At least ___ of 9 diagnostic tests must be met to be categorized as depression
5
Risk of suicide is high in which groups of people with depression?
white and asian-american men
what are some common meds used to treat depression?
-remeron, effexor, paxil, wellbutrin
dementia is a ___, not a disease
syndrome
Most common form of dementia is ___, which constitutes about ____% of cases
Alzheimer’s; 50-60%
what are the 4 main types of dementia?
alzheimer’s, fronto-temporal,vascular, dementia with lewy bodies,
2 main types of AD disease?
familial, nonfamilial
AD type: Only 5-10% of cases
Early onset
Gene mutation
familial
AD type: Role of apolipoprotein E (ApoE)
Complex gene/environment interactions
nonfamilial
patho of AD
amyloid plaques & abnormal deposits of proteins, neurofibrillary tangles, loss of synaptic connections, cell death /neuron (brain atrophy - shrinks)
- 5th leading cause of death in age >65
AD
what is the incidence of AD gender-wise/ethnicity?
women get it more, b/c they live longer. higher in African-american and hispanics
Impairment of language
aphasia
Inability to perform purposeful acts or manipulate objects
apraxia
Inability to recognize familiar objects or persons
agnosia
Loss of memory
amnesia
what are the 4 A’s related to AD?
amensia, agnosia, apraxia, aphasia
3 main causes of death for AD patients?
pneumonia (aspiration), malnutrition, and dehydration
med for AD:Increases levels of ACh (involved in memory and judgment)
Maintains memory skills for a period of time
Useful only in early stages
Cholinesterase Inhibitors
what are some meds given for patients with AD?
aricept, exelon, razadyne, cognex
what is the precaution needed for cognex(AD med)?
must monitor liver enzymes
med for AD:Regulates activity of glutamate
Used more often in middle to late stage AD
May combine with a cholinesterase inhibitor
memantine (namenda)
what are the alternative therapies to AD?
ginko biloba(vasodilation), huperzine A(cholinesterase inhibitor), Vitamin A
caused by reduced or blocked blood flow to the brain
vascular dementia
Treatment of Vascular Dementia-besides meds
Lower blood pressure
Reduce cholesterol
Prevent blood clotting
Control blood glucose
meds used to treat vascular dementia-
Anticoagulants
Alzheimer’s medications
which form of dementia has Parkinsonian sx?
DLB dementia with lewy bodies
Most striking symptom of DLB (dementia with lewy bodies)
visual hallucinations or delusions
this disease: Extreme sensitivity to neuroleptic meds (extreme agitation, even death)* no anticholinergic
DLB
Progressive, degenerative, hereditary neurologic disease (rare)
S/S usually begin in 30s-40s
Child of affected person has 50% chance of inheritance
1 in 10,000 men and women
Huntington’s
Poor prognosis: death usually occurs due to heart failure, pneumonia/infection, fall, or choking
Huntington’s
Slow progression (over 10-20 yrs) of:
Involuntary choreiform movements(writhing)
Speech problems
Dementia
Huntington’s
Rare brain disorder
Progressive degeneration of the gray matter of the brain (spongiform degeneration)
Cause: abnormal glycoprotein
Onset usually around age 60
cruetzfeldt-jacob disease
Unilateral facial paralysis
Sudden onset
Dysfunction of CN VII
Bell’s Palsy
Treatment – medications (steroids), artificial tears, sunglasses, facial massage (for pain), soft diet
Bell’s
Etiology unknown:
Possibly vascular ischemia, viral disease (herpes simplex, herpes zoster), autoimmune disease, or combination
Bell’s
another name for Trigeminal Neuralgia
tic douloreux
Chronic pain condition that affects CN V
Sudden, severe facial pain lasting a few seconds to minutes: stabbing and lightning-like
Etiology: likely due to vascular pressure
TIC douloreux (trigeminal neuralgia)
what are some meds used for trigeminal neuralgia?
carbamazepine (Tegretol)
Dilantin
Neurontin
Lioresal
Assist w/minimizing episodes of pain
Get creative re: ways to maintain hygiene w/o the typical means
Ex., use cotton to wash face, rinse mouth with mouthwash vs. brushing
Keep bathing water & beverages/food room temp
trigeminal neuralgia
Abnormal increase in CSF in the brain
Occurs if flow of CSF in brain/spinal column blocked
Ventricles enlarge, creating pressure on brain tissue
Can occur at any age, more common in elderly
May result from head trauma, infection, tumor, complications from surgery, subarachnoid hemorrhage; unknown.
Normal Pressure Hydrocephalus
what is the classic triad for pts. with normal pressure hydrocephalus?
-Progressive mental impairment & s/s dementia
-Impaired gait
General slowing or feeling “stuck” common
-Impaired bladder control leading to urinary frequency &/or incontinence
Surgical placement of shunt to drain excess CSF into abdomen (reabsorbed)
Brain then returns to normal size
normal pressure hydro.
