Alzheimer Presentation

MENTAL ILLNESS

Alzheimer Presentation by

Nimota Raji Gambari

What is Alzheimer DiseaseAlzheimer’s disease is a

progressive, degenerative disease of the brain, which causes thinking and memory to become seriously impaired.

Stages of AlzheimerEarly stageEarly in the disease, short-term memory loss

occurs. Other problems go along with this:being unusually forgetful; having a hard time concentrating; having a hard time coming up with the right

word; making poor choices or showing bad

judgment. During this stage, subtle changes in

personality may occur. The person may also not be able to adapt to changes in old routines.

Stages cont- Middle stage The middle stage of Alzheimer's disease is

characterized by more and more severe memory loss. The person is often not able to recognize family and friends. The person's judgment gets worse and worse. Sometimes the patient has delusions. He or she is less and less able to learn or adapt to new situations. The person may also have striking personality changes, become very active and lose language abilities. The impaired person may become unable to remember even basic safety rules. Thus daily activities such as cooking, driving or using appliances may pose a danger. The impaired person may also be subject to restlessness, wandering and sleep disturbances. You may have to watch over the person closely. You may have to keep the person from doing things he or she is used to. This part of care giving can be very hard.

Stages cont-Late stageIn the late stage of Alzheimer's disease,

patients may be able to carry out activities, but they lack the mental skills to do them with a clear purpose. Patients often become severely disoriented, losing touch with the world more and more. The impaired person may become ever more involved in delusions. (The person will believe in the delusions, but they will have no basis in fact.)

Alzheimer’s Screening Test-Mini Mental State Exam(MMSE)

It is used to test mental statusTakes about 10 minutes to completeAsk questions such as year, season, date,

day of the week, e.t.cScore range from 0-30Score less than 10 generally indicate severe

impairmentMild Alzheimer patient score 19-24Need verbal response

Critical Perspective on Mini Mental State Exam (MMSE)

Impossible to administer if the person is unable to read or write.

Creates a problem for individual with difficulty in speaking or expressing themselves.

Creates difficulty with hearing and vision impaired.

Creates a problem for patient with Arthritis.Difficulty spelling word backward for an

elderly person with cognitive impairment

The symptoms of Alzheimer disease Problems with language.

People with Alzheimer’s disease often forget simple words or substitute unusual words, making their speech or writing hard to understand. They may be unable to find the toothbrush, for example, and instead ask for "that thing for my mouth

Disorientation to time and place.People with Alzheimer’s disease can become lost in their own neighborhood, forget where they are and how they got there, and not know how to get back home.

Poor or decreased judgment.Those with Alzheimer’s may dress inappropriately, wearing several layers on a warm day or little clothing in the cold. They may show poor judgment, like giving away large sums of money to telemarketers.

Misplacing things.A person with Alzheimer’s disease may put things in unusual places: an iron in the freezer or a wristwatch in the sugar bowl.

Symptoms Cont- Memory Loss People with Alzheimer’s experience difficulties

communicating, learning, thinking and reasoning Someone with Alzheimer’s disease may show rapid

mood swings – from calm to tears to anger – for no apparent reason

Difficulty performing familiar tasks. People with dementia often find it hard to plan or complete everyday tasks. Individuals may lose track of the steps involved in preparing a meal, placing a telephone call or playing a game.

Loss of initiative.A person with Alzheimer’s disease may become very passive, sitting in front of the TV for hours, sleeping more than usual or not wanting to do usual activities

Risk factors of Alzheimer disease Age

Advancing age is the number one risk factor for developing Alzheimer’s disease. One out of eight people over the age of 65 has Alzheimer’s disease, and almost one out of every two people over the age of 85 has Alzheimer’s.

Family History

People who have a parent or sibling that developed Alzheimer’s disease are two to three times more likely to develop the disease than those with no family history of Alzheimer’s.

GeneThe first gene is ApoE4 and the second gene is the

Deterministic Gene. These could transfer from one generation to the other.

Causes of Alzheimer diseaseHead InjuryCardiovascular Problems like

heart attackToo much consumption of alcoholDiabetesHigh blood pressureStrokesStressMCI- Mild Cognitive impairment

Caring for Alzheimer patients

Environment Place picture signs on rooms, bathrooms, dining rooms,

and other areas. Keep personal items where the person can see them. Stay in the persons sight to the extent possible. Keep memory aids (large clocks, calendars) where the

person can see them. Keep noise level low Play music and show movies from the person’s past. Keep tasks and activities simple.Communication Approach the person in a calm and quiet manner.

Caring for Alzheimer patients Cont-

Promote communication Give simple explanations of all procedures and activities. Give consistent response

Safety Remove harmful sharp, and breakable object from the

environment. this include knives, scissors, glass, dishes, razors, and tools.

Provide plastic eating and drinking utensils when need. This helps prevent breakage and cuts.

Place safety plugs in electrical outlets. Keep cords and electrical items out of reach. Store personal care items(e.g., shampoo, deodorant, lotion) in a

safe place.


Supervise the person who smokes. Store smoking materials in a safe place. Prevent falls, fires, burns, and poisoning Keep doors to kitchens, utility rooms, and housekeeping closets

locked.

Wandering Keep doors and windows locked. Locks are often placed at the top

and bottoms of doors. The person is not likely to look for a lock in such places.

Keep door alarms turned on. The alarms goes off when the door is opened.

Make sure the person wear an ID bracelet at all times.


Do not use restraints. They tend to increase confusion and disorientation.

Do not argue with the person who wants to leave. Remember that the person does not understand what you are saying.

patients who are at risk of wandering should be registered with the Alzheimer society of Canada's safely home registry www.safelyhome.ca/en/safelyhome/safelyhome.asp .

