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Neurocog D/o Flashcards

1
Q

Major Cognitive Disorder

A

New name for dementia
Psychological behavioral symptoms as well as acquired deficits in ADLs and IADLs

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2
Q

DSM neuro cognitive disorders

A

Delirium
MCI
Major Neurocognitive Disorder

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3
Q

Mild Cognitive Impairment

A

Memory/thinking problems, able to take care of self, no personality changes

-lose things, forgetting events/appointments, having trouble coming up with words, movement difficulties, problem with sense of smell

May be early sign of more serious memory problems
See MD every 6-12 mo for monitoring

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4
Q

Signs of Major Neurocognitive Disorder

A

Forgetfulness maybe normal
Sign if aging, but dementia is not

Sx: memory loss, loss of cognitive function, thinking, remembering, learning, reasoning, behavioral abilities- language skills, visual perception, attention, personality changes

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5
Q

Dementia types

A

Alzheimer’s Disease, Lewy Body dementia, frontotemporal dementia, vascular dementis

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6
Q

Factors that may cause memory problems

A

Head trauma/concussion
Blood clots
Tumors
Infections
Thyroid, kidney, or liver problems
Medication side effects
Mental health conditions ie depression
Alcohol/drug use
Sleep problems
Decreased B12
Decreased eating healthy foods

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7
Q

Causes of neuro-cognitive disorders

A

Brain injury by trauma: ICH, SAH, blood clot, concussion, hypoxia, hypercapnia, dementia due to stroke, Alzheimer’s d/s, creutzfeldt-Jakob Disorder, diffused lewy body disease, Huntington’s disease, MS, Normal pressure hydrocephalus, Parkinson’s disease, Pick’s disease

Metabolic cause: kidney disease, liver disease, thyroid disease, deficits in vitamin B1, B12 folate

Drug/alcohol withdrawal: wernicke-korsakoff

Infections: septicemia, encephalitis, syphilis, prion infection

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8
Q

Creutz-feldt Jakob Disease

A

Brain damage leading to rapid decline in movement (involuntary muscle movement) loss of mentation (thinking, reasoning, confusion) secondary to prions (eating infected meat), progress unusually fast, folded proteins destroys brain cells

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9
Q

Huntington’s Disease

A

Genetic defect on chromosome 4, CAG repeat

Sx: hallucinations, irritability, moodiness, restfulness/fidgeting, behavioral disturbances, paranoia, psychosis

Abnormal facial movements/grimacing, head turning to shift eye position, quick jerky movements of arms, legs, face, slow uncontrollable movements, unsteady gait, prancing and wide walk

Dementia

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10
Q

Multiple sclerosis

A

Autoimmune disease affecting brain and spinal cord, effects women more, inflammation and damage to myelin sheath

Sx: LOB, muscle spasms, numbness, trouble moving UE/LE, trouble walking, bowel/bladder problems, constipation, double vision, trouble urinating, tremors, tingling/burning, fatigue

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11
Q

Parkinson’s disease

A

Certain brain cells dying, shaking tremors, trouble walking, decreased dopamine, dx after 50, more in men

Sx: rigidity/stiffness, muscle aches/pains, constipation, slow blinking, drooling, no facial expressions, LBP when you stand, stooped posture, sweating, difficulty swallowing, slowed quiet speech, decreased handwriting

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12
Q

Pick’s Disease/frontotemporal dementia

A

Group of d/o due to damage in frontal and temporal lobes, genetic component, abnormal substances inside nerve cells in damaged areas, may be as young as 20, common 40-60, average 54

Seen in ALS, progressive supranuclear palsy

Behavior variant vs primary progressive aphasia

Not able to keep a job, compulsive, impulsive, inappropriate behavior, inability to function, interact socially, problems with personal hygiene, repetitive behavior, withdrawal, abrupt mood changes, decreased recognization of behavioral changes, decreased empathy, mutism, shrinking vocabulary, weak uncoordinated speech, echolalia, aphasia, increased tone, memory loss, apraxia, urinary incontinence

