Classification of tremors
- resting
- action
- enhanced physiologic
- essential
- parkinsonism
- cerebellar
- psychogenic
Resting Tremor
- occurs in body pt at rest
- enhanced by stress or movement of another body part
Action Tremor
- Postural: maintain position against gravity (arm elevation)
- Isometric: m. contraction against station object (make fist)
- Kinetic: associated with voluntary movement and includes intention tremor
Enhanced Physiologic Tremor
- low amp, high freq at rest or during activity
- enhanced by anxiety and stress, meds,
Essential Tremor
- usually kinetic
- common in hands and wrists
- usually bilateral and progresses with age
- symmetrical tremor
- alcohol can help symptoms
- handwriting is very loopy and can be illegible
Parkinsonism Tremor/Parkinsons
- resting pill rolling tremor
- asymmetrical tremor
- flat affect
- reduced arm swing
- micrographia
- decreased smell
- shuffling gait
Cerebellar Tremor
- low freq slow intension tremor
- usually caused by MS with cerebellar plaques, stroke, brainstem tumors
Psychogenic Tremor
-abrupt onset, spontaneous remission, changing tremor characteristics
Dementia Prevalence
-females more common with older age b/c females live longer
Etiologies of Dementia
- Alzheimers
- Delirium
- Frontotemporal dementia
- HIV
- Intracranial tumor
- Lewy Body dementia
- Vascular dementia
6 Domains Affected by Dementia
- Complex Attn
- EF
- Language
- Learning and Memory
- Perceptual-Motor
- Social Cog
Complex Attention Domain Examples
normal tasks take longer, hard to remember a phone number to dial, work requires more checking, hard to complete tasks when multi stimuli present
Executive Function Domain Examples
-difficulty doing multistep tasks, hard to prepare meals, not wanting to participate in activities, social outings less enjoyable
Language Domain Examples
-difficulty finding correct words, using pronouns instead of names, mispronouncing words, problems understanding communication
Learning and Memory Domain Examples
-forgetting to buy items, repetition in conversation, forgetting to pay bills, relying on lists
Perceptual-motor Domain Examples
-difficulty using tech, tools, or appliances, getting lost
Social Cognition Domain
-apathy, increase inappropriate behaviors, loss of empathy
DSM-5 Criteria for Major Neurocog Disorder and Minor Neurocog disorder
Major Neurcog Disorder: significant cog decline in at least one domain interfering with activities of daily living
Minor Neurocog Disorder: modest cog decline that DOESNT interfere with activities of daily living
Reversible Causes of Dementia
- hypothyroidism
- vitamin deficiencies
- intracranial tumors
- depression
- hypoperfusion from heart failure
Testing for Cog Impairment Steps
- Brief Screening-Mini-Cog, Ascertain Dementia Questionnaire, General Practioner Assessment of Cog
- Screen for Degree: MMSE, MOCA, SLUMS
- Screen for depression and other reversible causes: GDE to rule out pseudodementia
