HSC 3502 Exam 2 Study Guide 2024 PDF

HSC 3502 #2- 2024 Content covered on the exam will be from the assigned chapters, videos, and in-class assignments for weeks 9-14. Consider themes such as risk factors, symptoms, diagnosis, assessment & treatment, vocational implications/accommodations, medical terminology. Additionally, be able to...

HSC 3502 #2- 2024 Content covered on the exam will be from the assigned chapters, videos, and in-class assignments for weeks 9-14. Consider themes such as risk factors, symptoms, diagnosis, assessment & treatment, vocational implications/accommodations, medical terminology. Additionally, be able to compare and contrast diseases, recommend proper exercise and secondary prevention techniques, understand any relevant historical perspectives. Identify diseases that commonly combine with others or predict greater risk of development. You can expect 2 questions from each “On Location” video- consider what caused the disease, how/when diagnosed, any complications, treatment, advice to health professionals. Cardiovascular Disease On Location Video – Nina - Christina Cinca – diagnosed with restrictive cardiomyopathy at 7 years old - Didn’t know she had it until she went to pediatric appointment who hear a heart murmur, referred her to Shands who ended up diagnosing her - She was very tired, couldn’t participate in recess, couldn’t stay up late at sleepovers - Tests: Echos, EKGs, at 10 or 11 she had to go on a treadmill to see how long she could walk and the incline/ the point to where she got tired - As she grew older, she wanted to participate in many things, but she was able to gravitate towards acting and singing instead of sports since she couldn’t do that - The diagnosis: “heart pumped really well but couldn’t relax” – so that is why she couldn’t do sports o It is very rare, so she was on the transplant list - Procedure and prep for the transplant: July 1st, 2014, she got the call for the transplant, but when she got there, she had pneumonia so she couldn’t get the heart that day; she saw it as a “practice run” o Got her transplant on September 24th, 2014 o In the hospital for 10-11 days o Brought in music therapist, Child Life, Streetlight volunteers - Her old hear was able to hold it in a bucket of ice  o Helped put pieces together as to how sick she was because she was able to see - After transplant: scared to go outside, slept with pillows all around her - Based on your experience, what do you advise health professionals and students to consider when interacting with their patients? – Sense, trust, and connection – be available to your patient, listen to your patient, take the time to answer questions - Medication: after one year mark don’t engage in contact sports, not allowed to take ibuprofen or Advil only Tylenol because it will intervene with her medicine; she’s on the tacrolimus (aka prograph) – anti-rejection immunosuppressant, baby aspirin - How often does she go back for checkups: Every three months, sometimes 6 months; to get a cath, every 1-3 years - Origin of Team Nina: when she was in 7th grade, her loved ones all wore Team Nina shirts and created it to support Nina along her journey o Would raise money for Children’s Cardiomyopathy Foundation and partnered with Who We Play For Objectives Structures of heart and vessels Heart Layers - Pericardium: outer sac - Myocardium: the heart muscle; site of necrosis/where a heart attack occurs - Endocardium: inner part of the heart, where all the valves are Circulation - Deoxygenated blood comes through the right area into the right pulmonary artery, then goes to lungs. - The oxygenated blood goes back into the aorta, into the left ventricle, to the rest of the body - Arteries take blood away from the heart - Veins take blood to the heart (usually have deoxygenated blood but NOT NECESSARILY) Heart Valve - Bicuspid (mitral) valve – a lot of issues can occur with this one - Valves need to have good closure, if they don’t then blood can go back in the opposite direction Electrical System  1. Sinoatrial (SA) node – starting of the pacing of the electrical activity, the polarization of the heart o Maintains heart rhythm o Coordinates contraction and relaxation o Occurs involuntarily o Adjusts heart rate depending on need for oxygen 2. Atrioventricular Node 3. His/Purkinje network 4. Ventricles Risk factors of heart disease Identify terms: atherosclerosis, arteriosclerosis, angina, arrhythmia, cardiac arrest - Arrythmia: irregular rate o Increases risk of stroke 5x o Symptoms include fluttering of heart, general fatigue, chest pain, exertional dyspnea, syncope o Management  Identify triggers: excessive caffeine/alcohol, poor sleep, increased stress  Medications – first step usually  Antiarrhythmics  Antihypertensives  Anticoagulants - Atherosclerosis: specific type of arteriosclerosis o Chronic inflammatory response o Common cause of heart conditions/stroke o Associated with hyperlipidemia o Varies due to level of stenosis o Sever stenosis can end up in heart attack o Symptoms include mild dizziness, vertigo, palpitation, blurred vision o All people with atherosclerosis have arteriosclerosis but not vice versa - Arteriosclerosis: hardening of the arteries o Result of old age, lack of elasticity of blood vessels o Doesn’t necessarily produce symptoms o No specific treatment - Angina pectoris: chest pain when you have blockage o Stable Angina: predictable and triggered by activity o Unstable Angina: occurs at rest and more severe/frequent  - Both: relieved with nitroglycerin (it dilates coronary arteries which helps with blockage) - Cardiac Arrythmias: very common and associated with various medical conditions o Idiopathic o Range from minor to life threatening  Sinus bradycardia  Ventricular fibrillation – concerning  Atrial Fibrillation  Sever: sudden cardiac arrest Describe differences between cardiac arrest and myocardial infarction - Myocardial Infarction: the heart and muscle hasn’t gotten enough oxygen leading to death of tissue in the heart o Symptoms: chest pain, pressure that radiates to left arm, neck pain, back pain, nausea, dyspnea, diaphoresis o Symptoms may be less dramatic and involve indigestion and feelings of doom o Emergency situation  Admission to CCU and initiate electrical stability - Cardiac Arrest: serious emergency and the heart might stop beating totally/ sudden cessation of heart function o Common cause of CAD o Often fatal unless CPR is successfully performed or defibrillator successfully used  Within 5-8 minutes Know “normal”/abnormal levels: blood pressure, cholesterol, blood sugar, heart rate - Blood Pressure o Diastole: resting phase  Heart is relaxed and chambers are filling  Bottom number o Systole: contracting phase  Blood pumped from chambers  Top number o 120/80 = normal o Prolonged hypertension is a major risk factor of heart disease - Hypertension o Primary (essential): most common, cause can’t be identified o Secondary: results from other conditions   Hyperthyroidism  Renal Artery Stenosis o Malignant: abrupt onset, dangerous - Heart Rate o Arrythmia: irregular heart rate o Tachycardia: too fast (over 100 bpm) o Bradycardia: too slow (under 60 bpm o Dysrhythmia: too irregular Know differences between CAD, heart failure, atrial fibrillation Coronary Artery Disease (CAD): inadequate blood supply to heart o Diminished oxygen supply o May lead to blockage (ischemia) o Can be caused by  Unstable angina pectoris  Myocardial infarction (MI): acute coronary syndrome (aka heart attack)  MI can be from atherosclerosis, thrombus, and