FATHER SATURNINO URIOS UNIVERSITY

San Francisco St. Butuan City 8600, Region XIII

Caraga, Philippines
Nursing Program

Name: Alsong, Julie Joy; Ayson, Quennie Loth; Azarcon, Rogen Kate; Baldo, Roxanne
Andrea
Section: N – 41
Date: January 17, 2023
Title: Topic Reporting on Dementia with Nursing Care and Alzheimer’s Disease with
Nursing Care
Content:
DEMENTIA
DEFINITION
• Dementia is a term used to describe a large group of conditions affecting the brain which
cause a progressive decline in a person’s ability to function.
• Dementia is not a normal part of aging. Although it generally affects people over 65, people
as young as 30, 40 or 50 can have dementia.
• Approximately 15% of people with dementia have reversible illness if treatment is initiated
before irreversible damage takes place.

CAUSE
• Dementia is caused by damage to or loss of nerve cells and their connections in the brain.
Depending on the area of the brain that's damaged, dementia can affect people differently
and cause different symptoms.
• Dementias are often grouped by what they have in common, such as the protein or
proteins deposited in the brain or the part of the brain that's affected. Some diseases look
like dementias, such as those caused by a reaction to medications or vitamin deficiencies,
and they might improve with treatment.

RISK FACTORS
• Age - The risk rises as you age, especially after age 65. However, dementia isn't a normal
part of aging, and dementia can occur in younger people.
• Family history - having a family history of dementia puts you at greater risk of developing
the condition. However, many people with a family history never develop symptoms, and
many people without a family history do. There are tests to determine whether you have
certain genetic mutations.
• Down syndrome- By middle age, many people with Down syndrome develop early-onset
Alzheimer's disease.

SIGNS AND SYMPTOMS

1. Early Stage
• Becoming forgetful, especially of things that have just happened
• Some difficulty with communication (e.g difficulty in finding words)
• Becoming lost and confused in familiar places - may lose items by putting them in unusual
places and be unable to find them
• Losing track of time, including time of day, month, year.
• Difficulty in making decisions and handling personal finances
• Having difficulty carrying out familiar tasks at home or work, trouble driving or forgetting
how to use appliances in the kitchen.
• Mood and behavior:
• Less active and motivated, loses interest in activities and hobbies
• May show mood changes, including depression or anxiety
• May react unusually angrily or aggressively on occasion.
2. Middle Stage
• Becoming very forgetful, especially of recent events and people’s names.
• Having difficulty comprehending time, date, place and events.
• Increasing difficulty with communication.
• Need help with personal care (i.e. toileting, dressing).
• Unable to prepare food, cook, clean or shop.
• Unable to live alone safely without considerable support.
• Behaviour changes (e.g. wandering, repeated questioning, calling out, clinging, disturbed
sleeping, hallucinations).
• Inappropriate behaviour (e.g. disinhibition, aggression).

3. Late Stage
• Unaware of time and place.
• May Not Understand What's Happening Around Them.
• Unable to recognize relatives and friends.
• Unable To Eat Without Assistance.
• Increasing Need For Assisted Self-care.
• May Have Bladder And Bowel Incontinence.
• May be unable to walk or be confined to a wheelchair or bed.
• Behaviour Changes May Escalate And Include aggression towards carer (kicking, hitting,
screaming or moaning).
• Unable To Find Their Way Around In The Home.

