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Copy of Untitled Prezi

Alzheimers
by

Laney Dinh

on 29 August 2013

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Transcript of Copy of Untitled Prezi

Alzheimer's vs.
Parkinson's

Alzheimer's Statistics
RISK FACTORS
A patient that experiences problems with memory always benefit from a structured, consistent environment.
THE CARE OF ALZHEIMER'S PATIENTS
WARNING SIGNS
WHAT CAN BE DONE
HEALTHY BRAIN & LIFESTYLE
REFERENCES



- Problems performing familiar tasks.

- Forgetting simple words.

- Changes in mood, behavior, and personality.

- Misplacing things.

- Poor judgment.
Steps to Reduce the Risk:

Early detection.

Visit the MD right away if symptoms arise.

1. Regular Exercise

2. Healthy Diet

3. Mental Stimulation

4. Quality Sleep

5. Stress Management

6. Active Social Life
Pathophysiology
Signs & Symptoms (cont'd)
1817 James Parkinson essay "Shaking Palsy."
Progressive Neurodegenerative disease.
Debilitated mobilty.
Rare <30 yrs.
Risk increases with age.
50% > men vs women.
Parkinson's
Disease
Alzheimer's Diagnostics

Psychotropic drugs
Treatment & Medication
Signs & Symptoms
Stage 1 of Alzheimer's
- Approximately 5.4 million Americans have Alzheimer’s disease. This number has doubled since 1980 and is expected to be about 16 million by 2050.

- In 2011, total Medicare and Medicaid spending for patients with Alzheimer’s disease was estimated at $130 billion.

- Mortality rates for Alzheimer’s disease are on the rise, while heart disease and cancer death rates are continuing to decline.
Youtube website. (2013). Alzheimer's Disease Facts and Figures 2013. Retrieved from http://www.youtube.com/watch?v=BXnZt5VMjZ Y
Centers of Disease Control and Prevention (2013). Alzheimer's disease. Retrieved from http://www.cdc.gov/aging/aginginfo/alzheimers.htm
The person does not experience or show any problems with memory.
The person may feel like they are having memory lapses or forget familiar words or the location of objects.
Problems coming up with the right word or name.
Experiencing greater difficulty performing tasks in social/work environments.
Losing or misplacing a valuable object
Increasing trouble with planning or organizing.
Signs & Symptoms (cont'd)
- Inability to recall recent events.
- Experiencing greater difficulty performing complex tasks, like planning a dinner or managing finances.
- Forgets one's own personal history.
- Becoming moody, depressed, or withdrawn (especially in socially or mentally challenging situations).
- Disoriented with time, place, and event.
- Need help choosing clothing for the day, season, or occasion.
- Increasingly dependent in ADLs.
- Exhibit major personality and/or behavioral changes, including suspiciousness and delusions (believing that their caregiver is an impostor) or compulsive, repetitive behavior like hand-wringing or shredding tissue.
- Have the tendency to wander or become lost.
Remember: It is hard to stage a person with Alzheimer's because s/s tend to overlap.
- Individuals lose the ability to respond to their environment.
- Lose verbal and motor skills (control of movement).
- Completely dependent in ADLs.
- Become completely incapacitated and bedridden - lose the ability to smile, sit without support, and to hold their heads up. Reflexes become abnormal. Muscles become rigid and swallowing becomes impaired.
- Agonsia (cannot recognize faces).
Alzheimer's Association. (2013). 7 Stages of alzheimer's. Retrieved from http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp
Resources
Donepezil (Aricept)
Memantine (Namenda)
Dr. Alois Alzheimer
Discovery of Alzheimer's
- Brain weight is reduced further than normal age related changes.

- Cerebral cortex atrophies.

- Vascular degeneration - nerve cells lose the ability to function properly.

- Cell death and deterioration can lead to hemorrhage.
- Neurofibrillary tangles are tangles found throughout the neurons.

- Neuritic plaques consist of degenerating nerve terminals containing beta amyloid, which are peptides that accumulate to form neurotoxic plaques on the brain.

- This interferes with the cholinergic innervation in the cerebral cortex and hippcampus, resulting in impaired cognition, ability to make new memories, and impairs recent memory. These regions also control thought, language, attention, and perception.
Cholinesterase Inhibitor

5 mg/day at bedtime
10 mg/day at bedtime
23 mg/day at bedtime

Improves cholinergic neurotransmission in the brain by increasing acetylcholine concentrations.

This slows the cognitive decline.

Other drugs: Galantamine (Reminyl), Rivastigmine (Exelon)
NMDA Receptor Antagonist

5mg/day
Target dose: 20mg/day (10mg BID)

- Blocks glutamate from damaging nerve cells.

- Indicated for advance Alzheimer's disease.

- May help patient function and some patients have improved thinking skills and memory.
Antidepressants
Psychotropic drugs
To treat depression.

