Neuro Cases 2 Flashcards
What is a tremor?
Involuntary, rhythmic, oscillatory movement of a body part and is the most common movement disorder seen in primary care
What are the different classifications of tremors?
Resting, action, enhanced physiological tremor, essential, parkinsonism, cerebellar, psychogenic, dystonic, Wilson disease
What is a resting tremor?
Occurs in a body part that is relaxed and completely supported against gravity; enhanced by stress or movement of another body part; diminished by voluntary movement of that body part
What is a postural tremor?
Maintaining a position against gravity (arm elevation)
What is a isometric tremor?
Muscle contraction against a rigid stationary object (making fist)
What is an action tremor?
Kinetic tremor associated with voluntary movement and includes intention tremor, which is produced with target-directed movement (reaching for a pen)
What is an enhanced physiologic tremor?
Everybody has an asymptomatic physiologic tremor; low amplitude, high frequency at rest and during activity; enhanced by anxiety, stress, certain medications and metabolic conditions; if patients have tremors that come and go with anxiety, med use, caffeine intake or fatigue, they don’t need further testing
What is an essential tremor?
Most common pathological tremor; most common in hands and wrists, but can also affect head, LEs, and voice; usually bilateral, present with different tasks, and interferes with activities; can be inherited, tends to progress with age; caffeine and fatigue exacerbate these tremors, alcohol can help symptoms
T/F: 95% of patients have primarily kinetic rather than postural tremors
True
What percent of those affected by essential tremors retire early or modify their career path?
25%
What is a parkinsonism tremor?
Classic tremor that starts as pill-rolling motion of the fingers; bradykinesia incldues difficulty rising from a seated position, reduced arm swing while walking, and micrographia; 70% of patients with Parkinson’s Disease have a resting tremor as their presenting feature, can get better with action
What is a cerebellar tremor?
Classic tremor; low-frequency, slow-intension or postural tremor, and is typically caused by multiple sclerosis with cerebellar plaques, stroke, or brainstem tumors
What is a psychogenic tremor?
Can be difficult to differentiate from organic tremor; some features that are inconsistent include abrupt onset, spontaneous remission, changing tremor characteristics (including location and frequency), increase with attention and extinction with distraction; more frequently seen in patients employed in allied health professions, those involved in litigation
What is dementia?
Loss of cognitive functioning - thinking, remembering, and reasoning - and behavioral abilities to such an extent that it interferes with a person’s daily life and activities; these functions include memory, language skills, visual perception, problem solving, self-management, and the ability to focus and pay attention
What is a major neurocognitive disorder?
Significant cognitive decline in at least one domain interfering with activities of daily living
What is a minor neurocognitive disorder?
Modest cognitive decline that does not interfere in daily living
What is a mini-cog test? What is the sensitivity and specificity?
Patient is asked to repeat three unrelated words, perform a clock drawing test, then recall the three words; sensitivity of 76-100%, specificity of 54-85% for detecting cognitive impairment; demonstrates better performance in patients with dementia than mild cognitive impairment
How do you score the mini-cog?
One point for each word remembered; 2 points for good clock (numbers correct, clock hands with arrows, length of arms doesn’t matter); score of 3, 4, or 5 indicates lower likelihood of dementia but doesn’t exclude some element of cognitive impairment
What does the ASCERTAIN 8-item informant questionnaire screen for? What is the specificity and sensitivity? How do you score it?
Screens for major and minor neurocognitive disorders; sensitivity of 85%, specificity of 86%; count the “yes” answers; 0-1 is normal, 2 or more means cognitive impairment likely to be present
If a screening is positive, what is your next step?
Next screen for DEGREE
What is a mini-mental state examination (MMSE)? What is the sensitivity and specificity?
Most commonly used DEGREE screening; sensitivity is 81% and specificity is 81% for detecting dementia; nomograms for normal versus impaired are based on age
What is the montreal cognitive assessment (MOCA)?
Designed for persons scoring 24 or higher on MMSE; accurate in patient’s with Parkinson’s Disease; another type of DEGREE screening
What are the 3 DEGREE screenings?
Mini-mental state examination (MMSE), Montreal Cognitive Assessment (MOCA), and St. Louis Mental Status Examination
What are the next steps after DEGREE screenings?
Geriatric Depression Scale to rule out pseudodementia; lab evaluation and neuroimaging for reversible causes of dementia
