cognition Flashcards
1
Q
What is cognition
A
- the process of acquiring knowledge and understanding from thought, experience and exploring the senses
- attention/awareness
- orientation
- concentration
- memory
- reasoning
- judgment
2
Q
What are the components of cognition
A
executive functioning
- planning
- manipulating
- recognizing errors/problems
- abstract thoughts
- initiating and ceasing an activity
perception:
- neglect
- agnosias
- apraxia
- right-left discrimination
- visual spatial
3
Q
What is dementia
and what areas are typically impaired
A
- it is a global term for a collection of symptoms that can be caused by alterations in the way the brain functions
three of the following areas will be impaired:
- language
- memory
- visuospatial skills
- emotion
- executive functioning skills
4
Q
cortical dementia
A
- dementia where the brain damage primarily effects the cortex
- tends to cause problems with memory, language, thinking, and social behavior
5
Q
subcortical dementia
A
- dementia that affects parts of the brain below the cortex
- tends to cause changes in emotions and movement in addition to problems with memory
6
Q
progressive dementia
A
- dementia that gets worse over time
- gradually interfering with more and more cognitive abilities
7
Q
primary dementia vs secondary dementia
A
- dementia such as AD that does not result from another disease
VS
- dementia that occurs as a result of a phsyical disease of injury
8
Q
MCI
mild cognitive impairments
A
- a syndrome in which cognition decline is > than expected for an individual’s age and education level
- often noticebale to family and friends
- 3-19% of those 65 years and older have this diagnosis
- possible precursor to alzhemiers disease/dementia
- may not further progress
9
Q
MCI and gait
A
- slowing of gait and speed during dual tasking conditions assoicate with poor performance
- attention
- execuative function
- working memory
10
Q
Alzheimer’s disease
incidence
A
- most common form of dementia in elderly
- affects more women than men (first degres relative or head traume)
- typical onset is 40-90 years of age
- greatest age group after 65 and risk increases every 5 years after
- memory and cognitive problems have a slow insidious onset
- eventually leads to a decline in ability to complete ADLs
11
Q
Alzheimer’s disease
definition and cause
A
- progressive, degenerative irreversible disease that affects the hippocampus, neocortex, and transcortical pathways of the brain
- plaques (beta amyloid) and neurofibrillary tangles (tau protein) progressively impede synpatic connections and cause neuronal death
- typically begins in hippocampus
- exact etiology is not known
12
Q
Alzheimer’s disease
medical diagnosis
A
- cannot confirm a diagnosis until death
- diagnostic techniques have improved
- medical and pscyhological evaluations are critial
- additional dementia’s need to be ruled out
13
Q
Alzheimer’s disease
guidelines for diagnosis
A
- biomarkers for beta-amyloid on PET scans and CSF
- tau protein in CSF
- glucose metabolism in brain on PET
14
Q
Alzheimer’s disease
three identified stages
A
- dementia due to Alzheimer’s disease - biomarkers changes with noticeable change in funciton
- mild cognition impairment due to Alzheimer’s disease - biomarkers change but insignificant changes with function
- preclinical Alzheimer’s disease - biomarkers only change
15
Q
Alzheimer’s disease
Clinical features
A
- progressive memory loss
- decline in cognitive function specifically executive
- changes in mood/personality (more common with frontotemporal dementia)
- aphasia
- agnosia
- apraxia
- visual changes
- motor function may be preserved in early stages
- gait changes
- communication deficits
- diffculty with ADLs
- primitive reflexes return like grasping
16
Q
Alzheimer’s disease
behaviors assoicated
A
- wandering aimless or night time (sundown syndrome)
- pacing: purposeful wandering)
- repetitive vocalizations
- agitation
- hoarding
- rummaging
- resistance usually with personal care
- sexually inappropriate
17
Q
Alzheimer’s disease
additional symptoms: sundowning
A
- later afternoon and evening
- disorientation/hallucinations may heighten
- possible causes: possibly related to fatigue, lighting, dehyrdation, poor routine/structure
18
Q
Alzheimer’s disease and gait
A
- increased TUG scores
- decreased gait speed in 10 meter walk test
- decreased times in tandem stance with eyes open and with eyes closed compared to those wihtout AD
- dual tasking typically results in gait disturbances
19
Q
treatment for AD
A
- primary goal of medications is to slow the disease process
- it does not prevent
- types of medication:
- cholinesterase inhibitors (prevents breakdown of ACh which aides in learnign and memory) may delay for 6-12 months
