Neuropsychiatric Disorders - Notes

Neuropsychiatric Disorders

Overview

• Neurologic diseases and self-feeding concerns
• Nutrition-related issues in neurology:
  • Cerebral Vascular Accident (CVA)
  • Traumatic Brain Injury (TBI)
  • Spinal Cord Injury (SCI)
  • Amyotrophic Lateral Sclerosis (ALS)
  • Epilepsy
  • Multiple Sclerosis (MS)
  • Parkinson’s Disease (PD)

Relationship between Nutrition and Neurologic Conditions

• Brain-Gut Communication:
  • Diet influences neurotransmitter production.
  • Neurotransmitters and lipids are crucial for brain health.
• Mental Health and Nutrition:
  • Mental health disorders can alter appetite and nutrition intake.
  • Medication interactions may affect nutritional status.

Dysphagia (Difficulty Swallowing)

• Can stem from various diseases and traumas (chronic or temporary).
• Signs and symptoms while eating:
  • Coughing or gagging
  • Inability to swallow.

Interventions for Dysphagia

1. Coordination of Care - Involves speech therapy:
   • Conduct swallow studies to assess safety during eating.
   • Provide techniques for safe swallowing.
2. Dietary Adjustments:
   • Texture-altered diets (Level 1, 2, 3 based on severity).
   • Thickened liquids (nectar-thick, honey-thick, pudding-thick).

Nutrition-related Neurologic Conditions

• Beriberi:
  • Thiamin (B1) deficiency; linked to poor diet or alcoholism.
• Pellagra:
  • Niacin (B3) deficiency.
• Pernicious Anemia:
  • Often seen in strict vegetarians/vegans due to B12 deficiency.

Cerebral Vascular Accident (Stroke)

• Defined as loss of blood flow to a part of the brain.
• Symptoms based on affected area:
  • Left-sided impacts vision/hearing.
  • Right-sided affects self-feeding, swallowing, and speech.
• Early Treatment:
  • First 24-48 hours: NPO (nothing by mouth) with IV fluids.
  • Enteral nutrition might be needed.

Stroke Management and Nutrition Therapy (MNT)

• Transition to liquids after confirming swallowing safety.
• Adjust textures as necessary.
• Nutritional guidelines:
  • Energy needs: 25-45 kcal/kg + 1.2-1.5 g/kg protein.
  • Increase monounsaturated fatty acids (MUFA) and decrease salt.
  • Regular lab monitoring for nutritional status and medication interactions.
• Provide education on nutrition and lifestyle before discharge.

Brain Injury

• Includes both traumatic (TBI) and nontraumatic conditions (e.g., infections).
• Potential symptoms: hyperphagia, aphasia, cachexia, and motor control loss.
• Long-term consequences can disrupt blood pressure regulation and self-feeding.

Brain Injury MNT

• Begin enteral nutrition as quickly as possible (ASAP).
• Nutritional guidelines:
  • Energy needs: 35-46 kcal/kg.
  • Protein: 2.0-2.5 g/kg to promote nitrogen balance.
• Monitor potassium, phosphorus, magnesium, and zinc levels.
• Focus on blood glucose control and maintaining optimum weight/fluid balance.

Spinal Cord Trauma

• Often leads to self-care deficits and increases risk of pressure ulcers.
• Muscle denervation decreases energy requirements.

Spinal Cord MNT

• Accurate measurement via indirect calorimetry; actual needs often 10% below predicted needs.
• Initiate enteral nutrition within 24-48 hours.
• Address enteral nutrition intolerance with parenteral nutrition when necessary.
• Monitor hydration and calcium to prevent kidney stones, energy intake to manage weight/muscle loss.

Amyotrophic Lateral Sclerosis (ALS)

• A progressive motor neuron disease.
• Symptoms include elevated metabolic needs and swallowing difficulties. About 16-55% of patients are malnourished.

ALS MNT

• Early Stages:
  • Monitor swallow safety, provide soft diets, high protein, thickened liquids.
  • Increase intake of carotenoids, omega-3 fatty acids, vitamin E, antioxidants, fiber; avoid excess iron and copper.
• Later Stages:
  • May require PEG or PEJ tube placement for severe dysphagia; use a formula providing 25-30 kcal/kg with 0.8-1.2 g/kg protein.
  • TPN (Total Parenteral Nutrition) is not indicated.

Epilepsy and Seizure Disorders

• Nutrition affects patients, especially those on antiepileptic drugs, which can impair bone and hepatic health.
• The ketogenic diet may help those with refractory epilepsy.

Epilepsy MNT

• Monitor for potential side effects such as:
  • Hyperuricemia or hypercalciuria from anticonvulsants.
  • Nutritional deficits affecting cardiac and bone health.
• Provide sufficient fiber and fluid to prevent constipation.
• Possible supplementation with calcium, vitamin D, folic acid, and vitamins B6 and B12.
• Pay special attention when feeding with medications like Phenytoin/Dilantin to ensure effective absorption.

Multiple Sclerosis (MS)

• A progressive or episodic disease leading to nerve degeneration; commonly onset between ages 20-40.
• Dysphagia is frequently encountered during symptoms.
• Vitamin D deficiency may be a contributing factor.

MS MNT

• Adjust energy to maintain weight; promote a balanced diet rich in anti-inflammatory foods, PUFAs, and vitamin D3.
• Reduce sodium, especially with medication use.
• Frequent small meals may help reduce mealtime fatigue.
• Coordinate care with other therapies as needed.

Parkinson’s Disease (PD)

• Characterized by significant dopamine loss at the basal ganglia.
• Symptoms include tremors, dysphagia, and difficulty chewing.
• The Mediterranean diet may mitigate cognitive decline. High protein may interfere with levodopa, thus should be limited to 0.5 g/kg.

PD MNT

• Administer levodopa 30-60 minutes before meals to enhance absorption.
• Monitor for gastrointestinal distress and related complications (e.g., elevated glucose/homocysteine).
• Limit vitamin B6 intake, while ensuring adequate B12, folate, and vitamin C levels are achieved. Monitor overall swallowing safety.