Alzheimer's Flashcards
what is AD?
○ AD is the most common cause of dementia, causing a severe burden on both
individuals and their caregivers.
what is the difference between Normal Forgetfulness and AD?
○ Normal aging: Slight forgetfulness (age-associated memory loss).
○ AD: Severe memory loss, especially new information, which interferes with daily
functioning.
What type of declines does AD cause?
○ AD involves a progressive decline in problem-solving, learning, and the ability to perform activities of daily living (ADLs).
What type of emotional and Neurological effects would a patient with AD experience?
anxiety, mood lability, depression, and
hallucinations or delusions.
what can we see in someone with stage 1 AD?
● Stage 1: Mild AD (DSM-5: Mild NCD)
○ Symptoms:
■ Loss of energy, drive, initiative.
■ Difficulty learning new things.
■ Personality and social behavior are typically intact, leading others to
underestimate cognitive decline.
■ Mild depression may occur.
○ Impact: The person may still function but struggles in new or challenging situations.
what can we see in someone with stage 2 AD?
Stage 2: Moderate AD (DSM-5: Major NCD)
○ Symptoms:
■ Agnosia: Inability to recognize familiar objects or people.
■ Apraxia: Inability to perform tasks without step-by-step instruction.
■ Incontinence and difficulty remembering the location of the toilet.
○ Care: Total care is often required.
what can we see in someone with stage 3 AD?
Stage 3: Severe AD (DSM-5: Major NCD)
○ Symptoms:
■ Severe cognitive decline, requiring total assistance.
■ Common symptoms include agitation, paranoia, and delusions.
○ Burden: Care becomes emotionally, financially, and physically taxing for the family.
what is the early and late onset of AD?
○ Early Onset: Occurs before age 65 (rare).
○ Late Onset: Most common, occurring after age 65.
what gender is mostly affected by AD? and why?
women because they live longer
what age group is affected mostly by AD?
85+
what is the biggest risk factor? and describe it
● Age is the greatest risk factor, but many elderly individuals maintain their cognitive
abilities well into their 80s and 90s without significant memory loss or dementia.
● Mild cognitive changes may occur with aging but do not always impact daily
functioning.
Biological Risk Factors: how do genes relate to AD?
● Genetic Factors:
○ Genetic mutations account for less than 1% of all dementia cases, leading to
early-onset Alzheimer’s disease (AD), which can occur before age 65,
sometimes as early as 30.
○ Apolipoprotein E (APOE) gene:
■ The e4 form of this gene is linked to late-onset AD, producing a protein involved in cholesterol transport and brain injury repair.
■ While the presence of this gene increases risk, research has shown inconsistent results.
○ Family history of dementia may increase risk due to a combination of genetic and shared lifestyle factors (James & Bennett, 2019).
Biological Risk Factors: how does heart disease and head injuries contribute to AD?
● Cardiovascular Disease:
○ Brain health is strongly linked to heart health.
○ Conditions associated with cardiovascular disease (such as inactivity, high
levels of “bad” cholesterol, diabetes, and obesity) are also risk factors for AD
(Alzheimer’s Association, 2019).
Head Injury and Traumatic Brain Injury:
○ Brain injuries and trauma increase the risk of developing AD and other dementias.
○ Those with repeated head trauma (e.g., boxers, football players) are at particularly high risk (James & Bennett, 2019).
what are the modifiable risk factors for AD?
● Cognitive Reserve:
○ Education and mentally stimulating activities are believed to build cognitive
reserve, allowing for better use of neural networks and potentially reducing the
risk of dementia.
● Other Modifiable Factors:
○ Physical exercise, social engagement, healthy diet, and sufficient sleep are also thought to reduce dementia risk.
○ Although these factors are promising, further research is needed to fully understand their impact (Alzheimer’s Association, 2019).
describe he progression of AD symptoms and cognitive decline
○ AD is marked by progressive cognitive decline, initially subtle and often
unnoticed.
○ Early on, individuals may compensate for cognitive deficits, and families may
deny signs of deterioration.
○ Symptoms worsen over time, revealing additional defense mechanisms like
confabulation and perseveration.
