RALLOS, RAFAELA FRANCINE B.

BS1E

MODULE 14: ANATOMY & PHYSIOLOGY CASE STUDY #4: NERVOUS SYSTEM

mood and personality changes, forgetfulness, poor-decision makings, memory lapses

n/a

Amlodopine 5mg od am

hypertension
visual inacquity of 20/50

aml
took amlodipine 9/18
ran over a stop sign ,
almost bumped a dog

progressive

irritated , lost of interest

n/a

n/a

n/a

n/a

n/a

n/a

still verbal

183 cm, 170lbs 68yrs old

BP: 120/80 Respiratory Rate: 15/min Pulse: 87 beats/min

Physical/Neuro Exam:
FBS: A1C - 5 / FPS Balance&Coordination
- 87 / OGT - 135 is normal FDG PET scan: low brain
metabolism activity

Decreased
FBS: A1C - 5 /brain mass,
FPS - 87 / OGT - 135 (not diabetic)

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MODULE 14: ANATOMY & PHYSIOLOGY CASE STUDY #4: NERVOUS SYSTEM

Pre-Assessment Questions:
1. What is a neuron? Describe it’s parts and draw a simple picture labeling them.

* NEURON - carries impulses

* DENDRITES - branch out from cell body and pick
up incoming messages
* NUCLEUS - contains DNA an RNA
* AXON - joins cell body at a specialized junction
called the axon hillock
* SOMA - carries genetic information, maintains the
neuron’s structure, and provides energy to drive
activitie

2. What might be occurring in Professor Daniels’ brain?

A major cause of the disease Alzheimer's is when there is build-up of amyloid plaques
(dense protein deposits) and tau-containing neurofibrillary tangles (twisted fiber deposits
inside the nerve cells) which causes for the brain cells or neurons to die. Alzheimer’s
causes the processes vital to neurons and their networks to wear off, this affects
communication, metabolism, and repair.

3. What are the main functions of the nervous system? Which functions are causing
Professor Daniels problems?
3 broad functions of the nervous system are sensory input, information processing, and motor
input. By sensory input, it means to gather data by the means of the neurons, glial cells, and
synapses. While, information processing starts with input from the sensory organs,
which transform physical stimuli into signals. Motor input is related to movement.

In Professor Daniel's case both his sensory input and information processing are causing the
problems
4. What is the difference between the central and peripheral nervous system?
Autonomic & somatic? Sympathetic & parasympathetic?
* The CNS includes the brain and spinal cord, the PNS includes all the nerves from the brain
throughout the body.
* The Autonomic Nervous System controls internal organs and glands, it also synapses in
the ganglion. While the Somatic Nervous System controls muscle and movement and goes
from brain to spinal cord to muscle.
* The sympathetic nervous system is responsible for "fight/flight" reaction while the
parasympathetic nervous system is for "rest/digest" response.

5. How is a nerve impulse conducted? Describe the process? Might there be any
problem in the conduction of Professor Daniels nerve impulses?

A neuron starts off in a resting state and is not conducting an impulse, then when
depolarization is initiated positively charged sodium enters the axon and inside becomes more
positive than negative. Re-polarization happens when the potassium leaves cell until it is back
into its complete resting stage. The impulse travels, quick ion movement then causes a wave
along the axon, myelin sheath causes the ion exchange to occur in the openings making
processes to go faster. Transmission then happens at the synapse and refractory period is
reached again. This period is where neuron goes back to resting potential.

Yes it is very possible that there is a problem with Professor Daniel's impulses. In Alzheimer's,
neurons and their connections are slowly destroyed especially in parts of the brain involved in
memory, including the entorhinal cortex and hippocampus.

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MODULE 14: ANATOMY & PHYSIOLOGY CASE STUDY #4: NERVOUS SYSTEM

Research:

Research
Team Member Notes from Team Member
Focus

Labs/Tests Requested (explain reasoning, expected results, & actual results for each!)
Fasting Blood Sugar (FBS) - elderly people are recommended to have regular (annual) laboratory exams of their blood
chemistry, in this case it helps cross out co-morbidity this include FPS and lipid profile. Actual results are in p.6 and all are
within normal range.
Physical/Neurological Exam - this will examine the patient's reflexes, sense of sight and hearing, coordination and
balance, this is significant for someone with Alzheimer's/Dementia to determine the stage of the disease and to know
how much care and monitoring the patient needs. Patient w/ Alzheimer's can still have normal results in the early stage but
as it progresses, lost of eyesight and coordination is to be expected.

FDG-PET is used to measure cerebral metabolic rates of glucose (CMRglc), a proxy for neuronal activity. A normal person
would have normal metabolic brain activities. A person w/ Dementia or Alzheimer's will have decreased glucose metabolic
rate .

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MODULE 14: ANATOMY & PHYSIOLOGY CASE STUDY #4: NERVOUS SYSTEM

Physical/Neuro Test are normal (w/ balance & coordination) but memory lapses should be noted,
FBS test shows no co-morbidity and FDG PET Scan shows low glucose metabollic activity

Creutzfeldt-Jakob disease - dementia, mood anxiety w/ movement difficulty

Corticol Basal Degeneration
Lewy Body Dementia - Visual hallucinations, REM sleep disorder, delirium,
Capgras' syndrome, parkinsonism affecting

FTD, frontotemporal dementia - Apathy; poor judgment/insight, speech/language;

Creutzfeldt-Jakob
hyperorality , halluciationsdisease
are uncommon

Frontotemporal Dementia

Memory loss, spatial disorientation, decreased

glucose metabolism in brain

In Alzheimer's hallucination are experienced, no

hallucinations are stated in his history/ language
disorientation (confusion in words) can also be noted

- A guardian should be present and the patient shall never be left alone

- An elderly home that can care for dementia needs maybe suggested if a guardian
can't be provided

- Donpezil - (Cholinesterase Inhibitors) is to be prescribed; prevents ACh from

breaking down and slows down progression of dementia. This reduces patient's anxiety, and
improves concentration
-
- psychiatric evaluation is to be don regularly , every 2 weeks to monitor patient's
progression and response to given medicine.

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MODULE 14: ANATOMY & PHYSIOLOGY CASE STUDY #4: NERVOUS SYSTEM

STATEMENT OF HEALTH: Written Presentation of Patient

Often, physicians are asked to provide a written statement of health for patients
for various reasons. In this case, Professor Daniels’ wife is requesting it as a formal
way to understand what her husband is going through, as well as a document to
use if she should need to try to have his drivers’ license legally revoked or
eventually get help in the home or an assisted living facility for him.

Draft a professional letter that includes the following information:

• Diagnosis and explanation

• Treatment plan

• Prognosis and expected outcomes

• Recommendations for future care

• Restrictions, if any

Outline of Statement of Health:

DIAGNOSIS: Frontotemporal Demtia; memory loss/lapses, spatial disorientation, reduced glucose metabolism in the brain.
DIAGNOSIS: FrontoTemporal
TREATMENT PLAN: Prescribed with Donzepil to help with memory and concentration; Citalopram may later be
prescribed for irritability and extreme mood swings. Regular exercise with supervision of guardian is recommended to
maintain reflexes, muscle strength,, and coordination.

EXPECTED OUTCOMES: Donzepil is expected to slow down the progression of the Dementia for 6 to 12 months;
Nausea and Vomiting are expected side effects.

Recommendations for Future Care: If progression has to come to degenerative stage, patient may be suggested to be
admitted to the hospital or elderly home.

Restrictions: N/A ,

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