Alzheimer's disease

Name: pooja Adhikari

Rollno: 27
SMTC
 Introduction
Alzheimer's disease is a progressive and irreversible
neurological brain disorder which is usually seen in
individuals older than 65 age. It affects the cells of
the brain and causes loss of memory, judgment and
changes in personality. It is also the most common
form of dementia, a group of disorders that impairs
mental functioning.
Cont..
• This disease was first described by Dr.Alois
Alzheimer, a German physician, in 1906.
• Memory loss is one of the earliest symptoms, along
with gradual decline of other intellectual and
thinking abilities, called cognitive functions and
changes in personality or behavior.
 Epidemiology
 Worldwide, nearly 50 million people have Alzheimer's or
related dementia. It is the 6th leading cause of death in the
united states(World Alzheimer's report, 2018).
 Every year, around 4.6 million new dementia cases are
added in the existing pool of Alzheimer's disease with the
highest growth projections in china along with its south
Asian neighbors (World Health Organization [WHO],
2001).
 About 3% of men and women ages 65 to 74 have
Alzheimer's disease, and nearly half of those ages 85
older may have this disease.
 Stages of AD
 Mild or Early Stage:
Friends, family and co workers begin to notice deficiencies.
Some common difficulties include:
 Forgets names
 Misplaces household items
 Mild memory loss
 Short attention span
 Changes in the personality
 Impaired judgment
 Poor performance at work
 Decline in ability to plan or organize
Cont..
 Moderate or Middle Stage: Major gaps in
memory and deficits in cognitive function. Some
assistance with day to day activities becomes
essential. Some common difficulties include:
 Disoriented to time, place and event
 Agitated
 Lose most awareness of recent experiences and
events as well as of their surroundings.
 Tend to wander and become lost
Cont..
 Unable to care for self
 Irritable and anxious
 Social isolation
 Has difficulty in following simple instructions
 Inability to recall important details such as their
current address, their telephone number etc.
Cont..
Severe or Late Stage:
This is the final stage of the disease when individuals
lose the ability to respond to their environment, the
ability to speak and the ability to control movement.
 Unable to communicate
 Does not recognize family
 Incontinence of urine and feces
 Loses the ability to stand and walk
 Need full assistance with eating and toileting.
 Causes
1.The exact cause of Alzheimer's disease is unknown.
2. However several factors are thought to be implicated
in this disease, Such as:
 Age: Increasing age is the greatest known factor for
Alzheimer's disease. It is not a part of normal aging
but as we grow older the likelihood of developing AD
increases with the age.
 Family history: People who have a parent or siblings
with Alzheimer's disease are more likely to get it
themselves.
Cont..
 Environmental factors:
 Cigarette smoking
 Certain infections
 Metals, industrials or other toxins
 Use of cholesterol lowering drugs (statin).
 Past head trauma: People who've had a severe head
trauma have a greater risk of Alzheimer's disease.
 Poor sleep patterns: Research has shown that poor sleep
patterns such as difficulty falling asleep or staying asleep
increased the risk of Alzheimer's disease.
 Pathophysiology
 Alzheimer's disease attacks nerves and brain cells as
well as neurotransmitters. The destruction of these
parts causes clumps of protein to form around the
brain cells. These clumps are known as plaques and
bundles. The presence of these plaques and bundles
start to destroy more connections between the brain
cells, which makes the condition worse.
Cont…
Due to different etiological factors such as:
environmental factors, head trauma, certain
infections.

Changes occurs in the protein of the nerve cells of the

cerebral cortex.

