Dementia and Mvmt Disorders Flashcards by Lauren Bainter

delirium sx

acute onset (over hours)
worse at night

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what is a common medical condition that causes delirium?

organ failure
multi - young; one - older

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what are some common drugs that cause delirium?

anticholinergic drugs
benzodiazepines
opiates
steroids
(also antihistamines, muscle relaxants, antibiotics)

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what is the main treatment for delirium?

eliminate the underlying cause

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how is normal aging different than dementia?

dementia interferes with normal IADLs

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dementia is diagnosed by the presence of 2 of the following: impaired…

learning and short-term memory
handling of complex tasks
reasoning ability (abstract thinking)
spatial ability & orientation
(constructional ability and agnosia)
language (aphasia)

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what other factors must be present for dementia diagnosis?

significant impairment in social and occupational functioning
decline from previous level of function
not due to delirium or major psy illness

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memory is mainly controlled by the ____ lobe

temporal

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spatial awareness is mainly controlled by the ____ lobe

parietal

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reasoning and complex tasks is mainly controlled by the ____ lobe

frontal

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what is the triad of sx for normal pressure hydrocephalus?

memory problems
gait problems - magnetic
incontinence

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what are cognitive assessments used to rule in or out dementia?

mini mental status exam (MMSE)
Montreal Cognitive Assessment (MOCA)
SLUMS exam
clock drawing
neuropsych tests (visual perception spatial function, executive function)

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which test is harder: MMSE or MOCA?

MOCA

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Alzheimer’s mainly effects _____ which leads to memory issues

hippocampus

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which domains does clock drawing test assess?

visuospatial
executive
attention
memory

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what are predictors of rapid progression in mild cognitive impairment (MCI)?

medial temporal lobe atrophy (MRI)
hypometabolic pattern (FDG-PET)

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T/F: there is no drug effective for MCI

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how does initial stage Alzheimer’s present?

short term memory loss
word finding difficulties
mild executive dysfunction
mild visuospatial deficits

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how does later stage Alzheimer’s present?

all aspects of memory impaired
fluctuating behavioral changes
disturbed sleep and appetite
hallucinations

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how does end stage Alzheimer’s present?

mute
aspiration risk
bed bound
incontinent

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which lobe(s) does Alzheimer’s usually effect?

temporal and parietal
(memory & visuospatial)

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what is the most common neurodegenerative disorder?

Alzheimer’s

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early onset Alzheimer’s is when it occurs in _____ years old

<60

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main theories of Alzheimer’s pathology (biomarkers)

neurofibillary tangles tau protein
senile plaques - amyloid

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what is the lobe progression of Alzheimer's?

hippocampus/temporal parietal frontal global

what are the deficits in vascular dementia?

attention and concentration (ex: remember words to recall with hints)

two main types of vascular dementia

multi-infarct subcortical

which portions of the MOCA will vascular dementia pts have trouble with?

visuospatial recall

cholinergic deficiency (in Alzheimer's) results from degeneration of the

nucleus basalis of Meynert

which med is for more severe Alzheimer's?

NMDA partial antagonist (Memantine (Namenda))

meds for Alzheimer's

cholinesterase inhibitor: - donepezil (Aricept) - galantamine (Razadyne) - rivastigmine (Exelon) antipsychotics benzodiazepines

what meds are used to clear out amyloid for Alzheimer's?

LECANEMAB (effective) Aduhelm (no effect shown yet)

what is a concerning side effect of Lecanemab?

brain bleeding

when can Lecanemab be administered?

EARLY stage ONLY

Lewy Body dementia is involvement of ____ and ____ lobes

parietal and occipital (not temporal like traditional)

what is a suspected if a person acts out their dreams and has Parkinsonism?

Lewy Body dementia

Lewy Body dementia probs

attention executive function visuospatial

which dementia has less memory issues?

Lewy Body dementia

Lewy Body dementia have 2 or more of ...

fluctuations recurrent visual hallucinations spontaneous parkinsonism REM sleep behavior disorder

meds of Lewy Body dementia

acetylcholinesterase inhibitor (rivastigmine) - hallucinations levodopa-carbidopa - parkinsonism antipsychotics (w/ caution)

which med should be avoided with Lewy Body dementia?

haldol (antipsychotic)

what is the 2nd most common cause of early onset dementia?

frontotemporal lobe degeneration (FTD)

if a younger person (45-60) has signs of dementia, which type is suspected?

frontotemporal lobe degeneration (FTD)

what is different about frontotemporal lobe degeneration (FTD)?