embolus o Medications: nitroglycerin, antiplatelet meds (aspirin), anticoagulants (heparin) Heart Failure (Left Sided) o The organ becomes very ineffective o Late-stage disease o Since on left side, indicative of pulmonary edema o Symptoms: unexpected weight gain, orthopnea, lower extremity edema, paroxysmal nocturnal dyspnea, fatigue and weakness, cognitive deficits Heart Failure (Right Sided) o Not as frequent o Might be peripheral edema (leg, ankle, abdomen swelling) o Symptoms: nocturia, dyspnea, gaining weight from excess fluid, fatigue o May be triggered by left-sided failure - Managing heart failure o Since it is an end-stage disease: cardiac resynchronization therapy would be used (trying to get the heartbeat going at a regular way)  Via pacemakers  Via implantable cardioconverter-defibrilator o Heart transplant o Medications  Antihypertensives   Digitalis  Diuretics Valvular Conditions - Mitral prolapse inadequate valve closure o Blood flows backward into atria o May have palpations o Possible surgery  Using regular valve or using a mechanical valve (requires long term anticoagulant treatment) - Endocarditis o Inflammation of heat chambers/valves o Usually bacterial infection o May be from mitral valve prolapse o May be result of dental work, colonoscopy, pacemaker o Symptoms include fever, chills, fatigue, night swears shortness of breath, chest pain when breathing o Treatment: antibiotics early to prevent life-threatening problems - Pericarditis o Inflammation of saclike membrane layer. The sac that surrounds the heart o May experience pain/low grade fever o May be from secondary virus from pacemaker, angiography o Most cases are mild and improve  Medication  Surgery is rarely involved - Rheumatic Heart Disease: developed from rheumatic fever o Usually strep infection o Possible valvular damage o Most common reason for mitral stenosis - Peripheral Arterial Disease o Affects lower extremities o Color changes due to inadequate blood flow o Intermittent claudication (especially when walking) (pain in legs or arms) o Rest relieves pain - Thromboangitis Obliterans: Buerger Disease o Rare autoimmune reaction o Occurs in mostly males 20-40 years of age o Associated with tobacco products o Diminished blood flow to distal legs and arms   Vessels are inflamed, swollen, can become blocked with clots  Symptoms include numbness, tingling, pain o Treatment: smoking cessation - Raynaud’s Phenomenon o Primary or secondary o Brought on by cold or emotional stress o Spasms of vessels to fingers or toes o Cause color change in fingers or toes o Treatment: vasodilation, biofeedback, warmth CPR changes (emphasis on compressions); use of defibrillator Cardiac assessments and their utility: EKG, Holter monitor, METS table, event monitor, stress test, cardiac catheterization, CT scan, telemetry, blood tests, chest x-ray - EKG (Electrocardiogram): records heart’s electrical activity o Records strength and timing of electrical signals o Can show signs of heart damage and previous/current heart attacks - Holter monitoring o Portable device, provides numerous data points, generally 24 hours/14 days o Diary entries - Event monitor: variety of different forms o Designed to detect transient/intermittent episodes o Worn for up to 30 days - Stress test o Create situation in which heart needs to work hard and beat  Treadmill, stationary bike, pharmacological o Measures taken: HR, BP, EKG - Cardiac Catheterization o Catheter threaded into a coronary artery o Dye injected into the catheter to determine any blockages - Echocardiography o Sound waves to map heart anatomy - CT scan - Telemetry - Blood tests and Chest X-Rays Surgical and minimally invasive interventions for heart conditions: angioplasty, CABG, heart transplant, mitral valve repair; ablation - Percutaneous Coronary intervention: angioplasty w/ stent o Contrast dye via fluoroscopy - Percutaneous Transluminal Coronary Angioplasty: minimally invasive o Cather insertion into occluded artery o Balloon and stent - Coronary Artery Bypass Graft (CABG): for severe heart disease o 3–6-hour operation under general anesthesia o Graft: typically, saphenous vein (veins in leg)/may be multiple vessels grafted o Incision in middle of chest o Medicine used to stop the heart and then patient is placed on heart-lung machine to pump the heart - Off-Pump CABG o Chest is opened and same as CABG but without stopping the hear or using a heart-lung bypass machine o May be called beating heart bypass o Slightly lower risk of complications - Bypass concerns: o Not a cure o 50% of bypasses become clogged with plaque within 10 years o Some people may die or have a stroke during surgery o Bypasses using arteries are better than using veins - Heart Transplant o People with HIV, active cancer, severe psychiatric condition, unable to adhere to complex management plan may disqualify someone from getting a heart transplant o The recipient: body size, heart size, blood type, organ preservation time (4 minutes), post-transplant immunosuppressant therapy - Valve reconstruction: repair of natural valve/valve replacement Lifestyle modifications to prevent and combat heart disease progression - Decrease stress - Maintain proper body weight - Reduce alcohol/smoking cessation - Diet high in lean protein, low-fat dairy, whole grains, fruit and veggie  - Decrease sodium, saturated fats, carbs - Get sufficient rest - When not sufficient, take medications – antihypertensives Extra - METs = Metabolic Equivalents – a way to measure how much oxygen the body consumes during physical activity compared to while resting Stroke On Location - Tim and Penny – Time had a stroke in 2000, he was in the golf industry before stroke o Was a salesman for 16 years in golf industry o Had a physical eight weeks before his stroke o Tim was traveling home from work and was found at a rest stop by a truck driver o Informed by his insurance company that they would not cover any rehabilitation, his wife became his mane caretaker o His first word after two years was banana o A lot of research in Gainesville for stroke survivors, which is why they moved to Gville - Tips for students: when it comes to dealing with health professionals, realize that aphasia isn’t loss of intelligence it’s a loss of words, so don’t assume o Tim knows exactly what he wants to say but can’t get the words out o Tim was experiencing expressive aphasia o “If you don’t get it back in 6 months, you’re never going to get it back” – this, put a lot of pressure on them and can lead to depression; but Tim was always improving - Tim has struggle with his right arm/hand; there is a lot of neglect with that side because he learned to do life with his left arm/hand - Post stroke advocacy: There is a book club for people with aphasia that they have been able to meet friends there o Brooks Rehab in Jacksonville – Tim was getting 5 hours a day for speech therapy o The Aphasia Center in Jacksonville – group settings and life after - Caregiving Aspect: “caregivers are crazy”  o There are stages in caregiving, and it changes as time goes by – the stroke didn’t affect only Tim it also affected Pam o There is a lot of expectations on the caregiver; she was doing a lot of OT, PT, Speech, etc. on top of the responsibilities that they shared before the stroke - Anything else they wanted to share regarding their experience: o Took a long time to find a new normal o They had to find hope, especially since they were told they weren’t getting rehab o Their son was only 10 when Tim had a stroke o The “Black Hole” – if over 21 and under 65 – there is a hole where you can’t get help, other than Medicaid, in terms of finances or costs – this led them to go to Gainesville from South Florida Objectives - 5th leading cause of U.S. mortality - Major cause of serious long-term disability - Stroke 2x higher in blacks than whites - Stroke Belt = southeast U.S. Signs & symptoms/pathophysiology - Weakness/paralysis in arm - Loss of balance - Loss of sensation - Double or blurred vision - Speech issues: speaking/understanding - Cognitive problems - Dizziness - Nausea and vomiting - Headache - Seizure What is a stroke? - Death of brain tissue - Infarction in brain - Hemorrhage - Ultimately, lack of blood flow and oxygenation to the brain When to use tissue plasminogen activator (tPA)- role of interventional neurologist  - If seen within 3 hours of having symptoms, may be eligible for tPA - Blood thinner – Activase (used in IV form) o Only for ischemic stroke (it dissolves the clot) - Will need to have a CT or MRI scan to determine the type of stroke Risk factors: Uncontrollable (genetic) and controllable (lifestyle) - Uncontrollable o Age o Gender o Race o Family history - Controllable o Smoking o Obesity o Sedentary lifestyle o Heavy alcohol intake o Sedentary lifestyle o Illicit drug use  Cocaine  Amphetamines Match lesion location (from lobes of the brain) with possible deficits - The lesion is opposite to the affected side - Ex: if the right side of the brain is damaged, then the left side will be affected Types of strokes: ischemic and hemorrhagic (consider pre- stroke: TIA; silent stroke) - Ischemic: blood flow to brain is blocked, depriving brain tissue of oxygen and nutrients o Can be due to thrombus or embolus - Hemorrhagic: blood vessel in the brain breaks, causing bleeding in or around the brain o Arteriovenous malformation (AVM) is an abnormal connection between arteries and veins that can occur anywhere in the body  When it ruptures, it can cause bleeding in the brain o Aneurysm: bulge or ballooning in the wall of a blood vessel; when it ruptures it causes stroke  - Transient Ischemic Attack (TIA): known as a mini stroke o Temporary interruption of blood supply o Symptoms may last for an hour or so but resolve within a day o Is a warning signal - Silent stroke: people may not know that they had a stroke; it’s a stroke that doesn’t cause any noticeable symptoms o May have momentary confusion of memory problems o Minor difficulty with walking/getting around o 10% of middle-aged people Stroke mechanisms (e.g., thrombus vs. embolus; aneurysm) - Thrombus: a blood clot forms in an artery that supplies blood to the brain; forms within brain arteries due to conditions like atherosclerosis - Embolus: a blood clot or plaque breaks loose from somewhere else in the body like the heart or neck, and travels to the brain - Aneurysm: bulging in the artery or wall of a blood vessel o Common locations: heart, brain, lower limb, intestine, spleen Common Deficits (speech, motor, emotional incontinence, depression, cognition) spasticity; pain; emotional dysregulation functional loss of one side of body- hemiparesis vs. hemiparalysis speech- global, receptive, expressive aphasia motor- subluxation of shoulder; antalgic gait cognitive- memory loss, confusion, possible seizures, impulsive Major effects of stroke - Sensory deficits: side opposite to where the stroke occurred is affected o Numbness o Paresis (hemiparesis) o Paralysis (hemiplegia) o Safety issues o Pain (central pain syndrome) o Interferes with syndrome - Motor deficits: affected side primarily o Gross motor movement/large motions affected o Fine motor movement: precision and coordination affected o Should subluxation (partial dislocation of shoulder joint)  o Spasticity (condition that causes muscles to feel stiff or rigid) o Contractures (permanent tightening of the muscles, tendons, and skin) o Pain o Flaccidity: state of being soft, limp, or flabby  Lack of tone  Limp, weakness - Cognitive deficits o Memory issues o Problems with problem solving o Confusion o Distractibility o Impaired judgment o Anosognosia: prevents a person from recognizing or accurately perceiving a health problem or disability that they have  Unilateral neglect: more severe in R hemisphere strokes  Denial of problem on the affected side  AKA hemispatial neglect, selective attention - Communication deficits o Aphasia: difficult to understand, speak, read, or write (expressive vs receptive) o Apraxia: cause people to be unable to perform learned movements or tasks, even though they are willing to do so o Dysarthria: makes it difficult to speak clearly because of weak or damaged muscles used for speech o Dysphagia: impairment of power to speak or understand speech - Psychosocial o Emotional lability (emotional incontinence)  Uncontrollable emotion  May be tearful watching any movie, laughing for no reason, usually embarrassing o Depression  Interferes with recovery, improperly/infrequently screened Neuroplasticity- what is it/how do you incorporate in treatment? - Brain’s ability to change - New pathways can be created  - “Neurons that fire together, wire together”; “neurons that fire out of sync, fail to link” Various interventions; evidence-based research & interventions - Constraint induced movement therapy (CIMT) o Based on learned non-use theory o Focused on retraining affected extremity - Robotics - Lokomat Treatment for stroke: rehab/surgery/medications - Therapies o ADL Training  Engagement in meaningful activity  Return to previous activities with adaptions o Splinting/positioning  Arm: resting hand split  Shoulder: sling  AFO: ankle foot orthosis  ROM: self-ranging  Handling techniques o Locomotor training: assistive device use o Psychological support  Individual or group treatment  Stroke support groups - Medications  Blood thinners  Blood pressure meds for hypertension  Statins for hypercholesterolemia  Antidepressants for depression  Baby aspirin (prophylaxis) - Speech o Articulation o Word finding o Cognitive exercises o Facial exercises o Swallowing - Surgical options (before and after CVA) o Carotid endarterectomy o Mechanical thrombectomy o Clipping of aneurysm o Stereotactic radiosurgery o Angioplasty and stents Association with other diseases/conditions - Arteriosclerosis - Hypertension - High cholesterol - Diabetes Strategies for stroke prevention (80% preventable) - ABCs o A: take aspirin o B: control/monitor blood pressure o C: manage cholesterol (get screened) o S: smoking cessation - Stroke education o FAST (face, arm, speech, time to call 911) - Know your numbers - Engage in healthy practices Pulmonary Disease Pulmonary System components (lobes, bronchioles, alveoli, etc.) - Composed of the breathing and gas exchange, diaphragm, nose, trachea, bronchi, bronchioles, lungs What is COPD (Chronic Obstructive Pulmonary Disease) - A group of lung diseases that make it difficult to breath - Decreased expiratory airflow - Airflow blockage - Problems related to breathing - Emphysema: conditions where the air sacs of the lungs are damaged and enlarges, making it difficult to breathe o Can result from obstruction caused by chronic bronchitis; there is back pressure on the alveoli and the walls break down o Large cavities of alveoli have coalesced (formed one mass or whole) leading to inadequate performance of gas transfer - Chronic bronchitis: long-term condition that cause inflammation of the bronchi o Inflammation or irritation of airways in the lungs o Fibrosis (scarring) of bronchioles = less