Chapter 60: Alzheimer’s Disease and 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
Depression is often mistaken for dementia in older adults, and, conversely, dementia for
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,
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
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
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