Week 3.1 Neurological Disorders & Age-Related Changes PDF

Some common neurological disorders Medical SLPs should know Date Your Footer Here 1 Some common neurological disorders Date 1. Change in mentation (delirium and dementia) 2. Stroke 3. Traumatic Brain Injury 4. Multiple sclerosis 5. Acute muscle weakness ( Guillian Barrie syndrome) 6. Progressive mus...

Some common neurological disorders Medical SLPs should know Date Your Footer Here 1 Some common neurological disorders Date 1. Change in mentation (delirium and dementia) 2. Stroke 3. Traumatic Brain Injury 4. Multiple sclerosis 5. Acute muscle weakness ( Guillian Barrie syndrome) 6. Progressive muscle weakness ( Amyotrophic lateral sclerosis (ALS) and Myasthenia gravis) 7. Movement disorders ( Parkinson’s and Dystonia) Your Footer Here 2 1. Change in mentation –Delirium Delirium: mental confusion and emotional disruption Usually transient and reversible It’s common among ER, surgical and medical ward patients In US, more than 30% of inpatients older than 70 yrs experience delirium In this case, SLP usually is consulted for all Speech, language, and swallowing evaluation Date Your Footer Here 3 1. Change in mentation –Delirium Causes of delirium: - Medications - Illicit substances (e.g., cocaine) - Renal insufficiency Risk factors of delirium: - Drug-drug interaction - Advanced aging - Dementia - Long hospitalization Date 4 1. Change in mentation –Delirium Clinical manifestation of delirium: Impaired level of consciousness Change in cognition (e.g., memory, attention, organization skills) These symptoms developed in a short period of time ( within hours or days) as a direct consequences of a medical condition Fluctuation in behaviors ( hallucination, agitation, confusion) Management of delirium: Complications of delirium: Aspiration pneumonia Long hospitalization Cognitive dysfunction Identify and correct the cause Medication- there is no FDA approved medication for delirium, but antipsychotic medications are used in some cases (e.g., to reduce hallucination) Physical restraints? Not effective and could exacerbate delirium therefore needs to be avoided. Date Your Footer Here 5 1. Change in mentation –Dementia Dementia: A progressive decline in memory functions associated with decline in another cognitive functions (e.g., language, calculation) Causes: Alzheimer's disease is the most common cause Complications of dementia: Injury and trauma Malnutrition Dysphagia Seizure Pressure ulcer Cerebrovascular diseases Management: Supportive care and supportive environment Symptomatic therapy ( including cognitive enhancers medications) Rehabilitation including PT, SLP and OT services Date Your Footer Here 6 2. Multiple sclerosis Multiple sclerosis (MS): autoimmune demyelinating disease of the central nervous system. The mean average age of MS onset is approximately 30 years Affects female more than male Causes: Unknown Clinical manifestations: Movement, visual, and sensory loss Dysarthria of speech ( the types depends on the affected neural pathway, could be ataxic, spastic, or flaccid) Dysphagia Date Your Footer Here 7 2. Multiple sclerosis Management of MS: The medical intervention goals in MS are: 1. Reduce recurrence rates and disease modification ( e.g., using Beta interferon) 2. Speed up recovery during recurrence 3. Treatment of symptoms and complications( e.g., dysphagia, dysarthria …etc) Date Your Footer Here 8 3. Acute muscle weakness (Guillian Barrie syndrome) Guillian Barrie syndrome (GBS) is a peripheral demyelinating disorder ( recurrences are not usually seen) Cause: Infection Clinical manifestations: Weakness or numbness started from lower to upper extremities. The weakness eventually extends to respiratory muscles leading respiratory problems requiring mechanical ventilation. The progression of muscle weakness usually up to 4 weeks after the onset. GBS could lead to complete paralysis. Dysphagia and dysarthria are commonly seen in patients with GBS. Date Your Footer Here 9 3. Acute muscle weakness (Guillian Barrie syndrome) Management of GBS: Medication ( disease –modifying agents) Comprehensive interdisciplinary intervention for respiratory problems SLP intervention for speech and swallowing Other Rehab. Interventions ( physical therapy) - Most patients with GBS recover completely Date Your Footer Here Complications of GBS: Long term physical weakness Respiratory failure Respiration pneumonia Prolonged ventilation Sudden unexplained cardiac death 10 4. Progressive muscle weakness ( Amyotrophic lateral sclerosis-ALS) Amyotrophic lateral sclerosis (ALS) Is a degenerative disease of upper motor neuron (UMN) and lower motor neuron (LMN) Causes : Cause of ALS is not known, 90% of the cases occur spontaneously and 5 to 10 % of the cases linked to a specific gene mutation Date Clinical manifestations: It depends on the type and which neurons are involved. ALS cases are varied in their symptoms but eventually ALS cases referred to SLP for dysarthria and dysphagia. Some of the common features of ALS: Common symptoms of ALS: Sialorrhea ( or excessive drooling) -Respiratory difficulty -Parkinson’s like symptoms -Cognitive impairment -Inappropriate