The document discusses Alzheimer's disease, covering its definition, risk factors, symptoms, stages, diagnostic evaluations, and management strategies. It highlights the disease's progressive nature and its impact on cognitive functions and daily living. Additionally, it addresses the specific risks posed to individuals with Alzheimer's disease during the COVID-19 pandemic and suggests mitigation strategies.

1. ALZHEIMER’S DISEASE

2. Objectives
 SPECIFIC OBJECTIVE: At the end of Seminar, group will be able to;
1. Introduce Alzheimer’s disease.
2. Define Alzheimer’s disease.
3. Warning signs of Alzheimer’s disease.
4. Risk factors leading to Alzheimer’s disease.
5. Causes of Alzheimer’s disease.
6. Stages of Alzheimer’s disease.
7. Diagnosis of Alzheimer’s disease.
8. Management of Alzheimer’s disease.

3. Origin of Alzheimer's Disease:
 The disease was first described by Dr. Alois Alzheimer, a German physician, in 1906.
 Alzheimer had a patient named Auguste D, in her fifties who suffered from what seemed to be a mental
illness. But when she died in 1906, an autopsy revealed dense deposits, now called neurotic plaques, outside
and around the nerve cells in her brain.
 Inside the cells were twisted strands of fibers, or neurofibrillary tangles.
 Since Dr. Alois Alzheimer's was the first person who discovered the disease, it was named as ‘Alzheimer’s
Disease’.
 Characterized by:
 Progressive impairment in memory, cognitive function, language, judgment, and ADL (Activities of daily
living).
 Ultimately, patients cannot perform self-care activities and become dependent on caregivers.
 Prognosis:
 Poor

4. Alzheimer’s and dementia aren’t the same thing.
Alzheimer’s disease is a type of dementia.

5. DEMENTIA
1. Dementia is a decline in cognitive function. To be considered dementia, mental impairment
must affect at least two brain functions. Dementia may affect:
• memory
• thinking
• language
• judgment
• behavior
 Dementia describes as a group of symptoms affecting memory, thinking and social abilities-
severely enough to interfere with your daily life. It isn't a specific disease, but several
different diseases may cause dementia.

6. ALZHEIMER’S
1. Alzheimer’s disease is a progressive, irreversible and degenerative neurological
condition that causes cerebral cortex to shrink (atrophy), especially the frontal lobe and
gradually leads to death of brain cells which causes memory loss and cognitive decline.
 Alzheimer’s starts slowly (ONCET) and progressively (COURSE) worsens
(INTENSITY).
 It is the cause of 60–70% of cases of dementia.

7. TEN WARNING SIGNS OF ALZHEIMER’S DISEASE
1. Memory loss: More than typical forgetfulness without remembering later.
2. Difficulty performing familiar everyday tasks: (e.g., preparing mal and grooming).
3. Problems with language: forgetting simple words or substituting unusual words.
4. Disorientation to time and place: may forget where they are and/or how they got there.
5. Poor or decreased judgement: dress without regard to weather or falling prey to scam
artists.

8. 6. Problems with abstract thinking: not just difficulty balancing a check book, but
forgetting what the numbers represent.
7. Misplacing things in unusual places, such as placing an iron in a freezer.
8. Changes in mood or behaviour: rapid mood swings with no apparent reason why.
9. Changes in personality: extreme confusion, suspicion, or fearfulness.
10. Loss of initiative: passivity and loss of interest in usual activities.

9. RISK FACTORS
 The one with Mild Cognitive Impairment (MCI) is at the foremost risk of getting the Alzheimer’s
disease with progression of MCI.
 Mild cognitive impairment (MCI) is a condition that can be an early sign of Alzheimer’s, but not
everyone with MCI will develop the disease.
 SignsofMCImayinclude:
 Losing things often
 Forgetting to go to events or appointments
 Having more trouble coming up with words than other people of the same age.
 Movement difficulties and problems with the sense of smell have also been linked to MCI.

10. Other risk factors include:
 Age: Increasing age is the greatest known risk factor for Alzheimer's disease.
 Family history and genetics: Your risk of developing Alzheimer's is somewhat higher if a
first-degree relative. One better understood genetic factor is a form of the apolipoprotein E
gene (APOE).
 Down syndrome: Many people with Down syndrome develop Alzheimer's disease. Signs and
symptoms of Alzheimer's tend to appear 10 to 20 years earlier in people with Down
syndrome than they do for the general population.
 Sex: There appears to be little difference in risk between men and women, but, overall,
there are more women with the disease because they generally live longer than men.
 Head trauma: People who've had a severe head trauma have a greater risk of Alzheimer's
disease. . Some studies indicate that the risk may be greatest within the first six months to
two years after the TBI (Traumatic brain injury).

