Pathophysiology - Alzheimer’s Disease

Alzheimer’s Disease

• More commonly seen in elderly geriatric clients
• Irreversible
• Recent memory loss
• client can recall events and activities of 10 years ago, but not 10 minutes ago
• Sundowner’s syndrome
• confused, disoriented behaviour that become noticeable after the sun goes down and during the night
• Wandering behaviour
• restlessness and activity-seeking behaviour; “the stalking of old haunts”
• Disorientation and inability to sustain intentions
• the person forgets what she or he set out to do
• Catastrophic reactions
• heightened anxiety occurring during interviewing or questioning, when a person cannot answer or perform
• Combative behavior

Geriatric Consideration

• The cardinal rule is: do not push too fast in getting information, assisting with activities of daily living, or insisting that the person socialize. Continued pressure and insistence on a task may result in combative behaviour
• Potential situations that can lead to combative behaviour are threats to self-image, new things or people in environment, illusions, pressure to remember, and direct confrontation

Parkinson’s Disease

Parkinson’s Disease

• A progressive neurological disorder causing destruction and degeneration of nerve cells in the basal ganglia; results in damage to the extra pyramidal system, causing difficulty in control and regulation movement.
• Dopamine , a neurotransmitter, is responsible for normal functioning of the extra pyramidal system
• The condition is correlated with depletion of, or imbalance in dopamine and an increased activity of acetylcholine

Clinical Manifestations

• General onset is after age 60
• Tremor: affects the arms and hands bilaterally – often the first sign; tremors usually occur at rest, voluntary movement may decreased tremor; tremors during voluntary movement not as common
• Described as “pill-rolling” tremor
• Aggravated by emotional stress and increased concentration
• Muscle rigidity: increased resistance to passive movement; movement may be describe as “cog-wheel rigidity” due to jerky movement of extremities
• Bradykinesia – slow activity
• Decreased blinking of the eyelids; loss of ability to swallow saliva; facial expression is blank or “mask-like”; loss of normal arm swing while walking; difficulty initiating movement
• Stooped posture, shuffling propulsive gait
• May exhibit mental deterioration similar to Alzheimer ’s disease
• Onset usually gradual

Pathophysiology - Dementia

Dementia

• Dementia is a syndrome characterized by loss of intellectual abilities to such an extent that social and occupational functioning is interfered with; involves memory, judgment, abstract thought, and changes in personality. Often, the disorders are progressive and follow an irreversible course in which the damage remains permanent.

Diagnostic Criteria: Dementia

• Loss of intellectual abilities that interfere with social and occupational functioning
• Memory impairment
• Impairment in abstract thinking, judgment, and language
• Personality changed demonstrated by exaggeration of previous personality traits
• Additional characteristics: anxiety or depression may be apparent; behaviour may demonstrate excessive orderliness, social or withdrawal, or the tendency to relate an event in excessive detail, age at onset: found predominantly in the elderly

Etiologic Factors: Dementia

• Neurological diseases – huntington’s chorea, parkinson’s disease
• Cardiovascular disorders causing anoxia and brain damage: Cerebral arteriosclerosis, cerebro vascular disease, stroke
• Brain trauma – chronic subdural hematoma

Pathophysiology - Seizure Disorders

Seizure Disorders – a sudden alteration in normal brain activity that causes distinct changes in behaviour and body function.

CLASSIFICATION

1. Partial or focal seizures – originate in localized area of the cortex
2. Simple partial seizures – do not affect consciousness and may have motor, sensory, autonomic symptoms
3. Complex partial seizures – includes alteration in consciousness coupled with automatisms (e.g. lip smacking, chewing, aimless walking)
4. Generalized seizures – involve diffuse regions of the brain in a bilaterally symmetric fashion
5. Tonic-clonic seizures (grand mal) – cause sudden loss of consciousness, loss of postural control, tonic muscular contractions producing teeth clenching and rigidity in extension (tonic phase) followed by rhythmic muscular jerking (clonic phase)
•  tongue biting and incontinence may occur during the seizure
•  phases – pre ictal, aura, post ictal
6. Absence seizure (petit mal) – there is sudden, brief impairment of unconsciousness without loss of postural control events rarely last longer  than 5-10 seconds but can recur many times per day