Describe AD Key Symptoms:
● Confabulation:
● Perseveration:
● Agraphia:
● Confabulation:
○ Creating stories or answers to fill memory gaps, not considered lying.
○ Example: A patient may state they went to lunch with their family when they have
been in bed all weekend.
● Perseveration:
○ Persistent repetition of words, phrases, or gestures even after the stimulus ends.
● Agraphia:
○ Early-stage AD symptom involving a loss of the ability to read or write.
Describe AD Key Symptoms:
● Aphasia:
● Apraxia:
● Agnosia:
● Hyperorality:
● Sundowning Syndrome:
● Aphasia:
○ Loss of language ability, progressing from difficulty finding words to babbling
or mutism.
● Apraxia:
○ Loss of purposeful movement without motor or sensory issues.
○ Example: In apraxia of dressing, the person may struggle to dress themselves
properly.
● Agnosia:
○ Inability to recognize objects or sounds, such as a familiar voice or a toothbrush.
● Hyperorality:
○ The tendency to put objects in the mouth and chew them.
● Sundowning Syndrome:
○ Mood deterioration and increased agitation in the late afternoon or evening.
what are additional symptoms?
Additional Symptoms
● Memory Impairment:
○ Initially affects recent memory, progressing to both recent and remote
memory loss.
**● Executive Functioning Disturbances:
**Problems with problem solving, planning, organizing, and abstract thinking. **
● Diminished Emotional Expression:
○ May result in a flat affect and unresponsiveness.
what dx test?
● Differential Diagnosis:
○ AD can be confused with other conditions like major depressive disorder or
pseudodementia (depression mimicking dementia).
○ Coexisting conditions like dementia and depression or dementia and delirium
are common, requiring accurate differentiation.
● Brain Imaging:
○ Tools like CT scans and PET scans reveal brain atrophy and help rule out other conditions, such as tumors.
● Mental Status Questionnaires:
○ Tests like the Mini-Mental State Examination assess cognitive decline and
mental status.
● Comprehensive Evaluation:
Physical and neurological exams, medical/psychiatric history, symptom review, and family observations contribute to accurate diagnosis.
○ Medication and nutritional evaluations are also important.
The nurse is aware that her patient with AD is at risk or has issues with what?
● Risk for Injury:
○ A priority diagnosis in AD due to risks like** wandering, falls, burns, medication
misuse, or ingesting harmful substances. **
● Impaired Verbal Communication:
○ As AD progresses, patients experience difficulty recognizing or naming objects, leading to communication challenges.
● Impaired Cognition and Confusion:
○ AD causes memory loss and increasing disorientation, requiring targeted interventions.
● Risk for Caregiver Stress:
○ Caregivers experience emotional loss, stress from the patient’s deterioration, and a need for education, support, and referrals to cope with the changing dynamics.
○ Assess family grief and provide support to ease their emotional burden.
Nurse Sally is creating a care plan for her patient with AD. She is tailoring her care plan specifically to her patient’s need. What things does Sally need to be aware of about the patient when creating this care plan?
● Address self-care needs:
○ Focus on supporting the patient’s ability to perform basic tasks.
● Impaired Environmental Interpretation:
○ Consider the patient’s difficulty interpreting surroundings when planning care.
● Chronic Confusion:
○ Plan care to support the patient’s cognitive function and reduce confusion.
Caregiver Role Strain:
○ Implement interventions to support caregivers in managing stress and maintaining their own well-being.
● Immediate Needs:
○ Care planning should address the immediate needs of the patient and family.
○ Assess the level of functioning and caregiver needs for effective planning.
what type of skill can help a patient with AD? and why?
● Unconditional Positive Regard:
○ A key approach in caring for people with dementia. It:
■ Encourages cooperation from patients.
■ Reduces catastrophic behaviors.
■ Increases family satisfaction with care.
How can person-centered care help a patient with AD?
● Person-Centered Care:
○ Focuses on preserving the personhood of individuals with dementia by:
■ Building meaningful relationships with the patient and caregivers.
■ Prioritizing relationships over tasks, which can be difficult in
task-focused systems.
■ Approaching patients in a way that reduces distressing behaviors by
entering their world.
what do you need to teach the families?
