CA Alzheimers

7/29/2019 CA Alzheimers

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Title Page


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Table of Contents


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Introduction

Alzheimers disease is a progressive, irreversible, degenerative neurologic

disease that begins insidiously and is characterized by gradual losses of

cognitive function and disturbances in behavior and affect. Although Alzheimersdisease can occur in people as young as 40 years of age, it is uncommon before

65 years of age. It is important to note that Alzheimers disease is not a normal

part of aging.

The greatest risk factor for Alzheimers disease is increasing age, many

environmental, dietary, and inflammatory factors also may determine whether a

person suffers from this cognitive disease. Alzheimers disease is a complex

brain disorder caused by a combination of various factors that may include

genetics, neurotransmitter changes, vascular abnormalities, stress hormones,

circadian changes, head trauma, and the presence of seizure disorders. It can be

classified into two types: familial or early onset Alzheimers disease and sporadic

or late onset Alzheimers disease. Familial Alzheimers disease is rare,

accounting for less than 10% of all cases and is frequently associated with

genetic mutations. It occurs in middle aged adults. If family members have at

least one other relative with Alzheimers disease, then there is a familial

component, which non-specifically includes both environmental triggers and

genetic determinants. (Textbook of Medical-Surgical Nursing, 12th Edition by

Brunner & Suddarth, published by Lippincott Williams & Wilkins, page 217)

In Alzheimers disease, over time, symptoms get worse. People may not

recognize family members or have trouble speaking, reading or writing. They

may forget how to brush their teeth or comb their hair. Later on, they may

become anxious or aggressive, or wander away from home. Eventually, theyneed total care. This can cause great stress for family members who must care

for them. No treatment can stop the disease. However, some drugs may help

keep symptoms from getting worse for a limited time.

http://www.nlm.nih.gov/medlineplus/alzheimersdisease.html
http://www.nlm.nih.gov/medlineplus/alzheimersdisease.htmlhttp://www.nlm.nih.gov/medlineplus/alzheimersdisease.htmlhttp://www.nlm.nih.gov/medlineplus/alzheimersdisease.html


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There are stages of Alzheimers disease: the Early stage (Forgetfulness),

Middle stage (Sundowning), and Late stage (Kluver Bucy like Syndrome). The

early stage of Alzheimer's disease (also referred to as "mild Alzheimer's

disease") refers to people of any age who have mild impairment. This differs from

the term "early onset," which refers to people who have been diagnosed with

Alzheimer's disease at a younger age than usual. During the moderate stage of

Alzheimer's, people grow more confused and forgetful and begin to need help

with daily activities and self-care. In the severe (late) stage of Alzheimer's, mental

function continues to decline and the disease has a growing impact on

movement and physical capabilities. The rate of progression for Alzheimer's

disease varies widely. On average, people with Alzheimer's disease live eight to

10 years after diagnosis, but some survive as long as 25 years.

http://www.mayoclinic.com/health/alzheimers-

stages/AZ00041/NSECTIONGROUP=2

Internationally, in 2012,an estimated 5.4 million Americans have AD,

including approximately 200,000 age


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As of 2004, the Philippines population aged 60 years old and above

totaled 5.7 million older persons. This is equivalent to about 6.9% of the Filipino

population. Currently the Philippines is ranked 5 th among Southeast Asian

countries with a high annual population growth rate. The 2000 census of

population and housing reported a total of 4.6 million elderly person with

Alzheimers disease accounted for almost 6% of the Philippine population, a

marked increased of 22.18% from the 3.7 million elderly persons in 1995. It is

estimated that the number of older persons will further increase to 7 million in

2010 in twice as much in about 16 years if the 4.39% growth rate persist.

http://www.mhlw.go.jp/bunya/kokusaigyomu/asean/asean/kokusai/siryou/dl/h19_

philippines.pdf

In Davao City, they said that the data as to number of cases, but it got at

least two new cases a week in some clinic.Their data show that about 70 percent

of Filipinos 60 years old and above manage to live good quality of life while the

remaining 30 percent of them are vulnerable to dementia.It is sad to note that

many dont get to see a doctor.

Angel is the only doctor in Davao City that practices Geriatric Medicine

and gets patients from as far as Lanao and the different parts of Mindanao.A

doctor also said the higher the age the more dementia cases would be, adding

that among the 70 years old, about 30 percent of them suffered dementia; while

for the 80 years old, around 40 percent and in the 90 years old bracket, about 50

percent of them have dementia. Aside from the attitude of not seeing a doctor,

the other problem would be economic because of the difficulty of convincing the

family to see a doctor as most of them declined due to the high cost of treatment.

