PRESENTATION
ALZHEIMER’S
DISEASE
Ali, Gaida Salona
Pulahong, Fatima Shareena
Samain, Kent
Rasonable, Jamee Maxinne
Victorio, Kyla Anne
INDEX
01 - Overview
02 - Pathophysiology
03 - Signs and Symptoms
04 - Nursing Diagnosis and Management
05 - Medications and Treatment
ALZHEIMER’S DISEASE
progressive
neurodegenerative
disorder
characterized by cognitive decline, memory loss,
and changes in behavior and personality
most common form of dementia, affecting primarily
older adults (60-80% of cases).
worsening symptoms may be experienced as the
disease advances, as individuals may require help
with daily activities and care.
Ongoing research continues to seek better
understanding, prevention, and treatment options
for Alzheimer's disease
DEMENTIA AND ALZHEIMER’S DISEASE
Dementia
broad term used to describe a decline
in cognitive function that interferes
with daily life.
a set of symptoms affecting memory,
cognition, and social skills, that can
be caused by various conditions,
including Alzheimer's disease.
Alzheimer's Disease:
Alzheimer's disease is the most common
form
Characterized by cognitive decline and
behavioral changes.
Caused by abnormal protein accumulation
in the brain, leading to nerve cell death and
tissue loss.
STAGES OF ALZHEIMER’S DISEASE
1. PRECLINICAL ALZHEIMER’S DISEASE
Stage before symptoms manifest
Symptoms aren't yet apparent, but detection is possible through advanced imaging
and biomarker tests.
Research aims to develop interventions to delay or prevent disease progression.
2. MILD COGNITIVE IMPAIRMENT (MCI) DUE TO AD
Individuals may start to experience mild cognitive decline,
such as forgetting recent events or having difficulty finding
words.
Daily functioning is generally not significantly impaired at
this stage.
3. MILD ALZHEIMER'S DISEASE
Symptoms become more noticeable and may include increased memory loss, difficulty
with problem-solving and planning
Individuals may also begin to experience mood changes or withdraw from social
activities.
4. MODERATE ALZHEIMER’S DISEASE
Cognitive decline becomes more pronounced, and individuals may require assistance
with daily activities
Memory loss worsens, and individuals may have difficulty recognizing family members or
familiar surroundings.
5. MODERATELY SEVERE ALZHEIMER’S DISEASE
Symptoms become more severe
Individuals may experience significant memory loss, confusion, and disorientation.
They may have difficulty communicating and require assistance with most daily
activities.
Behavioral symptoms such as agitation or aggression may also occur.
6. SEVERE ALZHEIMER’S DISEASE
Individuals lose the ability to communicate coherently and
may require round-the-clock care.
May be unable to recognize family members.
Physical symptoms such as difficulty swallowing or walking
may also develop.
7. END-STAGE ALZHEIMER’S DISEASE
completely dependent on others for care and may be bedridden.
may lose the ability to swallow, leading to complications such as infections or
aspiration pneumonia.
02 - PATHOPHYSIOLOGY
Predisposing Factors
Age. The risk for Alzheimer's goes up as you get older. For most people, it starts going up after age 65.
Gender. Women get the disease more often than men.
Family history. People who have a parent or sibling with Alzheimer’s are more likely to get it themselves.
Down syndrome. People with this disorder often get Alzheimer's disease in their 30s and 40s.
Head injury. Some studies have shown a link between Alzheimer's disease and a major head injury.
Other factors. High cholesterol levels and high blood pressure may also raise your risk.
02 - PATHOPHYSIOLOGY
Gross Pathophysiologic Changes
cortical atrophy
enlarged ventricles
basal ganglia wasting
Microscopically
changes in the proteins of the nerve cells of the cerebral cortex
accumulation of neurofibrillary tangles and neuritic plaques
granulovacuolar degeneration
loss of cholinergic nerve cells
Neurotransmitters Affected by AD
Acetylcholine - activates muscles and helps with arousal, short-term
memory, and learning. Some research suggests that plaques may be
one of the reasons for low levels of ACh.
Glutamate - is the most common neurotransmitter in the brain and is
involved in learning and memory. Excess glutamate becomes harmful
because it overstimulates healthy brain cells (a phenomenon called
excitotoxicity), causing them to become damaged or to die.
THE 4 A’S OF ALZHEIMER’S
Amnesia. Refers to loss of memory.
Aphasia. Loss of ability to express or understand speech.
Apraxia. Represents a loss in voluntary motor skills.
Agnosia. Occurs when the five senses can’t receive or or
correctly process information.
