ALZHEIMER’S DISEASE

>Definition
progressive, irreversible, degenerative, neurologic diease that begins indiously and is characterized by
gradual losses of cognitive function and disturbances in behavior and affect
>etiology
genetic/familial
>Risk factors >Complications: injury, malnutrition
female gender
advanced age
viruses
environmental toxins
silent brain infarcts
previous head injury
>S/Sx
Early: short term memory impairment
Mild anomia
Poor abstract reasoning and orientation
Topographic disorientation
Visual and spatial disorientation
Middle:Apraxia
Perseveration
Nocturnal restlessness
Apraxia
Aphasia
Agraphia
Advanced: progression of sign and symptoms
Dysarthria
Paranoid delusions
Short attention span
Wandering
Hyperactivity
Pacing
Restlessness
Agitation
Hallucinations
Los of spontaneity and social inhibitions
Urinary and fecal incontinence
Emaciation
Increased irritability
Unresponsiveness
>Diagnostics:
Detailed patient history
Noncontrast computed tomography
Magnetic resonance imaging
Single Photon emission computed tomography
Neuropsychological evaluation
Complete blood count
Commercial assasys for CSF
>medical mgt: Cholinesterase inhibitors
Donepezil ( Aricept) antidepressant
Galantamine ( Reminyl)
Memantine (Namenda)
MYASTHENIA GRAVIS
>Definition: chronic autoimmune disorder affecting the neuromuscular transmission of impulses in the
voluntary muscles if the body , characterized by varying degrees of weakness.
>Etiology: unknown
depletion of acetylcholine receptors at neuromuscular junctions brought about by an autoimmune
attack
>Risk factors: genetic
environmental factors
women
>S/Sx: extreme muscular weakness
easy fatigability
diplopia
ptosis
masklike facial expression
dysarthria
dysphagia
dysphonia
sudden respiratory distress
tachycardia
anxiety
>diagnostic: serum test for acetylcholine receptor antibodies
Edrophonium (Tensilon) test
Electrophysiologic testing
CT Scan
>Medical: oral anticholinesterase- neostigmine bromide (Prostigmin), pyridostigmine (Mestinon, Regonol)
immunosuppressive drugs- prednisone, azathioprine (Imuran)
Palsmapheresis- removes antibodies from blood
Thymectomy
Edrophonium (tensilon)
>Complication: Aspiration
Respiratory failure
Complications of decreased physical mobility

>Nursing Mgt:
Monitor respiratory status
Monitor speech and swallowing activities
Administer medications as prescribed
Provide rest periods
Instruct to avoid muscle stress
PARKINSON’S DISEASE
>definition: chronic, progressive neurologic disease affecting the brain centers responsible for control and
regulation of movement
>etiology: unknown
deficiency of dopamine, due to degenerative changes in the substantia nigra of the brain
>risk factors: genetic
atherosclerosis
head trauma
toxicity from pesticides, herbicides, methylphenyl-tetrahydropyridine or welding fumes
>S/Sx: Bradykinesia
Tremors
Rigidity
Resting “pill-rolling” tremors
Poor balance
Autonomic disorders- sleeplessness, salivation, orthostatic hypotension, dizziness
Depression
Dementia
Gait difficulties
Micrographia
Head bent forward
Masklike expressions
Drooling
Losss of postural reflexes
Bone demineralization
>diagnostics: Positron Emission Tomography
Physical examination
Sensorimotor assessment
>Medical: anticholinergics-trihexyphenidyl(Artane), benztropine(Cogentin), NS procyclidine(Kemadrin)
Amantadine (Symmetrel) – reduce transmission of cholinergic pathways
Levadopa -carbidopa (Sinemet)-inhibit destruction of levadopa in the bloodstream
Levadopa
Bromocriptine(Parlodel), pergolide(Permax), pramipexole(Mitrapex), ropinirole(Requip)
Monoamine oxidase inhibitor- selegiline, deprenyl(Eldepryl)
Tolcapone(Tasmar), entacapone(Comtan)
>Surgical: Medial Pallidotomy- electrode destroys cells in the globus pallidus and improves longstanding
symptoms
chronic deep brain stimulation of the thalamus, electrodes implanted in the thalamus or globus pallidus
brain tissue transplant
>Complication: dementia, aspiration, injury from falls
>nursing mgt: encourage patienty to participate in daily exercises
advise stretching and postural exercises
encourage to take warm baths and receive massages
suggest smaller meals and additional snacks
encourage compliance to medications
exercise facial muscles
encourage open medications
encourage foods with moderate fiber content and increase water
MULTIPLE SCLEROSIS
>definition: chronic, immune-mediated neurologic demyelinating disease of the CNS.
Characterized by the occurrence of small patches of demyelination of the white matter of the optic
nerve, brain , spinal cord
>classification:
1. relapsing remitting(RR)-clearly defined acute attacks, frequency of attacks once every two years
2. secondary progressive (SP)- always begins as RR but clinical course changes with declining attack
rate with steady deterioration in neurologic function unrelated to original attack
3. primary progressive(PP)- steady progression of disability from onset without exacerbations and
remissions
4. progressive relapsing(PR)- same as PP except that patients experience acute exacerbations along with
a steadily progressive course
>etiology: unknown
>risk factors: autoimmune dysfunction, genetic susceptibility, infectious process
>S/Sx: fatigue and weakness
Abnormal reflexes- absent or exaggerated
Vision disturbances-diplopia, nystagmus
Motor dysfunction- weakness, tremor, incoordination
Sensory disturbances- paresthesia, impaired deep sensation, impaired vibratory and position sense
Impaired speech- slurring, scanning(dysarthria)
Urinary dysfunction- hesitancy, frequency, urgency, retention, incontinence, upper UTI
Neurobehavioral syndromes- depression, cognitive impairment, emotional lability
>diagnostic: magnetic resonance imaging – visualizing plaques
electrophoresis of CSF- shows abnormal IgG antibodies
magnetic resonance spectropy
visual, auditory, and somatosensory evoked potentials- slowed conduction is evidence of MS
>complication: respiratory dysfunction, Infections-bladder, respiratory, sepsis, complications from
immobility,speech, voice and language disorders
>medical mgt:
corticosteroid or adrenocorticotropic hormone- decrease inflammation, shorten duration of relapse
immunosuppressive agents- stabilize the course of treatment
interferon beta-1a(Rebif, Avonex) and interferon beta 1b(Betaseron)
copolymer-1