This document provides information on Alzheimer's disease, including its symptoms, causes, diagnosis, and treatment. Some key points: - Alzheimer's is the most common cause of dementia, accounting for 60-80% of cases. Symptoms include memory loss, impaired judgment, and difficulties with language and abstract thinking. - It results from brain changes like amyloid plaques and tau tangles that damage and kill brain cells. Imaging tests can detect these changes. - Risk factors include age, family history, and health conditions like heart disease and diabetes. There is no cure, but medications and care approaches can temporarily improve symptoms. - Diagnosis involves medical history, exams of cognitive skills and thinking abilities, imaging

1. Subject- Mental Health Nursing
Unit-V
For GNM 2nd year student
Prepared by :Ritik kumar
Nursing
Hayat institute of Nursing

2. A PROGRESSIVE DETERIORATION OF
INTELLECT, BEHAVIOUR & PERSONALITY DUE
TO DIFFUSE DISEASE OF CEREBRAL
HEMISPHERE, MAXIMALLYAFFECTING THE
CEREBRAL CORTEX & HIPPOCAMPUS.
COMMON SIGNS & SYMPTOMS
-MEMORY LOSS
-IMPAIRED JUDGEMENT
-DIFFICULT WITH
ABSTRACT THINKING
-FAULTY REASONING
-INAPPROPRIATE
BEHAVIOUR
-LOSS OF COMMUNICATION
SKILLS
-DISORIENTATION TO PLACE &
TIME
-GAIT, MOTOR & BALANCE
PROBLEMS
-NEGLECT OF PERSONAL CARE &

3. AGE (ABOVE
65)/ SEX
(MALE)/
GENETIC
OVER
WEIGHT/
DRUG/SMOKIN
G/ ALCOHOL
BLOOD
PRESSURE/
BLOOD SUGAR/
CHOLESTEROL
DEPRESSI
ON/
STRESS
HEART
DISEASES/
DIABETES/
VASCULAR
DISEASES
HEAD INJURY/
INFLAMMATORY
STRESS/ TUMOR
HIV
INFECTION/
SOME
IMMUNOLOGIC
AL
DISORDERS
POOR
EDUCATION/
LOW PHYSICAL
ACTIVITY/
POOR
NUTRITION

4. • SYMPTOM RATHER THAN A SINGLE DISEASE ENTITY.
• OCCURS IN ANY AGE,MORE COMMON IN ELDERLY AGE
(ABOVE 65 YEARS).
• IF OCCURRED UNDER 65, IT IS TERMED AS PRE-
SENILE DEMENTIA.
• INCIDENCE RATE: 187/100,000 PERSONS.
• ACCELERATED BY CHANGE OF ENVIRONMENT,
INTERCURRENT INFECTIONS, SURGICAL
PROCEDURES.

5. INTEROSPECT
IVE: UNSURE
OF SELF
DIFFICULTY IN
COPING WITH
WORK & DAILY
ROUTINE
(RETAINED
INSIGHT)
LOSS OF INSIGHT,
BEHAVIOURAL
CHANGES, LOSS OF
INHIBITION
LONG TERM CARE;
CAN’TBEUN-
ATTENDED
MUTISM
INCONTINEN
CE, DEATH.

6. 1)ALZHEIMER’SDISEASE(60%OFALLCASES)
2)CEREBRO VASCULAR DISEASES (20% OF ALL CASES)
- MULTI INFARCT (ATHEROSCLEROTIC) DEMENTIA
- SUBCORTICALVASCULARDISEASE( BINSWANGER’SDISEASE)
3)NEURO DEGENERATIVE - PICK’SDISEASE; HUNTINGTON’SCHOREA; PARKINSON’SDISEASE
4)INFECTIONS- CREUTZFELD-JACKOB’S DISEASE; HIV(AIDSDEMENTIACOMLEX); VIRAL
ENCEPHALITIS; PROGRESSIVE MULTIFOCAL LEUCOENCEPHALOPATHY
5)NORMAL PRESSURE HYDROCEPHALUS
6)NUTRITIONAL -WERNICKE KORSAKOFF (THIAMINE DEFICIENCY); B12 DEFICIENCY;
FOLIATE DEFICIENCY
7)METABOLIC- HEPATICDISEASE;THYROIDDISEASE;PARATHYROIDDISEASE;CUSHING’SSYNDROME
8)CHRONIC INFLAMMATORY – COLLAGEN VASCULAR DISEASE & VASCULITIS,
MULTIPLE SCLEROSIS
9)TRAUMA – HEAD INJURY; PUNCH-DRUNK SYNDROME
10)TUMOR - eg: SUBFRONTAL MENINGOMA

