Alzheimer's

Disease
Presented to: Madam Farah Batool
Presented by: Hafiza Iqra Ashraf
(purple group)
BSN post RN
Objectives:
› At the end of this session we will be able to ..
› Define Alzheimer’s disease and prevalence &
Incidence
› Comprehend its causes and types
› Distinguish its sign & symptoms
› Review medical management
› Formulate nursing management
› Outline its complications
Alzheimer’s Disease:
›  Alzheimer's, is a chronic
progressive, irreversible,
neurodegenerative disease that
begins insidiously and
characterized by gradual loss of
cognitive functions and
disturbance in behavior and
affect.( Brunner and
Suddrath’s )
Prevalence Incidence
›  prevalence is the total  Incidence is the number
number of cases of the of new cases per unit of
disease in the population person–time at risk 
at any given time.

Regarding incidence, provide rates between 10 and

15 per thousand person–years for all dementias and
5–8 for AD, which means that half of new dementia
cases each year are AD.
 The World Health Organization estimated that in
2005, 0.379% of people worldwide had dementia,
and that the prevalence would increase to 0.441% in
2015 and to 0.556% in 2030
AD can be classified into two types…
› Familial or early-onset: › Sporadic or late-onset:
› 5 % -10% › 90%-95%
› Gene: presenilin ( work › Gene : e4 allele
with gamma secretase apolipoprotien E
subunit ) (APoEe4)
› psen-1 at chromosome
14
› psen-2 at chromosome
1
Pathophysiology:
› Specific neuropath logical and biochemical
changes are found in patient with AD.
› These include neurofibrillary tangles (tangled
masses of nonfunctioning neurons) and senile or
neuritic plaques ( deposits of amyloid protein
part of large protein called amyloid precursor
protein)in brain .
› Amyloid precursor protein ( app) helps in neuron
growth and repair it gets used , broken down and
recycled normally.
Conti…

› Accumulation of aggregated amyloid fibrils, which

are believed to be the toxic form of the protein
responsible for disrupting the
cell's calcium ion homeostasis,
induces programmed cell death (apoptosis)
› Tangles (neurofibrillary tangles) are aggregates of
the microtubule-associated protein tau which has
become hyperphosphorylated and accumulate
inside the cells themselves. 
Conti..
› Various inflammatory processes and cytokines may also
have a role in the pathology of Alzheimer's
disease. Inflammation is a general marker
of tissue damage in any disease, and may be either
secondary to tissue damage in AD or a marker of an
immunological response
› Cholinergic hypothesis, which proposes that AD is
caused by reduced synthesis of
the neurotransmitter acetylcholine. The cholinergic
hypothesis has not maintained widespread support,
largely because medications intended to treat
acetylcholine deficiency have not been very effective.
Clinical manifestations:
› Symptoms get worsen as plaques and tangles build
up….
› In early stage .. Might not detectable
› Short-term memory loss e.g. had for break fast
› Loss of some motor skill and language
› Long-term memory loss e.g. spouse’s name
› Disoriented .. Risk getting loss
› Bedridden
› Death due to infection
Diagnose:
› Medical history,
› History from relatives,
› Behavioral observations
› Advanced medical imaging with computed
tomography (CT) or magnetic resonance imaging (MRI),
and with single-photon emission computed
tomography (SPECT) or positron emission
tomography (PET)
› Assessment of intellectual functioning including memory
testing can further characterize the state of the disease.
Conti…
› The National Institute of Neurological and
Communicative Disorders and Stroke (NINCDS) and
the Alzheimer's Disease and Related Disorders
Association (ADRDA, now known as the Alzheimer's
Association) established the most commonly
used NINCDS-ADRDA Alzheimer's Criteria for
diagnosis in 1984,extensively updated in 2007.
› These criteria require that the presence of cognitive
impairment, and a suspected dementia syndrome,
be confirmed by neuropsychological testing for a
clinical diagnosis of possible or probable AD.
› A histopathologic confirmation including
a microscopic examination of brain tissue is
required for a definitive diagnosis.
› Eight intellectual domains are most commonly
impaired in AD—memory, language, perceptual
skills, attention, motor skills, orientation, problem
solving and executive functional abilities. These
domains are equivalent to the NINCDS-ADRDA
Alzheimer's Criteria as listed in the Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV-TR)
published by the American Psychiatric Association.
Medical management:
› In AD the primary goal is to manage the cognitive and
behavioral symptoms. Although there is no cure ,
several medications have been introduced to slow the
progression of the disease.
› The cholinesterase inhibitors (CEIs) Denopezil
hydrochloride (Aricept), Rivastigmine tartrarte (Exelon)
and Galantamine hydrobromide (razadyne) enhance
acetylcholine uptake in the brain, thus maintaining
memory skills for a period of time for mild to moerate
symptoms.
› Behavioral problems such as agitation and psychosis
cab be managed by behavioral and psychosocial
therapies.
Alzheimer's Disease Nursing Care
Plan
› Subjective Data:
› Difficulty finding words
during a conversation
› Difficulty remembering
names
› Poor short-term memory
› Forgetting details of
personal history (life events,
phone number, etc.)
› Inability to recognize faces
› Objective Data:
› Difficulty dressing or
performing ADLs
› Loss of bladder and bowel
control
› Personality changes
› Inappropriate behaviors
(aggression, sexual
gestures, etc.)
› Wandering or pacing
Nursing Interventions and Rationales:
› Perform complete nursing assessment
› Assess neurological status and level of confusion
routinely, per facility protocols
› Assess for depression or reclusiveness
› Routinely assess client for organic contributors to
behavior: Dehydration, Poor nutrition, Infection
(systemic, urinary)
› Communicate effectively: Speak in a slow and low,
comforting voice, Call client by name, Speak face-
to-face
› Monitor for non-verbal cues and anticipate client’s
needs Grimacing, Crying, Pointing
Conti..
› Orient client to environment as often as needed:
Calendars, Pictures, Signs
› Provide structured and guided activities that client
can accomplish with minimal challenge
› Maintain schedule and routine
› Assist with ADLs as needed
› Provide an opportunity for clients to interact with
others, but avoid forcing interaction
› Avoid allowing client to watch television or violence
on television
› Monitor client’s wandering habits and determine
specific reasons, if any, for wandering
› Educate family about disease process and resources
for coping: Therapy or counseling for families,
Support groups for families or caregivers, Respite
care options, Home modifications
› Administer medications appropriately and as
needed: Cholinesterase inhibitors (donepezil),
NMDA receptor antagonist (memantine),
Antipsychotics (olanzapine, quetiapine),
Benzodiazepines (lorazepam, temazepam), SSRI
antidepressants (citalopram, paroxetine)
› Minimize environmental hazards and make
pathways clear and illuminated
Bibliography:
› Hinkle, J. L. (2014). Brunner & Suddarth's textbook
of medical-surgical nursing (Edition 13.).
Philadelphia: Wolters Kluwer Health/Lippincott
Williams & Wilkins.
Reference:
› https://en.wikipedia.org/wiki/Alzheimer
%27s_disease

› :https://www.youtube.com/watch?v=nPT1nD6Wh6E
› https://www.nrsng.com/care-plan/alzheimers-
Thank you !!!!!
Any questions???