Alzheimer’s disease

1. Alzheimer’s disease

2. Description • Alzheimer’s disease is a chronic, progressive, degenerative disease that accounts for 60% of the dementias occurring in people older than 65 years. Alzheimer’s is manifested by loss of memory, judgment, and visuospatial perception and by a change in personality. Severe deterioration takes place and death occurs as a result of complications of immobility.

3. Pathophysiology • Structural Changes in the Brain • Marked atrophy of the cerebral cortex and loss of cortical neurons occur. The cerebral sulci and fissures, as well as the ventricles, are enlarged more than those of persons of the same age without Alzheimer’s. The areas that are particularly affected are the precentral gyrus of the frontal lobe, superior temporal gyrus, hippocampus, and substantianigra.

4. Pathophysiology • Chemical Changes in the Brain • Abnormalities in the neurotransmitters (acetylcholine, norepinephrine, dopamine, serotonin) may also occur in addition with the structural changes in the brain. • Acetyltransferase in the hippocampus is lost which interferes with cholinergic innervation to the cerebral cortex and this results in impaired cognition, recent memory, and the ability to acquire new memories.

5. Risk Factors • It is well established that age, gender (women more than men), and family history are the most important risk factors. • Genetics, chemical imbalances, environmental agents, and immunologic changes have also been proposed as theories for risk factors. • African Americans and Hispanics have a higher risk for the disease and it is not yet well known why that is.

6. Clinical Manifestations Clinical Manifestations of Alzheimer’s occur in cognitive changes, changes in behavior and personality, and changes in self-management skills. • Cognitive changes • Apraxia (inability to use objects correctly) • Aphasia (inability to speak or understand) • Anomia (inability to find words) • Agnosia (loss of sensory comprehension)

7. Clinical Manifestations • Behavior and Personality Changes • Aggressiveness, especially verbal and physical abusive tendencies • Rapid mood swings • Increased confusion at night or when the light is not adequate (sundowning) or in excessively fatigues patients • Wandering and getting lost • Paranoia, delusions, hallucinations, and depression may occur

8. Clinical Manifestations • Changes in self-management skills • Decreased interest in personal appearance • Selection of clothing that is inappropriate for the weather or event • Loss of bowel and bladder control • Decreased appetite or ability to eat

9. Diagnostic Tests • The CT scan typically shows cerebral atrophy and ventricular enlargement, wide sulci, and shrunken gyri in the later stages of Alzheimer’s • An MRI scan can also rule out other causes of neurologic disease • A PET and SPECT scan show a significant decrease in the metabolic activity in the brains of people with Alzheimer’s • An electroencephalogram (EEG) shows slow-wave delta activity

10. Pharmacotherapy • Cholinesterase Inhibitors are drugs approved to treat the symptoms of Alzheimer’s • (Aricept) donepezil • (Reminyl) galantamine • (Exelon) rivastigmine

11. Evidence-Based Treatment Modalities Alzheimer’s is an incurable disease but these are a few interventions for patients with Alzheimer’s • Cognitive stimulation to promote awareness and comprehension of surroundings by utilization of planned stimuli • Offer environmental stimulation through contact with varied personnel • Present change gradually • Allow for rest periods • Memory training • Stimulate memory by repeating patient’s last expressed thought • Reminisce about past experiences with the patient

12. Video This video is a brief explanation of what is going on in the brain with Alzheimer’s Disease https://www.youtube.com/watch?v=9Wv9jrk-gXc

13. References Ignatavicius, D. D., & Workman, M. L. (2010). Medical-Surgical Nursing: Patient-Centered Collaborative Care. St. Louis, Missouri: Elsevier.