 The most prevalent form of  dementia. First diagnosed by Alois Alzheimer in  1907 Course from onset to death might  ex...
 The most significant risk factor:  AGE Other risk factors: history of  head injury, lower levels of  education, and bei...
CAUSES:   Cholinergic hypothesis: the most    recognized and accepted      Levels of acetylcholine are reduced       in ...
   Destruction of cholinergic cell bodies (major    site: nucleus Basalis of Meynert) by oxidative    stress.      Free ...
   Genetics.      Early onset         Chromosome 21:amyolid precursor          protein gene         Presenilin1 gene f...
   Shrinking of the brain, weighing    about 2/3 of the weight of the    normal brain.      Atrophy begins in the tempor...
   Antioxidants have been found to    promote healthy neurons.      Free radicals, bits of oxygen       fragments that a...
We need to eat at least 5 kinds of Fruits & Vegetables
   ENVIRONMENTAL ISSUES   Excessive aluminum from using aluminum    cookware or using a deodorant has not    been proven...
The NUN STUDY
NONTRADITIONAL FINDING   The NUN STUDY     Conducted by Davin Snowdon of      the Sanders- Brown Center on      Aging at...
   Has some unexpected findings:      A sister who has lived more than 100       years old showed no cognitive decline  ...
 Complex use of language and  advanced education were two  background issues that were  isolated in the nuns who had the ...
CLASSIC BEHAVIORS
   Memory loss     The most noticeable initial problem     Long term memory remains intact at first.     Word- finding...
   Misinterpreting the environment.     Visual hallucinations are common.        Charles Bonnet Syndrome           Com...
   Delusions     Paranoia about spouses having      extramarital affairs, stealing      money and rearranging things at ...
   Sundown syndrome     A period, usually in the afternoon or      early evening, during which a patient      becomes mo...
FOUR A’s of Alzheimer’s        Disease and Adaptive Actions   Agnosia: Impaired ability to recognize or    identify famil...
   Aphasia: Language disturbances are exhibited in both    expressing and understanding spoken words.    Expressive aphas...
   Amnesia: Inability to learn new    information or to recall previously learned    information.      Do not expect pat...
   Apraxia: Inability to carry out motor    activities despite intact motor    function.      Assess and adapt for motor...
NURSE- PATIENT RELATIONSHIP
   GOLDEN RULE: Promote maximum functioning and have    patience.   Communication strategies:      Nurse must be pleasa...
   Recognize that patients might not be able to  tell the difference between a real argument  and an impassioned discussi...
   Scheduling strategies:      Develop a schedule that provides       structure to the day, because patients       adapt...
   Nutritional strategies:      Make sure that patients eat properly by       tailoring dietary needs to the patient.   ...
   Toileting strategies      Seek to keep the patient physically       comfortable.      Provide immaculate attention t...
   Wandering strategies      Wandering: leaving one’s residence, unsupervised,       and getting lost.         Might le...
   Psychopharmacology     Tacrine (Cognex)     Donepezil (Aricept)     Rivastigmine (Exelon)     Galantamine (Razadyn...
   Miliue management     Room temperature and lighting      should be the patient’s preference     Reduce noxious sound...
   Memory aids     Big blocks for each date (in a      calendar)     Notes are good reminders (but must      know to lo...
Alzheimers disease
Alzheimers disease
Alzheimers disease
Alzheimers disease
Alzheimers disease
Alzheimers disease
Alzheimers disease
Alzheimers disease
Upcoming SlideShare
Loading in …5
×

Alzheimers disease

1,941 views

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,941
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
0
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Alzheimers disease

