Alzheimers Disease Alzheimer's disease (AD) affects the mental abilities including memory, language, and cognition.

Progressively it leads todementiaand death. AD usually arises in late middle age or the elderly but there is a rarefamilial subtype that occurs earlier. Because AD is so well-known, other causes of dementiaormemory loss may beoverlooked. Other possible diagnoses include normalaging (if very mild symptoms), emotional problems, fatigue,depression, and certain medical conditions such as thyroid disease, brain tumors, multi-infarct disease, orHuntington's disease. In its early stages, a correct diagnosis of AD can also be overlooked itself and misdiagnosedas other conditions such asdepression,dementia, simpleforgetfulness,orsenility. Signs and Symptoms: Early symptoms ForgetfulnessLoss of concentration Forgetting names Progressing symptoms Memory loss Language deterioration Disorientation Forgetting how to do everyday tasksImpaired visual skills Confusion Thinking difficultyImpaired spatial skills Poor judgment Difficulty speakingDifficulty reading Later symptoms Indifferent attitudeCognition disintegrationLoss of speech ApathyPersonality disintegration Difficulty swallowing AnxietySuspicion Drooling DepressionHostility Incontinence AggressionInability to functionWandering Normal motor function(AD affects the brain but not the body) Diagnostic Tests: Urine tests Brain Scans: Blood tests Brain CT scan Neuropsychological testsBrain MRI scan Memory tests Brain PET scanCognitive tests Types of Alzheimers Disease: Familial Alzheimer's disease - an early-onset inherited genetic form. CURABLE TYPE:

Sporadic Alzheimer's disease RARE TYPE: Right parietal lobe syndrome related Alzheimer's disease AMNESIA TREATMENT Immediate attention to airway, breathing, and circulation Prompt treatment of suspected infections and trauma: CNS infections: Antibiotic and/or antiviral therapy Cases with Head trauma:Surgical intervention may be necessary to evacuate space-occupying traumatic lesions;concussions are treated symptomatically,patients should refrain from contact sports until symptoms resolvecontrol elevated intracranial pressure with head elevationmoderate hyperventilationmannitol administration and/or surgical drainage DELIRIUM TREATMENT Delirium is usually reversible with correction of the underlying causeDiscontinue possible contributing medications Treat infection if presentCorrect metabolic or electrolyte abnormalitiesPharmacologic therapyAntipsychotics (e.g., haloperidol) for hallucinations, delusions, or illusionsBenzodiazepines (e.g., lorazepam) for anxiety, agitation, insomnia, or alcohol withdrawalEnvironmental supports (e.g., calendars, direction signs) to help with orientationPsychosocial supportPhysical restraints paradoxically increase patient agitation; thus, other alternatives (e.g., safe environment, door alarms)should be used initially DEMENTIA TREATMENT Treat reversible causes (e.g., hypothyroidism, vitamin deficiency, cerebral vasculitis, neurosyphilis, HIV)Manage nonreversible etiologies, including genetic risks, health care planning, and help groups (e.g., Alzheimer'sAssociation) Nursing Considerations: APRAXIA During your assessment, be alert for signs and symptoms of increased intracranial pressure, such as headacheand vomiting. If you detect any, elevate the head of the bed 30 degrees and monitor the patient closely for altered pupilsize and reactivity, bradycardia, widened pulse pressure, and irregular respirations. Have emergency resuscitationequipment nearby, and be prepared to give mannitol I.V. to decrease cerebral edema.If the patient is experiencing seizures, stay with him and have another nurse notify the physician immediately.Avoid restraining the patient. Help him to a lying position, loosen tight clothing, and place a pillow or other soft objectbeneath his head. If the patientsteeth are clenched, dont force anything into his mouth. If his mouth is open, protect thetongue by placing a soft object, such as a washcloth, between his teeth. Turn the patients head to provide an openairway.Prepare the patient for diagnostic studies, which may include computed tomography and radionuclide brainscans. Because weakness, sensory deficits, confusion, and seizures may accompany apraxia, take measures to ensure thepatients safety. For example, assist him with gait apraxia in walking. AMNESIA Prepare the patient for diagnostic tests, such as computed tomography scan, magnetic resonance imaging,EEG, or cerebral angiography.Provide reality orientation for the patient with retrograde

amnesia, and encourage his family to help bysupplying familiar photos, objects, and music.If the patient has severe amnesia, consider basic needs, such as safety, elimination, and nutrition. If necessary,arrange for placement in an extended-care facility. CONFUSION Never leave a confused patient unattended, to prevent injury to himself and others. Take measures to ensure patient safety.Keep the patient calm and quiet, and plan uninterrupted rest periods.Correct the underlying cause of the patient's confusion. Patient Teaching: APRAXIA Explain the disorder to the patient.Encourage him to participate in his normal activities as tolerated. Help him overcome frustration arising from the inability to perform routine tasks by breaking each task downinto separate steps, demonstrating these steps, and having the patient repeat the actions you demonstrated as taught bythe physical and occupational therapists.Allow him sufficient time to perform each step.Avoid giving complex directions.Encourage family members to assist in the patients rehabilitation. AMNESIA Adjust your patient-teaching techniques for the patient with anterograde amnesia because he can't acquire newinformation.Include his family in teaching sessions. In addition, write down all instructionsparticularly medication dosagesand schedulesso the patient won't have to rely on his memory. CONFUSION To help the patient stay oriented, keep a large calendar and a clock visible, and make a list of his activities withspecific dates and times.Always reintroduce yourself to the patient each time you enter his room.If possible, explain to the patient and his family the cause of his confusion.. Prognosis: Poor. Progressive deterioration from 5-20 years. Prognosis for Alzheimer's Disease: AD is a progressive disease. The course of the disease varies from person toperson. Some people have the disease only for the last 5 years of life, while others may have it for as many as 20 years. The mostcommon cause of death in AD patients is infection.. Statistics: Deaths from Alzheimer's Disease: 53,852 deaths in USA 2001 (CDC); 44,536 annual deaths (NVSR Sep 2001) Cause of death rank: 8th leading cause of death in 1999 and 2000 (CDC) Estimated mortality rate: (from prevalence and deaths statistics) Deaths: 53,852 (USA annual deaths calculated from this data: 53,852 deaths in USA 2001 (CDC);44,536 annual deaths (NVSR Sep 2001)Incidence: 4,000,000 (USA prevalence calculated from this data: more than 4 million Americans (CDC);estimated 4 million people in the U.S (NHWIC)1.3% (ratio of deaths to prevalence).