Respond to both of these add on the conversation and topic and cite APA
TOPIC 1
Brief/condensed pathophysiologic overview of the selected topic
Dementia with Lewy Bodies (DBL) is a form of progressive dementia, closely related to Alzheimer’s Disease (AD) and Parkinson Disorder Dementia. Pathogenesis appears to be related to the aggregation of the proteins alpha-synuclein and ubiquitin into Lewy bodies and Lewy neurites in the brain. Neurofibrillary tangles and amyloid plaques can also be present in DLB, as in other dementias like AD. Dopamine and cholinergic neurons are affected, resulting in Parkinson-like symptoms. Inheritance is being investigated (Dlugasch & Story, 2024; Haider et al., 2023).
Symptoms/clinical manifestations/physical assessment findings
Progressive dementia is often the primary symptom. Impairment often begins with diminishing attention and executive and visuospatial impairment, rather than memory loss as in AD. The patient may experience fluctuating levels of alertness, somnolence, confusion, and irregular behavior. Hallucinations are common and a distinguishing feature from AD. Motor activity during dreaming is also common, as is Parkinsonism (irregular gait, limb rigidity, bradykinesia). Additional symptoms include frequent falls, fainting spells, delusions, depression, orthostatic hypotension, urinary incontinence, and constipation (Dlugasch & Story, 2024; Haider et al., 2023).
Morbidity and mortality data/incidence rates
DLB is underdiagnosed, but accounts for 20%-30% of dementia cases; it is more common in men and the risk increases with age. Family history of Parkinson’s Disease or DLB also increases the risk. Complications like falls, medication side effects, pneumonia, and suicide often cause death. Life expectancy is five to eight years after diagnosis (Haider et al., 2023). Compared to other dementias, DLB patients have shorter survival rates, higher hospitalization rates, and increased caregiver stress (Pan et al., 2024).
How can this condition be prevented? (If not preventable, please specify why.)
Like most dementias, DLB cannot be prevented but there are studies that show patients with high blood pressure are at a 40% higher risk of dementia of any type. Diabetes results in 80% higher risk. Therefore, healthy lifestyle choices like physical activity and a healthy diet may reduce the risk of dementia. Social and cognitive activities have also shown to have some preventive benefit (Mirzapure et al., 2022).
How is this condition diagnosed?
Diagnosis is based on history and physical. Key features such as hallucinations and Parkinsonism distinguish DLB from other dementias. Imaging and blood tests may be done to rule out other causes of the symptoms. The Lewy body composite risk score assesses motor and balance, stiffness, and non-motor symptoms. Currently, autopsy is the only definitive diagnosis (Dlugasch & Story, 2024; Haider et al., 2023). However, emerging research shows promise in multiple areas, including plasma metabolite parameters to distinguish DLB from AD (Pan et al., 2024).
How is this condition managed/treated?
Treatment focuses on managing symptoms, as there is no cure for DLB. Non-pharmacological treatment includes exercise, physical therapy, and memory aids. Medications can include cholinesterase inhibitors, memantine, and levodopa. Antipsychotics have an increased risk of severe sensitivity in up to 50% of patients with DLB, so they should be avoided. Melatonin and clonazepam may help with sleep disturbances and SSRIs may be necessary for depression (Dlugasch & Story, 2024; Haider et al., 2023).
Important client/patient information
DLB often results in decreased quality of life and caregivers suffer more than with other dementias. Multimodal therapies can be helpful (occupational, speech, physical, psychiatric, etc.). Support groups for the caregiver and the patient are important sources of information and assistance.
Caregivers need to monitor the patient closely and provide significant assistance with activities of daily living and proper medication administration as functional ability is severely limited. It is important to monitor for falls, aspiration, and changes in mental and physical status. Many patients eventually need long-term care outside the home.
DLB is closely related to other dementias, but it is important to distinguish it early; it may be more responsive to medication during early stages of the disease. However, there is no cure. Medications may have side effects so discuss the benefits and draw backs with the provider (Haider et al., 2023).
References
Dlugasch, L., & Story, L. (2024). Applied pathophysiology for the advanced practice nurse. Jones & Bartlett Learning.
Haider, A., Spurling, B. C., & Sánchez-Manso, J. C. (2023). Lewy body dementia. NIH National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK482441/
Mirzapure, S., Tiwaskar, S., & Pathade, A. (2022). Dementia in old age: Prevention, intervention & care. Journal of Pharmaceutical Negative Results, 13(8), 156–164. https://doi.org/10.47750/pnr.2022.13.s08.024
Pan, X., Donaghy, P. C., Roberts, G., Chouliaras, L., O’Brien, J. T., Thomas, A. J., Heslegrave, A. J., Zetterberg, H., McGuinness, B., Passmore, A. P., Green, B. D., & Kane, J. P. M. (2024). Plasma metabolites distinguish dementia with Lewy bodies from Alzheimer’s disease: a cross-sectional metabolomic analysis. Frontiers in Aging Neuroscience, 15. https://doi.org/10.3389/fnagi.2023.1326780
Please add on and discuss more about each topic. Thanks.
TOPIC 2
Neural Discussion
Amyotrophic lateral sclerosis (ALS) is a progressive degenerative neurological disorder which involves damage to the motor neurons (Dlugasch & Story, 2023). The upper motor neurons (UMNs) send electrical signals down to the spinal cord from the cerebral cortex (Kiper et al., 2023). Lower motor neurons (LMNs) send signals from the spinal cord to the muscles of the body (Kiper et al., 2023). In ALS, dysfunction of the UMNs leads to weaker impulses to the LMNs (Vacca, 2020). The weaker nerve impulses manifest as the signs and symptoms of ALS such as muscle weakness, spasticity, and hyperreflexia (article). ALS is most diagnosed in white males between the ages of 40-70 (Vacca. 2020). Approximately 10% of cases are caused by an inherited mutated gene (Kiper et al., 2023). According to Kiper et al. (2023), risk factors for ALS include age and family history of the disease. The etiology of ALS is unknown but most research focuses on genetic and environmental factors (Kiper et al., 2023).
