ALZHEIMER’S DISEASE

SITAL B. SHARMA
MSc NURSING PART I
COLLEGE OF NURSING
• Alzheimer’s disease is named after Dr. Alois Alzheimer.
• In 1906, Dr. Alzheimer noticed changes in the brain
tissue of a woman who had died of an unusual mental
illness. Her symptoms included memory loss, language
problems, and unpredictable behavior. After she died,
he examined her brain and found many abnormal
clumps (now called amyloid plaques) and tangled
bundles of fibers (now called neurofibrillary, or tau,
tangles).
• These plaques and tangles in the brain are still
considered some of the main features of Alzheimer’s
disease. Another feature is the loss of connections
between nerve cells (neurons) in the brain
INTRODUCTION
 ALZHEIMER’S DISEASE
Alzheimer’s disease is an irreversible,
progressive brain disorder that slowly destroys
memory and thinking skills, and, eventually,
the ability to carry out the simplest tasks.
 Incidence
• Alzheimer disease, a neurocognitive disorder,
is the most common cause of dementia; it
accounts for 50 to 80% of dementias in older
people..
• The percentage of people with Alzheimer
disease increases with age :
• Age 65 to 74: 3%
• Age 75 to 84: 17%
• Age ≥ 85: 32%
 RELATED ANATOMY
The Nervous System is broken down into three major
parts:
• The Central Nervous System, which includes the
brain and spinal cord,
• The Peripheral Nervous System, which includes all
nerves, which carry impulses to and from the brain
and spinal cord.
• The Autonomic Nervous System,which includes the
Sympathetic And Parasympathetic Nerves
• Brain- The brain is the largest part
composed of more than 100 billion
neurons and associated fibers.. The semi-
solid organ weighs about 1400g
(approximately 3 pounds) in the adult
human.
• Cerebrum -The largest part of the brain,
the cerebrum governs higher mental
processes including intellect, reason,
memory and language skills.
• The cerebrum consists of the cortex, large fiber tracts
(corpus callosum) and some deeper structures (basal
ganglia, amygdala and hippocampus). It integrates info
from all of the sense organs, initiates motor functions,
controls emotions and holds memory and thought
processes

• The cerebellum little brain responsible for coordination

of limb movements and balance

• The brain stem, which consists of the medulla (an

enlarged portion of the upper spinal
cord), pons and midbrain .
• The brain stem controls the reflexes and automatic
functions (heart rate, blood pressure), limb
movements and visceral functions (digestion,
urination).
• The hypothalamus and pituitary gland are
responsible for visceral functions, body temperature
and behavioral responses such as feeding,
drinking, sexual response, aggression and pleasure.
 Neurons
• Our brain has 100 billion nerve cells, called neurons. 
• Neurons have the amazing ability to gather and transmit
electrochemical signals
• Neurons have three basic parts:
• Cell body or soma. Consists of the nucleus  DNA, endoplasmic
reticulum and ribosomes mitochondria. If the cell body dies, the
neuron dies.
• Axon .cablelike projection of the cell carries the electrochemical
message (nerve impulse) along the length of the cell. covered
with a thin layer of myelin sheath in the peripheral nerves, while
non-myelinated neurons are found in the brain and spinal cord.
• Dendrites or nerve endings. branchlike projections allow the
neuron to talk with other cells or perceive the environment.
• Neurons come in many sizes. For example, a single sensory
neuron from your fingertip has an axon that extends the
length of your arm, while neurons within the brain may
extend only a few millimeters.
• They also have different shapes depending on their
functions. 
• Motor neurons that control muscle contractions have a cell
body on one end, a long axon in the middle and dendrites on
the other end. 
• Sensory neurons have dendrites on both ends, connected by
a long axon with a cell body in the middle.
•  Interneurons, or associative neurons, carry information
between motor and sensory neurons.
• The terminal ending of the
prejunctional cell contains
many vesicles, which
are packages
of the neurotransmitter
acetylcholine (ACh).
The gap between the
pre- and postjunctional membrane is on the order
of 15-30 nm. The transmitter is released by the
arrival of an action impulse/potential in the nerve; it
diffuses and binds to receptors in specialized
membranes of the postsynaptic cell.
 ETIOLOGY

