Dementia & Mmt Disorders Flashcards by Tori Chatman

Cognitive Screens for Dementia

-mini mental status exam
-Montreal cognitive assessment
-referral of neurophysiological testing

Benefits:
-cueing, instructions, education, documentation

Limitations:
-can be demeaning, only a screen

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Outcome Measures for Dementia

-TUG
-QoL
-Depression
-Anxiety
-caregiver burden
-Berg
-6MWT

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Test Selection: Dementia

-should be obvious
-short instructions
-short duration

Tips:
-clear speech
-friendly facial expressions
-eye contact
-remove distractions

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Aerobic Ex for Dementia

-lessens cognitive impairments and dementia risk
-neuroprotective
-reduces agitation
-moderations brain atrophy

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Strength Training Recommendations @ Old Age

-2x week major muscle groups
-mod to high intensity

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Balance Training @ Old Age

-3x week
-fall rpevention

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Home Exercise Program (Dementia)

-practice
-clear language
-big print
-increase self efficacy

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Maintaining Personhood

-person’s growth in coping skills
-focus on independence
-subjective experience of illness

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Remaining Cognitive Strengths

-reading simple words
-emotional and procedural memory
-L/R orientation

tie in to movement/exercise

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LEAD Rehabilitation Framework

Leveraging
Existing
Abilities In
Dementia

-developing an underlying knowledge
-integrate communication, cognition, coping

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Communication Strategies

-approach from front on their level
-remove distractions
-eye contact
-smiling
-explain
-invite to participate; allow to time to respond w/ repetition
-K.I.S.S: keep it short and simple
-ask questions based on currrent, not short term memory
-cues
-narrow choices

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Cognition/Education Strategies

Errorless learning
-with feedback

Modeling
- to utilize procedural memory (motor tasks, for language deficits)

Spaced Retreval
-builds on implicit or procedural memory
-retaining info by recalling
-learining without intention

External Memory Aids
-ABLED
-memory books
-planners/signs/calendars

Cognitive Task Analysis
-breaking down a task into simplest cognitive components

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ABLED

-accessible: easily seen
-bright
-legible: large
-explicit: simple
-done: able to cross off

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Coping Strategies

Reframing
-changing thinking and descalating

Re-Evaluating Expectation
-reasonable goals to the person

Substituting Behaviors
-replacing undesirable behaviors with others

Adjusting the Environment

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Pearls of Wisdom

-patient centered care
-Match patient and appropriate clinician
-Have back up plans
-know how much communication
-be creative

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Delirium

-acute confusional state
-short period of time
-worse at night
-80% of elderly in ICU
-15-50% of all hostpital pts

S/s:
-disrupted sleep
-disordered thinking
-delusion
-hallucinations
-restlessness

Causes:
-vascular
-Trauma/surgery
-Metabolic/infection
-Tumors/seizures
-Drugs

Treatment:
-reoreintation
-out of bed
-less noise at night
-solve underlying issues

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Dementia

-progressive loss of congitive functions that interfere activites

S/s;
-Impaired learning and memoy (temporal)
-impaired complex tasking and reasoning (frontal)
-impaired orientation (pareital)
-aphasia (temportal and parietal)
-changes in social
-decline from previous

Causes:
-alzheimers
-vascular
-parkinsons
-huntingtons
-alcohol
-CTE
-HIV/infections
-Meds

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Normal Pressure Hydrocephalus

-memory problems, gait (magnetic), incontinence

Imaging: large ventricles

Treatment: VP shunt

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Evaluation of Dementia

HX:
-impairement
-onset
-progression
-prior level of function

Exam:
-observstion
-mental status
-neuro

Labs:
-HIV/syphilis
-thyroid/liver/kidney
-B12/folate
-Lupus test

Imaging:
-MRI
-PET/Amyloid PET (ARIA-E)

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Mild Cognitive Impairement

-pre dementia
-impairement in 1 or more domain w/o dementia or ADL involvement
-12-18% of ppl >60

Predicitors:
-medial lobe attrophy

Tx:
-exercise (no drugs)

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Alzheimer Disease

-progressive cognitive, fucntiona behavior deficits
-MC neurodegenerative disorder
-6th MC cause of death in USA
-70% of dementia

S/s:
Early: short term mem loss, word finding difficulties, mild deficits of executive funtion

Later: all memory inpaired, behavior, sleep, appetite

End: mute, aspiration, bed bound, incontinent

RK:
-woman
-genertics
-education
-head trauma
-health

Alzheimer Cause

-brain atrophy (temporal and parietal MC) with neuron loss
-Neurofibrilary tangle tau protein and Senile plaques from amyloid beta protein

Vascular Dementia

-more issues with executive function, attention and recall

Multi-infarct Dementia:
-progressive
-step wise; stable then multiple strokes decline memory
-asymmetrical