pliable, thickening of lining, narrowing of airway  o Excessive, thick mucus which further plugs tubules and compromises breathing - Causes o Decreased expiratory air flow pressure o Increased resistance to expiratory air flow  Resulting from narrowing of airways o Airway obstruction and alveolar destruction Symptoms of chronic obstructive pulmonary disease (COPD) - Age 40 and over - Persistent/progressive dyspnea (shortness of breath) - Chronic cough - Sputum production - Unusual, noticeable decline in activity level - Subtle at first; affects small accommodations in daily life o People may avoid stairs or limit activities o People may think they just need to slow down or are getting older Epidemiology: Global disease - 16 million people in the U.S are affected - Debilitating and deadly – 3rd leading cause of death in the U.S. - Most cases are preventable; 8 in 10 COPD deaths are caused by smoking - People aged 65 and older are affected more - American Indians/Alaska natives, multiracial non-Hispanics - Women - Unemployed, retired, or unable to work - Less than a high school education - Divorced, widowed, or separated - Current or former smokers - History of asthma Etiology - Smoking is a key cause - Exposure to dust, fumes, and pollution - Genetic - Respiratory infections Testing: Pulmonary Function Testing (spirometry) - Determines severity; distinguishes the disease from asthma  - It is a breathing test that measures how well your lungs work by measuring how much air you can breathe in and out, and how quickly you can exhale Treatment: self-management, bronchodilators, inhaled corticosteroids, pulmonary rehab - more severe cases: oxygen, surgery - Adequate fluid intake - Use of expectorants - Bronchodilators - Inhaled corticosteroids - Oxygen therapy - Physical therapy, pulmonary rehabilitation o Learn to expel mucus from respiratory tract o Breathing exercises o Exercise reconditioning Participation restrictions due to COPD - Dyspnea is the most limiting factor o May be years before it limits the routine of ADLs o With time, there will be shortness of breath with dressing, bathing, speech, eating - Initially, sedentary activities may be accomplished without much difficulty o Driving may be possible - Walking even limited distances may not be feasible - Worse lower extremity function - Walking less distances - Weaker muscle strength in the upper and lower extremities - Less likely to have a partner - Received less emotional support - Rated a worse quality of life - May be unable to work - Higher medical costs - Depression, fear, and anxiety may arise o Some things to help: prepare for sedentary occupation, counseling, make satisfactory lifestyle changes - People may have to change employment goals and have accommodations at their workplace Poliomyelitis - Highly contagious viral disease that affects the nervous system and can cause paralysis  - AKA Poliovirus o Invades infected person’s brain and spine cord o Spread through person-to-person contact, fecal oral route, contaminated water and food o Multiplies in intestine o Invades the nervous system - Inflammation of the gray matter of spinal cord - Initial symptoms o Fever o Headache o Fatigue o Vomiting o Stiffness in neck o Pain in limbs o Paralysis: ranges from minimal to widespread - No cure, it is prevented by immunization o Vaccination effective in 1950s in US - not totally eradicated but extremely effective - The Iron Lung: a breathing machine used to treat polio patients who were paralyzed in their upper bodies and unable to breathe on their own; used back then, not now - Ranchos Los Amigos was a major center for polio patients Post-Polio Syndrome (PPS) - 1 million survivors - 20 years post diagnosis – can be 10-40 years later - Symptoms: o Fatigue o Pain o Breathing/swallowing problems o Weakness - Severity of polio and disability after recovery predicts the risk of developing PPS - Theories of etiology o Late failure of motor neuron system due to initial illness o Muscle damage from accumulated strain, chronic overuse of system previously weakened by polio - Progressive; periods of stability and decline - Diagnosis/physicians look for: o Prior polio, evidence of motor neuron loss o Period of partial/complete functional recover o Slowly progressive, persistent new weakness  o Symptoms persist for one year o Exclusion of other abnormalities - Functional Limitations o Difficulty performing activities of daily living o Managing fatigue and weakness o Difficulty standing and walking o Difficulty lifting o Difficulty breathing - Treatment o No pharmaceutical treatments o Do non-fatiguing exercising to improve muscle strength and reduce fatigue - Management o Judicious exercise o Mobility aids o Modified ADLs o Avoid activities causing pain/fatigue o Learn about PPS and discuss with family o Support groups o Counseling Vision Impairment and Blindness - Leading cause of impairment: uncorrected refractive errors and cataracts - Majority of people are over 50 years old Anatomy of the eyeball - Insert photo - Vision summary o Light passes through the cornea, enters through the pupil, passes through the lens o Sensory information registers on the retina o Conversion to electrical impulses to optic nerve o Message taken to occipital lobe where interpreted - Macula: located in the center of the retina Definition of blindness, legal blindness, low vision - Total blindness (no light perception): complete loss of form and visual light perception - Blindness: May be used to describe someone with severe visual impairment (some remaining vision) - Normal vision: 20/20  - Visual acuity (blind): 20/400 - Legally blind: 20/200 - Visual Loss o Temporary o Reversible o Progressive o Permanent - Low vision: vision is NOT fully corrected by glasses/lenses which interferes with activities; chronic visual impairment Common terms used to describe eye functions/impairment, visual acuity/visual field, accommodation, etc. - Visual field: area of vision which can be obtained by keeping head stable and eyes forward - Peripheral vision: corners of your eye – edges of visual field – side vision - Central vision: focal part of vision at the center of the eye – ability to see with sharp detail things straight ahead - Pupillary reactions: determines whether there is pupillary constriction when light present for 3 seconds - Blind spot (scotoma): decreased area of vision (can occur in the center or at edges of vision) o Normal: location where optic nerve and blood vessels leave the eyeball – no photoreceptors - Nystagmus: eyes moving rapidly and involuntarily (usually an abnormal finding) “dancing eyes” - Strabismus: misalignment of the 2 eyes o Both may be crossed o May have only one eye normal o Amblyopia: lazy eye Refractive Errors of the Eye - Myopia (near sightedness) – can see things up close - Hyperopia (far sightedness) – can see things in the distance - Astigmatism (irregular shape of cornea or lens) – results in vision distortion - Presbyopia – senior vision – holding arm straight in front of you to see more clearly from a slight distance - Treatment: refraction or corrective lenses, surgical intervention (Lasik) Assessment measures: - Inspect for abnormalities  o All structures including eyelids and eyelashes o Observe movement, evidence of discoloration, edema, discharge - Test cranial nerves II, III, IV, VI - Assess nystagmus, accommodation, visual acuity, visual fields, retinal health, intraocular pressure, PEERLA - Eye exam: Snellen Eye Chart and Tumbling Es o Positioned 20 feet away from chart o