Neurocog D/o

Question 1

Major Cognitive Disorder

Answer 1

New name for dementia
Psychological behavioral symptoms as well as acquired deficits in ADLs and IADLs

Question 2

DSM neuro cognitive disorders

Answer 2

Delirium
MCI
Major Neurocognitive Disorder

Question 3

Mild Cognitive Impairment

Answer 3

Memory/thinking problems, able to take care of self, no personality changes

-lose things, forgetting events/appointments, having trouble coming up with words, movement difficulties, problem with sense of smell

May be early sign of more serious memory problems
See MD every 6-12 mo for monitoring

Question 4

Signs of Major Neurocognitive Disorder

Answer 4

Forgetfulness maybe normal
Sign if aging, but dementia is not

Sx: memory loss, loss of cognitive function, thinking, remembering, learning, reasoning, behavioral abilities- language skills, visual perception, attention, personality changes

Question 5

Dementia types

Answer 5

Alzheimer’s Disease, Lewy Body dementia, frontotemporal dementia, vascular dementis

Question 6

Factors that may cause memory problems

Answer 6

Head trauma/concussion
Blood clots
Tumors
Infections
Thyroid, kidney, or liver problems
Medication side effects
Mental health conditions ie depression
Alcohol/drug use
Sleep problems
Decreased B12
Decreased eating healthy foods

Question 7

Causes of neuro-cognitive disorders

Answer 7

Brain injury by trauma: ICH, SAH, blood clot, concussion, hypoxia, hypercapnia, dementia due to stroke, Alzheimer’s d/s, creutzfeldt-Jakob Disorder, diffused lewy body disease, Huntington’s disease, MS, Normal pressure hydrocephalus, Parkinson’s disease, Pick’s disease

Metabolic cause: kidney disease, liver disease, thyroid disease, deficits in vitamin B1, B12 folate

Drug/alcohol withdrawal: wernicke-korsakoff

Infections: septicemia, encephalitis, syphilis, prion infection

Question 8

Creutz-feldt Jakob Disease

Answer 8

Brain damage leading to rapid decline in movement (involuntary muscle movement) loss of mentation (thinking, reasoning, confusion) secondary to prions (eating infected meat), progress unusually fast, folded proteins destroys brain cells

Question 9

Huntington’s Disease

Answer 9

Genetic defect on chromosome 4, CAG repeat

Sx: hallucinations, irritability, moodiness, restfulness/fidgeting, behavioral disturbances, paranoia, psychosis

Abnormal facial movements/grimacing, head turning to shift eye position, quick jerky movements of arms, legs, face, slow uncontrollable movements, unsteady gait, prancing and wide walk

Dementia

Question 10

Multiple sclerosis

Answer 10

Autoimmune disease affecting brain and spinal cord, effects women more, inflammation and damage to myelin sheath

Sx: LOB, muscle spasms, numbness, trouble moving UE/LE, trouble walking, bowel/bladder problems, constipation, double vision, trouble urinating, tremors, tingling/burning, fatigue

Question 11

Parkinson’s disease

Answer 11

Certain brain cells dying, shaking tremors, trouble walking, decreased dopamine, dx after 50, more in men

Sx: rigidity/stiffness, muscle aches/pains, constipation, slow blinking, drooling, no facial expressions, LBP when you stand, stooped posture, sweating, difficulty swallowing, slowed quiet speech, decreased handwriting

Question 12

Pick’s Disease/frontotemporal dementia

Answer 12

Group of d/o due to damage in frontal and temporal lobes, genetic component, abnormal substances inside nerve cells in damaged areas, may be as young as 20, common 40-60, average 54

Seen in ALS, progressive supranuclear palsy

Behavior variant vs primary progressive aphasia

Not able to keep a job, compulsive, impulsive, inappropriate behavior, inability to function, interact socially, problems with personal hygiene, repetitive behavior, withdrawal, abrupt mood changes, decreased recognization of behavioral changes, decreased empathy, mutism, shrinking vocabulary, weak uncoordinated speech, echolalia, aphasia, increased tone, memory loss, apraxia, urinary incontinence

