By Vicky Bach, CNS ARH/MMH, 2009

Arcus Senilis – yellow or grey-white ring between iris and sclera r/t accumulation of lipids

Affect – Mood, emotions, and expressions of emotions, e.g. happiness, sadness, joy, awe, regret, anger, confusion, depression, suspicion

Akathisia -- A movement disorder characterized by a feeling of inner restlessness and a compelling need to be in constant motion as well as by actions such as rocking while standing or sitting, lifting the feet as if marching on the spot and crossing and uncrossing the legs while sitting. People with akathisia are unable to sit or keep still, complain of restlessness, fidget, rock from foot to foot, and pace.
Akathisia is often a side effect of certain drugs. The drugs that can cause akathisia include neuroleptic (antipsychotic) agents, serotonin receptor antagonists, lithium, L-dopa,, calcium channel blockers and phenothiazine antiemetics such as prochlorperazine or metoclopropamide.

Apraxia -- The inability to execute a voluntary motor movement despite being able to demonstrate normal muscle function. Apraxia is not related to a lack of understanding or to any kind of physical paralysis but is caused by a problem in the cortex of the brain.

Agnosia -- The inability to recognize and identify objects or persons despite having knowledge of the characteristics of those objects or persons. People with agnosia may have difficulty recognizing the geometric features of an object or face or may be able to perceive the geometric features but not know what the object is used for or whether a face is familiar or not. Agnosia can be limited to one sensory modality such as vision or hearing. For example, a person may have difficulty in recognizing an object as a cup or identifying a sound as a cough. Agnosia can result from strokes, dementia, or other neurological disorders. It typically results from damage to specific brain areas in the occipital or parietal lobes of the brain. People with agnosia may retain their cognitive abilities in other areas.

Aphasia - One in a group of speech disorders in which there is a defect or loss of the power of expression by speech, writing, or signs, or a defect or loss of the power of comprehension of spoken or written language. See, for example, auditory aphasia. Aphasia, literally, means no speech.Less severe forms of aphasia may be called dysphasia.

Ataxia -- Wobbliness. Incoordination and unsteadiness due to the brain's failure to regulate the body's posture and regulate the strength and direction of limb movements. Ataxia is usually a consequence of disease in the brain, specifically in the cerebellum which lies beneath the back part of the cerebrum.

Crede’s Method -- A method of expressing urine by pressing the hand on the bladder, especially a paralyzed bladder.

Dementia – progressive cognitive decline

Vascular dementia – manifestation depends on area of brain affected; cognitive impairment (aphasia, memory), behaviour changes (apathy, depression), sensory-motor deficits (gait disturbance, urinary incontinence); may have abrupt onset and stepwise progression but silent most common

Lewy Body – second most common dementia; impaired executive functioning; fluctuating cognition over minutes/hours/days; increased sensitivity to neuroleptic meds; visual hallucinations; parkinsonism; falls; sleep disorders

Frontotemporal – includes Pick’s disease; personality changes; progressive aphasia; apathy; self neglect; disinhibition; perseverative activity; echoing; excessive/compulsive eating or drinking

Cerumen – ear wax; function is to cleanse, protect and lubricate the ear canal

Conductive hearing loss – characterized by reduced intensity of sounds and difficulty hearing vowels and low-pitched tones

Confrontation Test -- The 4-m confrontation visual field test has been successfully used at the Mayo Clinic for many years in addition to the standard 0.5-m confrontation visual field test. The 4-m confrontation visual field test is a test of macular function and can identify small central or paracentral scotomas that the examiner may not find when the patient is tested only at 0.5 m.

Dehydration – Signs: dry tongue and axillae; oliguria; highly concentrated urine; orthostatic hypotension; elevated HR; sudden weight loss;

Delusions – Fixed false beliefs; little or no basis in reality; cannot be corrected by appealing to reason. They are poorly organized, persecutory, readily forgotten. Paranoia is common type of delusion.

Dysphagia – difficulty swallowing sometimes accompanied by pain. Some people may be unable to swallow or may have trouble swallowing liquids, foods, or saliva. Commonly caused by neurologic disorders such as stroke and dementia.

