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ALZHEIMER’S DISEASE

ALZHEIMER’S DISEASE. Rebecca Nielsen. What is Alzheimer’s Disease?. Organic brain disorder “Impairment of brain tissue function” Progressive and irreversible Gradual decline in memory and thinking Characterized by beta-amyloid plaques & neurofibrillary tangles Terminal disease

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ALZHEIMER’S DISEASE

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  1. ALZHEIMER’S DISEASE Rebecca Nielsen

  2. What is Alzheimer’s Disease? • Organic brain disorder • “Impairment of brain tissue function” • Progressive and irreversible • Gradual decline in memory and thinking • Characterized by beta-amyloid plaques & neurofibrillary tangles • Terminal disease • Named for German doctor, Alois Alzheimer • (Neeb, 2006, pg 243)

  3. What is Alzheimer’s Disease? • Currently no cure • Not a normal part of aging • Risk increases with age • Symptoms may overlap, vary, progress at different rates or some may not occur • No one diagnostic test can diagnose AD • Autopsy is the only method to confirm AD • Usually consists of cognitive & behavior challenges • Apathy is usually present from the start to the end • (http://www.helpguide.org/elder/alzheimers_disease_symptoms_stages.htm) • alz.mndak

  4. Alzheimer’s Disease Statistics • Most common cause of dementia in people ages 65 and older, 60-80% • Currently affects 5.2 million in the U.S. • Risk for AD doubles every 5 years over age 65 • 10 million babyboomers will develop AD • $148 billion/year for the cost of cares nationally • Every 71 seconds a new case develops • 6th leading cause of death • 1 in 8, age 65 and older (13%) has AD • (Retrieved from • http:www.alz.org./national/documents/report-alzfactsfigures2008.pdf)

  5. Coexisting Medical Conditions • Usually 1 or more other serious medical conditions • Percentage with AD & coexisting condition • Hypertension 60% • Coronary heart disease 30% • Congestive heart failure 28% • Osteoarthritis 26% • Diabetes 21% • Peripheral vascular disease 19% • Chronic obstructive pulmonary disease 17% • (Retrieved from • http:www.alz.org/national/documents/report-alzfactsfigures2008.pdf)

  6. Duration of AD • Possibility of lasting for 3-20 years, average is 8 years • Dependent upon a number of factors • Age of onset • Health of individual • Type of support available • Coexisting medical conditions • Early onset is ages 30-60 • Late onset occurs in people ages 65 & older • (http://www.alz.org/brain/13.asp)

  7. Characteristics of AD • Plaques & tangles are prime suspects • Beta-amyloid plaques form between nerve cells interfering with communication • Neurofibrillary tangles destroy each nerve cell from within • Decreased levels of acetylcholine interrupt communication between nerve cells • (http://www.alz.org/alzheimers_disease_4719.asp)

  8. Progression of Alzheimer’s • Nerve cells are damaged affecting memory, thinking & reasoning • AD causes nerve cell death and tissue loss throughout the brain affecting other functions • Brain tissue continues to shrink as nerve cells die • Cortex & hippocampus involved in thinking & creating new memories shrink significantly • Ventricles (fluid-filled spaces) increase in size • Significant loss of nerve cells & synapses • Brain mass is decreased • (http://www.alz.org/alzheimers_disease_4719.asp)

  9. Typical Signs & Symptoms of AD • General confusion, disorientation to date, time, place • Apathy, irritability, depression, anxiety • Problems with language, math, abstract thinking & judgment • Personality changes with strange quirks or inappropriate behaviors • Wandering, hiding objects, eating & sleeping problem • Paranoia, delusions & hallucinations • Total loss of self & inability to control bodily functions • (http://www.helpguide.org/elder/alzheimers_disease_symptoms_stages.htm)

  10. Mild or Early Stage Symptoms • Short term memory loss • Difficulty finding the right words • Decline in work performance • Observable behavioral changes • Concept of time is altered • Loss of familiarity with the known • Loss of interest • Movement slows down • (Biel, C 2008, November. Dementia Workshop)

