ALZHEIMER’S wan

ALZHEIMER’S
DISEASE
(2173)

Prepared by,
Puan Wan Napisah binti Wan Omar

Learning objectives

At the end of this session, students should be able
to:

1. Define Alzheimer’s Disease (AD)
2. Explain the pathophysiology
3. Explain the etiology & risk factors
4. Identify 10 signs & symptoms of AD
5. Identify 4 stages of AD
6. Explain the important of proper management in

order to prevent complications and to slow
down the disease process.

ALZHEIMER’S DISEASE (AD)

AD is first described by Dr.
Alois Alzheimer . In 1906,
Dr.Alzheimer noticed
changes in the brain tissue
of a woman who died of an
unusual mental illness.

He noted in the autopsy
that there was shrinkage in
and around nerve cells in
her brain. Her symptoms
included memory loss,
language problems and
unpredictable behavior.

Alzheimer’s disease

Alzheimer's disease is a neurological disorder in
which the death of brain cells causes memory
loss, thinking and language skills, and behavioral
changes ( cognitive decline).

ALZHEIMER’S DISEASE (AD)

A neurodegenerative type of dementia, the
disease starts mild and gets progressively worse.

Alzheimer's disease is the most common type
of dementia. The term "dementia" describes a
loss of mental ability associated with gradual
death of brain cells.

Pathophysiology

Neurofibrillary tangles are a classic finding at
outopsy in the brains of patients with AD. They
consist of tangled massed of fibrous tissue
throughout the neurons.

Neuritic plaques are composed of degenerating
nerve terminal ,found in the hippocampus.
Deposit within the plaques are increased
amount of an abnormal protein called beta-
amyloid.

Abnormalities in the brain

Cont’d

High levels of beta-amyloid are associated with
significantly reduced acethylcoline (ACh),which
leads to a decrease in the amount of
acetyltransferase in the hippocampus.

This results in impaired cognition, recent
memory, and the ability to acquire new
memories.

Etiology

The exact cause of AD is unknown. Most
important risk factor is :

1)Age (65 > / 85> risk 50% )

2)Gender (women > men)

3)Family history
Other theories including:

1)Chemical imbalances

2)Environmental agents (Virus such as herpes
zoster/ head injury)

3)Immunologic changes

4) Ethnicity/ race (Africans Americans greater risk)

10 warning signs for early detection of AD

1) Memory loss
2) Difficulty to performing

familiar tasks
3) Problem with language
4) Disorientation to time and

place
5) Poor or decreased judgment
6) Problem with abstact

thinking
7) Misplacing things
8) Changes in mood or

behaviour
9) Change in personality
10) Loss of initiative

Stages of Alzheimer’s Disease

There are four stages based on the progress of the

disease.
 Stage 1 (pre-dementia )

Short-term memory loss
Decline in attention span
Decreased awareness

 Stage 2 (mild)

More severe learning and memory
impairment

Language difficulty
Apraxia



Cont’d

 Stage 3(moderate)

Long-term memory loss
Inability to recognise close relatives
Aimless wandering
Emotional change
Urinary incontinence

 Stage 4 (severe)

Complete loss of speech
Severe apathy and exhaustion
Bedridden; inability to feed oneself
Death

Clinical diagnostic

Alzheimer's disease is not simple to diagnose - there
is no single test for it.

The first thing doctors do is to rule out other
problems before confirming whether mental signs
and symptoms are severe enough to be a kind of
dementia or something else.

Doctors may:

1. Take a history -ADLs

2. Physical examination

3. Check neurological function

4. Sending off for tests of blood and urine samples

5. Brain scans (CT, MRI and EEG).

Management

There is no cure for AD. The goals of treatment
are:

1. Slow the progression of the disease
(although this is difficult to do)

2. Manage symptoms, such as behavior
problems, confusion, and sleep problems

3. Change your home environment so you can
better perform daily activities

4. Support family members and other
caregivers

Medications

Medicines are used to help slow down the rate
at which symptoms become worse.
Donepezil (Aricept), rivastigmine (Exelon), and
galantamine (Razadyne, formerly called
Reminyl).

Medicines are used to control aggressive,
agitated, or dangerous behaviors.
Haloperidol, risperidone.

Complications

1. Abuse by an over-stressed caregiver

2. Bedsores

3. Loss of muscle function that makes you unable to
move your joints

4. Infection, such as urinary tract infection and
pneumonia

5. Other complications related to immobility
Falls and broken bones
Harmful or violent behavior toward self or others
Loss of ability to function or care for self
Loss of ability to interact
Malnutrition and dehydration

Nursing intervensions

1. Impaired of meal intake related to cognitive
issue.

2. Increased of dependency for ADLs related to
disease process.

3. Impaired of sleep pattern related to disease
process.

4. Anxiety and lack of confident level to interact
related to cognitive and speech issue.

5. Risk of fall and fracture related to aging process
secondary to disease process.