ALZHEIMER'S DISEASE

Jerry Carley RN, MSN, MA, CNE 1

Concept Map: Selected Topics in Neurological Nursing ASSESSMENT

Physical Assessment

Inspection Palpation Percussion Auscultation

ICP Monitoring “Neuro Checks” Lab Monitoring

PATHOPHYSIOLOGY Traumatic Brain Injury Spinal Cord Injury Specific Disease Entities: Amyotropic Lateral Sclerosis Multiple Sclerosis Huntington’s Disease Alzheimer’s Disease Myasthenia Gravis Guillian-Barre ’ Syndrome Meningitis Parkinson’s Disease PHARMACOLOGY --Decrease ICP --Disease Specific Meds Care Planning Plan for client adl’s, Monitoring, med admin., Patient education, more…based On Nursing Process: A_D_O_P_I_E Nursing Interventions & Evaluation Execute the care plan, evaluate for Efficacy, revise as necessary

Alzheimer's Disease



Non - reversible dementia

that progressively develops through

3

many years stages over  Alzheimer's disease is the most common cause of dementia, or loss of intellectual function, among people aged 65 and older  Alzheimer's disease is

NOT

aging a normal part of 3

Alzheimer's Disease



Non - reversible dementia

that progressively develops through

3

many years stages over  Alzheimer's disease is the most common cause of dementia, or loss of intellectual function, among people aged 65 and older  Alzheimer's disease is

NOT

aging a normal part of 4

Characteristics



Memory loss



Impaired Judgment



Personality changes



Severe physical decline with cognitive changes

5

Pathophysiology

 Neurons, which produce acetylcholine (neurotransmitter) break connections with other nerve cells and ultimately die  Two types of

abnormal lesions clog the brains

of individuals with Alzheimer's disease:  Beta-amyloid

plaques

—sticky clumps of protein fragments and cellular material that form outside and around neurons  Neurofibrillary

tangles

—insoluble twisted fibers composed largely of the protein that build up inside nerve cells 6

Pathophysiology

 Neurons, which produce acetylcholine (neurotransmitter) break connections with other nerve cells and ultimately die  Two types of

abnormal lesions clog the brains

of individuals with Alzheimer's disease:  Beta-amyloid

plaques

—sticky clumps of protein fragments and cellular material that form outside and around neurons  Neurofibrillary

tangles

—insoluble twisted fibers composed largely of the protein that build up inside nerve cells 7

Stage 1 First 1-3 years:

Short-term memory loss -

Subtle

personality changes -Shorter attention span -Mild cognitive deficits -Difficulty with money,

numbers

and bills -Difficulty with depth perception 8

Stage 2 From 2 – 10 years:

-

Obvious

memory loss -

Wandering

-Confabulation -“Sundowning” -

Irritability

/ Agitation -Impaired motor skills, judgment

-Self-care deficits

9

Stage 3 From 8 – 10 years:

-

Severe

impairment of all cognitive abilities -Disoriented -B & B

incontinence

-

Inability to recognize

family & friends -Loss of speech 10

The

4

A’s of Alzheimer's

Amnesia

(inability to remember facts or events). Short-term memory is programmed in temporal lobe, while long-term memory is stored throughout extensive nerve cell networks in the temporal and parietal lobes. In Alzheimer's disease, short-term memory storage is damaged first  

Aphasia

(inability to communicate effectively). The loss of ability to speak and write is called expressive aphasia. With receptive aphasia, an individual may be unable to understand spoken or written words. Sometimes an individual pretends to understand and even nods in agreement; this is to cover-up aphasia. Although individuals may not understand words and grammar, they may still understand non verbal behavior, i.e. smiling  

Apraxia

(inability) to do pre-programmed motor tasks, or to perform activities of daily living such as brushing teeth and dressing. Sophisticated motor skills that require extensive learning, such as job-related skills, are first functions that become impaired. More instinctive functions like chewing, swallowing and walking are lost in the last stages of the disease  

Agnosia

(inability to correctly interpret signals from their five senses). May not recognize familiar people and objects. A common yet often unrecognized agnosia is the inability to appropriately perceive visceral, or internal, information such as a full bladder or chest pain. 11



Diagnosis

Clinicians can now diagnose with up to 90 % accuracy. But it can only be confirmed by an autopsy, pathologists look for the disease's characteristic plaques and tangles in brain tissue  Clinicians diagnose "probable" Alzheimer's disease by medical history, lab tests, physical exam, brain scans and neuropsychological tests that gauge memory, attention, language skills and problem-solving abilities  Proper diagnosis of Alzheimer's disease is critical since there are dozens of other reversible causes for Sx’s 12

Treatment

 U.S. Food and Drug Administration (FDA) has so far approved four drugs for the treatment of mild to moderate Alzheimer's disease: - Cognex®), introduced in 1993 - Donepezil hydrochloride ( approved in Feb/01

Aricept®

), marketed since 1996 - Rivastigmine (Exelon®), available since the spring 2000 -Galantamine hydrobromide (RazadyneTM-formerly called Reminyl®)  These drugs inhibit the enzyme that breaks down the brain chemical acetylcholine, and thereby may help slow the worsening of symptoms  The FDA in October 2003 approved memantine HCI (NamendaTM) for the treatment of moderate to severe Alzheimer's disease, which can slow the decline in mental function 13

Risk Factors

 People with a

family history

of Alzheimer's have a greater risk, implying that a genetic factor is involved. Some involve a mutation of the gene for the protein APP, found on chromosome 21  Adults who have had

head injuries

three times more likely to develop Alzheimer's disease are 14

Nursing Care

       

CONSISTENCY

gradually - Introduce change Use repetition Therapeutic touch if able

Avoid overstimulation

and

clutter

Don’t argue / Don’t reinforce – Acknowledge feelings / Distract Regular toileting Reality orientation, memory training Meds as needed 15

Safety Precautions

 

Alarm systems / Lock exit doors



Identification (on back of gown, etc) Keep up to date Picture



Frequent supervision



No throw rugs



Fall Program



Etc

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