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113
 ANNEXURE – M

BLUE PRINT OF THE TOOL

Know- Compre- No. of

Sl.No. Components Application Percentage
ledge hension questions

1. Meaning 1,3 2 3 10%

Incidence and
2. 4.5 2 7%
prevalence

3. Etiology 6,7 8 3 10%

9, 10,
Signs and
4. 12, 13, 11, 16 17, 18 10 43%
Symptoms
14, 15
21, 22,
Investigation
23, 24,
5. and 29, 30 19, 20 12 40%
25, 26,
management
27

TOTAL 64% 23% 13% 30 100%

114
 ANNEXURE – N

SCORING KEY

Sl.No. Answer Score Sl.No. Answer Score

1 A 1 16 A 1

2 B 1 17 B 1

3 C 1 18 C 1

4 B 1 19 B 1

5 C 1 20 A 1

6 A 1 21 C 1

7 C 1 22 B 1

8 B 1 23 A 1

9 A 1 24 B 1

10 B 1 25 C 1

11 A 1 26 A 1

12 C 1 27 B 1

13 A 1 28 A 1

14 B 1 29 B 1

15 C 1 30 C 1

Criteria Measures
Each correct response carries one (1) mark, incorrect response carries zero (0)
marks.

Total Score : 30

Adequate knowledge : 21 - 30

Moderately Adequate knowledge : 11 - 20

115
 Inadequate knowledge : 1 - 10

ANNEXURE – O

STATISTICAL FORMULAS USED IN THE STUDY

1. Standard Deviation

S.D. =

2. Spearman – Brown Prophecy Formula

r’ =

r = Correlation coefficient computed on split halves

r’ = Estimated reliability of the entire test

3. Karl Pearson Co-efficient of Correlation

r=

4. Chi-Square test

5. Yates correction

Where O = observed frequency,

E = expected frequency

116
 ANNEXURE – P

List of Content Validators of the prepared tool:

1 Dr. K. Reddemma
Professor and Head
Department of Nursing
NIMHANS, Bangalore –560029

2 Dr. K. Lalitha
Additional Professor
Department of Nursing
NIMHANS, Bangalore – 560029

3 Dr. Ramachandra
Assistant Professor
Department of Nursing
NIMHANS, Bangalore – 560029

4 Dr. Nagarajaiah
Assistant Professor
Department of Nursing
NIMHANS, Bangalore – 560029

5 Dr. Sailaxmi Gandhi

Nursing Tutor
Department of Nursing
NIMHANS, Bangalore - 560029

6 Dr. C.R. Chandrashekar

Professor
Department of Psychiatry
NIMHANS, Bangalore - 560029

7 Prof. B.H. Rajashekaraiah

Principal
R.V. College of Nursing
Bangalore - 560011

8 Mr. H.S. Surendra

Associate Professor of Statistics
U.A.S.G.K.V.K.
Bangalore – 560065

117
9 Mrs. Hilda Elizabeth Mony
Assistant Professor
Gayathri Educational Academy
Bangalore - 560 091.

10 Mr. P.V. Mohan Krishna

Nursing Tutor
Department of Nursing
NIMHANS, Bangalore – 560029

11 Mr. H.B. Prakash

Lecturer and H.O.D
Department of community Health Nursing,
Govt. college of Nursing,
Fort, Bangalore – 560 002.

118
 ALZHEIMER’S DISEASE INFORMATION BOOKLET
Preface:

The investigator selected the research study “A Descriptive

Study To Assess The Knowledge Regarding Alzheimer’s Disease
Among Adults In A Selected Community, Bangalore With A View
To Develop An Information Booklet”. As one of the objectives of
the study, the investigator prepared this booklet. This booklet is
designed for the adults. The main reason is to prepare this book is to
make adult aware on Alzheimer’s Disease.

Aim:
To impart knowledge and develop awareness regarding
Alzheimer’s Disease among adults.

Objectives: The Adults will be able to:

• Understands about Alzheimer’s Disease

• Symptoms of Alzheimer’s Disease
• Causes of Alzheimer’s Disease
• Diagnosis.
• Treatment
• Practical tips on dealing with the common challenges of
Alzheimer’s Disease
• Myths and misconceptions
• Knows about centre for Alzheimer’s Disease
• Memory clinic and institutional care

1
Introduction
The world is becoming more and
more health conscious, the newspapers;
TV channels are full of items on staying
healthy, benefits of exercise, eating foods
which is appropriately right for the body,
and so on and so forth. How many of us
Fig 1
actually pay attention to our mind?

India has a large segment of older people in the population.

Society in general and the health system in particular face the
challenge of ensuring quality of life for older people. One factor
responsible for increased morbidity in older people is Alzheimer’s
disease.