7. # FRONTAL
PREMOTOR
CORTEX.
#BEHAVIOUR
AL
CHANGES,
LOSS OF
INHIBITION,
ANTI-SOCIAL
BEHAVIOUR,
FACILE &
IRRESPONSI
BLE
#Eg: NORMAL
PRESSURE
ANTERI
OR
POSTERI
OR#PARIETAL &
TEMPORAL
LOBES.
#DISTURBANCE
OF COGNITIVE
FUNCTION
(MEMORY &
LANGUAGE)
WITHOUT
MARKED
CHANGE IN
BEHAVIOUR.
#Eg:ALZHEIMER’S
DISEASE.
SUB-
CORTICAL
CORTIC
AL
#APATHETIC
#FORGETFUL &
SLOW, POOR
ABILITY TO USE
KNOWLEDGE
#ASSOCIATED
WITH OTHER
NEUROLOGICAL
SIGNS &
MOVEMENT
DISORDERS.
#Eg:PARKINSON’S
DISEASE,
# HIGHER
CORTICAL
ABNORMALITIES
#DYSPHAS
IA,
AGNOSIA
,
APRAXIA
#Eg:ALZHEIMER’
S DISEASE

8. • Most common type of dementia; accounts for an estimated 60 to
80 percent of cases.
 Symptoms:
 Difficulty remembering names and recent events is
often an early clinical symptom.
 apathy and depression are also often early symptoms.
 Later symptoms include impaired judgment,
disorientation, confusion, behaviour changes
and difficulty speaking, swallowing and
walking.
 Brain changes:

9.  Previously known as multi-infarct or post-stroke dementia, vascular dementia is the second
most common cause of dementia after Alzheimer's disease.(20% Of all cases)
Eg:MULTI INFARCT DEMENTIA (ATHEROSCLEROTIC) , SUBCORTICAL VD (BINSWANGER’S
DISEASE-SUBCORTICAL LEUCOENCEPHALOPATHY)
Symptoms:
 Impaired judgment or ability to plan steps needed to complete a task is more likely to
be the initial symptom, as opposed to the memory loss often associated with the initial
symptoms of Alzheimer's.
 Occurs because of brain injuries such as microscopic bleeding and blood vessel
blockage.
 The location of the brain injury determines how the individual's thinking and physical
functioning are affected
Brain changes:
 Brain imaging can often detect blood vessel problems implicated in vascular dementia.

10. Eg: HUNTINGTON’SCHOREA, PARKINSON’S DISEASE
Parkinson’sdisease
 As Parkinson's disease progresses, it often results in a progressive dementia similar to
dementia with Lewy bodies or Alzheimer's.
Symptoms:
 Problems with movement are a common symptom early in the disease. If dementia develops,
symptoms are often similar to dementia with Lewy bodies.
 RESTING TREMOR, AKINETIC RIGIDITY,BENT POSTURE,HYPOMIMIA
Brain changes:
 Alpha-synuclein clumps are likely to begin in an area deep in the brain called the
substantia nigra. These clumps are thought to cause degeneration of the nerve cells that
produce dopamine.

11.  presents with impairment of recent memory associated with entorhinal cortex and hippocampal
dysfunction, Pick disease typically affects the frontal and/or anterolateral temporallobes.
 A TYPE OF FRONTO-TEMPORALDEMENTIA.
 Emotional & behavioral changes, mutism, aphasia, echolalia(repeating whatever spoken to
them), rigidity, apraxia, weakness, memory loss.
BRAIN CHANGES:
 Pick disease is defined pathologically by severe atrophy, neuronal loss, and gliosis.
 Frequently, Pick disease is accompanied by the occurrence of tau-positive inclusions.
 Swollen (ballooned) neurons (Pick cells) and argentophilic neuronal inclusions, known as
Pick bodies, can disproportionally affect the frontal and temporal cortical regions. Fewer Pick
bodies may be present in these regions if the primary symptoms are behavioral (behavioral
variant), compared with the primary symptoms of aphasia.

