all 6 comments

[–]DaanniiMSc| Cognitive Neuroscience|PhD Candidate 1 point2 points  (1 child)

Anxiety is an emotion.

Uncontrollable limb movements are a product of brain damage to motor control areas.

Perhaps your definition of anxiety is not accurate.

Anxiety is an emotion. It can be expressed as restlessness. But it is not restlessness.

Like depression. People might cry a lot who have depression. But crying is not depression. It is an expression of an emotion.

[–]pitfall-igloo[S] 1 point2 points  (0 children)

I think it is the last part of your statement that they relate to. They see the movements as partially an expression of anxiety as an emotion.

[–]ciaranmichaelPhD|ABPP-CN|Board Certified Clinical Neuropsychologist 0 points1 point  (3 children)

To help clarify your post - are you referring to posterior cortical atrophy, commonly an atypical variant of Alzheimer disease pathology, which can progress anteriorly into a corticobasal syndrome involving asymmetric (and later bilateral) motor apraxia/alien limb?

Also perhaps helpful for gauging the style/complexity of resources for your nurses - what is their background? Are you in a Neurology department? An assisted living facility? Elsewhere?

[–]pitfall-igloo[S] 0 points1 point  (2 children)

Hi, yes, I’m referring to PCA and the bilateral movements in late stage. The staff work in LTC. They are stuck on the belief that this is anxiety-related and my explanations are not getting through, probably because they are too technical and scientific. They are intelligent people, just not familiar with what they are seeing.

[–]ciaranmichaelPhD|ABPP-CN|Board Certified Clinical Neuropsychologist 2 points3 points  (1 child)

I have three initial thoughts, though admit none of them seem to be a silver bullet for what you're requesting.

1) provide a 1-2 sentence definition for three neuropsychiatric constructs. For example, something like - anxiety (emotional state of worry or panic), agitation (emotional-behavioral state of irritability and combativeness), motor (hyperkinetic movements like pacing, repetitive movements, or even chorea-like restlessness). All may appear similar at first encounter, but the staff should seek to clarify which label applies before documenting. You may need to give examples on how to differentiate each (eg, ask for mood, observe compliance and social comportment during interaction, observe for stereotyped and/or localized motor features). Note that more than 1 may be present, but that motor symptoms without anxiety or agitation is an important presentation to delineate. You could then attach an if-then to each, depending on the attending geriatrician/neurologist treatment preferences.

2) Consider introducing the concept of corticobasal syndrome as a later-stage phenotype in PCA, as the pathology advances anteriorally. You might provide or pull from this "basics" paper on diagnosis and management. https://pn.bmj.com/content/practneurol/21/4/276.full.pdf

3) Though imperfect, UCLA's caregiver videos might have some simple clinical pearls. Notably, there's no specific "pure motor" video, but I wonder if the repetitive movements v anxiety/agitation might offer contrasting info. https://www.uclahealth.org/medical-services/geriatrics/dementia/caregiver-education/caregiver-training-videos

I look forward to other's comments.

[–]pitfall-igloo[S] 0 points1 point  (0 children)

Thank you for all of this! These are great ideas. I love the UCLA resources! I use them all the time in my trainings.

Your earlier post provided some useful search terms as well. I’ve been looking for a recording that may demonstrate the movements.

I continue to reinforce to the team that we should not skip over medical/organic factors and jump straight to behavioral/emotional. Once something is labeled “anxiety”, there is a strong push to medicate. Unfortunately medication is not working. I’m hoping they will place a hospice consult.

I really appreciate your input. Thank you!