Explaining Alzheimer’s disease

Alzheimer’s disease is a form of progressive mental

deterioration due to generalized degeneration of the brain occurring
in middle or old age.

Alzheimer’s disease attacks the

parts of the brain that control thought,
memory and language. The onset of the
disease is gradual and the person’s decline
is usually slow.
Dr. Alois Alzheimer
2
 Alzheimer’s disease is named after Dr. Alois Alzheimer who
in 1906 described changes in the brain tissues of a woman who had
died of what was thought to be an unusual mental illness.

Alzheimer’s disease affects all groups in society and is not

linked with social class, gender, ethnic groups or geographical
location. And, although Alzheimer’s disease is more common
among elderly persons, younger persons can also be affected.

What are the symptoms of Alzheimer’s disease?

Alzheimer’s disease affects each person in a different way.

The symptoms of Alzheimer’s disease can best be understood in the
context of three stages of development early, middle and late. The
symptoms will vary from person to person and no one person will
experience the progress of the disease in exactly the same way as
another.

Early stage

It is difficult to identify the exact time this stage begins

because the onset of the disease is
gradual. The person may:

• Show difficulties with

language
• Experience significant
memory loss
Fig 2
3
 • Be disoriented in time
• Become lost in familiar places
• Lack initiative and motivation
• Display difficulty in making decisions
• Shows signs of depression and aggression

Middle Stage

As the disease progresses, problems become more evident

and restricting. The person with Alzheimer’s disease has difficulty
with day-today living.

• He may become very

forgetful – especially of
recent events and
people’s names

• Can no longer manage to

live alone without
problems.
Fig 3
• Is unable to cook, clean
or shop.
• May become extremely dependent
• Needs assistance with personal hygiene i.e. toilet,
washing and dressing.

• Has increased difficulty with speech.

4
 • Shows problems with wandering and other behavioural
abnormalities.

• Becomes lost at home and in the community.

• May see or hear certain things which are not present in

the environment like hearing some voices of people
while sitting alone.

Late Stage

This stage is one of total dependence and inactivity. Memory

disturbance are very serious and the physical side of the disease
becomes more obvious. The person may:

• Have difficulty eating.

• Not recognize relatives,
friends and familiar objects.
• Have difficulty understanding
and interpreting events.
Fig 4
• Be unable find their way
around in the home.
• Have difficulty walking.
• Have bladder and bowel incontinence.
• Display inappropriate behaviour in public.

5
What causes Alzheimer’s disease?

Currently the cause of Alzheimer’s disease is unknown.

However, it is known what does not cause Alzheimer’s disease they
are not:

• Caused by hardening of the arteries.

• Related to sexually transmitted diseases.

• Caused by infection.

• By exposure to aluminum of other metals.

Why is diagnosis important?

Early diagnosis is helpful in

order that the caregiver can be better

equipped to deal with the disease and to

know what to expect. A diagnosis is the

first step towards planning for the

future. Fig 5

There is no simple test to make a diagnosis. The diagnosis of

Alzheimer’s disease is made by taking a careful history of the
6
person’s problem from a close relative or friend, together with an
examination of the person’s physical and mental status. Other
diagnosis method are x-rays, CT scan, MRI, positron emissions
tomography of skull.

Is there treatment?

At the moment there is no exact curative treatment for

Alzheimer’s disease. However, there is a great deal that can be done
for the person with Alzheimer’s disease as well as things to ease the
burden on caregiver.

There are now some drugs available in some countries for

people with mild to moderate Alzheimer’s disease. These drugs do
not cure but may help some people to relieve some of the symptoms
of Alzheimer’s disease.

Practical tips on dealing with Alzheimer’s disease.

Common challenges of Alzheimer’s disease.

General guidelines:
• Provide as much as guidance necessary
• Gain eye contact
• Be gentle in interaction
• Eliminate unnecessary background noise.
• Be prepared to answer patient’s while asking the same
questions repeatedly.
7
 • Make the patient and the
family be aware of support
resources.
• Help to develop short and
long term planning.
Fig 6
• Help the family in decision
concerning institutionalization.

1. Bathing and personal

hygiene
• Maintain the person’s

former routine for

washing as much as Fig 7

possible

• Try to make bathing a pleasant and relaxing occasion

• Simplify the task as much as possible

• If the person refuses to bathe try again a little later, when

the mood may have changed.

• Allow the person to do as much as possible unaided.

8
2. Dressing

• Lay out clothes in the order they

are to be put on.

• Avoid clothes with complicated

fastenings

• Use repetition if necessary

• Encourage independence in
dressing as long as possible.
Fig 8
3. Toilet habits and Incontinence

• Create a schedule for going to

the toilet

• Label the toilet door using bright

colours and large letters.

• Leave the toilet door open so it

is easy to find

• Limit drinks within reason

before bed time Fig 9

• Get professional advice.

