Neuro disorders

Question 1

what happens with the of lens of our eyes as we age?

Answer 1

the lens thickens and loses elasticity resulting in cataracts and presbyopia

Question 2

what happens with the lens thickens

Answer 2

the thickening of the lens and decreasing size of the anterior chamber increases risk for glaucoma

Question 3

what do you call inclusion bodies in the posterior chamber vitreous?

Answer 3

floaters

Question 4

What type of changes happen with the retina as we age?

Answer 4

Retinal changes include a reduction in the number of rods and cones (decline in light and color sensitivity)

Question 5

what happens to the visual cortex as we get older?

Answer 5

diminished evoked potential responses in the visual cortex in the occipital lobes

Question 6

how does aging affect the macula?

Answer 6

increased risk of macular degeneration, diabetic retinopathy and blindness

Question 7

What happens with out hearing as we get older?

Answer 7

Age related hearing loss – presbyacusis
Nearly 1/3 of people over 65 and half over 85 have at least a 20% hearing loss.
Both hearing and visual loss can contribute to behavioral and social disabilities

Question 8

what happens with the elderly’s olfaction as they age?

Answer 8

decreased olfaction and its relation to taste results in poor nutritional

Question 9

what does the decrease in olfaction put elderly people at risk for?

Answer 9

decreased olfaction results in more elderly victims of home gas leaks (the normal threshold of detecting ethyl mercaptan in propane or natural gas is not reached with elderly)

Question 10

What have studies suspected may be a link with Alzheimer’s?

Answer 10

olfaction loss and Alzheimer’s disease

Question 11

what happens with elderly people lose their taste as they age?

Answer 11

decreased taste sensation along with loss of olfaction leads to reduced desire to eat
Weight loss results

Question 12

What is the most common risk factor for polyneuropathy?

Answer 12

DM

Question 13

Many people develop polyneuropathy from what

Answer 13

alcoholism or liver disease aging is also a risk factor for polyneuropathy particularly in the lower extremities

Question 14

How can people delay polyneuropathy?

Answer 14

In the aging population avoidance of toxins like ETOH or drugs, and tight control of BS in diabetics can delay the process

Question 15

Parkinsons disease is caused by what?

Answer 15

Caused by changes in the dopaminergic system (substantia nigra to corpus striatum)

Question 16

what is the clinical presentation for Parkinson’s disease

Answer 16

Resting tremor, rigidity and bradykinesia
sometimes caused by extrapyramidal effects of antipsychotic meds
retropulsion- when you push a patient and instead of gaining their balance they walk backwards at an increasing rate until they fall over

Question 17

what are Parkinson’s patients at risk of developing?

Answer 17

they can become depressed and demented

Question 18

what is the treatment for Parkinson’s?

Answer 18

Rx is carbidopa/levodopa; but over time pts become resistant to Rx so Rx should begin with lowest doses possible

Question 19

Stroke is the ____ leading cause of death in the elderly population?

Answer 19

3rd

Question 20

what is the single biggest risk factor for stroke?

Answer 20

advancing age (before the age of 44 there are 30 strokes/100k individuals; after the age of 75 there are 1230/100k individuals

Question 21

what is the definition of a TIA

Answer 21

ischemic event within the brain that resolves without residual deficit with in 24 hours (usually minutes or less than an hour
precursor of impending stroke
deficit will reflect the area of the brain with compromised circulation

Question 22

what causes a TIA

Answer 22

caused by a thromboembolic event

Question 23

what happens with a patient who has a TIA?

Answer 23

amaurosis fugax occurs if embolus reaches the opthalmic branch of ICA
Pts can have facial weakness, hemiparesis, aphasia if present in anterior circulation
Pts can have diplopia, bilateral blindness or blurry visions, unsteady gate, dysarthria

Question 24

What needs to be done in a patient with TIA

Answer 24

need a work up to determine the nature of the occlusion and then decision
untreated may go onto have a completed stroke

Question 25

what will increase the risk of stroke?

Answer 25

A. Fib, cardiovascular dz

Question 26

what is the hallmark tx for stroke?

Answer 26

Limit the extent of the stroke
Prevent or reduce risk of secondary complications
Reduce risk of subsequent strokes
Begin rehabilitative services as soon as feasible

Question 27

what needs to be done on a patient who experiences dizziness?

Answer 27

A thorough evaluation including otological testing and diagnostic brain imaging may be indicated if infarction, or neoplasm is considered.

Question 28

what needs to be ruled out in cases of dizziness complaints?

Answer 28

Orthostatic hypotension and other cardiovascular etiologies of dizziness or light headedness must also be r/o’d.
Always consider that meds commonly have side effects of dizziness

Question 29

How is depression usually manifested in elderly?

Answer 29

Rather than manifesting as a depressed mood, crying, or other known manifestations the elderly often present with somatic complaints

Question 30

what are somatic complaints in depression

Answer 30

Fatigue, H/A, anorexia, weight loss, abdominal or muscular pains can be due to depression.

Question 31

what needs to be ruled out with depression

Answer 31

Organic causes for the pts symptoms must be r/o’d.

Depression should always be considered when no organic etiology can be found.

Question 32

potential side effects of TCA medications

Answer 32

Postural hypotension
Urinary retention
Cognitive impairment
Cardiac arrhythmias

Question 33

what is herpes zoster

Answer 33

varicella zoster lie dormant in a nerve ganglion and reactivated manifesting itself as a painful condition with peripheral nerve presenting with a vesicular rash over a particular affected dermatome

Question 34

what is the clinical presentation for herpes zoster?

Answer 34

2-3 day prodromal of burning, tingling or paresthesia in affected dermatome.
Most common dermatome over thoracic region
Rash develops with severe pain over affected dermatome (does not cross midline).
Vesicular eruption –> pustules –> crusting

Question 35

post herpetic neuralgia is classified as what?

Answer 35

Pain lasting one month after resolution of rash is considered post herpetic neuralgia – complication of HZ
If no rash develops it is rare but called zoster sine herpete

Question 36

what is the tx for herpes zoster?

Answer 36

NSAID’s or narcotic analgesics PRN
Anti-virals – Zovirax etc
Burrows solution
Rash usually resolves in 2 – 3 weeks
Remember to recommend to your patients the vaccine to prevent Shingles

Question 37

whats important about the zostavax?

Answer 37

Zostavax – protects against Herpes Zoster
Even in pts who have ALREADY had HZ – reduces chance of recurrence
Reduces risk of Post herpetic neuralgia – which is very debilitating
CDC recommends Zostavax 60 and >

Question 38

what are complications with herpes zoster?

Answer 38

Post herpetic neuralgia
Superinfection
Meningitis
Ocular involvement with facial zoster
Corneal ulceration
Ramsay Hunt syndrome (acute facial paralysis with facial involvement)