DEGENERATIVE NEUROLOGIC DISORDER abnormalities.

Signs and Symptoms:

 What is degenerative disorder?  Slowness of voluntary movements,
Degenerative disorder is the result of especially in the initiation of such
continuous process based in degenerative movements as walking or rolling
cell changes, affecting tissues or organs, over in bed
which will increasingly deteriorates over  Decreased facial expression,
time, whether due to normal bodily wear of monotonous speech, and decreased
lifestyle choices such as exercise or eating eye blinking
habits  Unsteady balance; difficulty rising
from a sitting position
DEGENERATIVE DISEASES:  Abnormal tone or stiffness in the
trunk and extremities
 Parkinson’s Disease  Swallowing problem in later stages
 Alzheimer’s Disease  Light-headedness or fainting when
 Huntington’s Disease standing (orthostatic hypotension)
 Multiple Sclerosis
5 Stages of Parkinson’s disease
PARKINSON’S DISEASE
STAGE I: is the mildest form of Parkinson’s. At
Parkinson’s disease is a progressive disease this level, there may be an unusual symptoms, but
of the nervous system marked by tremor, muscular they’re not severe enough to interfere with daily
rigidity, and slow, imprecise movement, chiefly tasks and overall lifestyle. In fact, the signs of the
affecting middle-aged and elderly people. It is disorder are so minimal at this stage that they’re
associated with degeneration of the basal ganglia of often missed.
the brain and a deficiency of the neurotransmitter
STAGE II: is considered a moderate form of the
dopamine.
Parkinson’s, and the symptoms are much more
Causes: caused by the progressive impairment or noticeable; than those experienced in stage I.
deterioration of neurons (nerve cells) in an area of Stiffness, tremors, and trembling may be more
the brain know as the substantia nigra. When noticeable, and changes in facial expressions can
functioning normally, these neurons produce a vital occur. While muscle Stiffness prolongs task
brain chemical known as dopamine. completion, Stage II does not impair balance.
Disease Occurs: STAGE III: Is the mid-stage in Parkinson’s, and it
marks a major turning point in the progression of
• There is increasing evidence that
the disease. Many of the symptoms are the same as
Parkinson’s disease may be inherited
those in stage II, except now loss of balance and
(passed on genetically from family
decreased reflexes can also occur. This is why falls
members).
are common in stage III.
• There is considerable controversy
STAGE IV: Independence separates Parkinson’s
surrounding the possibility of a genetic
patients from stage III and stage IV. During stage
cause of Parkinson’s disease. In a small
IV, it’s possible to stand without assistance.
number of families, specific genetic
However, movement may require a walker or other
abnormalities leading to the illness have
type of assistive device.
been identified. However, the vast majority
of people with Parkinson’s disease do not STAGE V: is the most advanced and debilitating
have one of these identified genetic stage of Parkinson’s disease. Advanced stiffness in
the legs can also cause freezing upon standing. by bronchospasms, edema, and obstructive secretions.
Patients require wheelchairs, and are often unable to
stand without failing.Around-the-clock assistance is Alzheimer’s Disease
required to prevent falls.
Alzheimer’s disease is a neurologic disorder
Treatment : in which the death of brain cells causes memory
• Parkinson’s disease can’t be cured, but loss and cognitive decline. A neurodegenerative
medications can help control your type of dementia, the disease starts mild and gets
symptoms, often dramatically. In some later progressively worse
cases, surgery may be devised. Causes:
• Medications may help you manage problems  Like all types of dementia, Alzheimer’s is
with walking, Movement and tremor. These caused by brain cell death. It is a
medications increase or substitute for neurodegenerative disease, which means
dopamine, a specific signaling chemical there is progressive brain cells death that
(neurotransmitter) in your brain. happens over a course of time
Medications:  The total brain size shrinks with Alzheimer’-
tissue has progressively fewer nerve cells
 Carbidopalevodopa and connections
 Cabidopalevodopa infusion  As more and more brain cells die,
 Dopamine agonists Alzheimer’s leads to significant brain
 MAO-B inhibitors shrinkage. When doctors examine
 Catechol-O- Alzheimer’s brain tissue under the
methyltransferase(COMT) inhibitors microscope, the see two types of
 Anticholinergics abnormalities that considered hallmarks of
 Amantadine disease.

