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S4- Neuro 1 > Week 8- Progressive Cognitive Disorders > Flashcards

Week 8- Progressive Cognitive Disorders Flashcards

1
Q

PART 1: INTRODUCTION

A

PART 1: INTRODUCTION

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2
Q

What happens to cognition as we age?

A

Normal age-related changes vary from person to person in degree and severity.

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3
Q

Disturbances in ability to _______, ______, and ____________ certain experiences happen as we age.

A

-register, retain, and recall

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4
Q

With Cognition as We Age We See:

  • Slowed rate of learning ____ material.
  • Slowed ______ learning capabilities.
  • Slowed motor performance on tasks that require _______.
A
  • new material
  • motor learning
  • speed
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5
Q

10 Early Warning Signs of Abnormal Cognitive Decline:

  • Impaired ________/__________ memory, repeats self frequently.
  • Difficulty doing __________ but difficult tasks (managing medications, money, driving).
  • ______-finding difficulty, mis-naming, comprehension difficulties.
  • Disorientation to _____ and _______ (Getting lost while driving, Missing several appointments).
  • Worsening __________.
  • Impaired ________-______ or reasoning.
  • Misplacing things- finding them in “odd” places.
  • __________ changes.
  • ______ or _________ changes.
  • Loss of ________ (withdrawal from normally salient activities of interest).
A
  • immediate/short-term
  • familiar
  • word-finding
  • time and place
  • judgement
  • problem-solving
  • personality
  • mood or behavior
  • initiation
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6
Q

What are some other issues (besides dementia or neurological condition) that could lead to the 10 signs of abnormal cognitive deficit?

A
  • Medication side effect
  • Hearing loss, visual loss
  • Depression, anxiety
  • Acute illness
  • Etc…
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7
Q

What is dementia?

A

Describes a group of symptoms that involve a decline in memory, reasoning, and other cognitive skills, despite full alertness.

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8
Q

Dementia typically involves _______ and ____________, plus an addition of 1 or more of what 4 things?

A

-memory and orientation

  • impaired abstract thinking
  • impaired judgement and problem solving
  • impaired language
  • personality changes
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9
Q

What are some potential causes of dementia?

A
  • CVA
  • NPH
  • toxin exposure
  • infection
  • TBI
  • neurodegeneration
  • idiopathic
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10
Q

With dementia, do we see a chemical change or structural change in the brain?

A

both chemical and structural

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11
Q 
\_\_\_\_\_\_\_\_\_\_ = More acute and abrupt changes. (fluctuation of dementia)
\_\_\_\_\_\_\_\_\_\_ = Long standing changes (largely irreversible)
A
  • Chemical

- Structural

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12
Q

PART 2: ALZHEIMER’S DISEASE

A

PART 2: ALZHEIMER’S DISEASE

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13
Q

Alzheimer’s Disease:

  • Most common ___________ disease.
  • _____ cases in the US.
  • Accounts for ___-___% of all dementia cases.
  • Prevalence increases by ___% every 5 years >/=85 years.
  • Can onset at any age, but most likely after age ___.
A
  • neurodegenerative
  • 5.5 million
  • 60-80%
  • 20%
  • 65
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14
Q

What is the cause of Alzheimer’ Disease?

A

Ultimately unknown, genetics and environmental factors may play a role.

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15
Q

What is the “Amyloid Cascade Hypothesis”?

A

The amyloid cascade hypothesis postulates that the neurodegeneration in AD caused by abnormal accumulation of amyloid beta (Aβ) plaques in various areas of the brain.

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16
Q

Describe the Amyloid Cascade Hypothesis.

A

Abnormal buildup of amyloid beta and tau plaques throughout the brain leads to toxicity → inflammation, oxidative stress, impaired homeostasis → neuronal death and dysfunction → AD

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17
Q
  • Alzheimer’s = ______ immediate recall

- Age-Related Memory Loss = ___________ immediate recall

A
  • absent

- impaired

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18
Q
  • Alzheimer’s = ________ retrains short-term memory

- Age-Related Memory Loss = often shows _________ of short-term memory

A
  • rarely

- retention

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19
Q
  • Alzheimer’s = gradual ______ in response to memory aids

- Age-Related Memory Loss = responds ______ to memory aids

A
  • decline

- well

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20
Q
  • Alzheimer’s = progression to __________ in ADLs and functional mobility
  • Age-Related Memory Loss = retains some degree of ________ in ADLs and functional mobility
A
  • dependence

