Alzheimer's Disease Lecture Notes

Overview

• Alzheimer's disease is a chronic brain disease, a type of dementia.
• Most common form of dementia affecting neuron communication.
• Neurons lose ability to communicate, leading to cell death.

Pathophysiology

• Beta Amyloid Plaques

  • Form outside the neuron, impacting communication.
  • Cause inflammation, neuron death.

• Neurofibrillary Tangles

  • Form inside neuron, disrupting structure.
  • Made of Tau protein, compromises nutrient delivery.

Brain Impact

• Leads to brain atrophy and tissue shrinkage.
• Starts in the central part, spreading to cerebral cortex.
• Affects different brain regions over time:
  • Hippocampus: Memory and learning.
  • Entorhinal Area: Time understanding, memory.
  • Amygdala: Emotional response.

Symptoms

• Progressive memory loss, learning problems, behavioral changes.
• Severe mood swings, depression, and loss of self-care abilities.

Risk Factors

• Age (over 65), genetics, gender (female), ethnicity (Hispanics, African Americans).
• Lifestyle factors: smoking, diabetes, heart disease.

Interesting Facts

• 5th leading cause of death in adults 65+.
• Estimated 6.2 million Americans affected (2021).
• Expected to rise to 14 million by 2060.

Stages of Alzheimer's

1. Pre-Clinical: Brain changes but no symptoms.
2. Mild Cognitive Impairment: Subtle memory changes.
3. Mild Alzheimer's: Recognizable forgetfulness, diagnosis often occurs.
4. Moderate Alzheimer's: Increased confusion, need for assistance.
5. Severe Alzheimer's: Severe symptoms, minimal communication, constant care.

Diagnostic Testing

• Cognitive assessments, brain imaging (MRI, CT, PET scans).
• Biomarkers via spinal tap for CSF testing.
• New blood tests for beta amyloid proteins.

Nursing Role and Care

• Involved in all stages from diagnosis to end-of-life care.
• 7 M's of Alzheimer's Care: Memory, Movement, Mental Health, Maintain Safety, Maximize Communication, Medical Needs, Medications.
• Caregiver education on signs, symptoms, and safety.

Communication Tips

• Use simple, clear instructions.
• Maintain eye contact and use non-verbal communication.
• Avoid correcting or arguing, be patient and supportive.

Medications

• Cholinesterase Inhibitors (Dr. G mnemonic): Donepezil, Rivastigmine, Galantamine.
  • Increase acetylcholine availability, may cause GI upset, bradycardia.
• NMDA Antagonists: Memantine.
  • Used for moderate to severe stages, may cause dizziness, constipation.
• Aducanumab: New IV medication targeting beta-amyloid plaques.

Conclusion

• No cure, but treatments available to manage symptoms.
• Early detection is key for management and planning.
• Ongoing research and development of new diagnostic and treatment options.