Surgical Procedures: 3 Stages of Alzheimer’s

• Deep brain Stimulation. In deep brain STAGE I: Mild/Early (lasts 2-4 yrs) – Frequent
stimulation (DBS), surgeons implant recent memory loss, particularly of recent
electrodes into a specific part of your brain. conversations and events. Repeated questions,
The electrodes are connected to a generator some problems expressing and understanding
implanted in your chest near your collarbone language. Mild coordination problems:
that sends electrical pulses to your brain and Depression and apathy can occur, accompanied
may reduce your Parkinson’s disease by mood swings. Need reminders for daily
symptoms. activities, and may have difficulty driving.

Nursing Interventions & Rationales STAGE II: Moderate/Middle (lasts 2-10 yrs) –
Can no longer cover up problems. Pervasive and
•Observe patient and assess energy level and
endurance, and how these affect respiratory status. persistent memory loss, including forgetfulness
Rationale:Energy ability decreases with age and chronic about personal history and inability to recognize
disease like PD. friends and family. Rambling speech, unusual
•Assess respiratory status for rate, depth, ease, use of reasoning, and confusion about current events,
accessory muscles, and work of breathing. time, and place. More likely to become lost in
Rationale: For baseline data familiar settings, experience sleep disturbances,
•Auscultate the lung fields for the presence of wheezes, and changes in mood and behavior, which can
crackles, rhonchi, or decreased breath sounds.
be aggravated by stress and change.
Rationale:Wheezing results from squeezing of air past
the narrowed airways during expiration which is caused STAGE III: Severe. In the final stage of the
disease, dementia symptoms are severe. inappropriate times or places or using vulgar
Individuals lose the ability to carry on a language
conversation and eventually, to control * Inappropriate outbursts of anger
movement. They may still say words or phrases
but communicating pain becomes difficult. As * Restlessness, agitation, anxiety, tearfulness,
memory and cognitive skills continue to worsen, wandering—especially in the late afternoon or
significant personality changes may take place evening
and individuals need extensive care. * Repetitive statements or movement,
occasional muscle twitches
LATE/ SEVERE STAGE :
Signs and Symptoms :
* Inability to communicate
EARLY STAGE :
* Weight loss
*Memory loss
* Seizures
* Poor judgment leading to bad decisions
* Skin infections
* Loss of spontaneity and sense of initiative
* Difficulty swallowing
* Taking longer to complete normal daily tasks
* Groaning, moaning, or grunting
* Repeating questions
* Increased sleeping
* Trouble handling money and paying bills
* Loss of bowel and bladder control
* Wandering and getting lost How is Alzheimer’s treated?
* Losing things or misplacing them in odd • Alzheimer’s disease is complex, and it is
places unlikely that any one drug or other
* Mood and personality changes intervention can successfully treat it. Current
approaches focus on helping people
* Increased anxiety and/or aggression maintain mental function, manage
MIDDLE/ MODERATE STAGE: behavioral symptoms, and slow or delay the
symptoms of disease.
* Increased memory loss and confusion
Medications:
* Inability to learn new things
 Cholinesterase inhibitors
* Difficulty with language and problems with
 Memantine
reading, writing, and working with numbers
* Difficulty organizing thoughts and thinking (Alternative Medicine)
logically  Omega 3 fatty acids
* Shortened attention span  Curcumin
 Ginkgo
* Problems coping with new situations
 Vitamin E
* Difficulty carrying out multistep tasks, such as
getting dressed Nursing Interventions and Rationales
* Problems recognizing family and friends 1. Orient the patient to the environment as needed if
the patient’s short-term memory is intact. The use of
* Hallucinations, delusions, and paranoia calendars, radio, newspapers, television, and so forth
* Impulsive behavior such as undressing at are also appropriate. Reality orientation techniques
help improve patients’ awareness of self and
environment only for patients with confusion related to
delirium or depression. Depending on the stage of AD, it
Treatment:
may be reassuring for patients in the very early states  There’s no cure for Huntington’s disease
who are aware that they are losing their sense of and its progress can’t be reversed or slowed
reality. Still, it does not work when dementia becomes down.
irreversible because the patient can no longer
 As the condition progresses, it may put a
understand reality. Television and radio programs may
strain on family and relationships.
be overstimulating, may increase agitation, and
Treatments for Huntington’s disease aim to
disorientating patients who cannot distinguish between
improve any mood disturbance; this is done
