Parkinson's and Alzheimers Flashcards
Parkinson’s Disease
degenerative neuro disease, 2nd most common, onset is 50-60, men > women, permanent loss of dopamine producing nerve cells
Parkinsons patho
degenerative disorder of substantia nigra, a basal ganglia structure in mid brain, responsible for movement
Cells degenerate»_space;>
Results in depletion of dopamine (inhibitory neurotransmitter) &
increase in acetylcholine (excitatory neurotransmitter)
Causes impairment of movement
Parkinsons symptoms
Debilitating disease
4 cardinal signs
T.R.A.P.
1. Tremor
…often the 1st sign
2. Rigidity of muscles
3. Akinesia
loss of ability to move muscles
…or bradykinesia (slow movement)
4. Postural instability
40% of parkinson’s patients have what cognitive impairment?
Dementia
Other symptoms of Parkinsons
emotional lability, depression, paranoia, rapid mood swings, sleep disturbances, pill rolling tremor
Parkinson’s etiology
unknown, fungicides, well water consumption, genetic, head trauma (boxing)
Parkinson’s diagnostics
no specific diagnostic, SPECT scan, MRI, CT, Labs, made primarily by symptoms
SPECT
single photon emission tomography, to detect how brain produces/ uses dopamine
Parkinson’s Nursing care
Ineffective airway clearance, potential for injury, alteration in mobility, alteration in communication (slides 13-15)
Parkinson’s meds
Sinemet- levodopa carbidopa (levodopa converts to dopamine, carbidopa prevents reuptake)
Sinemet adverse effects
watch for hypotension
headache, N/V, loss of appetite, insomnia, unusual dreams
uncontrolled repetitive movements of tongue, lips, face, arms, legs
Tardive Dyskinesia
Sinemet toxicity
increased confusion, increased rigidity, hallucinations
Drug holiday for Sinemet
reduce medication dosage
change in medications
careful monitoring of patients during this time
because of potential complications: swallowing, injury etc….
Alzheimer’s
form of dementia (60-80%), degenerative disease of the brain, progressive impairment, no known cause or cure, eventually fatal
Facts about Alzheimer’s
Primarily affects > 65
Early onset
can begin at age 40-50
Fastest growing age-group in U.S.
>85 years
Likelihood of developing Alzheimer’s
doubles every 5 years after age 65
Affects > 5 million Americans
Almost 2/3 = women
6th leading cause of death
1 in 3 seniors die w/ Alzheimer’s dementia
Women 2x more likely to develop Alzheimer’s
than breast cancer
By 2050, may affect an estimated 16 million
people
Fatality of Alzheimer’s disease
end stages- impacts balance, walking and swallowing
cause of death- complications of immobility (falls, pneumonia, UTIs, pressure sores, aspiration)
Alzheimer’s patho
Plaques
Excess deposits of beta amyloid protein
normal amounts help neurons to grow
Protein fragments clump into plaques
and impair function of neurons
Tangles
Threads of special protein (Tau) become tangled
this affects neuron transport system
Production of neurotransmitters decreased
chemical “messenger” between neurons & cells
Serotonin
Acetylcholine
Alzheimer’s causes
Genetic Factors
Chromosomal abnormalities
Alteration in chromosome
1, 14, 19, 21
Environmental Factors
Free radicals
build up in neurons
can lead to oxidative damage
Aluminum & mercury
environmental toxins
Alzheimer’s risk factors
Age
Lack of exercise
Depression
CKD
Obesity
Exposure to metals/toxins
Previous head injury
Alzheimer’s S&S
Forgetfulness
Recent memory loss
Difficulty learning & remembering
Inability to concentrate
Decline in personal hygiene & appearance
Decline in inhibitions
Difficulty communicating
Symptoms are staged on a scale of 1-7
What are the 10 warning signs of AD
1. Memory loss
2. Challenges in planning/solving
3. Difficulty completing familiar tasks
4. Confusion w/ time and place
5. Trouble understanding images
6. New problems with speaking/writing
7. Misplacing things
8. Decreased/poor judgment
9. Withdrawal from work/social activities
10. Changes in mood/personality
Alzheimer’s diagnosis
Detailed medical & family history
Physical exam
neurologic and functional assessment
MRI
to rule out pathologic lesions
PET scan
Genotyping
process of examining DNA
to confirm diagnosis of late-onset AD
Early to moderate stage meds
Cholinesterase inhibitors: prevent breakdown of
acetylcholine (ACH) = chemical messenger for learning
& memory
donepezil (Aricept)
rivastigmine (Excelon)
galantamine (Razadyne)
Side effects: N/V, loss of appetite, increased
frequency of BM’s
Moderate to severe meds
NMDA receptor blocker: Glutamate (a neurotransmitter)
is blocked
Increased levels of glutamate can lead to brain cell death
memantine (Namenda)
Usually in combination with cholinesterase inhibitor
Can delay progression of symptoms
Side effects: HA, constipation, dizziness
Vitamin E and Alzheimer’s
Antioxidant: may protect brain cells
1997, Alzheimer’s Disease Cooperative Study
High doses delayed loss of ability to carry out ADL’s
ongoing research
does it help or hinder ??
NOT an FDA approved treatment
must be prescribed…may interact w/ other meds
studies have shown high dose vitamin E linked with
increased death risk in patients with CV disease
Do Alzheimer’s meds provide a cure?
No (implications: slide 23)
Alternative treatments for Alzheimer’s
Fish & omega-3 polyunsaturated fats
Decreases blood levels of beta amyloid protein
ongoing research
Antioxidants
Cocktail of vitamin E, vitamin C, & alpha lipoic
acid
Coenzyme-Q10
Mediterranean diet
Curcumin (curry spice)
Wine – moderate consumption ??
Limited evidence
Puzzle games, memory games, using non-dominant
hand, writing
Pet therapy
Decreases anxiety,
increases communication,
improve mood,
increase comfort,
decreases BP
Alzheimer’s Research
Vaccine Development
Clinical trials
Increase active immune defense against beta amyloid
Estrogen Therapy
May enhance cognitive function in postmenopausal women
conflicting research results
Immunotherapy
clearing neurotoxic beta amyloid from brain using passive
immunization
Alzheimer’s nursing care
Ensuring patient safety
Providing physical care
Promoting therapy and activity
Respecting the individual
Supporting the patients family
