parkinsons and alzheimers

pARKINSONS DISEASE\

• involvement of basal ganglia, primarily substantia nigra, and globus pallidus
• Depletion of CNS dopamine -dopamine controls movement
• Imbalanced cholinergic/dopaminergic transmission

• Symptomatically
• No specifict tes
• history and physical
• symptom development with correltation to medications taking- if symptoms improve with meds they diagnosed
• neurological exam
• mri ,ct, eef- rule out other things

• *RESTING TREMOR
• primarily of upper extremities aka "pill rolling tremors"
• *COGWHEEL RIGIDITY
• rhythmic interruption of movement - cant stop, faceplant
• *BRADYKINESIA
• slow shuffling walk, unsteady gait
• stooped posture
• con lead to akinesia ( can't walk)
• *LOSS OF AUTOMATIC MOVEMENTS
• impaired blinking, smiling, swinging arms, fixed staring eyes

• IMPAIRED SPEECH
• monotoned dysarthria (slurred speech) ecolalia ( repeat words- echo)
• IMPAIRED SWALLOWING
• tube feedings
• AUTONOMIC DYSFUNCTION
• othrostatic hypotension- severe w/ meds
• changes in skin texture
• flushing
• RIGIDITY
• causes facial mask-like expression
• difficulty in moving out of bed, chair
• changes in handwriting
• DEPRESSION, MOOD SWINGS, DEMENTIA

• early- mo functional impairment
• mild- honeymoon peirod
• mod-mulitple drugs, occcupational and social activities affected
• severe- side effects from drugs, resistant to therapym reduced quality of life
• Late- totally dependent in adl, wheelchair, or bed bound

physical, occupational, and speech therapy

• parkinsons
• sp-take brain tissue away
• es- pacemaker for brain, movement part
• id- cf fluid

• high protien
• high calorie foods
• soft to ease chewing problems- thickened liquids

• aspiration pneumonia
• fractures due to falls
• infections
• bowel and bladder complications
• drug toxicity -monitor drug levels
• malnutrition
• drpression suicidal behaviors
• airway obstruction

• Beta-amyloid plaques- which are dense depositis of protein and cellular material that accumulates outside and around nerve cells
• Neurofibrillary tangles, wharch ar twisted fibers that build up inside the nerve cell

Amyloid precursor protein (APP)

• Forgetfulness beyond what is seen in a normal person
• Short-term memory impairment, especially for new learning
• Difficulty recognizing what numbers mean
• Loss of initiative and interests
• decreased judgement
• Geographic disorientation
• Short attention span
• decreased performance when stressed

• Imparied ability to recognize close family or friends
• agitation
• wandering, getting lost
• loss of remote memory
• confusion
• impaired comprehension
• forgets how to do simple tasks
• apraxia
• receptive or expressive aphasia
• insomnia
• delusions
• illusions, hallucinations
• behavioral problems

• Little memory, unable to process new information
• Connot understand words
• difficulty eating, swallowing
• Repetitios words or sounds
• unable to perform self-care activities
• immobility
• incontinence
• •weight loss
• • seizures,
• • skin infections,
• •groaning, moaning, or grunting,
• • increased sleeping, loss of bladder and bowel control. •Death from aspiration pneumonia or other infections.

• •a detailed patient history
• •information from family and friends
• •physical and neurological exams and lab tests
• •neuropsychological tests
• •imaging tools such as CT scan, or magnetic resonance imaging (MRI). PET scans are used primarily for research purposes

• •Stay calm and be understanding.
• •Be patient and flexible. Don’t argue or try to convince
• .•Acknowledge requests and respond to them.
• •Try not to take behaviors personally. Remember: it’s the disease talking, not your loved one.

• Aricept
• Namenda

• Zoloft
• Celexa

• Neuroleptics: Seroquel
• Benzo: Ativan, Serax
• Antipsycotics: Risperidol, haldol

• oSelf care deficit
• oImpaired verbal communication
• oImbalanced nutrition
• oRisk for infection
• oImpaired physical mobility
• oCompromised family coping
• oDisturbed sleep pattern

• oCognitive stimulation: promote awareness to environment
• oPresent change slowly and repeat changes
• oUse therapeutic touch
• oStimulate memory by repeating requests
• oImplement memory techniques: name tags, visual clues, using computers, rehearsing activity of daily living
• oMonitor drug therapy for effectiveness
• oEncourage to participate in group activities
• oSafety is the most important

• Stress
• Fatique
• Alcohol
• Caffeine
• Increased physical activity

abrupt increase in muscle tone, loss of consciousness and loss of autonomic functions lasting 30 sec to minutes

muscle contraction and relaxation. Lasts typically several minutes

• barbiturates: (phentobarbital or luminol, mysoline) increase seizure threshold, may require high doses to raise the threshold: can be used for all seizures except absence.
• Side effects: many including vertigo, drowsy, N&V, night terrors, stevens-johnson syndrome (rash, fever, joint pains, resp infection and vomiting. Do not stop medication without weaning and without MD orders

• Dopamine agonists (bromocriptine, pergolide, pramipexole, ropinirole).
• Levodopa and carbidopa.
• COMT inhibitors (entacapone, tolcapone).
• Anticholinergic agents (benztropine, trihexyphenidyl). Selegiline (MAO-B inhibitor). Amantadine.