HARSHITAII nd YEARA.B.C.O.N

ALZHEIMER’S DISEASE

• Alzheimer is a disease that attacks brain. It is most common form of DEMENTIA.

• Dementia is a general term for a decline in mental ability severe enough to interfere with daily life.

• In Alzheimer's disease there is a progressive loss of brain cells.

• Also known as AD.

ALZHEIMER

ALZHEIMER BRAIN

ETIOLOGY

• The exact aeitopathogenesis is not known

• The hypotheses include cholinergic hypothesis (reduced acetylcholine), amyloid hypothesis, and tau hypoth

PATHOLOGY

• It consist principally of neuronal loss ; principally in temporal cortex but also in the frontal cortex.

• Senile plaques and neurofibrially tangles are regarded as hallmark of AD though they may also be present with normal again

PATHO -PHYSIOLOGY

• Alzheimer's disease is characterized by loss of neurons and synapses in the cerebral cortex and certain sub cortical regions.

• This loss results in gross atrophy of the affected regions, including degeneration in the temporal lobe and parietal lobe, and parts of the frontal cortex and cingulated gyrus

LABORATORY INVESTIGATION

• These are carried out to exclude a treatable cause of dementia.

• Common investigation are blood chemistry, a complete count, test for syphilis, serum levels of vitamin B12 and thyroid function.

• A CT scan of head is usually done to exclude an intracranial pathology.

CONTINUE• A MRI may be necessary to detect

presence of white matter ischemic lesions.

CAUSES• Alzheimer's disease is caused by

parts of the brain wasting away (atrophy), which damages the structure of the brain and how it works.

• It is not known exactly what causes this process to begin, but people with Alzheimer's disease have been found to have abnormal amounts of protein (amyloid plaques) and fibers (tau tangles) in the brain

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• These reduce the effectiveness of healthy neurons (nerve cells that carry messages to and from the brain), gradually destroying them.

• Over time, this damage spreads to other areas of the brain, such as the grey matter (responsible for processing thoughts) and the hippocampus (responsible for memory).

SIGN AND SYMPTOMS• The symptoms of Alzheimer’s

disease progress slowly over several years. However, the rate at which they progress will differ for each individual.

• No two cases of Alzheimer's disease are ever the same because different people react in different ways to the condition. However, generally, there are three stages to the condition:-

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Mild Alzheimer's diseaseCommon symptoms of mild

Alzheimer's disease include:• forgetfulness • mood swings• speech problems

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Moderate Alzheimer's diseaseAs Alzheimer's disease develops into

the moderate stage, it can also cause:

• Disorientation• Difficulty performing spatial tasks

(such as judging distances or finding your way around)

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• Problems with eyesight which could lead to poor vision, or in some cases hallucinations (where you hear or see things that are not there)

• Delusions – believing things that are untrue

• Obsessive or repetitive behaviour

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• A belief that you have done or experienced something that never happened

• Disturbed sleep• Incontinence – where you

unintentionally pass urine (urinary incontinence) or stools (faecal or bowel incontinence

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Severe Alzheimer's disease• Dysphagia (difficulty swallowing)• Difficulty changing position or

moving from place to place without assistance

• Weight loss or a loss of appetite• Increased vulnerability to infection

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• Complete loss of short-term and long-term memory

• Someone with severe Alzheimer's disease may seem very disorientated and is likely to experience hallucinations and delusions.

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• The hallucinations and delusions are often worse at night, and the person with Alzheimer's disease may start to become violent, demanding, and suspicious of those around them.

TREATMENT

MedicationMedications that may be prescribed for

Alzheimer’s disease include:• Donepezil 5mg daily • Galantamine 4mg twice a day • Rivastigmine 1.5mg twice a day

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Side effectsDonepezil, galantamine and rivastigmine

(AChE inhibitors) can cause side effects including:

• nausea (feeling sick)• vomiting• diarrhoea• headache • fatigue (extreme tiredness)• insomnia

NURSING MANAGEMENT

Nurse’s Role

• Promote independence and autonomy

• Prevent complications• Provide comfort• Promote quality of life• Education

Planning Care

• No cure available• Goals of treatment

–Slow progression–Manage manifestations

• Care giver experience needed–Long-term care–End-of-life care

Planning Care

• Challenging behaviors and psychiatric symptoms develop in the AD patient

• Settings used to care for AD patients– Individual’s home or family member’s

home– Hospitals– Long-term-care facilities (nursing homes)– Congregate living facilities– Hospice settings

Pharmacological Interventions

• Cholinesterase inhibitors–Slow progression of symptoms–Titrate dosages slowly

• Donepezil (Aricept)• Rivastigmine (Exelon)• Galantamine (Reminyl

CONTINUE• Memantine (Namenda)

– N-methyl-d-aspartate (NMDA) antagonist• Alternative and complementary therapies

– Vitamin E: limited support, more study needed

– Nonsteroidal anti-inflammatory drugs/statins: patients taking these have reduced development of AD

– Statins:are a class of drug used to lower cholesterol levels by inhibiting the enzyme HMG- CoA reductase.

Functional Impairments

• Utilize therapeutic nonverbal behaviors

• Avoid fatigue, nonroutine activities, and alcohol

• Avoid a high-stimulus environment• Prevent disability• Treat other conditions that lead to

physical decline

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• Identify and respond rapidly to acute changes in function

• Adapt care to accommodate neuro motor changes secondary to progression of dementia

Mood Disorders

• Be alert for changes–Appetite–Disinterest–Anhedonia–Sleep abnormality–Fatigue

Delusions and Hallucinations

• Cause–Delirium– Interaction of dementia and

personality–Separate mental disorder

coexisting with dementia–Disinhibition of cortical functions

Dependence in ADLs

• Promote, preserve functional independence

• Preventive plans of care

Inability to Initiate Meaningful Activities

• Results in apathy or agitation for dementia sufferer

• Promote social involvements

Anxiety• May be a primary disorder or a

symptom of depression• May result from delusions,

hallucinations, or functional impairment

• Plan interventions to reduce stress, enhance feelings of trust and safety

• Promote stability• Provide diversion activities

Spatial Disorientation

• Results in incorrect interpretation of objects or directions

• Results in fear, anxiety, suspicions, illusions, delusions, and safety concerns

• Promote familiarity with environment• Use landmarks to provide “pop-up”

cues

Elopement

• means to run away, and to not come back to the point of origination

• A valid concern in individuals with cognitive impairments

• Risk factors• Alzheimer’s Association Safe Return

Program

Resistance to Care• Common in middle to late stages of

dementia• Major reason for institutionalization

and use of psychotropic medications and restraints

• Management strategies–Restore calm–Time-out

Food Refusal

• Occurs in each of the progressive stages of AD

• Causes• Management interventions

Insomnia

• Insomnia noted months prior to AD diagnosis

• Establish routines to promote therapeutic sleep patterns–Establish sleep hygiene–Eliminate stimuli before bedtime

Apathy and Agitation

• Associated with increasing cognitive decline

• Escalation can result in violence and combative behaviors

• Promote interest in the environment

PharmacologicaL Interventions

• Used to promote comfort• Begin with lower dosages and

gradually increase• Monitor side effects closely

Late Stage Issues

• Institutionalization• Do not resuscitate decisions• Transfer to acute care facilities • Feeding tubes• Infections

PREVENTION• Quitting smoking• Avoid drinking large amounts of

alcohol• Eating a healthy balanced diet• Exercising for at least 150 m• If you have Diabetes, make sure you

keep to the diet and take and medicines

THANK YOU