Alzheimer’s Disease

AD is a progressive, irreversible,

degenerative neurologic disease that
begins insidiously and is characterized
by gradual loss of cognitive function
and disturbances in behaviour and
affect.
It is marked by progressive
deterioration, which affects
both the memory and
reasoning capabilities of an
individual.
AD is the most common form
of dementia.
AD Alzheimer’s is a unique
condition that is not the result
of common aging and natural
senility.
 Types of AD:

1. Familial Alzheimer’s Disease:

 This is a form of Alzheimer's disease that is
known to be entirely inherited. In affected
families, members of at least two generations
have had Alzheimer's disease. FAD is
extremely rare, accounting for less than 1% of
all cases of Alzheimer's disease. It has a much
earlier onset (often in the 40s) and can be
clearly seen to run in families.
2. Early-onset Alzheimer's Disease:
 This is a rare form of Alzheimer's disease in which
people are diagnosed with the disease before age 65.
People with Down syndrome are particularly at risk
for a form of early onset Alzheimer's disease. Adults
with Down syndrome are often in their mid- to late
40s or early 50s when symptoms first appear. Early-
onset Alzheimer's appears to be linked with a genetic
defect on chromosome 14, to which late-onset
Alzheimer's is not linked. A condition called
“myoclonus” a form of muscle twitching and spasmc
is also more commonly seen in early-onset
Alzheimer's than in late-onset Alzheimer's.
3. Late-onset Alzheimer’s Disease:
 This is the most common form of
Alzheimer's disease, accounting for
about 90% of cases and usually
occurring after age 65. Late-onset
Alzheimer's disease strikes almost half
of all people over the age of 85 and may
or may not be hereditary. Late-onset
dementia is also called sporadic
Alzheimer's disease.
 Risk Factors:
1.Age
The greatest known risk factor for Alzheimer’s is
increasing age. Most individuals with the disease
are 65 or older. The likelihood of developing
Alzheimer’s doubles about every five years after
age 65. After age 85, the risk reaches nearly 50
percent.  
2. Family history
Another risk factor is family history. Research has
shown that those who have a parent, brother or
sister, or child with Alzheimer’s are more likely to
develop Alzheimer’s.
 The risk increases if more than one
family member has the illness. When
diseases tend to run in families, either
heredity (genetics) or environmental
factors or both may play a role.   
In some families, clusters of cases are
seen. A gene called Apolipoprotein E
(ApoE) appears to be a risk factor for
the late-onset form of Alzheimer’s.
There are three forms of this gene: ApoE2,
ApoE3 and ApoE4. While inheritance of
ApoE4 increases the risk of developing the
disease, ApoE2 substantially protects
against it. Some current research is focused
on the association between these two forms
of ApoE and Alzheimer's disease. Several
other genes also appear to influence the
development of Alzheimer’s disease.
 Potential Contributing Factors:
Cardiovascular disease: 

