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• Syndrome characterized by dysfunction Syndrome characterized by dysfunction or loss of or loss of • MemoryMemory• OrientationOrientation• AttentionAttention• LanguageLanguage• Judgment Judgment • ReasoningReasoning
• Syndrome characterized by dysfunction Syndrome characterized by dysfunction or loss of or loss of • MemoryMemory• OrientationOrientation• AttentionAttention• LanguageLanguage• Judgment Judgment • ReasoningReasoning
• Other characteristics that can Other characteristics that can manifestmanifest• Personality changesPersonality changes• Behavioral problems such asBehavioral problems such as
• Other characteristics that can Other characteristics that can manifestmanifest• Personality changesPersonality changes• Behavioral problems such asBehavioral problems such as
• Problems disrupt individual’s Problems disrupt individual’s • WorkWork• Social responsibilitiesSocial responsibilities• Family responsibilities Family responsibilities
• Physicians usually diagnose when Physicians usually diagnose when two or more brain functions are two or more brain functions are significantly impairedsignificantly impaired
• Problems disrupt individual’s Problems disrupt individual’s • WorkWork• Social responsibilitiesSocial responsibilities• Family responsibilities Family responsibilities
• Physicians usually diagnose when Physicians usually diagnose when two or more brain functions are two or more brain functions are significantly impairedsignificantly impaired
• Not a normal part of agingNot a normal part of aging• Affects 15% of older Americans Affects 15% of older Americans • ~100 causes of dementia~100 causes of dementia• 60% to 80% cases of dementia patients 60% to 80% cases of dementia patients
have Alzheimer’s disease (AD)have Alzheimer’s disease (AD)• Half of the patients in most long-term Half of the patients in most long-term
care facilities have dementiacare facilities have dementia
• Not a normal part of agingNot a normal part of aging• Affects 15% of older Americans Affects 15% of older Americans • ~100 causes of dementia~100 causes of dementia• 60% to 80% cases of dementia patients 60% to 80% cases of dementia patients
have Alzheimer’s disease (AD)have Alzheimer’s disease (AD)• Half of the patients in most long-term Half of the patients in most long-term
care facilities have dementiacare facilities have dementia
DementiaDementiaEtiology and PathophysiologyEtiology and Pathophysiology
• Infectious diseases can result in Infectious diseases can result in vascular and neurodegenerative vascular and neurodegenerative changes that can lead to dementiachanges that can lead to dementia• Bacterial meningitis Bacterial meningitis • Viral encephalitisViral encephalitis
• Infectious diseases can result in Infectious diseases can result in vascular and neurodegenerative vascular and neurodegenerative changes that can lead to dementiachanges that can lead to dementia• Bacterial meningitis Bacterial meningitis • Viral encephalitisViral encephalitis
• Acute or subacute pattern of change Acute or subacute pattern of change may be more indicative of an may be more indicative of an infectious or metabolic changeinfectious or metabolic change
• Acute or subacute pattern of change Acute or subacute pattern of change may be more indicative of an may be more indicative of an infectious or metabolic changeinfectious or metabolic change
• Initial symptoms are related to Initial symptoms are related to changes in cognitive functionchanges in cognitive function
• Family members often report to Family members often report to doctordoctor• Memory lossMemory loss• Mild disorientationMild disorientation• Trouble with words and/or numbersTrouble with words and/or numbers
• Initial symptoms are related to Initial symptoms are related to changes in cognitive functionchanges in cognitive function
• Family members often report to Family members often report to doctordoctor• Memory lossMemory loss• Mild disorientationMild disorientation• Trouble with words and/or numbersTrouble with words and/or numbers
• Depression often mistaken for Depression often mistaken for dementia and vice versadementia and vice versa
• Manifestations of depression, Manifestations of depression, especially in older adultsespecially in older adults• SadnessSadness• Difficulty thinking and concentrating Difficulty thinking and concentrating
• Depression often mistaken for Depression often mistaken for dementia and vice versadementia and vice versa
• Manifestations of depression, Manifestations of depression, especially in older adultsespecially in older adults• SadnessSadness• Difficulty thinking and concentrating Difficulty thinking and concentrating
