Parkinson's and Alzheimers

Question 1

Parkinson’s Disease

Answer 1

degenerative neuro disease, 2nd most common, onset is 50-60, men > women, permanent loss of dopamine producing nerve cells

Question 2

Parkinsons patho

Answer 2

degenerative disorder of substantia nigra, a basal ganglia structure in mid brain, responsible for movement

Cells degenerate&raquo_space;>
 Results in depletion of dopamine (inhibitory neurotransmitter) &
increase in acetylcholine (excitatory neurotransmitter)
 Causes impairment of movement

Question 3

Parkinsons symptoms

Answer 3

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

Question 4

40% of parkinson’s patients have what cognitive impairment?

Answer 4

Dementia

Question 5

Other symptoms of Parkinsons

Answer 5

emotional lability, depression, paranoia, rapid mood swings, sleep disturbances, pill rolling tremor

Question 6

Parkinson’s etiology

Answer 6

unknown, fungicides, well water consumption, genetic, head trauma (boxing)

Question 7

Parkinson’s diagnostics

Answer 7

no specific diagnostic, SPECT scan, MRI, CT, Labs, made primarily by symptoms

Question 8

SPECT

Answer 8

single photon emission tomography, to detect how brain produces/ uses dopamine

Question 9

Parkinson’s Nursing care

Answer 9

Ineffective airway clearance, potential for injury, alteration in mobility, alteration in communication (slides 13-15)

Question 10

Parkinson’s meds

Answer 10

Sinemet- levodopa carbidopa (levodopa converts to dopamine, carbidopa prevents reuptake)

Question 11

Sinemet adverse effects

Answer 11

watch for hypotension
 headache, N/V, loss of appetite, insomnia, unusual dreams
 uncontrolled repetitive movements of tongue, lips, face, arms, legs
Tardive Dyskinesia

Question 12

Sinemet toxicity

Answer 12

increased confusion, increased rigidity, hallucinations

Question 13

Drug holiday for Sinemet

Answer 13

reduce medication dosage
 change in medications
 careful monitoring of patients during this time
 because of potential complications: swallowing, injury etc….

Question 14

Alzheimer’s

Answer 14

form of dementia (60-80%), degenerative disease of the brain, progressive impairment, no known cause or cure, eventually fatal

Question 15

Facts about Alzheimer’s

Answer 15

 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

Question 16

Fatality of Alzheimer’s disease

Answer 16

end stages- impacts balance, walking and swallowing
cause of death- complications of immobility (falls, pneumonia, UTIs, pressure sores, aspiration)

Question 17

Alzheimer’s patho

Answer 17

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

Question 18

Alzheimer’s causes

Answer 18

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

Question 19

Alzheimer’s risk factors

Answer 19

 Age
 Lack of exercise
 Depression
 CKD
 Obesity
 Exposure to metals/toxins
 Previous head injury

Question 20

Alzheimer’s S&S

Answer 20

 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

Question 21

What are the 10 warning signs of AD

Answer 21

 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

Question 22

Alzheimer’s diagnosis

Answer 22

 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

Question 23

Early to moderate stage meds

Answer 23

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

Question 24

Moderate to severe meds

Answer 24

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

Question 25

Vitamin E and Alzheimer’s

Answer 25

 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

Question 26

Do Alzheimer’s meds provide a cure?

Answer 26

No (implications: slide 23)

Question 27

Alternative treatments for Alzheimer’s

Answer 27

 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

Question 28

Alzheimer’s Research

Answer 28

 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

Question 29

Alzheimer’s nursing care

Answer 29

 Ensuring patient safety
 Providing physical care
 Promoting therapy and activity
 Respecting the individual
 Supporting the patients family