Risk factors associated with heart disease and

stroke, such as high blood pressure and high

cholesterol, may also increase one's risk of developing

Alzheimer's disease. High blood pressure may damage

blood vessels in the brain, disrupting regions that are

Head injury
 There appears to be a strong link
between serious head injury and
future risk of Alzheimer’s.
Cerebral hypoxia
After recovery from hypoxia (brought
on by such conditions as carbon
monoxide poisoning or acute
respiratory failure), the patient may
experience total amnesia for the event,
along with sensory disturbances, such
as numbness and tingling.
Head trauma
Depending on the trauma’s severity, amnesia may last
for minutes, hours, or longer. Usually, the patient
experiences brief retrograde and longer anterograde
amnesia as well as persistent amnesia about the
traumatic event. Severe head trauma can cause
permanent amnesia or difficulty retaining recent
memories. Related findings may include altered
respirations and LOC; headache; dizziness; confusion;
visual disturbances, such as blurred or double vision;
and motor and sensory disturbances, such as
hemiparesis and paresthesia, on the side of the body
opposite the injury.
Herpes simplex encephalitis
Recovery from herpes simplex encephalitis
commonly leaves the patient with severe
and possibly permanent amnesia.
Associated findings include signs and
symptoms of meningeal irritation, such as
headache, fever, and altered LOC, along
with seizures and various motor and sensory
disturbances (such as paresis, numbness,
and tingling).
Hysteria
Hysterical amnesia, a
complete and long-lasting
memory loss, begins and
ends abruptly and is typically
accompanied by confusion.
Seizures
In temporal lobe seizures, amnesia occurs
suddenly and lasts for several seconds to
minutes. The patient may recall an aura or
nothing at all. An irritable focus on the left side
of the brain primarily causes amnesia for verbal
memories, whereas an irritable focus on the right
side of the brain causes graphic and nonverbal
amnesia. Associated signs and symptoms may
include decreased LOC during the seizure,
confusion, abnormal mouth movements, and
visual, olfactory, and auditory hallucinations.
Drugs
Anterograde amnesia can be
precipitated by general anesthetics,
especially fentanyl, halothane, and
isoflurane; barbiturates, most
commonly pentobarbital and
thiopental; and certain
benzodiazepines, especially triazolam.
Electroconvulsive Therapy
The sudden onset of retrograde or
anterograde amnesia occurs with
electroconvulsive therapy. Typically, the
amnesia lasts for several minutes to
several hours, but severe, prolonged
amnesia occurs with treatments given
frequently over a prolonged period.
Temporal lobe surgery
Usually performed on only one
lobe, this surgery causes brief,
slight amnesia. However,
removal of both lobes results in
permanent amnesia.
 Causes
No single factor has been identified as the cause of
Alzheimer's disease.
1.Genetics
Mutations in genes on chromosomes 1, 14 and 21.
2.Non-genetics factor
-Age
-Gender
-Race
-Head Injury
 Stages of Alzheimer’s
Pre-dementia- The most noticeable
deficit is memory loss, which shows up as
difficulty in remembering recently learned
facts and inability to acquire new information.
-Apathy can be observed at this stage, and
remains the most
persistent neuropsychiatric symptom
throughout the course of the disease.
Early Dementia
Difficulties with language, executive
functions, perception(agnosia), or execution of
movements (apraxia) are more prominent than
memory problems.
Older memories of the person's life (episodic
memory), facts learned (semantic memory),
and implicit memory (the memory of the body
on how to do things, such as using a fork to eat)
are affected to a lesser degree than new facts or
memories.
Moderate Dementia
Speech difficulties become evident
due to an inability to recall vocabulary,
which leads to frequent incorrect word
substitutions (paraphasias).
Reading and writing skills are also
progressively lost. Complex motor
sequences become less coordinated as
time passes.
During this phase, memory problems
worsen, and the person may fail to recognise
close relatives.
Long-term memory, which was previously
intact, becomes impaired.
Common manifestations
are wandering, irritability and labile affect,
leading to crying, outbursts of
unpremeditated aggression, or resistance to
care giving. Sundowning can also appear.
Advance Dementia
Language is reduced to simple phrases or
even single words, eventually leading to
complete loss of speech.
Muscle mass and mobility deteriorate to the
point where they are bedridden, and they
lose the ability to feed themselves.
Aggressiveness can still be present, extreme
apathy and exhaustion are much more
common results.
Four A’s of AD
1. Amnesia: inability to learn new information
or to recall previously learned information.
2. Agnosia: failure to recognize or identify
objects despite intact sensory function.
3. Aphasia: language disturbances that can
manifest in both understanding and
expressing the spoken word.
4. Apraxia: inability to carry out motor
activities despite intact motor function.
 Signs and Symptoms
Early symptoms
-Forgetfullness
-Loss of concentration
-Forgetting names
Progressing symptoms
-Memory Loss
-Language Deterioration
 -Disorientation
 -Forgetting how to do every tasks
-Impaired visual skills
-Confusion
 -Thinking difficulty
-Impaired spatial skills
- Poor judgement
 -Difficulty speaking
--Difficulty reading
Later symptoms:
-Indifferent attitude -Cognition disintegration
-Loss of speech
 - Apathy -Personality disintegration
-Difficulty swallowing
 -Anxiety -Suspicion
 -Drooling
 -Depression -Hostility
-Incontinence
 -Aggression
 -Inability to function
 -Wandering
 -Normal motor function
 