• Manifestations of depression (cont’d)Manifestations of depression (cont’d)• FatigueFatigue• Apathy Apathy • Feelings of despairFeelings of despair• InactivityInactivity
• Manifestations of depression (cont’d)Manifestations of depression (cont’d)• FatigueFatigue• Apathy Apathy • Feelings of despairFeelings of despair• InactivityInactivity
• Severe depression can result in poor Severe depression can result in poor concentration and attentionconcentration and attention
• Dementia and depression occurring Dementia and depression occurring together can cause extreme together can cause extreme intellectual deteriorationintellectual deterioration
• Depression alone or with dementia is Depression alone or with dementia is treatabletreatable
• Severe depression can result in poor Severe depression can result in poor concentration and attentionconcentration and attention
• Dementia and depression occurring Dementia and depression occurring together can cause extreme together can cause extreme intellectual deteriorationintellectual deterioration
• Depression alone or with dementia is Depression alone or with dementia is treatabletreatable
• Computed tomography (CT)Computed tomography (CT)• Magnetic resonance imaging (MRI)Magnetic resonance imaging (MRI)• To characterize central nervous To characterize central nervous
• Computed tomography (CT)Computed tomography (CT)• Magnetic resonance imaging (MRI)Magnetic resonance imaging (MRI)• To characterize central nervous To characterize central nervous
• State of cognitive and functional State of cognitive and functional ability below defined norms that does ability below defined norms that does not meet criteria for dementianot meet criteria for dementia
• Memory impaired but function Memory impaired but function normallynormally
• State of cognitive and functional State of cognitive and functional ability below defined norms that does ability below defined norms that does not meet criteria for dementianot meet criteria for dementia
• Memory impaired but function Memory impaired but function normallynormally
• Characteristics Characteristics • Memory complaintMemory complaint• Abnormal memory for ageAbnormal memory for age• Intact activities of daily livingIntact activities of daily living• Normal general cognitive functioningNormal general cognitive functioning
• Characteristics Characteristics • Memory complaintMemory complaint• Abnormal memory for ageAbnormal memory for age• Intact activities of daily livingIntact activities of daily living• Normal general cognitive functioningNormal general cognitive functioning
• Presently no widely accepted Presently no widely accepted guidelines for treatmentguidelines for treatment• Insufficient evidenceInsufficient evidence• Research is being conductedResearch is being conducted
• Primary treatment consists of Primary treatment consists of ongoing monitoringongoing monitoring• Observe for 10 warning signs of ADObserve for 10 warning signs of AD
• Presently no widely accepted Presently no widely accepted guidelines for treatmentguidelines for treatment• Insufficient evidenceInsufficient evidence• Research is being conductedResearch is being conducted
• Primary treatment consists of Primary treatment consists of ongoing monitoringongoing monitoring• Observe for 10 warning signs of ADObserve for 10 warning signs of AD
• Economic cost of caring in the United Economic cost of caring in the United States is at least $100 billion annuallyStates is at least $100 billion annually
• Burden on patient, family, Burden on patient, family, caregivers, and society as a wholecaregivers, and society as a whole
• Women more likely to develop ADWomen more likely to develop AD
• Economic cost of caring in the United Economic cost of caring in the United States is at least $100 billion annuallyStates is at least $100 billion annually
• Burden on patient, family, Burden on patient, family, caregivers, and society as a wholecaregivers, and society as a whole
• Women more likely to develop ADWomen more likely to develop AD
Alzheimer’s DiseaseAlzheimer’s DiseaseEtiology and PathophysiologyEtiology and Pathophysiology
• Exact etiology is unknownExact etiology is unknown• Similar to other forms of dementiaSimilar to other forms of dementia• Age is most important risk factorAge is most important risk factor
• Exact etiology is unknownExact etiology is unknown• Similar to other forms of dementiaSimilar to other forms of dementia• Age is most important risk factorAge is most important risk factor
Alzheimer’s DiseaseAlzheimer’s DiseaseEtiology and PathophysiologyEtiology and Pathophysiology