Selective serotonin reuptake inhibitors:
- Paroxetine (Paxil) 20-50 mg/day in AM, Max: 50mg/day

- Sertraline (Zoloft) 25-50mg/day, Max: 200mg/day

* Tricyclic antidepressants should not be used because of their anticholinergic effects.
Also called antipsychotic or neuroleptic drugs.

For behavorial/emotional problems: hallucinations or delusions.

Used as a last resort - considered as chemical restraint.
Ignatavicius, D., Workman, L. (2013). Medical-surgical nursing (7th ed.). St. Louis, Mo.: Saunders.
German physician who noticed the following in one of his elderly female patients: profound memory loss and other worsening psychological changes. He saw shrinkage and abnormal deposits in and around the nerve cells in her brain at the autopsy.
Alzheimer's Association. (2013). Major milestones in alzheimer’s and brain research. Retrieved from http://www.alz.org/research/science major_milestones_in_alzheimers.asp
- Cause is unknown.

- Age: > 65 y/o
- Gender (more women than men)
- Family history
- Presenilin 1 & 2 - early onset.
- ApoE4.

- Repeated head trauma (boxers) may have an increased risk and at an earlier age.
African Americans have a greater risk for developing Alzheimer's. However, Hispanics tend of have an earlier onset of the disease.
- No laboratory test(s) confirm the dx of Alzheimer's.

- Computed Tomography (CT): cerebral atrophy, ventricular enlargment, wide sulci, and shrunken gyri.
Stage 2 of Alzheimer's
Stage 3 of Alzheimer's
- PET & SPECT scans: metabolic activity is signficantly decreased.
Diagnostics (cont'd)
Mini-Mental State Examination

It is not unusual for those with advanced Alzheimer's to score below 5.
What We Can Do As Nurses
- Develop a predictable routine for patient(s).
- Place single-date calendars in room.
- Large-face clocks.
- Arrange complete outfits for the day on hangers.
- Avoid large crowds to reduce excessive stimulation.
Cholinesterase inhibitors
N-methyl-D-aspartate (NMDA) receptor antagonist
Antidepressants (SSRIs)
Risk Factors (cont'd)
Laney Dinh

Angel Elliott
What do they have in common?

How do they differ?
Patho
Signs & Symptoms
Tests
Treatment & Goals
Nursing Care
Teaching
Causes
Drugs
Cerebral Cortex + Basal Ganglia + Cerebellum= Motor Activity
Heretitary link
Exposure to toxins
carbon monoxide
manganese dust
Phychoactive drugs
Rx or illicit
Repeated brain injury
athletes
Vastly Unknown
-destroys neurons in substantia nigra
"pill roll"
Joint pain
Rigidity
Akinesia
Bradykinesia
Drooling
Dysphagia
Oculogyric
crises
Initial Stage
Mild Stage
Moderate Disease
4
5
Death
Severe Disability
3
2
1
Unilateral
Minimal weakness
Hand & arm tremble
Bilateral
Masked face
Shuffling gait
Unstable
Posture
Worsening gait
Akinesia
Rigidity
Complete
ADL
Dependence
Aspiration PNA
Aspiration (choking)
Infection
Falls
UTI
Labs

Imaging
Depression
Mood swings
Sweating
Urintation
Dx
Low Dopamine
CSF
Urine
CT & MRI
rule out tumors,cva
SPECT & PET
dopamine level
Age, PMH, & 2/4 primary S/S:
tremor
rigidity
dyskinesia
instability
No Cure.
Increase mobility.
Maintain highest level of function for as long as possible.
Optimze O2 sat
B/P & HR
LOC
I&Os
Prone w/o pillow for posture
Assess swallow
Administer meds on time
Therpeutic drug level
Prevent pressure ulcers and Contractures
Diet:
High calorie, protien, fiber
Soft, frequent meals
Bowel routine
Assist with ambulation
PT/OT consult
ADLs
Help pt rock to initate movements
Low heel shoes
Assistive devices
Walker
raised toilet seat
Armed chairs
monitor for depression
sleep pattern
focus on pts strengths
encourage questions
BE PATIENT WITH YOUR PATIENT!
intellectual stimulation!!
Disease process & progressive nature.
Managment & treatment options.
Drug therapy
Food interaction with levodopa
Interactions with meds
Avoid B6
Avoid MAOIs
Change positions slowly.
Exercise.
Yaso, S. (2012). Treatment of alzheimer's disease. Primary health care, 23(6), 32-38.
PT
Surgery
Transplant
Skidmore-Roth, L. (2013). Mosby's 2013 nursing drug reference (26th ed.). St. Louis, Mo.:Mosby.
Dopamine Agonist & Replacement
Levodopa
Carbidopa
Catechol O-methyltranferase inhibitor (COMTs)
Monamine oxidase inhibitor-typeB (MAO-B)
Michael J. Fox
Dopamine receptor antagonist
Cholinesterase inhibitor
anticholinergics
Other
Baclofen (Kemstro)
Inhibits reflexes at spinal level
Muscle spasms
Atropine sulfate (Atropair)
Anticholengeric
Decreased drooling
Zolpidem tartrate (Ambien)
Sedative/hypnotic
Sleep aid
Venlafaxine (Effexor)
SSNRI
Depression
Alzheimer's Disease
Alzheimer's Disease
Parkinson's Disease
Different Pathophysiology
- Both diseases make the patients very weak.

