chronic neurological disorder | NURS240

what are the risk factors assocaited with developing multiple sclerosis (MS)?

1. autoimmune diseases (e.g., psoriasis, T1DM)

2. epstein-barr virus (EBV) infection

3. genetic predisposition (family history)

4. colder climates (less sunlight exposure)

5. low vitamin D levels

what are the signs and symptoms of multiple sclerosis

1. fatigue

2. vision problems (optic neuritis that causes blurred vision, pain with eye movement, or even loss of vision)

3. muscle weakness + spasticity

4. numbess/tingling (paresthesia)

5. balance + coordination issues (ataxia, tremor)

6. bladder dysfunction (urgency, retention)

how is multiple sclerosis (MS) diagnosed?

no single diagnostic test as many different things are often used like medical and supportive findings

1. MRI → detect CNS lesion (most important)

2. spinal tap (lumbar puncture) - oligoclonal bands in CSF)

3. optical coherence tomography (OCT) - lowered retinal nerve fiber layer thickness indicate MS
   evoked potentials → slowed nerve conduction

what is multiple sclerosis?

1. chronic autoimmune disease

2. affect CNS (brain + spinal cord)

3. causes demyelination → disrupt nerve disignaling

what part of the nervous system is affected in MS?

1. myelin sheath of nerve fibers → which causes nerve signals to slow or stop which lead to neurological symptoms

2. located in the brain and spinal cord

what are the main types of MS and a brief description of which of them are?

1. relapsing-remitting MS (RRMS) → characterized by episodes (relapses that can have gaps of months to years) followed by recovery (remission), during which the patient returns to baseline until relapse

2. primary-relapsing MS (PRMS) → frequent lapses with partial recovery, but the patient DOES NOT return to baseline after each lapse and continues to deteriorate over several years

3. primary-progressive MS (PPMS) → a steady and gradual deterioration of MS without remission - the disease is more of a progressive disability without acute attacks → a steady worsening with no clear relapses

4. secondary progressive (SPMS) → patient starts with RRMS, which steadily becomes progressive as it worsens over time

what should be assessed in a patient with multiple sclerosis (MS)?

1. history: vision change (blurred, double vision), mobility issues (difficulty walking), sensory changes (numbness, tingling)

2. physical: muscle weakness, spasticity, tremors, dysmetria (poor coordination), dysphagia (difficulty swallowing)

3. diagnostic: CSF analysis + MRI

what are the key nursing intervention for multiple sclerosis?

1. manage impaired immunity → since MS is an autoimmune disease, the immune system is dysregulated and attacks the myelin sheath

2. improve mobility as the demyelination slowed nerve signals and causes weakness, spasticity, and poor coordination which increases fall risk

3. support vision and cogniion for patient as the damage in the CNS affect the optic nerve and since there are brain involved, memory, focus, and processing issues are involve

4. self management education as MS is chronic and unpredictable (relapses) and patient need to recognize symptoms, manage fatigue, follow treatment

what are the risk factors for developing Parkinson’s disease?

1. older age (most important risk factor → PD tend to be around 60, but some have young onset which are those that developed under 30)

2. male sex

3. genetic disposition (family history)

4. environmental exposures (pesticides, toxins)

5. rural living/well water exposure

6. history of head trauma

is low dopamine a risk factor for Parkinson’s disease (PD)?

low dopamine is not a risk factor but it is the underlyin problem in PD as Parkinson’s is the degeneration of dopamine-producing neurons in the brain which lead to decreased dopamine levels and the decreased dopamine lead to motor symptoms (e.g., tremor, rigidity, slow movement)

true or false: there are current medications that can used to ease symptoms but none currently can be used to slow progression or cure the disease

true

what brain structures are involved in movement control (review to understand physiology)?

1. cerebral cortex

2. basal ganglia

3. cerebellum

they all work together to coordinate movement

what neurotransmitters regulate movement?

