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Introduction Alzheimers disease is a progressive, irreversible, degenerative neurologic disease that begins insidiously and is characterized by gradual losses of cognitive function and disturbances in behavior and affect. Although Alzheimers disease can occur in people as young as 40 years of age, it is uncommon before 65 years of age. It is important to note that Alzheimers disease is not a normal part of aging. The greatest risk factor for Alzheimers disease is increasing age, many environmental, dietary, and inflammatory factors also may determine whether a person suffers from this cognitive disease. Alzheimers disease is a complex brain disorder caused by a combination of various factors that may include genetics, neurotransmitter changes, vascular abnormalities, stress hormones, circadian changes, head trauma, and the presence of seizure disorders. It can be classified into two types: familial or early onset Alzheimers disease and sporadic or late onset Alzheimers disease. Familial Alzheimers disease is rare, accounting for less than 10% of all cases and is frequently associated with genetic mutations. It occurs in middle aged adults. If family members have at least one other relative with Alzheimers disease, then there is a familial component, which non-specifically includes both environmental triggers and genetic determinants. (Textbook of Medical-Surgical Nursing, 12th Edition by Brunner & Suddarth, published by Lippincott Williams & Wilkins, page 217) In Alzheimers disease, over time, symptoms get worse. People may not recognize family members or have trouble speaking, reading or writing. They may forget how to brush their teeth or comb their hair. Later on, they may become anxious or aggressive, or wander away from home. Eventually, they need total care. This can cause great stress for family members who must care for them. No treatment can stop the disease. However, some drugs may help keep symptoms from getting worse for a limited time.

http://www.nlm.nih.gov/medlineplus/alzheimersdisease.html

There are stages of Alzheimers disease: the Early stage (Forgetfulness), Middle stage (Sundowning), and Late stage (Kluver Bucy like Syndrome). The early stage of Alzheimer's disease (also referred to as "mild Alzheimer's disease") refers to people of any age who have mild impairment. This differs from the term "early onset," which refers to people who have been diagnosed with Alzheimer's disease at a younger age than usual. During the moderate stage of Alzheimer's, people grow more confused and forgetful and begin to need help with daily activities and self-care. In the severe (late) stage of Alzheimer's, mental function continues to decline and the disease has a growing impact on movement and physical capabilities. The rate of progression for Alzheimer's disease varies widely. On average, people with Alzheimer's disease live eight to 10 years after diagnosis, but some survive as long as 25 years.

http://www.mayoclinic.com/health/alzheimersstages/AZ00041/NSECTIONGROUP=2 Internationally, in 2012,an estimated 5.4 million Americans have AD, including approximately 200,000 age <65 years who comprise the younger-onset AD population. Over the coming decades, the aging of the baby boom generation is projected to result in an additional 10 million people with AD. Today, someone in America develops AD every 68 seconds. In 2011, more than 15 million family members and other unpaid caregivers provided an estimated 17.4 billion hours of care to people with AD and other dementias, a contribution valued at more than $210 billion. Medicare payments for services to beneficiaries age 65 years with AD and other dementias are three times as great as payments for beneficiaries without these conditions, and Medicaid payments are 19 times as great. As of 2010, there are an estimated 35.6 million people with dementia worldwide. This number will nearly double every 20 years, to an estimated 65.7 million in 2030, and 115.4 million in 2050. Much of the increase will be in developing countries. Already 58% of people with dementia live in developing countries, but by 2050 this will rise to 71%. The fastest growth in the elderly population is taking place in China, India, and their south Asian and western Pacific neighbors.

