1. HARSHITA
II nd YEAR
A.B.C.O.N
ALZHEIMER’S DISEASE

2. • Alzheimer is a disease that
attacks brain. It is most common
form of DEMENTIA.
• Dementia is a general term for a
decline in mental ability severe
enough to interfere with daily life.
• In Alzheimer's disease there is a
progressive loss of brain cells.
• Also known as AD.
ALZHEIMER

3. ALZHEIMER
BRAIN

4. ETIOLOGY
• The exact aeitopathogenesis is
not known
• The hypotheses include
cholinergic hypothesis (reduced
acetylcholine), amyloid
hypothesis, and tau hypoth

5. PATHOLOGY
• It consist principally of neuronal
loss ; principally in temporal
cortex but also in the frontal
cortex.
• Senile plaques and neurofibrially
tangles are regarded as hallmark
of AD though they may also be
present with normal again

6. PATHO -
PHYSIOLOGY
• Alzheimer's disease is characterized
by loss of neurons and synapses in
the cerebral cortex and certain sub
cortical regions.
• This loss results in gross atrophy of
the affected regions, including
degeneration in the temporal
lobe and parietal lobe, and parts of
the frontal cortex and cingulated
gyrus

7. LABORATORY
INVESTIGATION
• These are carried out to exclude a
treatable cause of dementia.
• Common investigation are blood
chemistry, a complete count, test
for syphilis, serum levels of
vitamin B12 and thyroid function.
• A CT scan of head is usually done
to exclude an intracranial
pathology.

8. CONTINUE
• A MRI may be necessary to detect
presence of white matter ischemic
lesions.

9. CAUSES
• Alzheimer's disease is caused by
parts of the brain wasting away
(atrophy), which damages the
structure of the brain and how it
works.
• It is not known exactly what
causes this process to begin, but
people with Alzheimer's
disease have been found to have
abnormal amounts of protein
(amyloid plaques) and fibers (tau
tangles) in the brain

11. CONTINUE
• These reduce the effectiveness
of healthy neurons (nerve cells
that carry messages to and from
the brain), gradually destroying
them.
• Over time, this damage spreads to
other areas of the brain, such as
the grey matter (responsible for
processing thoughts) and the
hippocampus (responsible for
memory).

12. SIGN AND
SYMPTOMS
• The symptoms of Alzheimer’s
disease progress slowly over
several years. However, the rate
at which they progress will differ
for each individual.
• No two cases of Alzheimer's
disease are ever the same
because different people react in
different ways to the condition.
However, generally, there are
three stages to the condition:-

13. CONTINUE
Mild Alzheimer's disease
Common symptoms of mild
Alzheimer's disease include:
• forgetfulness
• mood swings
• speech problems

14. CONTINUE
Moderate Alzheimer's disease
As Alzheimer's disease develops
into the moderate stage, it can
also cause:
• Disorientation
• Difficulty performing spatial tasks
(such as judging distances or
finding your way around)

15. CONTINUE
• Problems with eyesight which
could lead to poor vision, or in
some cases hallucinations (where
you hear or see things that are
not there)
• Delusions – believing things that
are untrue
• Obsessive or repetitive behaviour

16. CONTINUE
• A belief that you have done or
experienced something that never
happened
• Disturbed sleep
• Incontinence – where you
unintentionally pass urine (urinary
incontinence) or stools (faecal
or bowel incontinence

17. CONTINUE
Severe Alzheimer's disease
• Dysphagia (difficulty swallowing)
• Difficulty changing position or
moving from place to place
without assistance
• Weight loss or a loss of appetite
• Increased vulnerability to
infection

18. CONTINUE
• Complete loss of short-term and
long-term memory
• Someone with severe Alzheimer's
disease may seem very
disorientated and is likely to
experience hallucinations and
delusions.

19. CONTINUE
• The hallucinations and delusions
are often worse at night, and the
person with Alzheimer's disease
may start to become violent,
demanding, and suspicious of
those around them.

