Neurological Disorders and Mental Health

Question(s): What is likely to be different in the appearance of depression in a person who is 70 years old compared to its appearance in a person who is 20 years old? (Mention at least 3)

Guidelines:

*Original papers (NO plagiarism).

*APA Format.

*Answer should be based on Chapter 23-Neurological Disorders and Chapter 24 – Mental Health. (Both chapters ATTACHED), no just your opinion.

*Please, do not mention the signs and symptoms of depression. You need to mention the characteristics / symptoms that are common on a depressed 70 years old person than are different in a 20 years old depressed individual (do a comparison between the depressed 70 years old with the depressed 20 years old) (mention at least 3).

*Two reference beside the text book.

Chapter 23

Neurological Disorders

Interruptions in blood supply to the brain resulting in neurological damage
Are either ischemic or hemorrhagic
Manifest as strokes or transient ischemic attacks (TIAs)
More than two-thirds of all strokes occur in persons older than 65 years of age
There are significant regional differences in the percentage of persons who have strokes

Cerebrovascular Disease

Ischemic Events

Four main causes
Arterial disease
Cardioembolism

Caused by arrhythmia

Hematologic disorders

Coagulation disorders

Hyperviscosity syndromes

Systemic hypoperfusion

May result from dehydration, hypotension, cardiac arrest, fainting (syncope)

Symptoms begin to resolve within minutes
About one-third of those who have a TIA and do not receive treatment are likely to have a major stroke within 1 year
10% to 15% of these will have one within 3 months
Persons often do not seek care for a TIA

Transient Ischemic Attack

Less frequent than ischemic strokes but much more life threatening
Primarily caused by uncontrolled hypertension; less often by malformations of the blood vessels (e.g., aneurysms)
Usually see specific neurological changes, including seizures and more depressed level of consciousness than those with an ischemic stroke

Hemorrhagic Events

First signs of stroke and TIAs are neurological deficits consistent with the part of the brain affected and type of event
Include alterations in motor, sensory, and visual function; coordination; cognition; and language
If the individual is deeply unresponsive, he or she does not usually survive
Nausea and vomiting are common with increased cerebral edema

Signs and Symptoms

Chances of reoccurrence are increased
Long-term effects include paralysis, hemiparesis, dysarthria, dysphagia, aphasia, and depression
With paralysis, individuals may also experience spasticity of muscles, contractures, deep vein thrombosis (DVT), pressure ulcers, aspiration, pneumonia, and urinary tract infection

Complications

All cerebrovascular events are emergencies
Management is prevention
Reduce risk factors when possible
Administer anticoagulant therapy
Administer aspirin therapy
Multidisciplinary team is used for successful patient outcomes

Management

Prevention and prompt intervention are the keys to the management of a stroke
Control blood pressure and diabetes
Enter a smoking cessation program
Limit salt intake and alcohol consumption
Maintain a healthy diet
Encourage weight loss

Implications for Gerontological Nursing and Healthy Aging

Implement measures to prevent aspiration and DVTs
Work to prevent and minimize disability
Implement measures to prevent iatrogenic complications such as skin breakdown, falls, and increased confusion or delirium from medications and infections
Advocate participating in support groups for both the patient and caregivers

Acute Care

A patient who had a previous stroke states that he hopes he does not have another stroke. Which is the best response?

Drinking wine daily will decrease any risk factor of having a stroke.

Prevention is the best way to manage patients who have had strokes.

More fruits and vegetables in his diet will decrease the risk for stroke.

Because of collateral circulation, the incidence of another stroke is extremely low.

Question

B—Prevention is the best way to manage patients who have had strokes. It is accomplished by minimizing risk factors. Smoking cessation, low cholesterol diet, and limiting salt and alcohol intake are all changes the patient at risk can make. With a health care provider’s supervision, an exercise program and a weight management program will help to decrease the risk of another stroke.

Answer

Most common are Parkinson’s and Alzheimer’s diseases
Both are terminal conditions characterized by a progressive decline in function
Signs are usually slow to appear
Diagnostic process begins with assessing for reversible causes and increases in complexity when the person has other confounding chronic diseases, is very frail, or has sensory limitations

Neurodegenerative Disorders

Slowly progressing movement disorder that is the result of a destruction of the cells in the brain that produce the neurotransmitter dopamine
Slightly more common in men than in women; 96% are diagnosed after the age of 60 years
Exact cause is unknown

Parkinson’s Disease

Signs and symptoms begin slowly; therefore Parkinson’s disease is difficult to diagnose
Four major signs
Resting tremor

Arm and hand are most commonly affected

Not present during sleep

Increase with stress and anxiety

Muscular rigidity
Bradykinesia
Asymmetric onset

Signs and Symptoms

Medications focus on replacement, mimicking, or slowing dopamine receptors
First-line medications include carbidopa and levodopa
Medication therapy needs to be monitored; side effects may include hypotension, dyskinesias, dystonia, hallucinations, sleep disorders, and depression

Management

About 5 million people in the United States have dementia of some type; between 60% and 80% have Alzheimer disease
Sixth leading cause of death in the United States
Not a normal part of aging
Signs include memory loss, impaired thinking, the ability to find words, judgment, and behavior

Alzheimer’s Disease

There is no cure
Pharmacologic therapy has the potential to slow cognitive decline in some
Cholinesterase inhibitors
N-methyl D-aspartate (NMDA) antagonist
Effectiveness of medications and side effects varies
Treat coexisting depression and other mental health issues

Management of AD

Treatment focuses on
Making sure the person gets good care
Preserving self-care abilities
Preventing complications and injury
Providing support and guidance in dealing with progressive loss
Appropriately use nonpharmacologic and pharmacologic interventions
Promptly treat all reversible conditions
Coordinating care among all providers, including family members or partners

Implications for Gerontological Nursing and Healthy Aging

Impaired verbal communication from neurological disturbances deal with the person’s ability to receive information, understand what is being said, or articulate
Articulation is hampered by mechanical difficulties such as dysarthria, respiratory disease, destruction of the larynx, and strokes
Specific difficulties include…

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