memory is OK massive personality changes pt thinks they're fine

50% of all frontotemporal lobe degeneration (FTD) is

behavioral variant (bcFTD)

pathology of behavioral variant (bcFTD)

frontal and temporal lobe atrophy NO amyloid collection gradual onset of behavioral changes

meds for behavioral variant (bcFTD)

antidepressants antipsychotics cholinesterase inhibitors (less effective)

movement disorders are generally due to pathology of _____

basal ganglia (or cerebellum)

movement disorders are unrelated to ____ and ____

weakness and spasticity

extrapyramidal system main function

fine tuning

extrapyramidal system components

susbstantia nigra red nucleus subthalamic nucleus

difference between hypokinesia and bradykinesia

hypo - decreased amplitude (smaller mvmts) brady - slower

what is chorea?

ongoing RANDOM involuntary movements (dance-like)

what is a rhythmic oscillatory movement around an axis (predictable)?

tremor

what prevents stable posture?

athetosis

what is violent movement at a joint?

ballism

what is dystonia?

involuntary SUSTAINED or intermittent contractions cause twisting/repetitive movements or abnormal postures

what is repeated NON-RHYTHMIC BRIEF shock-like jerks?

myoclonus

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

tic

what is repetitive simple movements that CAN BE SURPRESSED?

stereotypy

postural tremor is revealed by _____ing a limb against gravity

extending

type of tremor? big handwriting small handwriting

big - essential tremor small - Parkinson's

essential tremor: location position direction frequency amplitude

location: bilateral position: action, posture direction: flexion-extension frequency: faster amplitude: high or low

Parkinson's tremor location position direction frequency amplitude

location: unilateral then bilaterla position: rest direction: pronation-supination frequency: slower amplitude: high or low

meds for essential tremor

primidone (antiepileptic) propranolol (beta-blocker) topirimate (antiepileptic)

location progression of essential tremor

hands --> head --> speech, chin, tongue, trunk, legs

Parkinson's has a loss of ___ cells in the ____

dopaminergic cells substantia nigra

what is the 2nd most common neurological disease?

Parkinson's

features of Parkinson's

rest tremor rigidity bradykinesia loss of postural reflexes freezing flexed posture of trunk, neck, & limbs

meds for Parkinson's

levodopa (motor) dopamine agonist (motor) COMT inhibitor (advanced Parkinson's) MAO inhibitor (advanced Parkinson's) anticholinergics (tremor) amantadine (dyskinesias) deep brain stimulation (advanced Parkinson's)

most common med for Parkinson's

levodopa

tx for advanced Parkinson's that does not have side effects

deep brain stimulation

at __% dopamine loss, motor symptoms begin

70%

the toxic level of dopamine window ____ as Parkinson's progresses

decreases

surgical tx of Parkinson's

thalamotomy (contra tremor & rigidity) pallidotomy (tremor, rigidity, bradykinesia) deep brain stimulation

atypical parkinsonism disorders

Lewy Body Dementia Progressive supranuclear palsy (PSP) Corticobasal degeneration (CBD) Multisystem atrophy (MSA)

sx of Progressive supranuclear palsy (PSP)

inability to look up or down axial rigidity early falls (first sx)

sx of Corticobasal degeneration (CBD)

alien limb/apraxia

sx of Multisystem atrophy (MSA)

orthostatic hypotension hyperreflexia

which parkinsonism is known as lower body parkinsonism?

vascular parkinsonism

MRI changes in vascular parkinsonism

extensive subcortical white matter ischemic disease

main drugs that cause rest tremor

dopamine blocking (antipsychotics) metoclopramide

which chromosome is faulty with Huntington's Disease?

4 (autosomal dominantly inherited)

main neuronal loss in Huntington's Disease is in the ___ and ____

caudate and putamen

sx of Huntington's Disease

personality changes dementia CHOREA athetosis

what is athetosis?

slow, nearly continuous writhing movements of the distal extremities

what is the main tx for chorea?

tetrabenazine

what is Wilson Disease?

treatable disease of copper metabolism can present with tremor

sx of Wilson Disease

behavioral and personality changes dysarthria ATAXIA ABNORMAL MOVEMENTS chorea, athetosis, tremor, rigidity

tx for Wilson Disease

chelation with D-penicillamine

Wilson Disease is common in what age group?

young (20-30s)

dystonia is initiated or worsened with

voluntary movement

what can help relieve dystonia?

sensory tricks - gentle touch to affected area

what body parts does focal dystonia effect?

head, neck, or limb muscles

focal dystonia age group generalized dystonia age group

focal - adults general - kids

med for dystonia

botox

dx requirements for Tourette Syndrome

>1 motor tic 1 vocal tic fluctuating course present >1 year onset must be before 21 yo

Tourette Syndrome peaks during

puberty

meds for Tourette Syndrome

neuroleptics (Haldol, pimozide) clonidine

what disorder is caused by a problem with the functioning of the NS not a structural issue?

Functional Neurological Disorder (FND)

characteristics of epileptic seizures

open eyes hypoventilation lack of memory 1-2 min duration GTC or tonic sudden onset unilateral shaking

what helps suppress movement disorders?

distraction (esp. Parkinson's)

test used for discriminating weakness and movement disorders?

Hoover sign