Alzheimer's disease
- 1. Presented by: Ms. Elizabeth M.Sc (N) Asst. Professor, Dept of MSN NNC, GNSU.
- 3. Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and disorders cognitive function
- 7. Although the risk of developing AD increases with age – in most people with AD, symptoms first appear after age 60 (5% incidence) AD is not a part of normal aging.
- 10. Pathophysiology and Etiology Gross pathophysiologic changes: ✓ cortical atrophy ✓ enlarged ventricles ✓ basal ganglia wasting
- 11. Microscopically: – Changes in the proteins of the nerve cells of the cerebral cortex – accumulation of neurofibrillary tangles and neuritic plaques (deposits of protein and altered cell structures on the interneuronal junctions) granulovascular degeneration – loss of cholinergic nerve cells (important in memory, function, cognition
- 12. • Biochemically: neurotransmitter systems are impaired • Cause: unknown
- 21. Diagnosis • Medical history, history from relatives, and behavioural observations. • Neurological Examination and MSE • CT, MRI, SPECT, PET can be used to help exclude other cerebral pathology
- 22. Lab diagnosis • complete blood count, sedimentation rate, chemistry panel, thyroid-stimulating hormone, test for syphilis, urinalysis, serum B12, folate level, and test for HIV • to rule out infectious or metabolic disorders
- 23. • cerebrospinal fluid (CSF) - tau protein and beta-amyloid Genetic testing In families with a history of Alzheimer's disease, test to confirm AD or to provide information to at-risk family members regarding their likelihood for development of AD
- 24. How is Alzheimer’s Disease managed at present? • Ideally, management should involve an interdisciplinary approach for assessment, treatment & education • The roles of nutritionists, caregivers, nurses, social workers and patients associations can be vital for the long term care • Pharmacological treatment – Cholinesterase inhibitors – Memantine
- 25. The 3 targets for Pharmacotherapy • Cognitive decline: memory, language, orientation, concentration, etc. • Behavioral abnormalities: delusions, aggressiveness, anxiety, depression, psychosis etc.. • Activities of Daily Living: dressing, bathing, feeding, use of household appliances, etc
- 26. CHOLINESTERASE INHIBITORS • Rivastigmine • Galantamine • Donepezil
- 27. Nicotine is a cholinergic agonist that acts both postsynaptically and pre-synaptically to release acetylcholine Melatonin - This neurohormone prevents neuronal death caused by exposure to the amyloid beta protein
- 28. Donepezil (Aricept) • Widely used in mild to moderate cases because it can be given once daily and is well tolerated • Starting at 5 mg hs and increased to 10 mg after 4 to 6 weeks
- 29. Galantamine • Given with food in dosage of 4 to 12 mg bid Should be restarted at 4 mg bid if interrupted for several days • Dose should be reduced in cases of renal or hepatic impairment
- 30. Rivastigmine • Given 1.5 mg bid with meals and increased up to 6 to 12 mg per day
- 31. Memantine • NMDA-receptor antagonist • The first of a new class approved for moderate to severe Alzheimer's • Dosage is 10 mg bid • Can be used with a cholinesterase inhibitor
- 32. • Patients with depressive symptoms should be considered for antidepressant therapy • Behavioral disturbances may require pharmacologic treatment anxiolytics, antipsychotics, anticonvulsants
- 33. Nonpharmacologic treatments used to improve cognition: • Environmental manipulation that decreases stimulation • Aromatherapy, Massage, Music therapy, Exercise
- 34. Drug Alert • Cholinesterase inhibitors initially aimed at improving memory and cognition seem to have an important impact on the behavioral changes that occur in patients with cognitive impairment • improves the apathy, disinhibition, pacing, and hallucinations commonly noted in dementia • Be alert for drug interactions with NSAIDs, succinylcholine-type muscle relaxants, cholinergic and anticholinergic agents, drugs that slow the heart, and other drugs
- 35. Nursing assessment • Perform cognitive assessment • Orientation, insight, abstract thinking, concentration, memory, verbal ability • Assess for changes in behavior and ability to perform adls • Evaluate nutrition and hydration • Check weight, skin turgor, meal habits • Assess motor ability, strength, muscle tone, flexibility
- 36. Nursing diagnoses • Self-care deficit • Constipation • Disabled family coping • Disturbed thought • Imbalanced nutrition: Less than body requirements Impaired verbal communication
- 37. • Ineffective coping • Interrupted family processes • Risk for infection • Risk for injury
- 38. Interventions • Establish an effective communication system with the patient and his family to help them adjust to the patient's altered cognitive abilities • Provide emotional support to the patient and his family • Encourage them to talk about their concerns • Listen carefully to them
- 39. • Use a soft tone and a slow, calm manner when speaking to him Because the patient may misperceive his environment • Allow the patient sufficient time to answer your questions his thought processes are slow, impairing his ability to communicate verbally
- 40. Intervention • Administer ordered medications to the patient and note their effects • If the patient has trouble swallowing, check with a pharmacist to see if tablets can be crushed or capsules can be opened and mixed with a semi- soft food • Protect the patient from injury • Provide a safe, structured environment • Provide rest periods between activities because these patients tire easily
- 41. • Encourage the patient to exercise to help maintain mobility • Encourage patient independence allow ample time for the patient to perform tasks • Encourage sufficient fluid intake and adequate nutrition Provide assistance with menu selection allow the patient to feed himself as much as he can • Provide a well-balanced diet with adequate fiber • Avoid stimulants, such as coffee, tea, cola, and chocolate
- 42. • Give the patient semisolid foods if he has dysphagia • Insert and care for a nasogastric tube or a gastrostomy tube for feeding as ordered • Because the patient may be disoriented or neuromuscular functioning may be impaired, take the patient to the bathroom at least every 2 hours • Assist the patient with hygiene and dressing as necessary • Many patients with Alzheimer's disease are incapable of performing these tasks
- 43. Complication • Aspiration • Pneumonia and other infections • Falls • Fractures • Bedsores • Malnutrition or dehydration
- 44. Prevention It is not a preventable condition. Lifestyle risk factors for Alzheimer's can be modified. Changes in diet, exercise and habits — steps to reduce the risk of cardiovascular disease — may also lower your risk of developing Alzheimer's disease
- 45. Heart-healthy lifestyle choices that may reduce the risk of Alzheimer's include the following: • Exercise regularly • Eat a diet of fresh produce, healthy oils and foods low in saturated fat • Follow treatment guidelines to manage high blood pressure, diabetes and high cholesterol • Quit smoking