Module 6
What stage of sleep is impaired with a diagnosis of narcolepsy?
REM sleep
Give 2 reasons why it is important for someone with a seizure disorder to regularly see their care team (Neurologist and PCP)
To make sure their current medication is managing their seizure disorder and to make sure there aren't any new conditions that would require pharmacologic intervention that could interfere with their seizure medication.
Hypersomnia is associated with what specific type of depression?
Atypical depression
Describe the phenomenon of aura.
Aura is a sensation or movement that feels different or "off", and is often described as a warning sign that a seizure is about to occur.
What are the 3 hallmark signs of Parkinson's disease?
Tremor, rigidity, bradykinesia
Alpha waves are characteristic of which stage of sleep?
stage 1
What type of stroke are tPA drugs used to treat? How soon after the onset of a stroke must they be administered?
tPA drugs are used to treat ischemic strokes and must be administered within 3-4.5 hours after the onset of stroke symptoms
List the neuroglial cells of the CNS and PNS.
CNS: oligodendrocytes, astrocytes, microglia, and the ependymal cells PNS: satellite cells and Schwann cells
What are the 2 types of strokes? Describe the difference between them.
Ischemic strokes are a disruption in blood flow to the brain as a result of a blocked blood vessel. Hemorrhagic strokes are a disruption in blood flow to the brain as a result of ruptured blood vessel.
A patient with a diagnosis of Alzheimer's disease has no awareness of their surroundings and is completely dependent for all ADLs. What stage of Alzheimer's disease are they in?
Late or severe Alzheimer's
Why is Levadopa given to treat Parkinson's disease as opposed to dopamine?
Levadopa will cross the blood brain barrier while dopamine does not
What type of EEG wave is associated with REM sleep?
beta waves
A patient with diagnosis of Alzheimer's disease is able to function independently at home, but their family reports that they have trouble planning and executing everyday tasks that used to come easy to them e.g. paying their bills. What stage of Alzheimer's disease are they in?
early or mild Alzheimer's
Describe a treatment option for moderate OSA.
A custom dental appliance that positions the tongue forward and protrudes the mandible can be used to maintain an open airway. Nasal/naso-oral continuous positive airway pressure (NCPAP) can be utilized during sleep. A mask is placed over the nose/nose and mouth which is connected to a machine that produces positive pressure which prevents the airway from collapse
Describe 3 ways in which neurotransmitters are removed from the synaptic cleft.
A neurotransmitter can be broken down by enzymatic activity into inactive substances A neurotransmitter can be drawn back into the presynaptic neuron by a process known as reuptake A neurotransmitter can diffuse into the intercellular fluid until its concentration is too low to elicit a postsynaptic response
What is the difference between afferent and efferent neurons?
Afferent neurons carry sensory information from the periphery to the spinal cord and brain while efferent neurons carry motor output from the brain and spinal cord to the periphery.
List 3 risk factors for OSA.
Any of the following are correct answers: - male gender - advanced age - family history - alcohol and drug abuse - obesity - large neck girth (>40 cm)
List 2 factors that could contribute to depression.
Any of the following are correct: -Inherited/familiar link -Chemical imbalance -Hormonal imbalance/change -Stress/trauma leading to an altered HPA axis
List 3 non-medicinal interventions that can be used to address sleep changes in someone with Alzheimer's disease.
Any of the following are correct: -Keep a regular routine during the day -Encourage daily exercise that is earlier in the day and not close to bedtime -Avoid caffeine intake altogether if possible but certainly in the afternoon and evening -Discourage watching television right before bed -Make sure the room environment is familiar and comfortable for the individual -Provide the person with any security object that is a source of comfort to them
Describe how CSF is produced and its function.
CSF serves as a cushion for the brain and spinal cord protecting them from outside physical force. It maintains a constant ionic environment that allows for the diffusion of essential nutrients, electrolytes, and metabolic waste products into the extracellular fluid surrounding the CNS neurons. A thin layer of neuroglial cells, collectively known as the ependyma, line the ventricles of the brain and the central canal of the spinal cord. Specialized ependymal cells called the choroid plexus project into the ventricles and produce CSF.
What are the goals of acute treatment of a hemorrhagic stroke?
Control bleeding and decrease pressure on the brain tissue
Be familiar with the cranial nerves and their general function. Refer to Table 6.1.
