Neurodegenerative Disorders

Patient Assessment (Rec. Cues)

• Patient/Family History

• Presenting Complaint

• Physical/Mental

• Psychosocial/lifestyle

• Age

Diagnostic Studies: Imaging

Diagnostic Studies: Labs

• CMP

• CBC

• Electrolytes

• Glucose (Hypoglycemia)

• Serology

• Drug Levels

• Drug Screen

• Cerebrospinal Fluid (CSF)

Diagnostic Tests

• Electromyography (EMG)

• Electroencephalography (EEG)

Electromyography (EMG)

Electroencephalography (EEG)

Lumbar Puncture

• Insertion of spinal needle into the subarachnoid space between the 3rd & 4th lumbar vertebrae

• Reasons for LP

• CSF should be clear & colorless

Nursing Considerations for Lumbar Puncture

Pre/Post Procedure

Evoked Potentials

Auditory, Visual, Somatosensory

Transcranial Dopplers

• Ultrasound for Cerebral Circulation

• Cerebral Vasospasm or narrowing of arteries

• May be used as an alternative to Cerebral Angiography

Autoimmune/Degenerative Disorders: Goals

• Maintain Quality of Life

• Curative Treatment?

• Manage Symptoms

• Help patient be independent as long as possible

• Support families as role changes

Autoimmune: Multiple Sclerosis (MS)

• Demyelination of myelin sheath in CNS

• Results in nerve impulses being either blocked or slowed

Psychosocial Concerns of MS

• Length of diagnosis (Misdiagnosis, “You just need sleep”)

• Upon Diagnosis (Relief vs. anger/ frustration

• After diagnosis (Anxiety, Depression)

• Promote open/therapeutic communication

• Assess for coping mechanisms & stress management

• Sexual Dysfunction

S/S of MS

• Remissions & Exacerbations

• Visual Changes

• Tremors

• Weakness

• Fatigue

• Paresthesia

• Ataxia (Gait, fine motor)

• Dysarthria, Dysphagia

• Bowel & Bladder dysfunction

• Cognitive changes (Memory Impairment)

MS Interventions (Disease Modifying Therapy)

• No cure

• Meds to treat Sx

• Baclofen, Docusate Sodium

• Freq. Assessment of liver & bone marrow function

• Medical Marijuana

• Physical & Occupational Therapy

• Education

• Use of Disease Modifying Drugs (DMD)

Diagnostic Tests for MS

• MRI

• Presence of IgG & increase of WBC in CSF

• Elevated igG in serum

• Evoked potential testing

Treatment of MS Exacerbation

• Glucocorticoid (Short course (3-5 days) of high-dose IV glucocorticoid

• IVIG-IV Immunoglobulin

Parkinson’s Disease

• Progressive neurodegenerative disorder

• Death usually occurs secondary to pulmonary or renal disease

Pathophysiology of PD

• Depletion of dopamine, the neurotransmitter required to control posture & voluntary movement (Causes of loss of voluntary movement)

What to remember for PD?

• Dopamine: Required for relaxation of muscles

• Acetylcholine: Required to contract muscles

S/S of PD

• 4 Cardinal Sx

• Muscle weakness

• Masklike appearance of face

• Drooling

• Impaired judgement& emotional instability

• Change in cognition, Psychosis (late)

What is the 4 Carinal Sx of PD

• Tremors

• Muscle Rigidity

• Bradykinesia or Akinesia

• Postural Instability

Other Sx of PD

• Pill Rolling

• Shuffling Gait

PD Diagnosis

• No specific diagnostic tests

• Dopamine transporter scan (newer) - radioactive agent binds to dopamine transporter

• CSF may show a decrease in dopamine levels

• Single-Photon Emission Computed Tomography (SPECT), may show loss of dopamine-producing neurons

• Presentation of Sx: 2 or more

Drug Tolerance

• Efficacy may wear off over time

• May choose to: Reduce drug dosage, Change drug to another, “Drug Holiday”

• Monitor Patient Sx during “Drug Holiday”

• Educate patient to report signs of worsening PD Sx

Treatments/Responding

• Deep Brain Stimulation

• Stereotactic Pallidotomy