Alzheimers Disease

-aka Dementia: a syndrome with progressive deterioration in intellectual functioning secondary to structural or functional changes. – Alzheimer’s disease is the most common type of dementia -Alzheimer’s disease is an irreversible form of senile dementia caused by nerve cell deterioration. -Individuals with Alzheimer’s disease experience cognitive deterioration & progressive loss of ability to carry out ADL’s. -The pt experiences a steady decline in physical & mental functioning and usually requires long-term care in a specialized facility in the final stages of the illness. Structural and Chemical changes occur in the brain with Alzheimer’s.

-structural atrophy and brain weight reduction -neurotransmitter abnormalities (acetylcholine, norepinephrine, dopamine, serotonin) Agnosia: failure to recognize or identify familiar objects despite intact sensory function; loss of sensory comprehension Prosopagnosia: inability to recognize oneself & other familiar faces Amnesia: loss of memory caused by brain degeneration Aphasia: language disturbance in understanding and expressing spoken words; inability to speak or understand Apraxia: inability to perform motor activities, despite intact motor function; inability to use objects correctly Anomia: inability to find words.

ETIOLOGY/ CAUSE/ INCIDENCE -exact cause is unknown (age, gender, family history) -more common in women -increased after age 65 (may affect anyone older than 40) -African Americans have increased risk -Hispanics develop earlier than other groups -genetics, chemical imbalances, environmental agents & immunologic changes are other theories. HEALTH PROMOTION – NO proven ways to prevent Alzheimers -current research theories: 1. eating balanced diet 2. eat dark colored fruits & vegetables, soy products, sufficient amts of folate and vitamin B12, C, and E.

3.walking, swimming, regular exercise STAGES OF ALZHEIMERS Early (Mild) or Stage I -1st symptoms up to 4 yrs -independent in ADL’s -no social or employment problems initially -denies presence of symptoms -forgets names; misplaces household items -short-term memory loss; difficulty recalling new information -subtle changes in personality and behavior -loss of initiative; less engaged in social relationships -mild cognitive impairments, problems with judgement -decreased performance, especially when stressed -unable to travel alone to new destinations -decreased sense of smell.

Middle (Moderate) or Stage II -2-3 yrs -impairment of all cognitive functions -problems with handling or unable to handle money & finances -disorientation to time, place, and event -possible depression, agitated -increasingly dependent in ADL’s -visuospatial deficits; difficulty driving, gets lost -speech & language deficits; less talkative, decrease in use of vocabulary, increasingly non-fluent, and eventually aphasic -incontinent -wandering; trouble sleeping LATE (Severe) or Stage III -completely incapacitated; bedridden -totally dependent in ADL’s.

-motor and verbal skills lost -general and focal neurologic deficits -agnosia (loss of facial recognition) COGNITION: refers to the ability of the brain to process, store, retrieve, and use information. -assess pt for deficits in: 1. attention & concentration 2. judgment & perception 3. learning & memory 4. communication & language 5. speed of information procession MMSE (Mini-Mental State Examination: one of the most popular tools nurse or other health care provider can use to assess cognitive status. **One of 1st symptoms of AD is SHORT-TERM MEMORY IMPAIRMENT.

INTERVENTIONS **providing a safe environment is a priority -identify & reinforce retained skills -orient pt to the environment -furnish environment with familiar possessions -acknowledge the pt’s feelings -assist pt & family to manage memory deficits and behavior changes -encourage family to express feelings about caregiving -provide caregiver with support groups -monitor pt’s ADL’s -remind pt to perform self care -help pt maintain independence -avoid activities that tax the memory -allow pt plenty of time to complete activity.

-offer constant encouragement with step to step simple approach -provide pt with mental stimulation with simple games or activities Interventions (con’t) WANDERING: -provide pt with safe environment -prevent unsafe wandering -provide pt with close supervision -close and secure doors -use ID bracelets and electronic surveillance COMMUNICATION: -adapt to the communication level of the pt -use a firm volume & a low-pitched voice to communicate -stand directly in front of the pt and maintain eye contact -call the pt by name and identify yourself; wait for a response -use a calm and reassuring voice.

