Chronic Disorders in Later Life pt.1.pdf CHRONIC DISORDERS IN LATE LIFE (PT. 1) • Parkinson's Disease • Alzheimer's Disease Learning Objectives • Identify the common chronic illnesses of the older persons • Organize an approach to the management of chronic illnesses and co-morbidities • Analyze how to diagnose and manage chronic illnesses of older adults in consideration to its impact on patient and family Top Health Conditions for Adults Over 65 (Accdg to American Nurses Credentialing Center) 1. Heart disease 2. Cancer 3. COPD 4.STROKE (CVD) 5.ALZHEIMER’S DSE 6. DIABETES 7. PNEUMONIA 8. ACCIDENTS 9. NEPHRITIS 10. SEPTICEMIA Impairments VISION • GLAUCOMA • CATARACTS • DIABETIC RETINOPATHY • MACULAR DEGENERATION • DETACHED RETINA • DRY EYE HEARING Sensorineural inner ear nerve damage Conductive hearing loss passing of sound waves from outer to middle ear Tinnitus perception of sound (ringing) in one or both ears when no external sound Interventions • Hearing aids • Cochlear implants • Assistive listening and adaptive devices Parkinson’s Disease Cerebrovascular Accident / Transient Ischemic Attack • 75 % occur in 65 y/o • Presentation: acute Neurological deficits, severe headache, seizures, decreased LOC, Nausea (ICP) • Treatment: preventive (Aspirin 81-325 mg/day), Clopidogrel Definition • Substantia nigra damage - dopamine producers in the brain stem • Presentation: tremor, bradykinesia, reduction of facial movement/arms hang at the side, Gait - festination • Neurodegenerative disorder / movement disorder • Imbalance of Dopamine and ACh Risk Factors (PD) • Middle aged and increased risk with age • Hereditary • Men are 1.5 more likely • Environment exposure to toxins 4 Major Symptoms (PD) Rigidity Muscles are tensed and contracted Resting Tremor Trembling Bradykinesia Slowness in initiating movement Loss of postural reflexes or instability Poor balance and coordination Non-motor Symptoms (PD) • Anxiety disorders, depression, sleep disturbances • Orthostatic hypotension • Olfaction dysfunction, dysphagia, sialorrhoea • Dementia, psychosis and visual hallucinations Resting tremor of hand • Result of palladium of Globulus Pallidus interna (GPi dysfunction) • Triggered by specific loss of dopaminergic projections from retrorubral ara Presence of Myerson’s sign • Eyes blinking when tapped on glabella (glabellar reflex) • Involuntary reflex disorder Cogwheel rigidity and bradykinesia • Muscular aches and sensation of fatigue • Masklike, opened mouth, drooling and reduced blinking • Under scaling of movement Gait and balance and postural reflexes • Under activity in the left cerebellar hemisphere with contrast of over activity in vermis • Associated with loss of lateral gravity shift in parkinsonian gait • Loss of postural reflexes • No tendency of falling forward • No difficulty of walking, turning and stopping • FESTINATING GAIT Causes and Pathogenesis (PD) • Degradation of dopaminergic neuron • Free radicals - Metabolism of dopamine by MAO produce hydrogen peroxide • Neurotoxin MPP - an oxidized product of MPTOP by the MAO-B • Genetic factors (Alpha-Synuclein) • Mutation of SNCA genes in chromosome 4 - Extra a-Synuclein • Alanine is replaced with threonine - misfold of a-Synuclein Diagnosis • Neurological examination • Autopsy of brain to find lewy bodies • Examinations • Occulomotor • Electroencephalograms (EEG) • Single photon emission computed tomography (SPECT) Treatment Medications Dopamine Tremor Relief • Levodopa (replace) • MAO Inhibitors (Stop breakdown) • COMT Inhibitors • Antihistamines • Anticholinergics Therapy Physiotherapy Stretching and strengthening exercises and balance training Occupational Lifestyle adaptations and assessments of safety in the home environment Speech Rehabilitation techniques to strengthen speech for improved communication Diet Modification Surgery • Cryothalamotomy • Pallidotomy • Deep Brain Stimulation Conclusion Cognitive Impairment • Patient has idiopathic Parkinson’s disease • There is no cure but therapies are available • Treatment aims to: • Prevent clinical progression • Improvement • Delay of motor complications • Complications: • Choking, falls, drug side effects • Prognosis: Normal life expectancy for treated patients • D/D/D • Alzheimer’s Disease (early and late onset) ALZHEIMERS DISEASE Definition • Neurological brain disorder • Most common form of dementia, a group of disorders that impairs mental functioning • Progressive and irreversible • Memory loss as one of the earliest symptoms Symptoms • Difficulty in performing otherwise familiar tasks • Memory loss that affects job skills • Language problems • Disorientation to time and place • Loss of good judgement • Problems with abstract thinking • Misplacing things • Rapid mood swings • Personality changes • Loss of initiative Stages Stage 1 Normal Mentally Healthy person Stage 2 Normal aged forgetfulness Persons over 65 experience subjective complaints of cognitive and/or functional difficulties Stage 3 Mild Cognitive Impairment The capacity to perform executive functions also becomes compromised • Commonly for persons who are still working, job performance may decline Stage 4 Mild Alzheimer’s Disease The most common functioning deficit is a decreased ability to manage instrumental (complex) activities of daily life (ability to manage finances and prepare meals) Stage 5 Moderate Alzheimer’s Disease Decrement in the ability to choose proper clothing for weather conditions and or daily circumstances Stage 6 Moderately Severe Alzheimer’s Disease Ability to perform ADLs are compromised Stage 7 Severe Alzheimer’s Disease Require continuous assistance with basic activities of daily life for survival Diagnostics Treatment Medical History Past Medical Problems Physical Examination Evaluations of hearing sight, heart and lungs Neuropsychological Testing Tools to assess memory, problem-solving, attention, visionmotor coordination, abstract thinking Brain-imaging scan MRI and CT Scans Drugs • Memory problems and other medical deficits • Behavioral Symptoms • Anti-agitation drugs Namena Memantine Razadyne, Reminyl Galantamine Exelon Rivastigmine Aricept Donepezil Cognex Tacrine
