Neuro disorders Flashcards
what happens with the of lens of our eyes as we age?
the lens thickens and loses elasticity resulting in cataracts and presbyopia
what happens with the lens thickens
the thickening of the lens and decreasing size of the anterior chamber increases risk for glaucoma
what do you call inclusion bodies in the posterior chamber vitreous?
floaters
What type of changes happen with the retina as we age?
Retinal changes include a reduction in the number of rods and cones (decline in light and color sensitivity)
what happens to the visual cortex as we get older?
diminished evoked potential responses in the visual cortex in the occipital lobes
how does aging affect the macula?
increased risk of macular degeneration, diabetic retinopathy and blindness
What happens with out hearing as we get older?
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
what happens with the elderly’s olfaction as they age?
decreased olfaction and its relation to taste results in poor nutritional
what does the decrease in olfaction put elderly people at risk for?
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)
What have studies suspected may be a link with Alzheimer’s?
olfaction loss and Alzheimer’s disease
what happens with elderly people lose their taste as they age?
decreased taste sensation along with loss of olfaction leads to reduced desire to eat
Weight loss results
What is the most common risk factor for polyneuropathy?
DM
Many people develop polyneuropathy from what
alcoholism or liver disease aging is also a risk factor for polyneuropathy particularly in the lower extremities
How can people delay polyneuropathy?
In the aging population avoidance of toxins like ETOH or drugs, and tight control of BS in diabetics can delay the process
Parkinsons disease is caused by what?
Caused by changes in the dopaminergic system (substantia nigra to corpus striatum)
what is the clinical presentation for Parkinson’s disease
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
what are Parkinson’s patients at risk of developing?
they can become depressed and demented
what is the treatment for Parkinson’s?
Rx is carbidopa/levodopa; but over time pts become resistant to Rx so Rx should begin with lowest doses possible
Stroke is the ____ leading cause of death in the elderly population?
3rd
what is the single biggest risk factor for stroke?
advancing age (before the age of 44 there are 30 strokes/100k individuals; after the age of 75 there are 1230/100k individuals
what is the definition of a TIA
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
what causes a TIA
caused by a thromboembolic event
what happens with a patient who has a TIA?
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
What needs to be done in a patient with TIA
need a work up to determine the nature of the occlusion and then decision
untreated may go onto have a completed stroke
what will increase the risk of stroke?
A. Fib, cardiovascular dz
what is the hallmark tx for stroke?
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
what needs to be done on a patient who experiences dizziness?
A thorough evaluation including otological testing and diagnostic brain imaging may be indicated if infarction, or neoplasm is considered.
what needs to be ruled out in cases of dizziness complaints?
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
How is depression usually manifested in elderly?
Rather than manifesting as a depressed mood, crying, or other known manifestations the elderly often present with somatic complaints
what are somatic complaints in depression
Fatigue, H/A, anorexia, weight loss, abdominal or muscular pains can be due to depression.
what needs to be ruled out with depression
Organic causes for the pts symptoms must be r/o’d.
Depression should always be considered when no organic etiology can be found.
potential side effects of TCA medications
Postural hypotension
Urinary retention
Cognitive impairment
Cardiac arrhythmias
what is herpes zoster
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
what is the clinical presentation for herpes zoster?
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
post herpetic neuralgia is classified as what?
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
what is the tx for herpes zoster?
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
whats important about the zostavax?
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 >
what are complications with herpes zoster?
Post herpetic neuralgia Superinfection Meningitis Ocular involvement with facial zoster Corneal ulceration Ramsay Hunt syndrome (acute facial paralysis with facial involvement)