• Early-onset Alzheimer’s disease occurs

between a person’s 30s and mid-60s very
small percent of all people with Alzheimer’s.
• Late-onset form of the disease, in which
symptoms become apparent in their mid-60s
• One form of the apolipoprotein epsilon
(APOE) gene does increase a person’s risk.
• People with Down syndrome develop
Alzheimer’s. This may be because people with
Down syndrome have an extra copy of
chromosome 21, which contains the gene that
generates harmful amyloid.
• Mutations in genes for the amyloid precursor
protein, presenilin I, and presenilin II may lead
to autosomal dominant forms of Alzheimer
disease
• There is a strong relationship between cognitive
decline and vascular conditions such as heart
disease, stroke, and high blood pressure, as well
as metabolic conditions such as diabetes and
obesity.
• Common in both the sexes.
• Prevalence in industrialized countries is expected
to increase as the proportion of older people
increases
• 5 distinct genetic loci, located on chromosomes 1,
12, 14, 19, and 21, influence initiation and
progression of Alzheimer disease
About 5 to 15% of cases are found familial.
 Pathophysiology
The beta-amyloid deposition extracellularly and neurofibrillary
tangles intracellularly lead to loss of synapses and neurons,
progressive neurotransmitter deficits, which results in gross
atrophy of the affected areas of the brain.
 • Prion mechanisms have been identified in
Alzheimer disease. In prion diseases, a normal
cell-surface brain protein called prion protein
becomes misfolded into a pathogenic form
termed a prion. The prion then causes other
prion proteins to misfold similarly, resulting in a
marked increase in the abnormal proteins, which
leads to brain damage. In Alzheimer disease, it is
thought that the beta-amyloid in cerebral
amyloid deposits and tau in neurofibrillary
tangles have prion-like, self-replicating
properties
CLINICAL MANIFESTATION
• Loss of short-term memory
(eg, asking repetitive questions, frequently
misplacing objects or forgetting appointments)
• Memory
• Everyone has occasional memory lapses. It's
normal to lose track of where you put your keys
or forget the name of an acquaintance. But the
memory loss associated with Alzheimer's
disease persists and worsens, affecting the
ability to function at work or at home.
• Get lost in familiar places
• Eventually forget the names of family members
and everyday objects
• Have trouble finding the right words to identify
objects, express thoughts or take part in
conversations
• Thinking and reasoning
• Alzheimer's disease causes difficulty
concentrating and thinking, especially about
abstract concepts such as numbers.
• Difficult Multitasking
• Challenging to manage finances, balance check books and
pay bills on time. These difficulties may progress to an
inability to recognize and deal with numbers.

• Making judgments and decisions

• The ability to make reasonable decisions and judgments in
everyday situations will decline. For example, a person may
make poor or uncharacteristic choices in social interactions or
wear clothes that are inappropriate for the weather.
• It may be more difficult to respond effectively to everyday
problems, such as food burning on the stove or unexpected
driving situations.
• Planning and performing familiar tasks
• Once-routine activities that require sequential
steps, become a struggle as the disease
progresses. people with advanced Alzheimer's
may forget how to perform basic tasks such as
dressing and bathing.