• Changes in brain structure and Changes in brain structure and functionfunction• Amyloid plaquesAmyloid plaques• Neurofibrillary tanglesNeurofibrillary tangles• Loss of connections between cells and Loss of connections between cells and
cell deathcell death
• Changes in brain structure and Changes in brain structure and functionfunction• Amyloid plaquesAmyloid plaques• Neurofibrillary tanglesNeurofibrillary tangles• Loss of connections between cells and Loss of connections between cells and
Alzheimer’s DiseaseAlzheimer’s DiseaseEtiology and PathophysiologyEtiology and Pathophysiology
• People develop some plaques in their People develop some plaques in their brain tissuebrain tissue
• In AD plaques are greater in certain In AD plaques are greater in certain partsparts• Clusters of insoluble plaque Clusters of insoluble plaque
•ββ-Amyloid, other proteins, remnants of -Amyloid, other proteins, remnants of neurons, non-nerve cells, and other cellsneurons, non-nerve cells, and other cells
• People develop some plaques in their People develop some plaques in their brain tissuebrain tissue
• In AD plaques are greater in certain In AD plaques are greater in certain partsparts• Clusters of insoluble plaque Clusters of insoluble plaque
•ββ-Amyloid, other proteins, remnants of -Amyloid, other proteins, remnants of neurons, non-nerve cells, and other cellsneurons, non-nerve cells, and other cells
Alzheimer’s DiseaseAlzheimer’s DiseaseEtiology and PathophysiologyEtiology and Pathophysiology
• Where plaques develop in the parts Where plaques develop in the parts of the brain used forof the brain used for• Memory Memory • Cognitive functionCognitive function
• Hippocampus Hippocampus
• Eventually develops in the cerebral Eventually develops in the cerebral cortexcortex
• Where plaques develop in the parts Where plaques develop in the parts of the brain used forof the brain used for• Memory Memory • Cognitive functionCognitive function
• Hippocampus Hippocampus
• Eventually develops in the cerebral Eventually develops in the cerebral cortexcortex
Alzheimer’s DiseaseAlzheimer’s DiseaseEtiology and PathophysiologyEtiology and Pathophysiology
• Tau proteinsTau proteins• Provide support for intracellular Provide support for intracellular
structurestructure• Hold microtubules together as railroad Hold microtubules together as railroad
ties hold railroad tracksties hold railroad tracks• Tau proteins alter in ADTau proteins alter in AD• Microtubules twist together in a helical Microtubules twist together in a helical
• Tau proteinsTau proteins• Provide support for intracellular Provide support for intracellular
structurestructure• Hold microtubules together as railroad Hold microtubules together as railroad
ties hold railroad tracksties hold railroad tracks• Tau proteins alter in ADTau proteins alter in AD• Microtubules twist together in a helical Microtubules twist together in a helical
Alzheimer’s DiseaseAlzheimer’s DiseaseEtiology and PathophysiologyEtiology and Pathophysiology
• Gradual loss of connections between Gradual loss of connections between neuronsneurons• Leads to damage and then death of Leads to damage and then death of
neuronsneurons• Affected parts of brain shrink Affected parts of brain shrink
• Brain atrophy Brain atrophy • Significant in final state of ADSignificant in final state of AD
• Gradual loss of connections between Gradual loss of connections between neuronsneurons• Leads to damage and then death of Leads to damage and then death of
neuronsneurons• Affected parts of brain shrink Affected parts of brain shrink
• Brain atrophy Brain atrophy • Significant in final state of ADSignificant in final state of AD
• May play significant role in how the May play significant role in how the brain processes brain processes ββ-amyloid protein-amyloid protein• ↑↑ ββ-Amyloid protein -Amyloid protein ↑↑ risk risk
• First gene associated with ADFirst gene associated with AD• Epsilon (E)-4 allele of apolipoprotein E Epsilon (E)-4 allele of apolipoprotein E
(ApoE) gene on chromosome 19(ApoE) gene on chromosome 19
• May play significant role in how the May play significant role in how the brain processes brain processes ββ-amyloid protein-amyloid protein• ↑↑ ββ-Amyloid protein -Amyloid protein ↑↑ risk risk
• First gene associated with ADFirst gene associated with AD• Epsilon (E)-4 allele of apolipoprotein E Epsilon (E)-4 allele of apolipoprotein E
(ApoE) gene on chromosome 19(ApoE) gene on chromosome 19
• ApoE comes in several forms of ApoE comes in several forms of allelesalleles• Three occur most commonlyThree occur most commonly• Inherit one allele from each parentInherit one allele from each parent