Measures visual acuity  Sharpness of vision  Discernment of forms and shapes o Does not detect glaucoma or diabetic retinopathy - Eye exam: Dilation (Mydriasis) o A process by which the pupil is temporarily enlarged with special eye drops; allows the eye care specialist to better view the inside of the eye o Short term side effects: light sensitivity, blurry vision, trouble focusing on close objects - Eye exam: Tonometry o Measures intraocular pressure o Normal pressure is 12-22 mm Hg o Air puff tonometry  Commonly used, especially with children o Goldmann tonometry – very accurate  Small probe flattens cornea  Numbing drops used for patient comfort - Eye exam: Fluorescein Angiography o Fluorescent dye injected into bloodstream  Dye highlights the back of the eye  Photographs taken for comparison later o Process: dilation eye drops and then injection o Particular problems  Macular degeneration  Diabetic neuropathy - Optical Coherence Tomography (OCT) o Non-invasive imaging test o Light waves record 3D images  Cross sectional images of the retina  Shows thickness of the retina  Shows any evidence of fluid leaks  Monitors treatment - Visual eye exam: pupils o Pupils  o Equal o Round o Reactive to o Light and o Accommodation - Pupil dilation causes o Cerebral edema o Drug overdose o Elevated intracranial pressure o Elevated intraocular pressure o Medication o Poisoning o Sexual arousal Specific and common diseases - Color blindness - Floaters: debris in the vitreous gel - Corneal abrasions: scratch on the surface of the eye o Pain, redness, light sensitivity, perception of foreign substance o Caused by  Dirty contact lenses/overwearing  Chemical irritation  Airborne particles  Poking eye with sharp object o Usual recovery within 3 days  Untreated can lead to corneal ulcers o Treatment  Saline solution  Lubricating solution  Antibiotic eye drops  Wear safety glasses  Adhere to prescribed wear time for contacts - Conjunctivitis (Pink Eye) o Inflammation of clear tissue covering eye and the inside of the eyelid (conjunctiva) o Due to bacterial or viral infections  Viral: no antibiotics  Bacterial: antibiotic drops or ointment o Wash hands, don’t share cosmetics or towels to prevent infection - Stye o Infection of oil gland at base of eyelash  o Raised red pimple o Pain, tenderness, swelling o Eyeball feels irritated o Warm compress to treat - Retinitis Pigmentosa o Hereditary, degenerative disease o Progressive peripheral vision loss  Night vision impaired - may be first symptom o Central vision may be adequate or may be impaired o No cure  Low vision aids  Vitamin A might help - Age-Related Macular Degeneration o Loss of central vision o Leading cause of vision loss for those over 50  At risk: smokers, family history o Slow or fast progression o Occurs in 1 or both eyes o Dry (most common) vs. wet form o Diagnosis: dilation - Cataracts: lens become cloudy o Symptoms  Blurry vision  Poor night vision  Halo around lights  Diplopia (seeing double) o Occurs in most people by the age of 80  At risk: smokers, sunbathers, steroid users, diabetics o Affects 1 or both eyes o Treatment: surgery - Diabetic Retinopathy o Affects blood vessels of the retina in those with diabetes o Blurry vision  Floating spots or streaks  Blindness o May cause other problems like diabetic macular edema, neurovascular glaucoma and retinal detachment o Assessments: dilation and fluorescein angiogram o Treatment: injections, laser treatment, surgery - Retinal detachment/tear o Scars form on back of the eye  o At risk: diabetics, past serious eye injuries/surgery, extreme myopic o Can pull retina away from choroid layer: tractional retinal detachment o Increased floaters, flashes of light, curtain over field of vision, cobwebs – elongated dark spots o Emergency situation  ER  Eye doctor  Surgical intervention - Glaucoma o Loss of peripheral vision due to damage of the optic nerve o At risk: over 60, Black or Latino over 40, family history o Occurs in 1 or both eyes o Slows process in developing symptoms  Without treatment – blindness  Common to have high intraocular pressure  Eye pressure varies  Dilation o Treatment: eye drops, laser, surgery Treatment - Eye professionals: o Ophthalmologist: MD or DO – specializes in dealing with disorders/disease of the eye; performs surgical procedures o Optometrist: (OD) assesses vision abnormalities and prescribes glasses/contacts o Optician: supplies/sells optical instruments, lenses (includes artificial eyes) according to prescriptions from above o Low vision therapists: certified low vision specialists  Ots with specialty certification in low vision  Vision rehabilitation therapist o Certified Orientation & Mobility Specialist - Eye exercises - Corrective Lenses o Glasses  Bifocal: lower part for near vision and upper part for distance  Trifocal: near, intermediate, far o Contacts  Hard  Soft - Medicines  o Eye drops  Lubricating  Antibiotic  Corticosteroid o Glaucoma Meds  Lowers fluid level in the eye  Variety of options from beta blockers and pills to different eye drops o Ointments  Infections  Localized external areas - Surgical procedures o Laser  Performed when patient is awake  Anesthetic drops used prior to surgery  Microkeratome used to create a flap on corneal surface  Sculpting of tissue o Implants o Vitrectomy: removes fluid from eye  Eye is numbed  Remove infections, remove blood and floaters  Fluid replaced with gas, air, saline solution  Eventually eye creates its own fluid  Low risk procedure and high chance of success o LASIK eye surgery  Refractive eye surgery using laser  Mild to moderate nearsightedness – most success  Healthy eyes – no other conditions  Good health – no immune system disease  Alters the shape of the cornea  Side effects: dry eyes, visual disturbances, usually short term - Guide dogs o As puppies (8 weeks old) they are placed in nurturing homes but are learning skills early o May be months of training to a year o Learns socialization, basic obedience, leash and harness walking, public harness o Common breeds: Labrador, golden retriever, German Shephard – due to their temperament, trainability, and intelligence o 3-4 months training by professional guide dog mobility instructors  o “Class training” – fully trained dog is matched with a person, and they have 2 weeks of learning together in real life situations o Spend 8-10 years working then they retire - Adaptive equipment o Optical and non-optical devices o Low tech and high tech - Orientation & Mobility Training - New devices o Ocutech glasses  Mini telescopes  Mounted on glasses o Victor reader stream  Handheld device  Accesses e-books, radio stations  Online reference tools  A multimedia library in your pocket o Smartphone Apps  Be my eyes: connects you to a sighted volunteer  Seeing AI: reads pieces of text out loud  Reads handwriting o WayAround: tag and scan system  Allows labels and instructions to be read out loud Hearing Impairment and Deafness - Greatest hearing loss age group is 60-69 - 90% of deaf children are born to hearing parents - Men are 2x more likely to have loss - 38 million report hearing loss - 30 million could benefit from hearing aids Hearing Components - Auditory system (tone and volume) o Sound wave frequency  Faster the vibration, higher the pitch (Hz cycles per second: 20-20,000 Hz range)  Most important sounds: 250-6,000 Hz  Greater the intensity, the louder the sound Impact of Hearing Loss - Depends on these factors o Child vs Elder o Type and degree of impairment o Affect on daily life  - Can lead to