AD+and+Huntingtons

Explain pathogenesis, s/s and pharmacological management of Alzheimer’s Disease and Huntington’s Disease **Alzheimer's Disease**- a chronic, progressive, degenerative disease. Characterized by loss of memory, judgment, and visuospatial perception, and by a change in personality. Over time the patient becomes increasingly cognitively impaired: severe physical deterioration takes place and death occurs as a result of complications of immobility. · the older adults brain weighs less and occupies less space · cerebral sulci widen, · gyri narrow · ventricles enlarged · cerebral atrophy · neurofibrillary tangles · senile or neuritic plaques · granulovascular degeneration · amyloid plaques · high level of beta amyloid · decrease ACh · Normally amyloid precurssor proteins are soluble and are cleared away, in AD amyloid precursor protein à amyliod B à stick together to form fibrils à amyloid plaques · abnormalities in neurotransmitters- NE, Dopamine, and serotonin <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· affect anyone 40 years old and greater <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· occurs more often >65 yo <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">·  familial occurence <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· early onset r/t acceleration of beta amyloid plaque formation and apoptosis <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· late stage apolipoprotein E on chromosome 19 <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· down syndrome often develop AD  <span style="mso-fareast-font-family: 'Times New Roman'; msofareastfontfamily: 'Times New Roman'; msolist: Ignore;">•  Alzheimer disease: amyloid plaques <span style="mso-fareast-font-family: 'Times New Roman'; msofareastfontfamily: 'Times New Roman'; msolist: Ignore;">• Pick disease: Pick bodies-atrophy or frontal and temporal areas of the brain <span style="mso-fareast-font-family: 'Times New Roman'; msofareastfontfamily: 'Times New Roman'; msolist: Ignore;">• Prion diseases: infective prion proteins <span style="mso-fareast-font-family: 'Times New Roman'; msofareastfontfamily: 'Times New Roman'; msolist: Ignore;">– Creutzfeldt-Jakob disease-transmissible form of dementia AD involves. <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· forgetfullness <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· memory <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· loss <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· short attention span <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· changes in personality behavior <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· First: short-term memory loss <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Second: confusional stage <span style="font-family: 'Courier New'; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;">o Disorientation, lack of insight, impaired hygiene and language use, sundown syndrome <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Third: incontinence, inability to recognize family and friends <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Microinfarcts: vascular dementia <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Vitamin B12 deficiency: Wernicke-Korsakoff syndrome <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Inherited atrophy of brain structure: Huntington disease <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Chronic confusion <span style="background: yellow; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-highlight: yellow; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msohighlight: yellow; msolist: Ignore;">·  Risk for Injury- <span style="background: yellow; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-highlight: yellow; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msohighlight: yellow; msolist: Ignore;">·  Compromised Family Coping <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Caregiver role strain <span style="background: yellow; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-highlight: yellow; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msohighlight: yellow; msolist: Ignore;">·  Disturbed sleep pattern <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Impaired verbal communication <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Imbalanced Nutrition: Less than body requirements <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Total urinary/bowel incontinence <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· social isolation <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· risk for impaired physical imbolity <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· self care deficit <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· risk for other directed violence <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· hopelessness <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· cognitive stimulation/memory training <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· structuring the environment <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· preventing overstimulation <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· provide consistency <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· promoting independence in ADLs <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Promoting continence <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Assisting with facial recognition <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· promoting communicatio <span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Drug therapy- <span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; msobidifontfamily: Wingdings; msofareastfontfamily: Wingdings; msolist: Ignore;">§ //Cholinesterase inhibitors//- symptomatic treatment of AD, act by delaying the destruction of ACh, thus delaying cognitive decline. Donepezil(Aricept), Galantamine (Reminyl), and Rivastigmine (Exelon). <span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; msobidifontfamily: Wingdings; msofareastfontfamily: Wingdings; msolist: Ignore;">§ //Memantine (Namenda)//- a low to moderate affinity NMDA receptor antagonist. drug blocks excess amounts of glutamate that can damage nerve cells. <span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; msobidifontfamily: Wingdings; msofareastfontfamily: Wingdings; msolist: Ignore;">§ //Antidepressants-// SSRI such as Paxil, zoloft are prescribed. **Huntington Disease**- a hereditary disorders transmitted as an autosomal dominant trait at the time of conception. men and women are affected equally and symptoms begin between 35-50 years of age, striking at a highly reproductive time in life. clinical onset is gradual. Two main symptoms- progressive mental status changes leading to dementia and chreiform movements in the limbs, trunks, and facial muscles. <span style="font-family: 'Courier New'; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;">o stage 1-onset of neurologic or psychological symptoms <span style="font-family: 'Courier New'; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;">o stage 2 is characterized by an increasing dependence on others for care <span style="font-family: 'Courier New'; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;">o stage 3 results in loss of independent function
 * 1) Structural changes in the brain
 * 1) Chemical changes in the brain
 * 1) Etiology and Genetic Risk
 * 1) Signs & Symptoms- see complete list page 966 IGGY
 * 1) Stages of AD
 * 1) Other causes of dementia
 * 1) Asses client for changes in cognition, behavior and personality, and self care skills
 * 2) Lab- none exist to diagnosis AD. Labs, CT, MRI usually drawn to rule out other disease processes.
 * 3) Nursing Diagnosis
 * 1) Interventions- see list on page 969
 * decreased levels of GAB A and ACh
 * Three stages each lasting about 5 years
 * diagnosis made on family history, clinical assessment,
 * signs and symptoms-chorea, poor balance, hesitant or explosive speech, dysphagia, impaired respiration, an bowel and bladder incontinence, decreased attention span, poor judgment, memory loss, personality changes, and dementia.
 * Antipsychotic agents or monoamine-depleting agents may be use manage dz, control agitation, hallucinations, psychotic delusions, depression, OCD.
 * Nursing diagnosis and Interventions same as AD