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Class 8b
Alzheimer's Disease
| Question | Answer |
|---|---|
| Alzheimer's Disease | Degenerative disorder which affects memory, cognition and ability to self care. Affect 20 million Americans; Cost is estimated at 90 billion annually |
| Clinical Manifestation | Gradual Onset, progressive decline and one or more of the following: |
| Aphasia | Language disturbance` |
| Apraxia | Impaired motor functioning |
| Agnosia | Failure to recognize or identify objects |
| Disturbance in executive functioning | Planning, organizing, sequencing, abstracting |
| Assessment & Diagnostic Findings in AD | Physical examination & Neurological Testing; Mini exam (MMSE); clock drawing test (test executive functioning); depression screening; CT or MRI; Diagnosis is confirmed by Cerebral Biopsy at autopsy-presence of neurofibrial tangles & neurotic plagues |
| Etiology | Neuropathic and Biochemical changes; Cholinergic deficit; neurofibrillary tangles and senile or neurotic plague (deposition of amyloid protein in the brain APP); depletion of Acetylcholine (Ach) |
| Etiology, cont'd | Decrease in choline acetyltransferase activity (the enzyme that makes Ach); increase in acetylcholinesterace (an enzyme that breaks down Ach) |
| Theories (none are proven) of Alzheimer's disease | Syphillis, stroke infarcts |
| Etiology cont'd | Alzheimers is a disease of Acetylcholine; there is no cure for Alzheimer's; drugs slow down the progression but doesn't stop it. |
| Management | Acetylcholinesterase inhibitors (AChEIs) - stop increasing it from breaking down; Donepezil (Aricept); Galantamine (Reminyl); Rivastigmine (Exelon); tacrine (Cognex) - enhances Ach uptake in brain; Safety & Structure |
| Nursing management | Maintain safety; reduce anxiety and agitation; improve communication; promote independence in self-care activities; promote adequate nutrition; promote balance activity and rest; supporting home & community based care; support & educate care givers |
| On the cutting edge of research: (Treats moderate to severe alzheimer's) | Namenda (memantine HCL) - treatment of moderate to severe Alzheimer's; Brain Health Workshops; Gene Studies - CETP W; beta amyloid plagues studied now by new imaging technology |
| CETPW (Gene Study) | Gene where people live longer than 90 years |
| Brain Health workshops | physician has link to site and can measure cognitive decline when pt. play teh game. The # of plays correspond with ... |
| Compare and Contrast Parkinson's Disease and Alzheimer's Disease | |
| Parkinson's Disease | Alzheimer's Disease |
| Dopamine | Acetylcholine |
| Treat Tremors disease pathway or symptoms | Cognitive impairment, way |
| Dopamine agonist; L dopa, Sinemet | memory loss; Dimentia for no other reason; disease path |
| Symptoms: Antihistamine, anticholinergic, benadryl | Mortality from forgeting to eat |
| Huntington's Disease | Cortex affected most and the basal ganglion protein leads the brain cell to death; once the gene turns on, it takes 10 to 30 years. |
| Huntington's Disease | Chronic progressive hereditary disease of nervous system; autosomal dominant genetic disorder; usually appears BTW ages 30 & 45; 10% develop disease during childhood; 30k in US currently suffer from HD; over 150k indiv face a 50% risk of developing it. |
| Clinical Manifestations | 1st physical symptoms are usually uncontrolled movements in the fingers, feet, face, or trunk (chorea). Balance & coordinatin decline, & swallowing, eating, walking, and speaking become difficult. |
| Clinical Manifestations cont'd | Initial emotional symptoms include mood swings, anger, and irritability. later, some experience deep depression or hostile outbursts, while othes grow largely apathetic; |
| Manifestations cont'd | Patients may have trouble concentrating, making decisions, remembering facts, and executing appropriate judgment; eventually infections, injuries, and complications strike, and most die within ten to 30 years. |
| Diagnosis of Huntington's Disease | Clinical Presentation; positive family history; CT, MRI (may show atrophy); genetic markers |
| Management of HD (Pharmacologic): | Navane or Haldol or Reserpine used to improve chorea; antidepressants; antipsychotics |
| Nursing: | Teach patient & family about medications; teach strategies to manage symptoms; refer to speech pathologist; genetic counseling; psychological counseling; emotional, financial and legal support. |
| On the cutting edge of research: | Huntington Gene & Protein have been pinpointed, researchers are trying to u nderstand exactly how they cause the cells to self-destruct; inducing Huntington's in animals, researchers can more easily examine why the disease occurs & how it might be cured. |
| Example | creatinine, fatty acids, and vitamin C have all had positive effects on animals with HD; many experiments in the lab are attempting to move to clinical trials. |
| Amyotropic Laeral Sclerosis (ALS) Lou Gerics Disease | Motor Neurons die. Can't move their muscles. Have less nerve impulse to the area. |
| ALS | Rapidly progressing, fatal degenerative disease of upper and lower motor neuron system. Movie: Pride of the Yankees |
| Clinical Manifestations | Fatigue; Progressive muscle weakness; lack of coordination; difficulty talking, swallowing and ultimately breathing; intellectual function remain intact; |
| Manifestations cont'd | Affect more men than women. Familial link; respiratory system eventually stop working; usually passes from respiratory infection. |
| Difference between Huntington and ALS | Huntington - Brain Cells die; ALS - motor neurons, no signal going to neurons |
| Management: | No specific therapy for ALS; Riluzole (Rilutek) 50 mg BID; it slows the deterioration of motor neurons (extend life by 3 months; Baclofen or Diazepam (Valium) used to treat spasticity; Robinal - controls Secretions |
| Nursing | Teaching/supportive role iwth patient and family; nutrition: patient may have aspiration/swallowing problems & require enteral feeding; PT/OT speech therapy; mechanical ventilation; assist wtih advanced directives/living will |
| On the cutting edge of research | Gene studies; pilot studies have indicated that useful biomarkers may exist in the blood or cerebrospinal fluid of people with ALS; the second - generation antisense also referred to by the company as ISIS 333611,m works by inhibiting SOD1; |
| Other Medications in research | Memantine, Tamoxifen (chemo), Thalidomide, Ceftriaxone (Antibiotic) |
Created by:
howardccnurs