Seeking treatment could reduce the problem but sustaining the treatment in order

to bring back quality of life was another thing.

http://hdmf.wordpress.com/2010/09/21/this-may-not-be-biz-story-but-i-want-to-

share-this-coz-all-of-us-have-older-persons-in-the-family/
http://www.mhlw.go.jp/bunya/kokusaigyomu/asean/asean/kokusai/siryou/dl/h19_philippines.pdfhttp://www.mhlw.go.jp/bunya/kokusaigyomu/asean/asean/kokusai/siryou/dl/h19_philippines.pdfhttp://www.mhlw.go.jp/bunya/kokusaigyomu/asean/asean/kokusai/siryou/dl/h19_philippines.pdfhttp://hdmf.wordpress.com/2010/09/21/this-may-not-be-biz-story-but-i-want-to-share-this-coz-all-of-us-have-older-persons-in-the-family/http://hdmf.wordpress.com/2010/09/21/this-may-not-be-biz-story-but-i-want-to-share-this-coz-all-of-us-have-older-persons-in-the-family/http://hdmf.wordpress.com/2010/09/21/this-may-not-be-biz-story-but-i-want-to-share-this-coz-all-of-us-have-older-persons-in-the-family/http://hdmf.wordpress.com/2010/09/21/this-may-not-be-biz-story-but-i-want-to-share-this-coz-all-of-us-have-older-persons-in-the-family/http://hdmf.wordpress.com/2010/09/21/this-may-not-be-biz-story-but-i-want-to-share-this-coz-all-of-us-have-older-persons-in-the-family/http://www.mhlw.go.jp/bunya/kokusaigyomu/asean/asean/kokusai/siryou/dl/h19_philippines.pdfhttp://www.mhlw.go.jp/bunya/kokusaigyomu/asean/asean/kokusai/siryou/dl/h19_philippines.pdf


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Objectives:

To know further the disease process.

To give information to others about the disease.

To further understand underlying cause of the disease.

To know proper nursing interventions for caring patient with AD.

To know treatments to slow the progression of the disease.


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Anatomy and Physiology

The brain is made of nerve cells and several other cell types. Nerve cells

also are called neurons. The neurons of all animals function in basically the same

way, even though animals can be very different from each other. Neurons survive

and function with the help and support of glial cells, the other main type of cell in

the brain. Glial cells hold neurons in place, provide them with nutrients, rid the

brain of damaged cells and other cellular debris, and provide insulation to

neurons in the brain and spinal cord.

Two cerebral hemispheres account for 85 percent of the brains weight.The billions of neurons in the two hemispheres are connected by thick bundles of

nerve cell fibers called the corpus callosum. Scientists now think that the two

hemispheres differ not so much in whatthey do (the logical versus artistic

notion), but in how they process information. The left hemisphere appears to
http://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-unraveling-mystery/glossary#cerebralhemisphereshttp://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-unraveling-mystery/glossary#corpuscallosumhttp://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-unraveling-mystery/glossary#corpuscallosumhttp://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-unraveling-mystery/glossary#cerebralhemispheres


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focus on details (such as recognizing a particular face in a crowd). The right

hemisphere focuses on broad background (such as understanding the relative

position of objects in a space). The cerebral hemispheres have an outer layer

called the cerebral cortex. This is where the brain processes sensory information

received from the outside world, controls voluntary movement, and regulates

cognitive functions, such as thinking, learning, speaking, remembering, and

making decisions. The hemispheres have four lobes, each of which has different

roles:

The frontal lobe, which is in the front of the brain, controls executive

function activities like thinking, organizing, planning, and problem solving, as

well as memory, attention, and movement.

The parietal lobe, which sits behind the frontal lobe, deals with the

perception and integration of stimuli from the senses.

The occipital lobe, which is at the back of the brain, is concerned with vision.

The temporal lobe, which runs along the side of the brain under the frontal

and parietal lobes, deals with the senses of smell, taste, and sound, and the

formation and storage of memories.

The cerebellum sits above the brain stem and beneath the occipital lobe.

It takes up a little more than 10 percent of the brain. This part of the brain plays

roles in balance and coordination. The cerebellum has two hemispheres, which

receive information from the eyes, ears, and muscles and joints about the

bodys movements and position. Once the cerebellum processes that

information, it sends instructions to the body through the rest of the brain and

spinal cord. The cerebellums work allows us to move smoothly, maintain our

balance, and turn around without even thinking about it. It also is involved with

motor learning and remembering how to do things like drive a car or write your

name.


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The brain stem sits at the base of the brain. It connects the spinal cord

with the rest of the brain. Even though it is the smallest of the three main

players, its functions are crucial to survival. The brain stem controls the

functions that happen automatically to keep us aliveour heart rate, blood

pressure, and breathing. It also relays information between the brain and the

spinal cord, which then sends out messages to the muscles, skin, and other

organs. Sleep and dreaming are also controlled by the brain stem.

Plaques and Tangles

The two most significant physical findings in the cells of brains affected by

Alzheimer's disease are neuritic plaques and neurofibrillary tangles. Another

significant factor in AD is the greatly reduced presence of acetylcholine in the

cerebral cortex. Acetylcholine is necessary for cognitive function.