Extreme behavioral changes and lack of insight

Question 13

Neuro degenerative disorders

Answer 13

Range of conditions that share primary feature of degeneration and loss if neurons in the brain, incurable/debilitating resulting in death of nerve cells, caused problems with movement (ataxia) and mental functions (dementia)

Most common: PD, Alzheimer’s disease
Less common: MS, atypical Parkinson’s, huntington disease, ALS

Question 14

6 neurocognitive domains

Answer 14

1) perceptual-motor function: visual perception, visuo constructional reasoning, perceptual motor coordination
2) language: object naming, word finding, fluency, grammar/syntax, receptive language
3) learning/memory: free recall, cued recall, recognition, memory, semantic/autobiographical long term memory implicit learning
4) social cognition: theory of mind, insight, recognition of emotion
5) complex attention: sustained attention, divided attention, selective attention, processing speed
6) executive function: planning, decision-making, working memory, responding to feedback, inhibition, flexibility

Question 15

Occipital lobe

Answer 15

Visual perceptual and visual
Motor, distance/depth perception, color determination, object/face recognition, memory function

Question 16

Temporal lobe

Answer 16

Learning/memory, managing emotions, processing information, information from senses, storing/retrieving memories, understanding language

Question 17

Parietal lobe

Answer 17

Perceptual motor function, language, receiving/processing sensory input of touch, pressure, heat, cold, and pain

Perception of body awareness and spatial coordinate system (mental map)

Question 18

Frontal lobe

Answer 18

Executive function, social cognition, complex attention, role in voluntary movement, expressive language, managing higher, level executive function

Plan, organize, initiate, self-monitor, control one’s responses to achieve a goal

Question 19

Functional Cognition

Answer 19

Combines constructs of function/cognition in context of performing everyday activities/occupations

Question 20

Performance Skills

Answer 20

Observable, goal-directed actions that result in a client’s quality of performing desired occupations, skills supported by context

Question 21

Assessing Functional cognition

Answer 21

Assess functional cognition, not specific cognitive skills, identifying client’s capacity to perform essential tasks given the totality of their abilities, includes use of strategies, habits, and routines, context/environmental resources

Question 22

Why assess functional cognition?

Answer 22

Evaluate how a person can participate in/perform ADLs/IADL tasks, identify barriers to function, provide recommendation about appropriate care environments and facilitate a successful dc plan to match functional abilities, provide education about most effective ways to support/communicate with pts, clinicians, family/caregivers

Research support to assess cognitive fxn for all geriatrics pt, early detection necessary for client-centered care, early intervention maximizes function, safety, and independence

Question 23

Performance based assessments

Answer 23

Executive Functional Performance Test (EFPT)

Performance Assessment of self care skills (PASS)

Weekly Calendar Planning Activity

Multiple Errands Test

Actual reality Assessment

AMPS

COPM

Question 24

Executive Function Performance Test

Answer 24

Elements of executive function impacting function, individual’s capacity for independent functioning amount of assistance for task completion

Question 25

Performance Assessment of Self Care Skills

Answer 25

Client-centered, performance based observational tool, assesses ADL/IADLs to provide snapshot of person’s ability to live (I)

Question 26

Multiple Errands Test

Answer 26

Performance based test, measure how executive performance deficit affect functioning in natural environments, multiple versions, 5 different settings

Question 27

Actual Reality Assessment

Answer 27

Performance based assessment approach use of internet to perform real everyday life activities MS

Question 28

AMPS: Assessment of motor and process skills

Answer 28

observational assessment that allows for the simultaneous evaluation of motor and process skills and their effect on the ability of an individual to perform complex or instrumental and personal activities of daily living Based on MOHO

Question 29

Skill based assessments

Answer 29

Examine foundational cognitive skills and allow clinician to extrapolate how deficits in these skills affect overall cognition MOCA SLUMs Mini Mental Status Exam Trail Making A/B ACL lacing screen Motor Free Visual perceptual test Clock drawing test Cognistat NCSE

Question 30

MOCA

Answer 30

Screen for MCI

Question 31

St. Louis University Mental Status Exam (SLUMs)

