 Presence of neurofibrillary tangles and

neuritic and senile plaques in the brain

(Diagnosis of Alzheimer’s Disease is via
autopsy before CT scans and MRI)
 It is characterized by disturbance in JAMCO
J – Judgment
A – Affect
M – Memory
C - Cognition
O – Orientation
• Has low ACETYLCHOLINE
 The course of the disease is 2 to 20 years
with Sundowner’s Syndrome(confusion and
orientation becomes noticeable in late
afternoon and night time; It is the anxiety of
dementia)
 Atrophy of the brain tissue characterized by
AMNESIA, AGNOSIA, APRAXIA, APHASIA AND
ANOMIA
 IRREVERSIBLE
 PET, EEG – no caffeine!

 CT scan and MRI – remove metals!

 AUTOPSY is the most reliable test!

 5A’s
Amnesia –recall (Anterograde Amnesia is seen
in Clients with Alzheimer’s Disease!)
Apraxia – perform (Receptive Aphasia is seen in
clients withAlzheimer’s Disease!)
Agnosia – recognize
Aphasia – talk
Anomia – name
• Forgetfulness, Confabulation and
Sundowner’s Syndrome
1. Forgetfulness – short term memory losses
2. Confusion – progressive memorydecline,
disorientation, depression and
confabulation)
3. Ambulatory Dementia – functional losses,
language problems, loss of reasoning,
depression and wandering behavior
4. End Stage – no recognition, very little
purposeful activities , immobile and does
not swallow and chew
 Disturbed thought process
 Acute or Chronic confusion
 Impaired verbal communication
 Risk for injury
 Disturbed sensory perception
 Impaired memory
 Situational low self-esteem
 Impaired social interaction
 Interrupted family processes
 Self-care deficit
 NOTE:

DO NOT PUSH TOO FAST OR PRESSURE

ELDERLY AS THIS WILL RESULT IN
COMBATIVE BEHAVIOR!
Temporal, Parietal and
Occipital regions of
Cerebral Cortex; and
Hippocampus
 “PLEASE CARE”

Provide basic human needs and sleep

Listen to what the person is NOT saying
Encourage periodic rest periods and sleep
Assist in ADL
Sing and dance, as necessary
Engage in reminiscing activities

Call person by name and always introduce yourself at the start

Actively involve client in activities and simple decision making
Redirect inappropriate behavior like anger
Exaggerate facial expression and gesture in communicating face-to-face
 PRIORITY: Safety!
Place bed in low position
Provide adequate lightning
• APPROACH: Consistency!
• THERAPY: Pet, Music, Reminiscence and Orient
to reality (Place clock and calendar to visible
areas)
• COMMUNICATION: Use simple words!
Assign consistent caregivers (Give detailed
instructions!)
Ask to participate in ADLs to increase self-esteem
 ANTI-DEMENTIA!

“ CARE ”

Cognex ( Tacrine)
Aricept ( Donepecil)
Reminyl (Galantamine)
Exelon (Rivastagmine)
NOTE: Aricept(Donepecil) is the drug of
choice for Alzheimer’s Disease because of
long half life and fewer side effects!
1. The nurse in the dementia unit cares for the
client diagnosed with dementia, Alzheimer
type. The client wanders in the halls at night
and talks about the past and family. Which
action, if taken by the nurse, is MOST
important?
A. Provide a bedtime snack.
B. Place the client's mattress on the floor.
C. Keep the client awake during daytime
hours.
D. Administer a bedtime sedative.
Rationale :
Correct Answer: B
prevents falls when confused
"MOST important" indicates discrimination is
required to answer the question.
(A is wrong) hunger is not a usual cause for
wandering; low blood sugar in a known insulin-
dependent diabetic may precipitate agitated or
otherwise bizarre behavior during the night
(C is wrong) keeping the client awake during the
day may increase the chance of sleep at night,
but may still awaken and wander into the hall
(D is wrong) giving sedatives may actually
precipitate a paradoxical reaction of agitation
2. During the evaluation of the quality of home
care for a client with Alzheimer’s disease,
the priority for the nurse is to reinforce
which statement by a family member?
A. At least 2 full meals a day is eaten
B. We go to a group discussion every week at
our community center
C.We have safety bars installed in the
bathroom and have 24 hour alarms on the
doors
D.The medication is not a problem to have it
taken 3 times a day
RATIONALE:
ANSWER C
Ensuring safety of the client with
increasing memory loss is a priority of home
care. Note all options are correct
statements. However, safety is most
important to reinforce.
3. Patient's with Alzheimer's Disease will most
likely exhibit the four A's namely: agnosia,
aphasia, amnesia, and apraxia.
In connection with this, the nurse plans to
include which of the following interventions
in the patients's plan of care?
A. Perform frequent memory testing
B. Provide new names for unrecognized
objects
C. Lessen stimulating activities that require
step-by-step instructions
D. Initiate motion with gentle guidance and
touch
RATIONALE:
ANSWER: D
Assistance or supervision that is as
unobtrusive (mahinhin) as possible protects
clients from injury while preserving their
dignity.
4. An 85 yr old man who is a resident in an
extended care facility is in the late stage of
ALzheimer's Disease. He tells his nurse the he
has a sore back muscle from all the construction
work he has been doing all day. Which response
by the nurse is most appropriate?
A. You know you don’t work in the construction
anymore
B. What type of motion did you do to precipitate
the soreness?
C. You are 85 yrs old and you’ve been here all
day. You don’t work in construction anymore.
D. Would you like me to rub your back for your?
RATIONALE:
ANSWER is D.
In LATE STAGE of AD, it is better to go
along with the clients reality rather than
confront h with logic and reasoning. Asking
close-ended, simple questions that relate to
his reality is non-threathening and calming .
5. When does Alzheimer's start?

A. Within 1 year of memory loss

B. About 5 years before memory loss
C. 20+ years before memory loss
D. Within 6 months of memory loss
RATIONALE:

Answer : C

Repeating yourself, getting lost, and showing

fuzzy thinking skills all show up after the
process of Alzheimer's has already begun in
the brain. The brain changes of
the disease may begin years or decades
before symptoms appear