Extreme behavioral changes and lack of insight

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13
Q

Neuro degenerative disorders

A

Range of conditions that share primary feature of degeneration and loss if neurons in the brain, incurable/debilitating resulting in death of nerve cells, caused problems with movement (ataxia) and mental functions (dementia)

Most common: PD, Alzheimer’s disease
Less common: MS, atypical Parkinson’s, huntington disease, ALS

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14
Q

6 neurocognitive domains

A

1) perceptual-motor function: visual perception, visuo constructional reasoning, perceptual motor coordination
2) language: object naming, word finding, fluency, grammar/syntax, receptive language
3) learning/memory: free recall, cued recall, recognition, memory, semantic/autobiographical long term memory implicit learning
4) social cognition: theory of mind, insight, recognition of emotion
5) complex attention: sustained attention, divided attention, selective attention, processing speed
6) executive function: planning, decision-making, working memory, responding to feedback, inhibition, flexibility

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15
Q

Occipital lobe

A

Visual perceptual and visual
Motor, distance/depth perception, color determination, object/face recognition, memory function

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16
Q

Temporal lobe

A

Learning/memory, managing emotions, processing information, information from senses, storing/retrieving memories, understanding language

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17
Q

Parietal lobe

A

Perceptual motor function, language, receiving/processing sensory input of touch, pressure, heat, cold, and pain

Perception of body awareness and spatial coordinate system (mental map)

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18
Q

Frontal lobe

A

Executive function, social cognition, complex attention, role in voluntary movement, expressive language, managing higher, level executive function

Plan, organize, initiate, self-monitor, control one’s responses to achieve a goal

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19
Q

Functional Cognition

A

Combines constructs of function/cognition in context of performing everyday activities/occupations

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20
Q

Performance Skills

A

Observable, goal-directed actions that result in a client’s quality of performing desired occupations, skills supported by context

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21
Q

Assessing Functional cognition

A

Assess functional cognition, not specific cognitive skills, identifying client’s capacity to perform essential tasks given the totality of their abilities, includes use of strategies, habits, and routines, context/environmental resources

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22
Q

Why assess functional cognition?

A

Evaluate how a person can participate in/perform ADLs/IADL tasks, identify barriers to function, provide recommendation about appropriate care environments and facilitate a successful dc plan to match functional abilities, provide education about most effective ways to support/communicate with pts, clinicians, family/caregivers

Research support to assess cognitive fxn for all geriatrics pt, early detection necessary for client-centered care, early intervention maximizes function, safety, and independence

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23
Q

Performance based assessments

A

Executive Functional Performance Test (EFPT)

Performance Assessment of self care skills (PASS)

Weekly Calendar Planning Activity

Multiple Errands Test

Actual reality Assessment

AMPS

COPM

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24
Q

Executive Function Performance Test

A

Elements of executive function impacting function, individual’s capacity for independent functioning amount of assistance for task completion

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25
Q

Performance Assessment of Self Care Skills

A

Client-centered, performance based observational tool, assesses ADL/IADLs to provide snapshot of person’s ability to live (I)

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26
Q

Multiple Errands Test

A

Performance based test, measure how executive performance deficit affect functioning in natural environments, multiple versions, 5 different settings

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27
Q

Actual Reality Assessment

A

Performance based assessment approach use of internet to perform real everyday life activities

MS

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28
Q

AMPS: Assessment of motor and process skills

A

observational assessment that allows for the simultaneous evaluation of motor and process skills and their effect on the ability of an individual to perform complex or instrumental and personal activities of daily living

Based on MOHO

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29
Q

Skill based assessments

A

Examine foundational cognitive skills and allow clinician to extrapolate how deficits in these skills affect overall cognition

MOCA
SLUMs
Mini Mental Status Exam
Trail Making A/B
ACL lacing screen
Motor Free Visual perceptual test
Clock drawing test
Cognistat NCSE

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30
Q

MOCA

A

Screen for MCI

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31
Q

St. Louis University Mental Status Exam (SLUMs)

A

Screen for dementia, cognitive deficits

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32
Q

Mini-mental Status Exam MMSE

A

Brief quantitative cognition screen, show cognitive changes over time

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33
Q

Trail Making A/B

A

Tests memory/executive functioning, correlate with driving ability component of other skill based assessments

