lecture 7: dementia and movenet disorders Flashcards by sophia carrasco

what is delirium

actue confusion state

How well did you know this?

Not at all

Perfectly

what is the progressive loss of cognitive functions which interfere with work or usual social activities

dementia

How well did you know this?

Not at all

Perfectly

what is an onset over a short period of time (typically over hours ) , worse at nights and has associated features of

– Disrupted sleep wake cycle
– Disorganized thinking
– Inattention
– Drowsiness
– Restlessness/agitation/combativeness – Delusions
– Hallucinations

delirium

How well did you know this?

Not at all

Perfectly

is delirium or dementia common in the hospital

delirium

How well did you know this?

Not at all

Perfectly

what drugs can causes ddelirum

-anticholinergic
-benzo
-opiates
-steroids

How well did you know this?

Not at all

Perfectly

what is the treatment for delirium

-eliminate the cause
- frequent re orientation with white boards w th days date and schedule
- out of bed during the day w blinds open
-reduce noise at night

How well did you know this?

Not at all

Perfectly

An 83-year-old man was evaluated for 2 years of progressive cognitive decline. He reported increasing problems remembering the names of distant acquaintances, thinking of words, and learning to use new devices. He started keeping a detailed to-do list and daily calendar because he had missed several medical appointments. His wife agreed that he had become more forgetful in the previous 2 years and commented that he now repeated himself in daily conversations. He remained active in local community organizations and was fully independent with all instrumental activities of daily living. His medical history was notable for well-controlled hypertension. He had been taking diphenhydramine at bedtime for many years for insomnia

would u think dementia ??

no just normla aging

How well did you know this?

Not at all

Perfectly

• Decrease in attention span and ability to learn new information with age.
• Mild and do not affect normal IADLs

what does this describe

normla aging

How well did you know this?

Not at all

Perfectly

Dementia?
A 73-year-old woman presented for evaluation of 3 years of progressive memory loss. Her husband reported that she frequently misplaced personal items, forgot passwords, and repeated the same questions. She had trouble locating her car in the parking lot and had been late paying bills. She had difficulty completing tasks and recently seemed overwhelmed when trying to plan travel for a vacation. She had shown less interest in previous hobbies but did not report low mood. She denied motor problems or disruption of sleep. Her husband had taken over managing finances and bill paying and had to remind her to take her medications. She was otherwise independent with day-to-day function

yes bc decline in PLOF

How well did you know this?

Not at all

Perfectly

what is dementia based on

history and mental status exam

How well did you know this?

Not at all

Perfectly

dementia is characterized by the presence of at 2 least of the following

-impaired learn and short term memory
- impaired handing complex task
- imparied reasoning ability
-impaired spatial ability and orientation
-impaired language

How well did you know this?

Not at all

Perfectly

dementia is Based on history and mental status exam, dementia characterized by presence of at least 2 of following:
– Impaired learning and short-term memory
– Impaired handling of complex tasks
– Impaired reasoning ability (abstract thinking)
– Impaired spatial ability and orientation (constructional ability and agnosia)
– Impaired language (aphasia’

what lobes are these in

Impaired learning and short-term memory (TEMP)
– Impaired handling of complex tasks (FRONT)
– Impaired reasoning ability (abstract thinking) (FRONT)
– Impaired spatial ability and orientation (PART)(constructional ability and agnosia)
– Impaired language (aphasia(TEMP/PAR)

How well did you know this?

Not at all

Perfectly

does dementia have a decline from PLLOF

yes

How well did you know this?

Not at all

Perfectly

• Alzheimerdisease
• DementiawithLewy
Bodies
• Frontotemoral Dementia
• Vascular dementia
• Parkinsondisease
with dementia
• Progressive supranuclear palsy
• Huntington disease
• Alcohol related dementia
• Chronic traumatic encephalopathy
• Medication side effects
• Prion disease
• HIV

these are all causes of what

dementia

How well did you know this?

Not at all

Perfectly

• Medication side effects
• Poor sleep - ? Sleep study
• Hypothyroidism, B12 deficiency, Thiamine deficiency
• Neurosyphilis, other infections
• Autoimmune encephalitis
• Normal pressure hydrocephalus

these are reversible casues of waht

dementia

How well did you know this?

Not at all

Perfectly

what will be the different on a image of a normla pressure hydrocephalaus vs atrophy

hydro will just be big ventricles and atrophy will be big ventricles but also atrophy of the brain

How well did you know this?