Diffuse White Matter Disease:
-chronic/progressive
-global

Subcortical:
-attention and concentration decline with psychomotor slowing

Alzheimer’s Treatment

Cholingeric deficiency:
-results from degeneration fo Nucleus Basalis of Meynert
-inhibitors slow progression a little

Amyloid:
-aducanunab/lecanemab makes antibodies to clear out amyloid in the brain
-slows decline by 27%
-must get it early/expensive/bleeding

Parkinson's Dementia

-Lewy Body Dementia -15-30% of dementia Dementia: -before parkinsons -attention/executive/memory 2+: -fluctuations -visual hallucinations -spontaneous parkinsons -REM sleep behavior disorder (night terrors) Suggestive Features: -neuroleptic sensitivity Supportive Features: -falls/syncope -autonomic dysfunction -hallucinations -depression -perserved medial temporal lobe Tx: -Rivastigmine for hallucinations -Levodopa-Carbidopa for motor parkinsons -Haldol Avoided for increase deterioration

Frontotemporal Lobe Degeneration

-2nd MC cuase of early onset dementia -45-64yr old -aren't aware they have a problem (unlike alzheimer's) Subtypes: -Behavioral variant: 50%, atrophy in frontal and temporal; tau; disinhibition/loss of empathy/apathy/increased sex drive -Primary progressive aphasia -Motor neuron disease

Movement Disorders

-neurological syndromes with excess of movement -basal ganglia -no weakness or spasticity -sudden onset -Entrainment: sync up -improves with distraction (parkinsons)

Pyramidal System

-Cortex -internal capsule -brainstem -medullary pyramids -corticospinal tractts -anterior horn of SC

Extrapyramidal System

-fine tuning motor control -basal ganglia -substantia nigra -red nuc -subthalamic nuc

Dyskinesia

-abnormal mmt

Akinesia

-loss of mmt

Tremor

-rhythmic oscillatory mmt around an axis -predictable contractions -Resting -Postural: reveal by extending limb against grav -Intention: moving a limb tto and from a target

Chorea

-random involuntary mmt -can be incorporated into mmt -dance-like

Athetosis

-prevents stable posture -slow writhing mmts

Ballism

-more violent mmt at a joint -proximal

Dystonia

-involuntary sustained or intermittent contractions cause abnormal postures and mmts -worsened by voluntary mmt -head, neck, limbs ex: torticolis, club foot Tx: -sensory tricks with gentle touch -botox -contracture prevention

Myoclonus

-repeated non rhythmic breif shock like jerks -everyone has

Tic

-mmt with an urge that is relieved by mmt (feel urge) -brief rapid mmt/sound -can be supressed

Stereotypy

-repetitive simple mmt that can be supressed Ex: restless leg

Parkinsonian Tremor

-unilateral to bilateral -hands/leg/chin -rest -pronation to supination -slower

Essential Tremor

-bilateral -fast (5-8hz) -flx/ext -large writing -slow progression -hands>head>speech

Parkinson Disease

-progressive, loss of dopaminergic cells within substantia nigra -2nd MC neurodegenerative disease -5th and 6th decades S/s: -Masked face -Bradykinesia: decreased blink, soft speech, loss of inflection, small writing, shuffling -Stooped posture -Rigidity: cog wheeling -Rest tremor: pill rolling/slower -loss of reflexes -freezing -Flexed posture Tx: -Meds -Deep brain stimulation -Thalamotomy: improves contra tremor, rigidity -Pallidotomy: globis palladis; improves tremor, bradykinesia, rigidity

Progressive Supranuclear Palsy

-Atypical parkinsonism disorder -inability to look up or down -axial rigidity -early falls

Corticobasal Degeneration

-alien limb -ataxia

Multisystem Atrophy

-ortho hypo -hyperreflexia

Vascular Parkinsonism

-lower body parkinsonism -normal UE -extensive subcortical white mattter ischemic disease -step deterioration

Huntington Disease

-autodomal dom, chrom 4 -35-42 -lifespan after diagnosis 17y -neuronal loss in the caudate and putamen S/s: -personality/dementia -chorea -athetosis: slow continuous writhing movements of distal extremities -enlarge lat venticles Tx: -Tetrabenazine: depletes dopamine

Wilson Disease

-treatable/ auto recessive -copper metabolism issues -tremor S/s: -behavior -dysarthria -ataxia -abnormal mmts -liver cirrhosis Tx: -chelation with penicillamine

Toruette Syndrome

-genetic disorder; auto dom -ass with OCD and ADHD 50% Dx: ->1 motor tic -1 vocal tic -flucuating ->1 yr -beore 21yrs Tx: -haldol, clonidine

Functional Neurological Disorders

-15-30% referrals to neuro -neuro s/s caused by problem in NS, not due to damage -must explain it is real Dx: -no inattention tremor (goes away) -might be psychological