1. acetylcholine (ACh) → excitatory (stimulates movement)

2. dopamine → inhibitory (smooths/controls movement)

what happens in the brain in Parkinson’s disease?

1. degeneration of substantia nigra

2. leads to decreased dopamine production

how does decreased dopamine affect movement in Parkinson’s disease?

• loss of dopamine → imbalance (↑ ACh, ↓ dopamine)

• causes loss of refined motor control

• results in: tremor, rigidity, slow movement

what are the cardinal symptoms of Parkinson’s disease?

1. resting tremor

2. rigidity

3. bradykinesia (slow movement)

how does Parkinson’s disease typically progress?

1. slow progression

2. may take 10-20 years before severe disability

3. younger-onset PD (YOPD) often progresses more slowly

4. treatment can relieve symptoms and slow progression

what are the common motor function symptoms of Parkinson’s disease?

1. akinesia (difficulty initiating movement)

2. resting tremor/pill-rolling tremor

3. mask-like face (reduced facial expression)

4. difficult chewing or swallowing

5. drooling

6. fatigue

7. decreased arm swing when walking

what posture and gait changes occur in Parkinson’s disease?

1. posture: stooped posture, flexed trunk

2. gait: slow-shuffling gait, short steps, propulsive gait (learning forward), difficulty stopping, impaired righting reflex

what speech changes occur in Parkinson’s disease?

1. dysarthria (slurred speech),

2. echolalia (repeating words)

3. changes in tone and volume (often soft voice)

what psychosocial symptoms may occur in Parkinson’s disease?

1. mood swings

2. sleep disturbances

3. depression

4. paranoia

5. dementia

review the drug therapies used to treat Parkinson’s disease? what is the goal of drug therapy in Parkinson’s disease?

• dopaminergics → levodopa + carbidopa (Sinemet)

• dopamine agonists → Pramipexole, Ropinirole

• MAO-B inhibitors → Selegiline, Rasagiline

• amantadine → Amantadine

• anticholinergics → Benztropine, Trihexyphenidyl

• COMT inhibitors → Tolcapone, Entacapone

the goal of drug therapy in Parkinson’s disease is to increase dopamine activity in the brain, improve motor control, and reduce tremor, rigidity, and bradykinesia

what exercise interventions are recommended for Parkinson’s disease?

1. range of motion (ROM) exercise

2. facial exercises to help maintain facial muscle control

3. ambulation/walking to maintain mobility

what nutritional interventions help patients with Parkinson’s disease?

1. food diary to monitor intake

2. small, frequent meals

3. high-protein, high-calorie diet (tremors and muscle rigidity can increase energy expenditure and difficult chewing/swallowing can cause reduced food intake which high calorie help prevent weight loss and malnutrition)

4. increase fiber and fluids (prevent constipation)

what surgical treatment may be used for Parkinson’s disease?

1. deep brain stimulation (DBS)

2. stereotactic pallidotomy

what causes Alzheimer’s disease?

the exact cause is unknown but several factor increase risk

1. genetic predisposition (family history increases risk with certain genes like the APOE-e4) increase likelihood

2. abnormal protein buildup in the brain (beta-amyloid plagues outside neurons or the tau-tangling inside neurons) which lead to damage and death of the brain cells

3. age (greatest risk factor → most cases occur after the age of 65)

4. other contributing factor → cardiovascular, head trauma, lifestyle factor

what are the main pathophysiological changes in Alzheimer’s disease?

• microtubule damage inside neurons

• neurofibrillary tangles (tau protein tangles)

• beta-amyloid plaques between neurons

what are the common signs and symptoms of Alzheimer’s disease?

1. memory loss (especially of recent events)

2. confusion/disorientation (to time, place, and/or people)

3. difficulty with language (finding word communication problems)

4. impaired judgement or decision-making

5. difficulty performing familiar tasks

6. personality or mood changes (irritability, depression)

true or false: drawing a clocks is a test screening for dementia?

true

how is Alzheimer’s disease diagnosed?

