Alzheimer’s disease 2


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Alzheimer’s disease 2

  2. 2. • Alzheimer is a disease that attacks brain. It is most common form of DEMENTIA. • Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. • In Alzheimer's disease there is a progressive loss of brain cells. • Also known as AD. ALZHEIMER
  4. 4. ETIOLOGY • The exact aeitopathogenesis is not known • The hypotheses include cholinergic hypothesis (reduced acetylcholine), amyloid hypothesis, and tau hypoth
  5. 5. PATHOLOGY • It consist principally of neuronal loss ; principally in temporal cortex but also in the frontal cortex. • Senile plaques and neurofibrially tangles are regarded as hallmark of AD though they may also be present with normal again
  6. 6. PATHO - PHYSIOLOGY • Alzheimer's disease is characterized by loss of neurons and synapses in the cerebral cortex and certain sub cortical regions. • This loss results in gross atrophy of the affected regions, including degeneration in the temporal lobe and parietal lobe, and parts of the frontal cortex and cingulated gyrus
  7. 7. LABORATORY INVESTIGATION • These are carried out to exclude a treatable cause of dementia. • Common investigation are blood chemistry, a complete count, test for syphilis, serum levels of vitamin B12 and thyroid function. • A CT scan of head is usually done to exclude an intracranial pathology.
  8. 8. CONTINUE • A MRI may be necessary to detect presence of white matter ischemic lesions.
  9. 9. CAUSES • Alzheimer's disease is caused by parts of the brain wasting away (atrophy), which damages the structure of the brain and how it works. • It is not known exactly what causes this process to begin, but people with Alzheimer's disease have been found to have abnormal amounts of protein (amyloid plaques) and fibers (tau tangles) in the brain
  10. 10. CONTINUE • These reduce the effectiveness of healthy neurons (nerve cells that carry messages to and from the brain), gradually destroying them. • Over time, this damage spreads to other areas of the brain, such as the grey matter (responsible for processing thoughts) and the hippocampus (responsible for memory).
  11. 11. SIGN AND SYMPTOMS • The symptoms of Alzheimer’s disease progress slowly over several years. However, the rate at which they progress will differ for each individual. • No two cases of Alzheimer's disease are ever the same because different people react in different ways to the condition. However, generally, there are three stages to the condition:-
  12. 12. CONTINUE Mild Alzheimer's disease Common symptoms of mild Alzheimer's disease include: • forgetfulness • mood swings • speech problems
  13. 13. CONTINUE Moderate Alzheimer's disease As Alzheimer's disease develops into the moderate stage, it can also cause: • Disorientation • Difficulty performing spatial tasks (such as judging distances or finding your way around)
  14. 14. CONTINUE • Problems with eyesight which could lead to poor vision, or in some cases hallucinations (where you hear or see things that are not there) • Delusions – believing things that are untrue • Obsessive or repetitive behaviour
  15. 15. CONTINUE • A belief that you have done or experienced something that never happened • Disturbed sleep • Incontinence – where you unintentionally pass urine (urinary incontinence) or stools (faecal or bowel incontinence
  16. 16. CONTINUE Severe Alzheimer's disease • Dysphagia (difficulty swallowing) • Difficulty changing position or moving from place to place without assistance • Weight loss or a loss of appetite • Increased vulnerability to infection
  17. 17. CONTINUE • Complete loss of short-term and long-term memory • Someone with severe Alzheimer's disease may seem very disorientated and is likely to experience hallucinations and delusions.
  18. 18. CONTINUE • The hallucinations and delusions are often worse at night, and the person with Alzheimer's disease may start to become violent, demanding, and suspicious of those around them.
