Podcast
Questions and Answers
Although AD usually manifests after age ______, some individuals experience symptoms as early as their 30s.
Although AD usually manifests after age ______, some individuals experience symptoms as early as their 30s.
65
The majority of people with younger-onset AD have ______ Alzheimer’s disease, which is the most common form and is not attributed to genetics.
The majority of people with younger-onset AD have ______ Alzheimer’s disease, which is the most common form and is not attributed to genetics.
sporadic
At first, AD typically destroys neurons and their connections in parts of the brain involved in ______, including the entorhinal cortex and hippocampus.
At first, AD typically destroys neurons and their connections in parts of the brain involved in ______, including the entorhinal cortex and hippocampus.
memory
Eventually, many other areas of the brain are damaged like neuronal death in the cerebral ______ producing loss of remote memory.
Eventually, many other areas of the brain are damaged like neuronal death in the cerebral ______ producing loss of remote memory.
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The cholinergic hypothesis: low levels of ______ (a cholinergic neurotransmitter) and decreased acetylcholine function appeared to produce memory deficits.
The cholinergic hypothesis: low levels of ______ (a cholinergic neurotransmitter) and decreased acetylcholine function appeared to produce memory deficits.
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What is the primary difference between early-onset AD and late-onset AD?
What is the primary difference between early-onset AD and late-onset AD?
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In which stage of AD do patients typically spend the most time?
In which stage of AD do patients typically spend the most time?
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What is the primary mechanism by which cholinergic therapy may slow brain atrophy?
What is the primary mechanism by which cholinergic therapy may slow brain atrophy?
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What is the approximate percentage of AD cases that are late-onset?
What is the approximate percentage of AD cases that are late-onset?
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What is the characteristic abnormality that develops in the brains of individuals with AD as the disease progresses?
What is the characteristic abnormality that develops in the brains of individuals with AD as the disease progresses?
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Attempts to develop ______ -targeting drugs to treat AD have ended in failure.
Attempts to develop ______ -targeting drugs to treat AD have ended in failure.
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With AD, individuals have abnormal ______ proteins that join and twist, forming neurofibrillary tangles.
With AD, individuals have abnormal ______ proteins that join and twist, forming neurofibrillary tangles.
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AD seems to be a disorder that is triggered by impairment of ______ metabolism and progresses through tau pathology.
AD seems to be a disorder that is triggered by impairment of ______ metabolism and progresses through tau pathology.
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The most prominent risk factor for Alzheimer disease is ______ age.
The most prominent risk factor for Alzheimer disease is ______ age.
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After the age of ______, individuals have a 50% chance of developing the disease.
After the age of ______, individuals have a 50% chance of developing the disease.
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Cardiovascular risk factors include ______, midlife obesity, midlife hypertension, and hyperlipidemia.
Cardiovascular risk factors include ______, midlife obesity, midlife hypertension, and hyperlipidemia.
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Lifestyle risk factors—including ______ smoking and sedentary lifestyle—also appear to increase risk.
Lifestyle risk factors—including ______ smoking and sedentary lifestyle—also appear to increase risk.
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Individuals exposed to repeated ______ trauma have increased risk for AD.
Individuals exposed to repeated ______ trauma have increased risk for AD.
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Depression is considered to be both a symptom of and risk factor for Alzheimer disease; early management of depression with ______ may prevent cognitive decline associated with dementia.
Depression is considered to be both a symptom of and risk factor for Alzheimer disease; early management of depression with ______ may prevent cognitive decline associated with dementia.
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SSRIs may be useful in the early stages of AD because SSRIs appear to slow the conversion from mild cognitive impairment to later stages of ______.
SSRIs may be useful in the early stages of AD because SSRIs appear to slow the conversion from mild cognitive impairment to later stages of ______.
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What is the primary mechanism by which the brain fails to process amyloid precursor-protein in Alzheimer's disease?
What is the primary mechanism by which the brain fails to process amyloid precursor-protein in Alzheimer's disease?
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What is the role of tau protein in the progression of Alzheimer's disease?
What is the role of tau protein in the progression of Alzheimer's disease?
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Which of the following is a nonmodifiable risk factor for Alzheimer's disease?
Which of the following is a nonmodifiable risk factor for Alzheimer's disease?
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What is the approximate doubling rate of the risk of developing Alzheimer's disease after the age of 65?
What is the approximate doubling rate of the risk of developing Alzheimer's disease after the age of 65?
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Which of the following is a lifestyle risk factor for Alzheimer's disease?
Which of the following is a lifestyle risk factor for Alzheimer's disease?
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What is the relationship between depression and Alzheimer's disease?
What is the relationship between depression and Alzheimer's disease?
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Which of the following proteins are central to the pathology of Alzheimer's disease and act as prions?
Which of the following proteins are central to the pathology of Alzheimer's disease and act as prions?
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At what age do individuals have a 50% chance of developing Alzheimer's disease?
At what age do individuals have a 50% chance of developing Alzheimer's disease?
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What is the potential benefit of using SSRIs in the early stages of Alzheimer's disease?
What is the potential benefit of using SSRIs in the early stages of Alzheimer's disease?
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What is the relationship between cardiovascular risk factors and Alzheimer's disease?
What is the relationship between cardiovascular risk factors and Alzheimer's disease?
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Adopting a heart-healthy diet, staying socially active and connected with others, seeking appropriate treatment for depression and alterations in sleep, and engaging in activities that exercise ______ function also helps.
Adopting a heart-healthy diet, staying socially active and connected with others, seeking appropriate treatment for depression and alterations in sleep, and engaging in activities that exercise ______ function also helps.
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Evidence-based teaching for prevention include reducing the incidence of ______ disorders and other health problems by adopting a healthy lifestyle.
Evidence-based teaching for prevention include reducing the incidence of ______ disorders and other health problems by adopting a healthy lifestyle.
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Diurnal changes in ______ function are typical, with patterns of diminished capacity in the evening.
Diurnal changes in ______ function are typical, with patterns of diminished capacity in the evening.
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Changes in mood or personality are also ______.
Changes in mood or personality are also ______.
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Quitting smoking and using safety measures (such as seat belts while driving) can reduce risk for developing ______ disease.
Quitting smoking and using safety measures (such as seat belts while driving) can reduce risk for developing ______ disease.
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What is the primary mechanism by which adopting a healthy lifestyle can reduce the incidence of cardiovascular disorders and other health problems?
What is the primary mechanism by which adopting a healthy lifestyle can reduce the incidence of cardiovascular disorders and other health problems?
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What is the characteristic pattern of cognitive decline in Alzheimer's disease?
What is the characteristic pattern of cognitive decline in Alzheimer's disease?
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What is the role of cognitive activities in preventing cognitive decline?
What is the role of cognitive activities in preventing cognitive decline?
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What is the relationship between depression and Alzheimer's disease?
What is the relationship between depression and Alzheimer's disease?
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What is the potential benefit of quitting smoking and using safety measures such as seat belts while driving?
What is the potential benefit of quitting smoking and using safety measures such as seat belts while driving?
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There is no definitive way to diagnose AD other than performing a brain ______.
There is no definitive way to diagnose AD other than performing a brain ______.
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Standard laboratory tests for AD include ______, complete blood count (CBC), serum B12, and folate.
Standard laboratory tests for AD include ______, complete blood count (CBC), serum B12, and folate.
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APOE-e4 is the first risk gene identified and remains the gene with the strongest impact on ______.
APOE-e4 is the first risk gene identified and remains the gene with the strongest impact on ______.
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Acetylcholinesterase (AChE) inhibitors work by inhibiting ______, an enzyme that normally breaks down acetylcholine.
Acetylcholinesterase (AChE) inhibitors work by inhibiting ______, an enzyme that normally breaks down acetylcholine.