reality and fantasy or what they may view on television.
to maintain skills used in daily living that
2. Suggest the use of a calendar or making a list of
can deteriorate over time.
reminders.
Written reminders can help remind the patient of  Medication can help manage some of the
certain actions. symptoms, such as irritability or excessive
3. Encourage the use of complementary and movement. Therapies such as speech and
alternative therapies such as exercises, guided language therapy and occupational therapy
meditation, massage. can help with communication and day-to-
These activities can help reduce stress; stress can day living.
aggravate memory loss.
4. Assist the client in setting up a medication box. Movement disorders
A medication box can help remind them to take their The movement disorders associated with
medication at prescribed times and refill the box. Huntington's disease can include both involuntary
movement problems and impairments in voluntary
movements, such as:
HUNTINGTON’S DISEASE • Involuntary jerking or writhing movements
(chorea)
Is an inherited condition that damages • Muscle problems, such as rigidity or muscle
certain nerve cells in the brain. This brain contracture (dystonia)
damage gets progressively wore over time and • Slow or abnormal eye movements
can affect movement, cognition (perception, • Impaired gait, posture and balance
awareness, thinking, judgement, and behavior • Difficulty with speech or swallowing
Impairments in voluntary movements — rather than
SIGNS AND SYMPTOMS: the involuntary movements — may have a greater
impact on a person's ability to work, perform daily
PHYSICAL EMOTIONAL
activities, communicate and remain independent.
-Forms of nervous -Short term memory
activity like loss Cognitive disorders
fidgeting, minor -Less ability to Cognitive impairments often associated with
twitching in finger organize routine tasks Huntington's disease include:
and toes or to cope with new * Difficulty organizing, prioritizing or focusing on
-Excessive station tasks
restlessness -Period of depression, * Lack of flexibility or the tendency to get stuck on a
-Some clumsiness apathy and irritability thought, behavior or action (perseveration)
-Sight alteration in -Impulsiveness * Lack of impulse control that can result in
handwriting outbursts, acting without thinking and sexual
-Minor difficulty promiscuity
with normal daily * Lack of awareness of one's own behaviors and
physical skills like abilities
driving. * Slowness in processing thoughts or ''finding''
words
* Difficulty in learning new information Autosomal dominant inheritance pattern
Open pop-up dialog box
Psychiatric disorders Huntington's disease is caused by an inherited defect
The most common psychiatric disorder associated in a single gene. Huntington's disease is an
with Huntington's disease is depression. This isn't autosomal dominant disorder, which means that a
simply a reaction to receiving a diagnosis of person needs only one copy of the defective gene to
Huntington's disease. Instead, depression appears to develop the disorder.
occur because of injury to the brain and subsequent
changes in brain function. With the exception of genes on & the sex
chromosomes, a person inherits two copies of every
Signs and symptoms may include: gene — one copy from each parent. A parent with a
* Feelings of irritability, sadness or apathy defective gene could pass along the defective copy
* Social withdrawal of the gene or the healthy copy. Each child in the
* Insomnia family, therefore, has a 50% chance of inheriting the
* Fatigue and loss of energy gene that causes the genetic disorder.
* Frequent thoughts of death, dying or suicide
Complications
Other common psychiatric disorders include: After Huntington's disease starts, a person's
functional abilities gradually worsen over time. The
* Obsessive-compulsive disorder, a condition
rate of disease progression and duration varies. The
marked by recurrent, intrusive thoughts and
time from disease emergence to death is often about
repetitive behaviors
10 to 30 years. Juvenile Huntington's disease usually
* Mania, which can cause elevated mood, results in death within 10 years after symptoms
overactivity, impulsive behavior and inflated self- develop.
esteem
* Bipolar disorder, a condition with alternating Common causes of death include:
episodes of depression and mania • Pneumonia or other infections
• Injuries related to falls
In addition to the above disorders, weight loss is • Complications related to the inability to
common in people with Huntington's disease, swallow
especially as the disease progresses.
Prevention
Symptoms of juvenile Huntington's disease In vitro fertilization
The start and progression of Huntington's disease in Open pop-up dialog box
younger people may be slightly different from that People with a known family history of Huntington's
