COMMON NEUROLOGICAL DISORDERS AMONG THE ELDERLY PARKINSON S DISEASE Slowly progressing neurological movement disorder that occurs

with certain neurons in the basal ganglia and substantia nigra dies or becomes impaired. Affects men more frequently than women as well as people of all ethnicity and socioeconomic background. Affects those over age 65 approximately 1% are seniors. Associated with decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia. Three cardinal signs of Parkinson's TREMORS Resting tremor that characteristically disappear with purposeful movement but is evident when the extremities are motionless. Rhythmic, slow turning motion of the forearm and the hand and the motion of the thumb against the fingers pill-rolling tremors . RIGIDITY Passive movement of an extremity that may cause the limb to move in jerky movements reffered to as cog wheeling . BRADYKINESIA Difficulty initiating movement such as rising from a sitting position or turning on bed. Hypokinesia Postural instability Micrographia Forward stoop Dysphonia

Shuffling Other manifestations: Excessive uncontrolled sweating Orthostatic hypotension Gastric and urinary retention Constipation Sexual disturbances Psychiatric changes: Dementia Depression Sleep disturbances Hallucinations Assessment and diagnostic findings Patients history Three cardinal manifestations Neurologic examination Medical Management PHARMACOLOGICAL THERAPY Anti-parkinsonian medication Anti-cholinergic therapy Anti-viral therapy Dopamine agonists MAOI COMT inhibitors Anti-depressants Antihistamines SURGICAL MANAGEMENT Thalamotomy and pallidotomy Neural transplantation Deep Brain Stimulation Nursing Care Management As a nurse or a caregiver, you need to monitor the physical and psychological condition of the elders Always check for signs of depression as they are prone to suicidal attempts Keep sharp objects or dangerous staffs away from them

Electroconvulsive therapy Understand their feelings and situation Encourage them to participate in any group activities and exercises Assist in giving relaxation techniques Explain the whole scenario to the family members and train them on how to take care of the elders once they reach home ALZHEIMER S DISEASE Characterized by loss of memory and the ability to perform daily tasks. Generally begins after the age of 65. Signs and Symptoms Difficulty experiencing what you mean in speech. Sudden inability to identify familiar objects. Forgetting to do simple tasks. Change in personality. Inability to comprehend new information. Change in reasoning. Difficulty paying attention. Misplacing items. Displaying poor judgment Diagnosis The only definitive diagnosis can be done are the time of death with an autopsy. Physicians rely on a patient s symptoms, abilities, history X-ray for early Alzheimer's disease detection. Treatment No known cure for Alzheimer s disease. Some guidelines for the care of a person with Alzheimer s disease A. Stabilize environment: Give explanation of care

Provide person with list of things to do and give specific times. Display familiar objects Label articles, doors, etc. B. Hygiene and Dressing: Encourage independence. Assist and supervise only when necessary. Suggest clothing that slips on easily. Label clothing, drawers. C. Meals and Nutrition: Allow person to select food Observe for difficulty swallowing Avoid hot foods. Cut solid foods. D. Sleep and Rest: Expect some agitation from some medications. Allow to rest and sleep at will. E. Exercise and Activity: allow enough space for safe walking activities. Encourage walks with an attendant. Provide passive exercise for those confined to bed. F. Elimination: Monitor input and output. Encourage fluids, fiber in diet and exercise. Label urinals and bathroom door. Expect confused people to use any convenient container on the floor for elimination. G. Medications avoid large capsules or pills Observe that medications are taken and swallowed w/o difficulty Crush pills or order liquid preparations Observe for adverse reaction or effectiveness

do not leave medications on bed sides H. Love and Belonging Person may withdraw and become isolated He/she can usually respond to touch and kindness Facts and Statistics Approximately 5.4 million in the U.S that have Alzheimers disease Approximately 10% of people over age 65 have AD. By the time the patient reaches age 85, there is 59% possibility that they will AD Alzheimers disease costs approximately 172billion dollars annually There are approximately 11 million people caring for an individual with AD Every 70 seconds a new individual devvelops the disease Deaths that are associated to AD rose from 2000-2006 by 47% About 500,000 Americans have been diagnosed with dementia AD is the cause of 65% of all dementia patient Up to 74% of all Alzheimer's patient are women Study Reveals New Link Between A.D and Healthy Aging August 17,2011 Researchers have analyzed changes in in gene expression in the aging and diseased brain, finding new clues to the biology of normal aging and neurodegenerative disorders. Comparing samples from healthy individuals ranging from 16 to 102 years old with samples from diseased individuals , the investigation uncovered striking similarity in the changes in gene expression patterns associated with aging and the neurodegenerative disease. CEREBROVASCULAR ATTACK

OTHER NAMES brain attack cerebral infarction cerebral hemorrhage stroke DEFINITION medical emergency An interruption of blood supply to a vital center in the brain WHO definition: Rapidly developed clinical sign of focal disturbance of cerebral function of presumed vascular origin and of more than 24 hours STROKE Stroke is the third largest killer in the Western World. Stroke is one of the major causes of disability, particularly in the elderly. Stroke patients may present with a variety of physical, cognitive and psychosocial problems. Most stroke patients show signs of recovery over time. TRANSIENT ISCHEMIC ATTACKS also called Mini-strokes occur when the blood supply to the brain is briefly interrupted recovery is complete within 24 hours but 10% of patients will go on to have a stroke should be considered an emergency because there is no guarantee that the situation will resolve and function will return Stages of CVA Transient ischemic attack (TIA) Reversible ischemic neurologic deficit (RIND) Stroke in evolution (SIE) Completed stroke (CS) CLASSIFICATIONS