• Changes in personality and behavior

• Brain changes that occur in Alzheimer's disease
can affect moods and behaviors. Problems may
include the following:
• Depression
• Apathy
• Social withdrawal
• Mood swings
• Distrust in others
• Irritability and aggressiveness
STAGES OF ALZHEIMER’S
DISEASE

1. MILD ALZHEIMER'S DISEASE

2. MODERATE ALZHEIMER'S DISEASE
3. SEVERE ALZHEIMER'S DISEASE
 Mild Alzheimer’s disease
Early stage of Alzheimer's, a person may function
independently.
He or she may still drive, work and be part of social
activities.
Despite this, the person may feel as if he or she is
having memory lapses, such as forgetting familiar
words or the location of everyday objects.
Friends, family or others close to the individual
begin to notice difficulties.
During a detailed medical interview, doctors may be
able to detect problems in memory or concentration.
• Common difficulties include:
• Problems coming up with the right word or
name
• Trouble remembering names when introduced
to new people
• Challenges performing tasks in social or work
settings.
• Forgetting material that one has just read
• Losing or misplacing a valuable object
• Increasing trouble with planning or organizing
• Moderate Alzheimer's disease (middle stage)
• Moderate Alzheimer's is typically the longest stage and can
last for many years. As the disease progresses, the person
with Alzheimer's will require a greater level of care.

During the moderate stage of Alzheimer’s, the dementia

symptoms are more pronounced. A person may have
greater difficulty performing tasks, such as paying bills, but
they may still remember significant details about their life.
• The person with Alzheimer's confusing words, getting
frustrated or angry, or acting in unexpected ways, such as
refusing to bathe. Damage to nerve cells in the brain can
make it difficult to express thoughts and perform routine
tasks.
 • At this point, symptoms will be noticeable to others and may
include:
• Forgetfulness of events or about one's own personal history
• Feeling moody or withdrawn, especially in socially or mentally
challenging situations
• Being unable to recall their own address or telephone number or the
high school or college from which they graduated
• Confusion about where they are or what day it is
• The need for help choosing proper clothing for the season or the
occasion
• Trouble controlling bladder and bowels in some individuals
• Changes in sleep patterns, such as sleeping during the day and
becoming restless at night
• An increased risk of wandering and becoming lost
• Personality and behavioral changes, including suspiciousness and
delusions or compulsive, repetitive behavior .
 Severe Alzheimer's disease (late stage)
In the final stage of this disease, dementia symptoms
are severe. Individuals lose the ability to respond to
their environment, to carry on a conversation and,
eventually, to control movement. They may still
say words or phrases, but communicating pain
becomes difficult. As memory and cognitive skills
continue to worsen, significant personality changes
may take place and individuals need extensive help
with daily activities.
• At this stage, individuals may:
• Need round-the-clock assistance with daily
activities and personal care
• Lose awareness of recent experiences as well as
of their surroundings
• Experience changes in physical abilities,
including the ability to walk, sit and, eventually,
swallow
• Have increasing difficulty communicating
• Become vulnerable to infections, especially
pneumonia
 DIAGNOSIS

• History taking of about overall health, use of

prescription and over-the-counter medicines, diet,
past medical problems, ability to carry out daily
activities, and changes in behavior and personality

• Neurological assessment-Tests of memory,

problem solving, attention, counting, and language
are conducted.

• Carry out standard medical tests, such as blood and

urine tests, to identify other possible causes of the
problem
• A low level of beta-amyloid in cerebrospinal
fluid (CSF)
• Positron emission tomography (PET)to detect
Beta-amyloid deposits in the brain
• CT scan and MRI to rule out other possible
causes.
• Alzheimer’s disease can be definitely
 diagnosed only after death, with an
examination of brain tissue in an autopsy
 TREATMENT
• A nutritious diet, physical activity, social
engagement , and mentally stimulating pursuits
have all been associated with helping people
stay healthy as they age
• Treatment should be initiated and supervised by
a physician experienced in the diagnosis and
treatment of Alzheimer's dementia.
• Therapy should only be started if a caregiver is
available who will regularly monitor the intake
of the medicinal product by the patient.