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34
Q

Motor Free-Visual Perceptual Test

A

Visual perceptual skills in spatial relation, figure ground, visual discrimination, visual closure, visual memory

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35
Q

Clock drawing Test

A

Screening tool, draw a clock, place #s, assesses visual-spatial, numerical sequencing, and planning abilities

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36
Q

Cognistat NCSE

A

Neuro behavioral cognitive status exam, neurocognitive assessment in consciousness, orientation, simple attention, language, constructional ability, memory, calculation skills, executive skils

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37
Q

CMS recommended Cognitive screening due to Impact Act

A

CAMS-confusion assessment method: ID delirium

BIMs-Brief Interview for Mental Status: ID cognitive impairment

Do not identify mild cognitive impairments, failing to identify subset of clients at risk for failed care transitions
Use skip pattern/gateway: use functional cog tool for individuals who pass CAM/BIMs

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38
Q

Dementia/major neurocognitive disorder

A

Syndrome resulting from a variety of disease processes which there is deterioration in cognitive function beyond expected from normal aging

55 million people, 7th cause of deaty

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39
Q

Risk factors for dementia

A

Age: strongest risk factor, doubles every 5 yeas after 65

Genetics: family hx

Poor health: increased BP, increased cholesterol, diabetes, smoking

Race/ethnicity: African Americans are 2x more likely to develop dementia, hispanics 1.5x more likely to develop dementia, possibly due to increased heart disease with lower accessibility to preventative medicine

TBI

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40
Q

SDOH and dementia

A

Education: lower levels of education and lower levels of cognitive reserve

Decreased access to health-prevention dx and tx, risk factors such as heart disease and DM

Loneliness/social isolation increased risk

Socio-economic: lower socio-economic linked to increased dementia and may correlate with other factors

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41
Q

Alzheimer’s Disease

A

60-80% of those with dementia, nerve cells are damaged by by beta-amyloid plaques and tau protein tangles build up in nerve cells

42
Q

Alzheimer’s Disease Symptoms

A

Insidious onset and gradually progressive memory loss
Early on difficult with familiar tasks
Displacing/losing things
Difficulty with new learning
Loss of orientation to place, time, situation
Difficulty communicating leading to withdrawal
Depression
Neuropsych sx: agitation, wandering, delusions, sleep disturbances
Visuospatial/language deficits
Gait disturbances

43
Q

Vascular Dementia

A

2nd most common dementia
Caused by vascular disease with smoking, DM, obesity, Afib, atherosclerosis

Risk factors: frequent h/o CVA/TIA

44
Q

Vascular Dementia Symptoms

A

Rapid onset when caused by cerebral vascular event, sx related to location
Slow/gradual when secondary to small
Vessel disease
Change in mood/personality
Executive functioning difficulty, loss of cognitive flexibility
Slow processing speed
Gait/balance impairment
Incontinence
Often progresses to more advanced level when there is Another CVE, step-like progression
Sx of depression, anxiety, and apathy

45
Q

Lewy Body dementia

A

Caused by abnormal protein deposits in the brain, called alpha-synuclein, 5% of all dementia, cases 2x more in men than women difficult to dx as similar to PD and Alzheimer’s

46
Q

Lewy Body Dementia symtoms

A

REM sleep D/O may be early sign
Executive function and attention impacted early on, memory is less affected
Fluctuating alertness/cognition
Parkinson’s type movement d/o, slow shuffling gait, rigid movement patterns
Visual hallucinations, early specific and vivid delusions, paranoia, anxiety, agitation common as disease progresses
Visuospatial deficits
Frequent falls
Highly sensitivity to antipsychotic medication

47
Q

Creutzfeldt-Jakob Disease Symptoms

A

Sporadic: develops spontaneously, 85% of cases,60-65 yo

Familial: caused by changes in the chromosome, 20 gene coding, 10-15% of cases, develops 20-40 yo

Acquired: from exposure to an external source of abnormal prion to protein, sources medical procedure involving instruments in neuro sx, growth hormone from transplanted human tissue vs meat or other products from cattle