ISCHEMIC when arteries are blocked by blood clots or by gradual build up of plaque and other fatty deposits HEMORRHAGIC when a blood vessel in the brain breaks leaking blood into the brain RISK FACTORS UNMODIFIABLE Over age 55 Male African American, Hispanic or Asian/Pacific Islander A family history of stroke A previous stroke or transient ischemic attack (TIA) RISK FACTORS MODIFIABLE High cholesterol Smoking cigarettes Diabetes Obesity and overweight Cardiovascular disease High blood pressure RISK FACTORS Birth control use or other hormone therapy Cocaine use Heavy use of alcohol CAUSES Blockage of an artery Embolic stroke Cerebral hemorrhage Subarachnoid hemorrhage Vasculitis Migraine headache SIGNS AND SYMPTOMS

Weakness or paralysis Numbness, tingling, decreased sensation Vision changes Speech problems Swallowing difficulties or drooling Loss of memory Vertigo (spinning sensation) Loss of balance and coordination Mood changes (depression, apathy) Drowsiness, lethargy, or loss of consciousness Uncontrollable eye movements or eyelid drooping Time is Critical! The longer the time period that the person remains unresponsive, the less likely it is that the person will recover. The first few days after onset is critical. The responsive person may: Show signs of memory loss or inconsistent behavior May be easily fatigued, lose bowel and bladder control, or have poor balance. Act F.A.S.T. F = Face Ask the person to smile. Does one side of the face droop? A = Arms Ask the person to raise both arms. Does one arm drift downward? S =Speech Ask the person to repeat a simple sentence. Does the speech sound slurred or strange? T = Time Call 911 / 117 immediately! Major effects of stroke  Hemiplegia Aphasia and Dysphasia Brain Damage

Hemianopsia Heart Attack Personality Changes Deep Vein Thrombosis Pulmonary Embolism Decubitus Ulcers Depression Pneumonia Diagnostic Procedures Magnetic resonance imaging (MRI) and/or computed tomography (CT) imaging Magnetic resonance angiography (MRA) Conventional Angiogram Carotid Doppler Ultrasound Heart Tests Blood Tests Nursing Diagnoses Ineffective tissue perfusion (cerebral) Disturbed sensory perception Impaired physical mobility Risk for injury Self-care deficit Impaired verbal communication Impaired swallowing Nursing Considerations Maintain patent airway. Monitor for changes in the client s level of consciousness (increased intracranial pressure sign). Elevate the client s head to reduce ICP and to promote venous drainage. Avoid extreme flexion or extension, maintain the head in a midline neutral position and elevate the head of bed to 30 degrees. Institute seizure precautions. Maintain a non-stimulating environment. Assist with communication skills if the client s speech is impaired.

Assist with safe feeding. Assess swallowing reflexes. Thicken liquid to avoid aspiration. Eat in an upright position and swallow with the head and neck flexed slightly forward. Place food in the back of the mouth on the unaffected side. Suction on standby. Maintain skin integrity. Encourage PROM every 2 hr to the affected extremities and AROM every 2 hr to the unaffected extremities. Elevate the affected extremities to promote venous return and to reduce swelling. Maintain a safe environment to reduce the risks of falls. Scanning technique (turning head from side to side) when eating and ambulating to compensate for hemianopsia. Provide care to prevent deep-vein thrombosis (sequential compression stockings, frequent position changes, mobilization). Administer medications as prescribed. The Stroke Team Doctor Nurse Physiotherapist Occupational Therapist Speech & Language Therapist Social Worker Dietician Psychologist Dentist Podiatrist Art Therapist Volunteers

Carers TREATMENT Tissue plasminogen activator (TPA) Heparin and aspirin Managing other Medical Problems Rehabilitation Stroke Prevention Get screened for high BP. Have your cholesterol level checked. LDL should be lower than 70 mg/dL. Follow a low-fat diet. Quit smoking! Exercise! Limit alcohol intake! MULTIPLE SCLEROSIS DEFINITION chronic, unpredictable, and often progressive disease of the central nervous system nerves of the central nervous system (brain and spinal cord) degenerate specifically the myelin sheath Diagnosed between 20 and 50 years of age, also with children and ELDERLY Twice as likely to occur in Caucasians as in any other group Women are twice as likely be affected than men TYPES Exacerbation of Multiple Sclerosis Relapsing-remitting (RR) MS Progressive relapsing (PR) Primary-progressive (PP) MS Secondary-progressive (SP) MS RISK FACTORS Being between the ages of 20 and 40. Being female Having a family history Having certain infections

Being white Living in countries with temperate climes Having certain other autoimmune diseases CAUSES MAIN CAUSE : UNKNOWN Immunologic Reaction Viral or other Infectious Agents Environmental Factors Genetic Factors SIGNS AND SYMPTOMS Primary symptoms Weakness Numbness Tremor loss of vision Pain Paralysis loss of balance bladder and bowel dysfunction SIGNS AND SYMPTOMS Secondary symptoms Inactivity poor postural alignment and trunk control muscle imbalances decreased bone density shallow, inefficient breathing Tertiary symptoms depression Diagnostic Procedures MRI electro-physiological test examining the cerebro-spinal fluid TREATMENT Currently no cure Synthetic forms of interferon Glatiramer acetate Treatments for specific symptoms Physical therapy and exercise