Module 1 Flashcards
Stroke
aka Cerebrovascular accident (CVA) or brain attack
Medical emergency
According to the American Stroke Association
3rd leading cause of death nationally
About 795,000 Americans each year suffer a new or recurrent stroke
A stroke occurs every 40 seconds
Stroke kills more than 143,000 people a year. That’s about 1 of every 17 deaths
On average,every 3 to 4minutes someone dies of stroke.
Americans will pay about $68.9 billion in 2009 for stroke-
related medical costs
U.S. Stroke Deaths 35+, 1991-8, by County
This map clearly shows the “Stroke Belt,”
an area in the Southeastern U.S. and Mississippi Valley with a high rate of stroke mortality.
Signs and Symptoms: Stroke
Sudden, severe headache Numbness- especially on one side depends on where on the mother strip is affected Weakness- especially on one side Trouble speaking or understanding Logaria: Can’t stop talking Dizziness Slurred Speech Blurred Vision Confusion Trouble walking or loss of balance/coordination
Types of CVA
Ischemic
Interruption of the blood supply (not to all parts of the brain)
~85% of strokes
Cause: Fatty deposits lining the walls of the blood vessels (atherosclerosis)
Two major types of obstruction:
Thrombotic (blood clot)
Embolic (traveling blood clot)
Hemorrhagic
Bleeding in the brain (common in young) Higher fatality rate, typically younger people ~15% of strokes Many times genetic component Two types: Aneurysm Arteriovenous Malformation (AVM)
Transient Ischemic Attack (TIA)
Mini Stroke
Similar symptoms to a “real” stroke
Most symptoms disappear within an hour, although they may persist for up to 24 hours
The more frequently TIAs occur, the higher the possibility of stroke
Dianosising a stroke
Neurological exam Motor function Muscle strength Cognitive function Vision (where in the field of vision lost) Sensory function CT Scan and MRI ----Looking at the location of build up (hemoragetic) Arteriogram/Angiogram Echocardiogram Carotid Ultrasound
Treatment
Tissue Plasminogen Activator (tPA) >>>>If someone can make it to the hospital within 3 hours, they will give the patient TPA to dislodge clot (unless hemoragic) Antiplatelet Therapy Surgery or Endovascular Treatment Rehabilitation hospital
Preventing a Stroke
Don’t smoke Know your blood pressure Eat healthy- low salt, low fat, low cholesterol Find out if you have any cardiac issues Exercise Limit alcohol Maintain a healthy weight Control diabetes Get regular check-ups
Traumatic Brain Injury
An injury that disrupts the function of the brain
Range of severity
Can result in a range of impairment involving:
—Cognitive
—Physical
—Psychological
Causes: TBI
Falls (28%)
Motor vehicle-traffic crashes (20%)
Struck by/against (19%)
Assaults (11%)
TBI Stats
Of the 1.7 million who sustain a TBI each year in the United States:
50,000 die
235,000 are hospitalized
1.1 million are treated and released from an emergency department (Langolis, et al. 2006)
Number of people with TBI who do not go to the hospital is unknown
Type of TBI
Open
Skull is broken
Symptoms similar to a stoke
just one area
Closed
No skull damage
Injury spreads with swelling and bouncing
axons tear, and stetch
Concussion
Mild TBI
Lack of oxygen
Drowning, heart attack
Other causes of TBI
Diffuse Axonal Injury
Penetrating Injury
Coup-Contrecoup Injury
Anoxic Brain Injury
Signs of mild (determined at sight of injury) TBI (like concussion)
Headaches or neck pain
Trouble with such mental tasks as remembering, concentrating, or decision-making
Slow thinking, speaking, acting, or reading
Confusion
Decreased energy or motivation (frontal lobe)
Mood changes (feeling sad or angry for no reason)
Changes in sleep patterns
Dizziness, balance issues
Nausea
Increased sensitivity to lights, sounds, or distractions
Difficulty moving limbs or extremities
Blurred vision or ‘tired’ eyes
Tinnitus
Moderate to severe TBI
Coma GCS Vegetative State/Persistent Vegetative State Minimally Conscious State Agitation, Aggression, Impulsivity Post-traumatic Amnesia, Confusion ATTENTION
Evaluating TBI
Neurological Exam Intracranial Pressure Glasgow Coma Scale 1 Eye Opening 2 Best Verbal Response 3 Best Motor Response CT Scan MRI ? Neurosurgical, ENT, Plastics involvement?
TBI Treatment
CPR? Surgery or Endovascular Techniques Prevent other complications (infections, bed sores, muscle contractions, hydrocephalus) Medications calming meds by slow brain recovery Rehabilitation
TBI Prevention
Wear a seat belt
Wear a helmet
Try to avoid falls around the home (handrails, stepstools, wet spots, safety gates)
Don’t drive under the influence
Firearm safety
Absorbable material for children’s playgrounds
Dementia
Loss of brain function
Degenerative, Progressive or Treatable
Usually first appears as forgetfulness
Symptoms: dementia
language, memory, perception, emotional behavior or personality, and cognitive skills; incontinence, swallowing problems
Degenerative Dementia
Typically occurs in people over age 60; risk increases as age increases
Two major types: dementia
Alzheimer’s Disease
Vascular Dementia
—–Someone who has have multiple stokes
Also, chronic untreated high blood pressure
Management Of Dementia
Evaluating:
Wide range of tests including:
CT Head, MRI, blood tests, toxicity tests, liver function tests, urinalysis, thyroid tests
Aging
Two factors—longer life spans and aging baby boomers—
will combine to double the population of Americans aged 65 years or older during the next 25 years to about 72 million.
By 2030, older adults will account for roughly 20% of the U.S. population
Main cause of death
1.Chronic diseases
Cancer, diabetes, heart disease
2.Degenerative illnesses
More than a quarter of all Americans and two out of every three older Americans have multiple chronic conditions, and treatment for this population accounts for 66% of the country’s health care budget.
Changes with healthy age
Physical changes
Range of Motion
Strength
Reaction Time
Balance
Neurological changes
Decrease in grey matter Decrease in white matter Cerebral ventricles enlarge ------As brain think CSF fills in space Changes in neurotransmitter
Social changes
Circle of friends
How do different societies treat their elderly?
Impact on society, healthcare, politics, economy
What are society’s expectations of how people “should act” as they grow older?
Cognitive changes
Semantic memory less affected ----——Changing in 30s Procedural memory stays about the same -----brush teeth Decreases noted in episodic memory and working memory- decreased ability to encode new events or facts
Chemical changes:
Decline in the synthesis of dopamine
Decrease in serotonin production
Decrease in glutamate
Role of genetics in huge
if we will get the disease
if medicine for the disease will work
Two people may be of the same chronological age, but differ in their mental and physical capacities.
Cognitive reserve
Influenced by
Biology
Genetics
Environment
How can we slow the effects of aging
Stay intellectually engaged
Exercise
Decrease stress
Maintain a healthy diet
Assessment and treatment
Identification of Complicating Conditions: know difference between (assessment)
Chronic medical condition
Visual/auditory deficits (sensitivity, agnosia)
Apraxia-plan/sequence motor activity
Dysarthria
Hemiparesis
Emotional/psychological disorders
Analysis of Cognitive Abilities
Attention Memory Visuospatial skills Language Executive Function
Analysis of Language Production
Semantics Syntax Discourse Pragmatics Gesture
Analysis of Language Comprehension
Semantics Syntax Discourse Pragmatics Gesture
Quality of Life
Activity and participation in society