CHANGES IN PERSONALITY
The personalities of people with
dementia can change dramatically.
They may become extremely confused,
suspicious, fearful, or dependent on a
family member.What's normal aging?
People's personalities do change
somewhat with age.
LOSS OF INITIATIVE 
A person with Alzheimer's disease may
become very passive, sitting in front of the
TV for hours, sleeping more than usual, or
not wanting to do usual activities.
What's normal aging?
Sometimes feeling weary of work or social
obligations.
MISPLACING THINGS 
A person with Alzheimer's disease may
put things in unusual places: an iron
might go in the freezer or a wristwatch
in the sugar bowl.What's normal
aging?
Misplacing keys or a wallet temporarily.
CHANGES IN MOOD OR
BEHAVIOR 
Someone with Alzheimer's disease may
show rapid mood swings — from calm
to tears to anger — for no apparent
reason.What's normal aging?
Occasionally feeling sad or moody.
POOR OR DECREASED JUDGMENT
Those with Alzheimer's may dress
inappropriately, wearing several layers on a
warm day or little clothing in the cold. They
may show poor judgment about money, like
giving away large sums to
telemarketers.What's normal aging?
Making a questionable or debatable decision
from time to time.
PROBLEMS WITH ABSTRACT
THINKING 
Someone with Alzheimer's disease may
have unusual difficulty performing
complex mental tasks, like forgetting
what numbers are and how they should
be used.What's normal aging?
Finding it challenging to balance a
checkbook.
PROBLEMS WITH LANGUAGE 
People with Alzheimer's disease often forget
simple words or substitute unusual words,
making their speech or writing hard to
understand. They may be unable to find the
toothbrush, for example, and instead ask for
"that thing for my mouth."What's normal
aging?
Sometimes having trouble finding the right
word.
 Diagnostic Tests:
Brain CT Scan: (hydrocephalus, tumor, atrophy,
hematoma)
Brain MRI Scan
Vitamin b12 (b12 deficiency)
Electroencephalography (EEG)
Urinalysis ( excessive protein and sugar)
Neuropsychological tests
Memory Test
Cognitive Test
 Nursing Diagnosis
Ineffective family processes related to decline in
patient’s cognitive function
Deficient knowledge of family/care giver related
to care for patient as cognitive function declines
Impaired social interaction related to cognitive
decline
Deficient self-care, bathing/hygiene, feeding,
toileting related to cognitive decline
Activity intolerance related to imbalance in
activity/rest pattern.
 Nursing Management
Supporting cognitive function
-a calm, predictable environment helps people
with AD interpret their surroundings and
activities.
-a quiet, pleasant manner of speaking, clear and
simple explanations and use of memory aids
and cues help minimize confusion and
disorientation and give patients a sense of
security.
 -prominently displays clock and calendar s may
enhance orientation to time
-color coding the doorway may help patients who
have difficulty locating their room.
-active participation may help patients maintain
cognitive, functional, and social interaction abilities
for a longer period.
Promoting physical safety
-a safe home environment allows the patient to move
about as freely as possible and relieves the family of
constant worry about safety
-to prevent falls and injuries, all obvious hazards
should be remove (a hazard-free environment
allows the patient maximum independence and a
sense of autonomy)
-adequate lighting especially in halls, stairs and
bathrooms is necessary
-nightlights are helpful particularly if the patient
has increased confusion at night (sundowning)
-doors leading from the house must be secured
-outside the home, all activities must be
supervised to protect the patient.
Promoting independence in self-
care activities
-simplify daily activities by organizing them into short,
achievable steps so that the patient experiences a sense
of accomplishment

