that she frequently misplaced personal items, forgot passwords, and repeated the same questions. She had trouble locating her car in the parking lot and had been late paying bills. She had difficulty completing tasks and recently seemed overwhelmed when trying to plan travel for a vacation. She had shown less interest in previous hobbies but did not report low mood. She denied motor problems or disruption of sleep. Her husband had taken over managing finances and bill paying and had to remind her to take her medications. She was otherwise independent with day-to-day function

A

yes bc decline in PLOF

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10
Q

what is dementia based on

A

history and mental status exam

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11
Q

dementia is characterized by the presence of at 2 least of the following

A

-impaired learn and short term memory
- impaired handing complex task
- imparied reasoning ability
-impaired spatial ability and orientation
-impaired language

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12
Q

dementia is Based on history and mental status exam, dementia characterized by presence of at least 2 of following:
– Impaired learning and short-term memory
– Impaired handling of complex tasks
– Impaired reasoning ability (abstract thinking)
– Impaired spatial ability and orientation (constructional ability and agnosia)
– Impaired language (aphasia’

what lobes are these in

A
  • Impaired learning and short-term memory (TEMP)
    – Impaired handling of complex tasks (FRONT)
    – Impaired reasoning ability (abstract thinking) (FRONT)
    – Impaired spatial ability and orientation (PART)(constructional ability and agnosia)
    – Impaired language (aphasia(TEMP/PAR)
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13
Q

does dementia have a decline from PLLOF

A

yes

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14
Q

• Alzheimerdisease
• DementiawithLewy
Bodies
• Frontotemoral Dementia
• Vascular dementia
• Parkinsondisease
with dementia
• Progressive supranuclear palsy
• Huntington disease
• Alcohol related dementia
• Chronic traumatic encephalopathy
• Medication side effects
• Prion disease
• HIV

these are all causes of what

A

dementia

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15
Q

• Medication side effects
• Poor sleep - ? Sleep study
• Hypothyroidism, B12 deficiency, Thiamine deficiency
• Neurosyphilis, other infections
• Autoimmune encephalitis
• Normal pressure hydrocephalus

these are reversible casues of waht

A

dementia

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16
Q

what will be the different on a image of a normla pressure hydrocephalaus vs atrophy

A

hydro will just be big ventricles and atrophy will be big ventricles but also atrophy of the brain

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17
Q

what is the triad of normal pressure hydrocephalus’s

A

-memory problems
-gait problems - magnetic major problme
- incontinence

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18
Q

what is the dx and rx for a normal pressure hydrocephalus

A

dx: large volume lumbar puncture
rx: VP shunt

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19
Q

what is the rx and dx for normal pressure hydrocephalus

A

rx:VP shunt
dx: large volume lumbar puncture

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20
Q

what is the bed side exam that is for dementia is assess cognitive and ask what is the year , season , date , time , country , to count back wards.. etc

A

mini mental status exam

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21
Q

what is a bed side exam for dementia that tells you what u are testing and is more common but harder then the others

A

montreal cognitive assessment (MOCA(

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22
Q

what is a bed side exam for dementia that tells the patients a story and they have to memorize some of it

A

SLUMS exam slu.edu

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23
Q

what cognitive domains does the clock drawing test

A

visuospatial , executive , attention , memory

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24
Q

what is the 3 hour cognitive testing that test visual perceptual spatial functional and executive functioning and is the best fore dementia it just takes the longest

A

neuropsychological testing for dementia

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25
Q

– Copy various geometric designs
– Identify faces
– Calculations
– Left right discrimination

this is apart of what functioning for the neuropsychological testing

A

visual perceptual spatial functioning

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26
Q

– Naming fluency
– Alternate numbers and letters in order – Stroop test
– Repeat series of hand gestures

these are for what functions for the neuropsychological testing

A

executive functioning

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27
Q

what is considered Pre-dementia/prodromaldementia

A

mild cognitive impairment (MCI)

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28
Q

what for MCI predictors of more rapid progressions

A

medial temporal lobe atrophy on MRI and hypo metabolic pattern on FDG-PET

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29
Q

what is progressive cognitive , functional and behavioral deficits

A

alzheimer’s disease

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30
Q

what lobes does alzheimer’s disease hit first

A

temporial (fisrt) and parietal lobe

Temporal Lobe: This lobe, which houses the hippocampus, is crucial for memory and learning. Alzheimer’s disease often begins here

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31
Q

if a patients initially presents with short term memory loss , work finding difficulties , mild executive dysfunction and mild visuospatial deficits what are u thinking

