All’s Gone Out the

Window

Levi Santana, R.N.

Bulacan State University
College of Nursing
 ALZHEIMER’S
DISEASE

Watching a loved one live

their lives with Alzheimer is
heart breaking
 Rendering
Proper Care

IT IS ONE OF THE HARDEST

JOBS IMAGINABLE
IT REQUIRES AN ABUNDANCE
OF EMOTIONAL AND
PHYSICAL ENERGY
ACCEPTNCE OF HELP AND
TAKING CARE OF YOURSELF IS
 What is Alzheimer’s
Disease
 Is a progressive, irreversible
brain disorder with no known
cause or cure
 It attacks and slowly erases the
minds of its victims
 Symptoms of the disease include
memory loss, confusion,
impaired judgment, personality
changes, disorientation, and loss
 ALWAYS FATAL

Most common form of

irreversible dementia
 EPIDEMIOLOGY
 Approximately 100,000 victims
die and 360,000 new cases of
Alzheimer's disease are
diagnosed each year
 In the U.S. alone, it is estimated
that by 2050, 14 million
Americans will have this disease.
 America is not all alone in this
malady.
 In every nation where life
expectancy has increased, so has
the incidence of Alzheimer's
disease
 Alzheimer's disease is becoming
tragically common
 It is estimated that by 2020, 30
million people will be affected by
this devastating disorder
worldwide and by 2050, the
 The disease usually begins after
age 60, and risk goes up with
age
 While younger people also may
get AD, it is much less common
 About 5 percent of men and
women ages 65 to 74 have AD,
and nearly half of those age 85
and older may have the disease
 AD is not a normal part of aging
 AD has a long history
 Although it was only in 1906 when the
disease has acquired a name.
 AD is named after Dr. Alois Alzheimer,
a German doctor.
 In 1906, Dr. Alzheimer noticed changes
in the brain tissue of a woman who had
died of an unusual mental illness.
 He found abnormal clumps (now called
amyloid plaques) and tangled bundles
of fibers (now called neurofibrillary
tangles).
 Scientists also have found
other brain changes in people
with AD.
 Nerve cells die in areas of the
brain that are vital to memory
and other mental abilities.
 There also are lower levels of
some of the chemicals in the
brain that carry messages back
and forth between nerve cells
 ETIOLOGY
 Scientists do not yet fully
understand what causes AD.
 There probably is not one
single cause, but several
factors that affect each
person differently.
 Age is the most important
known risk factor for AD.
 The number of people with
 RISK FACTORS
 Family history
– Scientists believe that genetics
may play a role in many AD cases.
– For example, familial AD, a rare
form of AD that usually occurs
between the ages of 30 and 60, is
inherited.
– The more common form of AD is
known as late-onset. It occurs later
in life, and no obvious inheritance
pattern is seen.
– However, several risk factor genes
may interact with each other to
cause the disease.
– The only risk factor gene identified
so far for late-onset AD, is a gene
that makes one form of a protein
called apolipoprotein E (apoE).
– Everyone has apoE, which helps
carry cholesterol in the blood.
– It is likely that other genes also
may increase the risk of AD or
 OTHER RISK FACTORS
 Education
 Diet
 Environment
 heart disease and stroke, such as
high blood pressure, high
cholesterol,
 low levels of the vitamin folate,
may predispose people to AD.
 Evidence for physical, mental, and
PATHOLOGY
 AMYLOID PLAQUES

