NCM 104: Neurologic Function

1|P a g e

Management of Clients with Degenerative Brain Disorders

Alzheimer's Disease
Alzheimer's disease is an irreversible form of senile dementia
caused by nerve cell deterioration.
Individuals with Alzheimer's disease experience cognitive
deterioration and progressive loss of ability to carry out
activities of daily living.
Characterized by disturbance in Judgement, Affect,
Memory, Cognition and Orientation
Course of the disease is 2 to 20 years, with SUNDOWNERS
SYNDROME
Types of Dementia
1. Alzheimers disease Most common form of dementia
among people over age of 65
2. Multi-infarct dementia Second most common type of
irreversible dementia that is related to blockage of small blood
vessels in the brain that destroys brain tissues
3. Lewy body dementia Similar to Alzheimers but progress
rapidly related to brain cells called cortical Lewy bodies that
occur throughout the brain and produces manifestations
4. Picks disease A form of dementia differ from AD in several
ways which is marked by pick bodies (rounded, microscopic
structures found within the affected cell)

Causes

Geneticsfamilial AD (FAD)
Vascular degeneration
Chemical imbalances
Family history

Notes

______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
_______________________

Stages
1. Forgetfulness
2. Confusion Progressive memory decline, disorientation, depression, and confabulation
3. Ambulatory Dementia Functional loses, language problems, loss of reasoning, depression and wandering
behaviour
4. End stage No recognition, very little purposeful activities, immobile and does not swallow and does not chew
Clinical Manifestations
Short-term memory
Language disturbance
Decline in motor skills
Loss of abstract thought processes
Visual processing impairment
Repetitive actions
Restlessness at night
Incontinence, emaciation, irritability, and coma
WORD GUIDE
Circumlocution - ___________________________________________________________________
Paraphasias - ______________________________________________________________________
Palilalia -__________________________________________________________________________
Apraxia - _________________________________________________________________________
Hyperorality - _____________________________________________________________________
Benguet State University
COLLEGE OF NURSING
La Trinidad, Benguet

Jam Ganda 2011^^

NCM 104: Neurologic Function

2|P a g e

Management of Clients with Degenerative Brain Disorders

Pathophysiology

Benguet State University

COLLEGE OF NURSING
La Trinidad, Benguet

Jam Ganda 2011^^

NCM 104: Neurologic Function

3|P a g e

Management of Clients with Degenerative Brain Disorders

Management
P
L
E
A
S
E
C
A
R
E

Provide basic human needs and safety

Listen to what the person is not saying (non-verbal cues)
Encourage periodic rest periods and sleep
Assist in activities of daily living
Sing and dance as necessary
Engage in reminiscing activities
Call person by name and always introduce yourself at the start
Actively involve client in activities and simple decision makings
Redirect inappropriate behaviour like anger
Exaggerate facial expressions and gestures in communicating face to face

Diagnostic Tests
Blood test
Diagnosis can only be confirmed by
examining brain tissue after death.
CT, MRI, or SPECT (single-photon
emission computed tomography).
Client history
Neuropsychological.
Mental status assessment.
Drugs
Donepezil (Acricept), tacrine (Cognex),
galanthamine (Reminyl) and rivastigmine
(Exelon).
Sertraline (Zoloft)
Haloperidol (Haldol)
Zolpidem (Ambien) Vitamin E

Note
The management of
Alzheimers
was
lifted
from
Carl
Balitas
Ultimate
Review Guide

Notes

______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
_______________________________

Parkinson s Disease
Parkinson's disease is a degenerative disease caused by the
depletion of dopamine, which interferes with the inhibition
of excitatory impulses, resulting in a dysfunction of the
extrapyramidal system.
It is a slow, progressive disease that results in a crippling
disability.
Mental deterioration occurs late in the disease.

Causes

Stages
1.
2.
3.
4.

Genetics
Endogenous toxins
Environmental exposure to toxins
Medications
Viral Infections
Structural brain disorders
Initial - Resting tremor with mild weakness, possibly
unilateral (one sided)
Mild - Bilateral symptoms with a mask-like faces, and a
slow shuffling gait
Moderate - All of the above symptoms with significant
progression of gait disturbance and postural instability
Severe Disability - Akinesia with rigidity. Rigidity can
interfere with contraction chewing and swallowing
(involvement of pharyngeal muscles), resulting in
malnutrition
Benguet State University
COLLEGE OF NURSING
La Trinidad, Benguet

Jam Ganda 2011^^

NCM 104: Neurologic Function

4|P a g e

Management of Clients with Degenerative Brain Disorders

Clinical Manifestation
Bradykinesia, abnormal slowness of movement, and
sluggishness of physical and mental responses
Akinesia
Monotonous speech
Micrographia
Tremors in hands and fingers at rest (pill rolling)
Tremors increasing when fatigued and decreasing
with purposeful activity or sleep
Rigidity with jerky movements
Restlessness and pacing
Blank facial expressionmask-like faces
Drooling
Difficulty swallowing and speaking
Loss of coordination and balance
Shuffling steps, stooped position, and propulsive
gait
Pathophysiology

Drugs

Levodopacarbidopa
(Sinemet)
Benzotropine
(Cogentin)
Selegiline
(Eldepryl)
Trihexyphenidyl
(Artane)
Diphenhydramine
(Benadryl)
Entacapone
(Comtan)