A

AD

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32
Q

if a pateints Initially has short term memory loss, word finding difficulties, mild executive dysfunction, mild visuospatial deficits, then Later has All aspects of memory become impaired, fluctuating behavioral changes, disturbed sleep and appetite, hallucinations

what are u think

A

AD

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33
Q

what is the end stage of AD

A

mute , aspiration risk , bed bound and incontinent

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34
Q

what is the most common neuro degenerative disorder

A

AD

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35
Q

what is the 6th most common causes of death in the USA

A

AD

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36
Q

what age is mostly affected by AD

A

75-84

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37
Q

what are teh 4 risk factors for AD

A

-fam history and genetics
-lower education
-gender (being a women)
-head trauma

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38
Q

for the gene ApoE ε4 the ______ carriers have 50% risk for developing AD in mid 60’s and _____ carried have 50% risk of AD in mid to late 70’s

A

homozygous
heterozygous

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39
Q

 Hypertension  Elevated BMI  Smoking
 Cholesterol
 Diabetes mellitus
 Hyperhomocysteinemia  Metabolic syndrome
 Physical inactivity
 Obstructive Sleep apnea

these are all ___ risk factors from AD

A

modifiable

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40
Q

what is the pathology for AD

A

-brain atrophy with neuron loss
- neuro fibrillar triangles tau protein
-senile plaques amyloid beta protein
-cerebrovascualr amyloid

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41
Q

where does AD start and end in the brain

A

hippocampus/temporal lobes
partietal
frontal
global

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42
Q

• Global dysfucntion
• Visuospatial function, calculations, orientation in space
-Memory impairment and naming/language
• Later in disease course executive dysfunction

put these in order of pattern of AD

A

• Memory impairment and naming/language
• Visuospatial function, calculations, orientation in space
• Later in disease course executive dysfunction
• Global dysfunction

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43
Q

what do the labs rule out for AD

A

reversible causes of dementia

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44
Q

what are the biomarkers of CSF for AD

A

amyloid beta (more pathology) and tau (more clinical S&S)

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45
Q

what imaging for u get for AD

A

mri

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46
Q

what is the second most common type of dementia

A

vascular dementia

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47
Q

– Step-wise progression (have normal mem then have stroke then mem is bad then have stroke again)
– Asymmetric focal weakness

what kind of dementia is this (type of vascular dementia)

A

multi infarct dementia

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48
Q

Diffuse white matter disease, subcortical leucoencephalopathy, Binswanger disease.. what is this

A

a type of vascular dementia and is a chronic progressive and diffuse global impairment

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49
Q

what vascular dementia has attention and concentration deficit with psychomotor slowing

A

subcortical

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50
Q

pertaining to the MOCA what is the difference between AD and VD ? what will be the problems with AD and VD

A

AD will have problems in the visuospatial and delayed recall section

VD will have problems int he attention area

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51
Q

– HIV, tests for syphilis
– thyroid, liver function tests
– Kidney function
– B12, folate

these are all a search for a reversible cause for what

A

dementia

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52
Q

what are the 3 different AD imaging

A

-MRI
-FDG-PET
- amyloid PET

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53
Q

for a amyloid PET can a patient still have amyloid deposition w no symptoms of dementia

A

yes

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54
Q

what is AD diagnosed based on

A

amyloid deposition in the brain

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55
Q

___ deficiency results from degeneration of the nucleus basalis of meynert

A

cholinergic deficiency

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56
Q

 Donepezil (Aricept)
 Galantamine (Razadyne)
 Rivastigmine (Exelon

these are exmaple of what inhibitory and whar does it help w

A

cholinesrterase and helps memory for AD

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57
Q

what is a NMDA partial antagonist

A

memantine (namenda)

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58
Q

what 2 medications are used to clear out amyloid for AD

A

lecanemad and aducanumad-avwa (aduhelm)

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59
Q

what is an IV medications given every 2 weeks to treat amyloid for AD but is very exopensive

A

lecanemab

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60
Q

 67 year-old man brought by wife for evaluation of “memory loss”
 Forgets where he puts things and has other problems with attention
 No longer draws or engages in conversation the way he used to.
 Will sit in front of TV and sleep for hours or just stare into space for a while
 Sometimes appears confused and sometimes seems to do well. Worse at night than during day
 At night wife notes he acts out his dreams (like he’s part of a parade….)