Not at all

Perfectly

what is the triad of normal pressure hydrocephalus’s

-memory problems
-gait problems - magnetic major problme
- incontinence

How well did you know this?

Not at all

Perfectly

what is the dx and rx for a normal pressure hydrocephalus

dx: large volume lumbar puncture
rx: VP shunt

How well did you know this?

Not at all

Perfectly

what is the rx and dx for normal pressure hydrocephalus

rx:VP shunt
dx: large volume lumbar puncture

How well did you know this?

Not at all

Perfectly

what is the bed side exam that is for dementia is assess cognitive and ask what is the year , season , date , time , country , to count back wards.. etc

mini mental status exam

How well did you know this?

Not at all

Perfectly

what is a bed side exam for dementia that tells you what u are testing and is more common but harder then the others

montreal cognitive assessment (MOCA(

How well did you know this?

Not at all

Perfectly

what is a bed side exam for dementia that tells the patients a story and they have to memorize some of it

SLUMS exam slu.edu

How well did you know this?

Not at all

Perfectly

what cognitive domains does the clock drawing test

visuospatial , executive , attention , memory

How well did you know this?

Not at all

Perfectly

what is the 3 hour cognitive testing that test visual perceptual spatial functional and executive functioning and is the best fore dementia it just takes the longest

neuropsychological testing for dementia

How well did you know this?

Not at all

Perfectly

– Copy various geometric designs – Identify faces – Calculations – Left right discrimination this is apart of what functioning for the neuropsychological testing

visual perceptual spatial functioning

– Naming fluency – Alternate numbers and letters in order – Stroop test – Repeat series of hand gestures these are for what functions for the neuropsychological testing

executive functioning

what is considered Pre-dementia/prodromaldementia

mild cognitive impairment (MCI)

what for MCI predictors of more rapid progressions

medial temporal lobe atrophy on MRI and hypo metabolic pattern on FDG-PET

what is progressive cognitive , functional and behavioral deficits

alzheimer’s disease

what lobes does alzheimer’s disease hit first

temporial (fisrt) and parietal lobe ## Footnote Temporal Lobe: This lobe, which houses the hippocampus, is crucial for memory and learning. Alzheimer's disease often begins here

if a patients initially presents with short term memory loss , work finding difficulties , mild executive dysfunction and mild visuospatial deficits what are u thinking

if a pateints Initially has short term memory loss, word finding difficulties, mild executive dysfunction, mild visuospatial deficits, then Later has All aspects of memory become impaired, fluctuating behavioral changes, disturbed sleep and appetite, hallucinations what are u think

what is the end stage of AD

mute , aspiration risk , bed bound and incontinent

what is the **most common** neuro degenerative disorder

what is the 6th most common causes of death in the USA

what age is mostly affected by AD

75-84

what are teh 4 risk factors for AD

-fam history and genetics -lower education -gender (being a women) -head trauma

for the gene ApoE ε4 the ______ carriers have 50% risk for developing AD in mid 60’s and _____ carried have 50% risk of AD in mid to late 70’s

homozygous heterozygous

 Hypertension  Elevated BMI  Smoking  Cholesterol  Diabetes mellitus  Hyperhomocysteinemia  Metabolic syndrome  Physical inactivity  Obstructive Sleep apnea these are all ___ risk factors from AD

modifiable

what is the pathology for AD

-brain atrophy with neuron loss - neuro fibrillar triangles tau protein -senile plaques amyloid beta protein -cerebrovascualr amyloid

where does AD start and end in the brain

hippocampus/temporal lobes partietal frontal global

• Global dysfucntion • Visuospatial function, calculations, orientation in space -Memory impairment and naming/language • Later in disease course executive dysfunction put these in order of pattern of AD

• Memory impairment and naming/language • Visuospatial function, calculations, orientation in space • Later in disease course executive dysfunction • Global dysfunction

what do the labs rule out for AD

reversible causes of dementia

what are the biomarkers of CSF for AD

amyloid beta (more pathology) and tau (more clinical S&S)

what imaging for u get for AD

mri

what is the second most common type of dementia

vascular dementia

– Step-wise progression (have normal mem then have stroke then mem is bad then have stroke again) – Asymmetric focal weakness what kind of dementia is this (type of vascular dementia)

multi infarct dementia

Diffuse white matter disease, subcortical leucoencephalopathy, Binswanger disease.. what is this

a type of vascular dementia and is a chronic progressive and diffuse global impairment

what vascular dementia has **attention** and **concentration** deficit with **psychomotor slowing**

subcortical

pertaining to the MOCA what is the difference between AD and VD ? what will be the problems with AD and VD