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NMDA receptor antagonists block the effects of ______.
NMDA receptor antagonists block the effects of ______.
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NMDA receptor antagonists do not reverse existing damage, but they do slow the rate at which new ______ occurs.
NMDA receptor antagonists do not reverse existing damage, but they do slow the rate at which new ______ occurs.
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Galantamine is approved for early to moderate stages of AD, while donepezil and rivastigmine are approved for all ______.
Galantamine is approved for early to moderate stages of AD, while donepezil and rivastigmine are approved for all ______.
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About half of individuals who take AChE inhibitors experience no delay in symptom ______.
About half of individuals who take AChE inhibitors experience no delay in symptom ______.
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Patient and caregiver teaching should include avoiding other medications that may increase the risk of ______ bleeding.
Patient and caregiver teaching should include avoiding other medications that may increase the risk of ______ bleeding.
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The patient’s nutritional status and fluid ______ should also be monitored.
The patient’s nutritional status and fluid ______ should also be monitored.
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What is the purpose of performing a differential diagnosis in Alzheimer's disease?
What is the purpose of performing a differential diagnosis in Alzheimer's disease?
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What is the role of APOE-e4 in Alzheimer's disease?
What is the role of APOE-e4 in Alzheimer's disease?
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What is the mechanism of action of acetylcholinesterase inhibitors in Alzheimer's disease?
What is the mechanism of action of acetylcholinesterase inhibitors in Alzheimer's disease?
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What is the primary benefit of using NMDA receptor antagonists in Alzheimer's disease?
What is the primary benefit of using NMDA receptor antagonists in Alzheimer's disease?
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What is the importance of monitoring nutritional status and fluid balance in patients taking acetylcholinesterase inhibitors?
What is the importance of monitoring nutritional status and fluid balance in patients taking acetylcholinesterase inhibitors?
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What is the reason for slowly increasing the dosage of acetylcholinesterase inhibitors?
What is the reason for slowly increasing the dosage of acetylcholinesterase inhibitors?
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What is the consequence of abruptly stopping acetylcholinesterase inhibitors?
What is the consequence of abruptly stopping acetylcholinesterase inhibitors?
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What is the purpose of patient and caregiver teaching for patients taking acetylcholinesterase inhibitors?
What is the purpose of patient and caregiver teaching for patients taking acetylcholinesterase inhibitors?
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What is the effect of acetylcholinesterase inhibitors on symptoms of Alzheimer's disease?
What is the effect of acetylcholinesterase inhibitors on symptoms of Alzheimer's disease?
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What percentage of individuals with Alzheimer's disease have the APOE-e4 risk gene?
What percentage of individuals with Alzheimer's disease have the APOE-e4 risk gene?
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Medications used to treat AD symptoms include ______ (to treat delusions or hallucinations), anxiolytics (to treat anxiety), and SSRI antidepressants (to treat depression).
Medications used to treat AD symptoms include ______ (to treat delusions or hallucinations), anxiolytics (to treat anxiety), and SSRI antidepressants (to treat depression).
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Nonpharmacologic interventions that have been demonstrated to be effective in treating AD include ______, reality orientation therapy, validation therapy, and reminiscence therapy.
Nonpharmacologic interventions that have been demonstrated to be effective in treating AD include ______, reality orientation therapy, validation therapy, and reminiscence therapy.
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Reality orientation therapy involves orienting individuals to ______, time, place, and situations at regular intervals and as needed through verbal communication and the use of visual cues.
Reality orientation therapy involves orienting individuals to ______, time, place, and situations at regular intervals and as needed through verbal communication and the use of visual cues.
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Validation therapy involves searching for ______ or intended meaning in verbal expressions and behaviors.
Validation therapy involves searching for ______ or intended meaning in verbal expressions and behaviors.
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Reminiscence therapy uses the process of purposely reflecting on past ______.
Reminiscence therapy uses the process of purposely reflecting on past ______.
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Unlike reality orientation, validation therapy does not unnecessarily challenge the patient’s perception of ______.
Unlike reality orientation, validation therapy does not unnecessarily challenge the patient’s perception of ______.
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In validation therapy, the goal is to elicit a response that identifies an unmet ______, such as, “Yes, I need her to give me my dinner.”
In validation therapy, the goal is to elicit a response that identifies an unmet ______, such as, “Yes, I need her to give me my dinner.”
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The nurse can then address the wandering and associated ______ by offering the patient something to eat or reassuring her that dinner will be available soon.
The nurse can then address the wandering and associated ______ by offering the patient something to eat or reassuring her that dinner will be available soon.
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Validation therapy does not try to correct or reorient the patient to the present ______.
Validation therapy does not try to correct or reorient the patient to the present ______.
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The use of ______ boards is an example of visual cues used in reality orientation therapy.
The use of ______ boards is an example of visual cues used in reality orientation therapy.
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Which therapy is used to reorient individuals to person, time, place, and situations?
Which therapy is used to reorient individuals to person, time, place, and situations?
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What is the primary goal of validation therapy?
What is the primary goal of validation therapy?
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Which type of therapy involves searching for emotion or intended meaning in verbal expressions and behaviors?
Which type of therapy involves searching for emotion or intended meaning in verbal expressions and behaviors?
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What is the primary purpose of reminiscence therapy?
What is the primary purpose of reminiscence therapy?
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Which medication is used to treat depression in individuals with AD?
Which medication is used to treat depression in individuals with AD?
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What is the benefit of using SSRIs in the early stages of AD?
What is the benefit of using SSRIs in the early stages of AD?
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What is the role of the healthcare team in reality orientation therapy?
What is the role of the healthcare team in reality orientation therapy?
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What is the primary difference between reality orientation therapy and validation therapy?
What is the primary difference between reality orientation therapy and validation therapy?
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Which type of therapy is used to treat anxiety in individuals with AD?
Which type of therapy is used to treat anxiety in individuals with AD?
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What is the benefit of using exercise as a nonpharmacologic therapy in AD?
What is the benefit of using exercise as a nonpharmacologic therapy in AD?
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There is currently no strong evidence that any complementary health approach or diet can prevent ______ impairment.
There is currently no strong evidence that any complementary health approach or diet can prevent ______ impairment.
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Serial assessments allow the nurse to monitor changes indicative of disease progression and the ability of the patient to manage safely in the current ______ environment.
Serial assessments allow the nurse to monitor changes indicative of disease progression and the ability of the patient to manage safely in the current ______ environment.
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Patients with mild dementia may not present any signs or symptoms notable on _______, at this stage.
Patients with mild dementia may not present any signs or symptoms notable on _______, at this stage.
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The patient interview should address family history of AD and other ______, medical history.
The patient interview should address family history of AD and other ______, medical history.
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The MMSE is the test most commonly used to assess ______ status.
The MMSE is the test most commonly used to assess ______ status.
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Throughout the exam, remain alert for possible signs of abuse, neglect, depression, malnutrition, elimination difficulties, and alterations in ______ integrity.
Throughout the exam, remain alert for possible signs of abuse, neglect, depression, malnutrition, elimination difficulties, and alterations in ______ integrity.
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One study showed that taking a ______ meditation class or a caregiver education class reduced stress more than just getting time off from providing care.
One study showed that taking a ______ meditation class or a caregiver education class reduced stress more than just getting time off from providing care.
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Complementary and alternative measures such as music and art therapy can relieve some of the distressing symptoms associated with ______ decline.
Complementary and alternative measures such as music and art therapy can relieve some of the distressing symptoms associated with ______ decline.
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For caregivers, one study showed that taking a ______ class or a caregiver education class reduced stress more than just getting time off from providing care.
For caregivers, one study showed that taking a ______ class or a caregiver education class reduced stress more than just getting time off from providing care.