 One of the hallmarks of Alzheimer's

disease is the accumulation of
amyloid plaques between nerve
cells (neurons) in the brain.
 Amyloid is a general term for
protein fragments that the body
produces normally.
 Beta-amyloid is a fragment of a
protein that is snipped from
another protein called amyloid
precursor protein (APP).
 In a healthy brain, these protein
NEUROFIBRILLARY
TANGLES
 Neurofibrillary tangles consist of
insoluble twisted fibers that are
found inside of the brain's cells.
 They primarily consist of a protein
called tau, which forms part of a
structure called a microtubule.
 The microtubule helps transport
nutrients and other important
substances from one part of the
nerve cell to another.
 In Alzheimer's disease, however,
the tau protein is abnormal and the
 How the Brain
and Nerve Cells
Change
During
Alzheimer's
Disease
 The ability to recognize faces and
to communicate is completely
lost in the final stages.
 Patients lose bowel and bladder
control, and eventually need
constant care.
 This stage of complete
dependency may last for years
before the patient dies.
 The average length of time from
diagnosis to death is 4 to 8
 There is an overall shrinkage of brain tissue as
Alzheimer's disease progresses.
 In addition, the ventricles, or chambers within
the brain that contain cerebrospinal fluid, are
noticeably enlarged.
 In the early stages of Alzheimer's disease,
short-term memory begins to decline when the
cells in the hippocampus, which is part of the
limbic system, degenerate.
 The ability to perform routine tasks also
declines. As Alzheimer's disease spreads
through the cerebral cortex (the outer layer of
the brain), judgment declines, emotional
outbursts may occur and language is impaired.
DIAGNOSIS OF
ALZHEIMER’S
DISEASE
 An early, accurate diagnosis of
AD helps patients and their
families plan for the future.
 It gives them time to discuss
care while the patient can still
take part in making decisions.
 Early diagnosis will also offer the
best chance to treat the
symptoms of the disease.
 Today, the only definite way to
diagnose AD is to find out whether
there are plaques and tangles in
brain tissue.
 To look at brain tissue, how-ever,
doctors must wait until they do an
autopsy, which is an examination of
the body done after a person dies.
 Therefore, doctors can only make a
diagnosis of "possible" or "probable"
AD while the person is still alive.
 TOOLS USED BY
PHYSICIANS
 questions about the person’s general
health, past medical problems, and
the history of any difficulties the
person has carrying out daily
activities,
 tests of memory, problem solving,
attention, counting, and language,
 medical tests—such as tests of blood,
urine, or spinal fluid, and
 brain scans.
DIFFERENTIAL
DIAGNOSIS
 Forexample, thyroid problems,
drug reactions, depression, brain
tumors, and blood vessel
disease in the brain can cause
AD-like symptoms.
 Some of these other conditions
can be treated successfully.
DIFFERENTIAL
DIAGNOSIS
 Mild cognitive impairment (MCI)
– different from both AD and normal
age-related memory change.
– People with MCI have ongoing
memory problems, but they do not
have other losses like confusion,
attention problems, and difficulty
with language.
– Study to learn whether early
diagnosis and treatment of MCI might
prevent or slow further memory loss,
including the development of AD.
TREATMENT OF
ALZHEIMER’S
DISEASE
 No treatment can stop AD.
 However, for some people in the early
and middle stages of the disease, the
drugs tacrine (Cognex), donepezil
(Aricept), rivastigmine (Exelon), or
galantamine (Reminyl) may help
prevent some symptoms from
becoming worse for a limited time.
 Another drug, memantine
(Namenda), has been approved for
treatment of moderate to severe AD.
 Also, some medicines may help
control behavioral symptoms of
AD such as sleeplessness,
agitation, wandering, anxiety,
and depression.
 Treating these symptoms often
makes patients more
comfortable and makes their
care easier for caregivers.
 Developing new treatments for
AD is an active area of research.
 Scientists are testing a number
of drugs to see if they prevent
AD, slow the disease, or help
reduce symptoms.
 ROLE OF ANTI-
INFLAMMATORY
 DRUGS
There is evidence that inflammation in
the brain may contribute to AD damage.
 Some scientists believe that drugs such
as nonsteroidal anti-inflammatory drugs
(NSAIDs) might help slow the
progression of AD.
 Although recent studies of two of these
drugs, rofecoxib (Vioxx) and naproxen
(Aleve), have shown that they did not
delay the progression of AD in people
who already have the disease.
 Now, scientists are studying the NSAIDs
celecoxib (Celebrex) and naproxen to
find out if they can slow the onset of the
disease.
 ROLE OF VITAMIN E
 Research has shown that
vitamin E slows the progress
of some consequences of AD
by about 7 months.
 Scientists now are studying
vitamin E to learn whether it
can prevent or delay AD in
patients with MCI.
 ROLE OF GINKGO
BILOBA
 Recent research suggests that
ginkgo biloba may be of some
help in treating AD symptoms.
 There is no evidence that ginkgo
will cure or prevent AD.
 Scientists now are trying to find
out whether ginkgo biloba can
delay or prevent dementia in
older people.
 ROLE OF HORMONE
REPLACEMENT
 THERAPY
Earlier studies had suggested that the
hormone replacement therapy that
millions of women take after menopause
may be protective against AD.
 However, the WOMEN Health Initiative
clinical trial found an increased risk of
AD in women taking hormones as
compared with those taking an inactive
pill.
 The trial used a commonly pre-scribed
pill combining estrogens and
progesterone.
 Further studies on estrogen alone and
other hormone preparations, such as the
estrogen patch, continue.
 STAGES OF
ALZHEIMER’S
DISEASE
 MILD STAGE
 Memory loss becomes more
noticeable
 Concentrating and paying
attention becomes harder,
leading to difficulties in
understanding written material,
doing calculations, or making
job-related decisions
 Misplacing or losing valuable
items
 Momentary disorientation in
 MODERATE
 Memory
STAGE
loss about recent events
and some details of personal lives
 Inappropriate use of words
 Difficulty in performing such
tasks as planning meals and
dressing
 Increased disorientation
 Agitation, anxiety, suspiciousness
 Confusion between day and night
 Sleep disturbances
 Wandering off and not knowing
how to return.
 SEVERE STAGE
 Memory loss nearly complete
 Severe disorientation and
confusion
 Speech declines to a few
intelligible words
 Loss of physical functions
like walking and sitting up
 Loss of bladder and bowel
control
 Ten Warning Signs
of Alzheimer’s
 1. Recent memory loss that
affects job skills
 2. Difficulty performing familiar
tasks
 3. Problems with language
 4. Disorientation of time and
place
 5. Poor or decreased judgment
 6. Problems with abstract
thinking
 7. Misplacing things
 ISSUES ON
CAREGIVING
ALZHEIMER’S
PATIENTS
 ISSUE NUMBER
1