in adults. Problems that often present early in the disease are understandably concerned about whether
course of the disease include: they may pass the Huntington gene on to their
Behavioral changes children. These people may consider genetic testing
* Difficulty paying attention and family planning options.
*Rapid, significant drop in overall school If an at-risk parent is considering genetic testing, it
performance can be helpful to meet with a genetic counselor. A
* Behavioral problems genetic counselor will discuss the potential risks of a
positive test result, which would indicate that the
parent will develop the disease. Also, couples will
Physical changes need to make additional choices about whether to
* Contracted and rigid muscles that affect gait have children or to consider alternatives, such as
(especially in young children) prenatal testing for the gene or in vitro fertilization
* Tremors or slight involuntary movements with donor sperm or eggs.
* Frequent falls or clumsiness
* Seizures Diagnosis
A preliminary diagnosis of Huntington's disease is
Causes based primarily on your answers to questions, a
general physical exam, a review of your family diagnosis was confirmed with a genetic test.
medical history, and neurological and psychiatric
examinations. Predictive genetic test
A genetic test can be given if you have a family
Neurological examination history of the disease but don't have symptoms. This
The neurologist will ask you questions and conduct is called predictive testing. The test can't tell you
relatively simple tests of your: when the disease will begin or what symptoms will
* Motor symptoms, such as reflexes, muscle strength appear first.
and balance
* Sensory symptoms, including sense of touch,
vision and hearing
* Psychiatric symptoms, such as mood and mental Treatment
status No treatments can alter the course of Huntington's
Neuropsychological testing disease. But medications can lessen some symptoms
The neurologist may also perform standardized of movement and psychiatric disorders. And
tests to check your: multiple interventions can help a person adapt to
* Memory changes in his or her abilities for a certain amount of
* Reasoning time.
* Mental agility
* Language skills Medications will likely evolve over the course of the
* Spatial reasoning disease, depending on overall treatment goals. Also,
Psychiatric evaluation drugs that treat some symptoms may result in side
effects that worsen other symptoms. Treatment goals
You'll likely be referred to a psychiatrist for an will be regularly reviewed and updated.
examination to look for a number of factors that
could contribute to your diagnosis, including: Medications for movement disorders
* Emotional state Drugs to treat movement disorders include
* Patterns of behaviors the following:
* Quality of judgment
* Coping skills * Drugs to control movement include tetrabenazine
* Signs of disordered thinking (Xenazine) and deutetrabenazine (Austedo), which
* Evidence of substance abuse have been specifically approved by the Food and
Drug Administration to suppress the involuntary
Brain imaging and function jerking and writhing movements (chorea) associated
Your doctor may order brain-imaging tests for with Huntington's disease. These drugs don't have
assessing the structure or function of the brain. The any effect on the progression of the disease,
imaging technologies may include MRI or CT scans however. Possible side effects include drowsiness,
that show detailed images of the brain. restlessness, and the risk of worsening or triggering
These images may reveal changes in the brain in depression or other psychiatric conditions.
areas affected by Huntington's disease. These
* Antipsychotic drugs, such as haloperidol
changes may not show up early in the course of the
(Haldol) and fluphenazine, have a side effect of
disease. These tests can also be used to rule out other
suppressing movements. Therefore, they may be
conditions that may be causing symptoms.
beneficial in treating chorea. However, these drugs
may worsen involuntary contractions (dystonia),
Genetic counseling and testing
restlessness and drowsiness.Other drugs, such as
If symptoms strongly suggest Huntington's disease,
risperidone (Risperdal), olanzapine (Zyprexa) and
your doctor may recommend a genetic test for the
quetiapine (Seroquel), may have fewer side effects
defective gene.
but still should be used with caution, as they may
also worsen symptoms.
This test can confirm the diagnosis. It may also be
* Other medications that may help suppress chorea
valuable if there's no known family history of
include amantadine (Gocovri ER, Osmolex ER),
Huntington's disease or if no other family member's
levetiracetam (Keppra, Elepsia XR, Spritam) and
clonazepam (Klonopin). However, side effects may supports to improve posture may help lessen the
limit their use. severity of some movement problems.