Benguet State University

COLLEGE OF NURSING
La Trinidad, Benguet

Management
P
Provide high-calorie, high-protein, high-fiber soft diet with small, frequent
feedings and increase fluid intake to 2000 ml/day.
A
Avoid rushing in activities and assist in ambulation and or provide assistive
devices. Perform activities in the morning
R
Rock back and forth to initiate movement and wear low-heeled shoes
K
Keep foot on the ground when walking and avoid prolonged sitting
I
Independence is highly promoted with safety measures
N
No pillows, firm mattress and in prone position when sleeping
S
Spine and neck should be aligned as much as possible. Promote physical
therapy and rehabilitation
O
On anticholinergic medications (inhibits the action of acetycholine) and
antiparkinsonian medications to increase dopamine in the CNS
N
No foods high in Vitamin B6
S
Stop taking monoamine oxidase inhibitors (MAOIS)

Jam Ganda 2011^^

NCM 104: Neurologic Function

5|P a g e

Management of Clients with Degenerative Brain Disorders

Other Treatments
Medial pallidotomy results in destruction of cells in
certain part of the brain, improving symptoms.
Chronic
deep
brain
(thalamus)
stimulation(DBS)- An implant is inserted under the
skin to stimulate and disrupt the area of the brain that
causes the disabling motor symptoms of Parkinsons
disease.

Notes

_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________

Benguet State University

COLLEGE OF NURSING
La Trinidad, Benguet

Jam Ganda 2011^^

NCM 104: Neurologic Function

6|P a g e

Management of Clients with Degenerative Brain Disorders

Huntingtons Disease
Huntingtons disease (HD), also known as
HUNTINGTONS CHOREA, is an
autosomal-dominant
degenerative
neurologic disease. It is characterized by
abnormal movements, intellectual decline,
and emotional disturbance.
Causes
Autosomal dominant
Genetics
Clinical Manifestations
Chorea which is characterized by abnormal
movements
Emotional disturbances and mental deterioration
Temper outbursts and sexual promiscuity
Severe mood swings
Cognitive decline
Pathophysiology

Notes

________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
______________________________
Benguet State University
COLLEGE OF NURSING
La Trinidad, Benguet

Jam Ganda 2011^^

NCM 104: Neurologic Function

7|P a g e

Management of Clients with Degenerative Brain Disorders

Management
H
U
N
T
I
N
G
T
O
N
S

Have foods that can be easily swallowed

Unhurried mealtimes and adaptive utensils
Note for anticholinergic and sedative effects of drugs impaired swallowing
Take 5000 calories a day (due to excessive movement) but it should be in
small frequent feedings
Ingest lots of water during hot weather
Never eat feed lying. It should be upright and chin down towards chest when
swallowing
Gestures should be sued in communication or cards with printed words
Try to repeat words that are understood (to let the client know) and make
communications simple
Offer light and simple to put on and off clothes
Never let the client ambulate alone
Safety, pads on wheelchairs and beds, shin guards and walking belts

DIAGNOSTIC TESTS
Based on clinical
manifestations and
family history
CT and MRI

MEDICAL MANAGEMENT
No pharmacologic
treatment for HD
Haloperidol (dopamine
blocker)
Diazepam
Antidepressants
Prevention and
treatment of infection

Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease)

It is a progressive degenerative disease involving
the motor system.
Attacks the nerve cells that control voluntary
muscles.
The cause of the disease may be related to an
excess of GLUTAMATE
Muscle
weakness
and
atrophy
develop > flaccid quadriplegia >
respiratory muscles become affected
>respiratory
compromise
>
pneumonia >death.
UPPER MOTOR NEURONS - Weak muscles
that are spastic with increased deep tendon
reflexes (DTRs). LOWER MOTOR NEURON Flaccid muscles, weakness, paralysis, and
wasting of muscle.
Clinical Manifestations
Fatigue
Death of motor neurons that control the voluntary
Fatigue while talking
muscles of arms, legs, face, neck, and body
Muscle weakness and atrophy
Destruction of muscles that control the ability to
Tongue atrophy
talk, chew, swallow, and breathe
Dysphagia
Weakness of the hands and arms
Fasciculations of the face
Nasal quality of speech
Dysarthria
Management
A
Actively watch for respiratory complications and provide treatments as ordered.
RESPIRATORY SUPPORT, MEDICATIONS, TREATMENTS AND STATUS.
L
Let the client be comfortable and independent as much as possible. Assess for
complications of immobility
S
Symptomatic treatment. Support the client and the family
Causes

Diagnostic Tests
Electromyography (EMG) - Gives information about
what is happening with the muscles.
Drugs
Riluzole (Rilutek)
Minocycline (Minocin)
Tamoxifen (Tamofen)
Coenzyme Q10
Benguet State University
COLLEGE OF NURSING
La Trinidad, Benguet

Notes

_____________________________________
_____________________________________
_____________________________________
_____________________________________
_______________________________
Jam Ganda 2011^^

NCM 104: Neurologic Function

8|P a g e

Management of Clients with Degenerative Brain Disorders

Benguet State University

COLLEGE OF NURSING
La Trinidad, Benguet

Jam Ganda 2011^^