Discussion #1 Elyse Ross
Musculoskeletal System
Definition of Osteoarthritis and Risk Factors Analysis
Osteoarthritis (OA) is a joint disease involving the degeneration of cartilage and the underlying bone. It usually influences weight-bearing joints like the knees, hips, and back. Symptoms may include joint pain, stiffness, and reduced range of motion (Garrick, 2019). Osteoarthrosis and osteoarthritis are sometimes used interchangeably, although strictly speaking, osteoarthrosis denotes a degenerative change of joints without inflammation, whereas osteoarthritis includes both degeneration and inflammation. In the clinical setting, the two terms are commonly used interchangeably.
Risk factors contributing to the diagnosis of osteoarthritis in this case include:
Age: 71 years old increases the likelihood of degenerative joint diseases.
Overweight: Excess weight puts increased stress on weight-bearing joints, such as the knees and hips, contributing to the development and progression of osteoarthritis.
Family history: G.J. mentions concern about osteoporosis in her family, suggesting a genetic predisposition to musculoskeletal issues.
Previous knee discomfort exacerbated by weight gain: Weight gain can aggravate symptoms of osteoarthritis due to increased mechanical stress on the joints.
Symptoms worsen with rain and improve with warm, dry weather: Weather sensitivity is often associated with osteoarthritis, though the exact mechanism is not fully understood.
Comparison between Osteoarthritis and Rheumatoid Arthritis
Unlike osteoarthritis, rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation of the synovial membrane, resulting in joint damage and systemic symptoms. The clinical manifestations of osteoarthritis are joint pain aggravated with activity, stiffness after a period of inactivity, and limited range of motion. On the other hand, rheumatoid arthritis commonly has symmetrical joint pain, swelling, morning stiffness lasting for more than 30 minutes, and systemic symptoms such as fatigue and weight loss (University of Michigan Health, 2019). Osteoarthritis mainly involves degenerative changes in particular joints, while rheumatoid arthritis causes chronic inflammation of synovial tissue and systemic manifestations. Typically, osteoarthritis affects weight-bearing joints, such as knees, hips, and spine, as well as hands and feet. Rheumatoid arthritis, on the other hand, often affects smaller joints, and it tends to develop symmetrically, e.g., hands, wrists, and feet.
Treatment Alternatives for Osteoarthritis
Management of osteoarthritis encompasses non-pharmacological and pharmacological interventions. Amongst non-pharmacological options are weight management to take stress off joints, exercise that improves joint flexibility and strength, and assistive devices to reduce common strain (Garrick, 2019). Pharmacologic approaches include using acetaminophen for pain management, nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and inflammation, topical agents such as capsaicin or topical NSAIDs for localized pain, use of intra-articular corticosteroid injections or hyaluronic acid injections for symptomatic relief. In severe cases, total knee replacement may be opted as a surgical option.
Handling Patient Concerns about Osteoporosis
Responding to G.J.’s concerns about osteoporosis includes education as well as intervention. Informing her of the risk factors and prevention of osteoporosis is highly important. Recommending a DEXA scan and advising lifestyle modifications, like weight-bearing exercises, calcium and vitamin D-rich intake, and smoking cessation are the critical steps. Pharmacological interventions, including bisphosphonates or selective estrogen receptor modulators (SERMs), may be indicated based on the DEXA scan and risk assessment results. Continuous monitoring and management are highlighted to maintain bone health and significantly lower the risk of fractures, clarifying any misunderstandings or fears about osteoporosis and its treatment.
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Discussion #2 Jennifer Derusso
Neurologic Function:
Name the most common risks factors for Alzheimers disease.
Alzheimer’s disease, the most common form of dementia, is influenced by various risk factors, both modifiable and non-modifiable (Dlugasch & Story, 2019). Age is the primary non-modifiable risk factor and increases significantly after the age of 65 and doubling every five years thereafter (Dlugasch & Story, 2019). Genetics also play a significant role, with family history and specific genetic mutations increasing susceptibility (Dlugasch & Story, 2019). Evidence suggests that accumulated oxidative stress may be one of the key mechanisms causing cognitive aging and neurodegenerative diseases such as AD (Ionescu-Tucker & Cotman, 2021). Other non-modifiable risk factors include a history of head trauma and certain medical conditions like Down syndrome (Dlugasch & Story, 2019). Modifiable risk factors include cardiovascular risk factors such as hypertension, high cholesterol, diabetes, obesity, and a sedentary lifestyle (Dlugasch & Story, 2019). Additionally, factors like smoking, excessive alcohol consumption, social isolation, and limited cognitive activity have been associated with an increased risk of Alzheimer’s disease (Dlugasch & Story, 2019).
Name and describe the similarities and the differences between Alzheimers disease, Vascular Dementia, Dementia with Lewy bodies, Frontotemporal dementia.
