Organic Brain disorders

Terms in this set (35)

Organic Brain Syndrome
Incompasses most common disorders involving sensory/motor functions in older adults
Chronic Brain Syndrome
Senile dementia (irreversible)
Acute Brain Syndrome
Delirium
(Reversible)
Dementia
An umbrella term used to describe the loss of cognative or intellectual functioning that is server enough to interfere with daily life

Decline from a previously attended intellectual level

Involves memory, judgment, abstract thoughts, and changes in behavior and personality
Dementia Causes
Results from a dysfunction or degeneration of the brain

Nerves in the cerebral cortex progressively weaken or shrink
Symptoms of Dementia
Defects in memory, orientation, intellect, judgment, and emotional and behavioral with psychotic features such as hallucinations, delusions, and paranoia
Progression of Dementia Phase 1
Forgetfulness: progressive memory impairment

Recent and short term memory effected

Deficits in attention, orientation, and concentration

Will try and cover up with note taking, confabulation

Withdrawal and denile
Progression of Dementia Phase 2
Confusional: safety becomes a concern

Disorganization and agitation

Increased difficulty with activities that require planning, decision making, and judgment

Significant memory impairment

Anomia (inability to name objects)

Decreased concern over appearance, work, hobbies, etc.

Unable to plan a meal or balance a check book

Inability to use objects correctly
Progression of Dementia Phase 2
Progression of difficulty interacting in social situations

Personality changes
Irritability
Rigidity
Perseveration (repeating of meaningless words and phrases)
Progression of Dementia Phase 3
Decline in ADL's

Communication become difficult

Agitation, wondering, and pacing

May be unaware of increasing deficits

Hallucinations and paranoia delusions may occur
Progressive Deterioration Phase 4
Total degeneration

No longer recognizes one self

Doesn't know family

Complications with UTI and pneumonia
Senile Dementia Alzheimer's Type (SDAT)
Progressive brain disorder resulting from neuron death in the cerebral cortex

Brain cells that make acetylcholine and involved in memory and learning are dying

Autopsy is the only conclusive way to diagnose

Cause is unknown
SDAT Risk Factors
Age

Family history

Genetics

Factors that may influence, head injury, heart-head connection, general aging, isolation
Pathologica Characteristics of SDAT
Degeneration of nerve cells with atrophy of frontal and temporal lobes of the brain

Presence of neuritic plaques (calcifications) called AMY plaques (amyloid)

Neurofibrillary tangles
Diagnostic process for SDAT
Find the right doctor

Medical and family hx

Cognitive tests

Physical examination

Neurological exame

Brain imaging
Precinial Alzheimer's Disease
Measurable changes in the brain

Cerebrospinal fluid or blood biomarkers indicating earliest signs

NO memory loss
Biomarker Tests
Those showing level of beta-amyloid accumulation in the brain

Those showing brain nerve vells are injured or degenerating
MCI (Mild cognitive impairment) Alzheimer's Disease
Noticeable changes in thinking but doesn't affect the individuals availability to carry out ADL's
Pick's Disease
Cortical atrophy confined to frontal and temporal lobes (unknown cause)

Effects more women then men

Ages 40-60yrs

Definitive diagnosis is autopsy
Pick's Disease S/S
Memory loss, lack of spontaneity, difficulty thinking and concentrating, speech disturbances
Vascular Dementia
Deterioration of mental capabilities caused by mutiple CVA's

Not reversable but recognition of an underlying condition offten leads to a specific treatment that can modify the progression
Dementia with Lewy Bodies (DLB)
Abnormal deposits of a protine called Lewy bodies
Dementia with Lewy Bodies (DLB) S/S
Sleep disturbances, well formed visual hallucinations, muscular ragifity and/or other parkinsonian movement features
Dementia with Lewy Bodies (DLB) Treatment
No spacific drug

May have best response to cholinesterase inhibitors

Parkinsons drugs if movements server

DO NOT USE antipsychotic drugs - pts have an extrem sensitivity
Treatment of Dementia
Relief of symptoms: psycoteopic and anti-anxiety drugs

Protect from harm

Support self-esteem and dignity

If possible restore client to greater productivity
Aricept (donepezil)
Cholinsterace inhibitors

Used to treat mild to moderate symptoms

Improvement in cognition, general function, and behavior with few side effects

5mg/day then increased to 10 mg/day after 4-6 weeks
Aricept
(donepezil) S/E
N, V, D
Cognex
(tacrine)
Cholinsterace inhibitors

Used to treat mild to moderate symptoms

Improvement in cognition, general function, and behavior with few side effects

10 mg/QID then gradually increased to 40 mg/QID

Hepatotoxic, Nausea, Diarrhea
Exelon (rivastigmine)
Cholinesterase inhibitor

1.5 mg BID initially, increasing by 3mg/day every two weeks till 6mg BID if tolerated

S/E N, V, wt loss, muscle weakness
Razadyne (galantamine HBr)
Cholinesterace inhibitor

4 mg BID and increasing after 4 weeks to 8mg BID, may increase to 12 mg BID

Give with food and fluids

S/E - N, V, D, anorexia, wt loss, possible bradacardia

Dont DC or gains will be lost
Cholinesterase inhibitors
Belived to prevent the breakdown of acetylcholine in the brain

Used to treat mild to moderate Alzheimer's Disease

Hard on stomach increasing the risk of stomach ulcers

NSAID's should be used with caution, to prevent the harshness on stomach
Namenda (memantine)
N-methyl D-aspartate (NMDA) antagonist

Believed to work by regulating glutamate, a chemical that when produced in excessive amounts may lead to brain cell death

Treatment for moderate to severe Alzheimer's Disease

S/E - dizziness, headache, constipation, and confusion
Delirium
Transient, acute, or sub-acute state of mental confusion

Usually lasts a few hours or days; rarely lasts over a month
Delirium Symptoms
Decreased attention span

Disorganized thinking

Rambling, incoherent speech

Decreased LOC

Illusions, hallucinations, or other perceptual disturbances

Disorientation

Memory impairment

Disturbances of sleep/wake cycles

Sudden increase in confusion

Physical and/or verbal aggression

Weeping

Increased demands
Symptoms of alcoholism in older adults
Insomnia

Rapid onset of confusion

Uncontrollable HTN

Frequent falls

Self-neglect

Withdrawal and isolation

Poor nutrition

Change in daily habits
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