• ApoE may clear amyloid plaquesApoE may clear amyloid plaques• Presence of ApoE-4 Presence of ApoE-4 ↑↑ risk of late- risk of late-
onset ADonset AD
• ApoE comes in several forms of ApoE comes in several forms of allelesalleles• Three occur most commonlyThree occur most commonly• Inherit one allele from each parentInherit one allele from each parent
• ApoE may clear amyloid plaquesApoE may clear amyloid plaques• Presence of ApoE-4 Presence of ApoE-4 ↑↑ risk of late- risk of late-
Alzheimer’s DiseaseAlzheimer’s Disease Etiology and PathophysiologyEtiology and Pathophysiology
• Researchers interested in link Researchers interested in link between inflammation and ADbetween inflammation and AD• Theory suggests formation of free Theory suggests formation of free
radicals damages neurons radicals damages neurons loss of loss of functionfunction
• Oxidative damage leads to Oxidative damage leads to inflammationinflammation
• Researchers interested in link Researchers interested in link between inflammation and ADbetween inflammation and AD• Theory suggests formation of free Theory suggests formation of free
radicals damages neurons radicals damages neurons loss of loss of functionfunction
• Oxidative damage leads to Oxidative damage leads to inflammationinflammation
Alzheimer’s DiseaseAlzheimer’s Disease Etiology and PathophysiologyEtiology and Pathophysiology
• Early findings show people who Early findings show people who engage in activities that involve engage in activities that involve information processing have a information processing have a decreased risk of developing ADdecreased risk of developing AD• ReadingReading• Crossword puzzlesCrossword puzzles• Learning a new languageLearning a new language
• Early findings show people who Early findings show people who engage in activities that involve engage in activities that involve information processing have a information processing have a decreased risk of developing ADdecreased risk of developing AD• ReadingReading• Crossword puzzlesCrossword puzzles• Learning a new languageLearning a new language
• Early signs of Alzheimer’s diseaseEarly signs of Alzheimer’s disease1.1. Memory loss that affects job skillsMemory loss that affects job skills2.2. Difficulty performing familiar tasksDifficulty performing familiar tasks3.3. Problems with languageProblems with language4.4. Disorientation to time and placeDisorientation to time and place5.5. Poor or Poor or ↓↓ judgment judgment6.6. Problems with abstract thinkingProblems with abstract thinking
• Early signs of Alzheimer’s diseaseEarly signs of Alzheimer’s disease1.1. Memory loss that affects job skillsMemory loss that affects job skills2.2. Difficulty performing familiar tasksDifficulty performing familiar tasks3.3. Problems with languageProblems with language4.4. Disorientation to time and placeDisorientation to time and place5.5. Poor or Poor or ↓↓ judgment judgment6.6. Problems with abstract thinkingProblems with abstract thinking
• Categorized similarly to those for Categorized similarly to those for dementiadementia• MildMild• ModerateModerate• LateLate
• Progression is variable from person to Progression is variable from person to person and ranges from 3 to 20 yearsperson and ranges from 3 to 20 years
• Categorized similarly to those for Categorized similarly to those for dementiadementia• MildMild• ModerateModerate• LateLate
• Progression is variable from person to Progression is variable from person to person and ranges from 3 to 20 yearsperson and ranges from 3 to 20 years
• Initial sign is subtle deterioration in Initial sign is subtle deterioration in memorymemory
• Inevitably progresses to more Inevitably progresses to more profound memory lossprofound memory loss
• Manifestations easier to recognize Manifestations easier to recognize when family members or patient when family members or patient seeks medical helpseeks medical help
• Initial sign is subtle deterioration in Initial sign is subtle deterioration in memorymemory
• Inevitably progresses to more Inevitably progresses to more profound memory lossprofound memory loss
• Manifestations easier to recognize Manifestations easier to recognize when family members or patient when family members or patient seeks medical helpseeks medical help
• Recent events and new information Recent events and new information cannot be recalledcannot be recalled
• Behavioral manifestations are not Behavioral manifestations are not intentional or controllable because of intentional or controllable because of ongoing loss of neuronsongoing loss of neurons
• Some develop psychotic Some develop psychotic manifestationsmanifestations