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Some research indicating that complementary and alternative measures such as music and art therapy can relieve some of the distressing symptoms associated with ______, pain and agitation and hypertension.
Some research indicating that complementary and alternative measures such as music and art therapy can relieve some of the distressing symptoms associated with ______, pain and agitation and hypertension.
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What is the primary purpose of serial assessments in patients with dementia?
What is the primary purpose of serial assessments in patients with dementia?
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What is the primary goal of the patient interview in patients with dementia?
What is the primary goal of the patient interview in patients with dementia?
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What is the name of the test commonly used to assess cognitive status in patients with dementia?
What is the name of the test commonly used to assess cognitive status in patients with dementia?
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What is the primary benefit of mindfulness meditation classes for caregivers of patients with dementia?
What is the primary benefit of mindfulness meditation classes for caregivers of patients with dementia?
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What is the potential benefit of music and art therapy in patients with dementia?
What is the potential benefit of music and art therapy in patients with dementia?
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What should the nurse remain alert for during the physical examination of patients with dementia?
What should the nurse remain alert for during the physical examination of patients with dementia?
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What is the importance of assessing family history of AD and other dementias in patients with dementia?
What is the importance of assessing family history of AD and other dementias in patients with dementia?
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What is the primary focus of the nursing process in caring for patients with dementia?
What is the primary focus of the nursing process in caring for patients with dementia?
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What is the importance of addressing changes in mood, sleep patterns, and ability to perform ADLs in patients with dementia?
What is the importance of addressing changes in mood, sleep patterns, and ability to perform ADLs in patients with dementia?
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What is the primary goal of caregiver education classes in patients with dementia?
What is the primary goal of caregiver education classes in patients with dementia?
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An assessment of functional status addresses any changes in ability to manage day-to-day ______ and instrumental activities of daily living.
An assessment of functional status addresses any changes in ability to manage day-to-day ______ and instrumental activities of daily living.
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Individuals with AD typically lose function over time managing the following activities: ______ use, meal preparation, handling medications, and managing finances.
Individuals with AD typically lose function over time managing the following activities: ______ use, meal preparation, handling medications, and managing finances.
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The ______ is a 25-item assessment tool that nurses can use to elicit caregiver reports about a variety of behaviors to determine magnitude of the disturbance in terms of patient and caregiver safety.
The ______ is a 25-item assessment tool that nurses can use to elicit caregiver reports about a variety of behaviors to determine magnitude of the disturbance in terms of patient and caregiver safety.
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Two practical tools for assessing caregiver burden include the Zarit Burden Interview (______) and the Caregiver Role Strain Index.
Two practical tools for assessing caregiver burden include the Zarit Burden Interview (______) and the Caregiver Role Strain Index.
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Older adults with Alzheimer disease lose ______ skills over time.
Older adults with Alzheimer disease lose ______ skills over time.
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The nurse should modify the assessment to accommodate the patient at this stage by giving the patient adequate time to ______.
The nurse should modify the assessment to accommodate the patient at this stage by giving the patient adequate time to ______.
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In the early stages, the person is still able to participate in ______ and engage in social activities.
In the early stages, the person is still able to participate in ______ and engage in social activities.
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The Geriatric Depression Scale (______) may be used to detect changes in mood.
The Geriatric Depression Scale (______) may be used to detect changes in mood.
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The Functional Activities Questionnaire (______) may also be used to assess functional status.
The Functional Activities Questionnaire (______) may also be used to assess functional status.
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Individuals with AD typically lose function over time managing the following activities: bathing, dressing, eating, ______, and transferring from bed to chair.
Individuals with AD typically lose function over time managing the following activities: bathing, dressing, eating, ______, and transferring from bed to chair.
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What functional activities do individuals with AD typically lose over time?
What functional activities do individuals with AD typically lose over time?
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What is the purpose of the BEHAVE-AD assessment tool?
What is the purpose of the BEHAVE-AD assessment tool?
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Why should the nurse modify the assessment for a patient with AD?
Why should the nurse modify the assessment for a patient with AD?
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What is the purpose of the Zarit Burden Interview (ZBI)?
What is the purpose of the Zarit Burden Interview (ZBI)?
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What is the Geriatric Depression Scale (GDS) used for?
What is the Geriatric Depression Scale (GDS) used for?
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What is the primary focus of the Working Phase when communicating with patients with AD?
What is the primary focus of the Working Phase when communicating with patients with AD?
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What is the purpose of the Functional Activities Questionnaire (FAQ)?
What is the purpose of the Functional Activities Questionnaire (FAQ)?
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What is the primary focus of the behavior assessment in patients with AD?
What is the primary focus of the behavior assessment in patients with AD?
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Why is it important to inquire about events that precipitate behavior changes in patients with AD?
Why is it important to inquire about events that precipitate behavior changes in patients with AD?
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What is the purpose of assessing the caregiver/living environment?
What is the purpose of assessing the caregiver/living environment?
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Begin every interaction by introducing yourself and stating the patient’s ______.
Begin every interaction by introducing yourself and stating the patient’s ______.
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Use ______ vocabulary and brief, straightforward sentences.
Use ______ vocabulary and brief, straightforward sentences.
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Caregivers may need guidance in recognizing the unmet needs that behaviors such as wandering and ______ represent.
Caregivers may need guidance in recognizing the unmet needs that behaviors such as wandering and ______ represent.
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Providing ______ and meaningful activities, such as art, music, and reminiscence, are effective behavioral strategies.
Providing ______ and meaningful activities, such as art, music, and reminiscence, are effective behavioral strategies.
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As the disease progresses, the emphasis of nursing care focuses on addressing behavioral manifestations of the disease, including ______ symptoms such as agitation, depression, and anxiety.
As the disease progresses, the emphasis of nursing care focuses on addressing behavioral manifestations of the disease, including ______ symptoms such as agitation, depression, and anxiety.
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The Progressively Lowered Stress Threshold (PLST) intervention model is supported by current clinical guidelines and is an approach that should guide nursing care during all stages of the ______.
The Progressively Lowered Stress Threshold (PLST) intervention model is supported by current clinical guidelines and is an approach that should guide nursing care during all stages of the ______.
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The use of physical and pharmacologic restraints in individuals with AD and dementia significantly increases the risk of ______ and death.
The use of physical and pharmacologic restraints in individuals with AD and dementia significantly increases the risk of ______ and death.
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Loss of driving ability can be a point of contention for both patients and family ______.
Loss of driving ability can be a point of contention for both patients and family ______.
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The risks and benefits of devices such as medic alert systems and patient tracking or alert systems should be discussed with patients and ______.
The risks and benefits of devices such as medic alert systems and patient tracking or alert systems should be discussed with patients and ______.
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Promote Safety and Physiologic Integrity: Emphasize the importance of adequate sleep, rest, nutrition, elimination, and ______ control.
Promote Safety and Physiologic Integrity: Emphasize the importance of adequate sleep, rest, nutrition, elimination, and ______ control.
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What is the primary goal of communication strategies for individuals with Alzheimer's disease?
What is the primary goal of communication strategies for individuals with Alzheimer's disease?
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What is the purpose of using simple and direct communication with individuals with Alzheimer's disease?
What is the purpose of using simple and direct communication with individuals with Alzheimer's disease?
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What is the role of caregivers in addressing behavioral manifestations of Alzheimer's disease?
What is the role of caregivers in addressing behavioral manifestations of Alzheimer's disease?
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What is the purpose of providing comforting and meaningful activities for individuals with Alzheimer's disease?
What is the purpose of providing comforting and meaningful activities for individuals with Alzheimer's disease?
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What is the goal of using questions that require yes or no answers in communication with individuals with Alzheimer's disease?
