Alteration in Cognitive Systems Flashcards
Are dementia persons clear with their thoughts and with what’s going on?
Dementia persons conscious is clear – they just don’t know where they are/what’s going on
S + S of excited delirium?
associated with altered mental status, combativeness, aggressiveness, tolerance to pain, rapid breathing, diaphoresis, severe agitation, increased temperature, noncompliance – “superhuman” strength and they don’t seem to fatigue
Onset and duration for delirium?
The onset for delirium is abrupt and its course is sporadic, the duration of delirium is limited to days or weeks and it is reversible for most patients.
Predisposing factors for middle ear infections?
allergies, sinusitis, cleft palate, hypertrophy of the adenoids, eustachian tube dysfunction, & immune deficiency
What is sensorineural hearing loss?
Impairment of part of the inner ear, or auditory nerve (Cranial Nerve VIII)
is MS a diffuse or focal disease? what does it result in? (What does it form)
It’s a progressive diffuse disease that results in patched of damage throughout the brain and spinal cord (forms hard yellow plaques of scar tissue)
Causes of sensorineural hearing loss?
Causes – noise exposure, aging, ototoxicity (side effect of medications), systemic diseases – like DM, neoplasms, autoimmune processes
What is Amyotrophic lateral sclerosis? What does it affect?
– neurodegenerative disease affects nerve cells of brain and spinal cord
What is causing the break in neurons in those with Alzheimers?
Tangles and plague development is whats causing the break in the neuron and causing the demntia – can’t see until autopsy
Why are ear infections more common in kids?
Due to eutation tube being smaller and straighter
What is the earliest sing of sensorineural hearing loss?
Delayed speech development is the earliest sign
What develops due to the loss of neurons in Alzheimer’s? What contributes to the decline?
Brain atrophy develops due to the loss of neurons
Loss of synapses, acetylcholine, and other neurotransmitters contributes to the decline
What is Guillain barre syndrome? Where is it directed at?
Acute inflammatory demyelinating polyneuropathy
Rare demyelinating disorder caused my an autoimmune reaction directed at the peripheral nerves
-Caused by a humeral and cell - mediated immunological reaction directed at the peripheral nerves
-occurs within days to sometimes weeks
What is Lateral sclerosis?
Lateral sclerosis – scarring of the corticospinal tract (occurs with ALS)
what disease would we see dementia with Lewy bodies? What is it present with?
Dementia with Lewy bodies that we would see in Parkinson’s present with visual hallucinations, delusions, sleep disorder, delirium
Signs and symptoms for Guillain barre syndrome? How long can recovery take?
Starts with tingling and numbness progresses to Paresis of the legs to complete quadriplegia
Starts in legs and moves upward
Respiratory insufficiency - worst thing that can happen
ANS instability
Recovery can take weeks, to months, to up to 2 years
Residual weakness in 30% of individuals
Similar symptoms of both AOM and OME?
Symptoms - both
Hearing loss
Ear fullness
What is dementia? What does it manifest as?
Dementia is a slow but stedy deterioration, can take months to years to develop and is rarely reversible.
Acquired deterioration and a progressive failure of many cerebral functions
Declining abilities may manifest in agitation, wandering, and aggression
No cure, treatments are supportive only
How many stages are there in macular degeneration?
2 step process that progresses from wet to dry
Dry stage – eye tissues start to degenerate – epithelial cells produce yellowish-white spots – deposited on retina – calcify, enlarge and multiply
Wet stage – new vessels develop beneath the epithelial cells – they are weak and leak serous fluid or blood– central vision is lost
What is responsible for the symptoms of parkinsions?
Reduction of dopamine upsets the normal balance between inhibitory dopamine and excitatory acetylcholine neurotransmitters
The effects of lower Dopamine is responsible for the symptoms of Parkinson’s
What is stimulation of the brain shown to do in those with Alzheimers?
stimulation shows downs progression , doesn’t stop it but it slows it down
When does Parkinson’s disease tradindtionally begin?
