Alzheimer disease by shelaydorado


									Alzheimer's Disease

Dementia is a loss of brain function that occurs with certain diseases. Alzheimer's disease (AD)
is one form of dementia that gradually gets worse over time. It affects memory, thinking, and
behavior. Memory impairment, as well as problems with language, decision-making ability,
judgment, and personality, are necessary features for the diagnosis.


Dementia symptoms include difficulty with many areas of mental function, including:

          Language
          Memory
          Perception
          Emotional behavior or personality
          Cognitive skills (such as calculation, abstract thinking, or judgment

Dementia usually first appears as forgetfulness. Mild cognitive impairment is the stage between
normal forgetfulness due to aging, and the development of AD. People with MCI have mild
problems with thinking and memory that do not interfere with everyday activities. They are often
aware of the forgetfulness. Not everyone with MCI develops AD.

Symptoms of MCI include:

          Forgetting recent events or conversations
          Difficulty performing more than one task at a time
          Difficulty solving problems
          Taking longer to perform more difficult activities

The early symptoms of AD can include:

          Language problems, such as trouble finding the name of familiar objects
          Misplacing items
         Getting lost on familiar routes
         Personality changes and loss of social skills
         Losing interest in things previously enjoyed, flat mood
         Difficulty performing tasks that take some thought, but used to come easily, such as
          balancing a checkbook, playing complex games (such as bridge), and learning new
          information or routines

As the AD becomes worse, symptoms are more obvious and interfere with your ability to take
care of yourself. Symptoms can include:

         Forgetting details about current events
         Forgetting events in your own life history, losing awareness of who you are
         Change in sleep patterns, often waking up at night

         Difficulty reading or writing
         Poor judgment and loss of ability to recognize danger
         Using the wrong word, mispronouncing words, speaking in confusing sentences
         Withdrawing from social contact
         Having hallucinations, arguments, striking out, and violent behavior
         Having delusions, depression, agitation
         Difficulty doing basic tasks, such as preparing meals, choosing proper clothing, and

People with severe AD can no longer:

         Understand language
         Recognize family members
         Perform basic activities of daily living, such as eating, dressing, and bathing

Other symptoms that may occur with AD:
          Incontinence
          Swallowing problems

Causes & Risk Factors

Age and family history are risk factors for AD.

          As you get older, yoru risk of developing AD goes up. However, developing
           Alzheimer's disease is not a part of normal aging.
          Having a close blood relative, such as a brother, sister, or parent who developed AD
           increases your risk.
          Having certain combination of genes for proteins that appear to be abnormal in
           Alzheimer's disease also increases your risk.

Other risk factors that are not as well proven include:

          Longstanding high blood pressure
          History of head trauma
          Female gender

There are two types of AD -- early onset and late onset.

          In early onset AD, symptoms first appear before age 60. Early onset AD is much less
           common than late onset. However, it tends to progress rapidly. Early onset disease can
           run in families. Several genes have been identified.
          Late onset AD, the most common form of the disease, develops in people age 60 and
           older. Late onset AD may run in some families, but the role of genes is less clear.

The cause of AD is not entirely known, but is thought to include both genetic and environmental
factors. A diagnosis of AD is made when certain symptoms are present, and by making sure
other causes of dementia are not present. The only way to know for certain that someone has AD
is to examine a sample of their brain tissue after death. The following changes are more common
in the brain tissue of people with AD:

          "Neurofibrillary tangles" (twisted fragments of protein within nerve cells that clog up
           the cell)
          "Neuritic plaques" (abnormal clusters of dead and dying nerve cells, other brain cells,
           and protein)
          "Senile plaques" (areas where products of dying nerve cells have accumulated around

When nerve cells (neurons) are destroyed, there is a decrease in the chemicals that help nerve
cells send messages to one another (called neurotransmitters). As a result, areas of the brain that
normally work together become disconnected. The buildup of aluminum, lead, mercury, and
other substances in the brain is no longer believed to be a cause of AD.

Tests & Diagnostics

AD can often be diagnosed through a history and physical exam by a skilled doctor or nurse. A
health care provider will take a history, do a physical exam (including a neurological exam), and
perform a mental status examination. Tests may be ordered to help determine whether other
medical problems could be causing dementia or making it worse. These conditions include:

          Thyroid disease
          Vitamin deficiency
          Brain tumor
          Stroke
          Intoxication from medication
          Chronic infection
          Anemia
          Severe depression

Computed tomography (CT) or magnetic resonance imaging (MRI) of the brain may be done to
look for other causes of dementia, such as a brain tumor or stroke.
          In the early stages of dementia, brain image scans may be normal. In later stages, an
           MRI may show a decrease in the size of different areas of the brain.
          While the scans do not confirm the diagnosis of AD, they do exclude other causes of
           dementia (such as stroke and tumor).

