Alzheimer's Disease

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Alzheimer's Disease
2014-05-03 20:57:32
alzheimer neuro

review of Alzheimer's lecture 4/25
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  1. Dementia is not a disease in and of itself, but a collection of:
  2. According to DSM, the diagnostic criteria for dementia is:
    • loss of intellectual abilities severe enough to interfere w/ function
    • memory impairment including recent and remote memory
    • plus at lease one of the following
    • -impaired abstract thinking
    • -impaired judgement
    • -other disturbances of higher cortical function including aphasia, apraxia, agnosia, constructional difficulty, inability to perform self-care, emotional and personality changes
  3. Reversible dementias include:
    • psychiatric disorders (depression, anxiety, and psychosis)
    • medication side affects/polpharmacy
    • nutritional disorders
    • metabolic disorder
    • obstructive or normal pressure hydrocephalus
  4. Irreversible dementias include:
    • Alzheimer's
    • Vascular dementia
    • multi infarct dementia
    • AIDS Dementia
    • MS Dementia
    • Parkinson's dementia
    • frontotemporal dementia
    • Huntington's dementia
    • Pick's disease
    • Lewy Body dementia
  5. What is Alzheimer's disease?
    irreversible, progressive brain disease that slowly destroys memory and thinking skills
  6. Neurons:
    • the brain has billions of neurons, each w/ an axon and many dendrites
    • to stay healthy, neurons must communicate w/ each other, carry out metabolism, and repair themselves
    • AD disrupts all three of these essential jobs
  7. The hallmarks of AD:
    plaques and tangles
  8. beta-amyloid plaques:
    dense deposits of protein and cellular material that accumulate outside and around nerve cells
  9. neurofibrillary tangles:
    twisted fibers that build up inside the nerve cell
  10. What is the precursor to amyloid plaque?
    amyloid precursor protein (APP)
  11. Amyloid precursor protein:
    • sticks through the neuron membrane
    • enzymes cut the APP into fragments of protein, including beta-amyloid
    • beta-amyloid fragments come together in clumps to form plaques
  12. In AD, many beta-amyloid clumps form, disrupting the work of neurons. This affects the:
    hippocampus and other areas of the cerebral cortex
  13. Neurons have an internal support structure partly made up of microtubules.  A protein called tau helps stabilize microtubules.  In AD, tau changes, causing...
    microtubules to collapse, and tau proteins clump together to form neurofibrillary tangles
  14. Epidemiologic studies:
    • mentally stimulating activity protects the brain in some ways
    • exercise has equally protective highlights
    • in early life, higher skills in grammar and density of ideas are associated w/ protection against AD in late life
  15. Early diagnosis has advantages:
    • doctors can rule out other conditions that may cause dementia
    • if it is AD, families have more time to plan
    • tx can start earlier, when they may be more effective
    • helps scientists learn more about the causes and development of AD
  16. Physicians today use a number of tools to diagnose AD:
    • a detailed pt history
    • info from family and friends
    • physical and neurological exams and lab tests
    • neuropsychological tests
    • imaging tools such as CT scan, or MRI. PET scans are used primarily for research purposes
  17. Drugs used to treat mild to moderate AD symptoms include:
    • aricept
    • exelon
    • reminyl
    • namenda (mod-severe)
  18. Signs of preclinical AD are first noticed in the...
    entorhinal cortex, then proceed to hippocampus
  19. Preclinical AD affected regions begin to shrink as...
    nerve cells die
  20. Preclinical AD changes can begin ___-___ years before symptoms appear.
  21. what is the first sign of preclinical AD?
    memory loss
  22. What are the stages of AD?
    • preclinical
    • mild
    • moderate
    • severe
  23. In mild AD, the cerebral cortex begins to shrink as more and more neurons stop working and die.  Goals are:
    to help the person cope w/ the changes and maintain their independence
  24. Mild AD deficits can include:
    • impaired learning and recent memory
    • impaired ability to attend to a specific stimulus in a complex environment
    • misplacing/losing personal possessions
    • word finding/anomia
  25. Intervention for mild AD may include:
    • memory aids
    • central and same location for possessions
    • use of routine and habit
    • ask simple questions
    • allow extra time
    • avoid correcting errors
    • respect denial as a coping skill
    • protect safety
  26. Mild Cognitive Impairment (MCI)
    • research indicates that improved performance is possible, but no standardized intervention approach
    • skill-building through task-oriented motor practice (STOMP)
  27. Skill-building through Task-Oriented Motor Practice (STOMP):
    • motor learning approach using mass practice
    • preliminary results indicate improvement in everyday tasks that is maintained three months post intervention
  28. Moderate AD intervention is focused on:
    changing the environment and helping caregivers to cope while helping the person live in as least restrictive environment possible
  29. Moderate AD deficits:
    • confusion and disorientation
    • safety concerns
    • difficulties w/ self-care
    • perservation
    • sleep disturbances
    • angry outbursts and agitation
  30. Moderate AD intervention:
    • use repetition
    • minimize distractions
    • focus on big picture v. detail
    • change environment for safety
    • simple one step instructions
    • use humor
    • use distraction when appropriate
    • encourage regular exercise and sleep habits
    • be calm
  31. In severe AD, extreme shrinkage occurs in the brain.  Pts are completely dependent on other for care.  this stage ultimately results in:
    death as the person's brain can't support bodily functions
  32. Symptoms of severe AD:
    • decreased recognition of family and familiar places
    • unable to dress
    • eating problems
    • incontinence
    • immobility
    • skin breakdown
  33. Severe AD intervention:
    • use routine
    • links from the past and environmental cues
    • promote automatic overlearned movement
    • use reassurance and repetition
    • avoid correcting
    • avoid rushing
    • eliminate safety hazards
  34. B/w 70-90% of people w/ AD eventually develop behavioral symptoms, including:
    sleeplessness, wandering and pacing, aggression, agitation, anger, depression, and hallucinations and delusions
  35. Experts suggest theses general coping strategies for managing difficult behaviors:
    • stay calm and be understanding
    • be patient and flexible.  Don't argue or try to convince
    • acknowledge requests and respond to them
    • try not to take behaviors personally.  Remember: it's the disease talking, not your loved one
    • medical tx is available if needed
  36. Common Behavioral issues:
    • losing important things
    • getting lost
    • repeated calls
    • refusing help
    • bad mouthing
    • making up stories
    • resisting/refusing care
    • making 911 calls
    • not sleeping
    • emotional meltdowns
    • swearing, sex talk, racial slurs, insulting
    • paranoid/delusional
    • threatening
    • shadowing
    • wandering
    • getting into things
    • striking out
    • not doing personal care
    • not following care plan
  37. List in order the most common caregivers:
    • spouses
    • daughters
    • grandchildren
    • daughters-in-law
    • sons
    • brothers and sisters
    • other