Answer 31

Screen for dementia, cognitive deficits

Question 32

Mini-mental Status Exam MMSE

Answer 32

Brief quantitative cognition screen, show cognitive changes over time

Question 33

Trail Making A/B

Answer 33

Tests memory/executive functioning, correlate with driving ability component of other skill based assessments

Question 34

Motor Free-Visual Perceptual Test

Answer 34

Visual perceptual skills in spatial relation, figure ground, visual discrimination, visual closure, visual memory

Question 35

Clock drawing Test

Answer 35

Screening tool, draw a clock, place #s, assesses visual-spatial, numerical sequencing, and planning abilities

Question 36

Cognistat NCSE

Answer 36

Neuro behavioral cognitive status exam, neurocognitive assessment in consciousness, orientation, simple attention, language, constructional ability, memory, calculation skills, executive skils

Question 37

CMS recommended Cognitive screening due to Impact Act

Answer 37

CAMS-confusion assessment method: ID delirium BIMs-Brief Interview for Mental Status: ID cognitive impairment Do not identify mild cognitive impairments, failing to identify subset of clients at risk for failed care transitions Use skip pattern/gateway: use functional cog tool for individuals who pass CAM/BIMs

Question 38

Dementia/major neurocognitive disorder

Answer 38

Syndrome resulting from a variety of disease processes which there is deterioration in cognitive function beyond expected from normal aging 55 million people, 7th cause of deaty

Question 39

Risk factors for dementia

Answer 39

Age: strongest risk factor, doubles every 5 yeas after 65 Genetics: family hx Poor health: increased BP, increased cholesterol, diabetes, smoking Race/ethnicity: African Americans are 2x more likely to develop dementia, hispanics 1.5x more likely to develop dementia, possibly due to increased heart disease with lower accessibility to preventative medicine TBI

Question 40

SDOH and dementia

Answer 40

Education: lower levels of education and lower levels of cognitive reserve Decreased access to health-prevention dx and tx, risk factors such as heart disease and DM Loneliness/social isolation increased risk Socio-economic: lower socio-economic linked to increased dementia and may correlate with other factors

Question 41

Alzheimer’s Disease

Answer 41

60-80% of those with dementia, nerve cells are damaged by by beta-amyloid plaques and tau protein tangles build up in nerve cells

Question 42

Alzheimer’s Disease Symptoms

Answer 42

Insidious onset and gradually progressive memory loss Early on difficult with familiar tasks Displacing/losing things Difficulty with new learning Loss of orientation to place, time, situation Difficulty communicating leading to withdrawal Depression Neuropsych sx: agitation, wandering, delusions, sleep disturbances Visuospatial/language deficits Gait disturbances

Question 43

Vascular Dementia

Answer 43

2nd most common dementia Caused by vascular disease with smoking, DM, obesity, Afib, atherosclerosis Risk factors: frequent h/o CVA/TIA

Question 44

Vascular Dementia Symptoms

Answer 44

Rapid onset when caused by cerebral vascular event, sx related to location Slow/gradual when secondary to small Vessel disease Change in mood/personality Executive functioning difficulty, loss of cognitive flexibility Slow processing speed Gait/balance impairment Incontinence Often progresses to more advanced level when there is Another CVE, step-like progression Sx of depression, anxiety, and apathy

Question 45

Lewy Body dementia

Answer 45

Caused by abnormal protein deposits in the brain, called alpha-synuclein, 5% of all dementia, cases 2x more in men than women difficult to dx as similar to PD and Alzheimer’s

Question 46

Lewy Body Dementia symtoms

Answer 46

REM sleep D/O may be early sign Executive function and attention impacted early on, memory is less affected Fluctuating alertness/cognition Parkinson’s type movement d/o, slow shuffling gait, rigid movement patterns Visual hallucinations, early specific and vivid delusions, paranoia, anxiety, agitation common as disease progresses Visuospatial deficits Frequent falls Highly sensitivity to antipsychotic medication

