ALZHEIMER

ALZHEIMER’S DISEASE
 Alzheimer’s disease is an irreversible, progressive

brain disease that slowly destroys memory and
thinking skills, and eventually even the ability to carry
out the simplest tasks. In most people with Diagnostic Examination
Alzheimer’s, symptoms first appear after age 60.
 Alzheimer’s disease is the most common cause of
 Alzheimer’s disease is usually diagnosed clinically from
the patient history, collateral history from relatives, and
dementia among older people. Dementia is the loss of
clinical observations, based on the presence of
cognitive functioning—thinking, remembering, and
characteristic neurological and neuropsychological
reasoning—to such an extent that it interferes with a
features and the absence of alternative conditions.
person’s daily life and activities. Estimates vary, but
experts suggest that as many as 5.1 million  Advanced medical imaging with computed tomography
Americans may have Alzheimer’s. (CT) or magnetic resonance imaging (MRI), and with
single photon emission computed tomography (SPECT)
 Dementia involves progressive decline in two or more
or positron emission tomography (PET) can be used to
of the following areas of cognition: memory, language,
help exclude other cerebral pathology or subtypes of
calculation, visual-spatial perception, judgment,
dementia.Moreover, it may predict conversion from
abstraction, and behavior.
prodromal stages (mild cognitive impairment) to
Causes
Alzheimer’s disease.
 The cause of AD is unknown but knowledge about the
hereditary links is growing.
 Assessment of intellectual functioning including memory
testing can further characterize the state of the
 Patients with Down syndrome eventually develop DAT
disease.Medical organisations have created diagnostic
if they live long enough. There is a higher-than-normal
criteria to ease and standardize the diagnostic process
concentration of aluminum in the brain of a person
for practicing physicians. The diagnosis can be confirmed
with DAT, but the effect is unknown.
with very high accuracy post-mortem when brain material
 A distinct protein, AZ 50, has been identified at is available and can be examined histologically.
autopsy in the brains of DAT patients. This protein
has been isolated from neurons that were not yet Primary Nursing Diagnosis
damaged, suggesting that its presence early in the Self-care deficit related to impaired cognitive and motor
degenerative process might cause the neuronal function
damage. The life expectancy of a DAT patient is
 Outcomes. Self-care: Activities of daily living—Bathing,
reduced 30% to 60%.
Hygiene, Eating, Toileting; Cognitive ability; Comfort
level; Role performance; Social interaction skills; Hope
Characteristics/ Signs and Symptoms  Interventions. Self-care assistance: Bathing and Hygiene;
The disease course is divided into four stages, with Oral health management; Behavior management;
progressive patterns of cognitive and functional impairments. Body image enhancement; Emotional support; Mutual
goal setting; Exercise therapy; Discharge planning
Pre-dementia
Stage 1 is characterized by recent memory loss, increased PET scan of the brain of a person with AD showing a loss of
irritability, impaired judgment, loss of interest in life, decline of
problem-solving ability, and reduction in abstract thinking. function in the temporal lobe
Remote memory and neurological exam remain unchanged Other Nursing Diagnosis
from baseline. Risk for Injury related to:
 Unable to recognize / identify hazards in the
Early environment.
Stage 2 lasts 2 to 4 years and reveals a decline in the patient’s  Disorientation, confusion, impaired decision making.
ability to manage personal and business affairs, an inability to  Weakness, the muscles are not coordinated, the
remember shapes of objects, continued repetition of a presence of seizure activity.
meaningless word or phrase (perseveration), wandering or
circular speech patterns (circumlocution dysphasia), wandering Medical Management
at night, restlessness, depression, anxiety, and intensification There is no cure for Alzheimer’s disease; available treatments
of cognitive and emotional changes of stage 1. offer relatively small symptomatic benefit but remain palliative
in nature.
Moderate
Stage 3 is characterized by impaired ability to speak (aphasia),
inability to recognize familiar objects (agnosia), inability to use The initial management of the patient begins with education of
objects properly (apraxia), inattention, distractibility, involuntary the family and caregivers regarding the disease, the prognosis,
emotional outbursts, urinary or fecal incontinence, lint-picking and changes in lifestyle that are necessary as the disease
motion, and chewing movements. Progression through stages progresses.
2 and 3 varies from 2 to 12 years.
Basic collaborative principles include:
 Keep requests for the patient simple
Advanced  Avoid confrontation and requests that might lead to
Stage 4, which lasts approximately 1 year, reveals a patient frustration
with a masklike facial expression, no communication, apathy,  Remain calm and supportive if the patient becomes upset
withdrawal, eventual immobility, assumed fetal position, no  Maintain a consistent environment
appetite, and emaciation.  Provide frequent cues and reminders to reorient the
patient
 Adjust expectations for the patient as he or she declines
in capacity
Pharmacologic Treatment
 Generally, therapy is focused on symptoms with an
attempt to maintain cognition.
 Donepezil (cholinesterase inhibitor; elevates
acetylcholine concentration in cerebral cortex by slowing
degradation of acetylcholine released by intact
neurons)which improves cognitive symptoms; improves
cognitive function in the early stages of the disease
only; drug effects diminish as the disease progresses
 Antidepressants (selective serotonin reuptake inhibitors;
increases activity of serotonin in the brain) which treats
depression, anxiety, and irritability
 Other Tests: Supporting tests include computed
tomography (CT) scan; magnetic resonance imaging
(MRI); positron emission tomography (PET). During the
early stages of dementia, CT and MRI may be normal,
but in later stages, an MRI may show a decrease in the
size of the cerebral cortex or of the area of the brain
responsible for memory, particularly the hippocampus.
Genetic testing for the ApoE gene is available and the
presence of the gene is a risk factor for AD. Genetic tests
may be helpful in diagnosis, but further studies are
needed to confirm their reliability.
Nursing Intervention
1. Establish an effective communication system with the
patient and his family to help them adjust to the patient’s
altered cognitive abilities.
2. Provide emotional support to the patient and his family.
3. Administer ordered medications and note their effects. If
the patient has trouble swallowing, crush tablets and
open capsules and mix them with a semi soft food.
4. Protect the patient from injury by providing a safe,
structured environment.
5. Provide rest periods between activities because the
patient tires easily.
6. Encourage the patient to exercise as ordered to help
maintain mobility.
7. Encourage patient independence and allow ample time
for him to perform tasks.
8. Encourage sufficient fluid intake and adequate nutrition.
9. Take the patient to the bathroom at least every 2 hours
and make sure he knows the location of the bathroom.
10. Assist the patient with hygiene and dressing as
necessary.
11. Frequently check the the patient’s vital signs.
12. Monitor the patient’s fluid and food intake to detect
imbalances.
13. Inspect the patient’s skin for evidence of trauma, such as
bruises or skin breakdown.
14. Encourage the family to allow the patient as much
independence as possible while ensuring safety to the
patient and others.

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ALZHEIMER’S DISEASE

 Alzheimer’s disease is an irreversible, progressive

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