Begins after age 40 – incidence increase after age 60
Risk factors for MS?
– may be smoking, vitamin D deficiency and Epstein-Barr virus, and family history
S + S of hypoactive delirium?
reduced motor activity,lethargy,withdrawal,drowsiness and stareing into space
Initially we will see decrease in mental function, attention span will decrease, will have inappropriate reactions to their environment, forgetfulness, & apathetic, their speech will be slowed and they will fall asleep easily and often
Symptoms of conductive hearing loss?
Diminished hearing and soft speaking voice – hearing their voice through bone conduction and it seems louder in comparison to external sound
There is something in the way/blocking – more likey that we can reverse it
When determining if it’s dementia or delirium what must we understand/consider?
How fast did it come on
3 phases for Guillain barre syndrome
Acute phase – ends in 1-3 weeks – no further deterioration
Plateau phase – last for several days – 2 weeks
Recovery phase – remyelination and axonal process regrowth – can last from 4 months to 2 years.
Primary sign of ALS?
Muscle weakness is primary sign
With MS what occurs before any symptoms appear?
Degeneration occurs before any symptoms appear – can have progressed substantially before diagnosis
What is macular degeneration? What vision do we lose?
Age-related macular degeneration (AMD)
Deterioration of tissue in the macula of the eye – severe and irreversible loss of central vision – peripheral vision can be maintained
What is primary Parkinson’s disease? What is it accompanied by?
Primary is complex motor disorder accompanied by systemic nonmotor and neurological symptoms
What do you loose with ALS?
Motor neurons eventually die & voluntary muscle movement is impacted
Lose the ability to eat, speak, move, and breathe
Gradual degeneration of upper and lower motor neurons – dead neurons can’t transport message
What kind of progression does ALS have?
Progresses quickly
What is Guillain Barre?
a rare disorder where the body’s immune system damages nerve. The damage to the nerves causes muscle weakness and sometimes paralysis. While its cause is not fully understood, the syndrome often follows infection with a virus or bacteria.
acute autoimmune disease associated with demyelination of peripheral nerves
-Occurs peripherally
Early S+S for Alzheimer’s?
Early:
Memory loss that affects job
Difficulty performing familiar tasks
Learning difficulties
Deterioration of appearance and personal hygiene
What is glaucoma?
Increased intraocular pressure
signs and symptoms of MS?
Visual disturbances
Paresthesia of face, trunk, or limbs
Weakness
Impaired gait
What is OME (Otitis Media with Effusion)?
accumulation of fluid in the middle ear without symptoms of an acute infection – can be caused by flying – changes in air pressure can close eustachian tube affecting fluid flow – fluid is present but it is not infected
What is dementia?
Dementiais a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life.
What is happening/ patho behind cataracts?
Cataracts are protein that is normally found on the lens, but with age has started clumping together
4 patho steps for MS/progrssion of the disorder?
1.Autoreactive T cells and B cells cross the BBB – triggering inflammation and loss of oligodendrocytes (myelin-producing cells
2.) Microglia (brain macrophages) activation which contribute to inflammation and injury – triggering an axonal degeneration
3.) Loss of myelin – interference in conduction of impulses – all fibers affected – motor, sensory, autonomic
- brain atrophy
4.) After myelin is destroyed, neuroglial tissue (oligodendrocytes, astrocytes, microglia, and ependymal cells) in the white matter proliferates, forming hard yellow plaques of scar tissue
What do we see in fully develop individuals with excited delirium?
Fully developed individuals will be inattentive with altered perceptions –experiencing misinterpretation
Will be distressed, conversation is incoherent. May have frank tremor & violent behaviour
Will not be able to sleep, skin will be flushed, pupils will be dilated, tachycardic,
Ex of things that can induce delirium?