- independence

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21
Q

Alzheimer’s Disease General Characteristics:

  • Initially ______, _________ onset with subtle loss of interest or withdrawal from enjoyable activities as well as early memory loss.
  • As disease progresses, dysfunction includes ___________ deficits such as word-finding (anomia), apraxia, and/or visuospatial disorders.
  • Moderate to advanced stages may see _________ changes such as wandering, paranoid, agitation, aggression, sexual disinhibition, or failure to recognize family/friends.
A
  • slow, insidious
  • perceptual
  • behavioral
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22
Q

With Alzheimer’s Disease, ________ dysfunction is usually seen in absence of many other neurological functions (motor, sensory functions and procedural memory usually spared).

A

cognitive

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23
Q

What are the 3 stages of Alzheimer’s Disease?

A
  • Mild
  • Moderate
  • Severe
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24
Q

Which stage is the longest and is where we will see a patient develop symptoms, loss of functional independence, and behavioral problems?

A

Moderate

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25
Q

AD Mild Stage (Memory and Thinking):

  • ↓ _____-_____ memory
  • slowed processing
  • ↓ attention
  • awareness of deficits initially __________

AD Mild Stage (Language):

  • _____-finding difficulties
  • cognitive fatigue leads to _______ compromise

AD Mild Stage (Mood):

  • frustration, irritability, agitation
  • apathy, ___________
  • _________
A
  • short-term
  • maintained
  • word-finding
  • language
  • depression
  • anxiety
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26
Q

AD Mild Stage (Function):
-breakdown of _______ and _____ function

AD Mild Stage (Behavior)

  • frequently losing items
  • constant _________

AD Mild Stage (Safety Concerns):

  • ______________
  • exploitation
A
  • IADL and ADL
  • repetition
  • driving
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27
Q

AD Mild Stage:

  • How long does it usually last?
  • In the mild stages of AD, are patients still aware of their deficits and losses as they are occurring?
  • They often try to ______ their deficits in the earlier stages because of denial or trying to hide it from family.
  • How are the mild stages noticed usually?
A
  • 2-4 years
  • Yes
  • mask
  • family member speaking up
28
Q

AD Moderate Stage (Memory and Thinking):

  • Continued ↓ ____-_____ memory, beginning to see ↓ ____-_____ memory.
  • Inability to recognize _______, _______, and ____________.
  • Inability to understand _____.
  • ↓ Insight
  • ↑ Self-absorption and withdrawal

AD Moderate Stage (Language):

  • ↓ Verbal and written __________.
  • ↓ Verbal _________.
  • Frequent __________ of words.

AD Moderate Stage (Mood):

  • ↓ Stress tolerance.
  • Very flat affect, blunted emotions.
  • “____________”
A
  • short-term, long-term
  • family, friends, and familiar tasks
  • time
  • comprehension
  • expression
  • repetition

-“Sundowning”

29
Q

AD Moderate Stage (Function):

  • ADL ___________.
  • Functional decline when tasks involve _________.
  • Altered __________ perception.
  • Impairment with starting an activity.
  • Often shows resistance to mobility attempts.
  • _____________

AD Moderate Stage (Behavior):

  • Withdrawal from ___________.
  • Fear of ____________.
  • Refuses care and services.
  • Increased confusion, agitation, belligerence.
  • Psychosis, Paranoia
  • Insomnia

AD Moderate Stage (Safety Concerns):

  • Elopement
  • Eating and drinking
A
  • dependence
  • cognition
  • deconditioning
  • socialization
  • abandonment
30
Q

AD Moderate Stage:

  • How long does it usually last?
  • Often have a _______ gait pattern.
  • Often found wondering around with no purpose unless what?
  • What is sundowning?
A
  • 2-10 years
  • shuffled
  • they have found a way to escape
  • significant decline in cognition, stress tolerance, and orientation that occurs
31
Q

AD Severe Stage (Memory and Thinking):
-memory __________ compromised

AD Severe Stage (Language):
-significant limited ________ output

AD Severe Stage (Mood):

  • agitation, irritability
  • lability
  • apathy
  • delusions, hallucinations
  • sleep and appetite changes
A
  • severely

- verbal output

32
Q

AD Severe Stage (Function):

  • ADL _________
  • incontinent bowel/bladder
  • ineffective swallow
  • functional ___________
  • progressive __________