excessive behavioral responses to emotional events -Muscle spasm Your Footer Here -Dyspnea 11 4. Progressive muscle weakness ( Amyotrophic lateral sclerosis-ALS) Date Your Footer Here 12 4. Progressive muscle weakness ( Amyotrophic lateral sclerosis-ALS) Management of ALS: Riluzole is the only FDA-approved medication used for ALS…..it aims to slow the progression of the disease Symptom management for breathing , drooling , muscle spams, fatigue and other difficulties - Anticholinergic medications are used to control drooling -Eventually ALS patients may need to use non-oral means of feeding (PEG tube) to maintain nutrition and AAC for communication …SLP needs to educate and prepare the patients and do continuing assessment Date Your Footer Here 13 5. Movement disorder (Parkinson’s disease) Parkinson’s disease (PD) is a neurodegenerative disease affecting extrapyramidal system PD is the second most common type of degenerative disease after Alzheimer's disease (AD) Causes: combination of aging, genetic and environmental factors Clinical manifestations: depends on the type, but the hallmark of the PD are: Date Tremor Bradykinesia (slow movement) Akinesia ( loss of voluntary movement) Rigidity Masked face Your Footer Here 14 5. Movement disorder (Parkinson’s disease) Symptoms of PD Date Your Footer Here 15 5. Movement disorder (Parkinson’s disease) Management of PD: Pharmacological treatments: to manage the early symptoms, advanced symptoms. Also, neuroprotective drugs used to slow down ongoing cell damage and death. Non-pharmacological treatments: Lee Silverman Voice Treatment (LSVT), it is an evidence-based treatment LSVT-loud to improve voice and speech intelligibility LSVT-Big ( adopted by PT) to improve muscle strength and movement Brain stimulation Deep brain stimulation (DBS) used to trigger dopamine production and reduce abnormal movements Date Your Footer Here 16 Communication difficulties caused by neurotherapeutic drugs Date Your Footer Here 17 Communication difficulties caused by drug adverse effect Medications used to treat neurological disorders are often involve modulation of neurotransmitter function ( Acetylcholine, dopamine, glutamate, GABA,…etc) Examples: Narcotic and hypnotic sedatives drugs indirectly affecting communication through their effect on cognition (attention, orientation, and memory) Anticholenergic drugs ( used for Parkinson’s disease ) can cause decrease of saliva and dry mouth leading to difficulties in speech and articulation, and also it affects cognition Antiepileptic drugs Date cerebellar type ataxic dysarthria, dysfluency Your Footer Here 18 Communication difficulties caused by drug adverse effect Management of communication difficulties resulting from drug adverse effects: 1. Comprehensive assessment of the symptoms profile ( Onset of the symptoms, time of using the drug, relieving factors …etc.) 2. Review the medication history ….consult a pharmacist or check the medication database 3. Rule out non-drug related potential causes 4. Discuss the medication with the physician Once the cause is eliminated, communication should improve spontaneously Date Your Footer Here 19 Normal age-related changes Date Your Footer Here 20 Normal age-related changes People age at different rate and the effect of aging on healthy individuals vary. Age-related changes include: - Reduced capacity - Decreased the ability of homeostasis and regulation of body systems ( the ability of the body to self-regulate) - Decline of visual and hearing acuity Detailed changes in the next slide Date Your Footer Here 21 Age-related changes Date Your Footer Here 22 Age-related changes Date Your Footer Here 23 Age-related changes …common issues Aging and Adverse drug reaction: About 1/3 of drugs are taken by people older than 65 years 30% of hospital admission in US are attributable to adverse drug events About 40% of adverse drug events are considered serious, and life-threating Normal age-related changes make older adults more vulnerable to adverse drug reactions Date Your Footer Here 24 Age-related changes …common issues Atypical and altered disease - Older adults may not report symptoms of the disease ….they learn to tolerate syndrome that develop slowly - Some common conditions are mistaken as a normal part of aging, for example: Memory loss, vision and hearing loss, and falls - Older adults may have different disease presentations and vague and non-specific symptoms Example, depression in young adults ( sadness), depression in older adults (confusion) Date Your Footer Here 25 Age-related changes …common issues Communication Older adults may experience changes in communication due to decrease of hearing and visual acuity, and also due to cognitive decline. Date Your Footer Here 26 Why SLP should be aware of these changes? 1. To use the right assessment tools, and make differential diagnosis when assess communication and swallowing disorders 2. To judge the prognosis of the disorder 3. To make proper decision about the management and treatment of communication and swallowing disorders ( maintaining function, improving function, or just provide palliative care and family education) Date Your Footer Here 27