Escala GDS y la enfermedad de Alzheimer

Escala GDS (Global Deterioration Scale)

• Reisberg developed the GDS in 1982, which consists of 7 stages to measure cognitive decline.

Stages of Cognitive Decline

• Stage 1: Normal cognitive function which is normal
• Stage 2: Very mild cognitive decline
• Stage 3: Mild cognitive decline (with incipient dementia)
• Stage 4: Moderate cognitive decline + Mild dementia
• Stage 5: Moderate to severe cognitive decline + Moderate dementia
• Stage 6: Severe cognitive decline + Moderate to severe dementia
• Stage 7: Very severe cognitive decline + Severe dementia

Alzheimer's Disease

• Alzheimer's can cause dementia in less than a year
• Characterized as degenerative dementia without a known cause.
• It involves a degenerative disease of brain cells (neurons) that is insidious and slowly progressive.
• Discovered in 1907 by Alois Alzheimer

Symptoms of Alzheimer's Disease

• Initial symptoms involve memory loss of recent events.
• Patients may suspect something is wrong, acknowledge their anomalies but downplay them, minimize their symptoms, and exhibit mood changes.
• Later symptoms are loss of memory and changes in behavior, speech, and coordination, increasing difficulties with daily activities.
• The disease can last from 2 to 10 years or more.
• Clinical manifestations can be cognitive, behavioral/psychotic/affective, and neurological.
• Cognitive manifestations include alterations in memory, language, apraxia, and agnosia.
• Behavioral, psychotic, and affective manifestations include delusions, and changes in personality

Neurological manifestations

• Neurological manifestations include alterations in gait, smell, seizures (convulsions), and extrapyramidal symptoms.
• Affects both men and women, typically over 65 years of age.
• It is the primary cause of dementia in the elderly.
• A definitive diagnosis is only possible with a necropsy.
• The Daniel macroscopic examination reveals diffuse atrophy, widened gyri, and dilated cerebral ventricles.
• Microscopic examination reveals senile or amyloid plaques that accumulate progressively, (more common in Down syndrome), outside the neuron.

Microscopic Details of Alzheimer's

• Neurofibrillary tangles are many "tau" proteins tangled together, preventing proper neuron function and affecting neuron processes.
• "Tau" proteins are involved in microtubule assembly, which occurs between neurons.
• There is a loss of synapses (more than 50% in the cortex), affecting communication between neurons.
• Degeneration occurs at the granular level in the neurons.
• 2 types of Alzheimer's - early and late onset
• Early-onset (onset before 65 years): Raro2, familial with early onset
• Late-onset (onset after 65 years): no early familiar pattern
• Alterations in chromosomes 1, 14, 19, and 21 are also associated with Alzheimer's.

Clinical Manifestation Phases

• Phase I: Characterized by clumsiness, recent memory loss, slips, mood changes, getting angry with errors mixing ideas, beginning of critical judgment deterioration, language is impoverished, cannot find words, shorter phrases, lack of spontaneity, less initiative, but able to reason
• Phase II: Characterized by personality changes, aggression, agitation, irritability, confusion, fears, hallucination, fatigue, and restlessness
• Phase III: characterized by failure to recognize family, only emotional memory is conserved, language and communication is lost

Medications for Alzheimer’s

• Medications that protect the cholinergic system may slow down progression
• There are three medications, to retard the progression of the disease, and improve cognitive function
• Tacrine: Rare to use; should take 4 times a day, elevates hepatic enzymes
• Donepezil: Improves cognitive decline; should take once a day, and has a long half life
• Rivastigmine: New medical; should take twice a day
• Suspend medications that may worsen conditions such as depressants, antihistamines or analgesics
• Anti-inflammatory medications are also used, but should not be used for prolonged use

Other Medications

• Estrogen replacement therapy
• Antioxidants - High dose vitamin E may be administered.

Care Strategies for Alzheimer's Patients

• Obtain information about their lifestyle, personality, and physical condition to structure their activities and understand their preferences.
• Value the patient's abilities and skills, setting realistic objectives.
• Determine the most suitable mode of care based on their needs.
• Maintain concise and concrete messages for communication.
• Provide environmental cues for orientation with familiar objects, mnemonic rules, and clear signaling of places.
• A person must learn how to care for themselves independently for things, such as posture.
• Must also have training on how to consume a meal with utensils.

Parkinson's Disease

• Parkinson's disease is a subcortical degenerative disorder of the extrapyramidal system.
• It is slowly progressive and characterized by decreased and slow movements, muscle rigidity, resting tremor, and postural instability.
• A brain area responsible for motor control and coordination, muscle tone, and posture is affected.

Origin of Parkinson’s

• Galen described it for the first time in the second century AD.
• In 1817, Dr. Parkinson presented it as "paralysis agitans", describing akinesia (paralysis) and tremor (agitation).
• Parkinson's Day is celebrated on April 11.
• Possible causes: living in rural areas, exposure to herbicides, lack of vitamins A and E, well water, and gasoline derivatives.
• A genetic component associated with environmental factors is admitted in the juvenile form, accelerating the aging of certain cell groups.
• Mutation of the "parkin" gene in individuals under 58 years old.

Parkinson's and the Brain

• The substantia nigra in the brain produces dopamine, a neurotransmitter enabling the basal ganglia to function.
• Basal ganglia coordinate and control movements smoothly.
• Parkinson's disease results in reduced dopamine levels, affecting the basal ganglia's function and causing slowness, rigidity, and tremors.
• Dopamine acts in the extrapyramidal system, regulating and controlling movement and posture and coordinating small muscle movements.
• Monoamine oxidase B (MAO-B) eliminates dopamine and block the removal of said dopamine.

Prevalence

• Affects all people, ages, races, and sexes worldwide.
• The average age of onset is 57 years, but it can occur in childhood and adolescence.
• It affects 1% of people over 65 years old and 0.4% of those over 40.
• Commonly occurs with dementia and depression; 20-30% of Parkinson's patients have dementia; 30-40% have cognitive impairment.
• Parkinson's can be primary or secondary
• Primary: the cause is unknown, onset slow and insidious
• Secondary: the cause is known is due to another disease, treatment.

Symptoms

• Tremor is the first symptom, the most common
• Tremors have a max intensity at 7-% rest period
• Affects the entire body, especially hands, arms, and legs
• Rigidity can also be a symptom, and will often have slow movement and postural imbalance.

Other Symptoms Cont.

• Monotonous and difficult speech
• Slurred Speech
• Altered tonality or emphasis

Secondary Symptoms

• Psychiatric conditions
• Poor breathing
• Bedwetting

Stages of Hoehn and Yahr

• The Hoehn and Yahr scale assess motor deficiencies
• Stage 1: Affected on just one side
• Stage 2: Affects both sides, doesn't impair balance
• Stage 3: Balance is impaired, is still independent
• Stage 4: Full disability
• Stage 5: Inability to function

Parkinson's Treatment

• Levodopa or L-dopa can be used
• Is a precursor to dopamine, and should take 30-60 min before a meal
• can also use Antichloinergics
• used when it is difficult to sleep
• can also use mono-amino oxidasa B inhibitors
• inhibits a degradative enzyme of dopamine

Parkinson's Therapies

• Speech therapy is used, with holiday breaks in between
• Surgery can also be used
• Durosibles
• Reversibles, uses electronic simulation to improve function