Prevalance & Impact on QOL

(Quality of Life)

* 3-10% over age 65 have dementia.

*25-50% over age 85 have dementia.

*4.5 million cases currently

*Projection for 2050- 15 million

*How many at home with caregiver? 70%

*How much is spent annually in the U.S?  100 million

Description/Causes/Diagnosis

*Also called AD,Senile Dementia.

*Degeneration of nerve cells(tangles & clumps of the brain)

*Loss of Neurons

*Progressive disease(permanent and progressive)

*Who does Alzheimer's affect?

(everyone)

Signs/Symptoms

(Early)

1. Forgetfulness-all the time

2. Mood changes-dpression,irritabilty,anxiety, paranoia.

3. Impaired attention- teaching, will be difficult, judgement is off.

4. Hygiene change-Forget to take the bath, chagne clothes,ect.

Signs/Symptoms

(Later)

1. Gait diturbance -walk as well, poor balance,forget to stop.

2. LAck of recgonition- forget family members and friends.

3. Incontinence- bowel and bladder control.

4. Sundowning- Late afternoon they will get more agitated.

Prevention

(theories)

* Vast amount of research

1. Vitamins e, folic acid #1.

2. Statins-thought will help(drugs for lipid lowering).

3. Estrogen- thought also that it will help.

4. anti-inflammatory drugs- motrin

*Risk Factors

1. Age-increasing age

2. hereditary.

Diagnosis

* Extensive history- 3-5 before diagnsois. Alot of history form cleint and family.

*Screening-minimental status exam.

1. MMSE-minimental status exam.

2. clock drawing task

3. lab test, imaging studies

Lab Tests/Imaging Studies

* Cerebral spinal fluid(CSF)-increasing protein lvl

* gene studies-May be doing that.

*MRI-brain scan

*PET scan-

*CT scans

All looking for dementia

Medication

(may improve their quality of life)

* tacrine-(cognex)

*donepezil-(aricpet)

*rivastigimeine-(exelon)

*galantimine-(Razadyne)

*memantine-(Namenda)

Treatment Goals

(managed behaviours)

* Temporary improvement-a littel more alert

*releif of confusion

*Support/Encouragement

*Maintain safety-prevent accidents and injury.

*promote self esteem- preserve their dignity.  Keep at highest lvl of functioning.

CareGivers

(Offer and provide support).

* Support groups-meet wkly.

*home health care agenices

*Day care Centers-they are great cost alot of money.

Stage I

(Mild AD)

Duration-2-4 years or more

Common charactersitics:

*may repeat themselves.

*Commonly misplace items- hiding things

*Have trouble naming common objects.

*May get lost-confusion

*personality change

Stage II-

(Moderate AD)

Duration 2-12 years

Disruptive behaviour

Common charateristics:

* Worsening mental functions

*Increased confusion.

*May require supervision.

*Caregiver stress

Stage III

(Severe AD)

Duration 1-2 years

Increased confusion

Common characteristics:

* Loss of independent functioning.

*Loss of language.

*Inability to recognize family.

*Susceptible to life threatening diseases.

Caregiver suggestions

*Improve self esteem-find some purposeful activity

*Assist with ADL's-wash theri face.

*Avoid stress-Think about noise;crowds.

*Environemental safety

*Daily routine-May have good time of the day to do things

Challenging Situations

How would you deal with it?

*repeated questioning-never ignore them.

*wandering- be able to. don't restrain them.

*Sleeplessness-Days and nights mixed up(keep them awake to break cycle)

*Lack of inappropriate response- Diversion,decrease stimuli,get out of way(be flexible with patient)

Communication strategies

1. Nonverbal communication.

2. Keep it simple

3. Maintain eye contact

4.Other forms of expressions

5. allow time for processing.

6. accpet their reality

7.embrace humor(laugh with them)

8. Have flexible expectations

Scoring on memory test

(age range& normal recall)

18-39 --->10 items right

40-59--->9 items right

60-69-->8 items right

70+-->7 items right