Sundowning Provide calm and quiet late in the day. Complete treatment

and activities early in the day. Dim lights, and play soft music. Promote elimination. A full ladder or constipation can increase

restlessness.

http://www.safelyhome.ca/en/safelyhome/safelyhome.asp


Do not try to reason with the person. He or she cannot understand what you are saying.

Do not ask the person what is bothering him or her. Communication is impaired. The person does not understand what you are asking and cannot think or speak clearly.

Hallucinations and delusions Do not argue with the person .he or she does not understand

what you are saying. Reassure the person. Tell him or her that you will provide

protection from harm. Distract the person with some item or activity. Use touch to calm and reassure the person.


Basic needsMeet food ad fluid needs. Provide finger

foods. Cut food and pour liquids as needed.Provide good skin care. Keep the person’s

skin free of urine and feces.Promote hygiene. Do not force the person

into a shower or tub. People with AD are often afraid of bathing. Try bathing them when he or she is calm. Use the bathing method preferred by the person do not rush the person.

Ecological FrameworkThe Role of The Social worker

To support and empower these individuals who are “aging in place” and making all attempts to remain independent and residing in their own homes.

To coordinate services for individuals in order to maintain their living environment for as long as possible.

To provide personalized services to clients and contribute by

enhancing their quality of life through consistent intervention.

The Role of The Social worker Cont-To conduct in-home or facility

assessment (Evaluation)To develop a care plan including

client’s need for community resources such as home care, home delivered meals

The Role of The Social worker Cont-In case of moving to a

Retirement Community, Long Term Homes, Nursing Homes, and Assisted Living. A review of financial, legal, and medical issues will be conducted. In addition, make appropriate referral for specific follow ups

Psychosocial Impact on Alzheimer PatientsSocial role in family is altered

because and older child or spouse has taken over their responsibilities.

They experience frustration and anger

Become depressed

PSYCHODYNAMIC FRAMEWORK (Psychosocial Intervention for Alzheimer patient)

Music Therapy: which can elevate agitation and apathy.

Snoezelen (Controlled Multisensory Stimulation): Might help with apathy.

Psychomotor Therapy: Might alleviate agitation

Reminiscence therapy helps to reflect on past life which can help with depression. i.e pictures, music, etc.

Education and support program for staff and caregivers are also effective

Alzheimer MedicationsEbixa has been conditionally approved by Health Canada to relieve the symptoms of people with moderate to severe Alzheimer's disease. It has been approved pending the results of further studies to verify its clinical benefit.

Ebixa may cause some undesirable reactions. These may include fatigue, dizziness, sleepiness, headache, hypertension (high blood pressure), constipation, vomiting, anxiety, confusion, hallucinations and sleep disturbance. If you develop any other side effects while taking this medication, consult the doctor. If you suffer from epileptic seizures, there is a slight possibility that the medication may increase the chances of one occurring. Also, as this product may cause sleepiness or dizziness, do not drive or operate machinery under these conditions.

Alzheimer Medications Cont-Aricept is one of a group of drugs called "cholinesterase inhibitors" which is used to treat symptoms in people with mild to moderate and advanced Alzheimer's disease.

Aricept may cause some undesirable reactions. The most common side effects include nausea, diarrhea, insomnia, vomiting, muscle cramps, fatigue and loss of appetite. In clinical studies these effects were often mild, and generally went away with continued treatment. In clinical studies some people treated with the drug experienced fainting. If you feel unwell in any other way or have any symptoms that you do not understand, or find distressing, you should contact your doctor immediately.

Alzheimer Medications Cont-Exelon is one of a group of drugs called

"cholinesterase inhibitors" which is used to treat symptoms in people with mild to moderate Alzheimer's disease and It comes in capsules and patch.

Common side effects, in addition to nausea, vomiting, loss of appetite and weight loss, include diarrhea, heartburn, stomach pains, dizziness, headache, weakness, fatigue. Some people also experienced fainting. Side effects are most likely to occur after an increase in dose and may go away with continued treatment.

Alzheimer Medications Cont-Reminyl (extended release

galantamine hydrobromide)

Reminyl ER is one of a group of drugs called"cholinesterase inhibitors" which is used to treatsymptoms in people with mild to moderateAlzheimer's disease. Reminyl ER may cause some undesirable

reactions. The most common side effects are nausea and vomiting. These adverse events should be monitored and the doctor informed, if they occur.

Alzheimer Medications Cont-Other possible side effects include: abdominal

pain, diarrhea, indigestion, decreased appetite, difficulty swallowing, bleeding in the digestive system, weight loss, low blood potassium, low blood pressure, dehydration (sometimes severe), seizures, agitation, aggression, hallucinations, weakness, fever, malaise, leg cramps, tingling in the hands or feet, ringing in the ears, headache, dizziness, tiredness, sleeplessness, runny nose, urinary tract infection, falling (sometimes resulting in injury), fainting or fluttering of the heart.

REFERENCES

Alzheimer Society Canada. (2009, March 17). Retrieved January, 2011, from www.alzheimer.ca

Alzheimer Society of Peel. (n.d.). Retrieved January 20, 2011, from www.alzheimerpeel.com

Alzheimer's Foundation for Caregiving in Canada. (2009). Retrieved January 20, 2011, from www.alzfdn.ca

Premier Homecare Services. (2008). Retrieved January 20, 2011, from www.premierhomecareservices.com

Sorrentino, S. A., & Gorek, B. (1997). Mosby's Essentials for Nursing Assistants. Colorado: Mosby Inc.

Dementia Stages Can Be Detected and Gauged by the Mini Mental State Exam. (2011).Retrieved February 2, 2011, from www.aginghomehealthcare.com/dementia_stages.html

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Alzheimer Presentation