Alzheimer's Disease

Alzheimer's disease (AD)

•Alzheimer's disease is an irreversible, progressive, degenerative brain disorder that slowly attacks the brain's nerve cells, or neurons, resulting in loss of memory, thinking and language skills, and behavioral changes. •Risk of Alzheimer's increases with age, but it is not a part of normal aging.

What are some implementations for the RN to promote psychological wellness?

•Assess response to diagnosis •Provide realistic information about disease •Avoid criticizing, judging feelings •Support positive family bonds •Encourage client to make decisions when capable •Encourage client, family to seek spiritual guidance that previously inspired hope •Return client, family phone calls

What are the FDA approved drugs for AD?

•Cholinesterase Inhibitors •Glutamate regulators : Namenda (Memantine)

What are some implementations for the RN for community-based care?

•Community resources: -In-home care services -Adult day care centers -Additional respite care providers outside of family members -Residential facilities, assisted living -Local support group meetings -Caregiver training workshops

How does an RN help prevent injury for a pt with AD?

•Decrease likelihood of falling •Assess usual environments for hazards •Observe areas of special concern •Evaluate muscle strength, gait •Check shoes for fit, support •Inquire about alcohol use, meds that affect mobility •Use night-light, increase daytime lighting •Keep traffic areas free from clutter

What are cholinesterase inhibitors?

•Donepezil (Aricept)- approved for all stages •Rivastigmine (Exelon)- approved for mild-to-moderate stages •Galantamine (Reminyl) )- approved for mild-to-moderate stages

What are some implementations for the RN to promote effective coping strategies for a pt with AD?

•For client in early/ mild stages suggest use of: •Cuing devices: detailed calendar, lists, reminders with sticky notes •Medication box labeled with days, times •Cues for meal times/medications such as phone alarms •List of loved ones' contact information

What is included in the nursing assessment for a patient with AD?

•Health history •Physical assessment •Possible signs of abuse, neglect, depression, malnutrition •Medications, supplements •Mental status examination •Results of mini-mental status exam (MMSE) •Assess orientation as needed

What are the patient problems for earlier stages of AD?

•Impaired memory •Chronic confusion •Denial •Risk for injury •Anxiety •Hopelessness •Imbalanced nutrition: less than body requirements

What is the action of glutamate regulators?

•Medication that improve memory, attention, reason, language and the ability to perform simple tasks. This medication works by regulating the activity of glutamate, a different chemical messenger that helps the brain process information •Approved for moderate-to-severe Alzheimer's disease

What is the action of cholinesterase inhibitors?

•Medications that treat symptoms related to memory, thinking, language, judgement and other thought processes. These medications prevent the breakdown of acetylcholine and help brain cells work more effectively

What are some implementations for the RN to promote balance between rest and activity?

•Monitor for fatigue, agitation •Remove from situations causing anxiety •Keep daily routine consistent •Schedule rest periods, quiet time •Provide quiet activities in late afternoon, early evening •Assess for physical cause if confusion, agitation persist or escalate

What is the medication for cholinesterase inhibitors + glutamate regulators?

•Namzeric-medication that contains both memantine extended release and donepezil (capsule form) •Blocks the toxic effects associated with excess glutamate and prevents breakdown of acetylcholine in the brain •Approved for moderate-to-severe Alzheimer's disease

What are the diagnostic tests of AD?

•No definitive way to diagnose •Brain autopsy •Differential diagnosis •MRI •Ongoing interviews •Mini Mental status examination (MMSE)-incorporate assessment of orientation: today's date, day of week, year, season, Math: subtracting by 3 or 7 going backwards from 100, Assess memory and recall of family members, current events; remember 3 words

What is the nurse's role for a patient with AD?

•Promote independence and autonomy to best of patient's ability •Provide safe, supportive environment that meets changing abilities and needs of client •Prevent complications of immobility •Provide comfort •Promote quality of life throughout stages •Education and support for client's family members as they cope with physical and emotional demands

What are the patient problems for when AD progresses?

•Risk for caregiver role strain •Risk for aspiration •Self-care deficit •Impaired social interaction •Impaired verbal communication •Incontinence of urine and stool •Impaired physical mobility •Wandering

What is the concept of Alzheimer's Disease?

Cognition

Late stage of AD

In its severe stages, Many have difficulty moving, are bed ridden and require round the clock daily personal care. They lose awareness of recent experiences as well as their surroundings, have trouble communicating, experience changes in physical abilities including walking, sitting and eventually swallowing.

When does damage to the brain start in AD?

Likely starts a decade or more before memory and other cognition problems appear

What is the pathophysiology of Alzheimer's?

