Alzheimer s

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					                         DEMENTIA
   DEFINITION:
     – Group of symptoms that can be caused by over
       60-70 disorders.
     – Syndrome which refers to progressive decline
       in intellectual functioning severe enough to
       interfere with person’s normal daily activities
       and social relationships. (National Institute on Aging-
            1995 No. 95-3782)



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                            Dementia
   – Marked by progressive, irreversible declines in
            » memory.
            » visual-spatial relationships
            » performance of routine tasks
            » language and communication skills
            » abstract thinking
            » ability to learn and carry out mathematical
              calculations.




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                     Dementia
   Two Types:
    – Reversible
    – Irreversible
   Individuals must have intensive medical
    physical to rule out reversible types of
    dementia.



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                           Dementia
   Reversible:
    – D=     Drugs, Delirium
    – E=     Emotions (such as depression) and
             Endocrine Disorders
    –   M=   Metabolic Disturbances
    –   E=   Eye and Ear Impairments
    –   N=   Nutritional Disorders
    –   T=   Tumors, Toxicity, Trauma to Head
    –   I=   Infectious Disorders
    –   A    Alcohol, Arteriosclerosis (Dick-Mulheke- Overview of
             Alzheimer's Disease)
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                       Dementia
     Irreversible:
     –      Alzheimer’s
     –      Lewy Body Dementia
     –      Pick’s Disease (Frontotemperal Dementia)
     –      Parkinson’s
     –      Heady Injury
     –      Huntington’s Disease
     –      Jacob-Cruzefeldt Disease

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                             Dementia
     Irreversible:
     – Alzheimer's most common type of irreversible
       dementia
     – Multi-Infarct dementia second most common type of
       irreversible dementia
            »   Death of cerebral cells
            »   Blockages of larger cerebral vessels, arteries
            »   More abrupt in onset
            »   Associated with previous strokes, hypertension
            »   Can be traced through diagnostic procedures


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                            Dementia
    – Lewy Body Dementia
       » Episodic confusion with intervals of lucidity with at
         least one of the following:
               1. Visual or auditory hallucinations
               2. Mild extrapyramidal symptoms (muscle rigidity, slow
                  movements
               3. Repeated unexplained falls

            » Progresses to severe dementia—found at autopsy.




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                            Dementia

   Diagnosis of Frontemporal Dementia (Pick’s
    Disease)
           Pick’s bodies in cells.
           Personality changes
           Behavioral dis-inhibition.
           Loss of social or personal awareness.
           Disengagement with apathy
           Maintain ability to draw and calculate well into later
            stages

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            •Alzheimer's Disease
  Estimated that 4,000,000 people in U.S.
  have Alzheimer's disease.
 Estimated that 25-35% of people over age
  85 have some time of dementia.
 After age 65 the percentage of affected
  people, doubles with every decade of life.
 Caring for patient with Alzheimer's disease
  can cost $47,000 per year (NIH).

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  Changes Caused by Alzheimer's
 Diminished blood flow
 Neurofibrillary Tangles
 Neuritic Plaques
 Degeneration of hippocampus, cerebral
  cortex, hypothalamus, and brain stem



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     Theories Regarding Causes of
              Alzheimer's
   Changes in Neurotransmitters
            » Acetycholine is decreased--necessary for cognitive
              functioning.
   Changes in Protein Synthesis
            » Beta amyloid--may be responsible for forming
              plaques.
            » Tau--major component of neurofibrillary tangles.
   Genetic Theories
            » ApoE4 on chromosone 19 linked to late-onset
              Alzheimer’s Disease.
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     Theories Regarding Causes of
              Alzheimer's
   Genetic Theories
            » Chromosome 21 --Responsible for early-onset
              Alzheimer’s Disease.
    Metabolic Theories
            » Glucose metabolism declines dramatically in
              Alzheimer’s patients.
    Calcium Theories
            » Too much calcium can kill cells. Suspect that it may
              reason why neurons die in Alzheimer's patients.

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     Theories Regarding Causes of
              Alzheimer's
   Environmental
            » Aluminum--Traces of metal found in brain.
            » Zinc--found in brains on autopsies.
            » Food borne poisons--amino acids found in legumes
              in Africa and India my cause neurological damage.
   Viral
            » May be hidden in body and attack brain cells years
              later. (NIH-1995)


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     Theories Regarding Causes of
              Alzheimer's
   Head Trauma
     – Head trauma increase the concentration of B-amyloid
       protein
   Low Level of Education
     – Individuals with low level of education less able to
       compensate for cognitive deficits
   Estrogen Deficiency
   Early Life Experience---have lost parent before
    age 16

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    Diagnosis of Dementia Due to
            Alzheimer’s
   Memory Impairment
   Multiple cognitive deficits with at least one
    disturbance in the following areas:
    – Aphasia—loss of the ability to use symbols to
      communicate orally or in writing
        » Two Types:
               Expressive—inability to form words
               Receptive—decreased ability to understand spoken or written
                language
       – Apraxia—inability to initiate complex learned motor
          movement or unable to perform activity on command
       – Agnosia---inability to recognize familiar objects by
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          sight, touch, taste, smell or sound                 15
            Diagnostic Tests

 Neurological Exam
 Brain Imaging—shrinkage, atrophy of brain
  (CT or MRI)
 Blood Work




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    Stages of Alzheimer’s Disease

   Mild Stage
     – Memory Loss
     – Symptoms:
            »   Confusion About Place
            »   Loss of Spontaneity
            »   Loss of Initiative
            »   Mood/Personality Changes
            »   Poor Judgment
            »   Takes Longer to Perform Routine chores
            »   Trouble Handling Money, Paying Bills


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    Stages of Alzheimer’s Disease
   Moderate Stage
     Impairments in:
            »   language
            »   motor ability
            »   object recognition
            »   increasing memory loss and confusion




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    Stages of Alzheimer’s Disease
   Moderate Stage
     – Symptoms:
        » Problems recognizing family members, close friends.
            »   Repetitive statements and/or movements.
            »   Restless, especially in late afternoon and at night.
            »   Occasional muscle twitches or jerking.
            »   Perceptual motor problems.
            »   Problems organizing thoughts, thinking logically.
            »   Can’t find right words, makes up stories.
            »   Problems reading and writing.
            »   May be suspicious, irritable, fidgety, teary or silly.



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    Stages of Alzheimer’s Disease
   Severe Stage
     – Symptoms:
            » Loses weight even with good diet.
            » Little capacity for self-care.
            » Can’t communicate with words.
            » May put everything in mouth or touch everything.
            » Can’t control bladder or bowel.
            » May have difficult with seizures, swallowing, skin
              breakdown, infections.

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    Stages of Alzheimer’s Disease
     Terminal Stage
     – Symptoms:
            » Loss of ability to ambulate.
            » Loss of ability to sit.
            » Loss of ability to smile.
            » Loss of ability to hold up head.
            » Loss of ability to swallow.




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    Stages of Alzheimer’s Disease
     Stage IV--Terminal Stage
     – Symptoms:
             » Loss of ability to ambulate.
             » Loss of ability to sit.
             » Loss of ability to smile.
             » Loss of ability to hold up head.
             » Loss of ability to swallow.

     Management of Challenging Behaviors in Dementia—Mahoney, Volicer, Hurley.
            Health Professionals Press:2000. Baltimore, Md   .

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