Etapas GDS y la enfermedad de Alzheimer

• GDS Scale: global deterioration scale, 7 stages

GDS Stages

• Stage 1: Normal aging
• Stage 2: Very mild cognitive decline
• Stage 3: Mild cognitive decline, 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
• Type (less than 1 year of dementia) Alzheimer's

CP (Clinical Presentation)

• Degenerative dementia of the primary nervous system without a known cause
• Degenerative disease in cerebral cells (neurons), insidious and slow progressive nature

Alzheimer's Disease Discovery

• Alois Alzheimer discovered the disease in 1907

Alzheimer's Symptoms

• Initial symptoms involve recent memory loss
• The patient becomes suspicious that something is happening, unaware of their errors, minimizes symptoms, experiences mood swings
• Later symptoms include memory loss and changes in speech, language, coordination of movement, and daily activities
• Disease duration is between 2 to 10 years or more

Clinical Manifestations

• Cognitive impairments include alterations in memory, language, apraxia, and agnosia
• Behavioral and psychotic changes, delusions, and personality changes are common
• Neurological problems include alterations in gait, olfaction, myoclonus, seizures (convulsions), extrapyramidal symptoms, etc

Prevalence

• Affects both men and women, typically +65 years old
• Leading cause of dementia in the elderly population
• Definitive diagnosis is only possible post-mortem (necropsy)

Neuropathology

• Macroscopic changes: Diffuse atrophy with widened sulci and dilated cerebral ventricles
• Microscopic Level:
  • Amyloid or senile plaques accumulate progressively
  • Neurofibrillary tangles: Numerous tau protein collections that disrupt neuron functionality
  • Loss of synapses (Over 50% in the cortex), and generalized degeneration of neurons

Genetic Factors

• Two main types of genetic factors:
  • Type 1 (Early onset): linked to RA02, has familiar inheritance, often <65 years
  • Type 2 (Late onset): typically >65 years, usually no family history

Chromosomes

• Alterations in chromosomes 1, 14, 19, and 21 are associated

Clinical Manifestations Phases

• Phase I: Recent memory loss, confusion, mood changes, difficulty finding words, shorter phrases, reduced initiative, but still can perform daily activities
• Phase II: Personality changes, aggression, agitation, irritability, confusion, fears, hallucinations, restless, fatigue,, uncoordinated, unsteady, poor hygiene, possible incontinence
• Phase III: Does not recognize family, only remembers emotions, cannot communicate, babbles, can't control gestures, cries, screams, agitation, difficulty swallowing, total incontinence, bedridden

Medication

• Medications aimed at protecting the cholinergic system (the messaging system between neurons)
• Three drugs to slow disease progression and improve cognitive function (TOOQI):
  • Tacrine elevates liver enzymes, rarely used now (approved first)
  • Donepezil stabilizes cognitive function, well tolerated. Available and taken once a day
  • Rivastigmine is a newer drug of similar efficacy, administered twice dailym

Consider Discontinuing

• It may be necessary to discontinue meds that increase confusion, e.g. depressants, painkillers and antihistamines

Anti-inflammatory Medications

• NSAIDs: Aspirin, ibuprofen, currently undergoing investigation for their potential benefits

Corticosteroids

• Should not be used for long periods of time
• Estrogen and other hormones: Estrogen replacement therapy
• Antioxidants: High doses (2,000) of vitamin E, selegiline, or both

Care Considerations

• Obtain life habits and physical state for structural activities
• Value and apply abilities of the patient, objective goals
• Determine method of attention
• Trastornos de la comunicación: messages concisos y concretos (Communication disorder: concise and concrete messages)
• Provide consistent environmental cues like familiar objects, mnemonic devices, and place signaling
• Use auditory (auditory) prosthesis
• Incapacidad para el autocuidado: Postura correcta, prevención UPP, dieta variada (Incapacity for self-care: Correct posture, UPP prevention and balanced diet.)
• Encourage and assist safe eating and sleeping patterns

Parkinson's - Concept

• Parkinson's: Chronic, progressive, degenerative disorder of the subcortical extrapyramidal system in the SNC, decrease in movement, stiffness, tremor, and postural instability
• It affects part of the brain (control and coordination), muscle tone, and posture

