Alzheimer's Disease

Alzheimer's Disease

1. Diagnosis (Goodridge, et al. 2018)

   • Definitive diagnosis occur after death with direct examination of the brain
   • Clinical and neuropsychological testing in tertiary care clinics
   • Diagnosis (Alzate, 2018)
     • Doctor may construct memory and cognitive tests
     • standard medical tests, such as blood and urine tests, to identify other possible causes of the problem
     • Computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET), to rule out other possible causes for symptoms

2. Medication for Treatment/ Prevent Worsening of Disease (Schneider et al., 2014)

   • Cholinesterase Inhibitors (Skidmore-Roth, 2018)
     • donepezil (Aricept)
     • galantamine (Razadyne)
     • rivastigmine (Exelon)
   • NMDA Receptor Antagonist
     • memantine (Namenda)
   • Serotoninergic agents ( 5‐HT6 receptor antagonists)
   • Monoamine oxidase inhibitors (selegiline)
   • Anti amyloids: α‐secretase activators: Epigallocatechin gallate
   • Be mindful that there is no known cure

3. Possible Causes (Bird, 2008)

   • Age/Gender
     • highest risk is 65-85 years of age
     • Prevalences increase after 85 years old
     • More common in woman than men
   • Family history
     • genetics
     • Down's syndrome
   • Enviornmental
     • typically head injury
     • viruses
     • toxins
     • low education level
   • Lifestyle choices
     • high fat diet
     • obesity
     • type II diabetes
     • cardiovascular disease

4. Collaborative Care (Goodridge, et al. 2018)

   • slow the decline of cognition
   • maintain and maximize quality of life
   • support family caregivers

5. Pathophysiology (Goodridge, et al. 2018)

   • Progressive neurodegenerative disorder
   • Most common form of dementia
   • Characterized in the brain by neurofibrillary tangles in the neurons of the cerebral cortex and hippocampus
   • Also characterized by the deposition of amyloid within senile plaques and cerebral blood vessels.
   • (Weinstein, 2017)
     • Cerebrovascular insufficiency: Less blood flowing to the brain
     • Damaging protein inclusions: plaques and tangles of proteins are found in the brains of individuals suffering from Alzheimer’s disease
     • Oxidation: oxidation can lead to damage of the molecular structures in the brain
     • Inflammation: as people get older, chronic inflammation in the brain can result from damaged microglia and astrocytes

6. Stages and Symptoms (Dolores, Fernandes & Galan, 2019).

   • Mild Alzheimer's (early stage)
     • Problems coming up with the right words
     • Trouble remembering names
     • Challenges performing tasks
     • Forgetting material
     • Losing or misplacing things
     • Increasing trouble with planning or organizing
   • Moderate Alzheimer's (middle stage)
     • Feeling moody or withdrawn
     • Unable to recall own information
     • Confusion about where they are
     • Forgetfulness of events
     • Trouble controlling bladder and bowels
     • Changes in sleep patterns
     • Increased wandering
     • Personality and behavioural changes
   • Severe Alzheimer's (late stage) (Alzheimer's Association, 2019)
     • Need round-the-clock assistance with daily activities and cares
     • Lose awareness of surroundings
     • Have increasing difficulty communicating
     • Become vulnerable to infections, especially pneumonia

7. 2.

8. 1.

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10. 5.

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13. 7.

14. "persistent impairment of intellectual function with compromise in at least three of the following mental aspects: language, memory, visuospatial skills, executive function, personality and cognition" (Alzate, 2018).

15. Client Centred Care (Vespa, Gori, & Spazzafumo, 2002)

    • musical activities
      • listening
      • singing
      • dancing
      • playing instruments
    • re-motivation socialization activities
      • table games/activites
        • colouring
        • bingo
        • cards
    • occupational activities
      • cooking
      • gardening
      • painting
    • psychomotor activities
      • exercising
      • ROM activities
      • ball games

16. Prevention Strategies (Hsu & Marshall, 2017)

    • Have a large social network
    • Manage and/or treat hypertension
    • Exercise
    • Cognitive training (ie. ADLs, problem solving)
    • Mediterranean diet (High in fruits, vegetables, and fish. Low in dairy, meat, wine)
    • Omega-3 supplementation

17. Nursing Centred Care (Vera, 2018)

    • Chronic confusion
      • Utilize cognitive function testing
      • Avoid frustrating situations and overstimulation
      • Maintain consistant scheduling
      • Provide time for reminiscing
    • Wandering
      • Assess reasons for wandering
      • Maintain safe environment and structured routine
      • Install bed alarms
      • Avoid use of restraints
      • Assess patient needs (thirst, hunger, pain, discomfort, need for toileting )
    • Social Isolation
      • Identify support systems
      • Assess ability to participate in social activities
      • Provide diversional activities as appropriate for functional ability
      • Provide rest and sleep periods
      • Avoid situations that cause frustration, agitation, or sensory overload
      • Assess patients feelings, anxiety, depression, and feelings of powerlessness
    • Risk for injury
      • Assess patients surroundings for hazards
      • Assess degree of impaired ability of competence, emergence of impulsive behaviour, and a decrease in visual persception
      • Maintain adequate lighting and clear pathways
      • Don't leave patient unattended when in later stages of the disease
      • Non slip shoes and shoes without laces
      • Ensure patient is wearing hearing aid and glasses
      • Maintain quiet environment

18. 8.

19. Our View on Alzheimer's Disease

    • Make the most of it
    • Remember there is an entire family behind the patient whom is also suffering from this change
    • As the prevalence of the disease increases, this is a comorbidity that we will have to be familiar with in our nursing practice
    • Finding Joy in an Alzheimer's Reality- TedTalk
      • https://www.youtube.com/watch?v=SxZqoIbnVis
        • Promote the happiness these people feel
        • Do not focus on the facts, engage with what interests the patient
        • Remember they don't mean to ask questions repeatedly, be polite and compassionate.

20. 9.

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