1. Alzheimer's Disease
Jerry Carley RN, MSN, MA, CNE

2. Concept Map: Selected Topics in Neurological Nursing
PATHOPHYSIOLOGY
Traumatic Brain Injury
Spinal Cord Injury
Specific Disease Entities:
Amyotropic Lateral Sclerosis
Multiple Sclerosis
Huntington’s Disease
Alzheimer’s Disease
Myasthenia Gravis
Guillian-Barre’ Syndrome
Meningitis
Parkinson’s Disease
ASSESSMENT
Physical Assessment
Inspection
Palpation
Percussion
Auscultation
ICP Monitoring
“Neuro Checks”
Lab Monitoring
PHARMACOLOGY
--Decrease ICP
--Disease Specific Meds
Care Planning
Plan for client adl’s,
Monitoring, med admin.,
Patient education, more…based
On Nursing Process:
A_D_O_P_I_E
Nursing Interventions & Evaluation
Execute the care plan, evaluate for
Efficacy, revise as necessary

3. Alzheimer's Disease
Non - reversible dementia that progressively develops through 3 stages over many years
Alzheimer's disease is the most common cause of dementia, or loss of intellectual function, among people aged 65 and older
Alzheimer's disease is NOT a normal part of aging

4. Alzheimer's Disease
Non - reversible dementia that progressively develops through 3 stages over many years
Alzheimer's disease is the most common cause of dementia, or loss of intellectual function, among people aged 65 and older
Alzheimer's disease is NOT a normal part of aging

5. Characteristics Memory loss Impaired Judgment Personality changes
Severe physical decline with cognitive changes

6. Pathophysiology
Neurons, which produce acetylcholine (neurotransmitter) break connections with other nerve cells and ultimately die
Two types of abnormal lesions clog the brains of individuals with Alzheimer's disease:
Beta-amyloid plaques—sticky clumps of protein fragments and cellular material that form outside and around neurons
Neurofibrillary tangles—insoluble twisted fibers composed largely of the protein that build up inside nerve cells

7. Pathophysiology
Neurons, which produce acetylcholine (neurotransmitter) break connections with other nerve cells and ultimately die
Two types of abnormal lesions clog the brains of individuals with Alzheimer's disease:
Beta-amyloid plaques—sticky clumps of protein fragments and cellular material that form outside and around neurons
Neurofibrillary tangles—insoluble twisted fibers composed largely of the protein that build up inside nerve cells

8. Stage 1 -Subtle personality changes -Shorter attention span
First 1-3 years:
-Short-term memory loss
-Subtle personality changes
-Shorter attention span
-Mild cognitive deficits
-Difficulty with money, numbers and bills
-Difficulty with depth perception

9. Stage 2 -Obvious memory loss -Wandering -Confabulation -“Sundowning”
From 2 – 10 years:
-Obvious memory loss
-Wandering
-Confabulation
-“Sundowning”
-Irritability / Agitation
-Impaired motor skills, judgment
-Self-care deficits

10. Stage 3 -Severe impairment of all cognitive abilities -Disoriented
From 8 – 10 years:
-Severe impairment of all cognitive abilities
-Disoriented
-B & B incontinence
-Inability to recognize family & friends
-Loss of speech

11. The 4 A’s of Alzheimer's Aphasia Apraxia Agnosia Amnesia
(inability to remember facts or events). Short-term memory is programmed in temporal lobe, while long-term memory is stored throughout extensive nerve cell networks in the temporal and parietal lobes. In Alzheimer's disease, short-term memory storage is damaged first
Aphasia
(inability to communicate effectively). The loss of ability to speak and write is called expressive aphasia. With receptive aphasia, an individual may be unable to understand spoken or written words. Sometimes an individual pretends to understand and even nods in agreement; this is to cover-up aphasia. Although individuals may not understand words and grammar, they may still understand non- verbal behavior, i.e. smiling
Apraxia
(inability) to do pre-programmed motor tasks, or to perform activities of daily living such as brushing teeth and dressing. Sophisticated motor skills that require extensive learning, such as job-related skills, are first functions that become impaired. More instinctive functions like chewing, swallowing and walking are lost in the last stages of the disease
Agnosia
(inability to correctly interpret signals from their five senses). May not recognize familiar people and objects. A common yet often unrecognized agnosia is the inability to appropriately perceive visceral, or internal, information such as a full bladder or chest pain.

12. Diagnosis
Clinicians can now diagnose with up to 90 % accuracy. But it can only be confirmed by an autopsy, pathologists look for the disease's characteristic plaques and tangles in brain tissue
Clinicians diagnose "probable" Alzheimer's disease by medical history, lab tests, physical exam, brain scans and neuropsychological tests that gauge memory, attention, language skills and problem-solving abilities
Proper diagnosis of Alzheimer's disease is critical since there are dozens of other reversible causes for Sx’s

13. Treatment
U.S. Food and Drug Administration (FDA) has so far approved four drugs for the treatment of mild to moderate Alzheimer's disease:
- Cognex®), introduced in 1993
- Donepezil hydrochloride (Aricept®), marketed since 1996
- Rivastigmine (Exelon®), available since the spring 2000
-Galantamine hydrobromide (RazadyneTM-formerly called Reminyl®) approved in Feb/01
These drugs inhibit the enzyme that breaks down the brain chemical acetylcholine, and thereby may help slow the worsening of symptoms
The FDA in October 2003 approved memantine HCI (NamendaTM) for the treatment of moderate to severe Alzheimer's disease, which can slow the decline in mental function

14. Risk Factors
People with a family history of Alzheimer's have a greater risk, implying that a genetic factor is involved. Some involve a mutation of the gene for the protein APP, found on chromosome 21
Adults who have had head injuries are three times more likely to develop Alzheimer's disease

15. Nursing Care CONSISTENCY - Introduce change gradually Use repetition
Therapeutic touch if able
Avoid overstimulation and clutter
Don’t argue / Don’t reinforce – Acknowledge feelings / Distract
Regular toileting
Reality orientation, memory training
Meds as needed

16. Safety Precautions Identification (on back of gown, etc)
Alarm systems / Lock exit doors
Keep up to date Picture
Frequent supervision
No throw rugs
Fall Program
Etc