degenerative disorders 17

Question 1

what are some examples of degenerative disorders?

Answer 1

Parkinson’s disease

• Delirium / Dementia
• Multiple sclerosis

Question 2

what is Parkinson’s?

Answer 2

-severe degeneration of teh substantia nigra (part of the basal nuceli) resulting in decrease in neurotransmitter dopamine

Question 3

what is secondary parkinsonism?

Answer 3

-similar to Parkinson’s disease but caused by trauma, infection, drugs (antipsychotics, antiemetics, etc). this is not “true Parkinson’s.

Question 4

what is TRAP?

Answer 4

• Tremor (at rest, unilateral bilateral)
• Rigidity (stiffness)
• Akinesia or bradykinesia
• postural disturbances

Question 5

what occurs with Parkinson Disease?

Answer 5

• postural changes

- shuffling’s type of gait, usually have delay in beginning to walk and trouble starting to move

Question 6

other symptoms of Parkinson’s

Answer 6

• 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

Question 7

Onset of Parkinson’s disease?

Answer 7

• onset after age 40
• peak between 58-62
• slightly more than women

Question 8

Diagnosis of Parkinson’s disease?

Answer 8

• 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

Question 9

treatment of Parkinson’s?

Answer 9

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

Question 10

what is a delirium?

Answer 10

• 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

Question 11

what is dementia?

Answer 11

• 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

Question 12

what are the types of dementia?

Answer 12

• Alzheimer’s disease
• fronto-temporal dementia
• dementia with lewy bodies

Question 13

what is the most common type of dementia?

Answer 13

• Alzheimer’s disease
• 4th leading cause of death in Canada
• affects 15% of general pop over age 65

Question 14

pathophysiology of alzheimers?

Answer 14

• degeneration of cholinergic neurons
• these neurons release ACH-linked to memory
• atrophy
• loss of ACH
• cerebral atrophy

Question 15

early manifestations of AD?

Answer 15

forgetfulness
memory loss 
missing appointments 
getting lost 
personality changes

Question 16

later manifestations of AD?

Answer 16

language 
disorientation 
confusion
lack of concentration 
decline in abstraction, problem solving 
lack of judgement
- neglects hygiene
wandering

Question 17

what is sundown syndrome?

Answer 17

manifestations that get worse in the evening

Question 18

what is end stage AD?

Answer 18

-incontinence
apathy
loss of interest in food
cant recognize family and friends

Question 19

diagnosis of AD?

Answer 19

• 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

Question 20

what Is delirium often a sign of in the older generation?

Answer 20

infection

Question 21

what is the pathophysiology of Multiple sclerosis?

Answer 21

• 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

Question 22

manifestations of MS?

Answer 22

• 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

Question 23

diagnosis of MS?

Answer 23

• history and physical exam
• MRI
• Evoked response studies

Question 24

Tx of MS?

Answer 24

• medications to reduce relapse
• symptom managment therapies (bladder, bowel, fatigue, pain)
• txs in development:
• repair tc such as stem cells

Question 25

difference between women and men in MS?

Answer 25

- men: more quicker and aggressive, steady decline | - women: more relapses

Question 26

what are the top 3 causes of blindness in Canada in order?

Answer 26

1) diabetic retinopathy 2) glaucoma 3) cataracts

Question 27

hearing loss is either.,

Answer 27

conductive or sensory

Question 28

what is glaucoma?

Answer 28

- pressure build-up that compresses optic nerve and its blood suppy - peripheral vision is lost first, then moves in - nerve is deprived of O2

Question 29

risk factors for glaucoma?

Answer 29

- age - ethnicity - diabetes - previous eye injury - far sightedness

Question 30

what are the two types of glaucoma?

Answer 30

open angle and closed angle | -both are failure of the aqueous humor to drain properly

Question 31

what is open angle glaucoma?

Answer 31

- onset is slow, chronic - slow because the drain is partially blocked with "sludge" - slows down drainage of fluid, due to eye infection

Question 32

what is closed angle glaucoma?

Answer 32

short, acute onset - angle by canal of schemm is not closed off - blocks off drainage port, hence by onset is fast

Question 33

with both types of glaucoma, what vision is lost first?

Answer 33

peripheral

Question 34

managment of glaucoma?

Answer 34

- regular screening (tests pressure, puff of air test) - medications to decrease fluid - surgery

Question 35

what are cataracts?

Answer 35

-cloudy from protein build up

Question 36

causes of cataracts?

Answer 36

- age - diabeties - genetics - glaucoma - sun exposure- sun can cause damage to lens of eye over time

Question 37

what is conductive hearing loss?

Answer 37

-changes in outer and middle ear affects ability of sound to travel to inner ear

Question 38

causes of conductive hearing loss?

Answer 38

- ear infection - foreign bodies - tumors

Question 39

manifestations of conductive hearing loss?

Answer 39

decreased hearing | soft voice- they speak louder because they can hear themselves more

Question 40

what is sensorineural hearing loss?

Answer 40

impairment of part of the inner ear, or auditory nerve (cranial nerve 8)

Question 41

causes of sensorineural hearing loss?

Answer 41

age loud noises drugs - some antibiotics can cause hearing loss congential

Question 42

manifestations of sensorineural hearing loss?

Answer 42

high-tone hearing loss- loose this first | tinnitus