• Recent events and new information Recent events and new information cannot be recalledcannot be recalled
• Behavioral manifestations are not Behavioral manifestations are not intentional or controllable because of intentional or controllable because of ongoing loss of neuronsongoing loss of neurons
• Some develop psychotic Some develop psychotic manifestationsmanifestations
• In AD that has progressedIn AD that has progressed• DysphasiaDysphasia• ApraxiaApraxia• Visual agnosiaVisual agnosia• DysgraphiaDysgraphia• Some long-term memory lossSome long-term memory loss• WanderingWandering
• In AD that has progressedIn AD that has progressed• DysphasiaDysphasia• ApraxiaApraxia• Visual agnosiaVisual agnosia• DysgraphiaDysgraphia• Some long-term memory lossSome long-term memory loss• WanderingWandering
• Late stagesLate stages• Long-term memory lossLong-term memory loss• Unable to communicateUnable to communicate• Cannot perform activities of daily Cannot perform activities of daily
living (ADLs)living (ADLs)• Patient may be unresponsive and Patient may be unresponsive and
incontinent, requiring total careincontinent, requiring total care
• Late stagesLate stages• Long-term memory lossLong-term memory loss• Unable to communicateUnable to communicate• Cannot perform activities of daily Cannot perform activities of daily
living (ADLs)living (ADLs)• Patient may be unresponsive and Patient may be unresponsive and
incontinent, requiring total careincontinent, requiring total care
• Diagnosis of exclusionDiagnosis of exclusion• No single clinical testNo single clinical test• Made once all other possible conditions Made once all other possible conditions
causing cognitive impairment have causing cognitive impairment have been ruled outbeen ruled out
• Diagnosis of exclusionDiagnosis of exclusion• No single clinical testNo single clinical test• Made once all other possible conditions Made once all other possible conditions
causing cognitive impairment have causing cognitive impairment have been ruled outbeen ruled out
• Neuropsychologic testing can help Neuropsychologic testing can help document degree of cognitive document degree of cognitive impairmentimpairment• Mini mental state examinationMini mental state examination• Also used to determine a baseline to Also used to determine a baseline to
evaluate change over timeevaluate change over time
• Neuropsychologic testing can help Neuropsychologic testing can help document degree of cognitive document degree of cognitive impairmentimpairment• Mini mental state examinationMini mental state examination• Also used to determine a baseline to Also used to determine a baseline to
evaluate change over timeevaluate change over time
• Depression often treated with Depression often treated with selective serotonin reuptake selective serotonin reuptake inhibitors inhibitors • May help with sleep problemsMay help with sleep problems
• Depression often treated with Depression often treated with selective serotonin reuptake selective serotonin reuptake inhibitors inhibitors • May help with sleep problemsMay help with sleep problems
• Subjective dataSubjective data• Past health historyPast health history• MedicationsMedications• Health perception Health perception • Nutritional state Nutritional state • Eliminating properly—incontinence Eliminating properly—incontinence
• Subjective dataSubjective data• Past health historyPast health history• MedicationsMedications• Health perception Health perception • Nutritional state Nutritional state • Eliminating properly—incontinence Eliminating properly—incontinence
• Subjective data (cont’d)Subjective data (cont’d)• Activity-exercise habits and stateActivity-exercise habits and state• Sleep-rest patternSleep-rest pattern• Cognitive-perceptual stateCognitive-perceptual state
• Subjective data (cont’d)Subjective data (cont’d)• Activity-exercise habits and stateActivity-exercise habits and state• Sleep-rest patternSleep-rest pattern• Cognitive-perceptual stateCognitive-perceptual state
• Overall goals for caregiver of a Overall goals for caregiver of a patientpatient• Reduce caregiver stressReduce caregiver stress• Maintain personal, emotional, and Maintain personal, emotional, and
physical healthphysical health• Cope with long-term effects associated Cope with long-term effects associated
with caregivingwith caregiving
• Overall goals for caregiver of a Overall goals for caregiver of a patientpatient• Reduce caregiver stressReduce caregiver stress• Maintain personal, emotional, and Maintain personal, emotional, and
physical healthphysical health• Cope with long-term effects associated Cope with long-term effects associated