DIAGNOSIS
• Cognitive and neurological tests. Used to evaluate thinking and physical functioning,
these tests include assessments of memory, problem solving, language skills, and math
skills, as well as balance, sensory response, and reflexes.
• Brain scans. These tests can identify strokes, tumors, and other problems that can cause
dementia. Scans also identify changes in the brain's structure and function.
a. Computed tomography (CT)
b. Magnetic resonance imaging (MRI)
c. Positron emission tomography (PET)
• Psychiatric evaluation. If someone is experiencing behavioral or mood changes, a
psychiatric evaluation may be recommended to help determine if depression or another
mental health condition is causing or contributing to a person's symptoms.
• Genetic tests. Some forms of dementia are caused by a person’s genes. In these rare
cases, a genetic test ordered by a doctor can help people know if they have the altered
genes.
• Cerebrospinal fluid (CSF) tests. Doctors collect CSF by performing a lumbar puncture,
also called a spinal tap. Measuring the levels of proteins or other substances in CSF may
be used to help diagnose Alzheimer's or other types of dementia.
• Blood tests. It is now possible for many doctors, dependent on state-specific availability
reflecting U.S. Food and Drug Administration guidelines, to order a blood test to measure
levels of beta-amyloid, a protein that accumulates abnormally in people with Alzheimer’s
or Dementia.

MEDICAL MANAGEMENT
The following are used to temporarily improve dementia symptoms.
• Cholinesterase inhibitors. These medications — including donepezil (Aricept),
rivastigmine (Exelon) and galantamine (Razadyne) — work by boosting levels of a
chemical messenger involved in memory and judgment. Although primarily used to treat
Alzheimer's disease, these medications might also be prescribed for other dementias,
including vascular dementia, Parkinson's disease dementia and Lewy body dementia.
Side effects can include nausea, vomiting and diarrhea. Other possible side effects include
slowed heart rate, fainting and sleep disturbances.
• Memantine. Memantine (Namenda) works by regulating the activity of glutamate, another
chemical messenger involved in brain functions, such as learning and memory. In some
cases, memantine is prescribed with a cholinesterase inhibitor. A common side effect of
memantine is dizziness.
 • Other medications. Your doctor might prescribe medications to treat other symptoms or
conditions, such as depression, sleep disturbances, hallucinations, parkinsonism or
agitation.

NURSING MANAGEMENT
• Orient client. Frequently orient client to reality and surroundings. Allow client to have
familiar objects around him or her; use other items, such as a clock, a calendar, and daily
schedules, to assist in maintaining reality orientation.
• Encourage caregivers about patient reorientation. Teach prospective caregivers how
to orient client to time, person, place, and circumstances, as required. These caregivers
will be responsible for client safety after discharge from the hospital.
• Enforce with positive feedback. Give positive feedback when thinking and behavior are
appropriate, or when client verbalizes that certain ideas expressed are not based in reality.
Positive feedback increases self-esteem and enhances desire to repeat appropriate
behavior.
• Explain simply. Use simple explanations and face-to-face interaction when
communicating with client. Do not shout message into client’s ear. Speaking slowly and in
a face-to-face position is most effective when communicating with an elderly individual
experiencing a hearing loss.
• Discourage suspiciousness of others. Express reasonable doubt if client relays
suspicious beliefs in response to delusional thinking. Discuss with the client the potential
personal negative effects of continued suspiciousness of others.
• Avoid cultivation of false ideas. Do not permit rumination of false ideas. When this
begins, talk to client about real people and real events.
• Observe client closely. Close observation of client’s behavior is indicated if delusional
thinking reveals an intention for violence. Client safety is a nursing priority.

ALZHEIMER’S DISEASE
DEFINITION
• Alzheimer’s Disease is a progressive brain disease that is the most prevalent type of
dementia, affecting 50 million individuals globally (WHO, 2017).
• Alzheimer’s disease involves parts of the brain that control thought, memory, and
language (CDC, 2023).
• It is characterized by the progressive loss of mental and physical function due to brain
degeneration. (Dubois et al., 2010).
• Currently, this type of disease has no cure and will always result in death (Alzheimer’s
Association, 2018).
• Over time, different areas of the brain shrink. The first areas usually affected are
responsible for memories.

CAUSES
• Alzheimer's disease is thought to be caused by the abnormal build-up of proteins in and
around brain cells.
• Amyloid Plaques Proteins deposits that form plaques around brain cells
• Neurofibrillary (Tau or Tangles) deposits which form tangles within brain cells
• These proteins are responsible for the loss of neurons and their connections.

