ALZEIMHER’S DISEASE STAGES OF ALZEIMHER’S DISEASE
 Degenerative disease of the central nervous system
characterized by premature senile retardation.
Degenerative disorder of the cerebral cortex.
 The etiology of Alzheimer’s disease is unknown.
 The most common non- traumatic cause of dementia is
Alzheimer’s disease at 65, 10% of the population has
Alzheimer’s; by 85, the percentage increases to half.
Multi-infarct dementia is the second most common
cause of non – traumatic dementia.
NATURE: Gradual, progressive; Onset: Usually after 65 (2-4%);
may begin at 40-65; may die within 2 yrs or 8-10 yrs if with
total care.
 The main pathology is of the disease is the presence
of senile plaques that destroys neurons leading to
decreased acetylcholine.
 The primary need of a patient with Alzheimer’s is
Reorientation.
4 CARDINAL SIGNS OF ALZHEIMER’S
1. Agnosia – sensory–inability to recognize objects/subjects
Patient with agnosia is unable to recognize persons.
 1st to forget: The name of an object
 2nd to forget is the function of an object
2. Apraxia – sensory-inability for purposeful movement.
Example: Tremors
3. Amnesia – 1st amnesia to appear: Anterograde amnesia –
recent memory
 2nd amnesia to appear: Retrograde – past
 TREATMENT: Reminiscing Group Therapy
4. Aphasia – sensory-inability for speech and communication
4 CARDINAL SIGNS
1. Agnosia
2. Apraxia
3. Amnesia
4. Aphasia
Predisposing/Contributing Factors:
(Psychiatric Mental Health Nursing 3rd edition by Mary C.
Townsend)
1. Exact cause unknown but several hypothesis were
introduced
2. Acetylcholine Alteration: Decrease in acetylcholine
reduces the amount of neurotransmitter which
results in disruption of cognitive process.
Accumulation of Aluminum: Studies show that aluminum
accumulates in damaged areas of the brain.
3. Alterations in the Immune System: Antibodies are
being produced in the brain which causes a reaction
against self it is called autoimmune
4. Head Trauma: Head injuries
5. Genetic Factor: Pattern of inheritance
I. Early stage (Forgetfulness Stage: Mild)
 The first symptom of Alzheimer’s disease is
Progressive memory loss. This is followed by
disorientation, personality changes, language
difficulty, and other symptoms & dementia.
 The patient can compensate for the memory loss but
the family may notice personality changes and mood
swing. Recent memory is affected including the
ability to learn new information. Managing daily living
activities becomes progressively more difficult. The
patient may notice difficulty balancing his checkbook
and may forget where he put things.
 Forgetfulness: loose things; forget names, short-term
memory loss, and the individual is aware of the
intellectual decline.
Early Confusion: Symptoms of confusion begins and
concentration may be interrupted. Individual may forget
major event in personal history such as birthday of his/her
child: experience declining activity to perform task; individual
may deny memory loss. Findings that are observed in the early
stages of Alzheimer’s disease are inappropriate affect,
disorientation to time, paranoia, memory loss, and an
impaired judgment.
Response of nursing assistant to an Alzheimer’s patient that
Needs Further Teaching includes a statement like, “How many
glasses of water did you drink today?” -> Anterograde
amnesia.
II. Middle stage (Wandering Stage/Sundown syndrome)
The patient is increasingly disoriented and completely unable
to learn and recall new information. He may wander or
become agitated or physically aggressive.
He may have bladder incontinence and may require assistance
with activities of daily living. Individual may be unable to recall
major life events even the name of spouse. Disorientation in
the surroundings is common and the person may be unable to
recall the day, season, and year.
Sleeping becomes a problem. Symptoms worsen in the
evening known as “SUNDOWNING.”
III. Late stage (Kluver Bucy like Syndrome)
The patient may be unable to walk and is completely
dependent on caregivers.
He’s totally incontinent of bowel and bladder. He may even be
unable to swallow and is at risk for aspiration. He’s unable to
speak intelligibly.
In the late stages of Alzheimer’s disease it is better to go along
with the patient’s reality rather than confront him with logical
reasoning. Asking close ended simple questions that relate to
his reality is non-threatening and calming.
Note that the nurse’s response in a way that is congruent is
the main concern. The individual may not recognize family
members. There may be problems of immobility.
Nursing Diagnosis: Risk for trauma
Nursing Intervention:
1. Milieu Therapy is needed: a CONSISTENT UNCHANGING &
FAMILIAR ENVIRONMENT IS NEEDED to decrease chances
of disorientation & confusion.
- In milieu therapy, patients plan and lead activities
rather than the staff Milieu therapy involves scientific
manipulation of the environment that can influence
improvement patient’s behavior
2. Store frequently used items within reach.
3. Keep bed in an elevated position with soft padding if client
has history of seizure and keep the rails up.
A confused Alzheimer’s patient who gets out of bed several
times must be provided with a safe environment like placing a
hand rails for the patient to hold. Bed of confused Alzheimer’s
patient must always have its side rails up.
for elderly w/ Alzheimer’s use short & simple words
& face him while you are talking.
3. Discourage rumination of delusional thinking. Talk
about real people and real events.
4. Monitor for medication side effects.
5. Use soft tone, simple sentences, and a slow, calm
manner when speaking to a person with Alzheimer’s
disease.
 If he doesn’t understand you, repeat yourself
using the same words.
 Your nonverbal communication is more
important than your actual spoken message.
Don’t a hurried tone, which will make the patient
feel stressed.
 Move slowly and maintain eye contact.
Nursing Diagnosis: Self Care Deficit
Nursing intervention:

4. Assign room near nurses’ station. 1. Identify self-care deficit and provide assistance.
5. Assist patient with ambulation. 2. Urinary incontinence in patient with Alzheimer’s can
6. Keep dim light on at night. Decrease environmental be controlled by decreasing fluid intake at night time
stimulus. 3. Allow plenty of time for the patient to perform task.
4. Provide guidance and support for independent
7. If patient is a smoker, stay with him/her at all times. actions by talking the patient through the task.
8. Frequently orient patient to time, place and situation. 5. Provide structure schedule of activities that does not
9. If patient is prone to wander, provide an area in which the change from day to day.
client is safe to wander. 6. ADLs should follow home routine as closely as
possible.
10. Family counseling about Alzheimer’s disease includes 7. Provide client’s nutritional needs, safety and security.
checking that patient is wearing ID bracelet when going 8. Give foods high in carbohydrates to an Alzheimer’s
out at all times who refuses to eat his meal
11. Soft restrain may be required if the client is disoriented
hyperactive as ordered by the physician. In an Alzheimer’s caregiver class, the nurse tells the
student that the reason why patient’s do not take a bath
12. Provision of simple, structured environment, ↓ choices is that they can’t remember any more if they have taken
 Consistency and ROUTINE in care to increase the bath already.
security; Brief, frequent contacts; reinforce
SCREENING TEST:
reality-oriented comments
 Ample time and patience to allow client to talk / 1. Electroencephalography
complete using associative patterns to improve 2. Computed tomography
recall: simplicity, focusing, repeating, 3. Magnetic Resonance Imaging
summarizing.
 Allow REMINISCING of past life / exploits / CONFIRMATIVE TEST:
achievements. Reminiscing helps lessen the
patient’s loneliness. 1. Cerebral Biopsy (After death)

13. Wear the Medical Alert Bracelet – (name, Address, COMPLICATIONS:

Tel #, Diagnosis, Medication) A. Infection
14. Avoid afternoon naps, avoid caffeine, TV & radio B. Malnutrition
remote
15. REMEMBER THE 3 C’s for Alzheimer’s to DECREASE BEST DRUGS:
DISORIENTATION:
 Color
Anticholinesterase: Increases ACH
 Calendar
(acetylcholine) levels
 Clock

Nursing Diagnosis: Altered thought process 1. Tacrine hydrochloride (Cognex)

Nursing intervention: 2. Donezepil (Aricept)
3. Rivastigmine (Exelon)
1. Frequently orient the patient to reality.
 Sensory stimulation for elders helps to increase
patient’s arousal
2. Keep explanation simple and use face-to-face
interaction. Speak slowly and do not shout. In caring
DRUG STUDY: Adverse effects are uncommon but may include GI
upset or using anticoagulants.
No cure or definitive treatment exists for Alzheimer’s
disease.
 However, three drugs, Tacrine (Cognex),
rivastigmine (Exelon), and donepezil
(Aricept), have been approved by the Food
and Drug Administration to improve
cognitive function in patients with mild to
moderate Alzheimer’s disease.
Tacrine hydrochloride (Cognex) – monitor patient
for liver toxicity
Tacrine hydrochloride (Cognex) – enhances
acetylcholine uptake in the brain, thus maintaining
memory skills for a period of time.

BEST HERBAL DRUG FOR ALZHEIMERS:

Enhancing memory with ginkgo biloba
 Ginkgo biloba, a plant extract, contains
several ingredients that many believe can
slow memory loss in people with
Alzheimer’s disease.

 Research has shown that ginkgo produces

arterial, venous, and capillary dilation,
leading to improved tissue perfusion and
blood flow.