  19. 19. TREATMENT Medication Medications that may be prescribed for Alzheimer’s disease include: • Donepezil 5mg daily • Galantamine 4mg twice a day • Rivastigmine 1.5mg twice a day
  20. 20. CONTINUE Side effects Donepezil, galantamine and rivastigmine (AChE inhibitors) can cause side effects including: • nausea (feeling sick) • vomiting • diarrhoea • headache • fatigue (extreme tiredness) • insomnia
  21. 21. Nurse’s Role • Promote independence and autonomy • Prevent complications • Provide comfort • Promote quality of life • Education
  22. 22. Planning Care • No cure available • Goals of treatment – Slow progression – Manage manifestations • Care giver experience needed – Long-term care – End-of-life care
  23. 23. Planning Care • Challenging behaviors and psychiatric symptoms develop in the AD patient • Settings used to care for AD patients – Individual’s home or family member’s home – Hospitals – Long-term-care facilities (nursing homes) – Congregate living facilities – Hospice settings
  24. 24. Pharmacological Interventions • Cholinesterase inhibitors – Slow progression of symptoms – Titrate dosages slowly •Donepezil (Aricept) •Rivastigmine (Exelon) •Galantamine (Reminyl
  25. 25. CONTINUE • Memantine (Namenda) – N-methyl-d-aspartate (NMDA) antagonist • Alternative and complementary therapies – Vitamin E: limited support, more study needed – Nonsteroidal anti-inflammatory drugs/statins: patients taking these have reduced development of AD – Statins:are a class of drug used to lower cholesterol levels by inhibiting the enzyme HMG- CoA reductase.
  26. 26. Functional Impairments • Utilize therapeutic nonverbal behaviors • Avoid fatigue, nonroutine activities, and alcohol • Avoid a high-stimulus environment • Prevent disability • Treat other conditions that lead to physical decline
  27. 27. CONTINUE • Identify and respond rapidly to acute changes in function • Adapt care to accommodate neuro motor changes secondary to progression of dementia
  28. 28. Mood Disorders • Be alert for changes – Appetite – Disinterest – Anhedonia – Sleep abnormality – Fatigue
  29. 29. Delusions and Hallucinations • Cause – Delirium – Interaction of dementia and personality – Separate mental disorder coexisting with dementia – Disinhibition of cortical functions
  30. 30. Dependence in ADLs • Promote, preserve functional independence • Preventive plans of care
  31. 31. Inability to Initiate Meaningful Activities • Results in apathy or agitation for dementia sufferer • Promote social involvements
  32. 32. Anxiety • May be a primary disorder or a symptom of depression • May result from delusions, hallucinations, or functional impairment • Plan interventions to reduce stress, enhance feelings of trust and safety • Promote stability • Provide diversion activities
  33. 33. Spatial Disorientation • Results in incorrect interpretation of objects or directions • Results in fear, anxiety, suspicions, illusions, delusions, and safety concerns • Promote familiarity with environment • Use landmarks to provide “pop- up” cues
  34. 34. Elopement • means to run away, and to not come back to the point of origination • A valid concern in individuals with cognitive impairments • Risk factors • Alzheimer’s Association Safe Return Program
  35. 35. Resistance to Care • Common in middle to late stages of dementia • Major reason for institutionalization and use of psychotropic medications and restraints • Management strategies – Restore calm – Time-out
  36. 36. Food Refusal • Occurs in each of the progressive stages of AD • Causes • Management interventions
  37. 37. Insomnia • Insomnia noted months prior to AD diagnosis • Establish routines to promote therapeutic sleep patterns – Establish sleep hygiene – Eliminate stimuli before bedtime
  38. 38. Apathy and Agitation • Associated with increasing cognitive decline • Escalation can result in violence and combative behaviors • Promote interest in the environment
  39. 39. PharmacologicaL Interventions • Used to promote comfort • Begin with lower dosages and gradually increase • Monitor side effects closely
  40. 40. Late Stage Issues • Institutionalization • Do not resuscitate decisions • Transfer to acute care facilities • Feeding tubes • Infections
  41. 41. PREVENTION • Quitting smoking • Avoid drinking large amounts of alcohol • Eating a healthy balanced diet • Exercising for at least 150 m • If you have Diabetes, make sure you keep to the diet and take and medicines