Alzheimer Disease Case Study
Alzheimer Disease Case Study
Alzheimer Disease Case Study
Alzheimer's disease (AD) affects the mental abilities including memory, language, and cognition.
Progressively it leads to dementia and death. AD usually arises in late middle age or the elderly but there is a rare
familial subtype that occurs earlier. Because AD is so well-known, other causes of dementia or memory loss may be
overlooked. Other possible diagnoses include normal aging (if very mild symptoms), emotional problems, fatigue,
depression, and certain medical conditions such as thyroid disease, brain tumors, multi-infarct disease, or
Huntington's disease. In its early stages, a correct diagnosis of AD can also be overlooked itself and misdiagnosed
as other conditions such as depression, dementia, simple forgetfulness, or senility.
• Early symptoms
• Progressing symptoms
judgment
• Later symptoms
o Normal motor function (AD affects the brain but not the body)
Diagnostic Tests:
Cognitive tests
CURABLE TYPE:
RARE TYPE:
Two types of AD exist: familial AD (FAD), which is found in families where AD follows a certain inheritance pattern; and sporadic
(seemingly random) AD, where no obvious inheritance pattern is seen. Because of differences in age at onset, AD is further
described as either early-onset (younger than 65 years old) or late-onset (65 years and older). Early-onset AD is rare and generally
affects people aged 30 to 60. Early-onset AD progresses faster than the more common, late-onset forms of AD.
Causes:
Cerebral hypoxia
After recovery from hypoxia (brought on by such conditions as carbon monoxide poisoning or acute respiratory failure), the
patient may experience total amnesia for the event, along with sensory disturbances, such as numbness and tingling.
Head trauma
Depending on the trauma’s severity, amnesia may last for minutes, hours, or longer. Usually, the patient experiences brief
retrograde and longer anterograde amnesia as well as persistent amnesia about the traumatic event. Severe head trauma can
cause permanent amnesia or difficulty retaining recent memories. Related findings may include altered respirations and LOC;
headache; dizziness; confusion; visual disturbances, such as blurred or double vision; and motor and sensory disturbances, such as
hemiparesis and paresthesia, on the side of the body opposite the injury.
Recovery from herpes simplex encephalitis commonly leaves the patient with severe and possibly permanent amnesia.
Associated findings include signs and symptoms of meningeal irritation, such as headache, fever, and altered LOC, along with
seizures and various motor and sensory disturbances (such as paresis, numbness, and tingling).
Hysteria
Hysterical amnesia, a complete and long-lasting memory loss, begins and ends abruptly and is typically accompanied by
confusion.
Seizures
In temporal lobe seizures, amnesia occurs suddenly and lasts for several seconds to minutes. The patient may recall an aura or
nothing at all. An irritable focus on the left side of the brain primarily causes amnesia for verbal memories, whereas an irritable
focus on the right side of the brain causes graphic and nonverbal amnesia. Associated signs and symptoms may include decreased
LOC during the seizure, confusion, abnormal mouth movements, and visual, olfactory, and auditory hallucinations.
Wernicke-Korsakoff syndrome
Retrograde and anterograde amnesia can become permanent without treatment in this syndrome. Accompanying signs and
symptoms include apathy, an inability to concentrate or to put events into sequence, and confabulation to fill memory gaps. The
syndrome may also cause diplopia, decreased LOC, head-ache, ataxia, and symptoms of peripheral neuropathy, such as numbness
and tingling.
Drugs
Anterograde amnesia can be precipitated by general anesthetics, especially fentanyl, halothane, and isoflurane; barbiturates,
most commonly pentobarbital and thiopental; and certain benzodiazepines, especially triazolam.
Electroconvulsive Therapy
The sudden onset of retrograde or anterograde amnesia occurs with electroconvulsive therapy. Typically, the amnesia lasts for
several minutes to several hours, but severe, prolonged amnesia occurs with treatments given frequently over a prolonged period.
Usually performed on only one lobe, this surgery causes brief, slight amnesia. However, removal of both lobes results in
permanent amnesia.
