Alzheimer's Disease

Definition • Alzheimer's disease is a physical disease which attacks the brain resulting in impaired memory, thinking and behaviour. The disease is named for the German physician, Alois Alzheimer who, in 1907, first described it.

Two different types: 1. Sporadic Alzheimer's disease • The disease can affect adults at any age, but usually occurs after age 65 • Sporadic Alzheimer's disease is by far the most common form of Alzheimer's disease • It affects people who may or may not have a family history of the disease

2. Familial Alzheimer's disease • The disease runs in a few families and is very rare • If a parent has a mutated gene, each child has a 50% chance of inheriting it • The presence of the gene means that the person will eventually develop Alzheimer's disease, usually in their 40's or 50's • Familial Alzheimer's disease affects a very small number of people

Risk Factors Neurochemical (deficiencies of neurotransmitters Environmental (repeated head trauma or exposure to aluminum and manganese)

Viral (slow CNS viruses) Genetic immunologic (abnormalities in chromosomes 14 and 21)

Pathophysiology Abnormalities in cholinergic neurotransmitters Decrease in acetylcholine synthesis Cellular degeneration & cellular atrophy

Abnormal material builds up as neurofibrillary tangles in the center of the brain cells and amyloidal plaques deposits outside the brain cells Disrupting messages within the brain Damaging connections between brain cells

Leads to the eventual death of the brain cells and prevents the recall of information

Alzheimer’s disease

Clinical manifestations Stage 1. Mild (Early confusion) • Early cognitive decline in one or more areas • Memory loss • Decrease ability to function in work • Name finding deficit • Decrease in social functioning • Recall difficulties and anxiety

Stage 2. Moderate • Unable to perform complex tasks (e.g. managing personal finances, planning a dinner party, unable to concentrate, no knowledge of current events).

Stage 3. Moderately severe ( Early Dementia) • Usually needs assistance for survival • Needs reminders to bath, selecting clothes and other daily functions. • Maybe disoriented to time or recent events although this can fluctuate. • May become tearful.

Stage 4. Severe (Dementia) • Needs assistance with dressing, bathing and toilet functions. • May forget spouse, and other family members names. • Generally unaware of his surroundings • Increase in CNS disturbances (e.g. agitation, delusions, paranoia, obsessive anxiety, increase potential for violent behaviour and tendency to wonder.

Stage 5. Very severe ( late dementia) • Unable to speak • May scream or make other sounds • Unable to ambulate, sit up, smile or feed self. • Unable to hold head erect. • Will ultimately sleep into stupor or coma.

Nursing Diagnosis • Problem: Inability to dress/groom self Nursing diagnosis: Self-care deficit: Dressing/grooming related to psychologic impairment secondary to depression • Problem: Suppressed feelings Nursing Diagnosis: In effected coping related to situational crisis. • Problem: Immobility Nursing Diagnosis: Impaired physical mobility related to generalized weakness and fatigue. • Problem: Disturbed Thought Process Nursing Diagnosis: Disturbed thought process related to Psychological changes: Neurochemical (deficiencies of neurotransmitters acetylcholine, somatostatin, substance P, and norepinephrine).

Diagnostic test findings • Dianosis is made by exclusion; tests are performed to rule out other diseases • Positive diagnosis is made on autopsy • Positron emission tomography shows metabolic activity of the cerebral cortex • Computed Tomography Scan reveals excessive and progressive brain atrophy • MRI rules out intracranial lesions.

• Cerebral blood flow studies show abnormalities in blood flow to the brain. • CSF analysis uncovers chronic neurologic infection. • EEG detects slowing of the brain waves in late stages of the disease. • Neuropsychologic tests reveal impaired cognitve ability and reasoning.

Treatment Cognitive Symptoms • Cholinesterase inhibitors: donepezil (Aricept), rivastigmine ( Exelon), galantamine (Reminyl), tacrine (Cognex) • Glutamate regulator: memantine (Namenda) • Experimental agents to slow progression: CX516 (Ampalex), atorvastatin (Lipitor), dimethylaminoethanol (Deanol), nefiracetam (Translon)

Behavioral Symptoms • Antianxiety drugs • Antidepressants • Antipsychotics

Nursing Considerations • Provide the patient with the safe environment; this may involve admission to a facility outside of the home. • Assist the patient with exercise, as ordered, to help maintain mobility. • Maintain and established daily routine to decreased confusion and disorientation.

• Ensure adequate nutrition by basing food choices on the patient’s current abilities, including the ability to chew and swallow or use utensils. • Intervene with an agitated or fearful patient by helping him focus on another activity. • Refer the patient and his family to appropriate community resources and support services.

• Establish an effective communication system with the patient and his family to help them adjust to the patient’s altered abilities. • Offer emotional support to the patient and his family.

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