AD will have problems in the visuospatial and delayed recall section VD will have problems int he attention area

– HIV, tests for syphilis – thyroid, liver function tests – Kidney function – B12, folate these are all a search for a reversible cause for what

dementia

what are the 3 different AD imaging

-MRI -FDG-PET - amyloid PET

for a amyloid PET can a patient still have amyloid deposition w no symptoms of dementia

yes

what is AD diagnosed based on

amyloid deposition in the brain

___ deficiency results from degeneration of the nucleus basalis of meynert

cholinergic deficiency

 Donepezil (Aricept)  Galantamine (Razadyne)  Rivastigmine (Exelon these are exmaple of what inhibitory and whar does it help w

cholinesrterase and helps memory for AD

what is a NMDA partial antagonist

memantine (namenda)

what 2 medications are used to clear out amyloid for AD

lecanemad and aducanumad-avwa (aduhelm)

what is an IV medications given every 2 weeks to treat amyloid for AD but is very exopensive

lecanemab

 67 year-old man brought by wife for evaluation of “memory loss”  Forgets where he puts things and has other problems with attention  No longer draws or engages in conversation the way he used to.  Will sit in front of TV and sleep for hours or just stare into space for a while  Sometimes appears confused and sometimes seems to do well. Worse at night than during day  At night wife notes he acts out his dreams (like he’s part of a parade....) Sometimestalksaboutanimalsrunningaroundthat are not in the house but not bothered by it • Exam–maskedfacesandstoopedposturewithen bloc turning. No tremor; +postural instability and axial rigidity. what can we suspect

lewy body dementia

how would u describe lewy body dementia

-more attention and visual spatial problems -not that much of a memory problems -hallucinations start early **-acts out dreams

what lobes does lewy body disease attack rather then dementia

partietal and occipital lobe not temporal lobe

for the MOCA exam where will someone with lewy body diease have problems

-visuospatial/executive -attention

what is **rivastigmine** used for in lewy body disease treatment

reduce hallucinations and fluctuation

what does Levodopa-carbidopa treat in LBD

motor symptoms of parkinsonism

haldol avoided can results in what for LBD

clinical deterioration and increased risk for death

what are frontal release signs

reflexes that babies have and come back w dementia

what is the 2nd most common causes of **early onset** dementia

frontotemporal lobe degeneration

what age group does Frontotemporal Lobe Degeneration attack

45-64 yo

Behavioral variant (bvFTD) is a subtype of what

Frontotemporal Lobe Degeneration

– Behavioral variant (bvFTD) – Primary progressive aphasia – FTD associated with motor neuron disease these are all subtypes of what

Frontotemporal Lobe Degeneration

if a patient appears too hones t, flippant , arrogant , aggressively egotistically anf a show off… **he thinks that nothing is wrong** w him , his **memory is okay** and he has **frontal release signs** what can we suspect

Frontotemporal Lobe Degeneration

what is the pathology for Behavioral variant (bvFTD)

atrophy in frontal and temporal lobes

what are the 2 main medications for Behavioral variant (bvFTD)

anitdepressents and antipsychotics

a MOVEMENT DISORDER is a Neurological syndromes in which there is either an excess of movement or a paucity of voluntary and automatic movement, unrelated to ____ or ____. Generally due to pathology in the ____ ___.

weakness or spasticity basal ganglia

what is the pyramidal system

primary sensoruimotor cortex (frontal partietal) thru the internal capsule , BS , meduallry pyramids , CST to the anterior horn cells of the spinal cord

what is the extra pyramidal system

fine tuning of motor control composed of BS (putamen , GP and caudate) , substantial nigra , red uncles and sub thalamic nucleus

what is hyperkinesia

excessive movement

what is dyskinesia

abnormal movement

what is hypokinesia

decreased amplitude of movemtn

what is bradykinesia

slowness of movement

what is akinesia

loss of movement

what is a Rhythmic oscillatory movement around an axis

tremor

what is ongoing random involuntary movements incorporated

chorea

what is athletosis

prevents stable posture

what is ballism

more violent movement at a joint

what is Involuntary sustained or intermittent contractions cause twisting/repetitive movements or abnormal postures

dystonia

what is Involuntary sustained or intermittent contractions cause twisting/repetitive movements or abnormal postures

dystonia

what are repeated non-rhythmic brief shock-like jerks

myoclonus

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

tic

what are repetitive simple movements that can be suppressed

stereotypy

what movements disorder is considered hypokinetic(not enough movement)

parkinsonism

• Tremor • Chorea • Ballism • Dystonia • Dyskinesia • Myoclonus • Tics • Stereotypies what classification would these movemtn disorders be

hyperkinetic (too much movement)

