Exam 5 - Cognition and Neuro pt. 1 Flashcards
what are the different types of dementia?
primary and secondary
what is primary dementia?
organic brain disease
untreatable
what is secondary dementia?
caused by or related to another condition
what is the most common death for those with alzheimers?
pneumonia aspiration
what are the 3 types of pathophysiology for alzheimers disease
neurofibillary tangles
neuritic plaques
shrinkage and death of neurons
what are the neurofibrillary tangles
hair like protein fibers tangled together like yarn
INSIDE CELLS
what are neuritic plaques
made of a protein core called beta
amyloid surrounded by debris from degenerating neurons
outside neurons near synapse
what is the shrinkage and death of neurons and how does it cause AD
greater significance than plaques and tangles
what neurotransmitter is decreased in AD
acetylcholine (but not the cause of AD)
what are the neurotransmitters involved in AD
norepinephrine
serotonin
dopamine
amino acid glutamate
how is norepinephrine affected in alzheimers
slows everything down
how is serotonin affected in alzhemiers
sleep too much during day and sleep too little at night
how is changes in dopamine affected in alzheimers
muscles, cognition, motivation, ability to process pain all effected
what does increased amino acid glutamate do?
kill cells
etiology of AD
unknown
risk factors of AD
less education previous brain injury down syndrome 65+ smoking and family history herpes
diagnostic tests for AD
brain biopsy
diagnosis by exclusion
what are the stages of AD
1-3
what is stage 1 of AD
memory loss (short term) lack of spontaneity subtle personality changes disorientation to time and date may forget to eat
- Impaired cognition and abstract thinking
- Restlessness and agitation
- Wandering, “Sundown syndrome”
- Inability to carry out ADLs
- Impaired judgment
- Inappropriate social behavior
- Lack of insight, abstract thinking
- Repetitive behavior
- Voracious appetite
all are examples of what stage of AD
stage 2
anomia is what? and what stage is it in for AD?
inability to recall names or objects - 2
- Also called the terminal stage
- Emaciation, indifference to food
- Inability to communicate
- Urinary and fecal incontinence
- Seizures
- Total loss of ability to care for self
all are examples of what stage of AD
stage 3
how long does each AD stage last?
1 = 2-4 years 2= several years 3 = 1-2 years, terminal stage
what is the treatment for AD
no meds cure, but slow progress
emotional and educational support to patient and caregivers
behavior interventions
what is the prevention of AD
bilingualism activity mild to moderate consumption of alcohol mediterranean diet living with companion or pet
what drugs should be used for AD
cholinergic drugs
produce actions which stimulate or mimic actions of parasympathetic nervous system
cholinergic drugs
is cholinergic drugs direct or indirect?
direct action and mimic AcH
what does acetylcholine do?
for memory and motor control
when is acetylcholine increased?
parkinsons and depression
what is acetylcholinerase?
enzyme that destroys acetylcholine
when is acetylcholinerase useful?
inhibiting properties utilized when a med wants more ACH as desired result
what does serotonin do?
regulates sleep and sensory perception helps with EPS and limbic system
when is serotonin increased and decreased
increased during mania and anxiety
decreased during depression
what does norepinephrine do?
regulates mood, cognition, perception, locomotion, cardiovascular function/ CNS & PNS sympathetic
when is norepinephrine increased/decreased?
during mania and anxiety
decreased during norepinephrine
what does dopamine do?
movement cognition, motivation, pleasure, pain processing, other/limbic system, PNS/sympathetic, hypothalamus
when is dopamine decreased
during parkinsons
what does gamma do or GABA
regulate neuronal excitability
muscle tone/cns
what med is related to GABA
epilepsy control
what does glutamate do?
work with GABA and CNS
what effect does anticholinergic drugs have on the AD patient
it may speed up progression
risk vs benefit
what does anticholinergic drugs do?