What is the goal of using questions that require yes or no answers in communication with individuals with Alzheimer's disease?
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What is the primary goal of the Progressively Lowered Stress Threshold (PLST) intervention model?
What is the primary goal of the Progressively Lowered Stress Threshold (PLST) intervention model?
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What is the consequence of using physical and pharmacologic restraints in individuals with Alzheimer's disease and dementia?
What is the consequence of using physical and pharmacologic restraints in individuals with Alzheimer's disease and dementia?
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What is the role of driver rehabilitation specialists in individuals with Alzheimer's disease?
What is the role of driver rehabilitation specialists in individuals with Alzheimer's disease?
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What is the advantage of using behavioral strategies such as distraction, consistent caregiving, and provision of meaningful activities?
What is the advantage of using behavioral strategies such as distraction, consistent caregiving, and provision of meaningful activities?
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What is the significance of discussing the risks and benefits of devices such as medic alert systems and patient tracking or alert systems with patients and families?
What is the significance of discussing the risks and benefits of devices such as medic alert systems and patient tracking or alert systems with patients and families?
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Nurses are often in a key position to counsel family members as they struggle with ambivalence and guilt related to the decision to transition the patient to a skilled ______ facility.
Nurses are often in a key position to counsel family members as they struggle with ambivalence and guilt related to the decision to transition the patient to a skilled ______ facility.
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Nurses should be cognizant of the phenomenon of ______ trauma or relocation syndrome—a worsening of symptoms associated with the stress of moving to a new environment.
Nurses should be cognizant of the phenomenon of ______ trauma or relocation syndrome—a worsening of symptoms associated with the stress of moving to a new environment.
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Strategies to address the transition include retaining as many aspects of the home environment and previous ______ as possible.
Strategies to address the transition include retaining as many aspects of the home environment and previous ______ as possible.
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Family members and caregivers who have not resolved relationship issues during earlier stages of the illness may have more difficulty with ______ decisions and are at increased risk for complicated grieving.
Family members and caregivers who have not resolved relationship issues during earlier stages of the illness may have more difficulty with ______ decisions and are at increased risk for complicated grieving.
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The focus is on ensuring that the patient and family achieve the optimal level of ______ for the particular stage of the disease.
The focus is on ensuring that the patient and family achieve the optimal level of ______ for the particular stage of the disease.
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What is the primary focus of nursing care for patients in the final stage of Alzheimer's disease?
What is the primary focus of nursing care for patients in the final stage of Alzheimer's disease?
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What is the challenge in providing palliative care to patients with Alzheimer's disease?
What is the challenge in providing palliative care to patients with Alzheimer's disease?
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What is the primary goal of evaluation in patients with Alzheimer's disease?
What is the primary goal of evaluation in patients with Alzheimer's disease?
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What is the purpose of retaining as many aspects of the home environment and previous routine as possible during the transition to a skilled nursing facility?
What is the purpose of retaining as many aspects of the home environment and previous routine as possible during the transition to a skilled nursing facility?
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What is the potential impact of unresolved relationship issues on family members and caregivers during the end-of-life care?
What is the potential impact of unresolved relationship issues on family members and caregivers during the end-of-life care?
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Damage to the ______ lobe can cause loss of reading comprehension and hallucinations.
Damage to the ______ lobe can cause loss of reading comprehension and hallucinations.
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Damage to the ______ lobe can cause difficulty recognizing places, people, and objects; hallucinations; seizures; unsteady movement; expressive aphasia; agraphia; and agnosia.
Damage to the ______ lobe can cause difficulty recognizing places, people, and objects; hallucinations; seizures; unsteady movement; expressive aphasia; agraphia; and agnosia.
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The ______ system, including the hippocampus, is affected in Alzheimer's disease, resulting in loss of memory and fluctuating emotions.
The ______ system, including the hippocampus, is affected in Alzheimer's disease, resulting in loss of memory and fluctuating emotions.
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Damage to the ______ lobe can cause problems with intentional movement, difficulty planning, emotional lability, and loss of walking, talking, and swallowing ability.
Damage to the ______ lobe can cause problems with intentional movement, difficulty planning, emotional lability, and loss of walking, talking, and swallowing ability.
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Damage to the ______ lobe can cause impaired memory and difficulty learning new things.
Damage to the ______ lobe can cause impaired memory and difficulty learning new things.
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Which brain region is associated with difficulty recognizing places, people, and objects, hallucinations, seizures, and unsteady movement?
Which brain region is associated with difficulty recognizing places, people, and objects, hallucinations, seizures, and unsteady movement?
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What is the primary symptom associated with damage to the temporal lobe?
What is the primary symptom associated with damage to the temporal lobe?
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Which brain region is responsible for processing emotional information and is often affected in individuals with Alzheimer's disease?
Which brain region is responsible for processing emotional information and is often affected in individuals with Alzheimer's disease?
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What is the primary symptom associated with damage to the occipital lobe?
What is the primary symptom associated with damage to the occipital lobe?
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Which brain region is responsible for planning and intentional movement and is often affected in individuals with Alzheimer's disease?
Which brain region is responsible for planning and intentional movement and is often affected in individuals with Alzheimer's disease?
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Individuals with Alzheimer's disease often experience personality ______, including extreme suspiciousness and fearfulness.
Individuals with Alzheimer's disease often experience personality ______, including extreme suspiciousness and fearfulness.
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Sundowning, delusions, compulsions, agitation, and violent outbursts are all symptoms of late-stage Alzheimer's disease, also known as ______.
Sundowning, delusions, compulsions, agitation, and violent outbursts are all symptoms of late-stage Alzheimer's disease, also known as ______.
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As Alzheimer's disease progresses, individuals often experience a gradual loss of the ability to walk, sit unaided, and hold their head ______.
As Alzheimer's disease progresses, individuals often experience a gradual loss of the ability to walk, sit unaided, and hold their head ______.
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Abnormal ______ reflexes are a common symptom of Alzheimer's disease.
Abnormal ______ reflexes are a common symptom of Alzheimer's disease.
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Physical ______ is a hallmark of advanced Alzheimer's disease.
Physical ______ is a hallmark of advanced Alzheimer's disease.
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Many individuals with Alzheimer's disease experience a loss of ______ ability.
Many individuals with Alzheimer's disease experience a loss of ______ ability.
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Development of abnormal ______ proteins is a characteristic abnormality of Alzheimer's disease.
Development of abnormal ______ proteins is a characteristic abnormality of Alzheimer's disease.
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Alzheimer's disease seems to be triggered by impairment of ______ metabolism and progresses through tau pathology.
Alzheimer's disease seems to be triggered by impairment of ______ metabolism and progresses through tau pathology.
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After the age of ______, individuals have a 50% chance of developing Alzheimer's disease.
After the age of ______, individuals have a 50% chance of developing Alzheimer's disease.
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Cognitive decline in Alzheimer's disease is characterized by diurnal changes in ______ function.
Cognitive decline in Alzheimer's disease is characterized by diurnal changes in ______ function.
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What is a common symptom of sundowning in individuals with Alzheimer's disease?
What is a common symptom of sundowning in individuals with Alzheimer's disease?
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What is the outcome of gradual loss of ability to walk, sit unaided, and hold one's head up in Alzheimer's disease?
What is the outcome of gradual loss of ability to walk, sit unaided, and hold one's head up in Alzheimer's disease?
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What is the characteristic feature of abnormal reflexes in Alzheimer's disease?
What is the characteristic feature of abnormal reflexes in Alzheimer's disease?
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What is the effect of Alzheimer's disease on an individual's swallowing ability?
What is the effect of Alzheimer's disease on an individual's swallowing ability?
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What is the primary feature of physical rigidity in Alzheimer's disease?