Accumulation of the neuro fibrillary tangles and beta

amyloid plaques
Cont..
Neuro degeneration changes

Neuronal Function loss

Loss of memory function, cognitive and

intellectual impairment.
 Ten Warning signs of AD
1. Memory loss
2. Difficulty in performing familiar tasks
3. Problems with language
4. Disorientation to time and place
5. Poor or decreased judgment
6. Misplacing things
7. Changes in mood or behavior
8. Changes in personality
9. Loss of initiative
10. Problems with abstract thinking
 Symptoms
• Confusion
• Disturbances in short term memory
• Problems with attention
• Personality changes
• Language difficulties
• Unexplained mood swings.
 Other Clinical features:
• Personality changes: lack of interest in day to day
activities, self centered, withdrawn, decreased self care.
• Memory impairment: Recent memory is prominently
affected.
• Cognitive impairment: Disorientation, poor judgment,
decreased attention span.
• Affective impairment: Irritableness, depression.
• Behavioral impairment: Stereotyped behavior,
alteration in sexual drives and activities, neurotic/
psychotic behavior.
Cont..
• Neurological impairment: Aphasia, agnosia,
seizures, headache.
• Sundowner syndrome: It is characterized by
drowsiness, confusion, ataxia; accidental falls may
occur at night when external stimuli such as light and
interpersonal orienting clues are diminished.
 Diagnosis
1. History Taking
2. Physical Examination
3. Mini- Mental status Examination : shows cognitive
impairment.
4. CT- scan and MRI of the brain shows structural and
neurologic changes
5. gbCerebro gSpinal fluid Analysis : shows increased beta
amyloid deposits.
6. Electro encephalogram (EEG)
7. Electromyogram
8. Definitive diagnosis: Autopsy after death
 Treatment
A. Pharmacological Treatment:
1. Acetyl cholinesterase inhibitors: Prevents the
breakdown of acetylcholine, a chemical messenger
important for learning and memory. Example:
Donepezil, Rivastigmine, Galantamine.
2. N- Methyl d- aspartate receptor antagonist
(NMDA): It is approved for moderate to severe
Alzheimer's disease treatment. Example: memantine.
Cont..
3. Anti Anxiety Drugs: It is used to treat agitation. It can
cause sleepiness, dizziness, falls so, they should be used for
short periods of time.
4. Antipsychotics Drugs : are sometimes used to treat
hallucinations, agitations and aggressions. Side effects of
these drugs can be serious including risk of death in some
older people with dementia. They should only be given to
people with Alzheimer's disease when the physician agrees
that the symptoms are severe.
5. Anticonvulsant Drugs: It is sometimes used to treat severe
aggression. Side effects may be sleepiness, dizziness, mood
swings etc.
Cont..
B. Nutrition:
People with Alzheimer's disease may forget to eat, lose
interest in preparing meals or does not eat a healthy
combination of foods. They may also forget to drink
enough, leading to dehydration and constipation. So,
they should be provided with high calorie, healthy
shakes of milk or other smoothies foods to prevent
difficulty in eating. Patients with AD should avoid
beverages with caffeine, which can increase with sleep
and trigger a frequent needs to urinate.
Cont..
C. Exercise
Regular exercise is an important part of a treatment plan.
Activities such as a daily walk can help to improve mood
and maintain the health of joints, muscles and the heart.
Exercise can also promote restful sleep and prevent
constipation.
D. Social engagement and activities: Social interactions
and activities can support the abilities and skills that are
preserved. Doing things that are meaningful and enjoyable
are important for the overall wellbeing of a person with
Alzheimer's disease.
Cont..
This may include:
- Listening to music or dancing
- Reading or listening to books
- Gardening or crafts
- Planned activities with children etc.
D. Coping and support: People with AD experience a
mixture of emotions like confusions, fear, anger, depression
etc. so, a calm and stable home environment can help to reduce
a behavior problems. The person should also be reassured that
life can be still enjoyed by providing support and doing the
best to help person too retain dignity and self respect.
 Nursing Management
Assessment
1. Assess the health history and mental status
examination and physical examination, noting
symptoms indicating dementia.
2. Assess impaired memory or thinking( cognitive)
skills.
3. Assess the concentration and attention span with
awareness of time, place and person.
4. Assess the patients ability to cope with events,
interests in surroundings and activity motivation.
Cont..
5. Assess the effects of communication and deficits.
6. Assess patients for presence of wandering behavior
and specific reasons for wandering.
7. Assess the degree of impaired ability of competence,