12. Eg: CREUTZFELD-JACOB DISEASE , HIV INFECTION (AIDS-DEMENTIA COMPLEX) ,
VIRAL ENCEPHALITIS , PROGRESSIVE MULTIFOCAL LEUCOENCEPHALOPATHY
CREUTZFELD-JACOB DISEASE
 CJD is the most common human form of a group of rare, fatal brain disorders affecting people and
certain other mammals. Variant CJD (“madcowdisease”)occurs in cattle, and has been transmitted
to people under certain circumstances.
Symptoms:
 Rapidly fatal disorder that impairs memory and coordination and causes behavior changes.
Brain changes:
 Results from misfolded prion protein that causes a "domino effect" in which prion protein
throughout the
brain misfolds and thus malfunctions.

13.  A condition that leads to the loss of intellectual abilities such as memory, judgment, and abstract
thinking. It can also cause changes in personality.
 AIDS Dementia Complex (or ADC) is a type of dementia that occurs in advanced stages of AIDS (acquired
immunodeficiency syndrome).
These are some of the first signs and symptoms of ADC:
•Short attention span
•Trouble remembering
•Poor judgment
•Slowed thinking and longer time needed to do tasks
•Irritability
•Unsteady gait, tremor, or trouble staying balanced
•Poor hand coordination
•Social withdrawal or depression
In later stages, you may have more severe symptoms:
•Extreme mood swings
•Psychosis
•Loss of bladder and bowel control

14. Symptoms:
 Symptoms include difficulty walking, memory loss and inability to control urination.
Brain changes:
 Caused by the build up of fluid in the brain. Can sometimes be corrected with surgical
installation of a shunt in the brain to drain excess fluid.
Nutritional
Eg: WERNICKE-KORSAKOFF (THIAMINE DEFICIENCY), B12
DEFICIENCY , FOLIC ACID DEFICIENCY
WERNICKE KORSAKOFF SYNDROME
 Korsakoff syndrome is a chronic memory disorder caused by severe deficiency of thiamine
(vitamin B-1). The most common cause is alcohol misuse.
Symptoms:
 Memory problems may be strikingly severe while other thinking and social skills seem
relatively unaffected.
Brain changes:
 Thiamine helps brain cells produce energy from sugar. When thiamine levels fall too low, brain
cells cannot generate enough energy to function properly.

15.  Eg: HEPATICDISEASES,THYROIDDISEASES,PARATHYROIDDISEASES,CUSHING’SSYNDROME
Chronic inflammatory
 Eg: COLLAGEN VASCULAR DISEASE, VASCULITIS, MULTIPLE SCLEROSIS
Trauma
 Eg: HEAD INJURY, PUNCH-DRUNK SYNDROME
Punch-Drunk Syndrome
A condition seen in boxers and alcoholics, caused by repeated cerebral
concussions and characterized by weakness in the lower limbs,
unsteadiness of gait, slowness of muscular movements, hand tremors,
hesitancy of speech, and mental dullness.
 Boxer's encephalopathy, dementia pugilistica. A syndrome affecting 10–20% of professional boxers, which
is the cumulative result of recurrent brain damage and progressive communicating hydrocephalus due to
extrapyramidal and cerebellar lesions that translate into dysarthria, ataxia, tremors, pyramidal lesions–
causing mental deterioration and personality changes–eg, rage reaction and morbid jealousy–

16.  Eg: SUBFRONTAL MENINGOMA
Dementia rarely may be due to intracranial tumour, especially when
tumours occur in certain anatomical sites.
Mental or behavioral changes occur in 50-70% of all brain tumours as
distinct from dementia which is associated with frontal lobe tumours,
III ventricle tumours and corpus callosum tumours.
 Cognitive impairment also occurs as a non metastatic complication of
systemic malignancy.

17. DEMENTIA CAN OCCUR AS A SYMPTOM OF MORE WIDE SPREAD DEGENERATIVE
DISORDERS
Eg:HUNTINGTON’SDISEASE,DIFFUSELEWYBODYDISEASE,PROGRESSIVESUPRANUCLEARPALSY,MOTOR
NEURON DISEASE etc.
DEMENTIA WITH LEWY BODY DISEASE (DLB)
Symptoms:
 People with dementia with Lewy bodies often have memory loss and thinking problems
common in Alzheimer's, but are more likely than people with Alzheimer's to have initial or early
symptoms such as sleep disturbances, well-formed visual hallucinations, and muscle
rigidity or other parkinsonian movement features.
Brain changes:
 Lewy bodies are abnormal aggregations (or clumps) of the protein Alpha- synuclein. When
they develop in the brain cortex, dementia can result. Alpha- synuclein also aggregates in the
brains of people with Parkinson's disease, but the aggregates may appear in a pattern that is
different from dementia with Lewy bodies.