Symptoms can begin in any muscle group and progress to more muscle groups over time (Vacca, 2020). Symptoms are dependent on the location of the affected motor neurons and can include loss of dexterity, fatigue, spasticity, muscle atrophy, muscle weakness, paralysis, involuntary movement, and clonus (Vacca, 2020). Cervical-level ALS onset affects both UMNs and LMNs and presents with the upper limbs such as fine motor movements which can be present unilaterally or bilaterally (Vacca, 2020). Lumbar-onset ALS is associated with muscle wasting and lower extremity weakness (Vacca, 2020). Bulbar involvement affects the muscles of the oral cavity including the tongue and results in dysphagia and dysarthia (Vacca, 2020).
ALS is a progressive neurodegenerative disease with a high morbidity and mortality rate (Vacca, 2020). It is the third most common neurodegenerative disease (Vacca, 2020). Individuals diagnosed with ALS have a life expectancy of around 5 years following the onset of symptoms (Vacca, 2020). According to Kiper et al. (2023), approximately 20,000 individuals in the United States are living with ALS. ALS most often affects males between the ages of 45-75 with a median age of 55 at onset (Vacca, 2020).
According to (Arsh et al., 2023), there are two types of ALS, sporadic, which accounts for 90 % of all cases while the remaining 10 % are familial. Because there is no known definitive cause of ALS, prevention is very difficult (Benetar et al., 2023). Research suggests recognizing risk factors for ALS could lead to prevention measures (Benetar et al., 2023). Identifying environmental risks associated with ALS could lead to future measures for prevention (Benetar et al., 2023).
According to Dlugasch & Story (2023), ALS is diagnosed by ruling out other neurological disorders. Electromyogram, MRI, nerve conduction studies, lumbar puncture and analysis, and muscle biopsy are examples of tests that are frequently used to diagnose ALS along with history and physical examination (Dlugasch & Story, 2023). According to Vacca (2020), the World Federation of Neurology has established the following guidelines for diagnosis of ALS which includes progressive weakness involving UMNs and LMNs simultaneously and exclusion of alternative diagnosis. Involvement of three of the following UMN and LMN sites is considered a definitive diagnosis: bulbar, cervical, thoracic, or lumbosacral (Vacca. 2020). The Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) is considered a reliable tool for assessment of functional status in patients with ALS (Vacca, 2020).
Since there is no cure for ALS, treatment focuses on slowing disease progression and symptom management (Dlugasch & Story, 2023). Currently, there are two medications approved for treatment of ALS: Riluzole and Edaravone (Dlugasch & Story, 2023). Riluzole which is thought to reduce motor neuron damage by reducing levels of glutamate (Vacca, 2020). According to Vacca (2020), Edaravone prevents oxidative damage to cells. According to Dlugasch & Story (2023), antispasmodic medications may be effective in treating muscle spasms associated with ALS. Maintaining and maximizing function through physical, occupational, and speech therapy is also key in the management of ALS disease progression (Dlugasch & Story, 2023). Palliative care can provide improvement in quality of life for patients with ALS (Dlugasch & Story, 2023). According to our text, as the disease progresses, respiratory management including oxygen therapy, respiratory treatments, and ventilation becomes necessary (Dlugasch & Story, 2023).
The goal in caring for patients with ALS is to promote quality of life and provide supportive measures to maximize function as the disease progresses (Kiper et al.,2023). Providing open communication with the patient and caregivers to verbalize questions and concerns is important. Patients diagnosed with ALS should be provided education regarding the progression and prognosis associated with the disease so that advanced care planning can be accomplished. The patient and caregivers should also be informed of available resources and support to assist with the patient’s physical and mental health care.
References
Arsh Haj Mohamad Ebrahim Ketabforoush, Rojin Chegini, Shirin Barati, Fatemeh Tahmasebi, Bardia Moghisseh, Mohammad Taghi Joghataei, Faezeh Faghihi, & Fereshteh Azedi. (2023). Masitinib: The promising actor in the next season of the amyotrophic lateral sclerosis treatment series. Biomedicine & Pharmacotherapy, 160(114378-). https://doi-org.ezproxy.una.edu/10.1016/j.biopha.2023.114378
Benatar, M., Goutman, S. A., Staats, K. A., Feldman, E. L., Weisskopf, M., Talbott, E., Dave, K. D., Thakur, N. M., & Al-Chalabi, A. (2023). A roadmap to ALS prevention: Strategies and priorities. Journal of Neurology, Neurosurgery, and Psychiatry, 94(5), 399–402. https://doi-org.ezproxy.una.edu/10.1136/jnnp-2022-330473
Dlugasch, L., & Story, L. (2023). Applied pathophysiology for the advanced practice nurse. Jones & Bartlett Learning.
Kiper, V., Gary, A., & Geist, R. (2023). Navigating ALS: An overlooked disease. Nursing, 53(2), 24–30. https://doi-org.ezproxy.una.edu/10.1097/01.NURSE.0000905700.44849.f4
Vacca Jr., V. M. (2020). Amyotrophic lateral sclerosis: Nursing care and considerations. Nursing, 50(6), 32–40. https://doi-org.ezproxy.una.edu/10.1097/01.NURSE.0000662348.31823.44
