Alzheimer's Disease Overview Unit 5.2

Alzheimer's Disease

• Alzheimer's disease is a chronic, progressive neurodegenerative condition causing significant cognitive dysfunction.
• Typically, onset occurs between ages 45-65.
• Characterized by nerve tangles and plaques forming.
• Acetylcholine (Ach) transmission is disrupted, preventing nerve-to-nerve communication.

Symptoms

• Mild: Memory lapses, difficulty concentrating, misplacing objects, problems with planning and organization.
• Moderate: Irritability, mood swings, withdrawal, frustration, anger, personality/behavioral changes, confusion, wandering.
• Severe: Forgetting recent experiences/people, needing assistance with daily living activities (ADLs), inability to interact, walk, sit, or swallow, prone to infections.

Acetylcholinesterase Inhibitors (Donepezil)

• Action: Increases the amount of acetylcholine available at neuron receptors in the brain by inhibiting acetylcholinesterase.
• Use: FDA approved for mild, moderate, and severe Alzheimer's disease, improving cognition (attention and memory), behavior, and daily activity engagement.
• Side effects/Adverse Reactions: Gastrointestinal upset (nausea, diarrhea, vomiting, anorexia), headaches, dizziness/drowsiness, headache, dry mouth, orthostatic hypotension, bradycardia, syncope, seizures. Avoid dehydration with higher doses.

Contraindications & Interactions

• Contraindications: Hypotension, bradycardia
• Interactions: Nonsteroidal anti-inflammatory drugs (NSAIDs) increase GI upset, other drugs causing bradycardia or hypotension. Alcohol consumption decreases drug effectiveness.

Assessment

• Vital signs
• Note client's cognitive and physical abilities - conduct baseline dementia assessment.
• Medical/medication history.
• Family's coping mechanisms.

Nursing Interventions

• Maintain care consistency.
• Set realistic expectations with family.
• Monitor vital signs.
• Monitor for side effects/adverse reactions.
• Minimize potential safety concerns.
• Monitor functional improvement/decline.
• Use an interprofessional collaborative approach.

Teaching

• Explain medication use; it helps with symptoms but does not cure the disease.
• Provide information on safety measures.
• Share details about available support groups.
• Explain that medication can be taken with or without food, and suggest food options client enjoys.
• Recommend taking medication at bedtime.

Evaluation

• Assess for improvements in cognition and physical abilities.