MNT for Neurological Disorders (part 1) Flashcards
Nutritional issues with neurological diseases include…
-Significant risk for malnutrition
-Difficulties with feeding depend on the area of the nervous system affected
What are some examples of problems that may be caused by neurological diseases?
-Paralysis and hemiparalysis
-Hemianopsia and neglect
-Aphasia
-Dementia
-Dysphagia
-Anosmia/dysnosmia
What are some nutrition concerns for someone with paralysis and hemiparesis?
-Coordination is a problem if the paralysis is on the dominant side
-Difficult to eat with one hand
-Fatigue
-Difficulty obtaining and preparing food
-May require assistive feeding devices
_____ is defective vision or blindness in half of the visual field (people may recognize half of a meal)
Hemianopsia
_____ is inattention to a weakened or paralyzed side of the body
Neglect
When hemianopsia and neglect occur together, the ability to ____ may be severely impaired
Eat
_____ is the loss of the ability to produce and/or comprehend language due to injury to brain areas specialized for these functions
Aphasia
Broca’s aphasia is also known as _____ aphasia
Expressive
Broca’s aphasia is due to injury to Broca’s area which is located in the ___ ___ ___ of the brain
Left frontal lobe
With Broca’s aphasia, people are unable to create ____-____ sentences
Grammatically-complex
With Broca’s aphasia, patients are usually _____ that they cannot speak properly
Aware
With Broca’s aphasia, _____ is relatively normal
Comprehension
Wernicke’s aphasia is also known as ____ ____
Receptive aphasia
Wernicke’s area is located in the ___ ___ ___ of the brain
Left temporal lobe
With Wernicke’s aphasia, speech patterns sound normal, but sentences are ____
Nonsensical
With Wernicke’s aphasia, there is pronounced impairment in _____
Comprehension
____ is a disease associated with loss of brain function resulting in memory, behavior, learning, and communication problems
Dementia
Dementia can be caused by what two things?
-Degenerative diseases of the brain
-Vascular diseases
Nutritional issues with dementia include…
-Ability to obtain and safely prepare foods
-Ability to follow diet restrictions
-May not eat safely
-May forget to eat
-May need enteral nutrition if c/w patient’s living will
_____ is a difficulty or inability to swallow properly
Dysphagia
What cranial nerves are involved in swallowing?
-Trigeminal (V): mastication
-Glossopharyngeal (IX): swallowing
-Hypoglossal (XII): tongue movement
Dysphagia may lead to…
-Malnutrition
-Dehydration
-Aspiration pneumonia
What are two neurological diseases that are caused by nutritional deficiencies?
-Pernicious anemia (B12)
-Wernicke-Korsakoff syndrome (Thiamin)
A ____ ____ is damage to brain tissue due to impaired blood supply
Cerebrovascular accident (stroke)
Acute onset of neurological deficits lasts for less than ___ ___ and are attributable to disease of the intra- or extra-cranial vasculature
24-hours
With a cardiovascular accident, symptoms last for at least 24 hours, but with a ___ ___ ___, symptoms resolve in less than 1 day
Transient ischemia attack
Cerebrovascular accidents are the ___th most common cause of death in the United States
5
What are two possible etiologies of cerebrovascular accidents?
-Ischemia (blood clot)
-Intracranial hemorrhage
Ischemia can be ____ or ____
-Embolic (blood clots that start somewhere else in the body and travel to the brain)
-Thrombolic
Thrombotic ischemia is caused by ____ in cerebral or carotid arteries
Atherosclerosis
What may cause an intracranial hemorrhage?
-Hypertension
-Aneurysm
What are some non-modifiable risk factors for cerebrovascular accidents?
-Older age
-Family history
-Race: African American
-Female gender
-Prior stroke, TIA, or MI
What are some modifiable risk factors for cerebrovascular accidents?
-Hypertension
-Smoking
-Atrial fibrillation
-Diabetes mellitus
-Carotid or peripheral artery disease
-Sickle cell anemia
-Coronary heart disease
-High serum cholesterol
-Physical inactivity
-Obesity
MNT for cerebrovascular accidents includes _____ by lifestyle and diet changes to decrease risk factors
Prevention
What are examples of lifestyle and dietary changes to decrease risk of CVA?
-Low sodium, DASH Diet (MNT for hypertension)
-AHA/DASH/Mediterranean Diet (MNT for heart disease)
-Weight loss
We should individualize MNT for CVA based on feeding difficulties such as…
-Dysphagia
-Hemiparesis
-Paralysis
We should also address any food-drug interactions for anticoagulants like Warfarin which would be…
Consistent Vitamin K intake
For CVA, it is important to provide nutrition in the most appropriate form to maintain nutritional status, as people may need ___ ___
Enteral nutrition
____ ____ is a progressive neurodegenerative disorder with loss of brain neurons
Alzheimer’s Disease
Alzheimer’s is the most common type of ____
Dementia
There is no known ___ or ___ for Alzheimer’s
Cause or cure
What are risk factors for Alzheimer’s Disease?
