degenerative disorders 17 Flashcards
what are some examples of degenerative disorders?
Parkinson’s disease
- Delirium / Dementia
- Multiple sclerosis
what is Parkinson’s?
-severe degeneration of teh substantia nigra (part of the basal nuceli) resulting in decrease in neurotransmitter dopamine
what is secondary parkinsonism?
-similar to Parkinson’s disease but caused by trauma, infection, drugs (antipsychotics, antiemetics, etc). this is not “true Parkinson’s.
what is TRAP?
- Tremor (at rest, unilateral bilateral)
- Rigidity (stiffness)
- Akinesia or bradykinesia
- postural disturbances
what occurs with Parkinson Disease?
- postural changes
- shuffling’s type of gait, usually have delay in beginning to walk and trouble starting to move
other symptoms of Parkinson’s
- motor movement disorder
- constipation, inappropriate sweating, and orthostatic hypotension (these ppl are at risk for fall because they have tremors that they cant control)
- low levels of dopamine
- low levels of sleep
- depression
Onset of Parkinson’s disease?
- onset after age 40
- peak between 58-62
- slightly more than women
Diagnosis of Parkinson’s disease?
- history and physical examination
- drug trial (if medication helps them, it confirms diagnosis)
- rule out other causes
- positron emission tomography (PET) in selected cases-not widely available
treatment of Parkinson’s?
Drug therapy to decrease symptoms
- increased dopamine levels and or block ACH
- newer strategic is to balance dopamine and ACH
- deep brain stimulation
- stem cell transplantation-helpful with some ppl
- goal of these two is to re-stimulate cell in brain that stimulate dopamine
what is a delirium?
- Acute confustional state
- is reversible
- functional in nature- due to drug and or alcohol withdrawl, medication adverse effects, sepsis, fever, pain
- develops in 2-3 days-can be treated and is reversed
what is dementia?
- progressive and irreversible (medication to only slow process)
- impaired memory, reasoning, judgement, language
- behavioural changes
- supportive tx only
- associated with parkinsons disease, CNS infection, atherosclerosis
what are the types of dementia?
- Alzheimer’s disease
- fronto-temporal dementia
- dementia with lewy bodies
what is the most common type of dementia?
- Alzheimer’s disease
- 4th leading cause of death in Canada
- affects 15% of general pop over age 65
pathophysiology of alzheimers?
- degeneration of cholinergic neurons
- these neurons release ACH-linked to memory
- atrophy
- loss of ACH
- cerebral atrophy
early manifestations of AD?
forgetfulness memory loss missing appointments getting lost personality changes
later manifestations of AD?
language disorientation confusion lack of concentration decline in abstraction, problem solving lack of judgement - neglects hygiene wandering
what is sundown syndrome?
manifestations that get worse in the evening
what is end stage AD?
-incontinence
apathy
loss of interest in food
cant recognize family and friends
diagnosis of AD?
- made by ruling out other causes of dementia
- ppl with AD cant “track back” to figure out where they left something, they dont know where they have been
- inability to form short term memory, and wont remember if they forgot something
what Is delirium often a sign of in the older generation?
infection
what is the pathophysiology of Multiple sclerosis?
- is an autoimmune disorder
- T cells and B cells cross the BB and start to attack myelin
- causes problems with transmission of impulses and eventually cerebral atrophy
- inflammation induced loss of oligodendrocytes
- disrupted nerve conduction with death of neurons and brain atrophy
manifestations of MS?
- multiple and vary
- depends on where in the brain this process is happening
- common to have vision changes in clarity, depth and perception
- relapse episodes (caused by stress and fatigue)
- sometimes are misdiagnosed with MS but actually have lyme disease
diagnosis of MS?
- history and physical exam
- MRI
- Evoked response studies
Tx of MS?
- medications to reduce relapse
- symptom managment therapies (bladder, bowel, fatigue, pain)
- txs in development:
- repair tc such as stem cells
difference between women and men in MS?
- men: more quicker and aggressive, steady decline
- women: more relapses
what are the top 3 causes of blindness in Canada in order?
1) diabetic retinopathy
2) glaucoma
3) cataracts
hearing loss is either.,
conductive or sensory
what is glaucoma?
- pressure build-up that compresses optic nerve and its blood suppy
- peripheral vision is lost first, then moves in
- nerve is deprived of O2
risk factors for glaucoma?
- age
- ethnicity
- diabetes
- previous eye injury
- far sightedness
what are the two types of glaucoma?
open angle and closed angle
-both are failure of the aqueous humor to drain properly
what is open angle glaucoma?
- onset is slow, chronic
- slow because the drain is partially blocked with “sludge”
- slows down drainage of fluid, due to eye infection
what is closed angle glaucoma?
short, acute onset
- angle by canal of schemm is not closed off
- blocks off drainage port, hence by onset is fast
with both types of glaucoma, what vision is lost first?
peripheral
managment of glaucoma?
- regular screening (tests pressure, puff of air test)
- medications to decrease fluid
- surgery
what are cataracts?
-cloudy from protein build up
causes of cataracts?
- age
- diabeties
- genetics
- glaucoma
- sun exposure- sun can cause damage to lens of eye over time
what is conductive hearing loss?
-changes in outer and middle ear affects ability of sound to travel to inner ear
causes of conductive hearing loss?
- ear infection
- foreign bodies
- tumors
manifestations of conductive hearing loss?
decreased hearing
soft voice- they speak louder because they can hear themselves more
what is sensorineural hearing loss?
impairment of part of the inner ear, or auditory nerve (cranial nerve 8)
causes of sensorineural hearing loss?
age
loud noises
drugs - some antibiotics can cause hearing loss
congential
manifestations of sensorineural hearing loss?
high-tone hearing loss- loose this first
tinnitus