• Diagnosis should be made according to current

guidelines
• Several medications are approved by the Food
and Drug Administration (FDA) to treat
symptoms of Alzheimer’s.
 • Donepezil (Aricept), rivastigmine (Exelon), and
galantamine (Razadyne) are used to treat mild to
moderate Alzheimer’s
(donepezil can be used for severe Alzheimer’s as well).
• The recommended dose is 5 mg orally once a day for
4 to 6 weeks, then increased to 10 mg once a day
• It is as an acetylcholinesterase inhibitor thus
inhibiting hydrolysis of acetylcholine. This increases
acetylcholine concentrations at cholinergic synapses.

• Donepezil has been shown to produce specific 

antiamnestic effects in animals.
 These drugs work by regulating
neurotransmitters, the chemicals that transmit
messages between neurons. They may help
reduce symptoms and help with certain
behavioral problems. However, these drugs
don’t change the underlying disease process.
They are effective for some but not all people,
and may help only for a limited time.
 • Memantine (Namenda), the Exelon patch, and
Namzaric (a combination of memantine and
donepezil) are used to treat moderate to severe
Alzheimer’s.
• Memantine tablets should be administered once a
day and should be taken at the same time every day.
The film coated tablets can be taken with or without
food.
• The tolerance and dosing of memantine should be
reassessed on a regular basis, preferably within three
months after start of treatment.
• Maintenance treatment can be continued for as
long as a therapeutic benefit is favourable and the
patient tolerates treatment with memantine.

• Discontinuation of memantine should be

considered when evidence of a therapeutic effect
is no longer present or if the patient does not
tolerate treatment
 • Medications may temporarily improve
symptoms or slow the rate of decline.

• High-dose vitamin E (1000 IU orally once

or twice a day)
 Prevention
• observational evidence suggests that risk of Alzheimer
disease may be decreased by the following:

• Continuing to do challenging mental activities (eg, learning

new skills, doing crossword puzzles) well into old age
• Exercising
• Controlling hypertension
• Lowering cholesterol levels
• Consuming a diet rich in omega-3 fatty acids and low in
saturated fats
• Once dementia develops, abstaining from alcohol is
usually recommended because alcohol can worsen
dementia symptom
 Nursing management
Nurses play a key role in promoting the
patient’s safety, independence in self-care
activities, reducing anxiety and agitation,
improving communication, providing for
socialization and intimacy, adequate
nutrition and supporting and educating the
family caregivers.
 Nursing care plan
NURSING GOAL IMPLEMENTATION
DIAGNOSIS
Disturbed Patient •Observe patient for cognitive functioning, memory
Thought will
Process changes, disorientation, difficulty with
have
improve communication, or changes in thinking patterns.
May be d •Assess level of confusionand disorientation, ability
related to thought to cope with events, interests in surroundings and
Chemical
imbalances
process activity, motivation, and changes in memory pattern.
in the brain, •Assess patient for sensory deprivation, concurrent
possibly use of CNS drugs, poor nutrition, dehydration,
evidenced infection, or other concomitant disease processes.
by- •Orient patient to environment as needed, if patient’s
Disorientatio
n to time, short term memory is intact. Using of calendars,
place, person radio, newspapers, television and so forth, are also
  appropriate.
• Maintain a regular daily schedule routine to
prevent problems that may result from thirst,
hunger, lack of sleep, or inadequate exercise.
• Allow patient the freedom to sit in a chair near
the window, utilize books and magazines as
desired.
• Label drawers, use written reminders notes,
pictures, or color-coding articles to assist
patients.
• Allow wandering in a controlled environment.
• Provide positive reinforcement and feedback
for positive behaviors
• Limit decisions that patient makes as he may be
unable to make even the simplest choice
decisions and this will result in frustration and
distraction.
• Provide opportunity for social interaction, but to
do not force interaction
• Inform patient of care to be done, with one
instruction at a time
• Maintain a nice quiet neighborhood.
• Face-to-face when talking with patients.
• Help the people closest to identify the risk of
hazards that may arise.
 Nursing Goal Implementation
diagnosis
Chronic Patient •Assess patient for reversible or irreversible
Confusion
May be related will dementia, causes, ability to interpret environment,
to have intellectual thought processes, memory loss,
Alzheimer’s minim disturbances with orientation, behavior, and
disease, al socialization.
Dementia confusi
Possibly oncogn •Avoid or terminate emotionally charged
evidenced by
Decreased itive situations or conversations. Avoid anger and
ability to impair expectation of patient to remember or follow
interpret one’s ment, instructions. Do not expect more than the patient
environment, and is capable of doing.
Decreased other
capacity for
thought,
dement •Ask family members about their ability to
Memory ia provide care for patient.
impairment,Di manife
sorientation station •Instruct family to avoid having patient watch
s. violent TV shows
• Instruct family regarding avoidance of arguing
with patient about what he thinks, sees, or hears.

