Alzheimers Disease

Alzheimers disease

Alzheimer's disease is a progressive disease that destroys

memory and other important mental functions.

It's the most common cause of dementia a group of

brain disorders that results in the loss of intellectual and
social skills. These changes are severe enough to interfere
with day-to-day life

In Alzheimer's disease, the connections between brain

cells and the brain cells themselves degenerate and die,
causing a steady decline in memory and mental function.

Epidemiology

Alzheimer's disease is most common in people over 65

years of age, and affects slightly more women than men.

TheAlzheimers Societyestimates thatdementiaaffects

around 650,000 people in England, with Alzheimers
disease responsible for around 62% of dementia cases.

Dementia in people under 65 years of age, known as

early-onset dementia, is less common. In the UK, around
2% of all dementia cases are early-onset dementia.

The risk increases with age, and people who are over 80
years of age are thought to have a one in six chance of
developing the condition.

Pathophysiology
Alzheimers disease is named after Dr. Alois Alzheimer. In
1906, Dr. Alzheimer noticed changes in the brain tissue of a
woman who had died of an unusual mental illness.Her
symptoms included memory loss, language problems, and
unpredictable behavior.
After she died, he examined her brain and found many :
1.

abnormal clumps (now called Amyloid plaques) and

2.

tangled bundles of fibers (now called neurofibrillary

tangles). Plaques and tangles in the brain are two of the main
features of Alzheimers disease.

3.

The third is the loss of connections between nerve cells

(neurons) in the brain.

I. Amyloid Plaques
The neurotic plaque is a cluster of degenerating nerve
terminals, both dendritic and axonal, that contain amyloid
proteins. During the metabolism the amyloid precursor
protein becomes embedded in the membrane of the
neuron. These plaques develop first in neocortex and other
cognitive functions

II. Neurofibrilarry Tangles

The Neurofibrilarry tangles are abnormal neurons in which
the cytoplasm is filled with bundles of abnormal protein
called paired helical filaments. These tangles attack the
function of learning and reasoning, memory storage and
recall, language abilities, and even consciousness

Etiology

The cause of AD has not been found, although several

risk factors have been identified.

The several risk factor include :

Age

Genetic inheritance

Environmental factors

Lifestyle and General health

and Other factors.

Risk Factors
Non-modifiable

Age (65 years and

older)

Genetic Inheritance

Most common in
women than men

Modifiable

Environment ( exposure
of alumunium)

People with Downs

Syndrome

Head Injuries include

boxers

Smoke

High Blood Pressure

High Cholesterol level

or Diabetes

Stroke

Clinical Manifestation

1.
.

Mild Alzheimers Disease

As Alzheimers disease progresses, memory loss worsens,
and changes in other cognitive abilities are evident.
Problems can include, for example, getting lost, trouble
handling money and paying bills, repeating questions,
taking longer to complete normal daily tasks, using poor
judgment, and having some mood and personality
changes. People often are diagnosed in this stage.

Clinical Manifestation

2.
.

Moderate Alzheimers Disease

In this stage, damage occurs in areas of the brain that
control language, reasoning, sensory processing, and
conscious thought. Memory loss and confusion grow worse,
and people begin to have problems recognizing family and
friends. They may be unable to learn new things, carry out
tasks that involve multiple steps (such as getting dressed),
or cope with new situations. They may have hallucinations,
delusions, and paranoia, and may behave impulsively.

Clinical Manifestation

3.
.

Severe Alzheimers Disease

By the final stage, plaques and tangles have spread
throughout the brain, and brain tissue has shrunk
significantly. People with severe Alzheimers cannot
communicate and are completely dependent on others for
their care. Near the end, the person may be in bed most or
all of the time as the body shuts down.

Clinical Manifestation

DIAGNOSTIC


1.
2.
3.

The diagnosis is confirmed with :

They are presence of dementia involving two or more
areas of cognition
Insidious onset, steady progression
Loss of normal alertness

Diagnostic Tests
The Diagnostic assessment with :
Electroencephalogram (EEG)
Computed Tomography (CT)
Positron Emission Tomography (PET)

Electroencephalogram (EEG)
Electroencephalogram detects
abnormalities in the brain waves
or electrical activity of the brain.
During the procedure, electrodes
consisting of small metal discs
with thin wires are pasted on the
scalp. The electrodes detect tiny
electrical charges that result
from the activity of the brain
cells. The charges are amplified
and appear as a graph on a
computer screen or as a
recording that may be printed
out on paper.
Yourdoctor then interprets the
reading.