What is the primary feature of physical rigidity in Alzheimer's disease?
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What is the common consequence of gradual loss of ability to walk in Alzheimer's disease?
What is the common consequence of gradual loss of ability to walk in Alzheimer's disease?
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What is the characteristic feature of delusions in Alzheimer's disease?
What is the characteristic feature of delusions in Alzheimer's disease?
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What is the effect of Alzheimer's disease on an individual's ability to sit unaided?
What is the effect of Alzheimer's disease on an individual's ability to sit unaided?
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What is the characteristic feature of compulsions in Alzheimer's disease?
What is the characteristic feature of compulsions in Alzheimer's disease?
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What is the common consequence of agitation and violent outbursts in Alzheimer's disease?
What is the common consequence of agitation and violent outbursts in Alzheimer's disease?
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What is the primary caution when using acetylcholinesterase inhibitor donepezil in patients with respiratory conditions?
What is the primary caution when using acetylcholinesterase inhibitor donepezil in patients with respiratory conditions?
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What is the effect of using antipsychotics, beta adrenergic blockers, corticosteroids, and anticholinergic drugs on patients with AD?
What is the effect of using antipsychotics, beta adrenergic blockers, corticosteroids, and anticholinergic drugs on patients with AD?
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Why should patients with AD avoid using anticholinergic drugs?
Why should patients with AD avoid using anticholinergic drugs?
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What is the effect of using memantine and donepezil in patients with AD?
What is the effect of using memantine and donepezil in patients with AD?
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What is the primary consideration when using acetylcholinesterase inhibitor donepezil in patients with AD?
What is the primary consideration when using acetylcholinesterase inhibitor donepezil in patients with AD?
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Study Notes
Alzheimer's Disease (AD) Demographics
- AD can manifest as early as the 30s, but typically occurs after age 65
- Most individuals with AD survive between 4 and 8 years after diagnosis
- Those diagnosed at younger ages may live up to two decades
Stages of Alzheimer's Disease
- Patients typically spend more time in the moderate stage of AD
- The disease progresses through stages, eventually damaging multiple areas of the brain
Pathophysiology of Alzheimer's Disease
- Younger-onset AD (before age 65) can be familial (inherited) or sporadic (no known cause)
- Familial AD genes tend to develop symptoms in the 30s to 50s
- Sporadic AD is the most common form and is not attributed to genetics
- Late-onset AD (at age 65 or later) accounts for over 90% of AD cases and is usually sporadic
Brain Damage and Abnormalities
- AD destroys neurons and connections in brain areas involved in memory, including the entorhinal cortex and hippocampus
- The disease later affects areas responsible for language, reasoning, and social behavior
- Eventual damage includes neuronal death in the cerebral lobes, producing loss of remote memory
- Two characteristic abnormalities in AD brains are neurofibrillary tangles and amyloid plaques
Cholinergic Hypothesis and Therapy
- Low levels of acetylcholine and decreased function produce memory deficits
- Cholinergic hypothesis led to development of acetylcholinesterase inhibitor drugs
- Cholinergic therapy may slow brain atrophy
Alzheimer's Disease (AD) Demographics
- AD can manifest as early as the 30s, but typically occurs after age 65
- Most individuals with AD survive between 4 and 8 years after diagnosis
- Those diagnosed at younger ages may live up to two decades
Stages of Alzheimer's Disease
- Patients typically spend more time in the moderate stage of AD
- The disease progresses through stages, eventually damaging multiple areas of the brain
Pathophysiology of Alzheimer's Disease
- Younger-onset AD (before age 65) can be familial (inherited) or sporadic (no known cause)
- Familial AD genes tend to develop symptoms in the 30s to 50s
- Sporadic AD is the most common form and is not attributed to genetics
- Late-onset AD (at age 65 or later) accounts for over 90% of AD cases and is usually sporadic
Brain Damage and Abnormalities
- AD destroys neurons and connections in brain areas involved in memory, including the entorhinal cortex and hippocampus
- The disease later affects areas responsible for language, reasoning, and social behavior
- Eventual damage includes neuronal death in the cerebral lobes, producing loss of remote memory
- Two characteristic abnormalities in AD brains are neurofibrillary tangles and amyloid plaques
Cholinergic Hypothesis and Therapy
- Low levels of acetylcholine and decreased function produce memory deficits
- Cholinergic hypothesis led to development of acetylcholinesterase inhibitor drugs
- Cholinergic therapy may slow brain atrophy
Amyloid and Tau Hypotheses
- Amyloid Hypothesis: AD arises from the brain's inability to process amyloid precursor-protein (APP), leading to the presence of beta-amyloid fragments.
- Tau Hypothesis: AD involves abnormal tau proteins that form neurofibrillary tangles.
Recent Research
- Proteins central to AD pathology act as prions, spreading through tissue like an infection.
- AD is triggered by impairment of APP metabolism and progresses through tau pathology, not beta-amyloid.
Risk Factors
- Nonmodifiable risk factors: age, sex, family history, and genetic factors.
- Higher risk in Hispanic and African American individuals, and women.
- Age: most prominent risk factor, with risk doubling every 5 years after 65 and a 50% chance of developing the disease after 85.
- Cardiovascular risk factors: diabetes, midlife obesity, midlife hypertension, and hyperlipidemia.
- Lifestyle risk factors: cigarette smoking, sedentary lifestyle, and repeated TBI trauma.
- Depression: both a symptom and risk factor, with early management potentially preventing cognitive decline.
Treatment and Prevention
- SSRIs may slow the conversion from mild cognitive impairment to later stages of AD.
- Certain benzodiazepines (estazolam, quazepam, temazepam, and triazolam) may contribute to cognitive deterioration.
- Antihistamines with anticholinergic properties (chlorpheniramine, diphenhydramine, doxylamine, dimenhydrinate, and meclizine) may accelerate cognitive deterioration.
Amyloid and Tau Hypotheses
- Amyloid Hypothesis: AD arises from the brain's inability to process amyloid precursor-protein (APP), leading to the presence of beta-amyloid fragments.
- Tau Hypothesis: AD involves abnormal tau proteins that form neurofibrillary tangles.
Recent Research
- Proteins central to AD pathology act as prions, spreading through tissue like an infection.
- AD is triggered by impairment of APP metabolism and progresses through tau pathology, not beta-amyloid.
Risk Factors
- Nonmodifiable risk factors: age, sex, family history, and genetic factors.
- Higher risk in Hispanic and African American individuals, and women.
- Age: most prominent risk factor, with risk doubling every 5 years after 65 and a 50% chance of developing the disease after 85.
- Cardiovascular risk factors: diabetes, midlife obesity, midlife hypertension, and hyperlipidemia.
- Lifestyle risk factors: cigarette smoking, sedentary lifestyle, and repeated TBI trauma.
- Depression: both a symptom and risk factor, with early management potentially preventing cognitive decline.
Treatment and Prevention
- SSRIs may slow the conversion from mild cognitive impairment to later stages of AD.
- Certain benzodiazepines (estazolam, quazepam, temazepam, and triazolam) may contribute to cognitive deterioration.
- Antihistamines with anticholinergic properties (chlorpheniramine, diphenhydramine, doxylamine, dimenhydrinate, and meclizine) may accelerate cognitive deterioration.
Prevention Strategies
- Quitting smoking and using safety measures (e.g., seat belts while driving) can reduce the risk of developing Alzheimer's disease.
- Engaging in moderate exercise improves cognitive function.
- Adopting a heart-healthy diet, staying socially active, and seeking treatment for depression can help prevent cognitive decline.
Cognitive Resilience
- Engaging in cognitive activities such as reading, completing puzzles, and learning new information or tasks helps build cognitive resilience and protects against cognitive decline.
