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23138778-Alzheimer-s-Disease

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Definition
• Alzheimer's disease is a physical disease
which attacks the brain resulting in
impaired memory, thinking and behaviour.
The disease is named for the German
physician, Alois Alzheimer who, in 1907,
first described it.
Two different types:
1. Sporadic Alzheimer's disease
• The disease can affect adults at any age,
but usually occurs after age 65
• Sporadic Alzheimer's disease is by far the
most common form of Alzheimer's disease
• It affects people who may or may not have
a family history of the disease
2. Familial Alzheimer's disease
• The disease runs in a few families and is very
rare
• If a parent has a mutated gene, each child has a
50% chance of inheriting it
• The presence of the gene means that the person
will eventually develop Alzheimer's disease,
usually in their 40's or 50's
• Familial Alzheimer's disease affects a very small
number of people
Risk Factors
Neurochemical (deficiencies of neurotransmitters
Environmental (repeated head trauma or exposure to
aluminum and manganese)
Viral
(slow CNS viruses)
Genetic immunologic (abnormalities in chromosomes 14
and 21)
Pathophysiology
Abnormalities in cholinergic
neurotransmitters
Decrease in acetylcholine synthesis
Cellular degeneration & cellular atrophy
Abnormal material builds up as
neurofibrillary tangles in the center of the
brain cells and amyloidal plaques deposits
outside the brain cells
Disrupting messages within the brain
Damaging connections between brain cells
Leads to the eventual death of the brain
cells and prevents the recall of information
Alzheimer’s disease
Clinical manifestations
Stage 1. Mild (Early
confusion)
• Early cognitive decline
in one or more areas
• Memory loss
• Decrease ability to
function in work
• Name finding deficit
• Decrease in social
functioning
• Recall difficulties and
anxiety
Stage 2. Moderate
• Unable to perform
complex tasks (e.g.
managing personal
finances, planning a
dinner party, unable
to concentrate, no
knowledge of current
events).
Stage 3. Moderately
severe ( Early Dementia)
• Usually needs assistance
for survival
• Needs reminders to bath,
selecting clothes and
other daily functions.
• Maybe disoriented to time
or recent events although
this can fluctuate.
• May become tearful.
Stage 4. Severe (Dementia)
• Needs assistance with dressing, bathing
and toilet functions.
• May forget spouse, and other family
members names.
• Generally unaware of his surroundings
• Increase in CNS disturbances (e.g.
agitation, delusions, paranoia, obsessive
anxiety, increase potential for violent
behaviour and tendency to wonder.
Stage 5. Very severe
( late dementia)
• Unable to speak
• May scream or make
other sounds
• Unable to ambulate,
sit up, smile or feed
self.
• Unable to hold head
erect.
• Will ultimately sleep
into stupor or coma.
Nursing Diagnosis
• Problem: Inability to dress/groom self
Nursing diagnosis: Self-care deficit: Dressing/grooming
related to psychologic impairment secondary to
depression
• Problem: Suppressed feelings
Nursing Diagnosis: In effected coping related to
situational crisis.
• Problem: Immobility
Nursing Diagnosis: Impaired physical mobility related to
generalized weakness and fatigue.
• Problem: Disturbed Thought Process
Nursing Diagnosis: Disturbed thought process related to
Psychological changes: Neurochemical (deficiencies of
neurotransmitters acetylcholine, somatostatin, substance
P, and norepinephrine).
Diagnostic test findings
• Dianosis is made by exclusion; tests are
performed to rule out other diseases
• Positive diagnosis is made on autopsy
• Positron emission tomography shows
metabolic activity of the cerebral cortex
• Computed Tomography Scan reveals
excessive and progressive brain atrophy
• MRI rules out intracranial lesions.
• Cerebral blood flow studies show
abnormalities in blood flow to the brain.
• CSF analysis uncovers chronic neurologic
infection.
• EEG detects slowing of the brain waves in
late stages of the disease.
• Neuropsychologic tests reveal impaired
cognitve ability and reasoning.
Treatment
Cognitive Symptoms
• Cholinesterase inhibitors: donepezil (Aricept),
rivastigmine ( Exelon), galantamine (Reminyl),
tacrine (Cognex)
• Glutamate regulator: memantine (Namenda)
• Experimental agents to slow progression: CX516
(Ampalex), atorvastatin (Lipitor),
dimethylaminoethanol (Deanol), nefiracetam
(Translon)
Behavioral Symptoms
• Antianxiety drugs
• Antidepressants
• Antipsychotics
Nursing Considerations
• Provide the patient with the safe
environment; this may involve admission
to a facility outside of the home.
• Assist the patient with exercise, as
ordered, to help maintain mobility.
• Maintain and established daily routine to
decreased confusion and disorientation.
• Ensure adequate nutrition by basing food
choices on the patient’s current abilities,
including the ability to chew and swallow
or use utensils.
• Intervene with an agitated or fearful
patient by helping him focus on another
activity.
• Refer the patient and his family to
appropriate community resources and
support services.
• Establish an effective communication
system with the patient and his family to
help them adjust to the patient’s altered
abilities.
• Offer emotional support to the patient and
his family.
The End
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