Alzheimer’s Disease

Course 120

Two contact hours

Monica Oram, RN, BSN

Upon completion of this course, the reader will be able to identify the following objectives:

Understand the definition of Alzheimer’s Disease Understand the pathophysiology of what causes AD Understand what types of individuals are at risk for AD Understand treatment modalities for AD Differentiate between stages of dementia Understand how to deal with problem behavior

Understanding Alzheimer Disease

Alzheimer’s Disease, (here on out referred to as AD), was discovered in 1906 by a German scientist named Alois Alzheimer. AD is a disease of the brain which is a progressive worsening and debilitating dementia that affects the mind and the intellect.

Although some intellectual dysfunction is a natural result of the aging process, the dementia caused by Alzheimer’s disease is by no means natural. Life expectancy after diagnosis of the onset of symptoms ranges from 5-20 years, with an average expectancy of 8 years. The course of the disease progression is different for all individuals.

AD affects the body’s immune system, therefore it is correct to say that a person really does not die FROM Alzheimer’s, but rather from complications associated with the disease itself.

AD is a serious disease that interferes with memory and mental abilities.

AD most often affects individuals over the age of 65, but can affect those as young as 50. When a person develops dementia before the age of 65, they are said to have PRE-SENILE DEMENTIA. When the person develops dementia after the age of 65, they are said to have SENILE DEMENTIA.

The term dementia simply means old. It is denoted as a loss of mental faculties. The medical dictionary ( Mosby: Medical, Nursing, and Allied Health Dictionary: sixth edition,2002) sums it up as:

Dementia /dimen shea/ (mens=mind): A progressive organic mental disorder characterized by chronic personality disintegration, confusion, disorientation, stupor, deterioration of intellectual capacity and function, and impairment of control of memory, judgment, and impulses. Dementia caused by drug intoxication, hyperthyroidism, pernicious anemia, paresis, subdural hematoma, benign brain tumor, hydrocephalus, insulin shock, and tumor of islet cells of the pancreas are all types of dementia that can be reversed by treating the condition. Alzheimer’s Disease, Pick’s Disease, and other organic forms of dementia are considered non- reversible types of dementia. They are progressive and incurable. However, CONDITIONS that cause the decline may be treatable or partially reversible. Kinds of dementia include: (though there are about 140 types known….)

Dementia paralytica Pick’s Disease Secondary dementia Senile dementia- Alzheimer’s type Toxic dementia

AD gets progressively worse over time. It is a degenerative condition that is irreversible and has no cure. AD can only be DEFINITIVELY and ACCURATELY diagnosed on an autopsy, so then why is it so many people are diagnosed with AD when they are still alive, if we can’t be sure unless an autopsy is done?

DIAGNOSING AD

AD is diagnosed by a series of tests and symptoms. Basically, AD is ruled out by exception. This means that a physician has to determine what IT IS NOT, before he or she can determine that the person may have AD. By a series of examinations, a medical history, a medication profile, and a look at family history, can all provide clues to the diagnosis of AD.

AD is common. People once believed that the loss of memory- senility- was part of “just getting old”. Scientists today agree that AD- NOT OLD AGE- is the major cause of progressive memory loss in people over the age of 65.

By ruling out other conditions that resemble AD, a doctor can have a more sophisticated idea that a more accurate diagnosis is determined before labeling a person as having AD.

Neurological testing: A patient’s brain functions can be tested in a number of ways.

These tests would include:

EEG ( electroencephalogram) CT Scan ( computerized tomography) MRI ( magnetic resonance imaging) Memory cards and evaluations

Psychological testing: A psychologist or psychiatrist determines a patient’s mental status by using a variety of testing, including the following:

A full clinical interview Tests to determine memory loss and general mental health

In many cases, another cause of the symptoms are found, and then treated.

When the German Scientist, Alois Alzheimer did a study on a 56 yr old woman, he found that she was becoming more and more forgetful, as she could not remember the names of simple objects she was shown. Taking such an active interest in this case, He preformed an autopsy on the woman when she died. What he found was by using a new tissue - staining technique, which was on the cutting edge of technology in 1906, he discovered an odd disorganization of the nerve cells in the cerebral cortex, (the part of the brain responsible for memory and reasoning) The cells were all bunched together like ropes tied in knots. These became known as AMYLOID PLAQUES and NEUROFIBRILLARY TANGLES . He also noticed an unexpected amount of accumulation of cellular debris around the affected nerves.