Clinical Manifestations of Alzheimer's Disease
- Initial symptoms emerge gradually, with subtle memory loss being the first manifestation.
- Other early signs include difficulty finding words, impaired judgment, disorientation to time and place, frequently misplacing things, decreased initiative, odd behavior, and signs of depression.
- Diurnal changes in cognitive function occur, with patterns of diminished capacity in the evening (sundowning).
- Changes in mood or personality are common as the disease progresses.
- Physical changes occur as the disease progresses.
Prevention Strategies
- Quitting smoking and using safety measures (e.g., seat belts while driving) can reduce the risk of developing Alzheimer's disease.
- Engaging in moderate exercise improves cognitive function.
- Adopting a heart-healthy diet, staying socially active, and seeking treatment for depression can help prevent cognitive decline.
Cognitive Resilience
- Engaging in cognitive activities such as reading, completing puzzles, and learning new information or tasks helps build cognitive resilience and protects against cognitive decline.
Clinical Manifestations of Alzheimer's Disease
- Initial symptoms emerge gradually, with subtle memory loss being the first manifestation.
- Other early signs include difficulty finding words, impaired judgment, disorientation to time and place, frequently misplacing things, decreased initiative, odd behavior, and signs of depression.
- Diurnal changes in cognitive function occur, with patterns of diminished capacity in the evening (sundowning).
- Changes in mood or personality are common as the disease progresses.
- Physical changes occur as the disease progresses.
Diagnosis of Alzheimer's Disease
- No definitive way to diagnose AD except through brain autopsy
- Practitioners rely on differential diagnosis to rule out other causes of symptoms
- Standard laboratory tests for AD include TSH, CBC, serum B12, folate, CMP, and STI testing
Genetics of Alzheimer's Disease
- APOE-e4 is the first identified risk gene and has the strongest impact on risk
- Estimated 40-65% of people diagnosed with AD have the APOE-e4 gene
Pharmacologic Therapy for Alzheimer's Disease
- Acetylcholinesterase inhibitors:
- Work by inhibiting acetylcholinesterase, increasing acetylcholine levels
- Temporarily stabilize symptoms related to language, memory, and reasoning for 6-12 months
- Examples: galantamine (early to moderate stages), donepezil and rivastigmine (all stages)
- Side effects: decreased appetite, nausea, diarrhea, headaches, dizziness
- Adverse effects: GI bleeding, bradycardia
- Patient and caregiver teaching: monitor pulse rate, avoid medications that increase GI bleeding risk
- NMDA receptor antagonists:
- Block the effects of glutamate
- Do not reverse existing damage, but slow new damage
- Typically prescribed for moderate-to-severe stages of AD
- Example: memantine (Namenda)
- Side effects: dizziness, constipation, confusion, headache, fatigue, increased blood pressure
- Caution: avoid activities requiring mental alertness or coordination until tolerance is established, take with food
Diagnosis of Alzheimer's Disease
- No definitive way to diagnose AD except through brain autopsy
- Practitioners rely on differential diagnosis to rule out other causes of symptoms
- Standard laboratory tests for AD include TSH, CBC, serum B12, folate, CMP, and STI testing
Genetics of Alzheimer's Disease
- APOE-e4 is the first identified risk gene and has the strongest impact on risk
- Estimated 40-65% of people diagnosed with AD have the APOE-e4 gene
Pharmacologic Therapy for Alzheimer's Disease
- Acetylcholinesterase inhibitors:
- Work by inhibiting acetylcholinesterase, increasing acetylcholine levels
- Temporarily stabilize symptoms related to language, memory, and reasoning for 6-12 months
- Examples: galantamine (early to moderate stages), donepezil and rivastigmine (all stages)
- Side effects: decreased appetite, nausea, diarrhea, headaches, dizziness
- Adverse effects: GI bleeding, bradycardia
- Patient and caregiver teaching: monitor pulse rate, avoid medications that increase GI bleeding risk
- NMDA receptor antagonists:
- Block the effects of glutamate
- Do not reverse existing damage, but slow new damage
- Typically prescribed for moderate-to-severe stages of AD
- Example: memantine (Namenda)
- Side effects: dizziness, constipation, confusion, headache, fatigue, increased blood pressure
- Caution: avoid activities requiring mental alertness or coordination until tolerance is established, take with food
Medications for AD Symptoms
- Antipsychotics are used to treat delusions or hallucinations
- Anxiolytics are used to treat anxiety
- SSRI antidepressants are used to treat depression
Nonpharmacologic Therapy
- Exercise has been demonstrated to be effective in treating AD
- Reality orientation therapy involves orienting individuals to person, time, place, and situations at regular intervals
- Validation therapy involves searching for emotion or intended meaning in verbal expressions and behaviors
- Reminiscence therapy uses the process of reflecting on past events to help retain long-term memory and provide comfort
Reality Orientation Therapy
- Involves orienting individuals to person, time, place, and situations at regular intervals
- Uses verbal communication and visual cues (pictures, clocks, calendars, orientation boards)
- Should be part of routine care and carried out by all members of the healthcare team
Validation Therapy
- Involves searching for emotion or intended meaning in verbal expressions and behaviors
- Aims to elicit a response that identifies an unmet need
- Does not unnecessarily challenge the patient’s perception of reality
Reminiscence Therapy
- Uses the process of reflecting on past events to help retain long-term memory
- Can provide comfort, self-esteem, identity, and purpose
- Can help prevent isolation and withdrawal
Medications for AD Symptoms
- Antipsychotics are used to treat delusions or hallucinations
- Anxiolytics are used to treat anxiety
- SSRI antidepressants are used to treat depression
Nonpharmacologic Therapy
- Exercise has been demonstrated to be effective in treating AD
- Reality orientation therapy involves orienting individuals to person, time, place, and situations at regular intervals
- Validation therapy involves searching for emotion or intended meaning in verbal expressions and behaviors
- Reminiscence therapy uses the process of reflecting on past events to help retain long-term memory and provide comfort
Reality Orientation Therapy
- Involves orienting individuals to person, time, place, and situations at regular intervals
- Uses verbal communication and visual cues (pictures, clocks, calendars, orientation boards)
- Should be part of routine care and carried out by all members of the healthcare team
Validation Therapy
- Involves searching for emotion or intended meaning in verbal expressions and behaviors
- Aims to elicit a response that identifies an unmet need
- Does not unnecessarily challenge the patient’s perception of reality
Reminiscence Therapy
- Uses the process of reflecting on past events to help retain long-term memory
- Can provide comfort, self-esteem, identity, and purpose
- Can help prevent isolation and withdrawal
Complementary Health Approaches
- There is no strong evidence that any complementary health approach or diet can prevent cognitive impairment.
- Music and art therapy can relieve symptoms associated with cognitive decline, such as pain, agitation, and hypertension.
- Mindfulness meditation and caregiver education can reduce stress in caregivers.
Nursing Process: Assessment
- Serial assessments monitor disease progression and ability to manage safely in the current living environment.
- Observation and patient interview are crucial for diagnosis.
Patient Presentation
- Patients with mild dementia may not display noticeable signs or symptoms.
- Family members may report changes in memory or cognitive abilities, indicating a problem.
- As dementia progresses, patients exhibit signs of difficulty maintaining self-care, difficulty focusing on tasks, and changes in gait.
Patient Interview
- Assess family history of AD and other dementias.
- Review medical history, medications, and supplement use.
- Evaluate changes in cognition, communication, memory, and behavior.
- Assess alterations in mood, sleep patterns, and ability to perform ADLs.
- Evaluate drug and alcohol use and risk for environmental toxins.
Mental Status Examination
- The MMSE is the most commonly used test to assess cognitive status.