Medical Interventions in Alzheimer's Disease

Alzheimer's disease is a progressive neurological disorder that initially causes patients to have
short-term memory loss, then progresses to an inability to use common, everyday objects and
tools, and ultimately results in death from complications such as malnutrition and infection.
There is no cure for Alzheimer's as of 2010; according to the medical reference UpToDate,
patients generally die within eight years of receiving a diagnosis. Several treatments have been

approved to help slow the progression of Alzheimer's disease, though their long-term benefit is

Nursing Interventions for Alzheimer's Disease


1. Patience and maintaining a routine are important when caring for a patient with Alzheimer's.
    Memory problems are the first sign of Alzheimer's disease. Patients may not remember
    recent events, names of children or family members, or to turn the stove off after cooking.
    Memory cues, such as written notes put in strategic places where the patient can easily see
    them while attempting certain tasks, are helpful, according to the Journal of Neuroscience
    Nursing. Reminders should be short, clear and to the point. Alzheimer's patients are often
    confused, anxious and fearful, so the clearer and more calming the reminder notes are, the
    less anxiety the patient will feel.

    Nursing interventions should also allow the patient to keep to his regular routine all the time,
    which means meals are at the same time every day, as are routine personal care tasks such as
   showering. Establishing a routine helps the patient understand what is going on around him.

   Have the patient keep written track of recent visitors and recall past events important to him,
   such as a birth of a child or marriage. This exercise serves as a memory booster.

   Social Interaction

2. Social activities are important for Alzheimer's patients.

   Boredom and a lack of self-esteem are common in Alzheimer's patients. It's important that
   nurses take the time to respect the patient and to provide activities to help stimulate the mind
   and alleviate boredom. According to the National Alzheimer's Association, studies show
   significant improvement in mood and behavior of Alzheimer's patients when activities and
   exercises are included in a nursing home setting.

   Another helpful nursing intervention is engaging Alzheimer's patients in social activities,
   such as listening to music and singing with others, taking a walk or playing games. Role-
   playing games involving real-life situations, including possible emergencies, allow patients
   to remain in their homes longer, because training via role-playing helps them maintain their
   independence. In addition to keeping them occupied, interactive games geared to the
   capabilities of the patients keep them feeling safe and less anxious.

   Music chosen by the patient is another useful intervention. Studies show that when music is
   played during routine exercises such as eating dinner or bathing, there are fewer incidents of
   agitated behavior and the mood of the patient is improved.

   Home Care

3. Family members and caregivers have their work cut out for them when working with
   Alzheimer's patients. Creating living conditions that are as stress-free as possible will help
   keep the patient calm and help strengthen his cognitive abilities, but that can be a tall order.

   Agitation, anger, confusion and other behavior problems in Alzheimer's patients can make
   the role of care giving a challenging one. Alzheimer's patients can become very frustrated
because of their condition, so it's important for nurses and caregivers to be very patient with
them, talk with them, ask them how they feel or what they want to eat. Interaction like this
shows respect, which is something every Alzheimer's patient needs and deserves.
    Pathophysiology of Alzheimer's disease

Pathophysiology studies changes in function of an organ or tissue caused by a disease or an
injury. According to the Mayo Clinic and American Academy of Family Physicians (AAFP),
there are two main pathophysiological changes in the brain found in Alzheimer's disease: plaques
and tangles.


1. Plaques are abnormal accumulations of the protein beta-amyloid in the brain. According to
    the American Academy of Family Physicians (AAFP), inflammation around these plaques
    leads to the death of nearby brain cells.


2. The Mayo Clinic and AAFP report that plaques may be caused by a problem in processing
    beta-amyloid. According to the AAFP, risk factors for the development of plaques include
    high blood pressure and high cholesterol; there is probably also a genetic component of
    plaque formation.


3. Tangles occur when strands of the protein tau, which gives brain cells their shape, becomes
    twisted; this pathophysiological change causes affected cells to die. Some people are
    genetically predisposed to developing tau that twists, according to the AAFP.


4. It is not known, according to the AAFP, whether the processes that cause plaques and
    tangles are related.


5. The pathophysiological changes of the brain in Alzheimer's disease lead to dementia, the
    slow, progressive (increasingly worse over time) loss of brain function. This affects
    memory, learning and behavior.
    Alzheimer’s disease

Submitted to: Mr. Brendon Crisologo, RN, MAN

Submitted by: Ms. Shierly D. Sibayan, SN

Group: C3A

Date: January 24, 2011

To top