– Drugs- neuroleptics – Post-encephalitic – Toxins- manganese, carbon monoxide, MPTP – Vascular – Brain tumor – Head trauma these are considered ____ parkinsonism

secondary

what is a tremor

rhythmic oscillation of a body part

what is the difference between a resting tremor , postural tremor and intention tremor

resting - seen w body part at rest postural- revealed by extending a limb against gravity intention tremor - moving limb to and from a target

what is the difference between essential tremor and parkinson’s disease tremor ? Location position direction frequency amplitude

-location E: bilateral (hands , leg ,head ,voice , tongue ) P: unilateral (hands , legs and chin) -position E: action , posture P: rest -direction E: flexion and extension P: pronation and supination -frequency E: fast P:slow amplitude the same anxiety makes it worse

how is the handwriting different for people with parkinson’s and essential tremor

for parkinson’s its smaller and essential it is bigger

• Frequency5-8Hz(fast) • Slow progression • Usually no other neurologic deficits • Hands>head>speech,chin,tongue,trunk,legs what tremor is this

essential

what is the treatment from essential tremors

– primidone (antiepileptic) – propranolol (Beta-blocker) – topirimate- an antiepileptic

what disease is A progressive, neurodegenerative disorder with loss of dopaminergic cells within the substantia nigra

parkinson’s disease

what is the second more common neurodenerative disease

parkinson’s disease (the first is AD)

what are PD sytmoms

-masked face -reduce arm swing -rest tremor -slightly flexed hip - shuffling short stepped gait -flexed elbows and writs -rigitidity -stooped posture

what is the rest tremor features of parkinson’s

distal extremities and limp , “pill rolling”, stops with action of the limb

what feature does this describe for parkinson’s x increased resistance to passive movement, equal in all directions, “cog-wheeling and velocity independent

rigidity

what feature of parkinson’s does this describe Masked facies, decreased blink, soft speech, loss of inflection, micrographia, drooling, shuffling gait

bradykinesia

Loss of postural reflexes: _____ * Freezing: motor blocks, start-hesitation difficulty moving through doorways/ hallways * Flexed posture of trunk, neck, and limbs these are features of what diease

retropulsion parkinson’s

what parkinson’s drug has the ability to replace brain dopamine

levodopa (sinemet , parcopa , stalevo)

what parkinson’s drug stimulates dopamine receptors

dopamine agonists (requip , mirapex, apokyn (injectable), neupro (patch)

what parkinson’s drug prevents the breakdown of levodopa only in advanced PD -only; in combo with levodopa

COMT inhibitor (contain , tasmar)

what parkinson’s drug prevents the break down of levodopa

MAO inhibitor (Selegiline (Zelapar) Rasagiline (Azilect

what parkinson’s drug works the best for TREMOR

Anticholinergics ( Artane, Cogentin, Benadryl)

what is peak dose dyskinesias for PD

to much dopamine leads to to much moments

how do u know if a patients has dystonia from PD

bc their foot will turn in

what is camp decorum for PD

slumped and hunched over

what is camptocormina for PD

forward flexion/ slumped over

what neurosurgical treatment for PD improves contralateral tremor, rigidity, not bradykinesia.

thalamotomy

what are the 2 things that are **overactive** in PD

subthalamic nucleus and globes pallidus

what neurosurgical treatment of PD Improves tremor, bradykinesia, and rigidity on side **opposite** the lesion

pallidotomy

what is via high frequency electrodes implanted in VIM nucleus of the thalamus, STN, or GPi and is used for PD

deep brain stimulation

what is a atypical parkinsonism disorder and has the inability to look up or down , has axial rigidity and early falls

professice supranuclear palsy

what is a atypical parkinsonism disorder and has alien limb/apraxia movement

corticobasal degeneration

what is an atypical parkinsonism disorder that has orthostatic hypotension and hypereflexia

multi system atrophy

IF a patient presents with prominent freezing , gait disturbance and postural instability in the context of relatively normla upper extremity what condition would u say this pateint has

vascular parkinsonism (lower body parkinsonism)

