Exam 5 - Cognition and Neuro pt. 1 Flashcards by Jessica Maskell

what are the different types of dementia?

primary and secondary

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what is primary dementia?

organic brain disease

untreatable

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what is secondary dementia?

caused by or related to another condition

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what is the most common death for those with alzheimers?

pneumonia aspiration

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what are the 3 types of pathophysiology for alzheimers disease

neurofibillary tangles
neuritic plaques
shrinkage and death of neurons

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what are the neurofibrillary tangles

hair like protein fibers tangled together like yarn

INSIDE CELLS

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what are neuritic plaques

made of a protein core called beta
amyloid surrounded by debris from degenerating neurons
outside neurons near synapse

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what is the shrinkage and death of neurons and how does it cause AD

greater significance than plaques and tangles

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what neurotransmitter is decreased in AD

acetylcholine (but not the cause of AD)

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what are the neurotransmitters involved in AD

norepinephrine
serotonin
dopamine
amino acid glutamate

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how is norepinephrine affected in alzheimers

slows everything down

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how is serotonin affected in alzhemiers

sleep too much during day and sleep too little at night

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how is changes in dopamine affected in alzheimers

muscles, cognition, motivation, ability to process pain all effected

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what does increased amino acid glutamate do?

kill cells

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etiology of AD

unknown

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risk factors of AD

less education
previous brain injury
down syndrome
65+
smoking and family history
herpes

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diagnostic tests for AD

brain biopsy

diagnosis by exclusion

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what are the stages of AD

1-3

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what is stage 1 of AD

memory loss (short term)
lack of spontaneity 
subtle personality changes
disorientation to time and date
may forget to eat

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Impaired cognition and abstract thinking
Restlessness and agitation
Wandering, “Sundown syndrome”
Inability to carry out ADLs
Impaired judgment
Inappropriate social behavior
Lack of insight, abstract thinking
Repetitive behavior
Voracious appetite

all are examples of what stage of AD

stage 2

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anomia is what? and what stage is it in for AD?

inability to recall names or objects - 2

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Also called the terminal stage
Emaciation, indifference to food
Inability to communicate
Urinary and fecal incontinence
Seizures
Total loss of ability to care for self

all are examples of what stage of AD

stage 3

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how long does each AD stage last?

1 = 2-4 years
2= several years
3 = 1-2 years, terminal stage

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what is the treatment for AD

no meds cure, but slow progress
emotional and educational support to patient and caregivers
behavior interventions

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what is the prevention of AD

``` bilingualism activity mild to moderate consumption of alcohol mediterranean diet living with companion or pet ```

what drugs should be used for AD

cholinergic drugs

produce actions which stimulate or mimic actions of parasympathetic nervous system

cholinergic drugs

is cholinergic drugs direct or indirect?

direct action and mimic AcH

what does acetylcholine do?

for memory and motor control

when is acetylcholine increased?

parkinsons and depression

what is acetylcholinerase?

enzyme that destroys acetylcholine

when is acetylcholinerase useful?

inhibiting properties utilized when a med wants more ACH as desired result

what does serotonin do?

regulates sleep and sensory perception helps with EPS and limbic system

when is serotonin increased and decreased

increased during mania and anxiety | decreased during depression

what does norepinephrine do?

``` regulates mood, cognition, perception, locomotion, cardiovascular function/ CNS & PNS sympathetic ```

when is norepinephrine increased/decreased?

during mania and anxiety | decreased during norepinephrine

what does dopamine do?

``` movement cognition, motivation, pleasure, pain processing, other/limbic system, PNS/sympathetic, hypothalamus ```

when is dopamine decreased

during parkinsons

what does gamma do or GABA

regulate neuronal excitability | muscle tone/cns

what med is related to GABA

epilepsy control

what does glutamate do?

work with GABA and CNS

what effect does anticholinergic drugs have on the AD patient

it may speed up progression | risk vs benefit

what does anticholinergic drugs do?

inhibit the breakdown of the enzyme acetylcholinerase

what are cholinesterase inhibitors

block degradation of acetylcholine by inhibiting acetylcholinervse

what are the cholinesterase inhibitor medication

tacrine (cognex) and donezipil (aricept)

tacrine cautions

client with hepatic dysfunction/not used much due to this

what cholinesterase drugs are used the most

donezipil (aricept)

what are side effects of aricept