inhibit the breakdown of the enzyme acetylcholinerase
what are cholinesterase inhibitors
block degradation of acetylcholine by inhibiting acetylcholinervse
what are the cholinesterase inhibitor medication
tacrine (cognex) and donezipil (aricept)
tacrine cautions
client with hepatic dysfunction/not used much due to this
what cholinesterase drugs are used the most
donezipil (aricept)
what are side effects of aricept
nausea vomitting diarrhea bradycardia cholinergic effects
what are the serious adverse for aricept or donezipil
resp depression
seizures
what is the newer therapy for AD
memantine (nemanda)
what does nemanda do?
shields brain from excess glutamate damage
side effects of nemanda
dizziness, headache
confusion
constipation
how long does it take for nemanda to work
several weeks
what shouldnt be used for AD treatment anymore
estrogen
what meds slow progress
NSAIDs vitamins(vit E) antidepressants antianxiety antipsychotic
how to antidepressants slow AD
decrease depression
enhance social function
improve appetite and sleep
what are adverse drug reactions to antidepressants
ortho hypo
what adverse drug reactions happen with tricyclic acid
sedation
anticholinergic
what adverse drug reactions happen with SSRI
nerovusness
agitiation
insomnia
irritability
how are anti anxiety helpful with AD
help with sundowning
help with insomnia
adverse drug reactions for anti anxiety
drowsiness
dizziness
fatigue
slow reaction
what is toxicity for anti anxiety meds?
loss of coordination
speech difficulty
antipsychotics help relieve behavioral issues for AD, but what are their adverse effects?
ortho hypo
cholinergic effects
sedation
extrapyramidial symptoms
what are extrapyramidal symptoms
acute dystonia reactions
what does extrapyramidal symptoms involved
eyes
jaw
neck
treatment for EPS
anticholinergic
antihistamine
what med is helpful for EPS
congentin
what are tardive dyskinesia
bizaare facial and tongue movement
stiff neck
when does EPS and tardive happen
eps within days of treatment
tardive within 3 months
treatment for EPS
dont do antiparkinsons anymore and reduce neuroleptic
benzo, clonidine and propanol usually help
what is complementary and alt therapy for AD
DHEA
gingko biloba
CO Q10
what is DHEA
precursor to androgen and estrogens
what is gingko biloba
natrual herbal antiinflammatory and antioxidant
what is CO Q10
antioxidant in our body
alexia
inability to see words or read
agnosia
inability to interpret sensations and recognize things
apraxia
inability to carry out fine motor skills
what is dysarthria
slurred slow speech that is difficult to comprehend and make sense of
expressive aphasia
inability to produce language
gloabal aphasia
effects for expressive and receptive language
what is receptive aphasia
or wernicke’s
inability to understand language
parasympathetic nervous system
rest and digest
sympathetic nervous sytem
fight or flight
what kind of receptors do the parasympathetic nervous system have
cholinergic
what kind of receptors does sympathetic have?
adregenic
alpha and beta
what is the neurotransmitter for the parasymp?
acetylcholine
what is the neurotransmitter for the sympathetic?
dopamine
norepineprhine
what do anticholinergic meds do
go from para symp to sympathetic
Dilate pupils, inhibit saliva, accelerate heart rate, dilates bronchi, inhibits peristalsis and secretion, inhibits bladder contraction all are a part of what?
sympathetic nervous system
Mental process by which knowledge is acquired and processed including is what?
cognition
Assess “What is happening?”,
Try to reorient them – it is not chronic,
Safety measures,
Make sure they are having enough sleep, Manage pain as best as we can,
Reduce stimuli,
What can we remove that is bothering them (ex: catheters, too much tubing, BP cuff?), Monitor electrolytes and hydration all are assessments for what?
delirium
Acquired, persistent intellectual impairment with compromised function in multiple spheres of mental activity?
dementia
What are the memory impairements of dementia?
apraxia
aphasia
agnosia
loss of executive function
What is loss of executive functioning?
incontinence