CAREGIVING IS A HEAVY
BURDEN
 The roles that family caregivers must
accept can be overwhelming.
 In addition to meeting the physical needs
of the relative with Alzheimer's, such as
helping with personal hygiene and
dressing, preparing meals, and
housekeeping, it is important to ensure
that the person is stimulated by both
social and physical activity.
 The caregiver must also think to the
future, plan for increasing custodial and
medical care, and usually take over
fiduciary responsibilities.
 Faced with all these tasks, caregivers can
 ISSUE NUMBER
2

RESENTFULNESS OF
THE CAREGIVER
 Another danger for the overburdened
caregiver is becoming resentful to the
point of neglecting the care recipient's
needs or engaging in abusive behavior--
psychological or physical.
 The National Elder Abuse Incidence Study
reported that in one year, 1996, more
than 550,000 persons age 60 or older had
experienced some type of neglect or
abuse, 90% at the hands of a family
member.
 Elderly persons with advancing
Alzheimer's or other dementia are more
vulnerable than most because they cannot
understand what is happening to them,
defend themselves, or communicate their
THIRD ISSUE

CARE FOR THE

CAREGIVERS
THEMSELVES
 Available to help the caregiver meet
this need are numerous support
services, many offered by volunteers
through local chapters of the
Alzheimer's Association, church
groups, or other local service
organizations.
 Of all services, respite care is
probably the most important, for what
the caregiver needs most is time
away, whether for a few hours or a few
days.
 For those who can afford it, residential
 FOURTH ISSUE

Accepting the role of

caregiver to a person
with Alzheimer's, with
all its responsibilities
as well as distasteful
tasks, requires
commitment and a
capacity for caring.
CAPACITY FOR
CAREGIVING
 development of caring capacity
for the care recipient
 development of capacity for
self-care
 development of caring capacity
for others.
 Further, their care giving
experience at home prompted
some to become caregivers for
 FIFTH ISSUE