Medications for psychiatric disorders Occupational therapy

Medications to treat psychiatric disorders will vary An occupational therapist can assist the person with
depending on the disorders and symptoms. Possible Huntington's disease, family members and
treatments include the following: caregivers on the use of assistive devices that
* Antidepressants include such drugs as improve functional abilities. These strategies may
citalopram (Celexa), escitalopram (Lexapro), include:
fluoxetine (Prozac, Sarafem) and sertraline (Zoloft). * Handrails at home
These drugs may also have some effect on treating * Assistive devices for activities such as bathing and
obsessive-compulsive disorder. Side effects may dressing
include nausea, diarrhea, drowsiness and low blood * Eating and drinking utensils adapted for people
pressure. with limited fine motor skills
* Antipsychotic drugs such as quetiapine
(Seroquel), risperidone (Risperdal) and olanzapine Nursing Intervention
(Zyprexa) may suppress violent outbursts, agitation, 1. Prevent injury and possible skin breakdown
and other symptoms of mood disorders or psychosis. * Pad the sides and head of the bed
However, these drugs may cause different * Keep the skin meticulously clean
movement disorders themselves. * Encourage ambulation with assistance to maintain
* Mood-stabilizing drugs that can help prevent muscle tone
the highs and lows associated with bipolar disorder * Secure the patient in bed or chair with padded
include anticonvulsants, such as divalproex protective devices making sure they are loosened
(Depakote), carbamazepine (Carbatrol, Epitol, frequently
others) and lamotrigine (Lamictal).
2. Keep patient as close to upright as possible while
feeding. Stabilize patient’s head gently with one hand
Psychotherapy
while feeding
A psychotherapist — a psychiatrist, psychologist
3. The nurse needs to educate and support the patient
or clinical social worker — can provide talk therapy
and family as they adjust to the lifestyle changes that
to help with behavioral problems, develop coping
strategies, manage expectations during progression are required.
of the disease and facilitate effective communication 4. The actions and potential side effects of medication
among family members. regimen need to be taught, monitored and adjusted to
the desired patient response.
Speech therapy 5. Regular moderate exercise can reduce stiffness and
Huntington's disease can significantly impair control tremors.
of muscles of the mouth and throat that are essential 6. As the disease progresses, the patient and family will
for speech, eating and swallowing. A speech require more assistance with activities of daily living,
therapist can help improve your ability to speak emotional support, and potential financial concerns.
clearly or teach you to use communication devices
— such as a board covered with pictures of everyday
items and activities. Speech therapists can also MULTIPLE SCLEROSIS
address difficulties with muscles used in eating and
Is an unpredictable, often disabling disease
swallowing.
of the central nervous system that disrupts the flow
of information within the brain between the brain
Physical therapy
A physical therapist can teach you appropriate and and body.
safe exercises that enhance strength, flexibility, In (MS) damage to the myelin coating
balance and coordination. These exercises can help around the nerve fibers in the central nervous
maintain mobility as long as possible and may
system and to the nerve fibers themselves interferes
reduce the risk of falls.
Instruction on appropriate posture and the use of
with the transmission of nerve signals between the
brain, spinal cord and the rest of the body. There's currently no cure for multiple
sclerosis (MS), but medicines and other treatments
Signs and Symptoms:
can help control the condition and ease some of the
 Fatigue symptoms.
 Vision problems Treatment for MS depends on the stage of the
 Numbness and tingling disease and the specific symptoms the person has.
 Muscle spasms
 Stiffness and weakness It may include:
 Mobility problems * treating relapses of MS symptoms (with steroids)
 Pain
* treating specific MS symptoms
 Problems with thinking planning and
learning * treatment to reduce the number of relapses
 Depression and anxiety (disease-modifying therapies)
 Sexual problems
You'll be supported by a team of different
 Bladder and bowel problems
healthcare professionals working together.
 Speech and swallowing difficulties
This may include a neurologist (specialist in
Causes: treating conditions of the nervous system), a
Its not clear what causes the immune system to physiotherapist, a speech and language therapist,
attack the myelin sheath. It seems likely that it’s and a number of other professionals.
partly caused by genes you inherit from your Treatment for multiple sclerosis relapses
parents and partly by outside factors that may
trigger the condition. Some possible causes include: Contact your specialist MS nurse or GP if you think
you're having a relapse.
-Genes
A flare-up of symptoms can sometimes be caused
-lack of sunlight vitamin D by something other than a relapse, such as an
-smoking infection, so your nurse or GP needs to check for
other possible causes.
-teenage obesity
Treatment for a relapse usually involves either:
-viral infection
* a 5-day course of steroid tablets taken at home
* injections of steroid medicine given in hospital for
DIAGNOSTIC TEST 3 to 5 days
Diagnosing MS is complicated because no Steroids can help speed up your recovery from a
single test can positively diagnose it. Other possible relapse, but they don't prevent further relapses or
causes of symptoms may need to be ruled out first. stop MS getting worse over time.
-MRI They're only given for a short period of time to
-Neurologic examination avoid possible steroid side effects, such as
osteoporosis (weak bones), weight gain and
-Evoked potential test diabetes, although some people will still experience
-Lumbar puncture problems.

