Alzheimer’s Disease
Definition
-most common type of dementia
-progressive and irreversible in deterioration in cognitive fxn
-selectively damages critical clusters of neurons in the cortex and limbic structures of CNS
S/S
-short-term memory impairment, wandering, poor judgment
-fxnal impairments: unable to assimilate and interpret new info
-visual-spatial fxn impaired
-personality changes, incontinence
-agitation, psychotic symptoms (paranoia, delusions, hallucinations)
-language skills eventually lost (aphasia, apraxia, agnosia)
Incidence/Prevalence
-10% of those 65+ are affected
-47% of those 85+ are affected
-women more often than men 2:1
-affects 4 million in US
-avg duration from onset to death is 8-10 yr
Risk Factors
-family hx of 1st degree relative
-family hx of Down syndrome
-genetic predisposition
-Hx of head injury with LOC
Pathophysiology
-exact cause unknown, current theories include:
-loss of neurotransmitter stimulation b choline acetyltransferase,
-mutation for encoding amyloid precursor protein
-alteration in apolipoprotein E (binds beta amyloid)
-accumulation of amyloid correlated with daydreaming and idle
thinking in young persons
-protein in neurons becomes distorted and twisted, forming a neurofibrillary tangle; tangles are bound by tau protein; groups of
nerve cells degenerate and coalesce around an amyloid core, forming senile plaques, which disrupt nerve-impulse
transmission
Alzheimer’s Disease
Therapy
Pharmocologic:
-donepezil / Aricept (5-10 mg QD)- cholinesterase inhibitor (reverses the inhibition of acetylcholinesterase in the brain); may
cause muscle relaxation, increase gastric acid secretion, may have vagotonic effects on heart
-memantine / Namenda (10 mg bid) blocks glutamate activity & slows progression
-NSAIDs: amyloid deposits and neuritic plaques are indicative of inflammation
-estrogen replacement: protective effect of estrogen as trophic hormones to cholinergic neurons
-antioxidants: selegiline, vitamin E, ginko biloba
-Lipitor may decrease amyloid deposits
-with depression, give SSRI as first line treatment, Tricyclic antidepressants not recommended because of anticholinergic
activity
Non-pharmacologic:
-modulate environment- decrease stimuli
-maintain routines
-expressive recreational activities
-exercise program
-read, watch news
-provide resources
Nursing Implications
-determine cognitive level using MMSE & gather info about pre-admission cognitive fxn
-assess for signs of depression: insomnia, poor appetite, flat affect, and withdrawn behavior
-determine normal routine and attempt to maintain them
-engage client in communication and maximize interaction and response
-decrease stimuli in environment (can decrease agitation)
Nursing Dx
-chronic confusion r/t Alzheimer’s
-compromised family coping r/t interrupted family processes
-adult failure to thrive r/t difficulty in reasoning, judgment, memory, concentration
-impaired memory r/t neurological disturbance
-wandering r/t cognitive impairment, frustration, physiological state
-risk for injury: risk factor: confusion
Client/Family
Education
-provide caregiver with info on illness processes, needed care, and what to expect in the future
-teach family how to converse with a memory-impaired person
-counsel family about resources regarding end-of-life decisions and legal concerns
-at terminal stages, provide info about hospice
Community
Resources
-Alzheimer’s Association: www.alz.org
-The 36 Hour Day by Nancy Mace and Peter Rabins
-www.caregiver.org
donepezil (don-pe-zil) (Aricept)
Dosage: 5-10 mg once daily
Indications: mild to moderate dementia associated with Alzheimer’s diseas
Actions: Improves cholinergic function by making more acetycholine available; enhances cognition and lessens dementia associated with
Alzheimer’s, but not cure the disease
Contraindications: Patient’s should not take this medication if they have cardiac disease, hx of ulcers, currently taking NSAIDS, hx of
seizures, hx of asthma, or hx of COPD
Adverse reactions: headache, abnormal dreams, depression, syncope, fatigue, hypertension, nausea, and anorexia


Pregnancy Category C
lorazapam (lor-az-e-pam) (Ativan)
Dosage (adults): 1-3mg 2 to 3 times/day
Indications: anxiety disorder, preoperative sedation, insomnia, panic disorder
Actions: depresses the CNS, inhibitory neurotransmitter, causes sedation, decreased anxiety, and decreased seizure
Contraindications: hypersensitivity, cross-sensitivity w/ other benzodiazapines, severe pain, sleep apnea, or pregnancy
Adverse reaction: dizziness, drowsiness, headache, confusion
Pregnancy Category D
memantine (me-man-teen) Namenda
Dosage (adult): 5 mg once daily initially, increase at weekly intervals to 10 mg daily (5 mg bid), then 15 mg per day (5 mg once daily, 10 mg once
daily, as separate doses), then to target dose of 20 mg daily (10 mg bid)
Indications: moderate to severe Alzheimer’s disease
Action: binds to CNS NMDA receptor sites preventing binding of glutamate, an excitatory neurotransmitter
Contraindications: severe renal impairment conditions that increase urine pH including severe UTI of renal tubular acidosis
Adverse reaction: dizziness, fatigue, headache, sedation, hypertension, rash, weight gain, anemia
 Pregnancy Category B