Alzheimers Disease

Agnes DiStasi DNP, RN, CNE NUR 310

 What is Dementia? What is the difference in Delerium vs Dementia? Delerium superimposed on dementia What is Alzheimers Disease?
http://www.alzheimers.org/rmedia/adanimation.htm

 Steps to getting a diagnosis of Alzheimers Disease

No single diagnostic test AD diagnosis is 80 90% accurate Definitive diagnosis of Alzheimers Disease is upon autopsy

 Is it Alzheimers? Ten Warning Signs of Alzheimers Disease Alzheimers vs. normal age-related memory changes

The Stages of Alzheimers Disease

Handout 7 Stages Other ways to stage Alzheimers disease
3 Stages: mild, moderate, severe General divisions: early-stage, mid-stage, late-stage

http://www.youtube.com/watch?v=7wbYE K7O14E

 Alzheimers Statistics A person with Alzheimers Disease will live an average of eight years and as many as 20 years or more from the onset of symptoms. Alzheimers Disease is the 6th leading cause of death in the US. 6 million Americans currently have the disease. Women are more likely than men to develop Alzheimers. 16 million Americans will have Alzheimers Disease by 2050 unless a cure is found. The cost of diagnosing and caring for people with Alzheimers Disease currently stands at $14.8 million.

 Alzheimers Disease Myths

Normal aging Senility Nothing can be done Mental illness Family burden Genetic (< 5% is truly familial)

Communication
The person with Alzheimers Disease will exhibit changes in his/her usual pattern of expressing him/herself. Communication changes progress and ability decreases as the disease progresses. The person who is in communication with a person who has Alzheimers disease must remember that patience is a virtue!! Do not dispute unless safety issue.

Challenging Behaviors
Assessment of the behavior
i.e. repetitive actions, wandering

Nursing Interventions for Specific Behaviors

If it isnt harmful, let it be answer the person, use memory aids, respond to the emotion behind the behavior clothespins and washcloths

Evaluate
is the repetitive action decreased if that is the goal?
Are other interventions needed?

 Assisting the person who has Alzheimers Disease with personal care
Bathing Dressing Grooming - Toileting - Dental Care - Eating

Implications for acute care environment Person-centered care in long term care

Caregiver Issues
Feelings of inadequacy/ feeling overwhelmed Withdraw from family, friends, activities Worry that the person with Alzheimers is safe Anxiety about money and healthcare decisions Denial of the impact of the disease and its effects on the family as a whole Grief or sadness that relationship has changed Frustration/anger toward the person with Alzheimers Health problems of their own
Alzheimers Association (2008)

 http://www.youtube.com/watch?v=q1BkfV 2h09g&gclid=COvLo_rnlJ0CFRpdswodOR x12A http://www.youtube.com/watch?v=rsUlj2E bc10&NR=1

Medications Cholinesterase Inhibitors

Cognex Aricept Exelon Razadyne

Cholinergics (Parasympathomimetics)
Slow the breakdown of acetylcholine Effective in mild to moderate Alzheimers VERY expensive

NMDA Antagonist
Namenda
N-methyl D-aspartate antagonist Believed to regulate glutamate in the brain Delays progression of some symptoms in moderate to severe Alzheimers Can be prescribed in combination with cholinesterase inhibitors i.e. Exelon + Namenda Aricept + Namenda

Other Medications
Anti-depressants Tranquilizers for severe agitation Anti-oxidants such as Vit.E, antiinflammatories, and estrogen replacement therapy in women are all currently being studied

Creative Storytelling Timeslips method creative expression for people with dementia through storytelling
www.timeslips.org

 Music Therapy Drumming Circles Memories in the Making/Art Therapy Poetry

 Pain Management and Alzheimers Disease ASPMN (2008) Is pain always subjective? Pain behaviors to watch for Pain assessment tools Alzheimers Disease in the acute care setting (Allen & Close, 2010) NICHE Model

Current Evidence
NHS www.nurseshealthstudy.org
Insulin Levels and Memory
(Okereke et al., 2006)
Stay tuned

Sleep Patterns and Cognitive Function

Diabetes and Alzheimers Risk

Relationship between diabetes and risk of Alzheimers and other dementias (2011)
More than 1000 men and women subjects over age 60 15-year study People with diabetes were twice as likely to develop Alzheimers within 15 years People with diabetes were 1.75 times more likely to develop dementia of any kind
(Kiyohara et al., 2011)

Additional Current Evidence

No relationship shown between statins and decreased Alzheimers risk (Arvanitakis, 2008; Haan, 2009) Drinking grape juice may help improve memory function in older adults with early memory decline (Krikorian, 2008) NSAIDS may not protect cognitive function (ADAPT Research Group, 2008) Vitamin E supplementation may lengthen survival in Alzheimers Disease (American Academy of Neurology Annual Meeting, 2008)

Additional Current Evidence

Atrial Fibrillation increases risk of AD
3045 subjects, 14 year study duration (Dublin et al., 2011)

Proton magnetic resonance spectroscopy can identify early changes in brain chemistry linked to AD prior to cognitive deficits (Kantarci et al., 2011
311 subjects in their 70s and 80s

 American Academy of Neurology www.aan.com Dementia/Alzheimers information Alzheimers Association www.alz.org

Alzheimers Foundation of America

www.alzfdn.org Excellence in Care Program

 Walk to End Alzheimers

Cincinnati
October 1, 2011