Neurodegenerative Diseases: Stroke, Motor Neurone Disease, Dementia Flashcards
(29 cards)
What is a stroke?
Stroke: life threatening medical condition that occurs when the blood supply to part of the brain is cut off
What are the 3 main types of stroke?
3 main types of stroke: Ischaemic stroke (80% of strokes), Haemorrhagic stroke (10% of strokes), Transient Ischaemic Attack (mini stroke)
Ischaemic stroke definition
Ischaemic strokes:
80% of strokes
• Brain cell death due to lack of oxygen from blockage of cerebral blood vessel
- One main blood vessel is blocked
Haemorrhagic stroke (intracranial haemorrhage) definition:
Haemorrhagic stroke (intracranial haemorrhage)
• 10% strokes
- Bleed on the brain
• Brain cell death due to lack of oxygen from a weak cerebral blood vessel bursting
Transient Ischaemic attack definition
Transient Ischaemic attack:
- Temporary disruption to the brain blood supply
- Mini stroke
- Blood supply recovers
Stroke Diagnosis
Stroke diagnosis:
To RECOGNISE a stroke (all symptoms may not be present):
B: Balance
E: Eyes (double vision, vision loss, drooping)
F: Face (drooping)
A: Arms (numbness, unable to lift)
S: Speech (slurred, lack of understanding, lack of tongue control)
T: Time
Stroke prevalence: GLOBAL
Global stroke prevalence
- 1 in 4 people will have a stroke in their lifetime
- 2019: 63% of strokes occurred in people <70 years
- 1 stroke every 3 seconds
- 101 million worldwide living with stroke aftermath
- Up to 80% of strokes and heart attacks occur in people with low or moderate CVD absolute risk
Stroke prevalence: UK
Stroke prevalence: UK
- 1 stroke every 5 minutes
- 100,000 strokes per year
- 400 childhood strokes per year
- 4th leading cause of death in the UK
- 1 person dies from stroke every 17minute
- Death rates are declining
- >55 years more likely to have a stroke
- 1.2million stroke survivors:
2/3 survivors leave hospital with a disability
2/3 of working age survivors never return to work
- More likely to have another stroke after 1st stroke
What are the 10 leading risk factors for a stroke?
10 leading stroke risk factors:
- Elevated systolic blood pressure
- Poor diet
- High body mass index
- High fasting glucose
- High LDL cholesterol
- Alcohol use
- Low physical activity
- Air pollution
- Smoking
Metabolic risks (high BP, high BMI, high FPG, high total cholesterol and low glomerular filtration rate)= 71% of stroke burden
Behavioural factors (smoking, poor diet and low physical activity)= 47% of stroke burden
High systolic blood pressure is the largest single risk for stroke.
Risk factors still apply if someone has already had a stroke.
Guidelines for stroke management (ESPEN 2018):
Guidelines for stroke management (ESPEN 2018):
- Screen for malnutrition within 48 hours of admission. Screen weekly after.
- Acute stroke: assess hydration within 4 hours of admission. Review regularly.
- Screen for dysphagia. Failed screen or signs of dysphagia? Formal swallow assessment should take place.
- Acute stroke: if adequately nourished and can meet nutritional needs orally, don’t give oral supplements routinely.
ABCDEF assessment of a stroke patient
ABCDEF assessment of a stroke patient:
Anthropometric: Weight loss, current status, muscle mass
Biochemistry: Cholesterol (lipids), kidney function, blood glucose, hydration
Clinical: Medical management and rehabilitation (speech and language therapist), bowels, organ function, hydration
Dietary: Dysphagia, intake, requirements
Environmental: Discharge planning, social support, psychological well-being
Functional: Ability to care for self
Dysphagic stroke nutrition interventions
Dysphagic stroke nutrition interventions
- IV fluids
- Nasogastric feeding within 24 hours to be considered
- Specialist nutritional assessment if swallowing difficulties present. Swallow can be rehabilitated.
- Alternative feeding routes: nasal route (short term), gastrostomy (long term >6 months). What about DoLs?
- Early feeeding may support increased survival
- Adapt to changes
- At risk of malnutrition? Care plan should be individualised
What are the considerations for dysphagic stroke nutrition interventions?
Dysphagic stroke nutrition interventions:
- Ethics of feeding
-Monitioring and adapting to changes
- Refeeding syndrome
- Discharge planning
- Patient preference and requirements
What is Motor Neurone Disease (MND)?