Depression, agitation, apathy, mood swings, rapidly worsening confusion, disorientation, problems with thinking, memory, planning, and judgment, difficulty walking, muscle stiffness, twitches/involuntary jerky movements, vision problems

48
Q

Normal Pressure Hydrocephalus

A

Excess cerebrospinal fluid accumulates in brain ventricles causing thinking and reasoning problems, difficulty walking, loss of bladder control, affects people on 60/70s

Caused by tumor, head injury, hemorrhage, infection/inflammation

49
Q

Normal Pressure Hydrocephalus symptoms

A

Difficulty walking-body bent forward, legs held wide apart and feet moving as if stuck
Mild dementia that involved loss of interest in daily activities, forgetfulness, difficulty completing routine tasks, STM loss
Decline in thinking skills that includes overall slow thought processes, apathy, impaired planning, and decision-making, decreased concentration, changes personality and behavior, loss of bladder control

50
Q

Korsakoff Syndrome

A

Chronic memory d/o caused by severe deficiency of thiamine (B1) caused by ETOH, decreased thiamine =cells cannot generate enough energy to function properly, can be associated with AIDS, Ca, poor nutrition, bariatric sx

51
Q

Korsakoff Syndrome symptoms

A

Problems learning new info
Inability to remember recent events
Long term memory gaps
Confabulate

52
Q

Mixed dementia

A

Brain changes of more than 1 cause of dementia occur, most common AD and vascular dementia

Sx depend on types involved
Similar sx to AD

53
Q

Stages of Dementia: 7 stage model

A

1) no impairment
2)very mild
3) mild
4) moderate (early stage dementia)
5) moderately severe (early to mid stage dementia)
6) severe (late mid stage dementia)
7) very severe (late stage dementia)

54
Q

Stages of dementia: 4 stage model

A

Mild
Moderate
Severe
Terminal

55
Q

4 stages model of dementia: mild

A

Forgetfulness of words/names
Misplacing/losing things
Difficulty tracking
Decline in goal oriented behavior outside of self care
Getting confused/disoriented in familiar places
Losing track of time
Poor judgement with planning and decision making
Concrete thinking
Loss of abstract thinking
Impaired attention to tasks/environment
Impaired safety awareness
Visuospatial changes/deficits
Mood changes
Difficulty with IADLs and multistep tasks
I with ADLs
Accesses community with some risk of getting loss
More successful in a structured environment
ACL 4.4-4.8

56
Q

4 stages model of dementia: moderate

A

Increased loss of orientation to time, place, situation, people
Not able to manage environment effectively requires assistance for safety
Communication difficulties, decreased use of language
Visuospatial deficits
Poor attention to safety and increased impulsivity, may lose socially appropriate behavior, safety risk is high
Loss of much purposeful activity
Needs support to initiate/engage in previously enjoyed activities
Benefits from sensory engagement
Difficulty with ADLs
Requires A for ADLs for safety
Assistance with incontinence and hygiene
Assistance for IADLs
Community activity limited
Wandering risks
Cues for hygiene
Eating may need adaptive dining strategies
cues to maintain routine
Can no longer live safely
Hallucinations, agitation, sleep disturbances with nightmare
ACL 3.6-4.2

57
Q

4 stages model of dementia: severe

A

No longer oriented
May recognize caregiver/family; however unable to name
1 step commands
Incoherent language
Assists with ADLs
May need 2 person assist
Benefits from routine
Incontinent
Cues to eat
Benefit from social engagement and repetitive action
Physical assistance to move safely
Neurological impact on movement (apraxia, possible tone)
Increased fall risk
Increased behaviors (resistance to care, agitation, aggression)
Unable to make needs known
May have unmet need increasing symptoms
24 hour care
At risk for pressure ulcer
Aspiration
Poor nutrition
Dehydration
Weight loss
Visuospatial deficits

ACL 3-3.4

58
Q

4 stages model of dementia: terminal

A

Limited responsiveness
Limited language if any
Benefits from comforting stimuli (familiar voices, soothing touch, music, massage)
Likely bed bound
Total a for care
Difficulty swallowing
Modified diet at risk for aspiration
Pain management
Palliative care
Supported positioning
Assistance for repositioning for pressure relief
Increased time
Contracture/rigid movement
Loss of mobility
Agitation
Toward end of life
At risk for pressure ulcers
Hospice Care
ACL less than or equal to 3