Substance abuse – alcohol or illegal drugs – or now legal drugs with cannabis
Can have a withdrawal from alcohol or illegal addictions
We can also induce delirium in some of the medications we give in a hospital setting –
General conditions that may result in delirium include trauma, metabolic disorders, hypothermia, dehydration, heart, kidney, or liver failure
Risk factors for macular degeneration? What age does it typically occur at?
Risk factors – HTN, smoking (2X), DM, & family history (increases your chanaces of develop) -
* Usually occurs after the age of 60 – more common in Caucasians, women more than men
What do we initially see in those with excited delirium?
Initially we will see a decreasing in ability to concentrate, restlessness, irritability, insomnia, poor appetite
May present with nightmares
What is happening in open angle glaucoma? what are it’s characteristics? What’s is its rate of development? Is it unilateral or bilateral?
Open angle the ciliary body is in the correct position but there is something blocking the trabecular meshwork
Can be inherited – occurs slowly –bilaterally it is the leading cause of blindness with few symptoms
Ex of general conditions that may result in delirium?
General conditions that may result in delirium include trauma, metabolic disorders, hypothermia, dehydration, heart, kidney, or liver failure
Risk factors for Alzheimers?
– lifestyle, environment, and genetic background can increase the likelihood of you developing Alzheimer’s – not the causes of the disease
Age – is the biggest one
Family history
Down syndrome
HTN – more likely to cause vascular dementia – indirectly through atheresclorosis
Smoking – toxins from smoking causes inflammation and stress
Diabetes – low blood sugars can cause damage to hypocampus (memory)
High cholesterol – higher risk in males
Obesity/sedentary lifestyle
Poor diet
Cognitive activity
Depression
Head injuries
Endstage S+S for alzheimers?
incontinence, apathy, loss of interest in food, can’t recognize family and friends
What is AOM (acute otitis media)?
Tympanic membrane changes from convex pearly grey to bulging pink/red – as fluid accumulates in the middle ear
What is delirium? What does it cause?
abrupt change in the brain that causes mental confusion and emotional disruption. It makes it difficult to think, remember, sleep, & pay attention
What is Multiple Sclerosis? Does it occur centrally or peripherally?
– progressive demyelination of the white matter of brain and spinal cord
-Is a chronic immune-mediated inflammatory disease involving degeneration of CNS myelin, scarring and loss of axons
-Occurs centrally
-Autoimmune response
onset age of MS?
20 - 40
Sings and Symptoms of ALS?
Early S&S depend on affected neurons
Muscle weakness is primary sign
Trouble lifting cup or holding a pen may occur or they may have trouble speaking or swallowing
Choking, excessive drooling, depression, inappropriate laughter
Progress to problems breathing
Can develop dementia at the same time
What happens pathophysicologicaly with Parkinson’s disease? (What is there a decrease of)
Dopamine deficiency occurs in the basal ganglia – the dopamine-releasing pathway that connects the substantia nigra to the corpus striatum and
responsible for smooth muscle movement
When does Guillain barre syndrome occur?
Occurs after a respiratory or gastro-intestinal infection – the association with immunizations is not proven
What is presbycusis?
- Presbycusis or age-related sensorineural hearing loss is the most common cause of hearing loss
What is ALS?
Motor Neuron Disease
Progressive neurodegenerative disease – affects nerve cells of the brain and spinal cord
Later S+S of Alzheimers?
– language, disorientation, confusion, lack of concentration, decline in abstraction, problem solving, and judgment, neglects hygiene, wandering,
Sundowners
osent of Open angle glaucoma?
Slow and progressive
What is secondary Parkinson’s disease?
Secondary is Parkinson’s is caused by some other factor such as trauma, infection, intoxication that affects the pathways causing the dopamine deficiency
What kind of disease process can glaucoma present as?
Can occur as a primary disease process or can be a secondary disease as the result of trauma, prolonged use of steroids, tumours or an inflammation in the eye.
What is Parkinsons disease?
motor disorder accompanied by systemic nonmotor and neurological symptoms
a brain disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination.
