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Neuro -Test II

Neuro Test 2 - AD, PD, ALS & GBS

Alzheimer’s (AD) causes No single identifiable cause. Amyloid plaques & neurofibrillary tangles. (ex Vit. B12 deficiency, hypothyroidism, age)
Is Alzheimer's a UMNL or LMNL UMNL
What causes NT exhaustion in AD? Stress and depression; lack of curiosity
Risk Factors for Alzheimer’s Markers on different genes and chromosomes (Trisomy 21), cardiovascular disease, type 2 Diabetes, Heart disease, increased BP, increased cholesterol and increased free radicals, obesity, & family history
Indications that point to having Alzheimer’s (AD) Dr’s look at Hx, physical exam and neuropsychological tests
Manifestation of AD Resembles natural aging; mild memory loss for recent events. Visiospatial events; navigating the environment, cooking & fixing or manipulating mechanical objects in the home.
Alzheimer’s libido suppressed or heightened? AD affects each person differently and can change throughout the disease; however, it either doesn’t change much or heightens libido
What is the only way to know if someone has Alzheimer’s? Only way to truly know if someone has AD is to do an autopsy
Distribution (epidemiology)for AD Equal for men and women
T/F: AD interferes with intellectual f(x)? True
What increases and decreases with Alzheimer’s? With AD you see a decline in ADLs, memory, decision-making but increase in anxiety and agitation
When does AD occur? Late Adulthood.
Which part of the brain is affected in AD? Limbic System: memory loss, behavioral changes, emotional and personality changes
Major differences between AD and PD AD: limbic system: memory/mental/spiritual/emotional decline and PD: Basal Ganglia: movement decline (primary target is mov’t)
Which lobe of the brain is for initiation of mov’t? Frontal Lobe
What does the cerebellum do? Balance, coordination and equilibrium
What is the Tx for AD? There is no cure. Get pt’s to live w/in their limits of disability. Group therapy with simple exercises. *NO LIGHT THERAPY*
Q. …controversy about cause of AD? A) Al3+ poisoning, level of Al3+ is the issue; if more than trace, then causes problems; Al3+ is found in deodorant and non-coated utensils
What year was AD first reported? 1907
Is AD reversible? No
In AD what part of the brain is affected? Memory
In an autopsy exam of someone with AD, there is an abundance of what abnormal substance? Amyloid Plaques and neurofibrillary tangles
In AD what do you notice about the brain? Enlargement of canals (ventricles); brain shrinks so canals become enlarged
What is not essential for Tx-ing for AD? Light Therapy
What is not a risk factor for those affected with AD? Gender
AD and PD - highlights of PT: Group therapy, visual cues, don’t exhaust, cool environment, regular routine ex’s, better in the a.m., and sun going down can affect them
Oxidative Dementia (PD) Need water, veggies, beans; water very impt; need antioxidants to get rid of oxidants * MOST IMPORTANT ANTIOXIDANT - WATER*
Sundowning (AD) Pt’s become more aggressive, signs/symptoms increase; can just take off; caretakers have to be alert towards sundown to prevent pt from wandering off
Characteristic signs of PD: Festinating gait, pill rolling tremors, masked facial expression, slowness (bradykinesia), freezing, mm rigidity, unstable posture
What part of the brain is involved with PD? Basal Ganglia
Is Parkinson's a UMNL or LMNL? UMNL
What is NOT having the ability to perform rapid, alternating mov’ts? Diadochokinesia
Who discovered PD? James Parkinson
When was Parkinson's discovered 1817
With PD what decreases? There is a decrease in the production of Dopamine
Why is depression not good? NE/epinephrine are decreased due to stress; produce adrenaline from dopamine, so low level dopamine = low level adrenaline = less ability to handle stress
What does Dopamine do for the human? Mov’t (if not emotionally involved then mov’t)
What affects production of Dopamine apart from exhaustion/depression? Free radicals (oxidants): need antioxidants to combat
What is the most important antioxidant? Water
Relate PD to ADL/Relate AD to ADL better to deal with ADLs than someone with AD?????
Parkinson's Risk factors Environmental toxins, gene mutations, high levels of Fe2+, O2 released by cells and damaging them