18.  Huntington’s disease is a progressive brain disorder caused by a single defective gene on
chromosome 4.
Symptoms:
 Include Huntington’s chorea, dysarthria, dysphagia, facial twitching, chameleon or
trombone tongue a severe decline in thinking and reasoning skills, and irritability,
depression and other mood changes.
Brain changes:
 The gene defect causes abnormalities in a brain protein that, over time, lead to worsening
symptoms.
Mixed Dementia
 In mixed dementia abnormalities linked to more than one type of dementia occur
simultaneously in the brain.
Brain changes:
 Characterized by the hallmark abnormalities of more than one type of dementia —most
commonly, Alzheimer's and vascular dementia, but also other types, such as dementia
with Lewy bodies.

19. - FROM PATIENT & RELATIVE
NOTE:
1) RATE OF INTELLECTUAL DECLINE
2) IMPAIRMENT OF SOCIAL FUNCTION
3) GENERAL HEALTH & RELEVANT DISORDERS
(Eg: STROKE, HEAD INJURY)
4) NUTRITION STATUS
5) DRUG HISTORY
6) FAMILYHISTORY OF DEMENTIA
TESTS ASSIGNED TO CHECK INTELLECTUAL FUNCTIONS ARE
DESIGNED TO CHECK:
1) MEMORY 2) ABSTRACT THOUGHT
3) JUDGEMENT
4) SPECIFIC HIGHER
CORTICAL
FUNCTIONS
IN EARLY / PSEUDO DEMENTIAS, A FORMAL ASSESSMENT
FROM A CLINICAL PSYCHOLOGIST IS
ADVISABLE

20. NOTE: FOCAL SIGNS
INVOLUNTARY
MOVEMENTS PSEUDO
BULBAR SIGNS
PRIMITIVE REFLEXES
CHECK: POUT REFLEX (Tap lips with a tendon hammer, a pout reflex is
observed)
GRASPREFLEX(Tappingin between eyes,patient can’t inhibit blinkingin responseto
stimulation)
GLABELLAR REFLEX (Stroking palm induces grip)
PALMOMENTAL REFLEX (Quick scratch on palm induces sudden
contraction of
mentalis muscle in face)
PRIMITIVE REFLEXES ARE PRESENT IN INFANCY & IN AGED
PEOPLE, AS WELL AS IN DEMENTIA
NEUROPSYCHOMETRIC TEST (ASSESSMENTOFONE’SCOGNITIVEFUNCTIONSSUCH AS
MEMORY, CONCENTRATION, PROBLEM SOLVING SKILLS) IS PERFORMED TO:

21. DIAGNOSTIC APPROACH:
IMAGINGMAINLYINCLUDES MRI , CT-SCAN , SPECT , PET etc.
LAB STUDIES INCLUDES CBC , ESR , THYROID HORMONE
TEST, VIT-B12 BLOOD TEST , LIVER
FUNCTION TEST
(ALT,AST,BLOOD TEST) , HIV
TEST, ELECTROLYTE TEST (TO CHECK KIDNEY FUNCTION),
TOXICOLOGY SCREEN (DRUG) , ANTINUCLEAR ANTIBODIES
(AUTOIMMUNE DISEASE) , LUMBAR
PUNCTURE (To check some proteins in spinal fluid), LEAD TEST (to
check heavy metals in blood) etc.

22. Specimen in end stage AD demonstrating
severe global atrophy.
The images show FDG-PET and axial FLAIR
images of a normal subject and of patients
with AD and FTD.
In AD there is a decreased metabolism of the
parietal lobes (yellow arrows), whereas in
FTD, there is frontal hypometabolism (red
Presenile AD with normal hippocampus
and severe parietal atrophy

23. The images show a patient with a strategic PCA
infarction involving the hippocampus.
This type of infarct can result in sudden dementia
if located in the dominant hemisphere.
It will usually not result in dementia if it occurs in
the non-dominant hemisphere.
The images are of a patient who had VaD,
but the medial temporal lobe was normal.
MTA in a patient with VaD