Risk Factors:
The major risk factors for AD are age and family history. Other possible risk factors include a serious head injury and lower levels
of education. Scientists are also studying additional factors to see if they may cause the disease. Some of these factors include:
Genetic (Inherited) Factors: Scientists believe that genetic factors may be involved in more than half of the cases of
AD. For example, a protein called apolipoprotein E (ApoE) may be important. Everyone has ApoE, which helps carry cholesterol in
the blood. However, the function of ApoE in the brain is less understood. The ApoE gene has three forms. One form seems to
protect a person from AD, and another form seems to make a person more likely to develop the disease. Scientists still need to
Environmental Factors: Scientists have found aluminum, zinc, and other metals in the brain tissue of people with AD. They
are studying these metals to see if they cause AD or if they build up in the brain as a result of the disease.
Viruses: Some scientists think that a virus may cause AD. They are studying viruses that might cause the changes seen in
AD probably is not caused by any one factor. It is more likely to be several factors that act differently in each person. For example,
genetic factors alone may not be enough to cause the disease. Other risk factors may combine with a person’s genetic makeup to
Treatments:
Mental stimulation
Supportive care
Nursing homes
AMNESIA TREATMENT
moderate hyperventilation
DELIRIUM TREATMENT
Pharmacologic therapy
Psychosocial support
Physical restraints paradoxically increase patient agitation; thus, other alternatives (e.g., safe environment, door alarms)
DEMENTIA TREATMENT
Treat reversible causes (e.g., hypothyroidism, vitamin deficiency, cerebral vasculitis, neurosyphilis, HIV)
Manage nonreversible etiologies, including genetic risks, health care planning, and help groups (e.g., Alzheimer's
Association)
Nursing Considerations:
APRAXIA
During your assessment, be alert for signs and symptoms of increased intracranial pressure, such as headache
and vomiting. If you detect any, elevate the head of the bed 30 degrees and monitor the patient closely for altered pupil
size and reactivity, bradycardia, widened pulse pressure, and irregular respirations. Have emergency resuscitation
equipment nearby, and be prepared to give mannitol I.V. to decrease cerebral edema.
If the patient is experiencing seizures, stay with him and have another nurse notify the physician immediately.
Avoid restraining the patient. Help him to a lying position, loosen tight clothing, and place a pillow or other soft object
beneath his head. If the patient’s teeth are clenched, don’t force anything into his mouth. If his mouth is open, protect the
tongue by placing a soft object, such as a washcloth, between his teeth. Turn the patient’s head to provide an open
airway.
Prepare the patient for diagnostic studies, which may include computed tomography and radionuclide brain
scans. Because weakness, sensory deficits, confusion, and seizures may accompany apraxia, take measures to ensure the
patient’s safety. For example, assist him with gait apraxia in walking.
AMNESIA
Prepare the patient for diagnostic tests, such as computed tomography scan, magnetic resonance imaging,
Provide reality orientation for the patient with retrograde amnesia, and encourage his family to help by
If the patient has severe amnesia, consider basic needs, such as safety, elimination, and nutrition. If necessary,
CONFUSION
Never leave a confused patient unattended, to prevent injury to himself and others.
Keep the patient calm and quiet, and plan uninterrupted rest periods.
Patient Teaching:
APRAXIA
into separate steps, demonstrating these steps, and having the patient repeat the actions you demonstrated as taught by
AMNESIA
Adjust your patient-teaching techniques for the patient with anterograde amnesia because he can't acquire new
information.
Include his family in teaching sessions. In addition, write down all instructions—particularly medication dosages
CONFUSION
To help the patient stay oriented, keep a large calendar and a clock visible, and make a list of his activities with
Always reintroduce yourself to the patient each time you enter his room.
If possible, explain to the patient and his family the cause of his confusion.
. Prognosis:
Prognosis for Alzheimer's Disease: AD is a progressive disease. The course of the disease varies from person to
person. Some people have the disease only for the last 5 years of life, while others may have it for as many as 20 years. The most
. Statistics:
Deaths from Alzheimer's Disease: 53,852 deaths in USA 2001 (CDC); 44,536 annual deaths (NVSR Sep 2001)
Cause of death rank: 8th leading cause of death in 1999 and 2000 (CDC)
Deaths: 53,852 (USA annual deaths calculated from this data: 53,852 deaths in USA 2001 (CDC);
Incidence: 4,000,000 (USA prevalence calculated from this data: more than 4 million Americans (CDC);