Alzheimer's disease is the most common form of dementia, typically beginning with memory loss and deteriorating over time. It involves the deposition of beta amyloid plaques and tau protein tangles in the brain, leading to the loss of connections between neurons. Risk factors include increasing age and family history, while potential causes relate to reduced acetylcholine levels, oxidative stress, and genetic mutations.

2.  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

3.  The most significant risk factor:
AGE
 Other risk factors: history of
head injury, lower levels of
education, and being female
 Stages:
 Mild
 Moderate
 Severe

4. 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

5.  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.

9.  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

10.  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.

13.  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.

14. We need to eat at least 5 kinds of Fruits & Vegetables

16.  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.

17. The NUN STUDY

18. 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

19.  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.

20.  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.

21. CLASSIC BEHAVIORS

22.  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.

23.  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

24.  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.

25.  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.

27. 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).

28.  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.

29.  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.

30.  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.

31. NURSE- PATIENT RELATIONSHIP

32.  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.

33. 
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.

34.  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.

35.  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.

36.  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.

37.  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

38.  Psychopharmacology
 Tacrine (Cognex)
 Donepezil (Aricept)
 Rivastigmine (Exelon)
 Galantamine (Razadyne)
 Memantine (Namenda)
 Other drugs
 SSRIs
 Venlaxafine (Effexor)

39.  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

40.  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)