11.  Air pollution: Studies in animals have indicated that air pollution particulates can speed
degeneration of the nerve.
 Excessive alcohol consumption: Drinking large amounts of alcohol has been known to cause brain
changes. E.g.- (Wernicke- Korsakoff syndrome), where there is “Wernicke’s encephalopathy” and
“Korsakoff’s psychosis”.
 Poor sleep patterns: Research has shown that poor sleep patterns, such as difficulty falling asleep
or staying asleep, are associated with an increased risk of Alzheimer's disease.
 Lifestyle and heart health: Research have shown that the same risk factors associated with heart
disease may also increase the risk of Alzheimer's disease. These include:
 Lack of exercise/ Obesity
 High blood pressure/ High Cholesterol
 Poorly controlled type 2 diabetes
 Smoking or exposure to second hand smoke

12. Causes
 The exact causes of Alzheimer's disease aren't fully understood.
 But at a basic level, brain proteins fail to function normally, which disrupts the work of brain cells
(neurons) and triggers a series of toxic events. Neurons are damaged, loose connections to each other
and eventually die.
 The damage primarily starts in the region of the brain that controls ‘Memory’ (hippocampus- Temporal lobe)
then it develops secondarily to (Frontal lobe- Action cortex and sensory cortex- Thus there is neuromuscular
incordination with loss of cognitive functions).

13. What exactly happens?
Sr. No Neurotransmitters Functions
1. ADRENALINE/ EPINEPRINE Fight or Flight response
2. NORADRENALINE/ NOREPINEPHRINE Concentration
3. DOPAMINE Pleasure
4. SEROTONIN Mood
5. ACETYLCHOLINE Learning
6. GLUTAMATE Memory
7. GABA Calming
8. ENDORPHINES
Euphoria (Released during exercise, excitement
and sex).
 Functions of Neurotransmitters are hampered. This loss of functions continues to
increase gradually due to loose connections among neurons and eventually
connections are totally disrupted showing the total dependency of patient on
others.

14. Role of two proteins:
Plaques: Plaques are deposits of a protein fragment called beta-amyloid that build up in the
spaces between nerve cells.
 (Increase in Size due to deposits): They appear to have a toxic effect on neurons and to disrupt
cell-to-cell communication. These clusters form larger deposits called amyloid plaques, which also
include other cellular debris.
Tangles: Tangles are twisted fibres of another protein called tau, that build up inside cells.
 (Changes shape into tangles): Tau proteins play a part in a neuron's internal support and
transport system to carry nutrients and other essential materials. In Alzheimer's disease, tau
proteins change shape and organize themselves into structures called neurofibrillary tangles. The
tangles disrupt the transport system and are toxic to cells.

15. Tangles: (Tau protein) Plaques: (Amyloid protein)
Intra cellular Inter cellular

16. Stages
1. (According to Alzheimer’s Association of America):
a. Mild
b. Moderate
c. Severe
2. (According to Dr. Barry Reisberg of New York University):
 Stage 1: Normal Stage
 Stage 2: Normal aged forgetfulness Stage
 Stage 3: Mild Neuro-cognitive disorder (MCI) Stage
 Stage 4: Mild Alzheimer’s Disease Stage
 Stage 5: Moderate Alzheimer’s Disease Stage
 Stage 6: Moderately severe Alzheimer’s Disease Stage
 Stage 7: Severe Alzheimer’s Disease

17. SEVERITY
Sr. no. Mild Moderate Severe
1. Memory loss
Behavioral and personality
changes
Unstable gait
2. Vocabulary difficulty Unable to learn & recall Incontinence
3. Mood and personality changes
Wandering and getting lost
Motor disturbance
4. Diminished judgement Long term memory affected Bedridden
5.
Agitation, aggression and confusion Requires assistance with ADL Dysphagia and mostly on mute
& vacant
Expected
length of
time from
diagnosis
0-2 years 2-6 years 6-9 years

19. Diagnosis
1) Blood and/or Urine tests: to study the vital statics of client.
2) Cognitive and Memory tests: to assess the person’s ability to think and remember.
 Tools for assessing Cognitive functions and impairment:
 The General Practitioner Assessment of Cognition Score (GPCOG)
 Mini-Cog
 Eight-item Informant Interview to Differentiate Aging and Dementia (AD8)
 Short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)
 Videos demonstrating cognitive assessment
3) Neurological function tests: to test their balance, senses, and reflexes.

20. 4) Brain- Imaging studies:
a) Magnetic resonance imaging (MRI). MRIs can help pick up key markers, such as inflammation,
bleeding, and structural issues.
b) Computed tomography (CT) scan. CT scans take X-ray images which can help your doctor look for
abnormal characteristics in your brain.
c) Amyloid PET imaging can measure the burden of amyloid deposits in the brain. This imaging is
primarily used in research but may be used if a person has unusual or very early onset of dementia
symptoms.
d) Tau PET imaging, which measures the burden of neurofibrillary tangles in the brain, is generally used
in the research setting.
5) Genetic testing:
 Some forms of the APOE e4 gene are associated with a higher chance of developing
Alzheimer’s disease.