  11. Moderate,Mid Stage Symptoms • Pronounced problems with language • Difficulty grasping directions • Disorientation & confusion • Increased memory loss • Loss of self-care skills • Incontinence • Severe personality changes • Paranoia , delusions & hallucinations • Seizures (new onset) • (Biel, C 2008, November. Dementia Workshop)

  12. Severe or Late Stage Symptoms • Inability to perform basic skills • Weight loss • Loss of ability to balance or walk • Increased loss of both short and long term memory • Frequently bedridden or inactive • Increased incontinence • Inability to care for self • Loss of affect & awareness • (Biel, C 2008, November. Dementia Workshop)

  13. Meds for Cognitive Symptoms • Cognitive medications may temporarily improve or stabilize memory & thinking skills • Cholinesterase inhibitors • Donepezil (Aricept) – all stages • Rivastigmine (Exelon) – mild to moderate stage • Galantamine (Razadyne) – mild to moderate stage • Memantine (Namenda) – moderate to severe stage • (http://www.alz.org/alzheimers_disease_standard_prescriptions.asp)

  14. Personality Changes • AD not only affects the mental abilities • Also affects ones’ emotions & personality • About 70-90% develop behavioral symptoms • Behaviors worsen as the day progresses (sundowning) • Different strategies can be implemented for managing behaviors • Prescribe meds only when behaviors becomes unmanageable • Symptoms are the most challenging to deal with • (http://www.nia.nih.gov/Alzheimers/Publications/speakerskit.htm)

  15. Meds for Behavioral Symptoms • Antidepressants for low mood & irritability • citalopram (Celexa), fluoxetine (Prozac), paroxeine • (Paxil), sertraline (Zoloft), trazodone (Desyrel) • Anxiolytics for anxiety, restlessness, resistance • lorazepam (Ativan), oxazepam (Serax) • Antipsychotics for hallucinations, delusions, agitation • olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), ziprasidone (Geodon) • Seizure medication/mood stabilizer for agitation • carbamazepine (Tegretol), divalproex (Depakote) • (http://www.alz.org/alzheimers_disease_standard_prescriptions.asp)

  16. Nutritional Interventions • Provide finger foods • Offer favorite foods • Use contrasting colors • Provide assistive devices • Stimulate swallowing reflex • Offer one food at a time • Provide a simple table setting, avoid patterns • Allow self-feeding as long as possible • Address feeding tube issues early • (Biel, C 2008, November. Dementia Workshop)

  17. Interventions for Wandering • Keep trigger items like hat, coat and keys out of sight • Clearly label rooms with signs or pictures • Redirect pacing or restless behavior into productive activities • Reassurance • Distraction • Reduce stimuli • Rule out hunger, thirst, elimination, pain needs • Avoid bright, busy colors in pictures or fabrics • (http://www.helpguide.org/elder/alzheimers_behavior_problems.htm)

  18. Interventions for Sleeplessness • Avoid alcohol, caffeine & nicotine • Treat pain symptoms • Maintain schedule for meals, waking up & bedtime • Encourage physical activity • Create a comfortable, familiar place for sleeping • Establish a bedtime routine of relaxing activities • Reduce noise & light • Use nightlight • Avoid upsetting activities near bedtime • (http://www.alz.org/alzheimers_disease_10429.asp)

  19. Diagnostic Tools for DX of AD • Medical history • Mental status evaluation • Physical exam • Neurological exam • Brain scans • Lab tests • Neuropsychological evaluation tests • Psychiatric evaluation • Experienced doctors can diagnose with 90% accuracy • (http://www.alzmndak.org/aboutmemoryloss/alzheimers/diagnosis/)