Question 47

Creutzfeldt-Jakob Disease Symptoms

Answer 47

Sporadic: develops spontaneously, 85% of cases,60-65 yo Familial: caused by changes in the chromosome, 20 gene coding, 10-15% of cases, develops 20-40 yo Acquired: from exposure to an external source of abnormal prion to protein, sources medical procedure involving instruments in neuro sx, growth hormone from transplanted human tissue vs meat or other products from cattle Depression, agitation, apathy, mood swings, rapidly worsening confusion, disorientation, problems with thinking, memory, planning, and judgment, difficulty walking, muscle stiffness, twitches/involuntary jerky movements, vision problems

Question 48

Normal Pressure Hydrocephalus

Answer 48

Excess cerebrospinal fluid accumulates in brain ventricles causing thinking and reasoning problems, difficulty walking, loss of bladder control, affects people on 60/70s Caused by tumor, head injury, hemorrhage, infection/inflammation

Question 49

Normal Pressure Hydrocephalus symptoms

Answer 49

Difficulty walking-body bent forward, legs held wide apart and feet moving as if stuck Mild dementia that involved loss of interest in daily activities, forgetfulness, difficulty completing routine tasks, STM loss Decline in thinking skills that includes overall slow thought processes, apathy, impaired planning, and decision-making, decreased concentration, changes personality and behavior, loss of bladder control

Question 50

Korsakoff Syndrome

Answer 50

Chronic memory d/o caused by severe deficiency of thiamine (B1) caused by ETOH, decreased thiamine =cells cannot generate enough energy to function properly, can be associated with AIDS, Ca, poor nutrition, bariatric sx

Question 51

Korsakoff Syndrome symptoms

Answer 51

Problems learning new info Inability to remember recent events Long term memory gaps Confabulate

Question 52

Mixed dementia

Answer 52

Brain changes of more than 1 cause of dementia occur, most common AD and vascular dementia Sx depend on types involved Similar sx to AD

Question 53

Stages of Dementia: 7 stage model

Answer 53

1) no impairment 2)very mild 3) mild 4) moderate (early stage dementia) 5) moderately severe (early to mid stage dementia) 6) severe (late mid stage dementia) 7) very severe (late stage dementia)

Question 54

Stages of dementia: 4 stage model

Answer 54

Mild Moderate Severe Terminal

Question 55

4 stages model of dementia: mild

Answer 55

Forgetfulness of words/names Misplacing/losing things Difficulty tracking Decline in goal oriented behavior outside of self care Getting confused/disoriented in familiar places Losing track of time Poor judgement with planning and decision making Concrete thinking Loss of abstract thinking Impaired attention to tasks/environment Impaired safety awareness Visuospatial changes/deficits Mood changes Difficulty with IADLs and multistep tasks I with ADLs Accesses community with some risk of getting loss More successful in a structured environment ACL 4.4-4.8

Question 56

4 stages model of dementia: moderate

Answer 56

Increased loss of orientation to time, place, situation, people Not able to manage environment effectively requires assistance for safety Communication difficulties, decreased use of language Visuospatial deficits Poor attention to safety and increased impulsivity, may lose socially appropriate behavior, safety risk is high Loss of much purposeful activity Needs support to initiate/engage in previously enjoyed activities Benefits from sensory engagement Difficulty with ADLs Requires A for ADLs for safety Assistance with incontinence and hygiene Assistance for IADLs Community activity limited Wandering risks Cues for hygiene Eating may need adaptive dining strategies cues to maintain routine Can no longer live safely Hallucinations, agitation, sleep disturbances with nightmare ACL 3.6-4.2

Question 57

4 stages model of dementia: severe

Answer 57

No longer oriented May recognize caregiver/family; however unable to name 1 step commands Incoherent language Assists with ADLs May need 2 person assist Benefits from routine Incontinent Cues to eat Benefit from social engagement and repetitive action Physical assistance to move safely Neurological impact on movement (apraxia, possible tone) Increased fall risk Increased behaviors (resistance to care, agitation, aggression) Unable to make needs known May have unmet need increasing symptoms 24 hour care At risk for pressure ulcer Aspiration Poor nutrition Dehydration Weight loss Visuospatial deficits ACL 3-3.4