24. Cerebro Amyloid Angiopathy showing
multiple peripherally located micro bleeds.
End stage FTLD with striking atrophy of
frontal and temporal lobes. No artophy of
parietal and occipital lobes.
images of the same patient show Fazekas 2
white matter hyprintensities.
Fronto-temporal Lobar Degeneration

25. Dementia, delirium and depression are the 3 most prevalent mental disorders in the
elderly.
While dementia and depression are prevalent in the community, hospitals and nursing
homes, delirium is seen most often in acute care hospitals.
 The first step is to recognise which of the syndromes is present.
Dementia is defined by a chronic loss of intellectual or cognitive function of sufficient
severity to interfere with social or occupational function.
Delirium is an acute disturbance of consciousness marked by an attention deficit and
a change in cognitive function.(Hallucinations, autonomic over reactivity as a
consequence of toxic, metabolic or infective conditions.
Depression is an affective disorder evidenced by a dysphoric mood, but the most
pervasive symptom is a loss of ability to enjoy usual activities.
These syndromes are not mutually exclusive, as dementia frequently coexists
with

26. - Altered mental status (AMS) not explained by dementia.
-AMS developed over a short period of time (hours to days) and fluctuates
-AMS could be explained by a drug, acute illness or metabolic disturbance
Diagnostic criteria for dementia
-Memory loss, impairment of language, praxis, recognition or abstract thinking
-Chronic and progressive
-Delirium ruled out
Delirium is attention disorder vs. dementia which is a memorydisorder.
In alcoholism before leaping into the diagnosis- WERNICKE KORASKOFF SYNDROME,
we should also consider the chance of CHRONIC SUBDURALHEMATOMA

27. PEOPLE WHO HAVE DEMENTIA DUE TO
STROKE, MAY BE ABLE TO PREVENT
FUTURE DECLINES BY REDUCING
THEIR RISK FOR HEART DISEASES.
FOR Eg: 1)TREAT OR PREVENT HIGH BP
2)DON’TSMOKE
3)STAYAT A HELTHY WEIGHT
(REDUCE RISK OF DIABETES)
4)KEEP YOUR CHOLESTEROL
NORMAL RANGE
5)PROPER PHYSICAL ACTIVITY
6)STAY MENTALLY & SOCIALLY ACTIVE

28. # Doctors use medicines to treat dementia in the following ways:
 correct a condition that's causing dementia, such as thyroid
replacement for hypothyroidism, vitamins for lack of vit-B12, or
antibiotics for infections.
 To maintain mental functioning for as long as possible when
dementia cannot be reversed.
 To prevent further strokes in people who have dementia caused by
stroke (vascular dementia).
 To manage mood or behaviour problems, such as depression,
insomnia, hallucinations, and agitation.

29. =>CHOLINESTERASE INHIBITORS
SUCH AS DONEPEZIL
(ARICEPT),GALANTAMINE (REMINYL), &
RIVASTIGMINE (EXELON) ARE
DEVELOPED TO TREAT PRIMARILY
ALZHEIMER’S, BUT ARE ALSO USED IN
OTHER DEMENTIAS ESPECIALLY IN
VASCULAR DEMENTIAS.
=>MEMENTINE (NAMENDA) USED TO
TREAT THE SYMPTOMS OF
ALZHEIMERS DISEASE, BUT MAY ALSO
HELP WITH MILD-MODERATE
VASCULAR DEMENTIA
=> IT IS NOT CLEAR THAT HOW
LONG THESE MEDICINES

30. # CHANGING WHAT YOU EAT CAN REDUCE DEMENTIA SYMPTOMS & IMPROVE MENTAL
CLARITY
=>Reduce intake of carbs & sugars ; Take enough protein , vitamins-C,D,E,B12 ,
omega 3s fatty acid, zinc @ prescribed amount).
SUCH AS RISPERIDONE (RISPERDAL) , OLANZEPINE
(ZYPREXIA)
=> ANTI-DEPRESSANTS:
ESPECIALLY SELECTIVE SERETONIN REUPTAKE
INHIBITORS
# MEDICINES TO PREVENT FUTURE STROKES
=>DOCTORS PRESCRIBE MEDICINES FOR HIGH BP
& CHOLESTEROL
(THESECAN’TREVERSEEXISTINGDEMENTIA;BUTPREVENTFURTHER
BRAIN DAMAGE DUE TO STROKES & HD)