21. Management
 Primary goals of treatment for Alzheimer's disease:
 To maximize functional abilities and improve quality of life by enhancing mood, cognition, and
behaviour.
 No curative treatment exists.
 Pharmacological
Management:

22.  Psychotherapeutic approaches:
1. Approach to achieve ‘Behaviour optimisation’.
2. Approach to achieve ‘Emotional stability’.
3. Approach to achieve ‘Cognition or stimulation-orientation’.
 Nursing Management:
Sr
no.
Interventions
1. Environmental safety first
2. Never leave client alone & be watchful
3. Avoid chaos, conflicts, disturbing behavior with and around client.
4. Make sure that client takes medications on time.
5. Maintained balanced diet and fluid and electrolyte balance.
6. Manage incontinence, constipation and overall hygiene.
7.
Have routinely check on physical assessment, mini mental status
examination and vitals.

23.  Role of Counseling in Alzheimer’s:
1. Impact on families and care taker:
2. Human rights of client.
3. Don’t neglect your own needs
 Here are some tips to combat forgetfulness:
 Learn a new skill.
 Stay involved in activities that can help both the mind and body.
 Volunteer in your community, at a school, or at your place of worship.
 Spend time with friends and family.
 Use memory tools such as big calendars, to-do lists, and notes to yourself.
 Put your wallet or purse, keys, and glasses in the same place each day.
 Get lots of rest.
 Exercise and eat well.

24. Summary:
We discussed and learnt about,
1. Definition of Alzheimer’s disease.
2. Risk factors and causes of Alzheimer’s disease.
3. Stages and clinical manifestations according to them.
4. Diagnostic evaluations of Alzheimer’s disease.
5. Management of Alzheimer’s disease.

25. Bibliography
1. “JN Vyas, Neeraj Ahuja”, ‘Textbook of Postgraduate Psychiatry’, ‘2nd edition’, ‘Jaypee publication’ – page no.- 146 to 154.
2. “M.S Bhatia”, ‘Essential of Psychiatry’, ‘7th edition’- page no.- 224 to 228.
3. “Gail w. Stuart”, ‘Principles and practise of Psychiatric Nursing’, ‘9th edition’, ‘Elsevier publication’- page no.- 118 to 126.
4. “Dr. Bimla Kapoor”, ‘A textbook of Psychiatric Nursing’, ‘Volume 2’, ‘2nd edition’, ‘Kumar publication’- page no.- 144 to 152.
5. “Anbu. T”, ‘Textbook of psychiatric Nursing’, ‘EMMESS publication’- page no.- 122 to 126.
6. www.webmd.com
7. www.mayoclinic.in
8. www.healthline.com
9. www.pyschcentral.com
10. www.nimh.nih.gov

26. The American Journal of Geriatric Psychiatry
Volume 28, Issue 7, July 2020, Pages 712-721
 Problem statement:
Anticipating and Mitigating the Impact of the COVID-19 Pandemic on
Alzheimer's Disease and Related Dementias.
Eric E.BrownM.D., M.Sc., F.R.C.P.C.†12SanjeevKumarM.D., F.R.C.P.C.†12Tarek K.RajjiM.D., F.R.C.P.C.12Bruce G.Pollock M.D., Ph.D.,
F.R.C.P.C.12Benoit H.Mulsant M.D., M.S., F.R.C.P.C.12
 Cite
https://doi.org/10.1016/j.jagp.2020.04.010
Research Article

27.  ABSTRACT
The COVID-19 pandemic is causing global morbidity and mortality, straining health systems, and disrupting society,
putting individuals with Alzheimer's disease and related dementias (ADRD) at risk of significant harm. In this
Special Article, we examine the current and expected impact of the pandemic on individuals with
ADRD. We discuss and propose mitigation strategies for: the risk of COVID-19 infection and its associated
morbidity and mortality for individuals with ADRD; the impact of COVID-19 on the diagnosis and clinical
management of ADRD; consequences of societal responses to COVID-19 in different ADRD care settings; the
effect of COVID-19 on caregivers and physicians of individuals with ADRD; mental hygiene, trauma, and
stigma in the time of COVID-19; and the potential impact of COVID-19 on ADRD research. Amid considerable
uncertainty, we may be able to prevent or reduce the harm of the COVID-19 pandemic and its consequences for
individuals with ADRD and their caregivers.
 CONCLUSIONS
The COVID-19 pandemic is disrupting the world and its health care systems in unprecedented ways, including
ADRD population, Which is more worsening due to pandemic crisis.

28. THANK YOU