AD Severe Stage (Behavior):
-still recognizes _________

AD Severe Stage (Safety Concerns):

  • high rates of ____________ and ________ pneumonia
  • __________ may occur
A
  • dependence
  • dependence
  • fatigue

-comfort

  • dehydration, aspiration pneumonia
  • seizures
33
Q

AD Severe Stage:

  • How long does it usually last?
  • How long does end-stage last?
  • What is often used to deescalate situations in this stage?
A
  • 1-3 years
  • 1-6 months
  • comfort items (baby doll)
34
Q

AD Diagnosis:

  • What is the gold standard for diagnosis?
  • What can we do before death to help with diagnosis?
  • What can be seen on a MRI and PET scan to help with diagnosis?
A
  • postmortem autopsy
  • diagnosis of exclusion, diagnostic imaging
  • MRI (hippocampal atrophy), PET (temporal and parietal hypometabolism)
35
Q

AD Treatment:

-Is there a curative treatment for AD?

A

No, but there are some medication found to slow the process of cognitive decline.

36
Q

AD Prognosis:

  • __-__ years to mortality from diagnosis.
  • ____ leading cause of death.
  • What are the main causes of death in this population? (4)
A
  • 6-15 years
  • 6th
  • pneumonia, infection, dehydration, malnutrition
37
Q

PART 3: VASCULAR DEMENTIA AND FRONTOTEMPORAL DEMENTIA

A

PART 3: VASCULAR DEMENTIA AND FRONTOTEMPORAL DEMENTIA

38
Q
  • Vascular Dementia is the _____ most common cause of dementia.
  • It is a unique type of dementia in that it has ________ and _________ undertones.
  • It results from multiple cortical and/or subcortical ________ or __________ strokes over time.
A
  • 2nd
  • cardiovascular and stroke
  • ischemic or hemorrhagic
39
Q

What are the 4 most closely linked risk factors to VD?

A
  1. ) Age
  2. ) Diabetes
  3. ) HTN
  4. ) Metabolic syndrome (presence of 3/4: obesity, HTN, dyslipidemia, insulin resistance)
40
Q

Treatment/management of VD is largely focused on ______ management.

A

CVA management

41
Q

How is VD diagnosed?

A

clinical examination + neuroimaging

42
Q

VD is dementia + ____________ deficits.

A

neurological

43
Q

VD:

  • Abrupt onset, with a _________ regression.
  • Unlike AD, will often see SxS of _____ injury, ______ deficits, and _________.
  • Severe ________ is often predominant feature.
A
  • stepwise
  • UMN injury, sensory deficits, aphasia
  • depression
44
Q

What is the main characteristic of cognitive impairments with VD is early and severe ___________ ___________ loss over everything else.

A

executive function loss

45
Q

What is the average years to mortality from initial infarct.

A

5 years

46
Q

Frontotemporal Dementia:

  • Average age of onset: mid ____ to ____.
  • Commonly misdiagnosed as __________ disorders.
A
  • 50s to 60s

- psychiatric disorders

47
Q

What is the cause of frontotemporal dementia?

A
  • genetic mutations linked to FTD

- unknown for ~50% of cases

48
Q

FTD Pathophysiology:

  • Variability, not entirely understood.
  • _________ build up is thought to be occurring, but not seen consistently with these patients and various involved __________ have been suggested.
  • Ultimately, see _________ and ________ _______ in frontal and temporal lobes of the brain.
A
  • protein

- atrophy and neuronal death

49
Q

Are temporal or frontal SxS seen most prominently in FTD?

A

frontal SxS

50
Q

What frontal SxS are seen with FTD?

A
  • disinhibition
  • apathy
  • loss of sympathy/empathy
  • repetitive/compulsive/ritualistic behavior
  • changes in eating/bathing habits
51
Q

What temporal SxS are seen with FTD?

A
  • progressive aphasia (most common: progressive nonfluent aphasia)
  • speech apraxia
52
Q

As dementia progresses, we can start to see widespread _________ involvement leading to things such as coordination, motor control, balance impairments, EOM dysfunction, and dysphagia.