While some neuritic plaques, or patches, are commonly found in brains of

elderly people, they appear in excessive numbers in the cerebral cortex of

Alzheimer's disease patients. A protein called beta amyloid occupies the center

of these plaques. Surrounding the protein are fragments of deteriorating neurons,

especially those that produce acetylcholine (ACh), a neurotransmitter essential

for processing memory and learning. Neurotransmitters are chemicals that

transport information or signals between neurons.

Neurofibrillary tangles (NFTs) are twisted remnants of a protein called tau,

which is found inside brain cells and is essential for maintaining proper cell

structure and function. An abnormality in the tau protein disrupts normal cell

activity.

Tau is a protein found in the axon of healthy neurons where it binds to the

structure of the neuron microtubules. It acts as a crosspiece and stabilizes the

neuron structure. Together, Tau and microtubules act as railway tracks over

which information is transported from one part of the neuron to another.


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Glossary of Terms for an Anatomy of the Brain

Amygdala - limbic structure involved in many brain functions, including emotion,

learning and memory. It is part of a system that processes "reflexive" emotions

like fear and anxiety.

Cerebellum - governs movement.

Cingulate gyrus - plays a role in processing conscious emotional experience.

Fornix - an arch-like structure that connects the hippocampus to other parts of

the limbic system.

Frontal lobe - helps control skilled muscle movements, mood, planning for the

future, setting goals and judging priorities.

Hippocampus - plays a significant role in the formation of long-term memories.

Medulla oblongata - contains centers for the control of vital processes such as

heart rate, respiration, blood pressure, and swallowing.

Limbic system - a group of interconnected structures that mediate emotions,

learning and memory.

Occipital lobe - helps process visual information.

Parahippocampal gyrus - an important connecting pathway of the limbic

system.

Parietal lobe - receives and processes information about temperature, taste,touch, and movement coming from the rest of the body. Reading and arithmetic

are also processed in this region.


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Pons - contains centers for the control of vital processes, including respiration

and cardiovascular functions. It also is involved in the coordination of eye

movements and balance.

Temporal lobe - processes hearing, memory and language functions.

Thalamus - a major relay station between the senses and the cortex (the outer

layer of the brain consisting of the parietal, occipital, frontal and temporal lobes).

PATIENTS PROFILE

NAME: R.E

AGE: 85 years old

DATE OF BIRTH: December 24, 1927

SEX: Male

CIVIL STATUS: Widowed

RELIGION: Catholic

EDUCATIONAL ATTAINMENT College graduate

OCCUPATION Colonel

ADDRESS: Buhangin, Davao City

HEIGHT: 153 cm

WEIGHT: 65 kg


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Comprehensive Assessment


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Pathophysiology


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Narrative

Researchers listed some of the predisposing and precipitating factors.

Predisposing factors are genetics, age and gender. Familial AD, a

form usually develop at young age, frequently associated with genetic mutations.

People who have a parent or sibling that developed Alzheimers disease are two

to three times more likely to develop the disease than those with no family history

of Alzheimers. As the age of a person is increasing the more it is a risk to AD,

but it is important to note that AD is not a normal part of aging. According to the

book of Brunner, males and females are equally affected, but conducting another

research women are more likely to develop AD than men, in part because they

live longer.

Precipitating factors are dietary, environmental, head trauma,

neurotransmitter changes and lastly the inflammatory factors. The lifestyle where

someone is exposed contributed a factor to AD, but a healthy diet can reduce the

risk for it. Elevated saturated fatty acids could have negative effects on age-

related cognitive decline and mild cognitive impairment (MCI), on which, can lead

to AD. MCI can be prevented the progression into AD, by applying healthy

lifestyle, promotion of exercise every day, aerobic exercise may improvecognitive agility, avoiding or limiting alcohol and tobacco consumption, staying

socially active, and engaging in intellectually stimulating activities. People with

experience having a severe or repeated head trauma appear to have a greater

risk of AD. As the build-up of neurofibrillary tangles and senile plaques

manifested, the neurotransmitter pathways will be block, as the neurotransmitter,


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specifically Acetylcholine, cannot pass through, making it difficult for the cells to

survive. Acetylcholine is major transmitter involve in memory. Risk factors

associated with heart disease and stroke, such as high blood pressure and high

cholesterol, may also increase one's risk of developing Alzheimer's disease. High

blood pressure may damage blood vessels in the brain, disrupting regions that

are important in decision-making, memory and verbal skills. This could contribute

to the progression of the disease. High cholesterol may inhibit the ability of the

blood to clear protein from the brain.

NCP1


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NCP2


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Drug Study 1


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Drug Study 2


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Drug Study 3


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Appendices


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Bibliography

Documents

CA Alzheimers