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What is Alzheimer's?
- Dementia
- Chronic, progressive, degenerative disease
- Loss of memory, judgement, and visuospatial perception, change in personality
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Changes in brain
- Natural aging changes but occur much more rapidly
- Neurofibrillary tangles- classic finding at autopsy
- Neuretic plaques
- Increased beta amyloid within the plaques
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Chemical changes
- ACh
- Norepi
- Dopamine
- Serotonin-all have abnormalities
- High levels of beta amyloid
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Stages
- Early (mild)
- Middle (moderate)
- Late (severe)
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Assess for deficits
- Attention & concentration
- Judgement & perception
- Learning & memory
- Communication & language
- Speed of information processing
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Changes in cognition
- Dysfunction of temporal and parietal lobes
- Frontal lobe impairment- problems c judgement, inability to make decisions, decreased attention span
- Apraxia- inability to use objects correctly
- Aphasia- inability to speak or understand
- Anomia- inability to find words
- Agnosia- loss of sensory comprehension
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Mini-Mental State Exam
Assesses orientation, registration, attention & calculation, recall, speech-language
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Assessment
- Aggressiveness
- Verbal/physical abuse tendencies
- Rapid mood swings
- Increased confusion at night
- Decreased appetite/ability to eat
- Loss of bowel/bladder control
- Decreased interest in personal appearance
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Lab tests
- CBC
- Serum electrlyte levels, BUN, glucose
- Vit B 12 levels
- Folate levels
- Thyroid/liver function tests
- Serologic test for syphilis
- Toxicity screening test; heavy metal screen
- Alcohol screening test
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Diagnostic Assessments
- CT scan- cerebral atrophy
- MRI-r/o other neurologic disease
- PET scan- decreased metabolic activity in brain
- EEG- shows activity in 2 & 3 stage of AD
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Structuring the environment
- Prevent overstimulation
- Environment should be orderly
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Orientation
- Remind pt of day/time/year
- Where they are
- Who you are
- Validation therapy appropriate in later stages-
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Meds
- Cholinesterase inhibitors
- Aricept
- Reminyl
- Exelon
- Antidepressant
- Antipsychotic
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Risk for injury
- Carefully evaluate environment
- Remove throw rugs
- Nonslippery floors
- Arrange furniture to ensure safety
- Minimize clutter
- Night lights
- Alarm systems
- Lock doors
- Decrease restlessness/wandering
- Engage in activities
- Avoid day-time naps
- Restraints as a last resort
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