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585-9
Alzheimer's/ Brain Tumor
| Term | Definition |
|---|---|
| characteristics of AD | Not due to accelerated brain aging Specific characteristics in neurons Gradual onset Has cognitive & behavioral impairments, & personality changes |
| 10 early signs of AD | Memory loss Mood change Misplacing stuff Hard to do similar tasks Confusion Vision change Communication struggle Poor judgement Social withdrawal |
| neuropathology of AD | Occurs due to dendritic changes & neurocortical degeneration These occur due to neuritic plaques & neurofibrillary tangles Abnormality of metabolism of 2 proteins |
| dendritic modification | In normal aging, we have degenerative changes in the dendrites of pyramidal neurons |
| neuritic plaques (beta-amyloid) | Discrete, spherical lesions consisting of beta-amyloid peptide Present in elderly ~80yr, lower prevalence rate & less number of plaques Plaques formed by defective breakdown of amyloid precursor protein. Will make sticky, insoluble shards, damages axons |
| density of plaques | Temporal lobe severely affected Hippocampus volume reduced by 60% Reduced connectivity of hippocampus with other brain regions Difficulty forming new memories |
| neurofilbrillary tangles | Only seen in AD Tau protein makes microtubules & stabilizes structure Chemical change in tau destroys its role & will become tangles Tangles make nerve die |
| neural systems for AD | Amygdala volume in advanced is reduced by 45% & may lead to changes in emotion & memory retention Supraschiasmatic nucleus in hypothalamus will affect circadian rhythm Middle temporal lobe affected first |
| NT abnormalities | Tracks formed by cholinergic neurons (that make ACh) are destroyed Nucleus basalis is origin of cholinergic projections to cortical areas Volume reduced by 70% |
| brain atrophy | Rate of neuron loss accelerates as disease progresses Brain weight decreases by 10-19% Unevenly distributed Mostly in gyri of association areas Ventricles enlarge, hippocampus shrinks |
| areas that aren't as affected in brain atrophy | Primary motor Primary somatosensory Primary visual cortices |
| sporadic onset of AD | 90% of AD Late onset Diagnosed at 65yrs No known genetic cause |
| risk factors of AD | Age Hx of head injury, depression, ECT Familial Genetic predisposition |
| AD age vs. hx of head injury | Risk doubles every 5 years after 65yo vs. Increase neuronal secretion of amyloid plaque. 2 fold increase risk for BI for loss of consciousness |
| AD familial vs. genetic predisposition | 10-15% of AD, genetic mutation, earlier onset vs. Increases production of amyloid plaques Chromosomes 21, 14, 1 are responsible for developing plaques more. Down syndrome has higher correlation |
| protective/ destructive factors | Environmental toxins Educational level, physical inactivity Bilingual may mask for longer, then rapid decline once expressed |
| types of dementia | Alzheimer's- 50-70% Vascular- 15-20% Frontotemporal dementia- 5% Dementia w/ lewy bodies- 10-20% of late onset |
| frontotemporal dementia pathophysiology | Young Progressive aphasia, cortico-basal degeneration Atrophy of frontal & ant temporal lobes, striatum Plaques not seen |
| frontotemporal dementia symptoms | Disinhibited & mood swing Aphasia, stereotypes speech, echolalia, perseveration Poor motivation, indifference, flat affect |
| dementia with Lewy bodies pathophysiology | Abnormal deposits of protein inside nerve cells Can occur by itself, w/ Alzheimers or Parkinsons Will have symptoms of both |
| dementia with Lewy bodies symptoms | Affects thinking & movement Memory problems are more end stage Speech problems Motor issues like repeated falls, loss of consciousness, hallucinations/ delusions |
| huntingtons disease | Inherited, progressive breakdown of basal ganglia At 30-50yo, but may be 2-80yrs Impacts functional abilities Uncontrolled mvmnt of arms, legs, head, face, upper body Psych, motor, cognitive |
| delirium | Caused by medical condition, medication, fever, substance abuse, stroke Temporary condition, ends when they are medically stable May progress to chronic brain syndrome |
| clinical presentation of dementia | Memory problems Impaired executive functioning Visuospatial deficits Impaired gait & balance Depression, anxiety, irritability Agitation, aggression, wandering, psychosis |
| 1. apraxia 2. aphasia 3. anomia 4. agnosia | 1. Can't select & sequence voluntary mvmnt (late) 2. Can't express language (mod-late) 3. Can't find right word (early) 4. Can't recognize things (early) |
| mild cognitive impairment | Prodromal stage of AD- 40% diagnosed within 3yrs Subjective memory complaints Word naming difficulties Clinical dementia rating score 0.5 ADLs/ IADLs not affected |
| mild AD changes in OP | Memory impairment in IADLs, ADLs remain intact Cling to habits Social interaction reduced, leisure declines Fears embarrassment & worries |
| moderate AD changes in OP | Impaired ADL, IADLs neglected Personality change Sleep-wake cycle disturbed Habits not followed Angry outbursts Social withdrawal Wandering & sundowning |
| severe AD changes in OP | Fully dependent on ADLs Can't ambulate safely Loss all performance skills Speech of few words Impact on MSK & mvmnt related function Eating/ swallowing problems Incontinence |
| OT ax for AD | Functional ax Cognitive ax Caregiver burden Environmental |
| OT intervention for mild AD | Meaningful occupations Family/ friends encourage social activities Reminiscence groups Multisensory activities Comp strategies for memory |
| OT intervention for moderate/ severe AD | Encourage meaningful occupation Repetitive routine practice Behavioral intervention Familiar places & people Wear address tags Exercise to maintain function |
| external memory strategies | Checklists, large timetables, visual cues Build into habit, tasks done in daily routine Good for low insight/ awareness |
| environmental adaptation | Safety/ fall risk/ reduce distractions Grab bars to reduce fear Orientation activities Easier navigation, road signs Simplify activities, break steps down |
| principles of intervention for AD | More task specific approach Less computerized remedial activities More environmental adapt Significant others/ caregivers Focus on strengths & needs of pt Cognitive strategy training COPM is best |
| overall tx for AD | Supportive care for pt, family, caregiver Disease tx- drugs, early detection Symptom tx |
| FOCUSED for caregivers | Face to face Orientation- simple instruction Continuity- min switching Unsticking- do you mean? Structure Exchange Direct |
| managing challenging behaviors | Distract not confront Listen to emotional context Use behavioral approach Meaningful activities in day time |
| environment and AD | Familiar env will reduce anxiety & increase mastery Opportunities to reminiscence, home like, familiar activities Watch for safety issues for leisure & participation Use senses |
Created by:
craftycats_
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