Physical Examination
- Be alert for signs of abuse, neglect, depression, malnutrition, elimination difficulties, and skin integrity issues.
- Conditions that mimic dementia and AD symptoms include:
- Drugs and alcohol
- Eyes and ears disorders
- Metabolic and endocrine disorders
- Emotional disorders
- Neurologic disorders
- Trauma or tumors
- Infection
- Arteriovascular disease
Complementary Health Approaches
- There is no strong evidence that any complementary health approach or diet can prevent cognitive impairment.
- Music and art therapy can relieve symptoms associated with cognitive decline, such as pain, agitation, and hypertension.
- Mindfulness meditation and caregiver education can reduce stress in caregivers.
Nursing Process: Assessment
- Serial assessments monitor disease progression and ability to manage safely in the current living environment.
- Observation and patient interview are crucial for diagnosis.
Patient Presentation
- Patients with mild dementia may not display noticeable signs or symptoms.
- Family members may report changes in memory or cognitive abilities, indicating a problem.
- As dementia progresses, patients exhibit signs of difficulty maintaining self-care, difficulty focusing on tasks, and changes in gait.
Patient Interview
- Assess family history of AD and other dementias.
- Review medical history, medications, and supplement use.
- Evaluate changes in cognition, communication, memory, and behavior.
- Assess alterations in mood, sleep patterns, and ability to perform ADLs.
- Evaluate drug and alcohol use and risk for environmental toxins.
Mental Status Examination
- The MMSE is the most commonly used test to assess cognitive status.
Physical Examination
- Be alert for signs of abuse, neglect, depression, malnutrition, elimination difficulties, and skin integrity issues.
- Conditions that mimic dementia and AD symptoms include:
- Drugs and alcohol
- Eyes and ears disorders
- Metabolic and endocrine disorders
- Emotional disorders
- Neurologic disorders
- Trauma or tumors
- Infection
- Arteriovascular disease
Functional Status Assessment
- Assess changes in ability to manage daily activities (ADLs) and instrumental activities of daily living (IADLs) in patients with Alzheimer's disease (AD)
- Use direct questioning of patients or family members or screening tools like the Functional Activities Questionnaire (FAQ)
- Identify loss of function over time in activities such as:
- Telephone use
- Meal preparation
- Handling medications
- Managing finances
- Housekeeping
- Shopping
- Traveling within the community
- Bathing
- Dressing
- Eating
- Toileting
- Walking across a small room
- Transferring from bed to chair
Behavior Assessment
- Assess for behavior changes associated with AD, including:
- Depression
- Anxiety
- Irritability
- Impulsivity
- Poor judgment
- Paranoia
- Delusions
- Hallucinations
- Identify events that precipitate behavior changes, such as a poor night's sleep
- Use tools like the Geriatric Depression Scale (GDS) to detect changes in mood
- Use the BEHAVE-AD to assess magnitude of disturbance in patient and caregiver safety
Caregiver/Living Environment
- Assess caregiver burden using:
- Zarit Burden Interview (ZBI)
- Caregiver Role Strain Index (CRI)
- Identify caregiver stress and strain
Communicating with Patients
- Adapt communication style to accommodate patient's language skills
- Give patients adequate time to respond
- Use prompts and ask for permission to involve caregivers if necessary
Functional Status Assessment
- Assess changes in ability to manage daily activities (ADLs) and instrumental activities of daily living (IADLs) in patients with Alzheimer's disease (AD)
- Use direct questioning of patients or family members or screening tools like the Functional Activities Questionnaire (FAQ)
- Identify loss of function over time in activities such as:
- Telephone use
- Meal preparation
- Handling medications
- Managing finances
- Housekeeping
- Shopping
- Traveling within the community
- Bathing
- Dressing
- Eating
- Toileting
- Walking across a small room
- Transferring from bed to chair
Behavior Assessment
- Assess for behavior changes associated with AD, including:
- Depression
- Anxiety
- Irritability
- Impulsivity
- Poor judgment
- Paranoia
- Delusions
- Hallucinations
- Identify events that precipitate behavior changes, such as a poor night's sleep
- Use tools like the Geriatric Depression Scale (GDS) to detect changes in mood
- Use the BEHAVE-AD to assess magnitude of disturbance in patient and caregiver safety
Caregiver/Living Environment
- Assess caregiver burden using:
- Zarit Burden Interview (ZBI)
- Caregiver Role Strain Index (CRI)
- Identify caregiver stress and strain
Communicating with Patients
- Adapt communication style to accommodate patient's language skills
- Give patients adequate time to respond
- Use prompts and ask for permission to involve caregivers if necessary
PLST Intervention Model
- The Progressively Lowered Stress Threshold (PLST) model is supported by current clinical guidelines and guides nursing care during all stages of dementia and Alzheimer's disease.
- The model proposes environmental modifications to cope with progressive cognitive decline, and an escalation in anxiety, depression, or behaviors may indicate inadequate modifications.
Promoting Safety and Physiologic Integrity
- Emphasize adequate sleep, rest, nutrition, elimination, and pain control to promote safety and physiologic integrity.
- Discuss the risks and benefits of devices like medic alert systems and patient tracking or alert systems with patients and families.
- Avoid using physical and pharmacologic restraints, as they increase the risk of injury and death.
- The rate of accidents in individuals with Alzheimer's disease diagnosis increases dramatically.
Driving Safety
- Loss of driving ability can be a point of contention for patients and family members.
- Signs indicating unsafe driving include minor fender benders, getting lost, or ignoring traffic signals.
- Driver rehabilitation specialists can evaluate driving abilities and recommend terminating driving privileges.
Promoting Adaptive Functioning and Coping
- Communication strategies for individuals with Alzheimer's disease include:
- Establishing eye contact and introducing oneself
- Using calm, reassuring tone and simple vocabulary
- Asking one question at a time and providing sufficient response time
- Repeating questions, explanations, and instructions as required
- Behavioral strategies for caregivers include:
- Recognizing unmet needs behind behaviors like wandering and restlessness
- Preventing fatigue, using consistency and simple communication
- Providing comforting and meaningful activities, quiet time, and reducing stimulation.
PLST Intervention Model
- The Progressively Lowered Stress Threshold (PLST) model is supported by current clinical guidelines and guides nursing care during all stages of dementia and Alzheimer's disease.
- The model proposes environmental modifications to cope with progressive cognitive decline, and an escalation in anxiety, depression, or behaviors may indicate inadequate modifications.
Promoting Safety and Physiologic Integrity
- Emphasize adequate sleep, rest, nutrition, elimination, and pain control to promote safety and physiologic integrity.
- Discuss the risks and benefits of devices like medic alert systems and patient tracking or alert systems with patients and families.
- Avoid using physical and pharmacologic restraints, as they increase the risk of injury and death.
- The rate of accidents in individuals with Alzheimer's disease diagnosis increases dramatically.
Driving Safety
- Loss of driving ability can be a point of contention for patients and family members.
- Signs indicating unsafe driving include minor fender benders, getting lost, or ignoring traffic signals.
- Driver rehabilitation specialists can evaluate driving abilities and recommend terminating driving privileges.
Promoting Adaptive Functioning and Coping
- Communication strategies for individuals with Alzheimer's disease include:
- Establishing eye contact and introducing oneself
- Using calm, reassuring tone and simple vocabulary
- Asking one question at a time and providing sufficient response time
- Repeating questions, explanations, and instructions as required
- Behavioral strategies for caregivers include:
- Recognizing unmet needs behind behaviors like wandering and restlessness
- Preventing fatigue, using consistency and simple communication
- Providing comforting and meaningful activities, quiet time, and reducing stimulation.
Counselling Family Members
- Nurses play a crucial role in counselling family members dealing with ambivalence and guilt when deciding to transfer patients to a skilled nursing facility.
