Jessica is 6 years old. Her parents recently saw her pediatrician ...

[Sufayan.ah]

Jessica is 6 years old. Her parents recently saw her pediatrician because they were concerned about the sleeping difficulties Jessica has been having.
 
  Often she would scream out loud in her sleep. Her parents would rush to her room and find her sitting upright in bed, panting heavily in a state of panic. Jessica would not respond to her parent's words of consolation, and the next morning she would have no memory of the incident at all. Her parents were worried about the anxiety their daughter was experiencing and asked the pediatrician what they could do about her nightmares. The pediatrician explained Jessica was likely suffering from sleep terrors and carefully described what that meant.
 
  What are the similarities and differences between nightmares and sleep terrors?
 
  What are the characteristics of motor, sensory, and autonomic function during REM sleep? What is thought to be the importance of this stage of sleep?
 
  Jessica's pediatrician said that the careful management of sleep hygiene may help to decrease the incidence of her sleep terrors. What is included in an overview of the general features that demonstrate good sleep hygiene?

Question 2

Ella is 88 years old and was living at home until very recently. Her children, who visited her regularly, noticed she was becoming more forgetful.
 
  At first, she mislaid objects, and then she began to forget her doctor's appointments. With time, her personality changed and she became withdrawn. At home she would forget to turn off the stove or leave the kettle on until it boiled dry. After seeking advice from a gerontologist and social worker, Ella's children placed her in a nursing home with a unit equipped for patients with Alzheimer disease.
 
  What is dementia? Why is Alzheimer disease based on a diagnosis of exclusion?
 
  What are the macroscopic and microscopic features of the brain that are typical in Alzheimer disease?
 
  One of Ella's children brought her a new pair of slippers to wear in the nursing home. A minute after she received them, Ella could not remember the exchange and asked what they were doing on her bed. What part of the brain has largely been affected to produce this behavior, and what is the pathophysiology involved?

[jjorrostieta]

Answer to Question 1

Both nightmares and sleep terrors cause frightening experiences and hyperarousal for the individual experiencing them. Nightmares occur during REM sleep and usually awaken the sleeper. The nightmare is remembered by the individual and often makes the return to sleep difficult as a result. Sleep terror, in contrast, occur during stage 3 and stage 4 sleeps. The individual is hyperaroused and appears awake, but is unresponsive to external stimuli. Unlike the experience of a nightmare, sleep terrors are not remembered, and the return to sleep happens quickly after the event.

During REM sleep, motor output is inhibited so that voluntary movements are lost accompanied by a decrease in muscle tone. Sensory input from the external environment is also inhibited, but internal sensory awareness (particularly auditory and visual senses) is heightened. The autonomic nervous system causes fluctuations in blood pressure, heart rate, and respirations during REM sleep.
The function of REM is thought to involve the vivid dreaming that takes place during this stage. Central nervous system reprogramming is thought to occur during this stage, and previous experiences are processed in preparation for new ones to come. Learning experiences and memories are also processed and organized during this stage.

Good sleep hygiene involves creating an environment that ensures the best sleep possible. It involves practices such as going to bed at a regular time and sleeping long enough to feel refreshed. Appropriate sleep hygiene emphasizes the restriction of caffeinated products before sleeping and the elimination of distractions from the bedroom. Finally, good sleep hygiene addresses the external bedroom environment; the best sleep is achieved in a room that is dark, quiet, and at a comfortable temperature.

Answer to Question 2

Dementia involves the deterioration of intellect to the extent that it interferes with occupational or social activity. Any disorder that damages the areas of the brain involved with memory and learning can result in dementia. Problem solving, memory, judgment, abstract thought, language, perception, and motor skills may all be affected in the presence of dementia.

Macroscopically, there is loss of neurons with cortical atrophy, particularly in the parietal and temporal lobes. The gyri narrow and the sulci deepen as tissue atrophies. The ventricles are also affected and enlarge as the brain mass declines.
Microscopically, neuritic plaques and neurofibrillary tangles characterize Alzheimer disease. Neuritic plaques (or senile plaques) consist of degenerating nerve terminals that form clusters around a neurotoxic amyloid -peptide nucleus. The plaques are largely found in the neocortex, hippocampus, and isocortex. Neurofibrillary tangles develop in the cytoplasm of neurons. The tangles are composed of fibrous proteins and hyperphosphorylated tau proteins wrapped tightly in a helical fashion. They are resistant to enzymatic breakdown and compromise the function of the neuron they inhabit.

The hippocampus is central to the encoding and consolidation of short-term memory and retrieval of long-term memory. It is also responsible for the processing of information. In Alzheimer disease, the hippocampus is particularly vulnerable to the development of neuritic plaques and neurofibrillary tangles. The production of choline acetyltransferase (an enzyme responsible for the synthesis of acetylcholine) declines as a result. When acetylcholine is deficient, the formation and processing of memory by the hippocampus are compromised.

[Sufayan.ah]

Correct answers!

[jjorrostieta]

Great! Please up vote