Alzheimer's Disease & Dementia Flashcards
3 most common conditions that affect cognition in older adults
Delirium
Dementia
Depression
Dementia
Generalized impairment of intellectual functioning, cerebral dysfunction syndrome of cognitive and functional decline
Decline in ability to perform ADL’s/IADL’s
Gradual, progressive and irreversible - still need to asses carefully to determine if delirium or dementia
Alzheimer’s most common form (70% of dementia patients)
Non-Alzheimer’s Dementia
- Degenerative, vascular, neoplastic, demyelinating, infections, inflammatory, toxic, metabolic, and psychiatric disorders Parkinsons disease Huntington's Disease Dementa with Lew Bodies Frontotemporal TBI, HIV
Dementia S/S
Wandering Restlessness Agitation Agression Sleep/Wake Cycle Disturbance Apathy Difficulty concentrating Delusions Hallucinations
Mild Dementia (stage 1)
Largely unable to function independently
Occasional forgetfulness, confusion, and lapse in judgement
Moderate Dementia (Stage 2)
May require assistance with daily activities
Greater extend of memory loss and other symptoms including sundowning
Severe Dementia (Stage 3)
Round-the-clock care required
Loss of mobility and difficulty performing functions such as swallowing
Alzheimer’s
AD is a progressive, irreversible, degenerative neurologic disease that begins insidiously (gradual and subtle way) and is characterized by gradual losses of cognitive function and disturbances in behavior and affect brain disorder
6th leading cause of death
Affects half of those 85 and older
Not a normal Aging Process
Two Types: Familial/early onset and Sporadic/Late onset
Average lifespan after diagnosis: 8 years
Pathogenesis of AD
Uncertain
Changes consist of neural fibrillary tangles (tangled masses of non functioning neurons) and amyloid plaques (deposits of amyloid protein, part of a larger protein called amyloid precursor proteins in the brain)
The neuronal damage occurs primarily in the cerebral cortex and results in decreased frame size
At the biochemical level, the enzyme active in producing acetylcholine (specifically involved in memory processing) is decreased
Progression of Alzheimer’s
Speaking skills deteriorate to nonsense syllables, agitation and physical activity increase, and patient may wander at night
Eventually assistance will be needed with ADLs including eating and toileting because dysphagia and incontinence develop
Terminal Stage- patients are usually immobile and require total care. could last months or years. Death occurs as a result of complications such as pneumonia, malnutrition or dehydration
Alzheimer’s Risk Factors
Aging Smoking Down Syndrome Family History (especially first degree relative) Mild Cognitive Impairment
Diagnosis of Alzheimer’s
Definitive diagnosis can only be made at autopsy
Most important goal is to rule out other causes of dementia that are reversible (depression, delirium, alcohol or drug abuse, etc)
Diagnostic tests include: CBC, chemistry profile, vitamin B 12 and thyroid hormone levels as well as screening with electroencephalography, computed tomography, magnetic resonance imaging, and examination of the cerebral spinal fluid.
AD non-pharmacological Management
Supportive care for physiologic, hygiene ambulation, psychiatric and behavioral needs
Maintain routine and familiar environment for patient; attempt to maintain nutritional status by offering and encouraging regular meals
Display calendars, clocks in prominent places
Provide verbal prompts and positive reinforcement for eating and independence
Reminiscent therapy: Display family pictures, memory evoking memorabilia, promote socialization
Fall precautions- remove loose rugs, use nonskid bathmats, low and sturdy chairs
Pacing, wandering and exciting precautions: secure environment, door alarms, obscure door knobs
Noxious stimulus free environment
Vascular Dementia
Second most common cause of dementia
Characterized by an uneven, stepwise downward decline in mental function
Vascular Dementia Risk Factors
History of heart attack, mini stroke or stroke Atherosclerosis High Cholesterol/Blood Pressure Diabetes Smoking Obesity Atrial Fibrillation *Prevention involves cardiovascular lifestyle modifications