- Complete dependence with ADLs.
Eventually...
Replaces & mimics dopamine by stimulating dopamine receptors in the brain.
- Memory is affected.

- Cognition is impaired.

- Changes in personality.

- Poor judgement.
1st med 3-5 yrs
Decreases dyskinesia
"Wearing off phenomenon"
Different S&S
Ortho hypo, hallucination, sleepy
Give with food to increase absorpotion & cross BBB
Alzheimer's & Parkinson's
Stops peripheral dopamine synthesis
Combo Sinemet
- Affects motor ability and function.

- Instability.

- Cognition is rarely affected.
Apomorphine (Apokyn)
Pramiexole (Mirapex)
Ropinirole (Requip)
Different Medications
Alzheimer's vs. Parkinson's
- NMDA drugs are aimed at slowing the damage to the nerve cells and the rate of cognitive decline.

- Psychotropic drugs and antidepressants are used for personality or mood changes associated with Alzheimer's.
Blocks dopamine breakdown & prolongs action of dopmaine.
Entacapone (Comtan)
Treats in several ways.
Some need specific dose.s of each
No cure...
Stalevo (levodopa, carbadopa, & entacapone)
Treatment
Slows the main type of monoamine oxidase in the brain(B), increases dopamine concentration.
Selegiline (Deprenyl)
Rasagiline mesylate (Azilect)
Freezing episodes
Quick Overview
Promotes the release of dopamine.
Parolodel
Helpful if pt has SE with Sinemet.
Anti-viral
Amantadine (Symmetrel)
Decreses s/s PD
w/ Sinemet to decrease dyskinesias.
Unknown MOA in Parkinson's
Slows uptake of Ach, only in PD with dementia.
Rivestigmine (Exalon)
Blocks cholenergic activity,restores balance of neurotransmitters in CNS
benztropine (Cogentin)
Rarely primary.
For severe tremors & rigidity.
Avoid in elderly- confusion, urine retention, constipation, dry mouth, blurred vision.
Long-term drug treatment.
Leads to tolerance and toxicity
Toxicity = delirium, decreases LOC, decreased drug effect (baseline important).
Decrease dose, change freq, drug holiday up to 10 days.
Medications
Complimentary treatment with drugs & surgery.
ROM (active & passive).
ADLs (OT).
Walking,tai chi & yoga.
Baths.
Massage.
Speech & respiratory exercises.
Intellectual stimulation.
Stem cell
Controversial
Fetal cells injected into pts brain-grow-produce dopamine- halt or slow dx process
Neuro
Use of nerve cells from other parts of the body
Stereotactic

Deep Brain Stimulation
Subthalamotomy/pallidotomy
Interrupts fx of subthalmic nucleus, pallidum, ventolateral nucleus.
Electrical coagulaiton
Freezing
Radioactivity
Most effective in younger pts.
Palliatve measure to stop involuntary movements.
Cholinesterase inhibitors

Improves cholinergic neurotransmission in the brain by increasing acetylcholine concentrations.

This slows the cognitive decline in Alzheimer's disease.

For Parkinson's disease, they are only used for those who have dementia.

Drugs: Donezepil (Aricept), Galantamine (Reminyl), and Rivastigmine (Exelon).
MRI guided threading electrode into thalmus or global pallidus to place device.
Pt activates when symptomatic.
Decrease need for medications.
Surgery
Alzheimer's vs. Parkinson's
- No surgery indicated for disease process.
- Stereotactic

- Deep brain stimulation.
Rodig, J.(2012). Parinson's Diease. Youtube video. Retrieved from http://www.youtube.com/watch?v=n_mGGir-Ng U
Brooks, B (2010). Imaging approaches to Parkinson disease. Journal of Nuclear Medicine (51)4, 596-609. doi:10.2967/jnumed.108.059998.
Anderson, L., Fagerlund, F. (2013) Original Research: The Perioperative Experience of Patients with Parkinson's Disease: A Qualitative Study. American Journal of Nursing (113) 2, 26-32. doi: 10.1097/01.NAJ.0000426686.84655.4a.
*advocate for med flexibility & rely on pt*

(Anderson & Fagerlund, 2013)
Supports Dx & use of meds
(Brooks,2010)
- Dopamine agonists replaces and mimics dopamine.

- COMTs blocks the breakdown of dopamine and prolongs the action of dopamine.

- MAO-Bs inhibits MAO-B to promotes dopamine.

Dopamine receptor antagonists promotes the release of dopamine.

Antivirals decreases s&s of dyskinesia.

Anticholinergics block cholinergic activity to restore balance of Ach and dopamine.

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