• No known method to reduce risk of ADNo known method to reduce risk of AD• Antioxidants may be of benefitAntioxidants may be of benefit• Promote safety in physical activities and Promote safety in physical activities and
drivingdriving• Recognize and treat depressionRecognize and treat depression• Genetic testing not performed on regular Genetic testing not performed on regular
basisbasis
• No known method to reduce risk of ADNo known method to reduce risk of AD• Antioxidants may be of benefitAntioxidants may be of benefit• Promote safety in physical activities and Promote safety in physical activities and
drivingdriving• Recognize and treat depressionRecognize and treat depression• Genetic testing not performed on regular Genetic testing not performed on regular
• Nurse should also assess family Nurse should also assess family members and their ability to cope members and their ability to cope and accept diagnosisand accept diagnosis
• Ongoing monitoring importantOngoing monitoring important• Work in collaboration with patient’s Work in collaboration with patient’s
caregivercaregiver• Teach caregiver how to manage careTeach caregiver how to manage care
• Nurse should also assess family Nurse should also assess family members and their ability to cope members and their ability to cope and accept diagnosisand accept diagnosis
• Ongoing monitoring importantOngoing monitoring important• Work in collaboration with patient’s Work in collaboration with patient’s
caregivercaregiver• Teach caregiver how to manage careTeach caregiver how to manage care
• AD patients subject to other health AD patients subject to other health care problemscare problems
• Inability to communicate symptoms Inability to communicate symptoms places responsibility on caregiver places responsibility on caregiver and health care professionalsand health care professionals
• Hospitalization can precipitate a Hospitalization can precipitate a worsening of disease or deliriumworsening of disease or delirium
• AD patients subject to other health AD patients subject to other health care problemscare problems
• Inability to communicate symptoms Inability to communicate symptoms places responsibility on caregiver places responsibility on caregiver and health care professionalsand health care professionals
• Hospitalization can precipitate a Hospitalization can precipitate a worsening of disease or deliriumworsening of disease or delirium
Alzheimer’s DiseaseAlzheimer’s DiseaseAmbulatory and Home CareAmbulatory and Home Care
• Demands on caregiver can exceed Demands on caregiver can exceed resources and total care is neededresources and total care is needed
• Person may need to be placed in a Person may need to be placed in a long-term care facility long-term care facility • Special units for AD patients are Special units for AD patients are
growing in long-term care facilities growing in long-term care facilities • Emphasis on safetyEmphasis on safety
• Demands on caregiver can exceed Demands on caregiver can exceed resources and total care is neededresources and total care is needed
• Person may need to be placed in a Person may need to be placed in a long-term care facility long-term care facility • Special units for AD patients are Special units for AD patients are
growing in long-term care facilities growing in long-term care facilities • Emphasis on safetyEmphasis on safety
• Behavior is unpredictable Behavior is unpredictable • Can be challenging for caregiverCan be challenging for caregiver• Behaviors are not intentional and Behaviors are not intentional and
difficult to controldifficult to control• Often lead to placement in Often lead to placement in
institutional settingsinstitutional settings
• Behavior is unpredictable Behavior is unpredictable • Can be challenging for caregiverCan be challenging for caregiver• Behaviors are not intentional and Behaviors are not intentional and
difficult to controldifficult to control• Often lead to placement in Often lead to placement in
• Are a patient’s way of responding to Are a patient’s way of responding to precipitating factorprecipitating factor• PainPain• FrustrationFrustration• Temperature extremesTemperature extremes• AnxietyAnxiety
• Are a patient’s way of responding to Are a patient’s way of responding to precipitating factorprecipitating factor• PainPain• FrustrationFrustration• Temperature extremesTemperature extremes• AnxietyAnxiety
• AD patients can experience AD patients can experience sundowningsundowning• Specific type of agitationSpecific type of agitation• Patient becomes more confused and Patient becomes more confused and