Computed Tomography (CT)

A computed tomography (CT) scan is a

technique in which multiple X-rays of
the body are taken from different angles
in a very short period of time. These
images are then fed into a computer,
which creates a series of cross-sectional
"slices" of the body. Contrast material
can be given to help differentiate
abnormal areas of the brain. CT imaging
creates the images by measuring how
quickly the body and organs absorb the
X-rays. CT scans often can reveal
certain changes that are characteristic
of Alzheimers disease in its later
stages. These changes include a
reduction in the size of the brain
(atrophy), widened indentations in the
tissues, and enlargement of the fluidfilled chambers called cerebral

Positron Emission Tomography

(PET)

Positron Emission Tomography (PET) scans may help

identify Alzheimer's disease in its early stages by
identifying lesions in the brain associated with Alzheimer's.
Two studies recently published in theArchives of
Neurologyshow that PET scans can distinguish between
normal brains and those of patients showing early signs of
Alzheimer's.

Laboratory Studies

Urinalysis
Complete Blood Count (CBC)
Erythrocyte Sedimentation Rate (ESR)
Electrolytes
Blood urea Nitrogen (BUN)
Creatinin values

Thyroid And Liver Function Tests

Calcium
Serum b12 levels

Management

There is currently no cure for Alzheimer's disease.

However,drug treatmentsare available that can temporarily
alleviate some symptoms or slow down their progression in
some people.

Medication

People with Alzheimer's have been shown to have a

shortage of the chemical acetylcholine in their brains.

Aricept, Exelon and Reminyl (Donepezil

hydrochloride, rivastigmine and galantamine)

work by maintaining existing supplies of acetylcholine.

These drugs are recommended as an option for people in

the mild-to-moderate stages of Alzheimer's disease

Medication

Ebixa
drug that is recommended for people in both the
moderate and severe stages of Alzheimer's disease.
Side-effects may include : dizziness, headaches and
tiredness, and - rarely - hallucinations or confusion.
These drugs are not a cure, but they may stabilise some of
the symptoms of Alzheimer's disease for a limited period,
typically 6-12 months or longer.

Medication

Tacrine (Cognex)
Inhibits breakdown of acethylcholinesterase in the brain,
allowing more ACh to be available for nerve impulse
transmission

Donepazil (Aricept)
Given only once a day
Helpful for people in the early stages

Nursing Care Plan

Nursing Care Plan

Nursing Diagnosis : Risk for Injury related to Disorientation

to time and place, Confusion, Forgetfulness and increased
memory loss

Nursing Interventions :

1.
.
1.

Evaluate clients level of competence and ability to

participate in preventive measures.
Rationale :
This is to assess the degree of risk for injury of client and
aids in detecting what appropriate measures you will
include in the plan of care.

Nursing Care Plan

2.

.
2.

Nursing Interventions :
Adapt communication to the level of client and speak
with the client using slow pace and simple words while
maintaining a firm volume and low pitch.
Rationale :
Communicating with the client in this way promotes
positive atmosphere and a relaxed pace for learning.

Nursing Care Plan

3.

.
3.

Nursing Interventions :
Observe for nonverbal behaviours and intervene if client
becomes angry or hostile by decreasing stressful stimuli
and approaching client in calm, reassuring manner.
Rationale :
Some personality changes may occur in clients with
Alzheimers such as irritability, suspiciousness, and
indifference. This would also aid in reducing demands on
client.

Nursing Care Plan

4.

.
4.

Nursing Interventions :
Frequently reorient of time, place, date, and person;
place a clock and a calendar in his room; allow him to
reminisce; and repeat instructions as necessary.
Rationale :
These measures are necessary in enhancing clients
memory.

Nursing Care Plan

5.

.
5.

Nursing Interventions :
Assess environment for potential factors indicating risk for
injury like dim lighted room, absence of hand rails, slippery
floor, and high bed.
Rationale :
This will provide information on what safety devices are
necessary to be instituted.

Nursing Care Plan

6.

.
6.

Nursing Interventions :
Ensure that client cannot leave the premises without being
noticed; provide an identification bracelet or tag for the
client to wear at all times.
Rationale :
Clients with Alzheimers disease are sometimes confused
making them wanders without valid reason (especially
during night time); this will avoid the client from being
missing or face accidents outside the institution.

Nursing Care Plan

7.

Nursing Interventions :
Educate family members and care giver of clients
condition and how to deal and care the client; the need for
safe environment; how to communicate with the client;
and measures that enhance memory.

Rationale :
8.

Providing health teachings regarding clients condition

could assist family members in understanding the
manifestations elicited by the client and would reassure
them that peculiar personality changes and increasing
memory loss is part of this condition; it would aid them
cope and take care with the client at home upon discharge.

Preventing Alzheimers
disease

quitting smoking

avoid drinking large amounts of alcohol

eating a healthy balanced diet, including at least five

portions of fruit and vegetables every day

exercising for at least 150 minutes (2 hours and 30

minutes) every week, doing moderate-intensity
aerobic activity (such as cycling or fast walking) as
this will improve both your physical and mental health

make sure your blood pressure is checked and

controlled through regular health tests

if you have diabetes, make sure you keep to the diet

and take and medicines

Stay Mentally active

Some activities that may reduce the risk of developing

dementia include:

reading

writing for pleasure

learning foreign languages

playing musical instruments

taking part in adult education courses

playing tennis

playing golf

swimming

group sports, such as bowling

walking