• A regular bowel routine, increased fluid intake of two

litres per day.

9
4. Eating

• The safest diet is semi solid like kanji.

• Cut the food in small pieces to prevent chocking.

• Remind the person to eat slowly.

Fig 10
• Be aware that the persons may not be able to sensitize
cold and hot and may burn their mouth on hot food or
liquids.
• Serve one portion of food at a time.
• Swallowing sequence are to place the food on the
tongue, close the lips and teeth, lift the tongue up and
then back and swallow.
• Increase to chew first in one side of the mouth and then
on the other.
• To control the build of saliva. The patient is reminded to
hold the head upright and make a conscious effort to
swallow.
• Massaging the facial and neck muscles before meals may
be beneficial.

10
5. Disturbed Sleep

• Try to discharge sleeping during the day.

• Try daily long walks and add more physical activity during
the day.
• Try to make the person as comfortable as possible at bed
time.
• Avoid providing caffeine and their stimulants.

6. Communication

• Approach the patient slowly

• and position yourself in front of

the patient.

• Speak clearly and in short

Fig 12
sentences with a minimum
explanations.

• Give instructions one at a time, supporting each one with

visual clues.

• Be prepared to repeat the instructions as needed

• Address the patient by name to get his / her attention.

11
7. Disorientation

• Get the patient a

big bright
picture calendar
with clear dates,
Fig 13
and a large
clock to help with orientation.

• As far as possible, maintain him / her in a predictable

routine.

• Be prepared to remind patients as often as in needed about

their location and their identity.

8. Wandering

• Make sure the person carries some

form of identification.

• Make sure your home is secure and

that the person is safe in your home
and cannot leave without your
knowing.
Fig 14
12
• Inform neighbours and local shops about the patient’s
condition. Seek their help with returning the patient home
providing your name, address and phone number for
convenience.

• Obtain an identity tag listing the patient’s telephone number

and address.

9. Safety measures:

• Do not leave a disoriented

patient alone.

• If he / she has a tendency of

fall provide a railing around
the bed and stay with the Fig 15
patient when he / she get out
of the bed for walks.

• Do not allow the patient to handle boiling water, matches,

cigarette lighters, gas stoves, fires, irons, medicines and
cleaning fluids.

• The patient should use the stove and other appliance only
under supervision.
13
10. Exercises

• Build on already existing

skills rather than expecting
the person to acquire new Fig 16
skills.

• Maintain a regular exercise schedule.

• Be flexible.

• Try to build exercises into activity, eg. Gardening, walking.

11. Sexual Activities

• Prevent the patient from performing sexual acts in public.

• Provide a private place.

• Try not to over – react to the behavior – remember it is the

disease taking effect.

• If the person removes clothing, gently discourage the

behavior, and try to distract the person.

14
 • Do be afraid to discuss these and related issues with a
professional who is trained to understand and help you
manage it.

12. Driving

• Suggest using public transportation as appropriate.

• The patient should not drive a

car.

• If the patient insist on driving

and he / she is on obvious
safety hazard, take measures to
disable the car and get the Fig 17
patient’s driver’s license
revoked.

13. Depression and Anxiety

• Give more love and support to

the person.

• Don’t expect the person to

snap out of the depression
immediately.

• Give supportive counseling.

15
Fig 18
 Myths and Misconceptions

Myth

This is senility; you can't reverse old age, so why go to a

doctor?

Fact

Alzheimer's disease is NOT "normal old age". Every elderly

individual does not necessarily get this disease. Thus, it is Important
to be aware of the signs and symptoms and consult a qualified
medical practitioner to get your loved one examined.

Myth

This is madness!
Fact

Although, some Alzheimer's disease

Fig 19
patients have abnormal behavioural
symptoms, these are an integral part of the disease process.
However, under no circumstances should this be considered to be
'madness'. The patients are unable to control their behaviour and
therefore, appropriate treatment is necessary. Although psychiatrists
do treat Alzheimer's disease, every patient treated by them is not
‘mad’.

16
Myth

He is possessed by evil spirits. I will take him to a magic

healer and get his evil spirit exorcised.

Fact

Alzheimer's disease
certainly does not indicate
possession by evil spirits nor is
it penance for sins committed in
previous lives. It is a well-
defined medical illness. Fig 20

Treatment should be received from a qualified medical practitioner

and not from faith healers or magic healer.

Myth

He behaves like a child. I will teach him sense.

Fact

Old age has been referred to in fiction as a "second

childhood". There may be some elements of child-like behaviour in
such patients but this is a superficial similarity. Family members
and, caregivers in their desire to be helpful, unknowingly try to
"teach the patient to behave". There are horror stories of patients
being beaten and scolded as children are. Family members must
realize that if the patients were capable of controlling their
17