Reducing Anxiety and Agitation

-despite profound cognitive losses, patients are
sometimes aware of their diminishing abilities.
-patient needs constant emotional support that
reinforces a positive self-image
-the environment should be kept familiar and noise-
free
-excitement and confusion can be upsetting and may
precipitate a combative, agitated state known as
catastrophic reaction (overreaction to excessive
stimulation). The patient may respond to
screaming, crying, or becoming abusive (this may
be the person’s only way of expressing an inability to
cope with the environment. When this occurs, it is
important to remain calm and unhurried. Don’t
force the patient to proceed with the activity
because it will increases agitation. It is better to
postpone the activity until later, even to another day
because frequently the patient quickly forgets what
triggered the reaction.
Improving Communication
-to promote patient’s interpretation of
messages, the nurse should remain
unhurried and reduce noises and
distractions
-use of clear, easy-to-understand sentences
convey messages is essential because
patients frequently forget the meaning of
words or have difficulty organizing and
expressing thoughts
Providing Socialization and
Intimacy Needs
-socialization are comforting. Visits should be brief
and non-stressful; reducing visitors to one or two at
a time helps reduce overstimulation
-Hobbies and activities such as walking, exercising
and socializing can improve the quality of life
-care of plants or pet can also be satisfying and an
outlet of energy
-touching and holding are often meaningful simple
expressions of love
Promoting Adequate Nutrition
-Mealtime can be a pleasant social occasion or a time of
upset and distress and it should be kept simple and calm
without confrontations
-Patients prefer familiar foods that look appetizing and
taste good
-To avoid any playing with food, one dish is offered at a
time. Food is cut into small pieces to prevent choking.
Liquids may be easier to swallow if they are converted to
gelatine
-Hot food and beverages are served warm, and the
temperature of the foods should be checked to prevent
burns
Promoting Balanced Activity and Rest
-If sleep is interrupted or the patient cannot
fall asleep, music, warm milk, or a back rub
may help patient to relax
-During the day patients should be
encouraged to participate in exercise
because a regular pattern of activity and
rest enhances night time sleep.
-Long periods of daytime sleeping are
discouraged.
Useful Medications for Patients with AD
Cholinesterase Inhibitors:
Donepezil (Aricept)
Action: Reversibly inhibit acetycholineesterase in the CNS (cerebral
cortex), resulting to increased acetycholine levels bec. of slow
degradation. It does not alter underlying dementia but temporarily
improves cognitive function in patient with AD.
Side Effects:
-Nausea and vomiting
-Insomia
-Headache and dizziness
-Muscle cramps
-Fatigue
Nursing Considerations:
-Assess mental status: affect, mood behavioral changes,
depression.
-Monitor for possible adverse reaction:
CNS: insomia, depression, seizures, vertigo, abnormal
crying, aphasian, abnormal dreams
CV: chest pain, hypertension, hypotension
EENT: cataract, sore throat, blurred vision, eye
irritation
GI: GI bleeding, epigastric pain
SKIN: Pruritus, urticaria
MUSCULOSKELETAL: muscle cramps, toothache
Teaching:
-Explain that drug does not alter underlying degenerative
disease but can alleviate symptoms.
-Instruct patient/caregiver to monitor and report any signs of
adverse reactions
-Tell caregiver to give drug before bedtime
-Instruct to take the drug as prescribes, do not increase or
abruptly decrease dose, this may result to serious
consequences
Rivastigmine ( Exelon)
Action: Increased acethycoline level by inhibiting the
cholinesterase enzyme which causes acetylcholine
hydrolysis which may lead to some memory improvement.
Side Effects
-Nausea and vomiting
-Abdominal pain
-Loss of appetite
-Dizziness and headache
-Tremor
Nursing Considerations:
-Assess mental status: affect, mood behavioral changes,
depression.
-Assess cognitive function
Teaching:
- Instruct to take the drug as prescribes, do not increase or
abruptly decrease dose, this may result to serious
consequences
Galantamine (Reminyl)
Action: Unknown; may enhance cholinergic functioning
by increasing the level of acetylcholine in the brain.
Side Effects:
-Nausea and vomiting
-Abdominal pain and diarrhea
-Headache
-GI bleeding
Nursing Considerations:
-Monitor VS: watch out for bradycardia and hearblock
-Monitor for adverse reaction:
CNS: dizziness, tremor, depression, insomia, fatigue
 CV: Bradycardia
EENT: Rhinitis
GI: Nausea, vomiting, diarrhea, abd. pain
HEMATOLOGIC: anemia
METABOILC: Weight loss
Teaching:
-Advice patient/caregiver that drug should be taken with
meals
-Advice to monitor and report signs of adverse reaction
Memantine (Abixa)
Action: Antagonizes N-methyl-D-aspartate (NMDA)
receptors. Persistent activation of theses receptors seems
to increase Alzheimer’s symptoms.
Side Effects:
-Hallucination
-Confusion
-Dizziness
-Headache
-Tiredness
Nursing Considerations:
-Assess mental status: affect, mood behavioral changes,
depression.
-Monitor for possible adverse reaction:
CNS: Abnormal gait, aggressiveness, agitation,
confusion
 CVA: depression, hallucination, insomia, ischemic
attack
CV: edema, heart failure, hypertension
RESPIRATORY: cough, dyspnea, pneumonia
Teaching:
-Advice to monitor and report signs of adverse reaction

There’s no surgical procedure in AD