ALZHEIMER’S DISEASE

Description
• Alzheimer’s disease is a chronic, progressive,
degenerative disease that accounts for 60% of
the dementias occurring in people older than
65 years. Alzheimer’s is manifested by loss of
memory, judgment, and visuospatial
perception and by a change in personality.
Severe deterioration takes place and death
occurs as a result of complications of
immobility.
 Pathophysiology
• Structural Changes in the Brain
• Marked atrophy of the cerebral cortex and loss of
cortical neurons occur. The cerebral sulci and
fissures, as well as the ventricles, are enlarged more
than those of persons of the same age without
Alzheimer’s. The areas that are particularly affected
are the precentral gyrus of the frontal lobe, superior
temporal gyrus, hippocampus, and substantia
nigra.
 Pathophysiology
• Chemical Changes in the Brain
• Abnormalities in the neurotransmitters
(acetylcholine, norepinephrine, dopamine,
serotonin) may also occur in addition with the
structural changes in the brain.
• Acetyltransferase in the hippocampus is lost which
interferes with cholinergic innervation to the
cerebral cortex and this results in impaired
cognition, recent memory, and the ability to acquire
new memories.
 Risk Factors
• It is well established that age, gender (women
more than men), and family history are the
most important risk factors.
• Genetics, chemical imbalances, environmental
agents, and immunologic changes have also
been proposed as theories for risk factors.
• African Americans and Hispanics have a
higher risk for the disease and it is not yet well
known why that is.
 Clinical Manifestations
Clinical Manifestations of Alzheimer’s occur in
cognitive changes, changes in behavior and
personality, and changes in self-management
skills.
• Cognitive changes

• Apraxia (inability to use objects correctly)

• Aphasia (inability to speak or understand)
• Anomia (inability to find words)
• Agnosia (loss of sensory comprehension)
 Clinical Manifestations
• Behavior and Personality Changes
• Aggressiveness, especially verbal and physical
abusive tendencies
• Rapid mood swings
• Increased confusion at night or when the light is not
adequate (sundowning) or in excessively fatigues
patients
• Wandering and getting lost
• Paranoia, delusions, hallucinations, and depression
may occur
 Clinical Manifestations
• Changes in self-management skills
• Decreased interest in personal appearance
• Selection of clothing that is inappropriate for the
weather or event
• Loss of bowel and bladder control
• Decreased appetite or ability to eat
 Diagnostic Tests
• The CT scan typically shows cerebral atrophy
and ventricular enlargement, wide sulci, and
shrunken gyri in the later stages of Alzheimer’s
• An MRI scan can also rule out other causes of
neurologic disease
• A PET and SPECT scan show a significant
decrease in the metabolic activity in the brains
of people with Alzheimer’s
• An electroencephalogram (EEG) shows slow-
wave delta activity
 Pharmacotherapy
• Cholinesterase Inhibitors are drugs approved
to treat the symptoms of Alzheimer’s
• (Aricept) donepezil
• (Reminyl) galantamine
• (Exelon) rivastigmine
 Evidence-Based Treatment
Modalities
Alzheimer’s is an incurable disease but these are a few
interventions for patients with Alzheimer’s
• Cognitive stimulation to promote awareness and

comprehension of surroundings by utilization of planned

stimuli
• Offer environmental stimulation through contact with varied
personnel
• Present change gradually
• Allow for rest periods
• Memory training
• Stimulate memory by repeating patient’s last expressed thought
• Reminisce about past experiences with the patient
 Video
This video is a brief explanation of what is going
on in the brain with Alzheimer’s Disease

https://www.youtube.com/watch?v=9Wv9jrk-
gXc
 References
Ignatavicius, D. D., & Workman, M. L. (2010).
Medical-Surgical Nursing: Patient-Centered
Collaborative Care. St. Louis, Missouri: Elsevier.