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Similar to Alzheimer's disease is a progressive brain disorder that affects memory and cognitive function.
Alzheimer's disease is a progressive brain disorder that affects memory and cognitive function.
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- 3. Alzheimer’s disease isan irreversible, progressive brain disease that slowly destroys memory and disorders cognitive function
- 6. Although the riskof 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.
- 9. Pathophysiology and Etiology Grosspathophysiologic changes: cortical atrophy enlarged ventricles basal ganglia wasting
- 10. Microscopically: – Changes inthe 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
- 11. • Biochemically: neurotransmittersystems are impaired • Cause: unknown
- 20. 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
- 21. Lab diagnosis • completeblood 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
- 22. • 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
- 23. How is Alzheimer’sDisease 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
- 24. The 3 targetsfor 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
- 25. CHOLINESTERASE INHIBITORS • Rivastigmine •Galantamine • Donepezil
- 26. Nicotine is acholinergic 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
- 27. Donepezil (Aricept) • Widelyused 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
- 28. Galantamine • Given withfood 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
- 29. Rivastigmine • Given 1.5mg bid with meals and increased up to 6 to 12 mg per day
- 30. 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
- 31. • Patients withdepressive symptoms should be considered for antidepressant therapy • Behavioral disturbances may require pharmacologic treatment anxiolytics, antipsychotics, anticonvulsants
- 32. Nonpharmacologic treatments usedto improve cognition: • Environmental manipulation that decreases stimulation • Aromatherapy, Massage, Music therapy, Exercise
- 33. Drug Alert • Cholinesteraseinhibitors 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
- 34. Nursing assessment • Performcognitive assessment • Orientation, insight, abstract memory, verbal ability thinking, concentration, • 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
- 35. Nursing diagnoses • Self-caredeficit • Constipation • Disabled family coping • Disturbed thought • Imbalanced nutrition: Less than body requirements Impaired verbal communication
- 36. • Ineffective coping •Interrupted family processes • Risk for infection • Risk for injury
- 37. Intervention s • Establish aneffective 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
- 38. • Use asoft 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
- 39. Interventio n • Administer orderedmedications 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
- 40. • Encourage thepatient 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
- 41. • Give thepatient 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
- 42. Complication • Aspiration • Pneumoniaand other infections • Falls • Fractures • Bedsores • Malnutrition or dehydration
- 43. Preventio n It is nota 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
- 44. Heart-healthy lifestyle choicesthat 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