Neurology chapter 11 Flashcards
Alzheimer’s disease - Description
a degenerative brain disease that causes progressive decline in neurocognitive functioning and substantially interferes with social and/or economic welfare.
Alzheimers description 2
Abnormal formation of beta-amyloid plaques and tau protein tangles results in severance of communication among neurons in the brain, leading to brain cell death and, eventually, substantial brain tissue loss in the cerebral cortex, hippocampus, and ventricles.
AD - Incidence
- most common form of dementia
- affects 5.5 million U.S residents
- 6th leading cause of death
- half of patients with AD have family history: increases by 30% with each member affected.
- 65-69 years old: rate 10 per 1,000 people
- average lifespan after diagnosis is 8 years.
AD - Risk factors
- aging
- smoking (2-4X increase)
- genetic markers on chromosomes 1, 12, 14, 19, 21
- down syndrome
- family history (especially first-degree relative)
- mild cognitive impairment may precede AD.
AD- Assessment findings
- most common, initial s/x = gradual worsening ability to remember new information.
- insidious onset, gradual progression.
- decline in memory, cognition, language, personality and mobility.
- impaired judgment, abstract thinking, memory, reasoning, orientation, and attention.
- difficulty with speech and other forms of communication.
- inability to interpret sounds, speech, and use of objects.
- arousal disturbances: insomnia, daytime sleepiness.
- hyperactivity, wandering, restlessness.
- mood disturbances and emotional outbursts.
- urinary and/or fecal incontinence.
- paranoia, hallucinations, delusions.
AD Differential d/x
- normal aging process
- lewy body dementia
- Parkinson dementia
- hypothyroidism
- depression
- vitamin B12 deficiency
- brain tumor
- alcoholism
- metabolic abnormalities
- schizophrenia
- delerium
- other neurological conditions
- side effects from medications
AD Diagnostic studies
- Medical and family history, including psychiatric history.
- APOE 34: risk gene
- Mini mental status exam
AD Diagnostic studies to rule out reversible causes
- CBC
- electrolytes
- CMP
- UA
- LFT
- Thyroid
- vitamin B12 and folate
- syphilis serology
- consider CT and MRI
- PET scan to rule out lewy body dementia
AD - prevention
- none proven
- early recognition and treatment are important to slow disease
AD- modifiable risk factors
- regular physical exercise.
- healthy diet
- management of risk factors: CV-HTN, diabetes
AD - Nonpharm management
- supportive care for physiologic, hygiene, ambulation, psychiatric and behavioral needs
- maintain routine familiar environment for patient
- attempt to maintain nutritional status by offering/encouraging regular meals.
- display calendars and clocks.
- provide verbal prompts and positive reinforcement for eating and iADL’s
- reminiscent therapy: display photos, memory-evoking memorabilia, promote socialization.
- fall precautions
- pacing, wandering, and exiting precautions
- noxious stimulus-free environments
AD- Nonpharm management 2
- emotional support and encouiragement to family members
- respite care for caregivers
- discuss advanced directives with family
- offer information on support group for family
AD - depression
Develops in 33% of patients who are d/x with AD; therefore, remain alert for symptoms. Start depression treatment at low doses.
AD- consultation/referral
- consult neurologist for new onset dementia
- consult social services as needed for family.
AD- follow-up
- depends on severity
- periodic follow up needed to assess rate of decline, predict prognosis, and assess caregiver coping.