agitated in late afternoon or eveningagitated in late afternoon or evening• Cause is unclearCause is unclear• Remain calm and avoid confrontationRemain calm and avoid confrontation
• AD patients can experience AD patients can experience sundowningsundowning• Specific type of agitationSpecific type of agitation• Patient becomes more confused and Patient becomes more confused and
agitated in late afternoon or eveningagitated in late afternoon or evening• Cause is unclearCause is unclear• Remain calm and avoid confrontationRemain calm and avoid confrontation
• Nursing interventions: SundowningNursing interventions: Sundowning• Create a quiet, calm environmentCreate a quiet, calm environment• Maximize exposure to daylightMaximize exposure to daylight• Evaluate medicationsEvaluate medications• Limit naps and caffeineLimit naps and caffeine• Consult health care provider on drug Consult health care provider on drug
therapytherapy
• Nursing interventions: SundowningNursing interventions: Sundowning• Create a quiet, calm environmentCreate a quiet, calm environment• Maximize exposure to daylightMaximize exposure to daylight• Evaluate medicationsEvaluate medications• Limit naps and caffeineLimit naps and caffeine• Consult health care provider on drug Consult health care provider on drug
• RisksRisks• Injury from fallsInjury from falls• Ingesting dangerous substancesIngesting dangerous substances• WanderingWandering• Injury to others and self Injury to others and self • Fire or burnsFire or burns• Inability to respond to crisisInability to respond to crisis
• RisksRisks• Injury from fallsInjury from falls• Ingesting dangerous substancesIngesting dangerous substances• WanderingWandering• Injury to others and self Injury to others and self • Fire or burnsFire or burns• Inability to respond to crisisInability to respond to crisis
• Pain should be recognized and Pain should be recognized and treated promptlytreated promptly• Monitor patient’s responseMonitor patient’s response• Patients can have difficulty Patients can have difficulty
communicating complaintscommunicating complaints• May exhibit changes in behaviorMay exhibit changes in behavior
• Pain should be recognized and Pain should be recognized and treated promptlytreated promptly• Monitor patient’s responseMonitor patient’s response• Patients can have difficulty Patients can have difficulty
communicating complaintscommunicating complaints• May exhibit changes in behaviorMay exhibit changes in behavior
Alzheimer’s DiseaseAlzheimer’s DiseaseEating and Swallowing DifficultiesEating and Swallowing Difficulties
• Undernutrition problem in middle Undernutrition problem in middle and late stagesand late stages• Loss of interest in foodLoss of interest in food• Decreased ability to self-feedDecreased ability to self-feed• Comorbid conditionsComorbid conditions
• Undernutrition problem in middle Undernutrition problem in middle and late stagesand late stages• Loss of interest in foodLoss of interest in food• Decreased ability to self-feedDecreased ability to self-feed• Comorbid conditionsComorbid conditions
Alzheimer’s DiseaseAlzheimer’s DiseaseEating and Swallowing DifficultiesEating and Swallowing Difficulties
• When chewing and swallowing When chewing and swallowing become difficult usebecome difficult use• Pureed foodPureed food• Thickening liquidsThickening liquids• Nutritional supplementsNutritional supplements
• Quiet and unhurried environmentQuiet and unhurried environment• Easy-grip utensilsEasy-grip utensils
• When chewing and swallowing When chewing and swallowing become difficult usebecome difficult use• Pureed foodPureed food• Thickening liquidsThickening liquids• Nutritional supplementsNutritional supplements
• Quiet and unhurried environmentQuiet and unhurried environment• Easy-grip utensilsEasy-grip utensils
• CommonCommon• Urinary tract infectionUrinary tract infection• PneumoniaPneumonia• Ultimately cause of death in many AD Ultimately cause of death in many AD
patientspatients
• Manifestations need prompt Manifestations need prompt evaluation and treatmentevaluation and treatment
• CommonCommon• Urinary tract infectionUrinary tract infection• PneumoniaPneumonia• Ultimately cause of death in many AD Ultimately cause of death in many AD
patientspatients
• Manifestations need prompt Manifestations need prompt evaluation and treatmentevaluation and treatment
Alzheimer’s DiseaseAlzheimer’s DiseaseSkin CareSkin Care
• In late stages patient at risk for skin In late stages patient at risk for skin breakdown breakdown • Incontinence, immobility, and Incontinence, immobility, and