Transfer Trauma or Relocation Syndrome
- Transfer trauma or relocation syndrome is a phenomenon characterized by a worsening of symptoms due to the stress of moving to a new environment.
- To minimize transfer trauma, nurses should aim to retain as many aspects of the home environment and previous routine as possible.
Providing End-of-Life Care
- The primary focus of nursing care for patients in the final stage of Alzheimer's disease (AD) is to promote quality of life and minimize discomfort associated with physiologic decline and cognitive deficits.
- Palliative care for individuals with AD is challenging due to the patient's inability to communicate their needs.
Family Dynamics and Grief
- Unresolved relationship issues between family members and caregivers may lead to difficulties in treatment decisions and increase the risk of complicated grieving.
Evaluation and Outcomes
- Patient outcomes are evaluated based on the understanding that patients can only achieve short-term outcomes due to the progressive nature of the disease.
- The primary goal is to ensure that patients and families achieve optimal wellness for their specific stage of the disease.
Counselling Family Members
- Nurses play a crucial role in counselling family members dealing with ambivalence and guilt when deciding to transfer patients to a skilled nursing facility.
Transfer Trauma or Relocation Syndrome
- Transfer trauma or relocation syndrome is a phenomenon characterized by a worsening of symptoms due to the stress of moving to a new environment.
- To minimize transfer trauma, nurses should aim to retain as many aspects of the home environment and previous routine as possible.
Providing End-of-Life Care
- The primary focus of nursing care for patients in the final stage of Alzheimer's disease (AD) is to promote quality of life and minimize discomfort associated with physiologic decline and cognitive deficits.
- Palliative care for individuals with AD is challenging due to the patient's inability to communicate their needs.
Family Dynamics and Grief
- Unresolved relationship issues between family members and caregivers may lead to difficulties in treatment decisions and increase the risk of complicated grieving.
Evaluation and Outcomes
- Patient outcomes are evaluated based on the understanding that patients can only achieve short-term outcomes due to the progressive nature of the disease.
- The primary goal is to ensure that patients and families achieve optimal wellness for their specific stage of the disease.
Brain Regions and Symptoms of Damage
Limbic System (including Hippocampus)
- Loss of recent memories ( forgetfulness of recent events) before remote memories
- Fluctuating emotions and depression
- Difficulty learning new information
Frontal Lobe
- Problems with intentional movement (loss of motor control)
- Difficulty planning and organization
- Emotional lability (mood swings)
- Loss of walking, talking, and swallowing ability
Occipital Lobe
- Loss of reading comprehension
- Hallucinations (visual disturbances)
Parietal Lobe
- Difficulty recognizing places, people, and objects (agnosia)
- Hallucinations and seizures
- Unsteady movement (ataxia) and poor coordination
- Expressive aphasia (difficulty expressing thoughts in words)
- Agraphia (difficulty with writing)
Temporal Lobe
- Impaired memory (difficulty recalling past events)
- Difficulty learning new things and forming new memories
- Receptive aphasia (difficulty understanding spoken language)
Brain Regions and Symptoms of Damage
Limbic System (including Hippocampus)
- Loss of recent memories ( forgetfulness of recent events) before remote memories
- Fluctuating emotions and depression
- Difficulty learning new information
Frontal Lobe
- Problems with intentional movement (loss of motor control)
- Difficulty planning and organization
- Emotional lability (mood swings)
- Loss of walking, talking, and swallowing ability
Occipital Lobe
- Loss of reading comprehension
- Hallucinations (visual disturbances)
Parietal Lobe
- Difficulty recognizing places, people, and objects (agnosia)
- Hallucinations and seizures
- Unsteady movement (ataxia) and poor coordination
- Expressive aphasia (difficulty expressing thoughts in words)
- Agraphia (difficulty with writing)
Temporal Lobe
- Impaired memory (difficulty recalling past events)
- Difficulty learning new things and forming new memories
- Receptive aphasia (difficulty understanding spoken language)
Stage I: Mild Cognitive Impairment
- Reduced concentration and memory lapses noticeable by others
- Difficulty learning new information
- Problems functioning in work or social settings
- Frequently losing or misplacing important objects
- Difficulties with planning and organization
- Forgetting recent events or conversations
Interventions for Stage I
- Patient/caregiver education and training
- Environmental modifications to promote safety
- Encourage planning for advanced stages of the disease while patients are still able to participate in decision making
- Use of cuing devices such as to-do lists, calendars, and verbal reminders
Stage II: Moderate Alzheimer's Disease
- Inability to carry out activities of daily living (ADLs) such as preparing meals for oneself
- Loss of ability to live independently
- Difficulty recalling one's address or phone number
- Increased problems finding words and communicating clearly
Interventions for Stage II
- Behavioral interventions such as distraction and provision of meaningful activities
- Continued use of cuing devices and established routines
- Assistance with ADLs
- Administration of anti-AD medications such as acetylcholinesterase inhibitors and NMDA inhibitors
- Administration of SSRIs and/or anxiolytics to address mood-related symptoms of depression and anxiety
- Occupational, physical, and speech therapy
Stage I: Mild AD
- Cognitive activity kits to maintain familiar words and objects
- Deliberate establishment of daily routines
- Referral to community resources, support groups, and counseling services
- Nonpharmacologic therapies such as validation, reality orientation, and reminiscence therapy
- Counseling regarding possible retirement or withdrawal from challenging aspects of one's job
Stage II: Moderate AD
- Inability to carry out activities of daily living (ADLs) independently
- Behavioral interventions such as distraction, provision of meaningful activities, and continued use of cuing devices and established routines
- Assistance with ADLs
- Administration of anti-AD acetylcholinesterase
- Nonpharmacologic therapies such as validation therapy and reminiscence therapy
- Consultation with a dietitian or nutritionist
- Respite care for family members and caregivers
- May require around-the-clock care or transition to a skilled nursing facility
Stage III: Severe AD
- Gradual inability to perform any ADLs, including bathing and toileting
- Assistance with all ADLs
- Continuation of earlier behavioral and pharmacologic therapies
- Round-the-clock care and/or admittance to a skilled nursing facility
- Eventual urinary and fecal incontinence
- Inability to identify family members and caregivers
- Extreme confusion and lack of awareness of one's surroundings
- Gradual loss of remote memory and ability to speak
- Frequent repositioning
- Hand feeding and/or liquid nutrition as appropriate
- Respite care for family members and caregivers
- End of life care
Acetylcholinesterase Inhibitors
- Reduce acetylcholine breakdown, increasing its availability in the brain.
- Examples: donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon).
- Have a modest effect in slowing an individual's rate of cognitive decline in Alzheimer's disease (AD).
N-Methyl-D-aspartate (NMDA) Receptor Antagonists
- Limit the effects of glutamate, which can be toxic to neurons.
- Examples: memantine (Namenda).
- May also be used for vascular dementia and Parkinson-related dementia.
Combination Drug
- Namzaric: a combination of memantine and donepezil.
- Used only after patients have been stabilized on memantine and donepezil.
Patient Education and Monitoring
- Emphasize the importance of taking medication as directed.
- Teach about discontinuation and resulting decline in function.
- Provide patient and caregiver education regarding side effects of dizziness, headache, GI upset, and fatigue.
- Promote adequate fluid intake.
- Monitor patient's pulse rate.
- Use with caution in patients with respiratory conditions (e.g., asthma, COPD).
- Avoid the use of antipsychotics, beta adrenergic blockers, corticosteroids, and anticholinergic drugs due to their antagonistic or synergistic effects.
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Description
This quiz covers the diagnosis, symptoms, and pathophysiology of Alzheimer's disease, including its various stages and possible causes.