Who can get PD Anyone can get it but higher incidence of young onset in Japan
Is there a cure for PD? No cure
What is the cause of personality changes in PD? The limbic system
Dance Therapy for PD New & innovative; one of the best things ppl can do regardless of illness or not
What type of disease is PD? Chronic, progressive disease of CNS
Basal Ganglia disorder? Deficiency of dopamine and degeneration of the substantia nigra; loss of inhibitory dopamine results in excessive excitatory output from cholinergic system of basal ganglia
Causes of PD? Commonly idiopathic but can also be infectious, atherosclerosis, toxic or drug induced
Clinical picture of PD slowly progressive with emergence of secondary impairments and permanent disability
Mentation deficits (PD) Bradyphrenia (slowing of thought processes), depression and dementia in advanced stages
Communication (PD) Dysarthria, hypophonia, masked face and micrographia
Musculoskeletal (PD) Contractures commonly present in flexors and adductors, persistent posturing in kyphosis with forward head, and osteoporosis leading to high risk of Fx
Sensory impairments (PD) Abnormal cramp-like sensations poorly localized & perceptual deficits; Visual problems,skin integrity, tone/reflexes:rigidity,resting tremors,pill-rolling,mm atrophy,motor control,balance & postural rxns,festinating gait,mm &general endurance
Festinating Gait (PD) shortened stride, decreased speed, increased cadence, decreased arm swing and trunk rotation
Impaired motor control (PD) bradykinesia, akinesia (results in freezing episodes), and slowed rxn time and mov’t time
What is ALS? Malnourishment of the mm resulting in atrophy; sensory still intact
Why ALS results in atrophy? Progressive; amyotrophic: mm fiber atrophy from peripheral nerve involvement; Degeneration and scarring of the motor neurons in the lateral aspect of the spinal cord, brainstem and cerebral cortex
True or False, ALS usually starts unilateral but eventually becomes bilateral. True
ALS LMNL signs asymmetrical, distal weakness w/ eventual progressive atrophy, facial weakness that results in difficulty with swallowing
ALS UMNL signs hyperactive tendon reflexes and spasticity
T/F: ALS is characterized by irreversible denervation? True
What is the most common neurodegenerative disease among adults ALS
Epidemiology of ALS 1 per 100,000; typically btw ages of 50-60 yrs; men > women
Is there a cure for ALS No cure; younger you are Dx’d, the slower the progression
How quickly does ALS progress? Death usually results in 2-5 yrs due to respiratory compromise
Differences between ALS and GBS GBS: LMN, temporary, starts fingers & toes ALS: UMN/LMN, permanent and fast, feet to head distal to proximal, starts unilaterally and goes bilaterally with sensory still intact
What is GBS GBS is multiple neuropathies; distal to proximal; usually in the appendages
GBS Polyneuritis with progressive muscular weakness that develops rapidly
Epidemiology of GBS Unknown but associated with autoimmune attack; Usually occurs after recovery from an infectious illness; Evolves over a few days or weeks w/ slow recovery (months to a year) back to or near full f(x)ing
Pathology of GBS Acute demyelination of both cranial and peripheral nerves
What does GBS resemble that it can be mis-Dx’d as? Carpal Tunnel Syndrome
Btw ALS and GBS: which one quickly need adaptive devices (orthoses)? ALS b/c starts at feet
Ratio of men to women with GBS 2:1 (men to women)
Why does GBS need aggressive PT? GBS will need aggressive exercise b/c mm’s waste rapidly; so need this aggressive exercise to prevent that from happening
GBS Tx Plasmaphoresis - filter blood (all cells WBC, RBC, platelets filtered out; removes defective cells/proteins) and put plasma back; 50/50 chance body will make correct cells that aren’t defective
Clinical Picture of GBS Aerobic capacity and endurance may be severely limited, especially w/ pulmonary involvement. Integumentary integrity: pain and paresthesias; typically less sensory involvement than motor
Motor Function GBS Motor paresis or paralysis: relative symmetrical distribution or weakness; Progresses from lower extremities to upper and from distal to proximal; May produce full tetraplegia with respiratory failure; Not uncommon to have residual bilateral foot-drop
Created by: srussel



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