http://www.alzheimersanddementia.com/article/S1552-5260(12)00032-5/abstract

As of 2004, the Philippines population aged 60 years old and above totaled 5.7 million older persons. This is equivalent to about 6.9% of the Filipino population. Currently the Philippines is ranked 5th among Southeast Asian countries with a high annual population growth rate. The 2000 census of population and housing reported a total of 4.6 million elderly person with Alzheimers disease accounted for almost 6% of the Philippine population, a marked increased of 22.18% from the 3.7 million elderly persons in 1995. It is estimated that the number of older persons will further increase to 7 million in 2010 in twice as much in about 16 years if the 4.39% growth rate persist. http://www.mhlw.go.jp/bunya/kokusaigyomu/asean/asean/kokusai/siryou/dl/h19_ philippines.pdf In Davao City, they said that the data as to number of cases, but it got at least two new cases a week in some clinic.Their data show that about 70 percent of Filipinos 60 years old and above manage to live good quality of life while the remaining 30 percent of them are vulnerable to dementia.It is sad to note that many dont get to see a doctor. Angel is the only doctor in Davao City that practices Geriatric Medicine and gets patients from as far as Lanao and the different parts of Mindanao.A doctor also said the higher the age the more dementia cases would be, adding that among the 70 years old, about 30 percent of them suffered dementia; while for the 80 years old, around 40 percent and in the 90 years old bracket, about 50 percent of them have dementia. Aside from the attitude of not seeing a doctor, the other problem would be economic because of the difficulty of convincing the family to see a doctor as most of them declined due to the high cost of treatment. Seeking treatment could reduce the problem but sustaining the treatment in order to bring back quality of life was another thing. http://hdmf.wordpress.com/2010/09/21/this-may-not-be-biz-story-but-i-want-toshare-this-coz-all-of-us-have-older-persons-in-the-family/

Objectives: To know further the disease process. To give information to others about the disease. To further understand underlying cause of the disease. To know proper nursing interventions for caring patient with AD. To know treatments to slow the progression of the disease.

Anatomy and Physiology

The brain is made of nerve cells and several other cell types. Nerve cells also are called neurons. The neurons of all animals function in basically the same way, even though animals can be very different from each other. Neurons survive and function with the help and support of glial cells, the other main type of cell in the brain. Glial cells hold neurons in place, provide them with nutrients, rid the brain of damaged cells and other cellular debris, and provide insulation to neurons in the brain and spinal cord.

Two cerebral hemispheres account for 85 percent of the brains weight. The billions of neurons in the two hemispheres are connected by thick bundles of nerve cell fibers called the corpus callosum. Scientists now think that the two hemispheres differ not so much in what they do (the logical versus artistic notion), but in how they process information. The left hemisphere appears to

focus on details (such as recognizing a particular face in a crowd). The right hemisphere focuses on broad background (such as understanding the relative position of objects in a space). The cerebral hemispheres have an outer layer called the cerebral cortex. This is where the brain processes sensory information received from the outside world, controls voluntary movement, and regulates cognitive functions, such as thinking, learning, speaking, remembering, and making decisions. The hemispheres have four lobes, each of which has different roles:

The frontal lobe, which is in the front of the brain, controls executive function activities like thinking, organizing, planning, and problem solving, as well as memory, attention, and movement.

The parietal lobe, which sits behind the frontal lobe, deals with the perception and integration of stimuli from the senses.

The occipital lobe, which is at the back of the brain, is concerned with vision. The temporal lobe, which runs along the side of the brain under the frontal and parietal lobes, deals with the senses of smell, taste, and sound, and the formation and storage of memories.

The cerebellum sits above the brain stem and beneath the occipital lobe. It takes up a little more than 10 percent of the brain. This part of the brain plays roles in balance and coordination. The cerebellum has two hemispheres, which receive information from the eyes, ears, and muscles and joints about the bodys movements and position. Once the cerebellum processes that information, it sends instructions to the body through the rest of the brain and spinal cord. The cerebellums work allows us to move smoothly, maintain our balance, and turn around without even thinking about it. It also is involved with motor learning and remembering how to do things like drive a car or write your name.

The brain stem sits at the base of the brain. It connects the spinal cord with the rest of the brain. Even though it is the smallest of the three main players, its functions are crucial to survival. The brain stem controls the functions that happen automatically to keep us aliveour heart rate, blood pressure, and breathing. It also relays information between the brain and the spinal cord, which then sends out messages to the muscles, skin, and other organs. Sleep and dreaming are also controlled by the brain stem.

