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Alzheimer's Disease. Jerry Carley RN, MSN, MA, CNE Spring, 2009. Concept Map: Selected Topics in Neurological Nursing. PATHOPHYSIOLOGY Traumatic Brain Injury Spinal Cord Injury Specific Disease Entities :

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alzheimer s disease

Alzheimer's Disease

Jerry Carley RN, MSN, MA, CNE

Spring, 2009

Concept Map: Selected Topics in Neurological Nursing


Traumatic Brain Injury

Spinal Cord Injury

Specific Disease Entities:

Amyotropic Lateral Sclerosis

Multiple Sclerosis

Huntington’s Disease

Alzheimer’s Disease

Myasthenia Gravis

Guillian-Barre’ Syndrome


Parkinson’s Disease


Physical Assessment





ICP Monitoring

“Neuro Checks”

Lab Monitoring


--Decrease ICP

--Disease Specific Meds

Care Planning

Plan for client adl’s,

Monitoring, med admin.,

Patient education, more…based

On Nursing Process:


Nursing Interventions & Evaluation

Execute the care plan, evaluate for

Efficacy, revise as necessary

alzheimer s disease1
Alzheimer's Disease
  • Non - reversible dementiathat progressively develops through 3 stages over many years
  • Alzheimer's disease is the most common cause of dementia, or loss of intellectual function, among people aged 65 and older
  • Alzheimer's disease is NOT a normal part of aging
  • Memory loss
  • Impaired Judgment
  • Personality changes
  • Severe physical decline with cognitive changes
  • Neurons, which produce acetylcholine (neurotransmitter) break connections with other nerve cells and ultimately die
  • Two types of abnormal lesions clog the brains of individuals with Alzheimer's disease:
    • Beta-amyloidplaques—sticky clumps of protein fragments and cellular material that form outside and around neurons
    • Neurofibrillarytangles—insoluble twisted fibers composed largely of the protein that build up inside nerve cells
stage 1
Stage 1

First 1-3 years:

-Short-term memory loss

-Subtle personality changes

-Shorter attention span

-Mild cognitive deficits

-Difficulty with money, numbers and bills

-Difficulty with depth perception

stage 2
Stage 2

From 2 – 10 years:

-Obvious memory loss




-Irritability / Agitation

-Impaired motor skills, judgment

-Self-care deficits

stage 3
Stage 3

From 8 – 10 years:

-Severe impairment of all cognitive abilities


-B & B incontinence

-Inability to recognize family & friends

-Loss of speech

the 4 a s of alzheimer s
The 4 A’s of Alzheimer's


(inability to remember facts or events). Short-term memory is programmed in temporal lobe, while long-term memory is stored throughout extensive nerve cell networks in the temporal and parietal lobes. In Alzheimer's disease, short-term memory storage is damaged first

  • Aphasia
  • (inability to communicate effectively). The loss of ability to speak and write is called expressive aphasia. With receptive aphasia, an individual may be unable to understand spoken or written words. Sometimes an individual pretends to understand and even nods in agreement; this is to cover-up aphasia. Although individuals may not understand words and grammar, they may still understand non-verbal behavior, i.e. smiling
  • Apraxia
  • (inability) to do pre-programmed motor tasks, or to perform activities of daily living such as brushing teeth and dressing. Sophisticated motor skills that require extensive learning, such as job-related skills, are first functions that become impaired. More instinctive functions like chewing, swallowing and walking are lost in the last stages of the disease
  • Agnosia
  • (inability to correctly interpret signals from their five senses). May not recognize familiar people and objects. A common yet often unrecognized agnosia is the inability to appropriately perceive visceral, or internal, information such as a full bladder or chest pain.
  • Clinicians can now diagnose with up to 90 % accuracy. But it can only be confirmed by an autopsy, pathologists look for the disease's characteristic plaques and tangles in brain tissue
  • Clinicians diagnose "probable" Alzheimer's disease by medical history, lab tests, physical exam, brain scans and neuropsychological tests that gauge memory, attention, language skills and problem-solving abilities
  • Proper diagnosis of Alzheimer's disease is critical since there are dozens of other reversible causes for Sx’s
  • U.S. Food and Drug Administration (FDA) has so far approved four drugs for the treatment of mild to moderate Alzheimer's disease:

- Cognex®), introduced in 1993

- Donepezil hydrochloride (Aricept®), marketed since 1996

- Rivastigmine (Exelon®), available since the spring 2000

-Galantaminehydrobromide (RazadyneTM-formerly called Reminyl®) approved in Feb/01

  • These drugs inhibit the enzyme that breaks down the brain chemical acetylcholine, and thereby may help slow the worsening of symptoms
  • The FDA in October 2003 approved memantine HCI (NamendaTM) for the treatment of moderate to severe Alzheimer's disease, which can slow the decline in mental function
risk factors
Risk Factors
  • People with a family historyof Alzheimer's have a greater risk, implying that a genetic factor is involved. Some involve a mutation of the gene for the protein APP, found on chromosome 21
  • Adults who have had head injuriesare three times more likely to develop Alzheimer's disease
nursing care
Nursing Care
  • CONSISTENCY - Introduce change gradually
  • Use repetition
  • Therapeutic touch if able
  • Avoid overstimulation and clutter
  • Don’t argue / Don’t reinforce – Acknowledge feelings / Distract
  • Regular toileting
  • Reality orientation, memory training
  • Meds as needed
safety precautions
Safety Precautions
  • Identification (on back of gown, etc)
  • Alarm systems / Lock exit doors
  • Keep up to date Picture
  • Frequent supervision
  • No throw rugs
  • Fall Program
  • Etc