Teach families about strategies for communication and self-care activities.
Why do we refer patients and their families to community supports?
● Alzheimer’s Association:
○ Provides national resources and a Community Resource Finder for local
assistance.
● Legal and Financial Guidance:
Help families prepare for transitions in care with information on:
■ Advance directives.
■ Durable power of attorney.
■ Guardianship and conservatorship.
● Placement Decisions:
○ Families may need guidance on when and how to transition to professional
care due to difficult behaviors, incontinence, or safety concerns.
what are the expected goals for a patient with AD?
● Delay Further Regression:
○ The goal is to promote optimal functioning and delay cognitive decline
whenever possible.
● Support Family Well-being:
○ Ensure the quality of life for both patient and family through ongoing evaluation and resource provision.
What is the overview on medications for AD?
Pharmacotherapy for Cognitive Symptoms
1. Medications Overview:
○ Five medications approved by the FDA for AD treatment.
○ These medications show statistically significant effects in slowing disease
progression compared to placebos.
○ Provide only marginal clinical improvement in cognition and functioning.
○ Benefits diminish after 1 to 2 years; patients should assess the risk of side
effects versus benefits.
what drug classes are used for AD?
Cholinesterase Inhibitors and N-Methyl-D-Aspartate (NMDA) Receptor Antagonist
describe the MOA, types of drugs, indications, benefits, side effects of: Cholinesterase Inhibitors
○ Mechanism: Prevent breakdown of acetylcholine by inhibiting cholinesterase, thus increasing acetylcholine levels.
○ Drugs: Donepezil (Aricept), Rivastigmine (Exelon), and Galantamine (Razadyne).
○ Indications:
Mild to moderate AD: All cholinesterase inhibitors.
■ Severe AD: Donepezil and Rivastigmine (transdermal patch).
○ Benefits:
■ Short-lived improvements in cognition.
■ Delay advancement of symptoms but do not significantly slow disease
progression.
○ Side Effects:
■ Primarily gastrointestinal: Nausea, vomiting, diarrhea.
■ Bradycardia (rare) due to cholinergic effects.
■ Increased risk of gastrointestinal bleeding when taken with NSAIDs.
■ For the Exelon Patch, potential skin irritation; discontinue if irritation
spreads beyond the patch area.
describe the Drug name, MOA, indication, combo therapy: N-Methyl-D-Aspartate (NMDA) Receptor Antagonist
○ Drug: Memantine (Namenda).
○ Mechanism: Blocks excessive glutamate activity by occupying NMDA receptors,
reducing neuronal damage from calcium influx.
○ Indication: Moderate to severe AD.
○ Combination Therapy: Memantine can be combined with cholinesterase
inhibitors. An extended-release formulation, Namzaric (memantine and donepezil), is available for patients who tolerate both drugs.
what type of behavioral symptoms call for medications?
- Common Behavioral Symptoms:
○ Psychosis: Hallucinations, paranoia.
○ Mood swings: Depression, anxiety, agitation.
○ Aggression: Verbal and physical combativeness.
○ Wandering and incontinence: Risk for injury or infection.
how to psychotropic medication correlate with AD?
- Psychotropic Medications:
○ FDA Warning: Antipsychotics are not FDA-approved for dementia-related
psychosis due to increased mortality risks (cardiovascular and infectious
causes).
○ Off-Label Use: Antidepressants, antipsychotics, antianxiety agents, and
anticonvulsants.
what are the nursing considerations for psychotropic medications?
○ Start with the lowest dose and titrate slowly (“start low, go slow”).
○ Use the smallest dose for the shortest duration and discontinue if ineffective.
○ Administer as needed based on nursing judgment, and only after
nonpharmacological interventions have been attempted.
what integrative therapy can be used for AD?
Integrative Therapy
Nutrition:
○ Omega-3 Fatty Acids: Obtained from foods like fatty fish, flaxseed, and canola
oils.
○ Controversy: Some studies suggest omega-3 fatty acids may reduce the
incidence of dementia, but the evidence for treating AD is inconclusive.
○ Canhada et al. (2018): Omega-3 supplementation may improve mild cognitive
impairment but lacks sufficient evidence for use in severe AD.
