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DEMENTIA AND ALZHEIMER’S DISEASE (AD)

Introduction
The three most common cognitive problems in adults are dementia, delirium (acute
confusion), and depression.
Definition
Delirium
Delirium, often called acute confusional state, begins with confusion and progresses to
disorientation.
Dementia
Dementia is a syndrome characterized by dysfunction or loss of memory, orientation,
attention, language, judgment, and reasoning.
Etiology
The two most common causes of dementia are
o Neurodegenerative conditions (e.g., AD)
o Vascular disorders: - . Vascular dementia, also called multi-infarct dementia, is the loss
of cognitive function resulting from ischemic, ischemic-hypoxic, or hemorrhagic brain
lesions caused by cardiovascular disease.
Alzheimer’s disease
Alzheimer’s disease is a progressive, irreversible, degenerative neurologic disease that
begins insidiously and is characterized by gradual losses of cognitive function and disturbances
in behavior and affect.
Etiology/risk factors
 Exact cause is unknown
 Advanced age
 Family history
 Infectious conditions such as bacterial meningitis and viral encephalitis.
Pathophysiology
Characteristic findings of AD relate to changes in the brain's structure and function:
 Amyloid plaques: - These plaques consist of clusters of insoluble deposits of a protein
called b-Amyloid, other proteins, remnants of neurons, non-nerve cells such as microglia
and other cells such as astrocytes.
 Neurofibrillary tangles: - Neurofibrillary tangles are abnormal collections of twisted
protein threads inside nerve cells.
 Loss of connections between cells and cell death: - The third feature of AD is the gradual
loss of connections between neurons. This process leads to damage and then death of the
neurons. Affected parts of the brain begin to shrink in a process called brain atrophy.
Clinical features (Dementia and Alzheimer’s disease)

 Early (Mild)
 Forgetfulness beyond what is seen in a normal person.
 Short-term memory impairment.
 Loss of initiative and interests.
 Decreased judgment
 Difficulty recognizing what numbers means.
 Middle (Moderate)
 Impaired ability to recognize close family or friends.
 Agitation
 Loss of remote memory.
 Confusion
 Insomnia
 Delusions
 Illusions, hallucinations
 Behavioral problems
  Impaired comprehension
 Late (Severe)
 Little memory, unable to process new information
 Cannot understand words
 Difficulty eating, swallowing
 Repetitious words or sounds
 Unable to perform self-care activities
 Immobility
 Incontinence

Diagnostic evaluation
 Health history including medical history
 Family history
 Physical examination
 Mental status examination
 Neurological assessment
 Blood test
 EEG
 CT and MRI scanning
 Examination of the cerebrospinal fluid
Medical management

Cholinesterase inhibitors:- Eg;- Rivastigmine

Benzodiazepines:- Eg;- Lorazepam
Conventional antipsychotics:- Eg;- Haloperidol
Tricyclic antidepressants:- Eg;- Nortriptyline
Nursing Management

Nursing diagnosis

 Disturbed thought processes related to effects of dementia as evidenced by loss of

memory and other cognitive deficits.
 Self-care deficit (bathing, dressing, toileting) related to memory deficit and
neuromuscular impairment as evidenced by inability to independently and appropriately
bathe, dress, or toilet.
 Risk for injury related to impaired judgment, possible gait instability, muscle weakness,
and sensory/perceptual alteration.

Nursing interventions

Nursing interventions are aimed at maintaining the patient’s physical safety; reducing
anxiety and agitation; improving communication; promoting independence in self-care activities;
providing for the patient’s needs for socialization, self-esteem, and intimacy; maintaining
adequate nutrition; managing sleep pattern disturbances; and supporting and educating family
caregivers.