Parkinson's - Origin

• Originated in the 2nd century
• Galeno described the disease
• In 1817 Dr. Parkinson introduced paralysis agitans

Parkinson's - Theories

• Due to living in rural areas, contact of pesticides, Vit A/E deficiency, water pollution

Parkinson's - Genetic

• Juvenile cases, a generic component accelerates the aging of determined cellular groups

Parkinson's - What occurs in the brain

• Dopamine production in the brain decreases, which is used for neurotransmission, the function of basal ganglia and control of the movements
• Without dopamine, the problems are related to rigidez y temblores (rigidity and tremors)

Parkinson's - Dopamine

• Coordinates the small muscle movements necessary for everyday tasks
• Monoamine oxidase B degrades the dopamine
• Drugs are inhibitors

Parkinson's - Prevalence

• Todas las personas, edades, raza y sexo em todo el mundo
• Affects people of all ages, genders, and races worldwide
• The average age of onset is 57 years, but it can occur in childhood and youth
• Affects 1% of adults older than 65 years and 0.4% of adults older than 40 years old
• Concurrent occurence with demetia and depression
• There is a 20-40% chance of cognitive decline

Parkinson's - Types

• Occurs primary (unknown cause)
• Or due to another condition/treatment

Parkinson's - Causes

• Vascular or aterosclerosis
• infections like encephalitis
• Traumática (TCE with hematoma subdural)
• Fármacos: neurolépticos, antieméticos, reserpina, alfametildopa, elnaricina
• Tóxicos: monóxido de carbono, manganeso
• Subproducto de síntesis de la heroína Otras n-MTHP(n-metil-1,2,3,4tetrahidropirina)
• causes: Tumores cerebrales, hidrocefalia, Infartos del mesencéfalo o ganglios basales

Parkinson's - Symptoms

• SINTOMAS PRIMARIOS, PRINCIPALES, FUNDAMENTALES O CARDINAL (Symptoms primary, main, fundamental or cardinal)
• Starts at hands, then arms, then legs and can turn bilateral

Parkinson's - Main Symptoms

• Temblor (Tremor) - Temblor or coin money

Parkinson's - Rigidez muscular (muscle stiffness)

• Limited movement, hard to start, and also paralysis

Parkinson's - Comina

• With step patterns

Parkinson's - Freezing

• Cant step feet, with sudden steps

Parkinson's - Hipomimia

• face of mask
• inflexible, and can be mistaken with depression

Parkinson's - Hipertonia

• muscle movement

Parkinson's - Brodiquinesia

• brodikinesia, brodianesia, brodipropria
• important symptonm with 77-87%

Parkinson's - Postural instability

• difficult to stay calm

Parkinson's - Alteración del eprikbão

• Peñalblo por mala estabilidad al estar poreado

Parkinson's - Segundo

• Habla, Habla monótono y difcultoso, Disfosia, tastemadeo, Disastra, actiulación onfiill ydefectjore, Hipotonia: volumen, Dispuosodia: alteraadi voz, eutonoción, etc
• (Speech, Monotonous speech, Dysastia)
• Alteraciones pricicos, 50% 100 demencia, (Pricicos alterations, 50-100)
• Labilidad emocional, y serona facial, (emotional lability )

Parkinson's - Diagnosis

• Dificultad o pocinar, subcortical Demenão
• H en el 15% de los costs,

Parkinson's - Levels

• Levels of volation, Webster, hoehn y mar
• Levels of Hohn Yahr (1-5)
  • unilateral -bilateral
  • bilateral with postural
  • bilanetal and inestable
  • incapacidad total (total incapability)
  • (UPDRS score/ check list)

Parkinson's - Tratamiento (Tretament)

• Levodopa or L-dope
• Precursor de la dopamine
• 30-60 minutes before food

Parkinson's - AD

• AD: Agomistas dopominégicos, Apeates anticolinergicos, p cs de 70 quos (AD: Dopaminergic agonists, choline treatment, for greater than 70 year olds)

Parkinson's - Treatment considerations

• Inhibidores de la MAO-B y de la CONT (MAO-B inhibitory)
• Inhbit the amino enzyme
• Blocos lo enzima (blocks enzyme)
• holoidaydescuro/descuro
• Very many deaths
• Others/ Rivastigmno

Parkinson's - Técnicos

• Duersibles, reversible, estimulor electicamente