Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
68 Cards in this Set
- Front
- Back
|
How long is MMSE
|
30 questions
|
|
|
Orientation questions
|
5 pts: What is the (year) (season) (date) (day) (month)?
5 pts: Where are we (state) (country) (town) (hospital) (floor)? |
|
|
Registration questions
|
o 3 pts: Name 3 objects: 1 second to say each. Then ask the patient to name all 3 after you have said them. Give 1 point for each correct answer.
o Then repeat them until he/she learns all 3. Count trials and record |
|
|
attention and calculation questions
|
o 5 pts: Serial 7’s. 1 point for each correct answer. Stop after 5 answers.
o Alternative: spell “world” backward. |
|
|
recall questions
|
o 3 pts: Ask for the 3 objects repeated above.
o Give 1 point for each correct answer. |
|
|
Language questions
|
o 2 ( ) Name a pencil and watch.
o 1 ( ) Repeat the following “No ifs, ands, or buts” o 3 ( ) Follow a 3-stage command: • “Take a paper in your hand, fold it in half, and put it on the floor.” o 1 pt: Read and obey the following: “Close your eyes.” o 1 pt: Write a sentence. o 1 pt: Copy the design shown. |
|
|
Normal MMSE
|
>27
|
|
|
MMSE suggesting dimentia?
|
22, 24 in educated ppl
|
|
|
mild dimentia
|
• Scores of 20-26
|
|
|
moderate dimentia
|
10-19
|
|
|
severe disease
|
<10
|
|
|
What is delirium
|
– Alteration (fluctuating) level of consciousness
– Associated with altered attention and cognition – Rapid Onset – May be reversible – Always due to a medical/surgical cause |
|
|
where is highest delirium
|
surgical ICU then cardio ICU
|
|
|
What is used to DX deliurium
|
CAM-ICU worksheet
|
|
|
most significant delirium elements of DX?
|
inattention and broad fluctuations
|
|
|
hyperactive delirium
|
• Obvious deficits in focused attention and fluctuations of presentation
|
|
|
quiet delirium
|
• State reflects inability to attend in sequential fashion to demands of environment
• Withdrawal • Lack of involvement in or communication with environment • Bland or flat affect • Depressed level of consciousness that is short of frank stupor |
|
|
Motor SX w/delirium
|
• Dysarthria
• Difficulty swallowing • Gait disturbances |
|
|
Affective SX w/delirium
|
• Dysphoria
• Lability • Anxiety |
|
|
Life threatening causes of delirium? (WWHHHIMP)
|
• Wernicke's encephalopathy: confusion + ataxia + ophthalmoplegia
• Withdrawal states after discontinuation of illicit or Rx drug use, even when small dosages used for short periods of time • Hypertensive encephalopathy - assess using vital signs • Hypoxia - assessed with arterial blood gases • Hypoglycemia - assessed with a serum glucose level • Intracranial bleeding suggested by headache and confirmed by neuroimaging • Meningitis and encephalitis almost always produce focal neurological signs as well as headache, loss of consciousness, and seizures • Poisons (including pesticides, solvents, or heavy metals) may lead to delirium |
|
|
what is Asterixis
|
commonly associated with liver failure where it produces the flapping tremor of hepatic encephalopathy. (Then it is called liver flap).
• The flapping of the hand is sometimes said to resemble a “bird flapping its wings.” |
|
|
what is dimentia
|
– Cognitive deficits and memory impairment
– Consciousness is NOT impaired as in delirium – Course is generally gradual and progressive – Very rarely is Dementia reversible |
|
|
what must you have at least one of to have dimentia
|
aphasia, apraxia, agnosia, Impaired executive functioning (planning, organizing, sequencing and abstraction).
|
|
|
aphasia?
|
disturbance in the comprehension or expression of language)
|
|
|
what is apraxia
|
impaired ability to perform a voluntary, purposeful motor activity despite intact motor ability. “Constructional apraxia” = cannot draw 2 or 3 dimensional forms).
|
|
|
what is agnosia
|
failure to recognize or identify objects despite intact sensory function).
|
|
|
qualifiers for cognitive disorder
|
• Condition must represent a change from the baseline
• Deficits must be clinically significant- interfere with social or occupational functioning • Deficits cannot occur exclusively during an episode of delirium • Condition cannot be accounted for by another DSM IV diagnosis |
|
|
Neuro findings in alzheimers
|
o Extracellular senile plaques
o Intracellular fibrillary tangles o Synapse degeneration o Loss of neurons in cortex and subcortex o Neuron loss affects neurotransmitter system • Decrease in acetylcholine in forebrain |
|
|
Temporal lobe
|
• Auditory
• Language comprehension (L) • Sensory prosody (R) • Memory and emotion |
|
|
early stages of alzheimers
|
loss ST memory, work finding difficulties (• Vague speech, Circumlocution, Use of clichés), develop apraxias (Affects dressing (motor apraxia), Affects eating)
|
|
|
later alzheimers stages
|
o Judgment becomes impaired
o May develop personality changes • Apathy • Hostility • Social withdrawal o Disturbed sleep-wake patterns |
|
|
psych issues in dimentia
|
depression, anxiety, dellutions, hallucinations, agitation
|
|
|
MC pesonality change in dimentia
|
apathy
|
|
|
what is Capgras Syndrome
|
misidentification syndrome: Belief that a friend, family member, or acquaintance been replaced by an identical-looking imposter
|
|
|
Phantom boarder syndrome
|
An unseen individual is living in the home
|
|
|
What type of hallucinations are more common
|
visual, in AA
|
|
|
RF alzheimer
|
o Increasing age
o Positive family history o History of head trauma o Down's Syndrome o Genetic component |
|
|
What 3 chromosomes have been linked to alzheimers
|
trisomy 21, chrom 14( presenilin 1 gene), chrom 1(presilin 2 gene)
|
|
|
o Apo-E4 allele
|
earlier age of onset
• Alzheimer’s disease without and with Lewy bodies • Pure Lewy body dementia • Parkinson’s dementia without Alzheimer’s beta-amyloid plaques |
|
|
What is vascular dimentia
|
– Progression is “step-wise”
– Diffuse distribution – Formerly referred to as multi-infarct dementia |
|
|
rf vascular dimentia
|
o Vascular disease
o Vasculitis o Embolic disease (including atrial fibrillation) o Stroke yields a nine-fold increased risk of dementia |
|
|
what is Creutzfeldt-Jakob Disease
|
category of diseases called transmissible spongiform encephalopathies (TSEs).
