CAUSES
 Neurofibrillary tangles
 Neuritic plaques
 Vascular degeneration
 Changes in neurotransmitters
 Increased amounts of abnormal protein beta amyloid (with
corresponding ACh)
 Stage 1 = early, mild, 1st s/s, lasts up to 4 years
 Stage 2 = middle/moderate, significant cognitive impairment;
significant cognitive impairment,  speech/language, wandering
 Stage 3 = later or severe; bedridden, incapacitated, don’t recognize
anyone; death from complications of immobility
AD = Alzheimers Disease = progressive
degenerative disease, 60% of dementias
INTERVENTIONS & TREATMENTS/THERAPIES
Interventions
 Complete neurological assessment; assess & tx other medical problems
 Provide cognitive stimulation and memory training
 Structure enviro to increase pt ability to function
 Orientation and validation therapy
 Promote self management
 Promote bowel and bladder continence
 Assist with facial recognition
 Promote communication
Risk for Injury:
 Coping with restlessness and wandering
 “Safe Return” program; have pt wear ID bracelet
 Frequent walks and structured activities
Compromised family Coping
 Encourage legal counsel (advanced directives, POA, finances, etc)
 Care for caregivers and family (respite care, adult daycare)
Disturbed sleep pattern
 Maintain day and night patterns of activity (exercise during day, etc)
S&S
 Loss of memory, judgment, visuospatial perception & personality
changes
 Short term memory impairment
  cognition
  communication & language ability
  personalitiy, behavior, udgement
  self care skills (unkempt,  appetite, etc)
 Needs psychosoc assessment, esp. reaction to  in routine)
 Aphasia = (root = speechlessness) impaired language (verbal, written)
 Apraxia = loss of ability to carry out purposeful movement = difficulty
with fine motor skills, inability to use objects
 Anomia = problem with finding words
 Agnosia = loss of sensory comprehension (facial recognition)
 Sundowning =  confusion @ night or w/ lighting
Mini Mental State Examination (MMSE): Pt must be able to read
 Assesses orientation, registration, attention, calculation, recall, speech-
language (incl. reading)
 Scoring 0-30, the lower the score, the more severe the cognitive deficit
FACT = Fruits, Animals, Colors, Towns = set test
 Name 10 items in each set
 Score = 0-40; 25+ = no dementia
 Not for pt w/hearing, speech, language impairments
Drug Therapy:
Cholinesterase inhibitors:  cholinergic action by delaying ACh destruction
 Slows onset of cognitive decline, doesn’t alter course of disease
o Donepezil = Aricept  DO NOT CRUSH
o Galantamine = Exelon (PATCH FORM AVAILABLE)
o Rivastigmine = Reminyl
NMDA (N-methyl-D-aspartate) receptor antagonist = glutamate blocker
 Indicated for advanced AD; slows pace of deterioration; may improve
memory & thinking skills
o MEMATINE = Namenda
 Can be given w/ donepezil