-Advanced age
-Family history
-Genetic factors
-Traumatic brain injury
-Vascular brain injury
-Vascular disease caused by hypertension, hyperlipidemia, and diabetes mellitus
-Smoking
Manifestations of Alzheimer’s disease:
-Memory loss
-Agnosia (lack of comprehension)
-Aphasia
-Behavioral changes
-Sundowning
-Progresses to a vegetative state
Medical management of Alzheimer’s may be done with ____ ____ which increases the level of acetylcholine in the brain
Cholinesterase inhibitors
One example of a cholinesterase inhibitor is _____
Donepezil
Cholinesterase inhibitors may help to reduce some ____ and ____ symptoms
Cognitive and behavioral
What are some food drug interactions with cholinesterase inhibitors?
-May cause weight loss, N/V/D, increased gastric acid, and GI bleeding
-Take with food to decrease GI irritation, monitor weight and food intake
_____ is another drug that may be used for those with Alzheimer’s and helps to reduce amyloid deposits in the brain and may help slow disease progression (IV drug given about once/month)
Aducanumab
Food drug interactions with Aducanumab:
-N/V/D
Nutrition implications of Alzheimer’s disease:
-Inadequate intake (inability to obtain and prepare food, feed self; may not eat safely; eating is neglected)
-Energy expenditure may increase due to constant movement/pacing
-Dehydration
-Dysphagia
-Weight loss and malnutrition are common especially as the disease progresses
-At risk for pressure injury
MNT for Alzheimer’s disease:
-Maintain a desirable body weight
-Provide nutrient-dense foods to prevent deficiencies
-Maintain proper hydration
-Consider antioxidant supplementation
-Decrease distractions at mealtime
-T 39-9 Interventions for Eating-Related Behavioral Problems
-Ultimately, tube feeding may be necessary due to inadequate intake, dysphagia, or vegetative state)
____ ____ ____ is a progressive disease involving degeneration of motor neurons throughout the body
Amyotrophic lateral sclerosis (ALS)
ALS results in generalized skeletal muscle ____ and ____
Weakness and atrophy
Is ALS more common in men or women?
Men
People over age ____ years have a higher risk of ALS
60
There is no known ____ or ____ for ALS
Etiology or treatment
Death usually occurs ___-___ years after the onset of symptoms
3-5
Early symptoms of ALS include…
-Muscle weakness in the hands and legs
-Oropharyngeal weakness and jaw spasticity
Advanced symptoms of ALS include…
-Tetraplegia
-Dysphagia
-Respiratory muscle weakness
-Decline in respiratory muscle strength (dyspnea, weak cough, decreased ventilation, respiratory failure, death)
With ALS, ____ and ____ ____ is maintained
Sensation and mental acuity
Nutritional problems in ALS:
-Hard foods are difficult to chew due to jaw fatigue
-Dysphagia due to oropharyngeal weakness (tongue, cheeks, and palate become less able to control and transport the bolus, aspiration risk with thin liquids)
-Dehydration
-Constipation
In the late phase of ALS, some nutrition problems might include…
-Negative nitrogen balance
-Will need assistance with feeding
-Progresses to an inability to eat
MNT for ALS:
-Proper texture of foods and thickened liquids as required (IDDSI diet)
-Adequate fluid and fiber
-Small, frequent meals
-Proper positioning while eating
-Vitamin and mineral supplementation
-Early placement of feeding tube (PEG tube)
Myasthenia Gravis is an ____ disease
Autoimmune
With Myasthenia Gravis, circulating antibodies attack ____ ____ at the neuromuscular junction, preventing acetylcholine from binding to the receptors
Acetylcholine receptors
Myasthenia Gravis results in a defect in ____ transmission at the neuromuscular junction
Impulse
Myasthenia Gravis is characterized by relapsing and remitting muscle ____ and ____, varying from minutes to days
Weakness and fatigue
Manifestations of Myasthenia Gravis:
-Diplopia
-Facial muscle weakness (difficulty chewing, drooling, dysarthria, dysphagia)
-Symptoms are worse at the end of the day
-Respiratory insufficiency is possible
MNT for Myasthenia Gravis?
-If muscle fatigue is a problem, serve the largest meal in the morning
-Consume nutrient-dense foods first
-Small, frequent meals that are easy to chew and swallow
-Proper texture and thickened liquids as recommended by SLP
-Rest 30 minutes prior to a meal