Motor Neurone Disease (MND):
- Group of diseases that affect the brain stem and spinal cord (nerves)
- Types: Amyotrophic lateral sclerosis, Progressive Bulbar Palsy/ Bulbar Onset MND, Progressive Atrophy
- 80% have communication issues
- MND attacks nerves that control movement> muscles no longer work
MND prevalence
Motor neurone disease prevalence:
- Lifetime risk 1 in 300
- More than 5,000 adults affected in UK at one time
- 6 people diagnosed every day
- 6 people die from MND each day
- Incidence: 2 in 100,000
- Most diagnosed >40 years.
- Highest prevalence 50-70 years.
What are the causes of MND?
MND causes:
- Uncertain
Maybe a mixture of:
- Genetic factors
- Lifestyle and environment
- Mechanical and/or electrical trauma
- High levels of exercises
- Exposure to agricultural chemicals
- Exposure to a variety of heavy metals
Motor Neurone Disease Management
Motor Neurone Disease Management:
- Medication: Riluzole/ Rilutek (glutamate receptor blocker). Preserves breathing pathway
- Symptom management/relief:
- Speech communication (speech boards, AAC devices)
- Seating (specific wheelchairs, stand support, foot support)
- Position and comfort (head collar to help keep neck upright)
- Mobility (wheelchair/hoist)
- Breathing support (NIV)
- Nutrition (feeding support, tubes?)
- Saliva management (reduction) to reduce aspiration risk
- Palliative care to ensure good life until death
Effect of MND on nutrition
Effect of MND on nutrition
- High malnutrition risk (under nutrition)
- Increased risk of death if malnourished
- Loss of BMI, Loss of 5% BW, Loss of 10% BW can increase risk of death
MND cause:
- Dysphagia
- Cognitive impairment
- Depression
- Anxiety
- Salivary issues (aspiration risk)
- Difficulty masticating
- Loss of limb dexterity (positioning)
- Hypermetablism
- Respiratory insufficiency
-Nausea
- Appetite loss
- Fatigue
- Constipation
- Polypharmacy (too much medication)
Guidelines for MND management
Guidelines for MND management:
- Baseline BMI < 25 kg/m2: weight gain recommended
- Baseline BMI 25-35 kg/m2 weight stabilisation recommended
- Baseline BMI >35kg/m2: weight loss recommended to improve passive and active mobilisation
- Dysphagia screening recommended
- Malnutrition screening at diagnosis.
- Follow up malnutrition screening every 3 months
- If EN is proposed: pros and cons should be discussed with patient, family and care givers.
When are artificial nutrition and hydration indicated in MND?
Artificial nutrition and hydration is indicated in MND patients who have:
- Severe Dysphagia with risk of aspiration pneumonia or recurring chest infections
- Malnutrition with weight loss of >10% from pre-diagnosis weight
- Suboptimal energy intake
Nutritional Intervention of MND
Nutritional Intervention of MND:
Quality of ethics and lifestyle are at the centre of decision making
Ensure nutritional requirements are met
• Food fortification
• Palatability
• Texture modification as per SLT
• Fluid (thickener)
• Artificial nutrition and hydration
What are the goals of artificial nutrition and hydration in MND?
Artificial nutrition and hydration goals in MND:
Meet nutritional needs - Stabilise body weight - Correct/prevent malnutrition - A route for medications and hydration - Decrease risk of aspiration - Quality of life (eg lack of hunger)
What is dementia?
Dementia:
* Collection of symptoms including memory loss, problems with reasoning and communication, and reduction in ability to carry out daily activities
* a general term for the impaired ability to remember, think, or make decisions that interferes with doing everyday activities. Alzheimer’s disease is the most common type of dementia.
Support a patient may require to manage their nutrition after a stroke
Support a patient may require to manage their nutrition after a stroke
* Patient may have: limb weakness, paralysis, numbness, blurred vision, confusion, communication issues, memory issues, co-ordination issues, headaches, dizziness, nausea, anxiety, depression, reduced safety awareness or dysphagia
* At risk of undernutrition
* Must assess to establish if dysphagic or not and malnutrition risk
* Might need support with preparing meals, might need food fortification to combat undernutrition, may need supplementation,
* Sensory impairment: add flavour, contrasting colours, reduce distractions, texture modification if dysphagic, new foods
* Physical impairment: adjusted cutlery, finger food, may need support with feeding,
* Memory: routine, visual cues, involve in food preparation,
* Nausea: little and often
* If dysphagic: IV fluids, nasogratric feeding possibly, SLT assessment