• Instruct family to utilize distraction techniques,

such as soothing music, going for a walk, or
looking at picture albums if patient has delusions.

•Instruct family and provide them with information

regarding community services and long-term health
care facilities.
 Nursing Goal Implementation
diagnosis
Impaired  •Assess the patient’s ability to speak, language deficit, cognitive or
Verbal Patient will sensory impairment, presence of aphasia, dysarthria, aphonia,
Communicat be able to dyslalia, or apraxia. Presence of psychosis, and/or other neurologic
ion have disorders affecting speech.
effective
May be •Assess effects of communication deficit
speech and
related to understandin •Monitor the patient for nonverbal communication, such as facial
disease g of grimacing, smiling, pointing, crying, and so forth; encourage use of
process, communicat speech when possible.
Dementia, ion, or will •Attempt to anticipate patient’s needs. Helps to prevent frustration
,Lack of be able to and anxiety.
stimuli use another •When communicating with patient, face patient and
Possibly method of maintain eye contact, speaking slowly and enunciating clearly in a
evidenced by communicat moderate or low-pitched tone allowing patient time to receive and
ion
Repetitive process the information.
speech, •Remove competing stimuli, and provide a calm, unhurried
inability to atmosphere for communication and allow patient time to decrease
speak frustration.
stuttering, •Use simple, direct questions requiring one-word answers. Repeat
slurring, and reword questions if misunderstanding occurs. Promotes self-
inability to confidence of the patient .
name words, •Utilize pencil and paper to write messages-Provides an alternative
inability to method of communication if fine motor function is not impaired;
identify use of magic slate is also suitable.
objects,
• Assess patient for hearing deficits, and use of
appropriate adaptive devices if needed.
Minimizes glare in room, speak normally, but
distinctly, and use short phrases with speech
attempts.
• Encourage patient to breath prior to speaking,
pause between words, and use tongue, lips,
and jaw to speak. Promotes coordinated
speech breathing.
• Instruct patient perform
facial muscle exercises, such as smiling,
frowning, sticking tongue out, moving tongue
from side to side and up and down
 Nursing Goal Implementation
Diagnosis
Self-Care Patient •Assess patient’s appearance, body odors, ability to recognize and user
Deficit:  will articles for washing and grooming, and any other self-care deficits.
May be have •Assess and identify patient’s previous history of grooming and bathing
related to self-care •Ensure all needed items are present in bathroom prior to the patient’s
disease needs arrival. Ensure that water temperature in tube is appropriate.
process Patient •Allow patient to perform as much of the task as able.
Possibly will be •Assist with as much activity as needed. Give patient a washcloth or
evidenced able to hand towel to hold on to.
by perform •Instruct patient in activity with short step-by-step method; do not rush
Inability a patient.
to:Wash portion •Instruct family members in bathing technique and what to observe for
body of self- during bath.
parts,, care . •Establish urinary and bowel care program if patient is unable to
comb hair, carry complete toileting
Shave, out •Monitor patient for sudden changes in urinary and bowel status.
Brush toileting •Encourage fluid intake of at least 2-3 L per day unless contraindicated.
teeth program •Administer stool softeners, laxatives, or suppositories and take patient
toileting to bathroom at same time each day to promote stool evacuation.
routine, •Instruct family regarding toileting program, times to take patient to the
flush toilet bathroom, and need to maintain consistent schedule.
•Instruct family in procedure for administration of suppositories or
enemas.
Nursing Goal Implementation
Diagnosis
Impaired Patient •Assess patient’s functional ability for mobility
Physical will
Mobility maintain •Assess patient’s degree of cognitive impairment and ability to follow
May be functional commands, and adapt interventions as needed.
related mobility
to- as long as •Provide patients with enough time to perform a mobility related
Disease possible assignment. Use simple instructions
progressio
n •Provide range of motion exercises every shift. Encourage active range
Possibly of motion exercises
evidence
d by- •Reposition patient every 2 hours
weakness, •Apply towel rolls and/or pillows to maintain joint alignment.
immobilit
y, balance •Avoid restraints as possible
and
coordinati •Avoid the use of walkers and canes as most patients cannot use them
on properly because of their cognitive impairment, and they may actually
deficits increase potential for injury.

