Neurological Disorders Part 1 Flashcards
2 Types of Stroke
- Ischemic
2. Hemorrhagic
Non-Modifiable Risk Factors of Ischemic Stroke
- Age
- Gender
- Low birth weight
- Race/ethnicity
- Genetic factors
Modifiable Risk Factors of Ischemic Stroke
- Hypertension
- Smoke
- Diabetes
- Afib
- Dislipidemia
- Post-menopausal hormone therapy
- Poor diet
- Obesity
- Inactivity
Pathophysiology of Stroke
Most strokes caused by thromboembolic event (related to atherosclerosis, hypertension, diabetes, gout). Embolic stroke and thrombotic stroke.
Embolic Stroke
Clot that travels to the brain, blocks an artery.
Thrombotic Stroke
Stationary clot that forms in the blood vessel.
Intracerebral Hemorrhage
Caused by a ruptured vessel inside the brain. Prevalence of hypertension is 80%.
Subarachnoid Hemorrhage (SAH)
Ruptured aneurism in the subarachnoid space or due to head trauma.
Medical Treatment for Stroke
Thrombolytic or “clot-busting” drugs to restore perfusion to affected areas within 6 hours of onset of stroke. Controlling intracranial pressure (ICP) while maintaining sufficient perfusion of the brain.
AHA/ASA Guidelines for Primary Prevention of Stroke
- Complete smoking cessation
- Blood lipid management
- Reduced intake of sodium
Dysphagia Treatment
- Posture changes
- Heightening sensory input
- Swallow maneuvers
- Active exercise programs
- Diet modifications
Dysphagia Management
- Nonoral feeding
- Psychological support
- Tube feeding for pts who cannot sustain sufficient oral caloric and/or fluid intake
Stroke MNT
Initially NPO for 24-48 hours. Tube feeding may be needed in some pts. Progress from NPO to oral feeds as tolerated. Provide adequate energy and protein intake:
- 25-45 kcal/kg
- 1.2-1.5g pro/kg may be needed dependent on weight status and loss of lean body mass
- Modify food texture to compensate for dysphagia
Alzheimer’s Disease
- Most common form of dementia
- Increases exponentially after age 40
- Prevalence in white males at age 100 is 41.5%
- Higher prevalence in women (3x) due to them living longer than men
Symptoms of Alzheimer’s Disease
- Forgetfulness
- Forget how to do simple tasks
- Get lost in familiar surroundings
- Echolalia: repeat words spoken by others
- Agnosia: loss of comprehension
- Motor skills deteriorate
- Loss of bowel and bladder control
- Limb weakness and contractures
- Intellectual activity ceases
- Vegetative state
Echolalia
Repeat words spoken by others.
Agnosia
Loss of comprehension
Alzheimer’s Disease Risk Factors
- Age; doubles every 5 years after 65
- Family hx; early onset strongly hereditary
- Those with a parent or sibling with AD are 2-3x more likely to develop it
- Head injury
- Down syndrome
- Low level of education
- Female gender
Treatment of Alzheimer’s Disease
- No drug can stop or reverse AD
- Some drugs may slow progress:
- Tacrine (Cognex)
- Donepezil (Aricept)
- Rivastigmine (Exelon)
- Galantamine (Razadyne)
- Other medications may treat symptoms such as sleeplessness, agitation, wandering, anxiety, and depression
Nutritional Consequences of Alzheimer’s Disease
- Wt loss is common due to increased pacing
- Decreased independence and impaired self-feeding
- Inability to recognize hunger, thirst, and satiety
- Meals forgotten as soon as eaten or may forget to eat
- Inability to recognize food when presented
- Risk of dehydration
MNT in Alzheimer’s Disease
- Vitamin/Mineral supplementation and assure intake of antioxidants
- Minimize distractions at mealtime
- Place foods on small plates and give one at a time
- Serve food on plates without a pattern (white plate)
MNT in Alzheimer’s Disease
- Model use of eating utensils and provide verbal cues
- Allow pt to use eating utensils as long as possible; use bowls for easier scooping
- Finger foods may be helpful, but monitor for swallowing problems and choking
- Frequent snacks, nutrient-dense foods, and nutritional supplements may be helpful
Migraine Headaches
Thought to be vascular in origin and can be throbbing, episodic, and intense. Varies by the individual and tolerance thresholds vary over time. Hx of intercurrent nausea, vomiting, photophobia, and visual or olfactory auras. Treated with NSAIDS, sympathomimetics, serotonin agonists, prophylaxis with calcium channel blockers, beta-adrenergic blockers, and serotonin antagonists.
Migraine Headaches and Food
Headaches may be triggered by foods like citrus fruits, tea, coffee, pork, chocolate, milk, nuts, vegetables, and cola drinks. No general recommendations about food avoidance, but may want to evaluate food and symptom diary.