1. history and physical exam (PE)

2. assessment of risk factors

3. neurological exam

4. cognitive tests (mini-mental, mini-cog)

5. medication review

6. medical work-up to rule out other causes

what is assessment during the neurological exam for Alzheimer’s disease?

1. reflexes

2. coordination

3. muscle tone and strength

4. speech

5. sensation

6. mental status and cognition

why is a medication review and medical-work-up important when diagnosing Alzheimer’s disease?

some conditions can mimic dementia symptoms, such as:

• medication side effects

• depression

• vitamin deficiencies

• thyroid disorders

• infections

what are the three stages of Alzheimer’s disease?

1. mild (early stage)

2. moderate (middle stage)

3. severe (late stage)

symptoms worsen as cognitive and functional ability disease

what are the symptoms of mild (early-stage) Alzheimer’s disease?

1. mild memory loss

2. short attention span

3. difficulty planning and organizing

4. problems with judgement

5. subtle personality changes

6. decreased awareness of current events

patient CAN still function INDEPENDENTLY but with DIFFICULTY

what are the symptoms of severe (late-stage) Alzheimer’s disease?

1. unable to respond to environment

2. very limited speech (single words or nonverbal)

3. require extensive help with ADLs

4. high risk for infections (especially pneumonia)

what are the symptoms of moderate (middle-stage) Alzheimer’s disease?

1. severe impairment of cognitive functions

2. confusion and disorientation

3. mood changes (depressed, agitated, withdrawn, frustrated)

4. loss of self-care ability

5. speech and language problems

what can trigger behavior symptoms in Alzheimer’s patients?

1. moving to a new environment

2. change in caregiver or routine

3. hospital admission

4. misperceived threats or confusion

what nursing interventions help structure the environment for patients with Alzheimer’s disease?

1. prevent overstimulation → too much noise/confusion worsens agitation

2. provide a calm environment → reduce anxiety and confusion

3. maintain consistency and routine → familiar patterns improve orientation

4. orientation or validation therapy (a. orientation: remind the patient of time/place/person, b. validation: acknowledge feelings rather than correcting confusion)

how can nurses promote communication with alzheimer’s patients?

1. reduce distractions → helps patient focus

2. speak slowly and clearly

3. use short, simple sentences

4. give one instruction at a time

5. demonstrate tasks if needed

what interventions help support daily functioning in Alzheimer’s patients?

• assist with facial recognition (photos, labeling)

• promote independence with ADLs as long as possible

• promote continence (scheduled toileting)

• promote sleep (consistent bedtime routine)

why caregiver support important in Alzheimer’s disease?

• disease is progressive and long-term

• caregivers often experience stress, burnout, and fatigue

• education and support help improve patient care and caregiver well-being

what safety interventions help manage restlessness in Alzheimer’s disease?

• frequent walks → helps release excess energy

• structured activities → reduces anxiety and agitation

restlessness often occurs because patients feel confused or unable to express needs

what interventions help prevent wandering in Alzheimer’s patients?

• ID bands (identification if patient gets lost)

• Safe Return program (tracking program for missing patients)

• Closed/secured units

• Alarm systems on doors

wandering occurs due to disorientation and confusion about confusion

what home safety measures are important for Alzheimer’s patients?

• remove fall hazards

• install door alarms or locks

• ensure good lighting

• supervise cooking and medications

prevent injury due to confusion or impaired judgement

what medications are used to treat Alzheimer’s disease?

• Cholinesterase inhibitors → increase acetylcholine in the brain

• Monoclonal antibodies → target beta-amyloid plaques

• NMDA receptor antagonists → regulate glutamate to protect neurons

what medications may be used to treat behavioral symptoms in Alzheimer’s disease?

Antidepressants

• Fluoxetine

• Sertraline

• Citalopram

• Paroxetine

Anxiolytics

• Lorazepam

• Oxazepam

Antipsychotics (used cautiously)

• Aripiprazole

• Haloperidol

• Olanzapine

• Risperidone