Chapter Five: Alzheimer's Disease

Introduction

• Alzheimer's Disease: A progressive disease that affects cognitive function.
• Cognition: The ability to think logically.
• Cognitive Impairment: The inability to think clearly.

Symptoms of Cognitive Impairment

• Slower reaction times.
• Trouble finding or using the right words.
• Sleep disturbances.
• Impaired motor skills.
• Dementia: General term that refers to serious loss of abilities such as thinking, remembering, reasoning, and communicating.

Common Types of Dementia

• Alzheimer’s Disease
• Multi-infarct or Vascular Dementia
• Lewy Body Dementia
• Parkinson’s Disease
• Huntington’s Disease

Impact on Daily Living

• Difficulty performing daily activities (eating, bathing, dressing, toileting).
• May forget common items like a toothbrush or misuse everyday objects.
• Alzheimer's is the most common cause of dementia in the elderly.
• Alzheimer's is characterized by tangled nerve fibers in the brain.
• Symptoms vary depending on where in the brain the nerve fibers grow.

Incidence and Demographics

• Alzheimer's Association: 5.2 million Americans living with Alzheimer’s.
• 1 in 8 older Americans has Alzheimer’s.
• Women more likely to have Alzheimer's than men.

Care and Management Strategies

Encouraging Independence

• Help with Activities of Daily Living (ADLs) but encourage the patient to do as much as possible by themselves.
• May help slow the progression of Alzheimer’s.

Communication Tips

• Approach from the front to avoid startling.
• Communicate in a calm and quiet area.
• Identify oneself and use the patient's name.
• Speak slowly in a lower tone of voice, repeat if necessary.
• Break complex tasks into smaller, manageable steps.
• Use gestures and pictures for better communication.

Managing Agitation and Behavioral Issues

• Sundowning: Increased confusion and restlessness in the evening.
• Triggers: Identifying and removing triggers that cause agitation.
• Violent Behavior: Avoid leaving the patient alone and step out of reach if they become violent.
• Hallucinations and Delusions: Know the difference; use redirection techniques.
• Repetitive Phrasing (Preservation): Answer consistently and use distraction techniques.

Support Strategies

• Routine and Consistency: Maintain a regular schedule.
• Privacy and Sensitivity: Provide privacy and be sensitive to their needs.
• Exercise and Activities: Encourage regular physical activities and hobbies.
• Safety Precautions: Implement safety measures like non-slip mats and clearly marked bathrooms.
• Adaptive Equipment: Use special utensils and plates to assist with eating.
• Nutrition: Offer easy-to-eat, nutritious foods that can be consumed on-the-go.

Addressing Specific Issues

• Bathing: Schedule during a calm time, prepare the environment, and ensure safety.
• Grooming and Dressing: Offer choices and avoid interruptions.
• Toilet Use: Encourage fluid intake, establish a routine, and use clearly marked bathrooms.
• Sleep Disturbances: Ensure exercise during the day, reduce evening stimuli, and minimize daytime napping.

Creative Therapies

• Reality Orientation: Useful in early stages for reminding patients of time and place.
• Validation Therapy: Useful in moderate to severe stages for accepting the patient's reality.
• Reminiscence Therapy: Encourage discussion of past events to stimulate memory.
• Activity Therapy: Engage in activities that bring joy and stimulate the mind.
• Music Therapy: Use music to evoke responses and improve communication.

Legal and Ethical Considerations

• Abuse: Legally required to report any suspected abuse.
• Professional Responsibility: Maintain a high standard of care and empathy.