- NMDA receptor: regulates activity of glutamate involved in learning and memory - side effects: nausea, confusion, dizziness and headaches
20
Q
Lewy Body dementia
A
- a progressive degenerative form of dementia that is named after the round lumps found in the nuceli of the cerebral cortex and brainstem
- difficulty to get a dx on this early on
- the cerebral cortex degenerates
- limbic cortex degenerates
- build up of protein within the cells - alpha-synuclein
- neurons die in midbrain similar to parkinsons
- affects production of neurotransmitter, dopamine and brain protein alpha-synuclein
21
Q
Dx criteria for LBD
A
3 must be present
- progressive cogntive decline that interferes with normal, social and occupational activities
- memory problems
- difficulties with attention, logical thinking, perceptions of space and time
2 of the following exist
- fluctuating cognition
- visual hallucinations
- parkinsonism
Other
- repeated falls, fainting, delusions, BP issues, sensitivity to certain drugs (antipsychotics)
22
Q
how to differentiate with LBD and parkinsons
A
- cognitive issue is the primary symptoms with LBD vs motor symptoms in parksons
- hallucinations occur in early stages, frequently and are vivid
- timing of motor vs cognitive symptoms
- tremor is less pronouced in LBD vs parkinsons
- patients with LBD respond less dramatically to Levadopa than those with parkinsons
23
Q
Motor preformance of those with LBD, AD, and PDD
A
- research has shown that those with LBD walked with decreased stride lengths
- did no preform as well on tinetti, berg, and dual task activites as those wtih PD and/or AD
- additional sutdies of the 9-hole PEG test - those with LBD has the lowest scores compared to those with PD and AD
24
Q
Vascular dementia
A
- dementia that is directly related to cerebrovascular disease
- previously referred to as a multi-infarct dementia
25
# diagnosis
vascular dementia (VD)
- CT and MRI brain scans
- guidelines vary per criteria used
- *per NINDS-AIREN criteria*
- dementia, CVA
- relationship between dementia and CVA
- onset of dementia within 3 months of CVA
- abrupt deterioration in cognition functions or fluctuating
26
Clinical features of VD
- gait disturbances
- frequency falls
- urinary frequnecy, urgency, incontinence
- focal neurological signs
- personality/mood changes
- frequently present with delayed processing, persveration, motor and sensory disturbances
- impulsivness, neglect and or aphasia
27
VD - ADDTC criteria
`ischemia VD will include`
- dementia
- 2 or more ischemic strokes or one stroke with clearly documented temporal relationship to the onset of dementia
- CT or MRI reveals infact of the cerebellum
- multiple infarcts or TIA's may be assoicated with Ischemic vascular disease
- History of HTN, CAD, DM
28
Normal pressure hydrocephalus
- typically occurs in elderly
- a malfunction in brain ventricles that leads to poorly controlled lower extremity movement and bladder control
Diagnosis: CT scan
Presentation:
- acute cogntive chagnes (memory)
- unsteady shuffling gait
- urinary incontinence
Treatment: shunt placement
rehab implications: falls, change in ADLs
29
Delirium (acute)
- acute disorder of dementia
- toxic psychosis, metabolic encephalopathy, peudodementia
- an abrupt onset of
- alterations in attention that fluctuate within the day
- disorganized thinking, rambling speech r incorherent that may change within the day/hour
- disturbed psychomotor activity
- changes in level of consciousness
- cause: illness, stress, age related changes medications
30
Complications of delirium
- falls
- malnutrition
- dehydration
31
rehab implications fo delirium
- mobilize as soon as able
- minimize use of restraints
- ADL training
32
depresison/anxiety
- 25-50% suffer from depression 70% goes undetected
- altered mood with loss of interest in all pleasureable activities
- Dx; decreased appetite, insomina, agitation, loss of interest, fatigue, feelings of worthlessness, guilt, decreased concentration, recurrent deaths of suicide/death
- giriatric depression scale = short survey 15-30 questions a score of 5 or higher may = depression
33
Wernicke-korsakoff syndrome
- vitamin B thiamine deficiency
- typically assoicated with chronic alcoholism
- two differnet condtions occuring simultaneously (wernicke's disease and koraskoff psychosis)
- affects STM more than LTM
34
Wernicke-korsakoff syndrome: presentation and treatment
presentation
- gradual
- apathy/passivity/confabulation
- gait is ataxic, decreased cadence
treatment:
- thiamine replacement
- cessation of ETHO
- memory loss may recover if early stages
35
rehab focus for those with cognitive disorders
- maintain physical and emotional health
- find activities that are meaningful/self-worth
- fall prevention - home safety
- caregiver support and training
- always maintain dignity and be mindful of the patients wishes
