ALZHEIMER’S DISEASE
 Alzheimer’s disease is an irreversible, progressive
brain disease that slowly destroys memory and
thinking skills, and eventually even the ability to carry
out the simplest tasks. In most people with
Alzheimer’s, symptoms first appear after age 60.
 Alzheimer’s disease is the most common cause of
dementia among older people. Dementia is the loss of
cognitive functioning—thinking, remembering, and
reasoning—to such an extent that it interferes with a
person’s daily life and activities. Estimates vary, but
experts suggest that as many as 5.1 million
Americans may have Alzheimer’s.
 Dementia involves progressive decline in two or more
of the following areas of cognition: memory, language,
calculation, visual-spatial perception, judgment,
abstraction, and behavior.
Causes
 The cause of AD is unknown but knowledge about the
hereditary links is growing.
 Patients with Down syndrome eventually develop DAT
if they live long enough. There is a higher-than-normal
concentration of aluminum in the brain of a person
with DAT, but the effect is unknown.
 A distinct protein, AZ 50, has been identified at
autopsy in the brains of DAT patients. This protein
has been isolated from neurons that were not yet
damaged, suggesting that its presence early in the
degenerative process might cause the neuronal
damage. The life expectancy of a DAT patient is
reduced 30% to 60%.
Characteristics/ Signs and Symptoms
The disease course is divided into four stages, with
progressive patterns of cognitive and functional impairments.
Pre-dementia
Stage 1 is characterized by recent memory loss, increased
irritability, impaired judgment, loss of interest in life, decline of
problem-solving ability, and reduction in abstract thinking.
Remote memory and neurological exam remain unchanged
from baseline.
Early
Stage 2 lasts 2 to 4 years and reveals a decline in the patient’s
ability to manage personal and business affairs, an inability to
remember shapes of objects, continued repetition of a
meaningless word or phrase (perseveration), wandering or
circular speech patterns (circumlocution dysphasia), wandering
at night, restlessness, depression, anxiety, and intensification
of cognitive and emotional changes of stage 1.
Moderate
Stage 3 is characterized by impaired ability to speak (aphasia),
inability to recognize familiar objects (agnosia), inability to use
objects properly (apraxia), inattention, distractibility, involuntary
emotional outbursts, urinary or fecal incontinence, lint-picking
motion, and chewing movements. Progression through stages
2 and 3 varies from 2 to 12 years.
Advanced
Stage 4, which lasts approximately 1 year, reveals a patient
with a masklike facial expression, no communication, apathy,
withdrawal, eventual immobility, assumed fetal position, no
appetite, and emaciation.
Diagnostic Examination
 Alzheimer’s disease is usually diagnosed clinically from
the patient history, collateral history from relatives, and
clinical observations, based on the presence of
characteristic neurological and neuropsychological
features and the absence of alternative conditions.
 Advanced medical imaging with computed tomography
(CT) or magnetic resonance imaging (MRI), and with
single photon emission computed tomography (SPECT)
or positron emission tomography (PET) can be used to
help exclude other cerebral pathology or subtypes of
dementia.Moreover, it may predict conversion from
prodromal stages (mild cognitive impairment) to
Alzheimer’s disease.
 Assessment of intellectual functioning including memory
testing can further characterize the state of the
disease.Medical organisations have created diagnostic
criteria to ease and standardize the diagnostic process
for practicing physicians. The diagnosis can be confirmed
with very high accuracy post-mortem when brain material
is available and can be examined histologically.
Primary Nursing Diagnosis
Self-care deficit related to impaired cognitive and motor
function
 Outcomes. Self-care: Activities of daily living—Bathing,
Hygiene, Eating, Toileting; Cognitive ability; Comfort
level; Role performance; Social interaction skills; Hope
 Interventions. Self-care assistance: Bathing and Hygiene;
Oral health management; Behavior management;
Body image enhancement; Emotional support; Mutual
goal setting; Exercise therapy; Discharge planning
PET scan of the brain of a person with AD showing a loss of
function in the temporal lobe
Other Nursing Diagnosis
Risk for Injury related to:
 Unable to recognize / identify hazards in the
environment.
 Disorientation, confusion, impaired decision making.
 Weakness, the muscles are not coordinated, the
presence of seizure activity.
Medical Management
There is no cure for Alzheimer’s disease; available treatments
offer relatively small symptomatic benefit but remain palliative
in nature.
The initial management of the patient begins with education of
the family and caregivers regarding the disease, the prognosis,
and changes in lifestyle that are necessary as the disease
progresses.
Basic collaborative principles include:
 Keep requests for the patient simple
 Avoid confrontation and requests that might lead to
frustration
 Remain calm and supportive if the patient becomes upset
 Maintain a consistent environment
 Provide frequent cues and reminders to reorient the
patient
  Adjust expectations for the patient as he or she declines
in capacity

Pharmacologic Treatment
 Generally, therapy is focused on symptoms with an
attempt to maintain cognition.
 Donepezil (cholinesterase inhibitor;  elevates
acetylcholine concentration in cerebral cortex  by slowing
degradation of  acetylcholine released by  intact
neurons)which improves cognitive symptoms; improves
cognitive function in the early stages of the disease
only; drug effects diminish as the disease progresses
 Antidepressants (selective serotonin reuptake  inhibitors;
increases activity  of serotonin in the brain) which treats
depression, anxiety, and irritability
 Other Tests: Supporting tests include computed
tomography (CT) scan; magnetic resonance imaging
(MRI); positron emission tomography (PET). During the
early stages of dementia, CT and MRI may be normal,
but in later stages, an MRI may show a decrease in the
size of the cerebral cortex or of the area of the brain
responsible for memory, particularly the hippocampus.
Genetic testing for the ApoE gene is available and the
presence of the gene is a risk factor for AD. Genetic tests
may be helpful in diagnosis, but further studies are
needed to confirm their reliability.

Nursing Intervention
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.