How will be MRI present with vascular parkinsonism

extensive subcortical white matter ischemia disease

• Akathisia • Athetosis • Ballism • Chorea • Dysmetria • Dystonia • Hemifacial spasm • Myoclonus • Paroxysmal dyskinesias • Restless legs syndrome ‘• Rigidity • Stereotypy • Tics • Tremor are they hyperkinesias or hypokinesias

hyper

what are the drug induced tremor from rest tremor (and PD)

-dopamine blocking (antipsychotics) -metoclopramide -despakote -lithium -calcium channel blockers *first 2 were in red on slide)

• Beta agonists • Caffiene • Nicotine • Thyroxine • Cocaine • Lithium • Tricyclic antidepressants these all cause what kind of tremor

postural/kinetic

what disease is -AUTOSOMAL DOMIANTLY INHERITED - has to do with **chromosome 4** -mean age of onset is 35-42 -average time to death is 17 years - mean neuronal loss is in the **caudate** and **putamen**

huntington disease

huntington disease is an ____ ____ inherited diease and has main neuronal loss in the ___ and ____

autsomal dominately caudate and putamen

what are the symptoms assoscuted with huntington’s disease

personality changes , dementia , CHOREA AND ATHETOSIS

if you see think or think chorea what disease can u suspect

huntingtons disease

what is chorea

rapid, jerky, irregular movements of the extremitie

what is Athetosis

slow, nearly continuous writhing movements of the distal extremities

what is the mainstay of treatment for CHOREA

Tetrabenazine

what is Tetrabenazine

main treatments for chorea

what is a treatable disease of COPPER METABOLISM , can ppresent with tremor and is an AUTOSOMAL RECESSIVE condition and is typically in younger people (20-30)

wilson’s disease

wilson’s disease is a treatable disease of ___ metabolism and can present w tremor … it is an ___ ____ condition

copper autosomal recessive

what are the symptoms of wilson’s diease

behavioral or personality change, dysarthria, ataxia, and abnormal movements (chorea, athetosis, tremor, or rigidity) *in the slide ataxia and abnormal movements was bolded)

what diease has the treatment chelation with D-penicillamine

wilson’s

what is the treatment of wilson’s disease

chelation with D-penicillamine

____ os Sustained or intermittent contractions that cause abnormal often repetitive movements, postures, or both

dystopia

dystonia is initiated or worsened by ___ movement

voluntary

what can relieve dystonia? anf what is it called

gentle touch to affected area called sensory tricks

what is focal dystonias invovled in and whoa re they usually developed in

head , neck or limb mms and usually developed in adults

what kind of dystonia is most commonly seen in CHILDERN

generalized

what is the treatment for dystonia

botulinum toxin injections, PT to prevent contractures, encourage search for sensory trick

what is writers cramp

sustained contraction only when writing

• Brief, sudden, rapid, intermittent movements or sounds • Can be repetitive and stereotyped • May be volitionally suppressed to some extent • Typically associated with preceding sensory phenomena • Can change over time what kind of disorder is this

tic

what kind of disorder is tourette syndrome

genetic disorder ; autosomal dominant

what does the dx require for tourette syndrome

- > 1 motor tic - 1 vocal tic - fluctuating course - present > 1 yr

if a patient presents with a. genetic disorder that is autosomal dominant … has > 1 motor tic , 1 vocal tic , fluctuating course , presents for > 1 year and is 15 years old what can we think they have

tourette’s syndrome

If someone has NEUROLOGICAL SYMPTOMS (such as limb weakness, numbness, shaking or blackouts) which are REAL (and not imagined ) caused by a PROBLEM with the FUNCTIONING of the nervous system and is not due to damage or structural disease of the nervous system and causes difficulty what can we suspect the pateitns has

functional neurological disorder

what are 6 things that would make it an epileptic seizure

• Open eyes • Hypoventilation • Lack of memory • 1-2 minutes • GTC or tonic • Sudden onset

if someone’s has • Closed eyes • Ictal hyperventilation • Memory of attack when GTC • Long duration • Prolonged motionlessness • Ictal weeping • Gradual onset what kind of seizure is this

Psychogenic Non-Epileptic (PNES)

what is hoover sign used for

weakness *have patient life tone leg up and put ur hand underneath their heel and wait to see if they try to dig their heel into ur hand to help lift the opposite leg up)

what will a pateitns MRI pressent with if they have functional weakness and sensory disturbance

contralateral hypoperfusion of thalamus and caudate