``` nausea vomitting diarrhea bradycardia cholinergic effects ```

what are the serious adverse for aricept or donezipil

resp depression | seizures

what is the newer therapy for AD

memantine (nemanda)

what does nemanda do?

shields brain from excess glutamate damage

side effects of nemanda

dizziness, headache confusion constipation

how long does it take for nemanda to work

several weeks

what shouldnt be used for AD treatment anymore

estrogen

what meds slow progress

``` NSAIDs vitamins(vit E) antidepressants antianxiety antipsychotic ```

how to antidepressants slow AD

decrease depression enhance social function improve appetite and sleep

what are adverse drug reactions to antidepressants

ortho hypo

what adverse drug reactions happen with tricyclic acid

sedation | anticholinergic

what adverse drug reactions happen with SSRI

nerovusness agitiation insomnia irritability

how are anti anxiety helpful with AD

help with sundowning | help with insomnia

adverse drug reactions for anti anxiety

drowsiness dizziness fatigue slow reaction

what is toxicity for anti anxiety meds?

loss of coordination | speech difficulty

antipsychotics help relieve behavioral issues for AD, but what are their adverse effects?

ortho hypo cholinergic effects sedation extrapyramidial symptoms

what are extrapyramidal symptoms

acute dystonia reactions

what does extrapyramidal symptoms involved

eyes jaw neck

treatment for EPS

anticholinergic | antihistamine

what med is helpful for EPS

congentin

what are tardive dyskinesia

bizaare facial and tongue movement | stiff neck

when does EPS and tardive happen

eps within days of treatment | tardive within 3 months

treatment for EPS

dont do antiparkinsons anymore and reduce neuroleptic benzo, clonidine and propanol usually help

what is complementary and alt therapy for AD

DHEA gingko biloba CO Q10

what is DHEA

precursor to androgen and estrogens

what is gingko biloba

natrual herbal antiinflammatory and antioxidant

what is CO Q10

antioxidant in our body

alexia

inability to see words or read

agnosia

inability to interpret sensations and recognize things

apraxia

inability to carry out fine motor skills

what is dysarthria

slurred slow speech that is difficult to comprehend and make sense of

expressive aphasia

inability to produce language

gloabal aphasia

effects for expressive and receptive language

what is receptive aphasia

or wernicke's | inability to understand language

parasympathetic nervous system

rest and digest

sympathetic nervous sytem

fight or flight

what kind of receptors do the parasympathetic nervous system have

cholinergic

what kind of receptors does sympathetic have?

adregenic | alpha and beta

what is the neurotransmitter for the parasymp?

acetylcholine

what is the neurotransmitter for the sympathetic?

dopamine | norepineprhine

what do anticholinergic meds do

go from para symp to sympathetic

Dilate pupils, inhibit saliva, accelerate heart rate, dilates bronchi, inhibits peristalsis and secretion, inhibits bladder contraction all are a part of what?

sympathetic nervous system

Mental process by which knowledge is acquired and processed including is what?

cognition

Assess “What is happening?”, Try to reorient them – it is not chronic, Safety measures, Make sure they are having enough sleep, Manage pain as best as we can, Reduce stimuli, What can we remove that is bothering them (ex: catheters, too much tubing, BP cuff?), Monitor electrolytes and hydration all are assessments for what?

delirium

Acquired, persistent intellectual impairment with compromised function in multiple spheres of mental activity?

dementia

What are the memory impairements of dementia?

apraxia aphasia agnosia loss of executive function

What is loss of executive functioning?

incontinence

Exam 5 - Cognition and Neuro pt. 1 Flashcards

(94 cards)