What is conductive hearing loss?
Changes in outer and middle ear affect ability of sound to travel to the inner ear
Conduction of sound is impaired from the outer ear through to the inner ear
Is MS more common in men than women? Which gender has a more severe progression?
more common in women than men, but men will have a more severe progression
-women affected twice as much as men?
S+S of cataracts?
Cloudy or opaque area in the lens = vision loss
Early stage – some light transmitted through lens – useful vision
Second stage – vision significantly decreased – lens appears opaque
Third stage – lens starts to increase in size
Fourth stage – lens may start to leak protein as it breaks down – can have an increase in intraocular pressure as well as blocking of the trabecular meshwork – which may lead to glaucoma – studied next
S + S of dementia?
Impaired memory, reasoning, judgment, language
Behavioural changes
Supportive treatment only
S+S of AOM?
ear pain, fever irritability, inflamed TM, & fluid in middle ear
What is excited delirium?
Excited delirium – agitated delirium hyperkinetic that can lead to sudden death
Onsent of closed angled glaucoma?
Where does it occur?
Sudden, acute
-Bilateraly
-Emergency
-Loss of sight in 24 hrs if not treated right away
S+S of sensorineural hearing loss?
Early sign is tinnitus or ringing in the ear and then eventually high-tone hearing loss
Sings and symptoms of Parkinson’s? (TRAP)
Tremor
Rigidity
Akinesia/bradykinesia
Postural disturbances
Dysarthria
Dysphagia
Resting tremor – starts unilateral and then bilateral
Rigidity
Akinesia/ bradykinesia – absence or slowing
Postural disturbances – stooped posture – flexed forward, difficulty walking – cannot correct themselves if falling – small stutter step to maintain balance when walking
Dysarthria/dysphagia – muscle control loss of ability to speak and swallow
Start alone or in combination but all present as disease progresses
What is cataracts?
Cataracts – most common – protein that’s floating around and starting to calcify – going to first see cloudy patches in their vision
S+S of AOM?
Pain, fever, purulent discharge if the eardrum ends up rupturing
What is happening in closed angle glaucoma?
How does it occur?
Closed angle – displaced iris pushes the ciliary body and blocks the fluid from reaching the trabecular meshwork
Occurs unilaterally, acutely - with severe pain and visual disturbances – may see a rainbow in their vision
Vision loss can occur within 24 hours
Onset of ALS? What gender is it more commonly seen in?
Onset between 40-70 20% more men than women
Progressively debilitating disease –rapidly fatal – survival time is < 3 years
What is delerium associated with? What can it be caused by?
Associated with autonomic nervous system overactivity
several neurotransmitters are involved – dopamine and acetylcholine
Can be an interference of neuronal metabolism or synaptic transmission – can be caused by metabolic concerns, medications, or toxins
Cataracts Risk factors?
Age
Diabetes
Genetics
Sun exposure
Cause of alzhemiers?
Cause is not clear-thought - build-up of proteins in and around brain cells – causes accumulation of extracellular neuritic plaques, intraneuronal neurofibrillary tangles,
These cause a disruption of nerve impulse transmission and neuron death
Risk factors for glaucoma?
HTN – cardiovascular disease, obesity, and DM
Smoking, caffeine, alcohol and illicit drugs may also contribute to increased intraocular pressure
Where/when would we see vascular dementia? What would we see patients present with?
Vascular dementia that may develop within 3 months of a stroke – these patients would present with apathy, delusions, anxiety, and motor slowing
Patho behind glaucoma?
Failure aqueous humor to drain properly
Pressure build-up compresses optic nerve and its blood supply
Nerve deprived of oxygen
Optic disc is compressed – optic nerve is deprived of oxygen - outside of the optic nerve is damaged first
Causes of conductive hearing loss?
Impacted cerumen, foreign bodies, tumours in the middle ear, ruptured tympanic membrane, or otitis media