  1. 1.  The most prevalent form of dementia. First diagnosed by Alois Alzheimer in 1907 Course from onset to death might exceed 10 years. Patients with a 10- to 20- year course has a more gradual and subtle decline. Average life expectancy from onset to death: 8 years
  2. 2.  The most significant risk factor: AGE Other risk factors: history of head injury, lower levels of education, and being female Stages:  Mild  Moderate  Severe
  3. 3. CAUSES: Cholinergic hypothesis: the most recognized and accepted  Levels of acetylcholine are reduced in the brain  ACTH: primary neurotransmitter that affects an individual’s ability to acquire new information, make simple and complex decisions, and retain memories
  4. 4.  Destruction of cholinergic cell bodies (major site: nucleus Basalis of Meynert) by oxidative stress.  Free radicals are produced killing these cells.  Tau protein is altered and forms twisted rope-like bundles within a cell, resulting in neurofibillary tangles. Deposits of beta amyloid plaque outside of the neurons.  Cell death may result from overabundance of these plaques.  The more amyloid plaques deposited , the greater the impairment is thought to be.
  5. 5.  Genetics.  Early onset  Chromosome 21:amyolid precursor protein gene  Presenilin1 gene found in Chromosome 14  Presinilin 2 gene found on chromosome 1  Linked to the development of amyloid plaques  Apolipoprotein (Apo-E4) found on chromosome 19
  6. 6.  Shrinking of the brain, weighing about 2/3 of the weight of the normal brain.  Atrophy begins in the temporal and parietal regions and processes the entire brain.  Smaller gyri and larger sulci undergo atrophic changes.  The more the brain shrinks, the larger the ventricles become.
  7. 7.  Antioxidants have been found to promote healthy neurons.  Free radicals, bits of oxygen fragments that are produced in the dying neuron, start a chain reaction that ends with nerve cell destruction.
  8. 8. We need to eat at least 5 kinds of Fruits & Vegetables
  9. 9.  ENVIRONMENTAL ISSUES Excessive aluminum from using aluminum cookware or using a deodorant has not been proven to cause Alzheimer’s disease. Dental amalgams were not also found to cause AD. No viral agent transmits this disease.
  10. 10. The NUN STUDY
  11. 11. NONTRADITIONAL FINDING The NUN STUDY  Conducted by Davin Snowdon of the Sanders- Brown Center on Aging at the University of Kentucky  Longitudinal study of the School Sisters of Notre Dame  678 nuns volunteered
  12. 12.  Has some unexpected findings:  A sister who has lived more than 100 years old showed no cognitive decline though there is abundance of both plaque and tangle formations.  Another nun in her 70s had profound dementia yet had few tangles and plaques.
  13. 13.  Complex use of language and advanced education were two background issues that were isolated in the nuns who had the highest ability. Nuns with a positive lifetime attitude were found to be in the highest cognitive group.
  14. 14. CLASSIC BEHAVIORS
  15. 15.  Memory loss  The most noticeable initial problem  Long term memory remains intact at first.  Word- finding difficulty: the easiest problem for the nurse to assess.  Trouble understanding a conversation, comprehending the plot of a book, or following a TV program frequently occurs.  Withdrawing from a former routine and pleasurable activities because of a lack of interest and of initiative further contributes to further cognitive decline.
  16. 16.  Misinterpreting the environment.  Visual hallucinations are common.  Charles Bonnet Syndrome  Common among those who have visual impairments (macular degeneration).  Often quite vivid and elaborate.  Often have visual hallucinations of dead relatives.  Least common: olfactory, tactile, and gustatory hallucinations
  17. 17.  Delusions  Paranoia about spouses having extramarital affairs, stealing money and rearranging things at home Misidentifications  Calling a family member or a friend by another person’s name.
  18. 18.  Sundown syndrome  A period, usually in the afternoon or early evening, during which a patient becomes more agitated and less redirectable.  Sundowning: more accurate term Loss of ability to care for oneself.  Incontinence of bowel and/ or bladder and wandering are unmanageable behaviors that make home care no longer possible for any caregivers.
  19. 19. FOUR A’s of Alzheimer’s Disease and Adaptive Actions Agnosia: Impaired ability to recognize or identify familiar objects and people in the absence of a visual or a hearing impairment.  Assess and adapt for visual impairment.  Do not expect the patient to remember you; introduce yourself.  Cover mirrors or pictures if they cause distress.  Name objects and demonstrate their use.  Keep area free of ingestible hazards (toiletries, chemicals, checkers, buttons, and unmonitored medicines).