Sometimestalksaboutanimalsrunningaroundthat are not in the house but not bothered by it
• Exam–maskedfacesandstoopedposturewithen bloc turning. No tremor; +postural instability and axial rigidity.

what can we suspect

A

lewy body dementia

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61
Q

how would u describe lewy body dementia

A

-more attention and visual spatial problems
-not that much of a memory problems
-hallucinations start early
**-acts out dreams

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62
Q

what lobes does lewy body disease attack rather then dementia

A

partietal and occipital lobe not temporal lobe

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63
Q

for the MOCA exam where will someone with lewy body diease have problems

A

-visuospatial/executive
-attention

64
Q

what is rivastigmine used for in lewy body disease treatment

A

reduce hallucinations and fluctuation

65
Q

what does Levodopa-carbidopa treat in LBD

A

motor symptoms of parkinsonism

66
Q

haldol avoided can results in what for LBD

A

clinical deterioration and increased risk for death

67
Q

what are frontal release signs

A

reflexes that babies have and come back w dementia

68
Q

what is the 2nd most common causes of early onset dementia

A

frontotemporal lobe degeneration

69
Q

what age group does Frontotemporal Lobe Degeneration attack

A

45-64 yo

70
Q

Behavioral variant (bvFTD) is a subtype of what

A

Frontotemporal Lobe Degeneration

71
Q

– Behavioral variant (bvFTD)
– Primary progressive aphasia
– FTD associated with motor neuron disease

these are all subtypes of what

A

Frontotemporal Lobe Degeneration

72
Q

if a patient appears too hones t, flippant , arrogant , aggressively egotistically anf a show off… he thinks that nothing is wrong w him , his memory is okay and he has frontal release signs what can we suspect

A

Frontotemporal Lobe Degeneration

73
Q

what is the pathology for Behavioral variant (bvFTD)

A

atrophy in frontal and temporal lobes

74
Q

what are the 2 main medications for Behavioral variant (bvFTD)

A

anitdepressents and antipsychotics

75
Q

a MOVEMENT DISORDER is a Neurological syndromes in which there is either an excess of movement or a paucity of voluntary and automatic movement, unrelated to ____ or ____. Generally due to pathology in the ____ ___.

A

weakness or spasticity

basal ganglia

76
Q

what is the pyramidal system

A

primary sensoruimotor cortex (frontal partietal) thru the internal capsule , BS , meduallry pyramids , CST to the anterior horn cells of the spinal cord

77
Q

what is the extra pyramidal system

A

fine tuning of motor control

composed of BS (putamen , GP and caudate) , substantial nigra , red uncles and sub thalamic nucleus

78
Q

what is hyperkinesia

A

excessive movement

79
Q

what is dyskinesia

A

abnormal movement

80
Q

what is hypokinesia

A

decreased amplitude of movemtn

81
Q

what is bradykinesia

A

slowness of movement

82
Q

what is akinesia

A

loss of movement

83
Q

what is a Rhythmic oscillatory movement around an axis

A

tremor

84
Q

what is ongoing random involuntary movements incorporated

A

chorea

85
Q

what is athletosis

A

prevents stable posture

86
Q

what is ballism

A

more violent movement at a joint

87
Q

what is Involuntary sustained or intermittent contractions cause twisting/repetitive movements or abnormal postures

A

dystonia

88
Q

what is Involuntary sustained or intermittent contractions cause twisting/repetitive movements or abnormal postures

A

dystonia

89
Q

what are repeated non-rhythmic brief shock-like jerks

A

myoclonus

90
Q

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

A

tic

91
Q

what are repetitive simple movements that can be suppressed

A

stereotypy

92
Q

what movements disorder is considered hypokinetic(not enough movement)

A

parkinsonism

93
Q

• Tremor
• Chorea
• Ballism
• Dystonia
• Dyskinesia • Myoclonus • Tics
• Stereotypies

what classification would these movemtn disorders be

A

hyperkinetic (too much movement)

94
Q

– Drugs- neuroleptics
– Post-encephalitic
– Toxins- manganese, carbon monoxide, MPTP – Vascular
– Brain tumor
– Head trauma

these are considered ____ parkinsonism

A

secondary

95
Q

what is a tremor

A

rhythmic oscillation of a body part

96
Q

what is the difference between a resting tremor , postural tremor and intention tremor

A

resting - seen w body part at rest
postural- revealed by extending a limb against gravity
intention tremor - moving limb to and from a target

97
Q

what is the difference between essential tremor and parkinson’s disease tremor ?