•Instruct family regarding ROM exercises, methods of transferring

patients from bed to wheelchair, and turning at routine intervals
Nursing Goal Implementation
Diagnosis
Wandering Patient •Assess patient for presence of wandering behavior, noting time, place,
May be will have and people whom he ambulates with.
related to minimized •Assess specific reasons for wandering, if patient is able to verbalize
disease behavior motivation
process. •Inquire how family handles the patient’s wandering behavior
Possibly •Allow patient to wander within boundaries in a safe environment.
evidenced Structure in the patient’s routine may decrease wandering tendencies.
by •Encourage patient to participate in activities if able to do so. Exercise
aimless helps to decrease restlessness and may decrease potential wandering
ambulation
Frequent or •Avoid using restraints if at all possible. Restraints increase agitation,
continuous anxiety, and cause complications of immobility, feelings of
movement powerlessness, and actual increase tendency for wandering.

•Assess patient for thirst, hunger, pain, or discomfort and need for
toileting.
•Instruct family regarding installing deadbolt locks, fences, locks on
gates, and locks on doors and windows.
•Instruct family to be prepared for possible escape attempts and to
keep up-to-date pictures of the patient, and other information available
Nursing Goal Implementation
Diagnosis

Social Patient will •Assess patient’s feelings about his behavioral problems, negative
Isolation be able to feelings about self, ability to communicate, anxiety, depression, and
May be maintain feeling of  powerlessness.Determines extent of loneliness and
related to effective isolation and reasons for it.
disease social
progression interaction •Identify possible support systems and ability to participate in social
Possibly activities.
evidenced
by •Provide diversional activities as appropriate for functional ability.
Uncommun
icative, •Provide rest and sleep periods; avoid situation that cause
Withdrawn, frustration, agitation, or sensory overload. Permits coping with
Isolation stimuli and prevents violent reactions.
from others
•Instruct patient/family regarding plan for periods of rest and
activities during the day.

•Instruct family regarding establishing a consistent bedtime routine

promotes sleep and helps to avoid frustration and confusion from
sleep deprivation
Nursing Goal Implementation
diagnosis

