1. Alzheimer’s disease

2. Description
Alzheimer’s disease is a chronic, progressive, degenerative disease that accounts for 60% of the dementias occurring in people older than 65 years. Alzheimer’s is manifested by loss of memory, judgment, and visuospatial perception and by a change in personality. Severe deterioration takes place and death occurs as a result of complications of immobility.

3. Pathophysiology Structural Changes in the Brain
Marked atrophy of the cerebral cortex and loss of cortical neurons occur. The cerebral sulci and fissures, as well as the ventricles, are enlarged more than those of persons of the same age without Alzheimer’s. The areas that are particularly affected are the precentral gyrus of the frontal lobe, superior temporal gyrus, hippocampus, and substantia nigra.

4. Pathophysiology Chemical Changes in the Brain
Abnormalities in the neurotransmitters (acetylcholine, norepinephrine, dopamine, serotonin) may also occur in addition with the structural changes in the brain.
Acetyltransferase in the hippocampus is lost which interferes with cholinergic innervation to the cerebral cortex and this results in impaired cognition, recent memory, and the ability to acquire new memories.

5. Risk Factors
It is well established that age, gender (women more than men), and family history are the most important risk factors.
Genetics, chemical imbalances, environmental agents, and immunologic changes have also been proposed as theories for risk factors.
African Americans and Hispanics have a higher risk for the disease and it is not yet well known why that is.

6. Clinical Manifestations
Clinical Manifestations of Alzheimer’s occur in cognitive changes, changes in behavior and personality, and changes in self-management skills.
Cognitive changes
Apraxia (inability to use objects correctly)
Aphasia (inability to speak or understand)
Anomia (inability to find words)
Agnosia (loss of sensory comprehension)

7. Clinical Manifestations
Behavior and Personality Changes
Aggressiveness, especially verbal and physical abusive tendencies
Rapid mood swings
Increased confusion at night or when the light is not adequate (sundowning) or in excessively fatigues patients
Wandering and getting lost
Paranoia, delusions, hallucinations, and depression may occur

8. Clinical Manifestations
Changes in self-management skills
Decreased interest in personal appearance
Selection of clothing that is inappropriate for the weather or event
Loss of bowel and bladder control
Decreased appetite or ability to eat

9. Diagnostic Tests
The CT scan typically shows cerebral atrophy and ventricular enlargement, wide sulci, and shrunken gyri in the later stages of Alzheimer’s
An MRI scan can also rule out other causes of neurologic disease
A PET and SPECT scan show a significant decrease in the metabolic activity in the brains of people with Alzheimer’s
An electroencephalogram (EEG) shows slow-wave delta activity

10. Pharmacotherapy
Cholinesterase Inhibitors are drugs approved to treat the symptoms of Alzheimer’s
(Aricept) donepezil
(Reminyl) galantamine
(Exelon) rivastigmine

11. Evidence-Based Treatment Modalities
Alzheimer’s is an incurable disease but these are a few interventions for patients with Alzheimer’s
Cognitive stimulation to promote awareness and comprehension of surroundings by utilization of planned stimuli
Offer environmental stimulation through contact with varied personnel
Present change gradually
Allow for rest periods
Memory training
Stimulate memory by repeating patient’s last expressed thought
Reminisce about past experiences with the patient

12. Video
This video is a brief explanation of what is going on in the brain with Alzheimer’s Disease

13. References
Ignatavicius, D. D., & Workman, M. L. (2010). Medical-Surgical Nursing: Patient-Centered Collaborative Care. St. Louis, Missouri: Elsevier.