Location
position
direction
frequency
amplitude

A

-location
E: bilateral (hands , leg ,head ,voice , tongue )
P: unilateral (hands , legs and chin)

-position
E: action , posture
P: rest

-direction
E: flexion and extension
P: pronation and supination

-frequency
E: fast
P:slow

amplitude
the same anxiety makes it worse

98
Q

how is the handwriting different for people with parkinson’s and essential tremor

A

for parkinson’s its smaller and essential it is bigger

99
Q

• Frequency5-8Hz(fast)
• Slow progression
• Usually no other neurologic deficits
• Hands>head>speech,chin,tongue,trunk,legs

what tremor is this

A

essential

100
Q

what is the treatment from essential tremors

A

– primidone (antiepileptic)
– propranolol (Beta-blocker)
– topirimate- an antiepileptic

101
Q

what disease is A progressive, neurodegenerative disorder with loss of dopaminergic cells within the substantia nigra

A

parkinson’s disease

102
Q

what is the second more common neurodenerative disease

A

parkinson’s disease (the first is AD)

103
Q

what are PD sytmoms

A

-masked face
-reduce arm swing
-rest tremor
-slightly flexed hip
- shuffling short stepped gait
-flexed elbows and writs
-rigitidity
-stooped posture

104
Q

what is the rest tremor features of parkinson’s

A

distal extremities and limp , “pill rolling”, stops with action of the limb

105
Q

what feature does this describe for parkinson’s x increased resistance to passive movement, equal in all directions, “cog-wheeling and velocity independent

A

rigidity

106
Q

what feature of parkinson’s does this describe Masked facies, decreased blink, soft speech, loss of inflection, micrographia, drooling, shuffling gait

A

bradykinesia

107
Q

Loss of postural reflexes: _____
* Freezing: motor blocks, start-hesitation difficulty moving through doorways/ hallways
* Flexed posture of trunk, neck, and limbs

these are features of what diease

A

retropulsion
parkinson’s

108
Q

what parkinson’s drug has the ability to replace brain dopamine

A

levodopa
(sinemet , parcopa , stalevo)

109
Q

what parkinson’s drug stimulates dopamine receptors

A

dopamine agonists
(requip , mirapex, apokyn (injectable), neupro (patch)

110
Q

what parkinson’s drug prevents the breakdown of levodopa only in advanced PD -only; in combo with levodopa

A

COMT inhibitor (contain , tasmar)

111
Q

what parkinson’s drug prevents the break down of levodopa

A

MAO inhibitor (Selegiline (Zelapar) Rasagiline (Azilect

112
Q

what parkinson’s drug works the best for TREMOR

A

Anticholinergics ( Artane, Cogentin, Benadryl)

113
Q

what is peak dose dyskinesias for PD

A

to much dopamine leads to to much moments

114
Q

how do u know if a patients has dystonia from PD

A

bc their foot will turn in

115
Q

what is camp decorum for PD

A

slumped and hunched over

116
Q

what is camptocormina for PD

A

forward flexion/ slumped over

117
Q

what neurosurgical treatment for PD improves
contralateral tremor, rigidity, not bradykinesia.

A

thalamotomy

118
Q

what are the 2 things that are overactive in PD

A

subthalamic nucleus and globes pallidus

119
Q

what neurosurgical treatment of PD Improves tremor, bradykinesia, and rigidity on side opposite the lesion

A

pallidotomy

120
Q

what is via high frequency electrodes implanted in VIM nucleus of the thalamus, STN, or GPi and is used for PD

A

deep brain stimulation

121
Q

what is a atypical parkinsonism disorder and has the inability to look up or down , has axial rigidity and early falls

A

professice supranuclear palsy

122
Q

what is a atypical parkinsonism disorder and has alien limb/apraxia movement

A

corticobasal degeneration

123
Q

what is an atypical parkinsonism disorder that has orthostatic hypotension and hypereflexia

A

multi system atrophy

124
Q

IF a patient presents with prominent freezing , gait disturbance and postural instability in the context of relatively normla upper extremity what condition would u say this pateint has

A

vascular parkinsonism (lower body parkinsonism)

125
Q

How will be MRI present with vascular parkinsonism

A

extensive subcortical white matter ischemia disease

126
Q

• Akathisia • Athetosis • Ballism
• Chorea
• Dysmetria
• Dystonia
• Hemifacial spasm
• Myoclonus
• Paroxysmal dyskinesias
• Restless legs syndrome
‘• Rigidity
• Stereotypy
• Tics
• Tremor

are they hyperkinesias or hypokinesias

A

hyper

127
Q

what are the drug induced tremor from rest tremor (and PD)

A

-dopamine blocking (antipsychotics)
-metoclopramide

-despakote
-lithium
-calcium channel blockers

*first 2 were in red on slide)