59
Q

Delirium

A

Sudden and severe change in brain function that causes person to appear confused/disoriented
difficulty maintaining focus
Thinking clearly and Remembering recent events
Fluctuating course

60
Q

Causes of delirium

A

Advanced age
existing brain disease such as dementia, h/o CVA, Parkinson’s disease
Immobility
Fracture
Malnutrition
Use if bladder catheter
Polypharmacy leading cause
Sleep deprivation
Poor eyesight/hearing
Advanced Ca
Organ failure
Sudden w/drawal of regular medication or cessation
ETOH

61
Q

Delirium symptoms

A

Hours to days
Unusual changes in levels of consciousness and thinking
May be withdrawn
Sleepy
Flat affectionate (hypoactice delirium)

Hyperactive delirium:
Active/agitated
Difficulty maintaining focus
Difficulty retaining new info
Disorientation to time and place
Visual hallucinations

Variable outcomes weeks to months
Can result in Long term memory/processing difficulties after recovery

Delirium linked to prolonged hospitalization and residual trauma

62
Q

Assessing delirium

A

Get assessment prior to planned hospitalization for a baseline, can be done by OT on primary care setting
Pre-admit tools: MOCA, Mini Adden Brooke’s Cognitive Exam

Delirium screens should be 2-3x/day due fluctuations
Screening tools: intensive care delirium screening checklist, confusion assessment measure (CAM) completed at regular intervals

63
Q

Treatment of delirium

A

Encourage movement
Time out of bed
Support person in maintaining regular sleep/wake cycle
Make sure using hearing aid/glasses
Avoid under/over stimulation
Someone at bedside for reassurance
Educate friends/families
Pharma - tx medical reason for hospitalization, avoid deliriogenic meds such as benzos antipsychotics, and histamine 2 receptor agonist

64
Q

Polypharmacy/adverse drug effects

A

Can be prescriptions, regular alcohol, illegal drug use
Ceasing medication suddenly
Some medications overtime increase likelihood of neurocog disorder

Increased polypharm in PD abd MS
Fatigue, cognitive complaints, fall secondary to dizziness/hypotension

65
Q

Treatments to reduce polypharmacy

A

Yearly medication review with PCP
Discuss strategies to reduce fall risk
Update cognitive screening regularly and monitor for changes
Update family, individual, and providers

66
Q

General dementia interventions

A

Home modifications, caregiver education, fall prevention, activity modification

67
Q

Dementia interventions: caregiver education

A

Improves ADL performance, reduces neuropsych sx, improves QOL

In person education on communication, behavior management, and adaptive strategies

Caregiver training on stress mgmt/reduction, respite resources, caregiver support groups
8 in home session 1-1.5 hours

68
Q

Dementia interventions: home
Modifications-safety concerns

A

Safety concerns addressed: wandering, falls, inattention, poor judgment, medication management, temperature adaptation, cooking, use of appliances, use of sharps

Remove clutter, rugs, access to unsafe objects, add grab bars, commodes, lighting, door locks, gate alarms, AT, ramps, lifts

69
Q

Dementia interventions: home
Modifications-neurospych symptoms

A

Improves neuropsych sx
Rooms designed with purpose of use
Ambient music (other than at meals)
Multisensory interventions
Reduced environmental noise/stimuli
Camouflage exits
Accessible environment with good visual access L shape cornets, visible toilet

70
Q

Dementia interventions: fall prevention

A

Individual exercise program to increase balance, group exercise programs that increase balance, occupation based intervention to increase gait, strength, flexibility, and balance

Fall prevention education for staff

Need more research for fall
Prevention for neurocog d/o

Programs: stepping on, a matter of balance

71
Q

Dementia intervention: activity modification

A

Personalized activity to increased engagement, decrease neuropsych symptoms, maintain function, and increase QOL