Question 58

4 stages model of dementia: terminal

Answer 58

Limited responsiveness Limited language if any Benefits from comforting stimuli (familiar voices, soothing touch, music, massage) Likely bed bound Total a for care Difficulty swallowing Modified diet at risk for aspiration Pain management Palliative care Supported positioning Assistance for repositioning for pressure relief Increased time Contracture/rigid movement Loss of mobility Agitation Toward end of life At risk for pressure ulcers Hospice Care ACL less than or equal to 3

Question 59

Delirium

Answer 59

Sudden and severe change in brain function that causes person to appear confused/disoriented difficulty maintaining focus Thinking clearly and Remembering recent events Fluctuating course

Question 60

Causes of delirium

Answer 60

Advanced age existing brain disease such as dementia, h/o CVA, Parkinson’s disease Immobility Fracture Malnutrition Use if bladder catheter Polypharmacy leading cause Sleep deprivation Poor eyesight/hearing Advanced Ca Organ failure Sudden w/drawal of regular medication or cessation ETOH

Question 61

Delirium symptoms

Answer 61

Hours to days Unusual changes in levels of consciousness and thinking May be withdrawn Sleepy Flat affectionate (hypoactice delirium) Hyperactive delirium: Active/agitated Difficulty maintaining focus Difficulty retaining new info Disorientation to time and place Visual hallucinations Variable outcomes weeks to months Can result in Long term memory/processing difficulties after recovery Delirium linked to prolonged hospitalization and residual trauma

Question 62

Assessing delirium

Answer 62

Get assessment prior to planned hospitalization for a baseline, can be done by OT on primary care setting Pre-admit tools: MOCA, Mini Adden Brooke’s Cognitive Exam Delirium screens should be 2-3x/day due fluctuations Screening tools: intensive care delirium screening checklist, confusion assessment measure (CAM) completed at regular intervals

Question 63

Treatment of delirium

Answer 63

Encourage movement Time out of bed Support person in maintaining regular sleep/wake cycle Make sure using hearing aid/glasses Avoid under/over stimulation Someone at bedside for reassurance Educate friends/families Pharma - tx medical reason for hospitalization, avoid deliriogenic meds such as benzos antipsychotics, and histamine 2 receptor agonist

Question 64

Polypharmacy/adverse drug effects

Answer 64

Can be prescriptions, regular alcohol, illegal drug use Ceasing medication suddenly Some medications overtime increase likelihood of neurocog disorder Increased polypharm in PD abd MS Fatigue, cognitive complaints, fall secondary to dizziness/hypotension

Question 65

Treatments to reduce polypharmacy

Answer 65

Yearly medication review with PCP Discuss strategies to reduce fall risk Update cognitive screening regularly and monitor for changes Update family, individual, and providers

Question 66

General dementia interventions

Answer 66

Home modifications, caregiver education, fall prevention, activity modification

Question 67

Dementia interventions: caregiver education

Answer 67

Improves ADL performance, reduces neuropsych sx, improves QOL In person education on communication, behavior management, and adaptive strategies Caregiver training on stress mgmt/reduction, respite resources, caregiver support groups 8 in home session 1-1.5 hours

Question 68

Dementia interventions: home Modifications-safety concerns

Answer 68

Safety concerns addressed: wandering, falls, inattention, poor judgment, medication management, temperature adaptation, cooking, use of appliances, use of sharps Remove clutter, rugs, access to unsafe objects, add grab bars, commodes, lighting, door locks, gate alarms, AT, ramps, lifts

Question 69

Dementia interventions: home Modifications-neurospych symptoms

Answer 69

Improves neuropsych sx Rooms designed with purpose of use Ambient music (other than at meals) Multisensory interventions Reduced environmental noise/stimuli Camouflage exits Accessible environment with good visual access L shape cornets, visible toilet

Question 70

Dementia interventions: fall prevention

Answer 70

Individual exercise program to increase balance, group exercise programs that increase balance, occupation based intervention to increase gait, strength, flexibility, and balance Fall prevention education for staff Need more research for fall Prevention for neurocog d/o Programs: stepping on, a matter of balance

Question 71

Dementia intervention: activity modification

Answer 71

Personalized activity to increased engagement, decrease neuropsych symptoms, maintain function, and increase QOL Individual program: draw on previous experiences/interest, support choice match existing skills/capacities, support with caregiver education and facilitation, match cues to cognitive capacity, use direct simple cues Modify environment for success, decrease distractions, increased visual cues, use adaptive strategies that are familiar and intuitive

