NUR 502 Module 6 Discussion Neurologic Function
NUR 502 Module 6 Discussion
Neurologic Function
Alzheimer’s disease (AD) is a degenerative brain disease that is the number one cause of dementia in older adults. With AD, the brain atrophies over time, causing a loss of cognitive function. It causes memory loss, behavioral changes, difficulty performing tasks and general cognitive decline. There are no definitive causes for AD but there are various risk factors such as age, female gender, lifestyle, family history and others.
Types of Dementia
Alzheimer’s is characterized by progressive disease with gradual changes over time. It is characterized by abnormal deposits of tau protein, which are necessary for microtubule health in the neurons. Vascular Dementia is caused by decreased blood flow to the brain and can be caused by stroke or cardiovascular disease. Vascular dementia tends to have a sudden onset after the cardiovascular event. Similar to AD, Dementia with Lewy bodies (DLB) is a progressive disease that is characterized by abnormal protein deposits in the brain. The manifestations differ in that DLB causes changes in executive function and may cause visual hallucinations. Frontotemporal is a group of disorders that affect the brain’s frontal and/or temporal lobe of the brain. There are three variants: behavioral, semantic, and non-fluent variant. Frontotemporal dementia is progressive and affects the patient’s ability to function normally or even to speak.
Explicit and Implicit memory
Explicit memory or declarative memory can be described as conscious thought which requires processing through the hippocampus. This type of memory is recalling facts and events, such as knowing your birthday or your mother’s name. Implicit memory, on the other hand, is non-declarative and is done subconsciously. It does not need to be processed through the hippocampus but is instead a reflex pathway. This includes things like walking or riding a bicycle.
Diagnosis Criteria for Alzheimer’s Disease
There are multiple causes for dementia, and it is important that the correct diagnosis be made to tailor treatment to the patient. The provider needs to first conduct a thorough history and physical to determine what medications the patient is taking and determine if there are any other causes for mental changes. Next, a cognitive test needs to be conducted, which includes memory, problem-solving, attention, etc. Blood and urine tests need to be conducted to rule out infection as a cause for any changes seen. A psychiatric evaluation is needed to rule out mental health conditions as a contributing factor. If there is no clear differential, a lumbar puncture needs to be done to analyze the CSF for causative abnormal proteins. The patient can then have an MRI, CT, or PET scan to confirm the diagnosis.
Patient Recommendation
Ms. HM appears to be having early signs of Alzheimer’s dementia. After a full work-up, if the diagnosis is confirmed, she will be started on Memantine, any medications with sedative effects will be re-evaluated to verify necessity. Ms. HM will be referred to a social worker early to assess needs at home, such as a home health aide. Her family will be involved in her care plan and will need to have a discussion about advanced directives and to ensure that Ms. HM is in a safe environment.
References
Armstrong, R. A. (2019). Risk factors for alzheimer’s disease. Folia Neuropathologica, 57(2), 87–105. https://doi.org/10.5114/fn.2019.85929
Dlugasch, L., & Story, L. (2020). Applied Pathophysiology for the Advanced Practice Nurse. Jones and Bartlett Learning.
How Is Alzheimer’s Disease Diagnosed? (n.d.). National Institute on aging. Retrieved February 14, 2024, from https://www.nia.nih.gov/health/alzheimers-symptoms-and-diagnosis/how-alzheimers-disease-diagnosed