•Two types of abnormal lesions clog the brain making it increasingly difficult for brain signals to be sent properly : •Beta-amyloid plaques •Neurofibrillary tangles comprised of filaments of tau protein •Previously healthy neurons stop functioning, causing them to lose connection with other neurons, and die

What are the warning signs of AD?

Memory loss that disrupts daily life Trouble understanding visual images and spatial relationships Challenges in planning or solving problems New problems with words in speaking or writing Withdrawal from work or social activities Difficulty completing familiar tasks at home, at work, or at leisure Misplacing things and losing the ability to retrace steps Changes in mood and personality Confusion with time or place Decreased or poor judgement

What are the side effects of glutamate regulators?

Nausea, vomiting, diarrhea, constipation, loss of appetite dizziness; fatigue; unusual weakness weight loss edema in extremities Tachycardia (monitor patients with atrial fibrillation closely) Bruising or bleeding Joint pain Anxiety, aggression

What are the side effects of cholinesterase inhibitors?

Nausea, vomiting, loss of appetite and increase in stools.

What are some nursing goals/plan of care for a patient with AD?

Pt will remain free from injury Pt will perform ADL's with caregiver assistance Pt will exhibit reduced anxiety, agitation, and restlessness Pt will take all meds prescribed Pt will utilize memory aids

What are non-pharmacological therapies for AD?

Speech therapy Physical therapy Occupational therapy (ADL's) Disability benefits Advocacy groups such as The Alzheimer's Association

Why are those with Down Syndrome at risk for developing AD?

Those with Down's Syndrome have an extra copy of chromosome 21, which produces APP (amyloid precursor protein), and leads to buildup of beta-amyloid plaques in the brain (one of the hallmarks of AD) By age 40, most people with Down syndrome have these plaques, along with other protein deposits which cause problems with how the brain functions and increases the risk of developing Alzheimer's disease as they age.

What are complimentary/alternative therapies for AD?

*Antioxidants- help to fight harmful compounds in the body that are linked to illnesses, diabetes, heart disease and cancer *Omega-3 fatty acids (cardiovascular health) *Music therapy: many with AD will fully remember song lyrics from music of their generation: *Therapeutic touch (apply lotion to arms & legs) *Aromatherapy: loss of smell is a common symptom of AD *Therapy pets: some assisted living facilities have live pets- dogs, cats, birds, fish *Doll therapy: controversial with some family members, as they feel staff is treating their parent like a child. Patients often respond positively. Caring for doll reminds them of caring for their own children

What are the risk factors of Alzheimer's?

>65 years of age •Family history/Genetics •Head injury •Brain health is connected to heart health: •Hypertension •Elevated cholesterol •Stroke

What is the most common cause of dementia?

Alzheimer's

Dementia

An umbrella term used to describe a range of symptoms associated with cognitive impairment including changes in: Memory Perception Reasoning Attention/concentration Thinking Judgement Language Must be severe enough to interfere with a person's ability to function

What are some implementations for the RN to facilitate stress management for caregivers?

Caregivers are usually spouses, family members •Economic, psychosocial stressors: -Fear -Fatigue -Isolation •Teach caregivers self-care techniques •Have caregiver identify, take part in physical activities they enjoy

What are the causes of Alzheimer's?

Death of neurons Shrinkage of brain Loss of functioning capabilities in almost all parts of brain, not just the ones that affect memory Formation of plaques and tangles within the brain Eventually, leads to death Genetics-due, in part, to mutations in certain genes

What are preventative measure for reducing risk factors of Alzheimer's?

Decreasing BP & cholesterol, exercising, staying mentally and socially active, interactive games

In what stages do medications for AD work best for symptoms?

Early or middle stages •No treatment stops or reverses mental deterioration

Early stage of AD

In its mild (early) stages, people experience some memory loss, have difficulty performing tasks in social or work settings, lose or misplace a valuable object, have trouble planning and organizing or remembering names when introduced to new people. In the early part of this stage, many people relate the problems to "normal age-related forgetfulness but as symptoms progress a person can have trouble remembering where they are or what day it is. People are normally diagnosed in this stage. This stage typically is the longest stage and can last many years.

Middle stage of AD

In its moderate stages, dementia is more pronounced Individuals can have trouble controlling their bladder and bowels, have trouble recalling information about themselves like their address or telephone number, high school or college they attended, show a tendency to wander and get lost, demonstrate personality and behavior changes, including suspiciousness, they may have repetitive behaviors like hand-wringing or tissue shredding. They begin to forget events or personal history. In this stage individuals can still participate in daily activities with assistance. As there need for assistance grows in this stage, caregivers may need to consider adult day care or respite care (help that provides short term relief for caregivers)