Alzheimer's disease

P. Vijayalakshmi Reddy
MSN

Definition
Alzheimers disease is a chronic,

progressive degenerative disorder of the brain characterized by profound global impairment of cognitive functions.

Epidmeology
Affect people at any age. But usually it involves people in middle and late life. Insidious onset with a generally progressive deteriorating course. Pre senile dementia Senile dementia in persons 65 yrs and above.

Pathophysiology


Reduced activity of choline acetyle transferase, the enzyme necessary for acetylecholine synthesis and a decrease in acetyle choline synthesis.

Betaprotein, a major component of the amyloid fibris, has also been located on chromosome 21 in elder patients with Downs syndrome and AD.

Cerebral atrophy and cellular degeneration are the changes noted at autopsy. The cellular degenerative changes include neuro fibrillary tangles and amyloidal plaque deposits found in the tempero parietal and anterior frontal regions.

Neurofibrillary tangles are composed of cytoskeletal elements, primarily phosphorylated tau protein.

Friendship_04_176x144.3gp

Signs and symptoms

Progressive impairment of short long term memory is a major feature of AD

Stage I: Early stage- 2-4 years



Forgetful Declining interest in environment, people and present affairs

Demonstrates vague unnecessary and hesitancy in initiating actions

Performs poorly at work.

Stage 2: Middle stage- 2-12 yrs

Progressive memory loss. Hesitates in response to questions; shows signs of aphasia Difficulty following simple instructions or doing calculations. Episodic bouts of irritability Evasive, anxious and physically active.
Contd

 

 

   

More active at night owing to sleepwakefulness cycle disturbances Wanders particularly in night Apraxic for many basic activities Loses important papers. Loses way home in a familiar surroundings or loses way in own home Contd

 

Forgets to pay bills; lets household chores slip and news papers pile-up; does not dispose of garbage; does not take medications Loses possessions and then claims that they were stolen Neglects personal hygiene Loses social graces

Stage 3: Final stage

 

    

Loses much weight unable to communicate verbally or writing Does not recognize family incontinent of urine and feces Predisposition for major seizures Finally loses ability to stand and walk Death

Diagnosis
    

An accurate history Neurological examination MSE CT,MRI, PET, EEG Other laboratory tests to rule out other conditions.

Treatment
No specific treatment . Tacrine hydrochloride (Cognex) acts to increase acetylcholine levels.


Slows mental deterioration.

Nursing management
Provide supervision Encourage to participate in ADLs as long as possible. Provide for nutritional needs. Provide the family and patient with specific information about the disease.

Make the patient and family aware of such resources. Encourage the family to seek legal advice Make referrals to social services and community resources Encourage the development of realistic short and long term planning.

 

Encourage to seek medical supervision Help the families understand caregiver stress and develop coping skills. Referral for counseling may be appropriate. Develop strategies to deal with specific problems of patient management. Help the family in decisions concerning institutionalization.

Thank you..