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• It is a chronic, degenerative disorder of the cerebral cortex characterized by dementia

with progressive impairment of memory, cognitive function, language and self-care
ability. Although exact cause is unknown, genetics and female gender are thought to
be risk factors. Viruses, environmental toxins, silent brain infarcts and previous head
injury may also play a role.

• Changes occur in the proteins of the nerve cells of the cerebral cortex and
lead to accumulation of neurofibrillary tangles (abnormal tangled fibers),
granulovascular degeneration, and characteristic senile plaques (degenerated
nerve cell pieces which form around a fibrous core in the cerebral cortex)

• Reduction in neurotransmitters

I. Assessment

A. Stages- Patients may or may not progress through them in sequence.

i. Early, Stage 1:
1. forgets names
2. misplaces household items
3. short attention span
4. decreased knowledge of current events
5. with judgment
6. decreased performance when stressed
7. unable to travel alone to new destinations
8. inability to make decisions such as managing finances
9. increased confusion at night (“sundowning”)
10. personality changes such as irritability, suspiciousness and
neglect of appearance

ii. Moderate, Stage 2:

1. Gross intellectual impairment
2. complete disorientation to time, place and events
3. agitated
4. possible depression
5. loss of ability to care for self
6. speech and language deficits
7. visuospatial deficits
8. apraxia (inability to perform purposeful activity)
9. agraphia (inability to write)
iii. Severe, Stage 3:
1. Completely incapacitated
2. motor and verbal skills lost
3. urinary and fecal incontinence
4. totally dependent in ADL
5. delusions and hallucinations

II. Diagnostic evaluation

A. Laboratory testing such as blood chemistry, thyroid function tests and

urinalysis to rule out metabolic disorders.
B. Imaging studies such as MRI and CT scan of the brain to rule out treatable
forms of dementia.
C. Neuropsychological evaluation to establish clinical criteria for diagnosis.
D. Assay for CSF. Genetic testing are available but not ready for widespread

III. Nursing Management

A. Promote independence in ADL. Use occupational therapy as a resource.

B. Promote bowel and bladder continence by taking the client to the

bathroom frequently during the day and less frequently during the night.

C. Assist with facial recognition by encouraging presence of family pictures

and reminiscing.

D. Behavioral interventions are used to manage memory problems and

intellectual dysfunction. Try to engage the patient in a more stimulating
activity because boredom and tension may be the basis of wandering.
Advise caregiver to encourage activities that provide physical exercise and
repetitive movement such as dancing, painting, doing laundry, or

E. Schedule the patient’s daily activities and be consistent. Order and

predictability reduce anxiety and promote security. Prepare patient for
changes in routine.

F. Teach about the need to eliminate caffeine in the diet because it can cause
sleep disturbance.

G. Ingesting fish (a source of omega-3 fatty acids) one or more times per
week may decrease the incidence of Alzheimer’s
H. Have the patient wear identification bracelet with name, address and
contact number.

I. Medication therapy
i. Use of Aricept and Cognex to improve cognitive function
ii. Antidepressants and other psychotropic drugs may be appropriate
to relieve hallucinations and delusions.
iii. Cholinesterase inhibitors such as donepezil and galantamine
improve cognitive functioning and quality life for some patients.
iv. Promote sleep.

IV. Complementary/ Alternative therapy

A. Ingesting fish (a source of omega-3 fatty acids) one or more times per
week may decrease the incidence of Alzheimer’s