undernutritionundernutrition• Tend to rashes, areas of rednessTend to rashes, areas of redness• Keep skin dry and cleanKeep skin dry and clean• Change patient’s position regularlyChange patient’s position regularly
• In late stages patient at risk for skin In late stages patient at risk for skin breakdown breakdown • Incontinence, immobility, and Incontinence, immobility, and
undernutritionundernutrition• Tend to rashes, areas of rednessTend to rashes, areas of redness• Keep skin dry and cleanKeep skin dry and clean• Change patient’s position regularlyChange patient’s position regularly
Alzheimer’s DiseaseAlzheimer’s DiseaseCaregiver SupportCaregiver Support
• Work with caregiver to Work with caregiver to • Assess stressors Assess stressors • Identify coping strategies Identify coping strategies • Find a support group Find a support group
• Local Alzheimer Association chapterLocal Alzheimer Association chapter
• Work with caregiver to Work with caregiver to • Assess stressors Assess stressors • Identify coping strategies Identify coping strategies • Find a support group Find a support group
• Local Alzheimer Association chapterLocal Alzheimer Association chapter
and toileting with assistance as neededand toileting with assistance as needed• Experiences no injuryExperiences no injury• Uses assistive devices appropriately for Uses assistive devices appropriately for
ambulation supportambulation support
• Patient goalsPatient goals• Functions at highest level of cognitive Functions at highest level of cognitive
and toileting with assistance as neededand toileting with assistance as needed• Experiences no injuryExperiences no injury• Uses assistive devices appropriately for Uses assistive devices appropriately for
• Patient goals (cont’d)Patient goals (cont’d)• Uses effective coping strategies to Uses effective coping strategies to
manage grief related to diagnosis of ADmanage grief related to diagnosis of AD• Verbalizes reality of health situationVerbalizes reality of health situation• Remains in restricted area during Remains in restricted area during
ambulation and activityambulation and activity
• Patient goals (cont’d)Patient goals (cont’d)• Uses effective coping strategies to Uses effective coping strategies to
manage grief related to diagnosis of ADmanage grief related to diagnosis of AD• Verbalizes reality of health situationVerbalizes reality of health situation• Remains in restricted area during Remains in restricted area during
Other Neurodegenerative Other Neurodegenerative DiseasesDiseases
• Creutzfeldt-Jakob disease (CJD)Creutzfeldt-Jakob disease (CJD)• Rare and fatal brain disorderRare and fatal brain disorder• Caused by a prion proteinCaused by a prion protein
• Creutzfeldt-Jakob disease (CJD)Creutzfeldt-Jakob disease (CJD)• Rare and fatal brain disorderRare and fatal brain disorder• Caused by a prion proteinCaused by a prion protein
Other Neurodegenerative Other Neurodegenerative DiseasesDiseases
• Pick’s diseasePick’s disease• Type of frontotemporal dementiaType of frontotemporal dementia• Rare brain disorderRare brain disorder• Characterized byCharacterized by
• Disturbances in behaviorDisturbances in behavior• Sleep Sleep • PersonalityPersonality• Eventual memory lossEventual memory loss
• Pick’s diseasePick’s disease• Type of frontotemporal dementiaType of frontotemporal dementia• Rare brain disorderRare brain disorder• Characterized byCharacterized by
• Disturbances in behaviorDisturbances in behavior• Sleep Sleep • PersonalityPersonality• Eventual memory lossEventual memory loss
Other Neurodegenerative Other Neurodegenerative DiseasesDiseases
• Normal-pressure hydrocephalusNormal-pressure hydrocephalus• Uncommon disorderUncommon disorder• Characterized by obstruction in the Characterized by obstruction in the
flow of CSF causing a buildup of fluid flow of CSF causing a buildup of fluid in brainin brain
• Normal-pressure hydrocephalusNormal-pressure hydrocephalus• Uncommon disorderUncommon disorder• Characterized by obstruction in the Characterized by obstruction in the
flow of CSF causing a buildup of fluid flow of CSF causing a buildup of fluid in brainin brain
Other Neurodegenerative Other Neurodegenerative DiseasesDiseases
• Normal-pressure hydrocephalus Normal-pressure hydrocephalus (cont’d)(cont’d)• If diagnosed early, disease is treatable If diagnosed early, disease is treatable
by surgeryby surgery• Shunt is inserted to divert fluid away Shunt is inserted to divert fluid away
from brainfrom brain
• Normal-pressure hydrocephalus Normal-pressure hydrocephalus (cont’d)(cont’d)• If diagnosed early, disease is treatable If diagnosed early, disease is treatable
by surgeryby surgery• Shunt is inserted to divert fluid away Shunt is inserted to divert fluid away