SIGNS AND SYMPTOMS

Early-stage:
• Memory loss - defining characteristic of Alzheimer’s disease as the brain starts decaying
in regions associated with memory function.
• Forgetting recently learned information
• Forgetting important dates or events
• Asking the same questions over and over
• Increasingly needing to rely on memory aids
• Communicative difficulty - new problems in speaking or writing
• Confusion with time or place
• Challenges in planning or solving problems - may experience changes in their ability to
develop and follow a plan.
• Difficulty completing familiar tasks
• Misplacing things and losing the ability to retrace steps
• Poor judgment
 • Withdrawal from work or social activities - due to the inability to hold or follow a
conversation thus, they withdraw from hobbies, social activities, or other engagements.
• Changes in mood and personality - confused, suspicious, depressed, fearful, or anxious,
may be easily upset, especially when out of their comfort zone.

Middle-stage:
• increasing confusion and disorientation – for example, getting lost or wandering and not
knowing what time of day it is
• obsessive, repetitive, or impulsive behavior
• delusions (believing things that are untrue) or feeling paranoid and suspicious about
carers or family members
• problems with speech or language (aphasia)
• disturbed sleep
• changes in mood, such as frequent mood swings, depression, and feeling increasingly
anxious, frustrated, or agitated
• difficulty performing spatial tasks, such as judging distances
• seeing or hearing things that other people do not (hallucinations)

As it progresses, the symptoms become more severe.

Late-stage
• difficulty eating and swallowing (dysphagia)
• difficulty changing position or moving around without assistance
• weight loss – sometimes severe
• unintentional passing of urine (urinary incontinence) or stools (bowel incontinence)
• a gradual loss of speech
• significant problems with short- and long-term memory

RISK FACTORS
• Age. Your risk for Alzheimer's goes up as you get older. For most people, it starts going
up after age 65.
• Gender. Women get the disease more often than men.
• Family history. People who have a parent or sibling with Alzheimer’s are more likely to
get it themselves.
• Down Syndrome. It’s not clear why, but people with this disorder often get Alzheimer's
disease in their 30s and 40s.
• Head injury. Some studies have shown a link between Alzheimer's disease and a major
head injury.
• Other factors. High cholesterol levels and high blood pressure may also raise your
risk.

DIAGNOSIS AND LABORATORY TESTS

Healthcare providers use several methods to determine if a person with memory issues
has Alzheimer’s disease. This is because many other conditions, especially neurological
conditions, can cause dementia and other symptoms of Alzheimer’s. In the beginning steps of an
Alzheimer’s diagnosis, a provider will ask questions to better understand the health and daily
living about:

• Overall health.
• Current medications.
• Medical history.
• Ability to carry out daily activities.
• Changes in mood, behavior and personality.

A provider will also:

1. Perform a physical exam and a neurological exam.

2. Perform a mental status exam, which includes tests to assess memory, problem-solving,
attention, basic math and language.
3. Order standard medical tests, such as blood and urine tests, to rule out other possible
causes of the symptoms.
4. Order brain imaging tests, such as a brain CT, brain MRI or positron emission tomography,
to support an Alzheimer’s diagnosis or to rule out other possible conditions.
Mental status and neuropsychological testing
- Longer forms of neuropsychological testing may provide additional details about mental
function compared with people of a similar age and education level. These tests can help
establish a diagnosis and serve as a starting point to track the progression of symptoms
in the future.
- Imaging of disease processes can be performed with positron emission tomography
(PET). During a PET scan, a low-level radioactive tracer is injected into the blood to reveal
a particular feature in the brain. PET imaging may include the following:

• Fluorodeoxyglucose (FDG) PET scans show areas of the brain in which nutrients
are poorly metabolized. Identifying patterns of degeneration — areas of low
metabolism — can help distinguish between Alzheimer's disease and other types of
dementia.
• Amyloid PET imaging can measure the burden of amyloid deposits in the brain.
This imaging is primarily used in research but may be used if a person has unusual
or very early onset of dementia symptoms.
• Tau PET imaging, which measures the burden of neurofibrillary tangles in the brain,
is generally used in the research setting.
MEDICAL MANAGEMENT
There’s no cure for Alzheimer’s disease, but certain medications can temporarily slow the
worsening of dementia symptoms. There are a multitude of studies on the use of several drugs
to treat depression in dementia (Huang et al., 2020), including antidepressants, anxiolytics, and
anticholinergic medications. Some of these are either administered by themselves or in
combination with antidepressants. For example, anxiolytics and hypnotics were often used in lieu
of, or in addition to antidepressant therapy (Evers et al., 2002). Some studies have shown that
anticholinergic medications can also lessen depressive symptoms in dementia patients (Birks,
2006; Mowla, Mosavinasab, Haghshenas, & Borhani Haghighi, 2007).
Medications and other interventions can also help with behavioral symptoms. Beginning
treatment for Alzheimer's as early as possible could help maintain daily functioning for a while.
However, current medications won’t stop or reverse AD.
The U.S. Food and Drug Administration (FDA) has approved two types of drugs to treat the
symptoms of Alzheimer’s disease:

• Cholinesterase inhibitors.
• NMDA antagonists.

Cholinesterase inhibitors

These drugs work by blocking the action of acetylcholinesterase, the enzyme responsible
for destroying acetylcholine. Acetylcholine is one of the chemicals that help nerve cells
communicate. Researchers believe that reduced levels of acetylcholine cause some of the
symptoms of Alzheimer’s disease. These drugs can improve some memory problems and reduce
some behavioral symptoms of Alzheimer’s disease.
The following cholinesterase inhibitors can help treat the symptoms of mild to moderate
Alzheimer’s disease:

• Donepezil (Aricept®). This is also FDA-approved to treat moderate to severe AD.

• Rivastigmine (Exelon®).
• Galantamine (Razadyne®).

NMDA antagonists

(N-Methyl-D-Aspartate)-receptor subtype of glutamate receptor. It is used to slow the

neurotoxicity thought to be involved in Alzheimer disease and other neurodegenerative diseases.
Studies have shown that people with Alzheimer’s who take memantine perform better in common
activities of daily living such as eating, walking, toileting, bathing and dressing.
Memantine (Namenda®) is FDA-approved for treating moderate to severe Alzheimer’s disease.
It helps keep certain brain cells healthier.
No medication has been approved for the management of behavioral symptoms in Alzheimer’s
dementia. Certain medications may help in some people, including:
 • Antidepressants: These drugs can treat anxiety, restlessness, aggression and
depression.
• Anti-anxiety drugs: These medications can treat agitation.
• Anticonvulsant drugs: These medications can sometimes treat aggression.
• Antipsychotics (neuroleptics): These drugs can treat paranoia, hallucinations and
agitation.

NURSING MANAGEMENT

1. Establish an effective communication system with the patient and his family to help them
adjust to the patient’s altered cognitive abilities.
2. Provide emotional support to the patient and his family.
3. Administer ordered medications and note their effects. If the patient has trouble
swallowing, crush tablets and open capsules and mix them with a semi soft food.
4. Protect the patient from injury by providing a safe, structured environment.
5. Provide rest periods between activities because the patient tires easily.
6. Encourage the patient to exercise as ordered to help maintain mobility.
7. Encourage patient independence and allow ample time for him to perform tasks.
8. Encourage sufficient fluid intake and adequate nutrition.
9. Take the patient to the bathroom at least every 2 hours and make sure he knows the
location of the bathroom.
10. Assist the patient with hygiene and dressing as necessary.
11. Frequently check the the patient’s vital signs.
12. Monitor the patient’s fluid and food intake to detect imbalances.
13. Inspect the patient’s skin for evidence of trauma, such as bruises or skin breakdown.
14. Encourage the family to allow the patient as much independence as possible while
ensuring safety to the patient and others.
REFERENCES:

10 Early Signs and Symptoms of Alzheimer’s. (n.d.). Alzheimer’s Association.

https://www.alz.org/alzheimers-dementia/10_signs

Alzheimer’s Disease: Causes, Symptoms, Treatment & Stages. (n.d.). Cleveland Clinic.
https://my.clevelandclinic.org/health/diseases/9164-alzheimers-disease

Alzheimer’s disease - Diagnosis and treatment - Mayo Clinic. (2022, February 19).
https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/diagnosis-t
reatment/drc-20350453
Alzheimer’s Disease and Related Dementias. (2020, October 26). Centers for Disease Control
and Prevention.
https://www.cdc.gov/aging/aginginfo/alzheimers.htm#:~:text=Alzheimer's%20disease%2
0is%20the%20most,thought%2C%20memory%2C%20and%20language.

Belleza, M. (2021) Dementia Nursing Care Management. https://nurseslabs.com/dementia/

Cassoobhoy, A. (2020). Causes of Alzheimer’s Disease. WebMD.

https://www.webmd.com/alzheimers/guide/alzheimers-causes-risk-factors

Dementia. (2006, February 3). WebMD. https://www.webmd.com/alzheimers/types-dementia

Dementia - Diagnosis and treatment- Mayo Clinic. (2022, October 12)

https://www.mayoclinic.org/diseases-conditions/dementia/diagnosis-treatment/drc-2
0352019

Dementia - Symptoms and causes. (2022, October 12). Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-203
52013

Moustafa, A. (2020). Alzheimer’s Disease Understanding Biomarkers, Big Data, and Therapy.
Elsevier Inc. ISBN: 978-0-12-821334-6

Stages of Alzheimer’s. (n.d.). Alzheimer’s Disease and Dementia. https://www.alz.org/alzheimers-

dementia/stages

Symptoms - Alzheimer’s disease. (2021, July 5). NHS. https://www.nhs.uk/conditions/alzheimers-

disease/symptoms/
QUESTIONS
1. What is the disease characterized by the progressive loss of mental and physical
function due to brain degeneration?
a. Aging c. Alzheimer’s Disease
b. Depression d. Parkinson’s Disease

2. The risk of acquiring Alzheimer's disease increases when you reach age ___ and
older
a. 25 c. 65
b. 35 d. 75

3. What two types of proteins are thought to have a role in the development of
Alzheimer's?
a. Amyloid Plaques and Neurofibrillary
b. Amyloid Plaques and Neurofibromatosis
c. Atherosclerotic Plaque and Neurofibrillary
d. Keratin and Elastin

4. Which finding in a patient with Alzheimer’s disease best describes the term
agnosia?
a. The patient uses a fork to eat a bowl of soup.
b. The patient makes up a word to recall the name of an object.
c. The patient can’t recall their address.
d. The patient is unable to perform the movements needed to use their hair brush.

5. The following cholinesterase inhibitors can help treat the symptoms of mild to
moderate Alzheimer’s disease, EXCEPT:
a. Donepezil
b. Rivastigmine
c. Galantamine
d. Memantine

6. What is the most common cause of progressive dementia?

a. Early sign dementia
b. Alzheimer’s disease
c. Huntington's disease
d. Parkinson's disease

7. This is referred to motor impairments such as impaired ability to carry out motor
activities despite intact motor action
a. Apraxia
b. Aphasia
c. Bradykinesia
d. Agnosia

8. TRUE or FALSE: Dementia is an inherent aspect of aging.

9. The life expectancy of Alzheimer’s Disease (AD) after symptoms begin is about _ to
_ years
a. 10 to 12 years
b. 6 to 10 years
c. 8 to 10 years
d. 5 to 8 years

10. ___ is the greatest risk factor for dementia.

a. Alcoholism
b. Age
c. Hereditary
d. Sedentary Lifestyle