128
Q

• Beta agonists
• Caffiene
• Nicotine
• Thyroxine
• Cocaine
• Lithium
• Tricyclic antidepressants
these all cause what kind of tremor

A

postural/kinetic

129
Q

what disease is
-AUTOSOMAL DOMIANTLY INHERITED
- has to do with chromosome 4
-mean age of onset is 35-42
-average time to death is 17 years
- mean neuronal loss is in the caudate and putamen

A

huntington disease

130
Q

huntington disease is an ____ ____ inherited diease and has main neuronal loss in the ___ and ____

A

autsomal dominately
caudate and putamen

131
Q

what are the symptoms assoscuted with huntington’s disease

A

personality changes , dementia , CHOREA AND ATHETOSIS

132
Q

if you see think or think chorea what disease can u suspect

A

huntingtons disease

133
Q

what is chorea

A

rapid, jerky, irregular movements of the extremitie

134
Q

what is Athetosis

A

slow, nearly continuous writhing movements of the distal extremities

135
Q

what is the mainstay of treatment for CHOREA

A

Tetrabenazine

136
Q

what is Tetrabenazine

A

main treatments for chorea

137
Q

what is a treatable disease of COPPER METABOLISM , can ppresent with tremor and is an AUTOSOMAL RECESSIVE condition and is typically in younger people (20-30)

A

wilson’s disease

138
Q

wilson’s disease is a treatable disease of ___ metabolism and can present w tremor … it is an ___ ____ condition

A

copper
autosomal recessive

139
Q

what are the symptoms of wilson’s diease

A

behavioral or personality change, dysarthria, ataxia, and abnormal movements (chorea, athetosis, tremor, or rigidity)

*in the slide ataxia and abnormal movements was bolded)

140
Q

what diease has the treatment chelation with D-penicillamine

A

wilson’s

141
Q

what is the treatment of wilson’s disease

A

chelation with D-penicillamine

142
Q

____ os Sustained or intermittent contractions that cause abnormal often repetitive movements, postures, or both

A

dystopia

143
Q

dystonia is initiated or worsened by ___ movement

A

voluntary

144
Q

what can relieve dystonia? anf what is it called

A

gentle touch to affected area called sensory tricks

145
Q

what is focal dystonias invovled in and whoa re they usually developed in

A

head , neck or limb mms and usually developed in adults

146
Q

what kind of dystonia is most commonly seen in CHILDERN

A

generalized

147
Q

what is the treatment for dystonia

A

botulinum toxin injections, PT to prevent contractures, encourage search for sensory trick

148
Q

what is writers cramp

A

sustained contraction only when writing

149
Q

• Brief, sudden, rapid, intermittent movements or sounds
• Can be repetitive and stereotyped
• May be volitionally suppressed to some extent
• Typically associated with preceding sensory phenomena
• Can change over time

what kind of disorder is this

A

tic

150
Q

what kind of disorder is tourette syndrome

A

genetic disorder ; autosomal dominant

151
Q

what does the dx require for tourette syndrome

A
  • > 1 motor tic
  • 1 vocal tic
  • fluctuating course
  • present > 1 yr
152
Q

if a patient presents with a. genetic disorder that is autosomal dominant … has > 1 motor tic , 1 vocal tic , fluctuating course , presents for > 1 year and is 15 years old what can we think they have

A

tourette’s syndrome

153
Q

If someone has NEUROLOGICAL SYMPTOMS (such as limb weakness, numbness, shaking or blackouts) which are REAL (and not imagined ) caused by a PROBLEM with the FUNCTIONING of the nervous system and is not due to damage or structural disease of the nervous system and causes difficulty what can we suspect the pateitns has

A

functional neurological disorder

154
Q

what are 6 things that would make it an epileptic seizure

A

• Open eyes
• Hypoventilation
• Lack of memory
• 1-2 minutes
• GTC or tonic
• Sudden onset

155
Q

if someone’s has

• Closed eyes
• Ictal hyperventilation
• Memory of attack when GTC • Long duration
• Prolonged motionlessness
• Ictal weeping
• Gradual onset

what kind of seizure is this

A

Psychogenic Non-Epileptic (PNES)

156
Q

what is hoover sign used for

A

weakness

*have patient life tone leg up and put ur hand underneath their heel and wait to see if they try to dig their heel into ur hand to help lift the opposite leg up)

157
Q

what will a pateitns MRI pressent with if they have functional weakness and sensory disturbance

A

contralateral hypoperfusion of thalamus and caudate

NEUROMUSCULAR (15 decks)

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