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BIOC33H3 (127)

Alzheimer’s Disease and Dementia

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Biological Sciences
Stephen Reid

Chapter 60: Alzheimer’s Disease and Dementia DEMENTIA  Dementia is a syndrome characterized by dysfunction or loss of memory, orientation, attention, language, judgment, and reasoning. Personality changes and behavioral problems such as agitation, delusions, and hallucinations may result.  The two most common causes of dementia are neurodegenerative conditions (e.g., Alzheimer’s disease) and vascular disorders. Vascular dementia, also called multiinfarct dementia, is the loss of cognitive function resulting from ischemic, ischemic-hypoxic, or hemorrhagic brain lesions caused by cardiovascular disease.  Depending on the cause of the dementia, the onset of symptoms may be insidious and gradual or more abrupt. Often dementia associated with neurologic degeneration is gradual and progressive over time.  Regardless of the cause of dementia, the initial symptoms are related to changes in cognitive functioning. Patients may have complaints of memory loss, mild disorientation, and/or trouble with words and numbers.  An important first step in the diagnosis of dementia is a thorough medical, neurologic, and psychologic history. Also, mental status testing is an important component of the patient evaluation.  Depression is often mistaken for dementia in older adults, and, conversely, dementia for depression. MILD COGNITIVE IMPAIRMENT  Mild cognitive impairment (MCI) is a state of cognitive functioning that is below defined norms, yet does not meet the criteria for dementia.  Causes of MCI may include stress, anxiety, depression, or physical illness.  The nurse caring for the patient with MCI must recognize the importance of monitoring the patient for changes in memory and thinking skills that would indicate a worsening of symptoms or a progression to dementia. ALZHEIMER’S DISEASE  Alzheimer’s disease (AD) is a chronic, progressive, degenerative disease of the brain. It is the most common form of dementia.  The exact etiology of AD is unknown. Similar to other forms of dementia, age is the most important risk factor for developing AD.  Characteristic findings of AD relate to changes in the brain’s structure and function: (1) amyloid plaques, (2) neurofibrillary tangles, and (3) loss of connections between cells and cell death.  Multiple genetic factors have been linked to the development of AD. Inflammation is also believed to contribute to AD.  The manifestations of AD can be categorized similar to those for dementia as mild, moderate, and late.  An initial sign of AD is a subtle deterioration in memory. With progression of AD, additional cognitive impairments are noted, including dysphasia, apraxia, visual agnosia, and dysgraphia.  The diagnosis of AD is primarily a diagnosis of exclusion. No single clinical test can be used to diagnose AD.  At this time there is no cure for AD. The collaborative management of AD is aimed at (1) improving or controlling decline in cognition, and (2) controlling the undesirable behavioral manifestations that the patient may exhibit.  The diagnosis of AD is traumatic for both the patient and the family. It is not unusual for the patient to respond with depression, denial, anxiety and fear, isolation, and feelings of loss. The nurse is in an important position to assess for depression and suicidal ideation.  Currently, family members and friends care for the majority of individuals with AD in their homes. Others with AD reside in various facilities, including long-term care and assisted living facilities. Regardless of the setting, the severity of the problems and the amount of nursing care intensify over time.  As the patient with AD progresses to the late stages (severe impairment) of AD, there is increased difficulty with the most basic functions, including walking and talking. Total care is required.  Behavioral problems occur in about 90% of patients with AD. These problems include repetitiveness, delusions, illusions, hallucinations, agitation, aggression, altered sleeping patterns, wandering, and resisting care. Nursing strategies that address difficult behavior include
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