Alzheimer’s disease, vascular dementia, dementia with Lewy bodies, and frontotemporal dementia are all types of dementia, sharing some similarities while also exhibiting distinct characteristics. They all involve progressive cognitive decline, memory impairment, and changes in behavior and personality. However, Alzheimer’s disease is characterized by the accumulation of beta-amyloid plaques and tau protein tangles in the brain, leading to widespread neuronal damage and loss (Dlugasch & Story, 2019). Vascular dementia results from impaired blood flow to the brain due to strokes or other vascular conditions, causing cognitive decline often accompanied by neurological symptoms such as weakness or paralysis (Dlugasch & Story, 2019). Dementia with Lewy bodies is the presence of abnormal protein deposits called Lewy bodies in the brain, leading to cognitive fluctuations, visual hallucinations, and motor symptoms resembling Parkinson’s disease (Dlugasch & Story, 2019). Frontotemporal dementia primarily affects the frontal and temporal lobes of the brain, resulting in changes in behavior, personality, and language skills, often occurring at a younger age compared to other forms of dementia (Dlugasch & Story, 2019)
Define and describe explicit and implicit memory.
Explicit memory, also known as declarative memory, refers to the conscious recollection of past experiences, facts, and events (Dlugasch & Story, 2019). It involves the ability to intentionally recall specific information and is typically characterized by conscious awareness and effortful retrieval processes (Dlugasch & Story, 2019). Explicit memory can be further divided into semantic memory, which pertains to general knowledge and factual information about the world, and episodic memory, which involves the recollection of personal experiences and specific events linked to time and place (Dlugasch & Story, 2019). For example, remembering your last birthday party or recalling historical facts about a certain event are instances of explicit memory (Dlugasch & Story, 2019). This type of memory relies heavily on regions of the brain such as the hippocampus and prefrontal cortex, which are involved in encoding, storing, and retrieving information (Dlugasch & Story, 2019). Explicit memory plays a crucial role in various aspects of daily life, including learning, problem-solving, and decision-making (Dlugasch & Story, 2019).
Describe the diagnosis criteria developed for the Alzheimers disease by the National Institute of Aging and the Alzheimers Association
The diagnostic criteria developed by the National Institute of Aging and the Alzheimers Association are divided into three stages: preclinical Alzheimer’s disease, mild cognitive impairment (MCI) due to Alzheimer’s disease, and dementia due to Alzheimer’s disease (Alzheimer’s and Dementia, 2023.). In the preclinical stage, individuals may have evidence of Alzheimer’s pathology (e.g., beta-amyloid and tau accumulation) without noticeable cognitive symptoms (Alzheimer’s and Dementia, 2023.). Biomarkers such as cerebrospinal fluid analysis, positron emission tomography (PET) imaging, and genetic testing may be used to detect early signs of AD pathology (Alzheimer’s and Dementia, 2023.).
In the MCI stage, individuals exhibit mild cognitive impairment that is greater than expected for age and education level but does not significantly impair daily functioning (Alzheimer’s and Dementia, 2023.). Biomarker evidence of Alzheimer’s pathology is often present, supporting the diagnosis of MCI due to Alzheimer’s disease (Alzheimer’s and Dementia, 2023.).
Finally, in the dementia stage, individuals experience significant cognitive decline that interferes with daily functioning and is consistent with Alzheimer’s pathology. Biomarker evidence may further support the diagnosis of dementia due to Alzheimer’s disease (Alzheimer’s and Dementia, 2023.).
What would be the best therapeutic approach for C.J?
The behaviors CJ’s daughter describes indicate CJ has mild to moderate cognitive impairment. Recommended therapies and interventions for patients that are experiencing cognitive decline are aimed at managing symptoms, slowing disease progression, and improving overall quality of life (Alzheimer’s and Dementia, 2023). Healthy lifestyle habits such as getting adequate sleep, managing stress, avoiding smoking and excessive alcohol consumption, and maintaining a mentally stimulating environment can support overall brain health and cognitive function (Alzheimer’s and Dementia, 2023).
Additionally, cognitively stimulating activities that challenge the brain, like puzzles, word games, and memory exercises, may improve cognitive function (Alzheimer’s and Dementia, 2023). Regular physical activity has cognitive benefits by improving blood flow to the brain, reducing inflammation, and promoting the release of neuroprotective factors (Zhou et al., 2022). Walking, swimming, and tai chi are particularly beneficial (Zhou et al., 2022). Maintaining social connections and participating in social activities can help prevent isolation and depression (Alzheimer’s and Dementia, 2023). She should also eat a balanced diet of fruits, vegetables, whole grains, and lean proteins to support brain health (Alzheimer’s and Dementia, 2023). Specific diets, such as the Mediterranean diet, have been associated with a lower risk of cognitive impairment (Alzheimer’s and Dementia, 2023). If indicated, certain medications used to treat Alzheimer’s disease, such as cholinesterase inhibitors (e.g., donepezil, rivastigmine) and memantine, may also be appropriate (Alzheimer’s and Dementia, 2023).