A

cortical

53
Q

FTD Clinical Course And Prognosis:

  • Does it usually start with frontal or temporal SxS?
  • ___-___ years to mortality from onset of symptoms.
A
  • frontal, but can start with temporal

- 10-15 years

54
Q

PART 4: TREATMENT CONSIDERATIONS

A

PART 4: TREATMENT CONSIDERATIONS

55
Q

Anti-Dementia Therapy:

  • ____________ inhibitors: slow progression and increase function in Alzheimer’s disease, DLB, and vascular dementia.
  • ________/_________: manage compulsive behaviors in FTLD and Alzheimer’s disease.
  • _____, mood stabilizer, antipsychotics for behavioral symptoms and depression in FTLD and vascular dementia.
  • Currently no FDA-approved medications for ________ and _________ seen in dementia.
A
  • Cholinesterase
  • Namenda/Memantine
  • SSRIs
  • agitation or psychosis
56
Q

List some cognitive outcome measures used for dementia.

A

Global Functioning

  • MMSE
  • Alzheimer’s Disease Activity Scale-Cog
  • Severe Impairment Battery
  • MOCA

Executive Functioning

  • Verbal Fluency Test-Category
  • Verbal Fluency Test- Letters
  • Clock Drawing Test
57
Q

List some physical outcome measures used in dementia to address mobility, endurance, balance/fall risk, and muscle strength.

A

Mobility

  • TUG, TUG-cog, TUG-man
  • 6 meter walk/gait speed

Endurance
-6MWT

Balance/Fall Risk

  • Berg Balance scale
  • Mini-BESTest
  • Groningen Meander Walking Test

Muscle Strength/Power

  • 5x Sit to Stand
  • 30s chair rise
58
Q

What is the most common cognitive outcome measures used for dementia?

A

MMSE

59
Q

MMSE:

  • Brief screening tool, provides quantitative assessment of _________ impairment.
  • ___ simple questions, __ domains (total: __ points)
A
  • cognitive
  • 11 questions, 7 domains, (30 points)
  • orientation to time, orientation to place, registration of 3 words attention and calculation, recall of 3 words, language, visual construction
60
Q

What are the cutoff scores for the MMSE?

A
  • > /=24- no cognitive impairment
  • 18-24- mild cognitive impairment
  • 0-17- severe cognitive impairment
61
Q

One of the biggest underlying factors to a patients cognitive status getting in the way of a PT treatment session is they have a progressively lowered _______ threshold.

A

stress

62
Q

What are the 6 notable points to help define difficulty? (Progressively Lowered Stress Threshold Theory)

A
  1. ) People with dementia prefer to lead a lifestyle as close as possible to what they have lived across the lifespan.
  2. ) Person with dementia will become progressively disabled in coping with stress.
  3. ) Secondary behavioral symptoms occur when stress exceeds the person’s capacity: like panic attacks
  4. ) People experiencing secondary behavioral symptoms are uncomfortable.
  5. ) Prior to this reaction, the patient experiences anxiety and often tries to relieve stress prior to the incident.
  6. ) Factors triggering these episodes can be controlled or modified to prevent excess disability and can occur up to 36 hours prior to the stress-related event.
63
Q

What are the 3 main categories for treatment considerations?

A
  • Fatigue
  • Engagement
  • Communication
64
Q

Fatigue:

  • _________ is often a primary factor contributing to behavior challenges.
  • What are some treatment strategies to address this?
  • _________ activity has been shown to help cognitive fatigue. (3-5x/week, 20-30min/day)
A
  • fatigue
  • frequent cognitive (and motor) rest breaks, strategic scheduling, established routines, consider environment
  • aerobic activity
65
Q

Engagement:

  • Find activities and create environments that create __________ experiences for your patients.
  • Maximize success through adaptations and supportive cues.
  • __________ activities often elicit more positive responses than new or _________ ones.
  • Use _________ to your benefit as able.
A
  • meaningful
  • familiar, unfamiliar
  • family
66
Q

Communication:

  • Important to consider that these patients have poor _________ and ____-____ memory, repetition, understanding, and issues with identification of words and names. Also, language is often vague, tangential.
  • Try to avoid arguing, reasoning, over-explaining, or coercing when a patient has inappropriate or incorrect thought. Avoid making the patient feel _______ for not remembering. Avoid
A

-immediate and short-term memory

-

67
Q

With these patients, what do we need to do?

  • Reassure, agreement
  • Apologize
  • Avoid yes/no
  • Defer when needed
  • Redirect, distract
  • Praise and thank
A

Enter their reality.

S4- Neuro 1 (12 decks)

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