Individual program: draw on previous experiences/interest, support choice match existing skills/capacities, support with caregiver education and facilitation, match cues to cognitive capacity, use direct simple cues

Modify environment for success, decrease distractions, increased visual cues, use adaptive strategies that are familiar and intuitive

72
Q

Tailored Activity Program

A

Person-environment-occupation framework, considers preserved capabilities, caregiver readiness, and environmental factors

Decrease symptoms through 3 meaningful activities tailored to match skills/interest of person

Requires training/certificate to practice

73
Q

Skills 2 care

A

Caregiver training program that requires certification focused on education, routine modification, behavioral management, and home modification to promote function snd outcomes in the home

74
Q

Multi modal OT program

A

Cog-oriented approach improve cognitive dysfunction and increased BADLs and IADLs

75
Q

Reminiscence therapy

A

Effective in Alzheimer’s disease regarding cognition, depression, ADLs, QOL

Regular small group 45 minutes, 8-12 week duration, mild to moderate ADs

Photo, video, and music

76
Q

Sensory Therapy

A

In residential facilities, strong evidence for massage

Moderate evidence for environmental based multisensory activity=lighting

Gardenunt, music, meal time (no music), montessori animal assisted therapy, dance/yoga

Inconclusive evidence for art, aromatherapy, snoezelen rooms

77
Q

Goals of intervention in acute care setting for neurocog d/o

A

Return to prior environment
Return to PLOF
In unable, identify new supports for home setting, modify interventions for new baseline

78
Q

Assessment in acute care setting for neurocog d/o

A

Functional cognition with performance based assessment

Consider baseline level of fxn vs expected fxn at d/c, recommend specific cognitive skill assessment secondary to neurocog screen, eval ADL/IADL performance

79
Q

intervention in acute care setting for neurocog d/o

A

Retrain ADLs/IADLs with compensatory/adaptive strategies
Strength based intervention to support increase cognitive level
Collaborate with natural supports to anticipate challenges in dc environment,
Train and make environmental recommendarion

80
Q

Goals of intervention in community/home health setting for neurocog d/o

A

Support function
Participate in home environment
Support autonomy with attention to safety
Assure natural supports support function and safety

81
Q

Assessment in community/home health for neurocog d/o

A

Assess Cognitive status with performance based assessment
What is needed to function in environment for additional tool guide

Secondary neurocog screen, home safety assessment, evaluate ability to perform ADLs/IADL, interview natural supports to understand barriers/neuropsych symptoms

82
Q

intervention in community/home health setting for neurocog d/o

A

Dementia specific concerns- wandering, safety, modify routine/environment, address underlying needs (pain, loss of meaningful activity), ADL/IADL training, AE/DME training, address accessibility, reduce falls, strength based interventions, caregiver training

83
Q

Goals of intervention in memory care and palliative stages

A

Support function/participation in home
Support comfort, dignity, and safety
Assure natural supports can support routine care, safety, and comfort

84
Q

Assessments in memory care and palliative stages

A

Functional cognitive performance test, with more advanced dementia, formal cog test not needed

Eval ADL with focus on insight, safety, and caregiver assistance

Environmental considerations, interview supports for barriers and neuropsych symptoms, home safety assessment

85
Q

Intervention in memory care and palliative stages

A

Address safety, wandering, difficulty participating in ADLs

Accessibility tx

Fall prevention

Safety in eating, positioning, skin integrity

Underlying needs pain vs meaningful activities

Use activity plan, sensory interventions, and environmental modifications to reduce neuropsych symptoms

86
Q

Mild neurocognitive disorder

A

Not part of normal aging, does not impact(I) functioning, but noticeable by family

May be reversible, not all leads to dementia

Early intervention best to address reversible causes

87
Q

Mild neurocognitive disorder risk factors

A

Age, diabetes, smoking, increased cholesterol, htn, depression, sedentary lifestyle, limited mental/social stim

88
Q

Causes if mild neurocognitive
Disorder

A

Reversible causes: delirium, depression, NPH, metabolic/nutritional deficiencies, sleep apnea, drug use, acute infection

Nonreversible causes: TBI, vascular events, PD, neurocog decline early stages of dementia, MS, ALS, atypical PD