Executive function – Insight, judgment, reasoning, attention, concept formation, problem solving skills, abstraction, self-evaluation; ability to plan and initiate activity with future goals in mind; the cognitive process that regulates an individual's ability to organize thoughts and activities, prioritize tasks, manage time efficiently, and make decisions.

Hallucinations – Sensory experiences that have no basis in external stimuli. Visual and auditory common but also tactile, olfactory, and gustatory. They are vivid, visual, colorful, threatening. Accusatory auditory hallucinations induced by ETOH withdrawal.

Illusions – Misperception of external stimulus; some basis in reality. Often brief, poorly organized.

Hypothermia -- Hypothermia usually occurs gradually. Common signs to look for are shivering, which is your body's attempt to generate heat through muscle activity, and the "-umbles": Stumbles; mumbles; fumbles; grumbles. These behaviours may be result of changes in consciousness and motor coordination. Also slurred speech; decreased respiratory rate; cold, pale skin; lethargy or apathy.

Heat Stroke -- an acute medical emergency caused by failure of the heat-regulating mechanisms of the body. Heat stroke is a form of hyperthermia, an abnormally elevated body temperature with accompanying physical and neurological symptoms. Unlike heat cramps and heat exhaustion, two forms of hyperthermia that are less severe, heat stroke is a true medical emergency that can be fatal if not properly and promptly treated. Symptoms include nausea, vomiting, fatigue, weakness, headache, muscle cramps, dizziness. Also high body temperature and absence of sweating, rapid pulse.

Heat Exhaustion – Heat exhaustion is a milder form of heat-related illness that can develop after several days of exposure to high temperatures and inadequate or unbalanced replacement of fluids. Symptoms include heavy sweating, paleness, muscle cramps, dizziness, headache, fainting.

Hypotension

Orthostatic hypotension – reduction in systolic BP of at least 20 mmHg and diastolic BP of 10 mmHg within 1 to 4 min of standing after being recumbent for at least 5 minutes.

 -- occurs in 10 – 15% > 65 years and 1/3 to ½ of older adults in nursing homes

Symptoms – lightheadedness, weakness or tiredness, cognitive difficulties, blurred vision, tremulousness, pallor

-- associated with increased mortality and is an independent risk for falling; increased risk for stroke and TIAs and coronary events

Postprandial hypotension – BP reduction of 20 mmHg within 75 minutes of eating a meal; 82% of older adults with Parkinsonism; r/t quicker rate of gastric emptying, release of vasoactive GI hormones, consumption of carbs, impaired autonomic regulation of gastrointestinal perfusion; contributes to falls, syncope, hip fractures, MI, stroke-related dizziness, malnutrition

Paranoia – An extreme state of suspiciousness

Presbyopia – diminished ability to focus on near objects

Presbycusis – degenerative hearing impairment especially in presence of background noise; occurs in both ears but degree of impairment can vary between ears;

Sensory p. – associated with degenerative changes; sharp hearing loss at high frequencies

Neural p. – widespread degenerative changes in nerve fibers in cochlea; reduced speech discrimination

Metabolic p. – degenerative changes in vasculature and interruption in nutrient supply; reduce sensitivity to all sound frequencies and speech discrimination

Mechanical p. – changes to inner ear structures; progressive loss from lower to higher frequencies

Snellen Test -- Test of visual acuity.

Suicide Risk – Older adults have among highest rate of suicide. Older men (> 80 years) have highest rate of suicide in Canada. Risk factors: prior suicidal behaviour; mental illness and addictions; personality traits and disorders; medical illness; functional impairment; negative life events or transitions and low social support.

Urinary Incontinence – characterized according to s & s:

Urge – involuntary leakage due to inability to hold urine long enough to reach a toilet after perceiving the urge to void

Stress – involuntary leakage as a result of an activity that increases abdominal pressure (lifting, coughing, sneezing,        laughing, exercise)

Detrusor overactivity – leakage due to an involuntary detrusor contraction

Urethral relaxation – relaxation of the urethra that occurs concurrently with increased abdominal pressure or detrusor overactivity

Mixed – leakage with sensation of urgency and with stress

Weight Loss – unintentional loss of more than 5% of body weight in 1 month, more than 7.5% in 3 months or more than 10% in 6 months is significant indicator of poor nutrition