isolation, loneliness, sensory deprivation, vulnerability - Invisible disability - Denial of problem o Rejection of screening o Rejection of hearing devices o Viewed as possible stigma Hearing Impairment - May not be diagnosed early - May be confused with behavior disorder - May be interpreted as intellectual deficit - May interfere with literacy - May cause lag in speech production/understanding o Prelingual (before 3 years) o Post lingual o Prevocational (before 19) - People with hearing impairment may o Be hypersensitive to loss o Deny any hearing problems o Blame others for not enunciating o Avoid certain situations due to noise level o Talk loudly o Pretend they can hear Causes of Hearing Impairment - Congenital o Genetic o Prenatal exposure to drugs/toxins/infection - Acquired o Recurrent ear infections o Injury (TBI) o Viruses (mumps, measles, meningitis) o Noise (prolonged, intense) o Degenerative conditions o Aging Anatomy of the ear - Outer Ear: collects sound waves and directs to the eardrum o Wax formation glands: cerumen (wax) o Conditions:  Otitis externa (swimmer’s ear)   Allergic reaction (piercings and earrings)  Burns/skin issues  Obstruction - Middle Ear: transfers acoustic energy from compression waves in air to fluid membrane waves within cochlea o Conditions  Ruptured tympanic membrane (eardrum)  Ear infections/pressure changes are common with tear of membrane  Often heals without intervention  Otitis media  Collection of fluid  Often associated with respiratory infection  Pain, diminished hearing – probable hearing return  Tx: antibiotics (possibly) and pain control  Otosclerosis  Abnormal tissue remodeling of the 3 bones (malleus, incus, stapes)  Disrupts vibration ability  Tx: possible surgery and hearing aid - Inner Ear: vibration of 3 bones stimulates hair cells which stimulates nerve endings o More permanent o Labyrinthitis (vestibular neuritis) o May be due to a virus  Viral (more common) and bacterial infections o Dizziness, nausea, vertigo o Tx: antivirals, steroids, vestibular rehab Classification of hearing loss and associated causes - Central hearing loss: problems with brain processing info - Peripheral hearing loss o Conductive  Most common in children  Temporary or permanent  One or both ears  Infection of ear canal or middle ear  Congenital malformation  Perforation or scarring of eardrum  Cerumen buildup  Dislocation of 3 middle ear bones  Foreign objects in canal  Otosclerosis (middle ear)  Unusual growths/middle ear  o Sensorineural: permanent  Usually both ears  Damage to inner ear or nerve  Most common type of ADULT hearing loss  May be present at birth  Typically not treated medically/surgically  May be caused by  injury/viral infections/ high fever  ototoxic drugs  genetic conditions  tumors  diabetes, strokes, meniers, meningitis  prolonged loud noise exposure o Mixed: combination of conductive and sensorineural Differentiate terms: - Vertigo: perception of motion (rotation and spinning) - Dizziness: unsteadiness, lightheadedness - Tinnitus: abnormal noise perceived in either one or both ears o Intermittent vs. constant o Low vs. high pitch o Fairly common o Disruptive o Mostly associated with hearing impairment o Treatment:  Medication  Dietary adjustment  Stress reduction techniques  Counseling  Tinnitus retraining therapy  Noise masking devices  Constant low-level sounds like fan, surf, white noise  Hearing aid, cochlear implant - Meniere’s (usually one ear): Buildup of fluid (endolymph) o Chronic condition o Vertigo o Sensation of pressure or pain o Possible overabundance of fluid o Sensorineural hearing loss (fluctuating) o Tinnitus o Episodic (remission or relapse) o Treatment:   Dietary methods  Limiting salt intake  Lifestyle changes  Decreasing stress  Vestibular and balance rehabilitation therapy  Surgery (extreme cases)  Hearing aid  Medications  Diuretic  Valium (vertigo)  Injection into middle ear - Presbycusis o Degenerative changes o Age-related structural changes o Slow onset – range of mild to severe o Higher tones affected first  May involve word discrimination issues o Tx: Hearing Aid o Degenerative changes o Age-related structural changes o Slow onset – range of mild to severe o Higher tones affected first  May involve word discrimination issues o Tx: hearing aid - Benign Paroxysmal Positional Vertigo (BPPV) o Debris (crystals) in the semicircular canals o Sense linear acceleration & deceleration o May be intermittent  Dependent on certain head positions o Head movement affects the crystals  Causes vertigo and nausea  Fall risks o Intervention: particle positioning procedures: series of maneuvers (vestibular head and eye movement combinations) performed to dislodged otoconia - Mal de Debarquement Syndrome o Balance disorder  Typically after cruise/boating  Prolonged treadmill running  Usually resolves in hours/days  May be accompanied by fatigue and difficulty concentrating Hearing Specialists - ENT (otolaryngologist) – medical surgical care o Otologist: ear disease o Neurotologist: neurological disorders of the ear - Primary care: check wax build-up and referrals - Audiologist: screen, diagnose, fit, and dispense aids - Hearing instrument specialist: fit and dispense aids - Speech Language Pathologist (SLP) o Work with hearing impaired children in improving speech intelligibility o Assistive communication (AT) o Diagnosing and treating ASD o Cognitive-communication disorders o Communication disorder  Aphasic patients  Swallowing issues Hearing Evaluation - Otoscope evaluation - Basic screening – questions and checklists - Tuning fork: differentiates conductive vs. sensorineural loss - Tympanogram: detects air pressure - Audiometry o Speech audiometry  Speech reception  Speech discrimination o Pure tone audiometry  Audiogram  Decibel loss  Profound hearing loss is greater than 90 dB o Acoustic Immittance Impedance Audiometry  Evaluates status of eardrum  Flexibility of tympanic membrane  Response to sound transmissions  Greater impedance means less sound traveling to middle and inner ear o Indicative of a middle ear condition  Acoustic reflex (reaction to loud sound from malleus and stapes) - Otoacoustic emissions evaluates cochlea - Auditory brain stem response rules out cochlea conditions, degenerative auditory conditions (MS), tumors of auditory system Hearing Devices - Hearing Aids o Components  Microphone  Amplifier  Receiver  Battery o Types  Behind ear  In the ear canal/outer ear  Entirely in the canal (barely visible)  Analog vs. digital vs. implantable  Monoaural vs. binaural  Telecoil circuitry (tone control) o Individualized  Orientation  Audiological rehab  Different types may lessen stigma  Careful handling/maintenance o Trial period o Find licensed audiologist o Expense  Digital range from $1500 – 3500 each  Others range from $500 – 1500 - Portable telephone amplifiers - Telecommunication display device (TDD) - Closed captioning - Hard-wired systems - Alerting devices (service dog, lights, vibrator) - Large-area systems o Audio loop o FM (frequency-modulated) o Infrared Surgical Intervention - Myringotomy o Eardrum incision to release pus and relieve pressure in middle ear o Needle aspiration o Ventilation tube - Mastoidectomy o Older procedure  o Removal of infected mastoid air cells - Tympanoplasty: surgical repair of a hole in the eardrum - Stapedectomy: removal and then replacement prosthesis Cochlear implants: - Stimulates auditory nerve directly - Improves speech reading ability - Enables hearing warning signals - Requires auditory rehabilitation - Criteria