rapidly progressing prion infection |
|
|
What is spongiform
|
• Infected brains become filled with holes and begin to look like sponges when viewed under a microscope. CJD is the most common of the known human TSEs.
|
|
|
MC CJD
|
sporadic
|
|
|
Most infrequent CJD?
|
acquired
• Exposure to brain or nervous system tissue (medical procedures). • No evidence is contagious through casual contact with someone who has CJD |
|
|
How can CJD be transmitted
|
• The use of contaminated dura mater or corneal grafts
• By ingesting meat from cattle infected with bovine spongiform encephalopathy |
|
|
First CJD signs
|
– First signs may be vague somatic complaints or unspecified feeling of anxiety
|
|
|
other CJD Si
|
o Ataxia
o Extrapyramidal signs o Choreoathetosis o Dysarthria o Myoclonic jerks |
|
|
other CJD SX
|
o Emotional lability
o Anxiety o Euphoria o Depression o Delusions o Hallucinations |
|
|
What gene is huntingtons on
|
chrom 4
|
|
|
onset of huntingtons
|
o Onset in 30-40's (Patient usually has children by this time)
o Choreiform movements seen first and become more severe |
|
|
dimentia in huntingtons
|
o Dementia presents later- often with psychotic features.
o Dementia may first be described as a personality change |
|
|
Describe Common dimentia of lewy dementia
|
– Extreme sensitivity to antipsychotic drugs
– Visual hallucinations – More marked response to cholinesterase inhibitors |
|
|
Clinical presentation of lewy dementia
|
o Shares features of both Alzheimer's disease and Parkinson's disease
o May have repeated falls o Unusually sensitive to adverse effects of neuroleptics o Common psychiatric symptoms include depression and systematized delusions |
|
|
DX criteria for Lewy Dementia
|
o Progressive cognitive decline
o At least two of the following for probable diagnosis • Recurrent (well formed) visual hallucinations. May see auditory hallucinations • Parkinsonism • Fluctuating cognition (with variation in attention and alertness) – like dementia! |
|
|
where is eosinophilic intraneuronal inclusion lewy body found
|
cortex and subcortex
|
|
|
Parkinsons symptoms
|
(bradykinesia, resting tremor, pill-rolling tremor, mask-like faces (flat affect), shuffling gait, etc…)
|
|
|
What is Pick's disease
|
– Frontal lobe is predominately involved
– See frontal signs of disinhibition – Relative preservation of cognition |
|
|
what may patients with picks disease have
|
Kluver-Bucy Syndrome (hypersexuality, hyperorality – compulsion to examine objects by mouth, placidity/docility – low aggression, diminished fear response)
|
|
|
What is pseudo dimentia
|
– Depression that presents with cognitive and memory impairment that resembles dementia
– Treat with anti-depressant medication or ECT |
|
|
What meds should you use for dementia
|
increases the level of acetylcholine in the brain, enabling neurons to communicate with one another more effectively
– Meds used block the action of acetylcholinesterase- key enzyme involved in breakdown of acetylcholine in the synaptic cleft – Drugs that enhance cognition |
|
|
Cholinesterase acting meds
|
tacrine, donepezil, revastigmine, galantamine
|
|
|
MOA Memantine Hydrochloride (Namenda)
|
• NMDA (N-methyl-D-aspartate) antagonist. Slows down the progression of the disease by blocking excessive stimulation of NMDA receptors
|
|
|
MCC Amnestic disorder
|
thiamine deficiency associated with alcohol dependency
|
|
|
TRIAD SX for hydrocephalus that you should consider in dementia pts
|
• Unsteadiness of gait
• Psychomotor retardation • Urinary incontinence • Wet, Wacky, and Wobbly |
|
|
wht type of cognitive impairment do hydrocephalus pattients exhibit
|
• Inattentive
• Easily sidetracked • Memory loss • Slow, but accurate recall |
|
|
Hydrocephalus motor sx
|
o Walk slowly
o Take shorter strides o Shuffle feet when walk |
|
|
hydrocephalus outcomes
|
• 1/3 significantly improve
• 1/3 stabilize or experience minor change • 1/3 continue to decline |
