Alzheimer's Disease Overview

• Alzheimer's disease is more common in older adults, especially those 65 years and older
• Alzheimer's can occur in younger individuals, but this is less common

Definition of Alzheimer's Disease

• Progressive, irreversible, degenerative neurologic disease
• Characterized by gradual cognitive function loss
• Also presents as disturbances in behavior and affect

Disease Statistics in the Elderly

• Data from the USA in 2019 shows that of Americans with Alzheimer's disease:
• 16% are aged 65-74
• 45% are aged 75-84
• 36% are aged 85 and older

Pathophysiology

• Pathological hallmarks include Beta-amyloid deposits outside of cells in neuritic plaques and also intracellular neurofibrillary tangles (PHFs)
• Accumulation of beta-amyloid and neurofibrillary tangles causes synaptic and neuronal loss
• Atrophy occurs in specific brain regions, usually beginning in the mesial temporal lobe

Pathological Features

• Reduction in brain size and targeted decrease in neurons, primarily in the hippocampus & basal forebrain
• Cholinergic neuron depletion in the hippocampus and frontal cortex
• Widespread cerebral cortex shrinkage & expansion of the ventricular system

Risk Factors

• Age
• Genetic factors
• Family history
• Down syndrome
• Cardiovascular health
• Head injuries
• Lifestyle factors
• Neurotransmitter imbalances

Stages of the Disease: Early Stage (Mild)

• A person may feel as if they have memory slips
• Common difficulties include:
• Coming up with the right word or name
• Recalling names
• Trouble performing assignments in social or work settings
• Overlooking recently read material
• Losing items

Stages of the Disease: Middle Stage (Moderate)

• Individual requires a more prominent level of care as the infection advances
• Indications are more articulated.
• Individual may confound words, get baffled or irate, and act in startling ways, such as denying to bathe
• Harm to nerve cells in the brain can make it troublesome to express considerations and perform errands
• Becomes distracted and loses individual history.
• Can be touchy or pulled back, particularly in socially or rationally challenging situations
• Incapable of recalling personal data, like phone number or the school they attended
• Experiences perplexity around where they are or what day it is
• Requires assistance choosing clothing for the season

Stages of the Disease: Late Stage (Severe)

• Alzheimer's side effects are serious
• People lose the capacity to react to their environment, to carry on a discussion, and to control development
• Communicating torment becomes difficult.
• Requires round-the-clock help with day by day individual care
• Loses mindfulness of later encounters, as well as of their surroundings
• Experiences changes in physical capacities, counting strolling, sitting and swallowing
• Has trouble communicating
• May end up helpless to diseases, particularly pneumonia

Signs and Symptoms: Mild Stage

• Memory loss
• Difficulty finding words
• Mild problem-solving, planning, or organization issues
• Confusion over time or location
• Difficulty with familiar tasks
• Misplacing items and tracing steps to locate them
• Mood or personality changes

Signs and Symptoms: Moderate Stage

• Progressive memory loss
• Confusion, disorientation, and difficulties with spatial awareness
• Increased communication challenges
• Behavioral changes
• Trouble with daily activities
• Needs support and supervision

Signs and Symptoms: Severe Stage

• Severe memory loss, failing to recognize familiar faces, places, or objects
• Significant communication impairment
• Complete reliance on others for everyday activities
• Loss of motor skills might lead to an increased risk of infections and medical problems
• May become bedridden and require round-the-clock care

Early Diagnosis

• Early and accurate diagnosis provides patients and families time to discuss care options while the patient can still participate in decision-making
• Early diagnosis provides the best chance to treat symptoms

Diagnosis

• Medical history and physical exam
• Lab tests

Brain Imaging Techniques

• Detects specific brain changes caused by Alzheimer's
• Magnetic Resonance Imaging (MRI)
  • Shows shrinkage of some brain regions associated with Alzheimer's
  • Rules out other conditions
• Computerized Tomography (CT)
• Special X-Ray, used to rule out tumors, strokes, and head injuries

Diagnosis Note

• It should be noted that Definitive diagnosis often requires examining brain tissue after death, as none of the methods offer a definitive diagnosis for Alzheimer's disease"

Assessment

• Complete history and physical examination is key
• History from family and caregivers is important, as patients may lack knowledge of their disease
• Characterize onset and early side effects to separate from other dementias
• Complete evaluation of useful capacities and essential exercises of daily living
• Total physical examination with neurological and mental status exams are required