Risk for Patient will •Assess the degree of impaired ability of competence, Impairment
Injury:  remain safe of visual perception increase the risk of falling. Identify potential
Related to; from enviro risks in the environment and heighten awareness so that caregivers
Alzheimer’s nmental more aware of the danger.
disease, hazards •Assess patient’s surroundings for hazards and remove them.AD
Disorientati resulting decreases awareness of potential dangers, and disease progression
on, from coupled with hazardous environment that could lead to accidents.
confusion, cognitive •Eliminate or minimize sources of hazards in the environment.
impaired impairment •Divert attention to a client when agitated or dangerous behaviors
decision . like getting out of bed by climbing the fence bed.
making. •Maintain adequate lighting and clear pathways
Weakness, •Assess patient for hyperoralitypatients frequently have
the muscles unexplained movement of the mouth and tongue. The patient may
are not chew on fingers or put other items in mouth that can potentially be
coordinated dangerous or poisonous.
the •During the middle and later stages of AD, the patient must not be
presence of left unattended. cannot rationalize cause and effect. This can result
seizure activ in wandering outside without clothes on, exposure to extreme cold
ity. or heat, and may cause dehydration in the long run.
• Safety and supportive measures for Alzheimer
disease are the same as those for all dementias.
For example, the environment should be
bright, cheerful, and familiar, and it should be
designed to reinforce orientation (eg,
placement of large clocks and calendars in the
room).
• Instruct family regarding removal or locking up
knives and sharp objects away from the patient,
these includes cleaning supplies, insecticides, other
household chemicals, all medications, aerosol
sprays, weapons, power tools, small
appliances, smoking materials, and breakable items.
• Instruct family to apply protective guard over
electrical outlets, thermostats, and stove knobs.
• Instruct family to keep pathways clear, move
furniture against the wall, remove throw rugs,
remove wheels on beds and chairs or set lock them
in place, and keep rooms and hallways well lighted.
• Instruct family to ensure that patient has
hearing aids, glasses, and others if they have a
sensory deficit.

• Instruct family to provide non slip shoes, and

shoes without laces when possible.

• Assess visual acuity, visual difficulties or loss

and its effect from these changes; presence
of cataract, glaucoma, and status of remaining
vision.
• Assess olfactory or gustatory loss, changes
in appetite and eating patterns, and amount
of loss and effect on nutritional status.

• Allow for interaction during mealtime

promotes interest in eating.

• Prevent any exposure to extreme

temperatures, and pressure to skin.
• Disturbed Sleep Pattern: 
related to Depression,Environmental stimuli,Possibly evidenced by
Interrupted sleep,Difficulty falling asleep,Awakening early
• Goal
• Patient will achieve and maintain restorative restful sleep
• Implementation
• Assess patient’s sleep patterns ,provide information on which to
establish a plan of care for correction of sleep deprivation. If
patient is sleeping during the day, Sundowning syndrome may be
the problem, with the patient’s day and night mixed up. By
keeping the patient up during the day, sleeping at night may
return.
• Monitor patient’s medications, use of alcohol
(if any), and caffeine.
• Ensure environment is quiet, well-ventilated,
absence of odor, and has comfortable
temperature.
• Provide ritualistic procedures of warm drink,
extra covers, clean linens, or warm baths prior
to bedtime.
• Provide backrubs, music other relaxation
techniques
• Help patient do exercises,may promote sleep.
 Prognosis

• The symptoms of Alzheimer's disease

worsen over time, although the rate at
which the disease progresses varies.
• On average, a person with
Alzheimer's lives four to eight years
after diagnosis, but can live as long as
20 years, depending on other factors.
 CONCLUSION
• Alzheimer's disease is a progressive disorder that causes
brain cells to waste away (degenerate) and die.
Alzheimer's disease is the most common cause of
dementia — a continuous decline in thinking, behavioral
and social skills that disrupts a person's ability to
function independently.

• There is no treatment that cures Alzheimer's disease or

alters the disease process in the brain. In advanced stages
of the disease, complications from severe loss of brain
functions, such as dehydration, malnutrition or infection
may result in death.
 BIBLIOGRAPHY
• Brunner & Suddarth’s.Textbook of Medical
-Surgical Nursing Volume 2. 12th Edition. 1976
- 84
• Lewis’s Medical Surgical Nursing, , 2011
Elsevier 145, 1451-54
• Also available at www.slideshare.net