  20. Benefits of Early Diagnosis • Rule out other conditions • More time to develop strategies for coping with AD • Opportunity to plan for the future such as legal plans and include person in making decisions • Identify the actual cause of dementia to receive the proper care • More effective treatments by starting earlier • Allows scientists to learn about causes & development of disease (http://www.alz.org/living_with_alzheimers_5167.asp)

  21. Risk Factors for AD • Advancing age • Family history • Genetics • Previous head injury • Vascular factors • Environmental toxins • Stress, high levels of anxiety • Women • Fewer years of formal education • (http://www.helpguide.org/elder/alzheimers_diagnosis_risk_factors.htm)

  22. Prevention of AD • Protect the brain (avoid jarring) • Socialize with family & friends • Brain stimulating exercises • Maintain healthy diet • Physical activity • Healthy cardiovascular system • Manage disease & stress • More years of formal education • Lifelong learning • (http://www.helpguide.org/elder/alzheimers_prevention_slowing_down_treatment.htm)

  23. The Impact of AD on Caregivers • Significant physical & emotional strain on caregivers • AD caregivers’ tasks more time consuming than caregivers’ tasks of other diseases • Tremendous psychological & physical burden on families • Needs of caregivers change over time with the progression of AD • (http://www.nia.nih.gov/Alzheimers/Publications/speakerskit.htm)

  24. The Impact of AD on Society • A major health problem for the U.S. • individuals • families • health care system • society • With longevity an increase in number of people will develop age related diseases including Alzheimer’s Disease. • (http://www.nia.nih.gov/Alzheimers/Publications/speakerskit.htm) • Book New Discoveries, New Insights

  25. References alzheimer’s association. 2008 Alzheimer’s Disease Facts and Figures Report. Retrieved March 13, 2009 http:www.alz.org/national/documents/report-alzfactsfigures2008.pdf alzheimer’s association. (n.d.). Brain Tour. Retrieved March 13, 2009 from http://www.alz.org/alzheimers_disease_4719.asp alzheimer’s association. (n.d.). Standard Treatments. Retrieved March 13, 2009 from http://www.alz.org/alzheimers_disease_standard_prescriptions.asp alzheimer’s association. (n.d.). Talking About the Future. Retrieved April 11, 2009 from http:www.alz.org/living_with_alzheimers_5167.asp alzheimer’s association. (n.d.). Treatments for Sleep Changes. Retrieved March 13, 2009 from http:www.alz.org/alzheimers_disease_10429.asp Alzheimer’s Association MN-ND Chapter. (n.d.). Diagnosis. Retrieved April 11, 2007 from http://www.alzmndak.org/aboutmemoryloss/alzheimers/diagnosis/ Alzheimer’s Disease Education and Referral. (n.d.). Alzheimer’s Disease: Unraveling the Mystery. Retrieved October 31, 2008 from http://www.nia.nih.gov/Alzheimers/Publications/speakerskit.htm Biel, C. (2008, November). Providing “Dementia Friendly” Care in the General and Developmentally Delayed Communities [Workshop]. Sponsored by ARC Headwaters, Bemidji, MN. helpguide. (n.d.). Alzheimer’s Behavior Management. Retrieved January 28, 2009 from http://www.helpguide.org/elder/alzheimers_behavior_problems.htm helpguide. (n.d.). Alzheimer’s Disease: Signs, Symptoms & Stages. Retrieved January 28, 2009 from http://www.helpguide.org/elder/alzheimers_disease_symptoms_stages.htm helpguide. (n.d.). Alzheimer’s Diagnosis and Risk Factors. Retrieved January 28, 2009 from http://www.helpguide.org/elder/alzheimers_diagnosis_risk_factors.htm helpguide. (n.d.). Preventing & Treating Alzheimer’s. Retrieved January 28, 2009 http://www.helpguide.org/elder/alzheimers_prevention_slowing_down_treatment.htm Neeb, K. (2006). Fundamentals of Mental Health Nursing (3rd ed.). Philadelphia, PA: F.A. Davis.

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