Plaques and Tangles The two most significant physical findings in the cells of brains affected by Alzheimer's disease are neuritic plaques and neurofibrillary tangles. Another significant factor in AD is the greatly reduced presence of acetylcholine in the cerebral cortex. Acetylcholine is necessary for cognitive function. While some neuritic plaques, or patches, are commonly found in brains of elderly people, they appear in excessive numbers in the cerebral cortex of Alzheimer's disease patients. A protein called beta amyloid occupies the center of these plaques. Surrounding the protein are fragments of deteriorating neurons, especially those that produce acetylcholine (ACh), a neurotransmitter essential for processing memory and learning. Neurotransmitters are chemicals that transport information or signals between neurons. Neurofibrillary tangles (NFTs) are twisted remnants of a protein called tau, which is found inside brain cells and is essential for maintaining proper cell structure and function. An abnormality in the tau protein disrupts normal cell activity. Tau is a protein found in the axon of healthy neurons where it binds to the structure of the neuron microtubules. It acts as a crosspiece and stabilizes the neuron structure. Together, Tau and microtubules act as railway tracks over which information is transported from one part of the neuron to another.

Glossary of Terms for an Anatomy of the Brain Amygdala - limbic structure involved in many brain functions, including emotion, learning and memory. It is part of a system that processes "reflexive" emotions like fear and anxiety. Cerebellum - governs movement. Cingulate gyrus - plays a role in processing conscious emotional experience. Fornix - an arch-like structure that connects the hippocampus to other parts of the limbic system. Frontal lobe - helps control skilled muscle movements, mood, planning for the future, setting goals and judging priorities. Hippocampus - plays a significant role in the formation of long-term memories. Medulla oblongata - contains centers for the control of vital processes such as heart rate, respiration, blood pressure, and swallowing. Limbic system - a group of interconnected structures that mediate emotions, learning and memory. Occipital lobe - helps process visual information. Parahippocampal gyrus - an important connecting pathway of the limbic system. Parietal lobe - receives and processes information about temperature, taste, touch, and movement coming from the rest of the body. Reading and arithmetic are also processed in this region.

Pons - contains centers for the control of vital processes, including respiration and cardiovascular functions. It also is involved in the coordination of eye movements and balance. Temporal lobe - processes hearing, memory and language functions. Thalamus - a major relay station between the senses and the cortex (the outer layer of the brain consisting of the parietal, occipital, frontal and temporal lobes). PATIENTS PROFILE NAME: AGE: DATE OF BIRTH: SEX: CIVIL STATUS: RELIGION: EDUCATIONAL ATTAINMENT OCCUPATION ADDRESS: HEIGHT: WEIGHT: R.E 85 years old December 24, 1927 Male Widowed Catholic College graduate Colonel Buhangin, Davao City 153 cm 65 kg

Comprehensive Assessment

Pathophysiology

Narrative Researchers listed some of the predisposing and precipitating factors. Predisposing factors are genetics, age and gender. Familial AD, a form usually develop at young age, frequently associated with genetic mutations. People who have a parent or sibling that developed Alzheimers disease are two to three times more likely to develop the disease than those with no family history of Alzheimers. As the age of a person is increasing the more it is a risk to AD, but it is important to note that AD is not a normal part of aging. According to the book of Brunner, males and females are equally affected, but conducting another research women are more likely to develop AD than men, in part because they live longer. Precipitating factors are dietary, environmental, head trauma, neurotransmitter changes and lastly the inflammatory factors. The lifestyle where someone is exposed contributed a factor to AD, but a healthy diet can reduce the risk for it. Elevated saturated fatty acids could have negative effects on agerelated cognitive decline and mild cognitive impairment (MCI), on which, can lead to AD. MCI can be prevented the progression into AD, by applying healthy lifestyle, promotion of exercise every day, aerobic exercise may improve

cognitive agility, avoiding or limiting alcohol and tobacco consumption, staying socially active, and engaging in intellectually stimulating activities. People with experience having a severe or repeated head trauma appear to have a greater risk of AD. As the build-up of neurofibrillary tangles and senile plaques manifested, the neurotransmitter pathways will be block, as the neurotransmitter,

specifically Acetylcholine, cannot pass through, making it difficult for the cells to survive. Acetylcholine is major transmitter involve in memory. Risk factors associated with heart disease and stroke, such as high blood pressure and high cholesterol, may also increase one's risk of developing Alzheimer's disease. High blood pressure may damage blood vessels in the brain, disrupting regions that are important in decision-making, memory and verbal skills. This could contribute to the progression of the disease. High cholesterol may inhibit the ability of the blood to clear protein from the brain. NCP1

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Appendices

Bibliography

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