emergence of impulsive behavior and decrease in
visual perception.
8. Assess patients surroundings for hazards and remove
them.
 Nursing Diagnosis
1. Disturbed thought process related to chemical
imbalances in the brain as evidenced by
disorientation to time, place and circumstance.
2. Impaired verbal communication related to decreased
circulation to the brain as evidenced by confusion,
repetitive speech, stuttering or slurring speech.
3. Self care deficit related to cognitive and
neuromuscular impairment as evidenced by inability
to wash body parts and maintain appearance at
satisfactory levels.
Cont..
4. Impaired physical mobility related to dementia as
evidenced by decrease fine and gross motor
movement.
5. Disturbed sleep pattern related to Alzheimer's disease
progression as evidenced by sleeplessness and
fatigue.
6. Risk for injury related to decline in cognitive
function.
7. Anxiety related to confused thought process.
 Nursing Intervention
A. Improving thought process:
1. Assess patient for depressive behaviors, causative
events and orient the patient to reality as warranted.
2. Establish a trusting relationship and permits the
patient to discuss topics that can help the patient to
deal with appropriate ways.
3. Use a non-judgmental attitude toward the patient and
actively listen to his feelings and concern.
4. Provide a calm, predictable environment to avoid
confusion and disorientation.
Cont..
B. Improving verbal communication:
1. Assess the patients ability to speak, language deficit,
cognitive or sensory impairment, presence of
aphasia, aphonia.
2. Instruct the patient to make a conscious effort to
speak slowly with deliberate attention to what the
listener are speaking.
3. Monitor the patient for non verbal communication
such as facial grimacing, smiling, crying, and
encourage the use of speech when possible.
Cont..
4. Remove competing stimuli and provide a clam,
unhurried atmosphere for communication.
5. Avoid rushing the patient when struggling to express
feelings and thoughts.
C. Promoting independence in self care
activities:
1. Determine the specific cause of each deficit such as
visual problems, weakness and cognitive impairment.
2. Provide positive reinforcement for all activities
attempted by the patients.
3. Render supervision for each activity until the patient
exhibits the skill effectively and is secured in
independent.
Cont..
4. Apply regular routines and allow adequate time for
the patient to complete task.
5. Guide the patient in accepting the needed amount of
dependence.
6. Maintain patients personal dignity and autonomy.
D. Promoting physical ability:
1. Teach the patient to concentrate on walking erectly.
2. Instruct the patient to perform a daily exercise that
will increase muscle strength.
3. Encourage the patient to raise the head of bed and
make position changes slowly.
4. Refer the patient to physical therapist.
5. Provide warm baths and massages.
E. Maintaining sleep pattern:
1.Assess patients sleep patterns and changes, naps,
frequency, amount of activity, number of time of
awakenings during night.
2. Ensure environment is calm, quiet, well ventilated and
absence of odor.
3. Monitor patients medications, use of alcohol and caffeine.
4. Provide backrubs, music and other relaxation techniques
before sleep.
5. Help patient to do exercises.
F. Promoting physical safety:
1. Provide a safe environment to allow the patient to
move freely as possible and relieves worry about
safety.
2. Prevent falls or other accidents by removing obvious
hazards and provide adequate lighting.
3. Prohibit driving.
4. Supervise all the activities outside the home to protect
the patient. As needed secure doors of the house.
5. Ensure that the patients wear an identification
bracelets or neck chain.
6. Avoid restraints because they may increase agitation.
7. Reduce the wandering behavior with gentle
persuasion and distraction.
G. Reducing anxiety and agitation:
1. Provide emotional support to reinforce a positive self
image.
2. Keep the environment simple, familiar and noise free,
limit changes.
3. Remain calm and unhurried while performing any
procedures or tasks to the patients.
4. Encourage patients to participate in simple activities or
hobbies.
5. Provide adequate rest and comfortable sleep.
 Evaluation
• Maintained self care.
• Improved physical ability.
• Exhibits improved thought process.
• Improved sleep pattern.
• Improved verbal communication.
• Reduced anxiety levels.
 Reference
1. Williams and wilkims, lippincott manual of nursing.
5th edition. Wolters kluwer(india)pvt.ltd. Newdelhi
page no: 175-177).
2. Brunner and siddharths, Textbook of Medical and
surgical nusring. 12th edition, 2013. walters
kluwer(india) pvt.ltd. Newdelhi.
3. Mandal, G.N(2019), Medical surgical nursing.
Crown point printing house pvt.ltd.
Thank you