o Severe to profound sensorineural deafness o Less than 50% of speech understood o Motivated and stable o Right timing (whether child or adult) Deaf Culture - Being deaf: not a deficiency or disability - ASL: source of pride (brought together by language) - Participate in own schools, theater, literature - May be anti-surgery - Audism: discrimination against deafness o Rules of behavior (values, rule, traditions) o Obtaining attention (tapping, waving, flicking light) - Socialism o Value children as the future of deaf children - Promotes environment that views vision as primary sense Vestibular Rehabilitation Therapy (VRT) - Specialized exercise-based therapy o Reduces vertigo & dizziness o Reduces gaze instability  Fixating on object while head moving o Decreases imbalances & falls  Balance training o Promotes compensation o Promotes habituation  Reduces dizziness through repeated exposure to provoking stimuli - Home program essential (compliance) o Incorporate into daily life o Symptoms worsen in beginning - Education of person & caregiver - Recovery more effective with monoaurals  - Factors limiting recovery o Pain o Sedentary lifestyle o Other medical conditions o Certain medications o Emotional concerns Assisted Interventions - Lip reading - Sign language - Interpreters - Augmented communication - Over the counter PSAP Personal sound amplification products Prevention - Protect ears (wear earplugs, headphones) - Headphone use: keep volume low, rest breaks - Dry ears after swimming - Exercise - Good nutrition o Limit salt intake o Avoid stimulants (nicotine & caffeine) - Adequate rest/sleep - Avoid ototoxic drugs - Avoid using cotton tipped swabs (outer only) o Use earwax softener and irrigating syringe Parkinson’s Disease On Location - Keith Teller said he was diagnosed at 58 – realized he wasn’t going to die from PD, he was going to die with it - 45 on roster and 16-20 people a class - Hydrating is important when having PD - They work on balance, coordination, strength – very helpful because stiffness is a problem with PD - Another man had PD for 14 years – claims boxing is the most fun activity, he goes twice a week - Most of the time after they come back from the doctor, they have good results and their symptoms are decreasing, as well as a decrease in the medication they take  - Rhythmic movement helps people with Parkinson’s – cycling, swimming, running, walking, weightlift - Keith Teller started the class – he wanted to fight the whole time and help others fight their fight Objectives - 7-10 million worldwide with PD - 1 million in the US - Incidence increases with age - 2nd most common age-related neurodegenerative disorder - Celebrities with PD: Muhammad Ali, Robin Williams, Michael J. Fox Causes, symptoms and risk factors - What is it o Neurodegenerative disease o Progressive deterioration o Basal ganglia changes o Loss of dopamine and dopamine producing cells - Cause o Unknown o Genetics o Environmental triggers o Presence of Lewy bodies in substantia nigra  Abnormal aggregates of protein o Location is critical - Risk factors o Usually 60 or older o Hereditary o Male o Exposure to toxins  Herbicides  Pesticides  Agent orange - Cardinal Symptoms o Tremors  Involuntary, rhythmic shaking  Frequently seen as pill-rolling (thumb and index finger rub against each other, looking like you are rolling a pill)  May be intermittent or constant  Usually one side of the body   Usually starts with one hand o Bradykinesia (slowness of movement)  Often unpredictable  Loss automaticity of movement: blinking, arm swing while walking, swallowing  Difficult to initiate movement  Interferes with ADLs o Dyskinesia  Involuntary, erratic, writhing movement – face, arms, legs, trunk  Complication from medication  Levodopa-induced dyskinesia  Usually occurs after a few years of levodopa treatment  Can manage dyskinesias with amantadine  Seen as preferable to Parkinson’s symptoms  May be mild to severe o Postural instability  Shuffling  Difficult to initiate stepping  Stooped posture  Arms don’t swing when walking o Rigidity  Mask-like face  Movement is stiff  Interferes with sleep  Freezing o Speech & Swallowing  Dysphagia  Aspiration, pneumonia, drooling  Hypophonia  Decreased volume, no infection, sometimes hoarse - Worsening of Symptoms o Though a progressive disease, symptoms are slow to present o Symptoms may intensify due to  Medication changes  Infection (UTI is common)  Dehydration  Sleep deprivation  Recent surgery  Stress Types of PD - Primary Parkinsonism o 75-80% of PD cases o Classic idiopathic PD  Sporadic: caused by environmental factors  Familial: heritable - Secondary Parkinsonism o Drug ingestion o Toxic exposure  Carbon monoxide  Chemicals o Alzheimer’s o Encephalitis o Brain tumor o Head trauma - Young Onset PD o 21-50 years o Similar symptoms o More frequently have a family history o Typically experience  Slower progression of symptoms  More side effects from meds  More frequent dystonia (movement disorder that causes muscles to contract) Prodromal symptoms - Tremors or shaking - Changes in or difficulty walking - Changes in handwriting - Fatigue Role of dopamine Differentiate PD from young onset and secondary parkinsonism diagnosis - Overall diagnosis o No specific definitive test o Medical history  Signs & symptoms  Neuro exam o SPECT: specific single photon emission computerized tomography – dopamine transporter scan  Radiopharmaceutical o Blood tests  o Imaging tests Methods to classify PD severity and the stages - Stages: o Stage 1: Mild symptoms: some tremor, loss of erect posture, diminished facial expressions – may only affect one side o Stage 2: tremors, some body rigidity, walking/posture problems are apparent o Stage 3: loss of balance, bradykinesia, falls are common o Stage 4: symptoms are severe and limiting- needing assistance to stand o Stage 5: most advanced stage – difficult to stand or walk; used wheelchair for mobility; may experience hallucinations and delusions - Methods o Hoehn and Yahr Scale  Stages 0-5  Includes stages for unilateral/bilateral disease  Simple rating scale o Unified Parkinson’s Disease Rating Scale  More comprehensive tool  Addresses motor and non-motor symptoms  Questionnaire  Behavior/mood  ADLs  Motor abilities  Complications of therapy Complications of PD - Depression - Bladder problems - Constipation - Sleep disorders - BP changes - Hyposmia (smell dysfunction) - Fatigue - Sexual dysfunction - Swallowing/chewing - Writing (micrographia) - Thinking (later stages) Treatment/management strategies  - Remain active - Simplify daily tasks - Use assistive devices o Wrist weights o Rolling walker o Handwriting aid o Grab bars o Clear environment - Remove clutter/organize - Choose healthy foods o Whole grains, nuts, fish, mediterranean diet o Ginger for nausea o Green tea (caution: caffeine) o Antioxidants - Avoid/manage stress - Avoid cold environment - Avoid alcohol/smoking/caffeine - Cognitive behavioral therapy (CBT) - Medications o Carbidopa – levodopa  Touted as most effective  Benefit wears off overtime  High doses lead to dyskinesia (involuntary movement)  Needs to be taken on time (don’t wait until it has worn off)  Improves quality of life  Doesn’t treat all symptoms  Dramatically helps with most disabling motor symptoms o Amantadine (early/mild symptoms) o Dopamine agonists o Mao B inhibitors o Anticholinergics - Support groups/counseling - Other considerations o Home evaluation to check safety and assess equipment needs o Driving evaluation to evaluate driving skills and