-demonstrate task if the pt is unable to understand spoken words -speak slowly & clearly, using short words and simple sentences -ask only one question at a time & give one direction at a time -repeat questions if necessary, but do not rephrase IMPAIRED JUDGMENT: -remove throw rugs, toxic substances, and dangerous electrical appliances from the environment. Never leave meds out, take knobs off stove -reduce hot water heater temperature -maintain clear pathway between bed and bathroom at all times ALTERED THOUGHT PROCESS: -call pt by their name -orient the pt frequently -use familiar objects in the room.

-place a calendar and clock in a visible place -maintain familiar routines -allow the pt to reminisce -make tasks simple -allow time for the pt to complete a task -provide positive reinforcement for positive behaviors -promote continence by taking pt to bathroom or giving bedpan or urinal every 2 hrs. ALTERED SLEEP PATTERNS: -allow the pt to wander in a safe place until they become tired -prevent shadows in the room by using indirect light -avoid the use of hypnotics because they cause confusion and aggravate the sundown effect. Sundown syndrome: awake during the night and sleep during the day -discourage day time naps.

-keep daily routine with scheduled activities throughout the day -establish bedtime ritual (snack, bathing, toileting, brushing teeth) AGITATION: -assess the precipitant of the agitation -reassure the pt -remove items that can be hazardous when the pt is agitated -approach the pt slowly and calmly from the front, and speak, gesture and move slowly -remove the pt to a less stressful environment; decrease excess stimuli -use touch gently -do not argue with or force the pt MEDICATIONS 1. Donepezil (Aricept): acetylcholinesterase inhibitor used to treat mild to moderate dementia.

Side effects: nausea, diarrhea, slow heart rate (bradycardia) 2. Galantamine (Razadyne): cholinesterase inhibitor used to treat mild to moderate dementia Side effects: N/V/D, anorexia, weight loss ***can cause bronchoconstriction (use with caution in asthma & COPD) 3. Rivastigmine (Exelon): cholinesterase inhibitor used to treat mild to moderate dementia Side effects: N/V/D, abdominal pain, anorexia ***use cautiously with peptic ulcer disease, bradycardia, sick sinus syndrome, urinary obstruction, lung disease (it enhances cholinergic transmission, intensifying symptoms of these disorders) 4.

Tacrine (Cognex): cholinesterase inhibitor used to treat mild to moderate dementia Side effects: ataxia, loss of appetite, N/V/D ***ADVERSE EFFECT- hepatotoxicity (monitor liver studies) 5. Memantine (Namenda): N-methyl-D-aspartate (NMDA) receptor antagonist for treatment of moderate to severe dementia Side effects: dizziness, headache, confusion, constipation Anti-depressants: some pts with AD develop depression and may be treated with anti-depressants. SSRI’s are usually prescribed ( paxil, zoloft ) Psychotropic drugs: considered chemical restraints -used as a last resort for pts with emotional and behavioral health problems.

-aka Dementia: a syndrome with progressive deterioration in intellectual functioning secondary to structural or functional changes. – Alzheimer’s disease is the most common type of dementia -Alzheimer’s disease is an irreversible form of senile dementia caused by nerve cell deterioration. …

Alzheimer’s disease is a “degenerative brain disease of unknown cause that is the most common form of dementia, that results in progressive memory loss, impaired thinking, disorientation, and changes in personality and mood, that leads in advanced cases to a …

Alzheimer is a disease that results from accumulation of beta-amyloid which is a type of protein normally found in the brain of human beings. According to research when there is an increase in production of this specific protein, the nerve …

Abstract The following paper focuses on Alzheimer’s disease, the disease which is a devastating brain disease and is one of the most typical forms of dementia, a general term that is most commonly used for memory loss and the diminishing …

Medicinal Melodies Imagine a lifelong loved one responding to your greeting with an expression of unreserved confusion. They withdraw from the sincere hug you offer while demanding, “Who are you?” An embrace that was hoped to steal them from the …

Introduction Loss of memory, forgetfulness, personal change, even death, are common related disorders caused by a disease called Dementia or better known to most people as Alzheimer’s disease. This disease is the fourth leading cause of death in the United …

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