Cranial Nerve & Functions CNI (Olfactory Nerve)- olfaction (sense of smell) CNII (Optic Nerve)- Vision (sense of sight) CNIII (Oculomotor Nerve)- Pupillary constriction, accommodation, eye movement and eye lid movement CNIV (Trochlear Nerve)- Movement of eye down and inward CNV (Trigeminal Nerve)- Mastication (chewing) and sensation to the face, nose, and mouth CNVI (Abducens Nerve)- Movement of the eye laterally CNVII (Facial Nerve)- Facial expression as well as sensation of taste to the anterior tongue CNVIII (Vestibulocochlear Nerve)- Auditory sensation (sense of hearing) as well as balance and equilibrium CNIX (Glossopharyngeal Nerve)- Motor innervation to muscles involved in swallowing as well as the sensation of taste to the posterior tongue CNX (Vagus Nerve)- Digestion, regulation of heart rate, and sensation to the digestive tract CNXI (Accessory Nerve)- Motor innervation to cervical rotator muscles and the trapezius muscle CNXII (Hypoglossal Nerve)- Voluntary tongue movements
A "nervous tick" is associated with what specific type of depression?
Depression with catatonic features
Parkinson's disease is characterized by a loss of which neurotransmitter?
Dopamine
Compare and contrast NREM and REM sleep regarding muscle tone, vital signs, and brain activity.
During NREM sleep, muscle tone is moderate; vital signs and brain activity are decreased. During REM sleep, muscle tone decreases; vital signs and brain activity increases.
What is the main difference between focal and generalized seizures?
Focal seizures affect one specific part of the brain in 1 hemisphere. Generalized seizures affect both hemispheres of the brain.
Be familiar with risk factors for CVA/stroke. Refer to Table 6.3.
Nonmodifiable factors: Age- incidence increases with age Sex- men have a higher rate of incidence at younger age. Women are more likely to die of a stroke because they live longer than men on average Race- African American and Hispanic/Latino Americans have a higher mortality rate compared to White caucasians -prior history of stroke -family history of stroke Modifiable factors: -hypertension -hypercholesteremia -diabetes -hypercoagulopathy -cardiac disease Modifiable behaviors: -smoking -alcohol consumptions -birth control pills especially in combination with smoking -immobility -obesity -illicit drug use
List the 4 diagnostic characteristics of insomnia.
One is considered to have insomnia if they experience 3 of the following: - difficulty initiating sleep - difficulty maintaining sleep - waking up too early - chronic nonrestorative or poor sleep
Describe each phase of an action potential.
Phase 1: Resting Potential: during the resting phase, both sodium and potassium gates are closed Phase 2: Depolarization: the sodium gates open, and sodium rushes into the axon during the depolarization phase of the action potential. Voltage travels to zero and then up to +40mV. Phase 3: Repolarization: the sodium gates close, and potassium gates open allowing potassium to rush out of the axon. This returns a negative voltage to the inside of the axon. Phase 4: After-polarization: also called hyperpolarization. Potassium gates are slow to close, and there is an undershoot of the potential. The voltage drops below -70mV and then returns to -70mV as the resting state is re-established.
What is sleep hygiene?
Sleep hygiene involves the establishment of consistent sleep patterns (going to bed at the same time each night and only sleeping as long as one needs to feel refreshed during the day), creating a comfortable sleeping environment (optimal room temperature), avoidance of screens and excessive light right before bed, and finally, avoidance of stimulants (caffeine) several hours prior to normal bedtime.
List the 2 major divisions of the nervous system and the structures found in each.
The 2 divisions of the nervous system are the central nervous system (CNS) containing the brain and the spinal cord an the peripheral nervous system (PNS) containing spinal nerves, cranial nerves, and ganglia that are outside of the PNS.
Be familiar with each division of the nervous system and their function. Refer to Figure 6.4.
The Nervous System CNS or PNS PNS (afferent or efferent) leads to Somatic Nervous system (voluntary control) or Autonomatic Nervous system (involuntary control) Autonomatic Nervous system leads to sympathetic (activates and prepares the body for vigorous muscular activity, stress, and emergencies) or parasympathetic (operates during normal resting situations, permitting digestion and the conservation of energy.)
What is the major difference between central sleep apnea and obstructive sleep apnea?
The brain does not properly signal the respiratory muscles with central sleep apnea. With OSA, the airway collapses, but the respiratory muscles maintain their function.
Describe the meninges and their function.
The meninges are connective tissue sheaths that surround the brain and spinal cord. The pia mater is the innermost layer of the meninges. It is thin and delicate and contains surface level blood vessels that perfuse the brain and spinal cord. The second layer of the meninges is the arachnoid layer. It encases the entire CNS and is delicate, nonvascular, and waterproof. Cerebrospinal fluid (CSF) circulates in an area just below the arachnoid layer called the subarachnoid space. The third later of the meninges is known as the dura mater. The dura mater is a strong, continuous connective tissue sheath that provides the brain and spinal cord with most of its protection.
What is a TIA and why are they important?
Transient ischemic attacks (TIAs) are often referred to as "mini strokes". There is a temporary disruption of blood flow as with an ischemic stroke usually due to atherosclerotic blockage in the main feeding arteries to the brain. A person will experience symptoms; however, the symptoms will resolve within 24 hours without permanent damage to the brain. These should not be ignored as they serve as a warning sign. Most people who experience a TIA will eventually experience a stroke.
