Alzheimer's Disease: Causes, Symptoms, and Treatment - PDF

Here is the information extracted and converted into a structured markdown format: # ALZHEIMER'S DISEASE ## Degenerative Neurologic Disorders * The disorder causes progressive decline in neurologic function. * Family should be taught what to expect such as: * a. the usual areas of decl...

Here is the information extracted and converted into a structured markdown format: # ALZHEIMER'S DISEASE ## Degenerative Neurologic Disorders * The disorder causes progressive decline in neurologic function. * Family should be taught what to expect such as: * a. the usual areas of decline * b. how to provide care and support * c. how to manage stress and cope with the progressive nature of the disorder. ## Common Nursing Diagnoses * Altered thought process * Memory deficit * Visual-Perceptual Alteration * Impaired Physical Mobility * Incontinence * Self-care Deficit * Impaired Individual and family Coping **Major goal of care**: Help client achieve an optimal level of functioning in light of chronic neurologic deficit. ## Definition of Terms * **Dementia** refers to the loss of memory, reasoning, judgment, and language to such an extent that it interferes with daily life. * **Cognition** is the act or process of thinking, perceiving, and learning. The image also includes a drawing of an elderly woman and an elderly man with question marks above their heads to the right of this text. ## Cognitive Activities Destroyed by Dementia * Decision-making, judgment * Memory, thinking * Spatial orientation * Reasoning * Calculation * Personality and verbal communication * Behavior and personality ## Alzheimer's disease AD- progressive mental deterioration due to generalized degeneration of the brain. Two types: * a. Early onset-mutation of beta amyloid protein * b. Sporadic- most common, occurring in people over 65 years of age. results from genetic and environmental influences ## Etiology and Risk Factors * Cause is idiopathic **Risk Factors** * Genetics * Elevated homocysteine levels * Inflammation, stroke * Oxidative damage from free radicals ## Pathophysiology The image shows two cells. The cell on the left is labelled "Normal", and shows a neuron. The cell on the right is labelled "Alzheimer's", and shows neurofibrillary tangles, amyloid plaques, and a neuron. The image shows two more cells. The first cell on the left is labelled "Healthy Neuron." It shows dendrites, microtubules, and axons. The second cell on the left is labelled "Diseased Neuron." It shows disintegrating microtubules. The first brain on the right is labelled "Healthy Brain." It shows the cerebral cortex and hippocampus. The second brain on the right is labelled "Alzheimer's Disease." It shows severe cortical shrinkage, severely enlarged ventricles, and severe shrinkage of the hippocampus. ## Gross Brain Changes * Structural Changes The image shows a normal brain next to a brain with Alzheimer's. The brain with Alzheimer's has ventricles and loss of language and memory. * Neurotransmitter changes * Decreased Ach The image shows a spinal cord, nerve, axon terminals at neuromuscular junctions, motor neurons and muscle fibers. It is comparing a normal cell structure to an Alzheimer's cell structure, and the image shows the breakdown. ## Clinical Manifestations **Preclinical** AD begins in the hippocampus and leads to memory loss with time (10-20 years) **Mild** * Memory disturbance noticed by family members before client does * Poor judgment & problem solving skills. Confused where they are and begin to get lost easily. * Routine and daily tasks take longer * Become careless in work. **Moderate** * Language disturbance/circumlocution (repetitiveness) * Repeat words spoken by themselves (Palilalia) * Repeat words spoken by others (Echolalia) * Use words in the wrong context (Paraphasias) * Loss of ability to perform activities (apraxia) * Desire to take everything into the mouth (Hyperorality) * Delusions and psychosis * Wandering at night is common **Severe** * Client cannot recognize family or friends * Do not communicate * Frequent urinary and fecal incontinence * aspiration pneumonia is frequent * Limbs become ridged with flexor posturing(decortication) The photo shows what flexor posturing looks like ## Diagnostic Findings Diagnosis is confirmed with: * Presence of dementia involving 2 or more areas of cognition. * Thinking * Perceiving * learning * Insidious onset and steady progression * Loss of normal alertness PET scans use radioactive tracers to highlight amyloid protein plaques in the brain, which are a hallmark of Alzheimer's disease. ## Medical Management Maintain mental function * Acetylcholinesterase inhibitor- temporarily improves thinking abilities and less likely to demonstrate advance AD, such as wandering, agitation, and inappropriate behavior. * Alpha-tocopherol (vit. E) * Selegiline (MAO B inhibitor) * Delay the development of later stages of AD by combating the effects of oxygen free radicals. * Ginkgo biloba contains terpenes used to treat cerebral and peripheral vascular disease * Anxiolytics for anxiety and agitation * Neuroleptics for unusual or troubled behavior * Antidepressants for mood disorders **Note**: No specific drugs or dosages address the wide range of problems that clients with AD experience. ## Nursing Diagnosis Impaired memory related to loss of short term memory, inability to execute complex mental processes, or inability to concentrate on specific tasks. **Interventions:** * Reorient client by placing calendar and clock in obvious places. * Use repetition for ensuring maximal retention of information. * Allow clients to reminisce because long term memory is retained longer than short term memory. ## Nursing Diagnosis Risk for injury related to impaired judgment, forgetfulness, or motor impairments. **Interventions** * Inpatient setting: * Ensure client cannot leave the premises without being noticed. Wear ID, secure doors and windows. * Home setting: * Teach family members to eliminate safety hazards, such as electrical devices, toxic substances, loose rugs, inadequate lighting, and unlock doors. * Dangerous objects should be kept out of reach. Cooking should be supervised. * Driving skills should be supervised. ## Nursing Diagnosis Caregiver Role Strain related to grieving the loss of a family member to AD, a change in social role, and intense demands for time commitment and provision of care. **Interventions** allow them to discuss concerns about caring for the client: * Do they know about community resources? (AD and Related Disorders Asso.) * Do they have someone to call when they can no longer cope with caregiving? * Chore service workers * Adult day care * Respite care involves admission of client to an extensive care facility for a few days to few weeks to allow the caregiver time to recover from the demands of providing 24-hour care. * Nursing home care * May be the only option when the caregiver suffers burnout and becomes unable to provide adequate care. ## Image of Parents The image shows two panels; on the left, parents escort their child to school ("WHAT PARENTS DO"), and on the right, the child escorts their elderly parent to the old age home ("WHAT THEY GET"). Below is the phrase "They didn't Leave you when you were Kid" and "Don't Leave them when they're Old".