  20. 20.  Aphasia: Language disturbances are exhibited in both expressing and understanding spoken words. Expressive aphasia is the inability to express thoughts in words; receptive aphasia is the inability to understand what is said.  Assess and adapt for hearing loss.  Observe for use of gestures, tone and facial expressions.  Provide help with word finding.  Restate your understanding of behaviors and word findings.  Acknowledge feelings expressed verbally and nonverbally.  Use simple words and phrases; be concise and organized.  Allow time for response.  Listen carefully and encourage nonverbal praise.  Use pictures, symbols, and sign- ins.
  21. 21.  Amnesia: Inability to learn new information or to recall previously learned information.  Do not expect patient to remember you; introduce yourself.  Do not test the patient’s memory unnecessarily.  Operate in the here and now.  Provide orientation cues.  Remember, you must adapt when the patient cannot change.  Compensate for patient’s lost judgment or reasoning.
  22. 22.  Apraxia: Inability to carry out motor activities despite intact motor function.  Assess and adapt for motor weakness and swallowing difficulties.  Simplify tasks: give step- by- step instructions and time for response.  Initiate motion for patient with gentle guidance or touch.
  23. 23. NURSE- PATIENT RELATIONSHIP
  24. 24.  GOLDEN RULE: Promote maximum functioning and have patience. Communication strategies:  Nurse must be pleasant, smile, be kind, use good eye contact, and to repeat, be patient.  TIPS:  If an interaction is going poorly, stop, walk away (providing it is safe to do so), and return in a few minutes with a fresh start.  Remember, effective communication starts with nonverbal behavior, so use a kind voice and make eye contact.  Be positive and stay with pleasant subjects.  Do not use sasrcasm, jokes, and metaphor because the patient’s loss of abstract thinking makes understanding these language subtleties almost impossible.
  25. 25.  Recognize that patients might not be able to tell the difference between a real argument and an impassioned discussion about a new movie. Observing staff members in such a debate can be frightening and confusing to these patients. Use short sentences, do not use complex ones. Give directions slowly, one step at a time. Do not finish sentences for patients; give them time to finish their thoughts. Approach patients from the front in case they have visual or hearing impairments, Lots of chatter can be confusing, because patients struggle to track one conversation when several are going around them.
  26. 26.  Scheduling strategies:  Develop a schedule that provides structure to the day, because patients adapt better when they have a predictable routine.  Focus on patient- centered activities.  Develop singular activities because multiple activities overwhelm the patients. For example, turn off the television while the patient is putting together a puzzle.  Provide a group exercise with one subject approached at a time. Too mush stimulation increases anxiety and might lead to agitation.
  27. 27.  Nutritional strategies:  Make sure that patients eat properly by tailoring dietary needs to the patient. Serve smaller meals several times per day. If too much food is on the plate,, the patient might be overwhelmed.  Also, finger foods work well for people who will not stay at the table.  Find out about a patient’s favorite foods and provide them as much as possible.  Remember that beverage supplements can provide nutrition when regular food intake lessens.
  28. 28.  Toileting strategies  Seek to keep the patient physically comfortable.  Provide immaculate attention to personal hygiene and toileting needs.  Take the patient to the bathroom every 2 hours to promote continence.
  29. 29.  Wandering strategies  Wandering: leaving one’s residence, unsupervised, and getting lost.  Might leave in search their own residences in search of their “homes” or have day- night reversal and walk at night.  Wandering paths (for long term care facilities): must be continuous and without end.  Windows, interesting art on the walls, and an unobstructed hallway provide a safe place to wander as well.  Make the exit door less obvious and paint attractive scenes.  Photograph the patients and keep the patient updated and on the file (“safe return program”)  Safe return armbands  Global positioning devices (necklaces and
  30. 30.  Psychopharmacology  Tacrine (Cognex)  Donepezil (Aricept)  Rivastigmine (Exelon)  Galantamine (Razadyne)  Memantine (Namenda)  Other drugs  SSRIs  Venlaxafine (Effexor)
  31. 31.  Miliue management  Room temperature and lighting should be the patient’s preference  Reduce noxious sounds that might offend or frighten patients  TV should not be allowed (unless purposeful viewing)  Match roommate’s personalities when possible
  32. 32.  Memory aids  Big blocks for each date (in a calendar)  Notes are good reminders (but must know to look for them)  Directions must be written in large print to instruct patients on how to operate new appliances  Use one universal remote control (for several appliances)  Pillboxes for a day or a month (might have an alarm)

×