Question 72

Tailored Activity Program

Answer 72

Person-environment-occupation framework, considers preserved capabilities, caregiver readiness, and environmental factors Decrease symptoms through 3 meaningful activities tailored to match skills/interest of person Requires training/certificate to practice

Question 73

Skills 2 care

Answer 73

Caregiver training program that requires certification focused on education, routine modification, behavioral management, and home modification to promote function snd outcomes in the home

Question 74

Multi modal OT program

Answer 74

Cog-oriented approach improve cognitive dysfunction and increased BADLs and IADLs

Question 75

Reminiscence therapy

Answer 75

Effective in Alzheimer’s disease regarding cognition, depression, ADLs, QOL Regular small group 45 minutes, 8-12 week duration, mild to moderate ADs Photo, video, and music

Question 76

Sensory Therapy

Answer 76

In residential facilities, strong evidence for massage Moderate evidence for environmental based multisensory activity=lighting Gardenunt, music, meal time (no music), montessori animal assisted therapy, dance/yoga Inconclusive evidence for art, aromatherapy, snoezelen rooms

Question 77

Goals of intervention in acute care setting for neurocog d/o

Answer 77

Return to prior environment Return to PLOF In unable, identify new supports for home setting, modify interventions for new baseline

Question 78

Assessment in acute care setting for neurocog d/o

Answer 78

Functional cognition with performance based assessment Consider baseline level of fxn vs expected fxn at d/c, recommend specific cognitive skill assessment secondary to neurocog screen, eval ADL/IADL performance

Question 79

intervention in acute care setting for neurocog d/o

Answer 79

Retrain ADLs/IADLs with compensatory/adaptive strategies Strength based intervention to support increase cognitive level Collaborate with natural supports to anticipate challenges in dc environment, Train and make environmental recommendarion

Question 80

Goals of intervention in community/home health setting for neurocog d/o

Answer 80

Support function Participate in home environment Support autonomy with attention to safety Assure natural supports support function and safety

Question 81

Assessment in community/home health for neurocog d/o

Answer 81

Assess Cognitive status with performance based assessment What is needed to function in environment for additional tool guide Secondary neurocog screen, home safety assessment, evaluate ability to perform ADLs/IADL, interview natural supports to understand barriers/neuropsych symptoms

Question 82

intervention in community/home health setting for neurocog d/o

Answer 82

Dementia specific concerns- wandering, safety, modify routine/environment, address underlying needs (pain, loss of meaningful activity), ADL/IADL training, AE/DME training, address accessibility, reduce falls, strength based interventions, caregiver training

Question 83

Goals of intervention in memory care and palliative stages

Answer 83

Support function/participation in home Support comfort, dignity, and safety Assure natural supports can support routine care, safety, and comfort

Question 84

Assessments in memory care and palliative stages

Answer 84

Functional cognitive performance test, with more advanced dementia, formal cog test not needed Eval ADL with focus on insight, safety, and caregiver assistance Environmental considerations, interview supports for barriers and neuropsych symptoms, home safety assessment

Question 85

Intervention in memory care and palliative stages

Answer 85

Address safety, wandering, difficulty participating in ADLs Accessibility tx Fall prevention Safety in eating, positioning, skin integrity Underlying needs pain vs meaningful activities Use activity plan, sensory interventions, and environmental modifications to reduce neuropsych symptoms

Question 86

Mild neurocognitive disorder

Answer 86

Not part of normal aging, does not impact(I) functioning, but noticeable by family May be reversible, not all leads to dementia Early intervention best to address reversible causes

Question 87

Mild neurocognitive disorder risk factors

Answer 87

Age, diabetes, smoking, increased cholesterol, htn, depression, sedentary lifestyle, limited mental/social stim

Question 88

Causes if mild neurocognitive Disorder

Answer 88

Reversible causes: delirium, depression, NPH, metabolic/nutritional deficiencies, sleep apnea, drug use, acute infection Nonreversible causes: TBI, vascular events, PD, neurocog decline early stages of dementia, MS, ALS, atypical PD