20. TREATMENT
Medication
Medications that may be prescribed
for Alzheimer’s disease include:
• Donepezil 5mg daily
• Galantamine 4mg twice a day
• Rivastigmine 1.5mg twice a day

21. CONTINUE
Side effects
Donepezil, galantamine and
rivastigmine (AChE inhibitors) can
cause side effects including:
• nausea (feeling sick)
• vomiting
• diarrhoea
• headache
• fatigue (extreme tiredness)
• insomnia

23. Nurse’s Role
• Promote independence and
autonomy
• Prevent complications
• Provide comfort
• Promote quality of life
• Education

24. Planning Care
• No cure available
• Goals of treatment
– Slow progression
– Manage manifestations
• Care giver experience needed
– Long-term care
– End-of-life care

25. Planning Care
• Challenging behaviors and psychiatric
symptoms develop in the AD patient
• Settings used to care for AD patients
– Individual’s home or family member’s
home
– Hospitals
– Long-term-care facilities (nursing
homes)
– Congregate living facilities
– Hospice settings

26. Pharmacological
Interventions
• Cholinesterase inhibitors
– Slow progression of symptoms
– Titrate dosages slowly
•Donepezil (Aricept)
•Rivastigmine (Exelon)
•Galantamine (Reminyl

27. CONTINUE
• Memantine (Namenda)
– N-methyl-d-aspartate (NMDA)
antagonist
• Alternative and complementary therapies
– Vitamin E: limited support, more study
needed
– Nonsteroidal anti-inflammatory
drugs/statins: patients taking these
have reduced development of AD
– Statins:are a class of drug used to
lower cholesterol levels by inhibiting
the enzyme HMG- CoA reductase.

28. Functional
Impairments
• Utilize therapeutic nonverbal
behaviors
• Avoid fatigue, nonroutine
activities, and alcohol
• Avoid a high-stimulus environment
• Prevent disability
• Treat other conditions that lead to
physical decline

29. CONTINUE
• Identify and respond rapidly to
acute changes in function
• Adapt care to accommodate
neuro motor changes secondary
to progression of dementia

30. Mood
Disorders
• Be alert for changes
– Appetite
– Disinterest
– Anhedonia
– Sleep abnormality
– Fatigue

31. Delusions and
Hallucinations
• Cause
– Delirium
– Interaction of dementia and
personality
– Separate mental disorder
coexisting with dementia
– Disinhibition of cortical
functions

32. Dependence in
ADLs
• Promote, preserve functional
independence
• Preventive plans of care

33. Inability to
Initiate Meaningful
Activities
• Results in apathy or agitation for
dementia sufferer
• Promote social involvements

34. Anxiety
• May be a primary disorder or a
symptom of depression
• May result from delusions,
hallucinations, or functional
impairment
• Plan interventions to reduce stress,
enhance feelings of trust and
safety
• Promote stability
• Provide diversion activities

35. Spatial
Disorientation
• Results in incorrect interpretation
of objects or directions
• Results in fear, anxiety,
suspicions, illusions, delusions,
and safety concerns
• Promote familiarity with
environment
• Use landmarks to provide “pop-
up” cues

36. Elopement
• means to run away, and to not
come back to the point of
origination
• A valid concern in individuals with
cognitive impairments
• Risk factors
• Alzheimer’s Association Safe
Return Program

37. Resistance to
Care
• Common in middle to late stages of
dementia
• Major reason for
institutionalization and use of
psychotropic medications and
restraints
• Management strategies
– Restore calm
– Time-out

38. Food Refusal
• Occurs in each of the progressive
stages of AD
• Causes
• Management interventions

39. Insomnia
• Insomnia noted months prior to
AD diagnosis
• Establish routines to promote
therapeutic sleep patterns
– Establish sleep hygiene
– Eliminate stimuli before bedtime

40. Apathy and
Agitation
• Associated with increasing
cognitive decline
• Escalation can result in violence
and combative behaviors
• Promote interest in the
environment

41. PharmacologicaL
Interventions
• Used to promote comfort
• Begin with lower dosages and
gradually increase
• Monitor side effects closely

42. Late Stage
Issues
• Institutionalization
• Do not resuscitate decisions
• Transfer to acute care facilities
• Feeding tubes
• Infections

43. PREVENTION
• Quitting smoking
• Avoid drinking large amounts of
alcohol
• Eating a healthy balanced diet
• Exercising for at least 150 m
• If you have Diabetes, make sure
you keep to the diet and take and
medicines