Nursing Diagnoses for AD

Here are so examples of nursing diagnoses that may be common for patient's with Alzheimer's disease:

1) Risk for injury related to inability to recognize hazards in the environment

2) Impaired verbal communication related to intellectual changes 

3) Chronic confusion related to Alzheimer's disease as evidence by: altered interpretation, altered personality, altered response to stimuli, impaired long term memory; impaired short-term memory; progressive cognitive impairment

• Goal: Patient will participate in activities of daily living at the maximum of functional ability
• Intervention: Provide scheduled activities that are matched to the client's abilities and personality. 
• Rationale: Activities that are individualized to the client's abilities and personality can reduce agitation and improve quality of life (Ackley 2011, p 252)

4) Fear related to loss of self

5) Self neglect related to loss of cognitive function 

Sources: Ackley, B., & Ladwig, G. (2011). Nursing Diagnosis Handbook an Evidence-Based Guide to Planning Care. (9th ed.). London: Elsevier Health Sciences.

Support Groups

On www.alz.org anyone can search for an Alzheimer's support group locally in their area. These support groups are primarily for care givers caring for a patient with Alzheimer's since the patient is slowing losing their mind and can't really participate meaningfully. These support groups are aimed at helping caregivers learn how to better care for these patient's and emotional support for them as it can get hard to deal with a person with AD. There are several support groups in Oregon, as found on www.alz.org: 

• The Portland support group will meet every Tuesday from Oct. 6 to Nov. 17 (except for Nov. 3). This group is for people in the early stages of dementia, as well as their care partners.  Registration and screening are required. Please call 800-272-3900 for more details and to register.
  
• The Eugene support group meets the third Wednesday of each month. This group is for people in the early stages of dementia, as well as their care partners. Registration and screening are required.
  Note: As of April 2015, the Eugene support group is at capacity. To learn about potential alternatives, please call 800-272-3900.
  
• The Bend support group meets the second Wednesday of each month. This group is for people in the early stages of dementia, as well as their care partners. Registration and screening are required. Please call 800-272-3900 for more details and to register.
    
• The Medford support group meets every Monday for eight weeks. This group is for people in the early stages of dementia, as well as their care partners. Registration is required. Registration and screening are required. Please call 800-272-3900 for more details and to register.
  
• The Ashland support group meets every Monday for eight weeks. This group is for people in the early stages of dementia, as well as their care partners. Registration is required. Registration and screening are required. Please call 800-272-3900 for more details and to register."

Also these links provide support:

https://alzheimersspeaks.wordpress.com/2010/12/16/memory-people-new-facebook-group-for-alzheimers-patients-caregivers/

http://www.eldercare.gov/eldercare.net/public/resources/topic/Caregiver.aspx

https://www.caring.com/alzheimers-support

Source & image: www.alz.org

Reputable Source

A great website that I used a lot in my research on Alzheimer's disease and where I found most of my information for this blog was http://www.alz.org. This website provides almost everything you could possibly want to know about AD, from the pathophysiology of how this disease came about and its prognosis to dietary recommendations and how to find help. This website includes search options to help you navigate and find exactly what you need related to AD. It provides information regarding this disease that ranges from medical terminology that healthcare professionals understand to easy to follow facts for those who have no medical background. It also has lots of great images that can help you better understand the content of the articles. There is also a helpline that is available 24/7 on their website. The website is credible because it is sponsored by the Alzheimer's Association, which " is the world's leading voluntary health organization in Alzheimer's care, support and research." 

Source & image: www.alz.org

Dietary Recommendations

People that have Alzheimer's disease do not need a special diet nor can any diet really lessen or cure symptoms. However, there are a few simple dietary recommendations. Like everyone, patients with AD should be eating a well-balanced diet that consists of fruits and vegetables, whole grains, low-fat dairy products, and protein, while staying away from foods that are high in saturated fat, cholesterol, sodium, and refined sugars.Due to memory loss, having a diet that consists of familiar foods that they ate before can help them recognize and have a greater appetite for food. Patient's typically experience a decreased appetite that can be due to their medications or decreased sense of taste, so accustomed foods will help with this problem.


image: http://www.wallstreetotc.com/wp-content/uploads/2015/03/New-Way-of-Reducing-Alzheimer’s-Disease-MIND-Diet.jpg

Source: https://www.alz.org/care/alzheimers-food-eating.asp

Treatment Options

There is no known cure for Alzheimer's disease, however, there are a variety of drugs and other treatments to help alleviate symptoms or slow the progression of this disease. 
There are two classes of memory loss drugs for AD: cholinesterase inhibitors and NMDA antagonists

image: http://www.uspharmacist.com/CMSImagesContent/2012/3/USP1203-Law-T1.gif



Other types of drugs like anti-depressants and antipsychotics may also be prescribed accordingly.

Other treatments:
The presence of an understanding caretaker that can help cater to the needs of the patient by providing a safe, familiar environment and avoiding confrontational or otherwise, problematic situations. This will help them feel comfortable and reduce stress due to their behavioral changes. 

Source: http://www.alz.org/alzheimers_disease_treatments_for_behavior.asp

Signs & Symptoms

Here are some of the signs and symptoms of Alzheimer's Disease:

1)  Memory loss-- the most common sign, people typically forget information such as appointments dates, birthdays, names, etc. These people start needing to rely more on making notes and post it's to help them remember important things. 