-Blood test Not using steroids more than 3 times a year (if
possible) will also help to reduce the risk of side
Treatment: effects.
Nursing Intervention
•Note and accept the presence of fatigue.

Rationale: Fatigue is the most persistent and common

symptom of MS. Studies indicate that the fatigue
encountered by patients with MS occurs with
expenditure of minimal energy, is more frequent and
severe than “normal” fatigue, has a disproportionate
impact on ADLs, has a slower recovery time, and may
show no direct relationship between fatigue severity REPORTERS: (GROUP 6)
and patient’s clinical neurological status.
Hanin Macapado
•Identify and review factors affecting the ability to be
Isnihara Bint Lucman
active: temperature extremes, inadequate food intake,
insomnia, use of medications, time of day Najlah Shaynie Mangigin

Rationale:Provides an opportunity to problem-solve to Nayla Salic

maintain or improve mobility. Norfaisah Bitor
•Accept when the patient is unable to do activities. Norjanah Gapar

Rationale: Ability can vary from moment to moment. Roselainine Baute

Nonjudgmental acceptance of patient’s evaluation of Samirah Samad
day-to-day variations in capabilities provides the
opportunity to promote independence while supporting
fluctuations in the level of required care

•Determine the need for walking aids. Provide braces,

walkers, or wheelchairs. Review safety considerations

Rationale: Mobility aids can decrease fatigue, enhancing

independence and comfort, as well as safety. However,
individual may display poor judgment about the ability
to safely engage in an activity.

•Stress need for stopping exercise or activity just short

of fatigue.

Rationale: Pushing self beyond individual physical limits

can result in excessive or prolonged fatigue and
discouragement. In time, the patient can become very
adept at knowing limitations.

• Recommend participation in groups involved in

fitness or exercise and/or the Multiple Sclerosis
Society

Rationale: Can help the patient to stay motivated to

remain active within the limits of the disability or
condition. Group activities need to be selected carefully
to meet the patient’s needs and prevent
discouragement or anxiety