RACIAL AND CULTURAL

DIFFERENCES
 A qualitative study conducted by
Ana Ortiz et al among Latino and
Irish American caregivers of
demented elders in the Boston
area showed how "ties to
homelands and neighborhood
institutions act as mediators and
shapers of anticipatory grief,
caregiver burdens, and caregiver
resources, serving as a buffer
against exhaustion and despair
for some families (primarily the
Irish American sample) and as an
INTERACTION ISSUES
OF THE CAREGIVER
WITH THE PATIENT
 1. Arguments are useless and in fact,
make matters worse. Confusion
memory loss and frustration are
making the person behave irrationally
and you can't "argue" them out of it.
 2. Actions help when verbal
communication may fail. Help the
person by demonstrating what you
mean or sometimes by starting him or
her in the activity
 3. Assume that people with Alzheimers
may understand and hear what you
say even if they are confused. Do not
say things to others in front of them as
 5. Appropriate activities help people
with Alzheimer's pass the time
meaningfully and productively and
reduce agitation, boredom , daytime
sleeping and depression
 6. Agitation can be alleviated when the
caregiver remains calm, reassuring
and respectful of the person's feelings
 7. Adults with disabilities are still
adults. Mental level is not always
equal to social level.
 8. Adapt the task to fit the ability of
the patient. Break down the activity
into separate steps or simplify the
 COPING
MECHANISMS
 Family caregivers must learn how
to cope with their burden of care,
fears, depression, physical strain,
and psychological stress.
 They need support.
 True care giving families share
the burden, providing at least
respite care and temporary or
occasional help to the primary
caregiver.
 If family help is not available, it is
imperative that the caregiver
 OTHER ISSUES
 Care away from home
 Public awareness and
social/government response
 Impact on society
 How to face the end--decisions,
care, feelings
 Adult Day Services
 Retirement Housing
 Assisted Living
 Nursing Home
 Continuing Care Retirement
CREATIVE IDEAS IN
CARING FOR
ALZHEIMER’S
PATIENTS
 EARLY STAGE

Individuals in this stage are often

quite active, aware that they have
AD and struggling to remain
independent.
Gifts that enhance independence
or encourage activity are excellent
choices.
 Games - simple but familiar games, such as
dominoes, large numbered cards, or bingo have the
potential for quite a bit of enjoyment
 Tickets to a concert, musical, circus, or sporting event
can be a fun choice. Remember, though, that your
loved one may be overwhelmed by too much activity.
 Visit a shopping mall and "window shop," then have
lunch or ice cream together. Limit your trips to no more
than three hours.
 Frozen homemade meals can be reheated in a
microwave and are especially good for couples.
 Collage - frame a collage of old family photos
highlighting the major events in the person's life.
 Fruit basket or flowers - always a welcome gift.
 MODERATE
STAGE

Persons with moderate stage AD will

require more assistance, but still
remain active.
Wandering is frequently seen in the
group, so exercise is important.
Attention span varies; activities are
best limited to about 15 minutes
 Materials to sort - coins, a bag of buttons, or large
beads can be fun to sort. Men might enjoy sorting
keys, nuts and bolts, or cards better.
 Music, especially "old songs," often brings back
wonderful memories. Check with record stores for
remakes of older albums.
 A jewelry box with a variety of costume jewelry to
rummage through is ideal. Low-cost items can be
found at thrift shops and garage sales. Make
inexpensive copies of the person's good jewelry for
them to wear. If items are lost, the good jewerly will
remain safe with the family.
 Basket of yarn or fabric - for rummaging and
sorting. Be sure to include fabrics with different
textures to stimulate the sense of touch.
 Taped church services - mid-stage dementia
individuals may not attend church, but will enjoy the
 LATE STAGE

In the late stage of the disease, people with

dementia do not have the capacity to deal
with anything but the simplest of tasks.
At this stage, they are "living in the past"
and may believe that they are much
younger and living in the home or
community of their younger years.
Attention span and understanding are both
very poor.
 Memory books - a gathering of old pictures and
mementos from the person's past may allow them to think
about and enjoy intact memories.
 Animals - many people with late-stage dementia still
enjoy visits from dogs, cats, and other animals such as
guinea pigs and rabbits. Box turtles are also a big hit, as
well as bird watching. Be sure the larger animals are well-
trained to handle certain behaviors of the late stage
individual.
 Knee warmers - good for an inactive, wheelchair-bound
person with late stage AD. Circulation is often poor at this
stage, and the knee warmer or lap blanket helps conserve
heat and reduce symptoms associated with poor
circulation.
 Cuddle animals or dolls - many late stage dementia
patients enjoy having a soft cuddle object to bring back
 WHEN CARING FOR
ALZHEIMER’S PATIENT’S WHAT
IS IMPORTANT IS LOVE,
UNDERSTANDING AND
EMOTIONAL STRENGTH
THANK YOU