Neurological Assessment

• Neurological exam is usually typical in Alzheimer's
• Mental status examination should survey concentration, consideration, memory, dialect, visuospatial working, praxis, and official functioning
• Follow-up visits should incorporate a full mental status examination to assess infection movement and neuropsychiatric indications
• Assess level of confusion and disorientation
• Assess visual acuity, difficulties, or loss, including cataracts, glaucoma, and remaining vision

Treatment

• The FDA has approved prescription medications for Alzheimer's management but there is currently no recognized cure
• The majority of FDA-approved medications function best for those with Alzheimer's in the early or intermediate stages

Medications for Mild to Moderate Alzheimer's Disease

• Cholinesterase inhibitors like donepezil, rivastigmine, and galantamine are given for mild to moderate symptoms
• These medications can reduce or regulate behavioral and cognitive problems

Medications for Moderate to Severe Alzheimer's Disease

• This prescription is provided to reduce symptoms, allowing some to continue with daily activities a little longer
• The drug memantine, an N-methyl-D-aspartate (NMDA) antagonist, may be recommended

Managing Behavioral Symptoms

• Address restlessness, melancholy, agitation, anxiety, hostility, insomnia, and wandering
• Researchers are figuring out why these symptoms happen
• Behavioral signs of Alzheimer's can be treated to help patients feel more comfortable and ease the burden on carers
• Medications should come only after non-pharmacological approaches are exhausted

Medicines Requiring Caution

• These are alternatives weighing the following:
• Every risk and adverse effect of the medication has been discussed with a physician
• Treatment with other, less risky non-drug approaches has not been effective
• Exercise caution when using antipsychotics, anticonvulsants, anti-anxiety medications, and sleep aids

Future Treatments

• Researchers are investigating both the symptoms and underlying causes
• Many novel potential therapies are being developed and tested in ongoing clinical trials
• Trials consist of pharmacological treatments, immunotherapy treatments, as well as cognitive training, food, and exercise

Nursing Management: Communication

• Communicate with patients in a way that does not stress them out
• Engage in conversations in a quiet and distraction-free area
• Maintain eye contact and direct interaction with the patient.
• Be patient and provide reassurance when the patient makes mistakes
• Use clear, direct, and simple questions requiring yes or no answers

Nursing Management: Care Plan

• Making a nursing care plan and daily routine will assist in reducing anxiety and restlessness
• Consider what times of day the patient functions best and when he gets distracted
• Plan should be flexible and suitable for the nurse and patient

Nursing Management: General Care

• Assign the same personnel to care for the patient
• Avoid room changes to prevent increased anxiety and confusion
• Provide physical and verbal reminders, such as touching the patient's forearm at mealtime
• Explain everything while providing care or treatments

Nursing Management: Self-Care

• Nurses should give time for self-care
• They should do this to avoid getting affected emotionally, as they become attached to patients and their families

Primary Prevention Measures

• Healthy Lifestyle Choices:
• Regular Physical Exercise: Has benefits for brain health, 20 minutes every day
• Balanced Diet: The Mediterranean or DASH diet has been associated with a reduced risk
• Heart-Healthy Habits: Maintain cardiovascular health, conditions like high blood pressure, high cholesterol, and diabetes are risk factors

Prevention Measures (Continued)

• Chronic Disease Management:
• Managing chronic conditions such as diabetes, high blood pressure, and high cholesterol is important for reducing the risk, these conditions can negatively impact cardiovascular health and increase the risk of cognitive decline

Secondary Prevention Measures

• Cognitive Stimulation:
• Lifelong Learning: Engaging in intellectually stimulating activities throughout life has been associated with a lower risk
• Mental Exercises: May have a positive impact on cognitive function, helps improve cognitive abilities and maintain mental sharpness

Prevention Measures (Continued)

• Social Engagement: Staying socially active and maintaining strong social connections have been linked to a reduced risk of cognitive decline
• Participating in social activities, joining clubs or groups, volunteering, attending community events, and maintaining relationships with family and friends provides cognitive stimulation, emotional support, and a sense of purpose

Tertiary Prevention Measures

• Medication and Treatment:
• Medications: FDA-approved medications are available to manage symptoms and slow the progression, medications include cholinesterase inhibitors
• Individualized Treatment Plans: Healthcare professionals will develop personalized treatment plans based on the individual's specific symptoms, needs, and health status

Prevention Measures (Continued)

• Supportive Care and Services:
• Caregiver Support: Providing support and resources for caregivers is crucial
• Emotional and Psychological Support:
• Counseling and Therapy: For individuals and their families may benefit to address challenges, this can help with coping strategies, problem-solving, and emotional well-being

Conclusion

• The quality of life will not remain the same without memory
• Everyone’s memory declines as they age
• Awareness of environmental factors can prevent the progression of Alzheimer's disease