03 - SIGNS AND SYMPTOMS
Early Stage (Mild)
1. Short Term Memory Loss
2. Mild Cognitive Impairment
3. Difficulty with Problem-Solving
4. Language Problems
5. Misplacing Item
6. Changes in Mood and Personality
03 - SIGNS AND SYMPTOMS
Middle Stage (Moderate)
1. Increased Memory Loss
2. Disorientation
3. Difficulty with Activities of Daily Living
4. Behavioral Changes
5. Communication Problems
6. Impaired Judgment
7. Loss of Social Skills
03 - SIGNS AND SYMPTOMS
Late Stage (Severe)
1. Severe Memory Loss
2. Complete Dependence
3. Loss of Motor Skills
4. Incontinence
5. Profound Disorientation
6. Inability to Communicate
7. Increased Susceptibility to Infections
8. Difficulty Swallowing
03 - SIGNS AND SYMPTOMS
Sundown Syndrome
Also referred to as SUNDOWNING.
A phenomenon in which a person with Alzheimer’s
disease experiences groups of symptoms during
late afternoon and lasting to evening hours.
Agitation
Confusion
Hallucinations
Increased Anxiety
Aggression
Wandering
Resistance to Care
Sleep Disturbances
Increased Vocalization
Hyperactivity
FORGETFULNESS
CONFUSION
DECLINE IN ACTIVITIES OF DAILY LIVING
04 - NURSING DIAGNOSES
1.
2.
3.
Altered Behavior
Ineffective Coping
Disturbed Thought Process
NURSING MANAGEMENT
Maintain simple, consistent routines
Encourage independence as much as possible while ensuring the safety of
the client and other people.
Allow the patient sufficient time to answer your questions
Use a soft tone and a slow, calm manner when speaking to clients with AD
Client Statement: "I want to go home. My family is waiting for me."
Appropriate Nurse Response: "It sounds like you're feeling homesick and missing your
family. Let's sit down together and talk about some of your favorite memories with them.
Maybe we can find a way to bring some of that comfort here to you."
Institute music or reminiscence therapy
Minimize noise, clutter, and distractions in the environment
Facilitate social interactions
Promote physical activity
gentle exercises and activities
Administer ordered medications to the patient and note their effects
Identify triggers for delusions (DO NOT CONFRONT)
Distract from hallucinations and situations that produce
catastrophic reactions
Monitor for signs of DEPRESSION
changes in appetite, sleep disturbances, social withdrawal,
very confused , going downhill, behavior worsening
FIRST-LINE STRATEGIES: SUPPORT GROUPS AND OTHER
NONDRUG TREATMENTS
Talk therapy
Cognitive behavioral therapy
Cognitive stimulation therapy
Cognitive rehabilitation
“Life story work”
Music and art therapy
05 - MEDICATIONS/TREATMENT
The medications for Alzheimer’s depend on its
severity. They are classified as mild to moderate
and moderate to severe.
For general:
Brexpiprazole
an atypical antipsychotic that has been
approved to treat agitation associated
with Alzheimer’s.
FOR MILD TO MODERATE MEDICATIONS:
Cholinesterase inhibitors
prevent the breakdown of acetylcholine, a brain
chemical believed to be important for memory
and thinking.
Common side effects can include nausea,
vomiting and diarrhea
Examples: Donepezil, Galantamine, Rivastigmine
FOR MODERATE TO SEVERE MEDICATIONS:
N-methyl-D-aspartate (NMDA) antagonist
Example:
Memantine - It works by regulating the
activity of glutamate, a messenger
chemical
widely
involved
in
brain
functions — including learning and
memory.
Possible side effects include dizziness,
headache, diarrhea, constipation, and
confusion. Delivered once or twice a day
through a tablet, liquid, or an extendedrelease capsule.
OTHER FDA-APPROVED TREATMENT FOR ALZHEIMER'S:
Lecanemab (le-ka-na-mab)
Brand Name: Leqembi
Disease-modifying immunotherapy.
Delivered through IV over one hour every two weeks.
Treats mild cognitive impairment or mild Alzheimer’s by removing abnormal betaamyloid to help reduce the number of plaques in the brain.
Possible side effects include brain swelling and bleeding, headache, cough,
diarrhea, nausea, vomiting, fever, chills, body aches, fatigue, high blood pressure,
low blood pressure, and low oxygen.
References
Kumar, A. (2022, June 5). Alzheimer disease (nursing). StatPearls [Internet].
https://www.ncbi.nlm.nih.gov/books/NBK568805/
Slideshare. (2011, March 28). Alzheimer’s disease: Management. SlideShare.
https://www.slideshare.net/reynel89/alzheimers-disease-management
Stages of Alzheimer’s disease. (2024, February 29). Johns Hopkins Medicine.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/alzheimersdisease/stages-of-alzheimer-disease
Sundowning: Late-day confusion. (2022, May 27). Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/expertanswers/sundowning/faq-20058511