89
Q

Mild neurocognitive disorder impact on ADL

A

Less cognitive processing due to routine usually not affected

(I) maintain further in disease process than dementia

Can be mire affected by physical symptoms

Decline in ADLs means disease progression

90
Q

Mild neurocognitive disorder impact on IADL

A

Requires more functioning in multiple cognitive domains and more varied take demands, needs executive functioning skills, physical impairment affects

changes can be subtle/compensated for prior to function being affected

91
Q

Signs if mild neurocognitive Disorder

A

Challenges with more complex multi-step tasks
Medication errors
Forgetfulness/difficulty tracking leading to miss appointments
Misplacing items
Missing social events
Decreased attention to environment
Increased clutter
Unpaid bills
Spoiled food
Trouble remembering/tracking conversations
Difficulty with word finding
Decreased visuospatial skills

92
Q

Assessing mild neurocognitive disorder

A

Functional cognitive assessment
Performance based activity
Formal performance based assessment

iADL predicting factor if rehospitalizations

93
Q

Interventions for mild cognitive disorders

A

Exercise, cognitive training/retraining, skill training/modifications for lifestyle management

Simulate real like
Grade task in error less learning
Group tx to increase cognitive skills

94
Q

Motor symptoms of Parkinson’s disease

A

Tremor including non-intention tremors in arms, legs, jaws, and head, pill rolling

Bradykinesia slowed movements and difficulty initiation movement

Rigidity lack of facial expression, decrease arm swing while walking

Postural instability impaired balance, related to combo of tremors, bradykisia, and rigidity

Vocal: soft slow speech

95
Q

Non motor symptoms of parkinson’s

A

Depression
Sleep problems: fatigue, restless leg, insomnia
Loss of smell 95%, one of the first symptoms
Sweating and increased risk of skin Ca
GI-constipation

96
Q

5 stages of Parkinson’s Disease

A

1) slight tremor on one side of the body, mild sx, changes in walking, posture, and facial expression

2) symptoms worsen, affects both sides, changes in walking making daily tasks more difficult

3) LOB, slowness of movement, falls more common, impaired ADLs

4) severe symptoms and limit ability to live alone, walkers and AD used

5)confined to wheelchair vs. bed, 24 hour caregiver, many experience hallucinations

97
Q

PD dementia risk factors

A

Hallucinations in someone who does not have dementia symptoms yes

Daytime sleepiness

Postural instability and gait disturbances symptom pattern

98
Q

Pharma tx if Parkinson’s Disease

A

Clonazepam/melatonin to tx symptom of REM disorder
SSRI tx depression
Cholinesterace inhibitor- visual hallucinations, sleep disturbances, and behavior changes

99
Q

Medical tx of Parkinson’s disease

A

Levadopa to increase dopamine
MAO B inhibitor/COMT inhibitors slow enzyme that breakdown dopamine
Amantadine to reduce involuntary movement

Deep Brain stimulations-placing electrode into brain to stimulate areas of motor context related to movement symptoms

100
Q

OT tx for Parkinson’s Disease

A

Physical activity: LSVT-Big based on proprioceptive recalibration, physical activity slows progression and improve symptoms

ADL-specific goal setting/tx, task analysis with forward chaining, decrease distractors, educate on cog load/avoid multitasking, adaptive strategies/AE

Cognitive strategies-cognitive retraining vs compensatory strategies, cog retraining can lead to LT cog improvements, compensatory may be for those not interested or have PD dementia

Fall prevention-home assessment for environmental modification, educate on fall triggers such as changing direction step to turn then move forward, avoid dual task, avoid carrying objects

Mindfulness-body scan, mindfulness meditation

ECT/fatigue management: caregiver/pt education on ECT, structure day so most valued activity at peak medication time, education on sleep hygiene

101
Q

Mindfulness meditation based Complex exercise lrogram

A

Parkinson’s Disease
Prep phase: discuss HEP
Exercise: elastic band/stretching exercise, ball exercise, stretching with deep breaths
Meditation with basic breathing: breathing meditation, loving-kindness meditation, breathing imagery meditation

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