Question 89

Mild neurocognitive disorder impact on ADL

Answer 89

Less cognitive processing due to routine usually not affected (I) maintain further in disease process than dementia Can be mire affected by physical symptoms Decline in ADLs means disease progression

Question 90

Mild neurocognitive disorder impact on IADL

Answer 90

Requires more functioning in multiple cognitive domains and more varied take demands, needs executive functioning skills, physical impairment affects changes can be subtle/compensated for prior to function being affected

Question 91

Signs if mild neurocognitive Disorder

Answer 91

Challenges with more complex multi-step tasks Medication errors Forgetfulness/difficulty tracking leading to miss appointments Misplacing items Missing social events Decreased attention to environment Increased clutter Unpaid bills Spoiled food Trouble remembering/tracking conversations Difficulty with word finding Decreased visuospatial skills

Question 92

Assessing mild neurocognitive disorder

Answer 92

Functional cognitive assessment Performance based activity Formal performance based assessment iADL predicting factor if rehospitalizations

Question 93

Interventions for mild cognitive disorders

Answer 93

Exercise, cognitive training/retraining, skill training/modifications for lifestyle management Simulate real like Grade task in error less learning Group tx to increase cognitive skills

Question 94

Motor symptoms of Parkinson’s disease

Answer 94

Tremor including non-intention tremors in arms, legs, jaws, and head, pill rolling Bradykinesia slowed movements and difficulty initiation movement Rigidity lack of facial expression, decrease arm swing while walking Postural instability impaired balance, related to combo of tremors, bradykisia, and rigidity Vocal: soft slow speech

Question 95

Non motor symptoms of parkinson’s

Answer 95

Depression Sleep problems: fatigue, restless leg, insomnia Loss of smell 95%, one of the first symptoms Sweating and increased risk of skin Ca GI-constipation

Question 96

5 stages of Parkinson’s Disease

Answer 96

1) slight tremor on one side of the body, mild sx, changes in walking, posture, and facial expression 2) symptoms worsen, affects both sides, changes in walking making daily tasks more difficult 3) LOB, slowness of movement, falls more common, impaired ADLs 4) severe symptoms and limit ability to live alone, walkers and AD used 5)confined to wheelchair vs. bed, 24 hour caregiver, many experience hallucinations

Question 97

PD dementia risk factors

Answer 97

Hallucinations in someone who does not have dementia symptoms yes Daytime sleepiness Postural instability and gait disturbances symptom pattern

Question 98

Pharma tx if Parkinson’s Disease

Answer 98

Clonazepam/melatonin to tx symptom of REM disorder SSRI tx depression Cholinesterace inhibitor- visual hallucinations, sleep disturbances, and behavior changes

Question 99

Medical tx of Parkinson’s disease

Answer 99

Levadopa to increase dopamine MAO B inhibitor/COMT inhibitors slow enzyme that breakdown dopamine Amantadine to reduce involuntary movement Deep Brain stimulations-placing electrode into brain to stimulate areas of motor context related to movement symptoms

Question 100

OT tx for Parkinson’s Disease

Answer 100

Physical activity: LSVT-Big based on proprioceptive recalibration, physical activity slows progression and improve symptoms ADL-specific goal setting/tx, task analysis with forward chaining, decrease distractors, educate on cog load/avoid multitasking, adaptive strategies/AE Cognitive strategies-cognitive retraining vs compensatory strategies, cog retraining can lead to LT cog improvements, compensatory may be for those not interested or have PD dementia Fall prevention-home assessment for environmental modification, educate on fall triggers such as changing direction step to turn then move forward, avoid dual task, avoid carrying objects Mindfulness-body scan, mindfulness meditation ECT/fatigue management: caregiver/pt education on ECT, structure day so most valued activity at peak medication time, education on sleep hygiene

Question 101

Mindfulness meditation based Complex exercise lrogram

Answer 101

Parkinson’s Disease Prep phase: discuss HEP Exercise: elastic band/stretching exercise, ball exercise, stretching with deep breaths Meditation with basic breathing: breathing meditation, loving-kindness meditation, breathing imagery meditation