prescribe devices Exercise specifics for PD - Flexibility  - Aerobic - Resistance training - Practice large rhythmical movement - Practice handwriting - Change tempo of movement, direction of movement - Challenge motor planning - Benefits o 2.5 hours per week of exercise o Improvements in gait, balance, decreased tremors, flexibility, cognition, depression, fatigue - Alternative methods o Massage o Tai Chi o Yoga o Meditation o Pet therapy o Humor o Dancing o Non-contact boxing Surgical Options - Deep brain stimulation (DBS) o Electrical impulses interfere and block signals that cause PD symptoms o NOT A CURE o Does not slow progression o Lasts about 5 years o For patients who have had the disease for at least 4 years and have uncontrollable symptoms o Possible candidates for DBS  Good response to individual doses of levodopa  Good general health  Good family support  Typical PD with tremor  Wearing off spells  NOT recommended if medication controls the disease - Duopa o Tube in small intestine to deliver carbidopa-levodopa gel o Consists of j-peg, cassette (gel), pump o Advantage is consistent drug delivery Association between dementia and Parkinson’s Disease  - At later stages, dementia is possible Research - Parkinson’s Outcomes Project o Began in 2009 o Discovered slower decline of quality of life with exercise o Depression and anxiety are number one factors in impacting health o Regular care by neurologist can save lives proposed new areas for research - Parkinson’s Foundation Prevalence Project o Purpose is to understand the rate of incidence (new cases) and prevalence (all individuals with PD) in various states o New study findings  Males more than females affected  Risk increases with age  PD prevalence varies by region  FL has high prevalence Alzheimer’s Disease and Dementia Define Dementia and its symptoms (characteristics) - General term for a range of neurological conditions that cause a decline in mental ability and interfere with daily life - Group of symptoms - Loss of memory - Interferes with daily life - Symptoms o Memory loss o Difficulty communicating o Difficulty problem solving o Difficulty handling complex tasks o Difficulty planning and organizing o Difficulty with coordination o Confusion and disorientation o Psychological changes o Personality changes o Depression o Anxiety o Inappropriate behavior o Paranoia o Agitation  o Hallucinations Types: vascular; mixed; dementia-like symptoms - Vascular dementia: chronic condition that occurs when the brain doesn’t receive enough blood flow, which damages brain tissue and impairs thinking, memory, and behavior - Mixed: more than one type of dementia - Dementia-like symptoms caused by o Depression o Drug interaction o Thyroid problems o Excess alcohol use o Vitamin deficiencies Alzheimer’s Disease (most common form of dementia): late and early onset - Irreversible, Progressive brain disorder - Problems with memory, thinking, language, behavior - 60-80% of cases - Typically occurs after age 60, doubles every 5 years beyond age 65 - Late-Onset o APOE 4 gene o More common o First appears in a person’s mid 60s - Early Onset o Familiar Alzheimer’s Disease (FAD) o Very rare o First appears between 30s – mid 60s - Dr. Alois Alzheimer o 1906 o Had a patient with memory loss, paranoia, psychological decline o Found abnormal clumps and tangled bundles of fiber in brain autopsy Brain changes and etiology Brain Changes - Abnormal clumps = Amyloid plaques o Amyloid B-protein o Clumps together in plaques o Disrupts cell functions  - Tangled fibers = neurofibrillary tangles o Abnormal accumulations or protein tau o Sticks together, threads o Block neuron’s transport - Widespread brain damage o Neurons stop functioning o Loss of connections o Death of neurons - Memory o Entorhinal cortex, hippocampus - Language, reasoning, social behavior o Cerebral cortex Etiology - Still unclear - Alterations in processing of amyloid-beta protein may be initiating factor - Underlying cause of change unknown - Combination of genetic and environmental factors National Alzheimer’s Project Act (NAPA) - 2011 - Five ambitious goals o Prevent and effectively treat Alzheimer’s Disease by 2025 o Optimize care quality and efficiency o Expand supports for people with AD and their families o Enhance public awareness and engagement o Track progress and drive improvement Diagnosis: via interview, memory & problem solving (mini-cog, MMSE, MoCA), brain scans - Medical interview - Tests of memory, problem solving, attention - Standard medical tests o To identify other possible causes - Brain scans o Computed tomography (CT) o Magnetic resonance imaging (MRI) o Positron emission tomography (PET) o To rule out other possible causes - Screening o Mini-Cog Test   First: remember and a few minutes later repeat, names of three common objects  Second: draw the face of a clock showing 12 numbers in correct places in specified time o Mini-Mental Status Examination (MMSE)  Dementia screening tool  Measure decline and recovery  Health professional asks patient questions  Range of everyday mental skills  Scoring  Mild dementia: 20-24  Moderate dementia: 13-20  Severe dementia: dementia Stages of Alzheimer’s: Characteristics of stages (Pre-clinical AD, mild cognitive impairment, mild dementia due to AD, moderate dementia due to AD, severe dementia due to AD) - Preclinical Alzheimer’s Disease o Before symptoms o Brain changes begin - Mild cognitive impairment due to AD o Mild change to cognitive impairment o Memory lapses o Does not impact work/relationships - Mild dementia due to AD o Memory loss of recent events o Difficulty problem solving o Poor judgment o Personality changes o Difficulty organizing and expressing thoughts o Losing things, getting lost o Friends, family, doctors note - Moderate dementia due to AD o Increasingly confused, forgetful o Poor judgment and deepening confusion  o Wander o Greater judgment loss o Require help with daily activities o Significant personality, behavior changes o Unfounded suspicions o Restless, agitated, aggressive - Severe dementia due to AD o Continued decline o Lose ability to communicate o Total assistance ADLs o Decline in physical function o Lose ability to swallow o Lose bowel/bladder control o Causes of death  Pneumonia  Dehydration  Malnutrition  Falls Specialists - Geriatricians o Manage older adults in healthcare - Geriatric Psychiatrists o Specialize in older adult mental and emotional problems - Neuropsychologists o Assess memory - Neurologists o Specialize in abnormalities of the brain, central nervous system Drug Treatment - Maintains mental functions - Donepezil, rivastigmine, galantamine, memantine - Regulates neurotransmitters - Reduces symptoms - Effective for some - Limited time Behavioral Management - Safety from wandering, aggression, accidents - Structure environment - Enjoyable activities  - Maintain function - Improve quality of life - Promote dignity and maintain choice Residential housing options - Assisted Living o Assisted Living Federation of America (ALFA) o Assisted Living Residence  Housing  Personalized supportive services  Health care  People who need help with ADLs o Oak Hammock: continuing care retirement community (CCRC) Healthy aging strategies to reduce AD risk - Nutritious diet - Avoid tobacco, excessive alcohol - Stay socially connected - Exercise mind and body - Mental stimulation Reducing Risk - Factors other than genetics play a role - There is potential association with: o Heart disease o Stroke o High blood pressure o Diabetes o Obesity