2)  Unusual challenges-- they experience an inability to effectively solve problems that they would normally be able to do easily. For example, when cooking a familiar meal they forget the recipe, even though they have made it a million times before. 

3)  Confusion with time or place-- people start to lose track of time and don't even know what day of the week it is but tend to remember later. Also, sometimes they randomly forget where they are or what they should be doing.

4)  Speech problems-- people are often at a loss for words and don't recall how to say what they want to say. It is hard for them to find the right word to say.

5)  Losing things-- they are prone to misplace or lose random things and it is hard for them to recall where they left it. The object could be something simple like a pencil they were just using or an important item like their wallet. 

A fun image to summarize some signs & symptoms:


image:http://www.alzheimerstreatment.space/tag/body-dementia-symptoms

Source: http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp

How Alzheimer's is diagnosed

Alzheimer's disease can only officially be confirmed with clinical findings. A microscopic examination of brain tissue can reveal the presence of this disease.This is obtained from cerebral biopsy or an autopsy (if the person is deceased). 


image: http://www.123rf.com/photo_15688227_alzheimer-disease-brain-tissue-with-amyloid-plaque.html

However, typically brain scans are the preferred method if doctors are suspicious as this a much less invasive way of diagnosing AD. By comparing the brain activity of an Alzheimer's brain to a normal brain, the presence of AD can readily be observed. This picture shows the clear difference between a normal brain and one with AD.


Image: http://www.berkeley.edu/news/media/releases/2009/07/14_alzheimers.shtml

To put the degenerative effects of Alzheimer's disease into perspective here is a comparison of a normal brain vs one affected by Alzheimer's. You can see how much the brain shrunk because neural tissue died.

Image: http://blogs.atribuna.com.br/maissaude/wp-content/uploads/2015/08/alzheimer.jpg

Source: Porth, C., & Porth, C. (2007). Essentials of Pathophysiology: Concepts of Altered Health States (2nd ed.). Philadelphia: Lippincott Williams & Wilkins

How it happens..

Alzheimer's is characterized by a continuing loss of neural tissue. It is a terminal disease that occurs in stages, often over the course of a decade. Over time, neurons in the brain, especially those associated with memory in the hippocampus, die. Typically, the loss of tissue occurs before symptoms surface. Eventually, memory loss is not the only manifestation of the disease. Progressively, patients lose the cognitive ability to process complex thoughts. This commonly leads to apparent changes in behavior and personality. In the final stages, the sections of the brain that affect how senses are perceived and where one's long-term memories are stored are degraded. Finally, the brain tissue that controls vital functions, such as breathing, are attacked and compromised, leading to death.

 At the microscopic level, neuritic plaques, neurofibrillary tangles, and amyloid angiopathy are present. "The plaques are patches or flat areas composed of clusters of degenerating nerve terminals arranged around a central amyloid core. The neurofibrillary tangles, found in the cytoplasm of abnormal neurons, consist of fibrous proteins that are wound around each other in a helical fashion. These tangles are resistant to chemical or enzymatic breakdown and they persist in brain tissue long after the neuron in which they rose has died and disappeared (Porth, 2007, p. 959-960). Basically, these three factors kill neurons and they cannot be killed by the body's defense systems. Thus, over time, they accumulate, destroy brain tissue, and spread to other areas of the brain. The fact that these cannot be stopped by the body and propagate is the reason Alzheimer's is a terminal disease with distinct stages

Image: https://media.licdn.com/mpr/mpr/p/6/005/0a4/21d/2b3a1b6.jpg

Sources:
Porth, C., & Porth, C. (2007). Essentials of Pathophysiology: Concepts of Altered Health States (2nd ed.). Philadelphia: Lippincott Williams & Wilkins

The epidemiology of Alzheimer's disease

Epidemiology: What are the chances YOU will have it?

According to Alzheimer's Association: 

About 5.3 million Americans of all ages have Alzheimer's disease in 2015. 

• 5.1 million of those Americans with Alzheimer's are 65 years or older
• Of the 5.1 million, age 65+, 3.2 million are women and 1.9 million are men
• 200,000 of the 5.3 million are under age 65
• It is expected to reach 12 to 16 million Americans by 2050

To put it in another perspective, every 67 seconds someone in America is diagnosed with Alzheimer's disease. 

      Race/Ethnicity

Majority of people in the United States with Alzheimer's disease and other dementias are non-white hispanics. Of the 5.1 million people who are 65 years or older and are suffering from AD, 7.8% of them are whites, 18.8% are African-Americans, and 20.8% are Hispanics. 

      Education

Studies show that those with fewer years of education are at a higher risk for Alzheimer's disease than those with more years of education. This is said to be because those with a higher level of education have a "cognitive reserve*" that helps people better deal with changes in the brain that can occur from AD. Although, having a higher level of education can help reduce the risk of developing AD, once these people have memory loss, having this higher education, does not protect against how fast they will lose their memory.

*Cognitive reserve is how well your brain resists damage psychologically. This means that people with a higher cognitive reserve are less susceptible to the behavioral affects of AD. Even if their brain shows signs of the development of the disease, they have minimal symptoms because they have strong cognitive reserve. Cognitive reserve literally means how well one can keep his or her mind, despite physical changes in the brain. 

Sources: http://www.alz.org/facts/
http://www.nursingceu.com/courses/400/index_nceu.html
http://www.cumc.columbia.edu/dept/sergievsky/pdfs/CogResTheory.pdf
Image: http://www.alz.org/facts/