Transcript NUR4160 Dillon-Alzheimers Disease Presentation

Alzheimer’s Disease
Tessa Dillon
Nova Southeastern University
Clinical Genetics
Teri Doolittle, PA-C, MHP, DHSc
August 3, 2008
Incidence
 Alzheimer’s
Disease (AD) is the most
common cause of dementia in older
adults
 About 25% of AD cases are
hereditary
 Having a 1st degree relative with AD =
20% to 25% risk of developing AD
Bird, 208, p.3; National Institute of Health [NIH], 2006
At- Risk Population
Early onset AD = 1%-3% of all cases
 Early onset Familial AD accounts for
13% of cases
 Down’s Syndrome in 40’s



Results from Trisomy 21
60% of patients with dementia or AD
live in the Western World
Bird, 208, p.3; Blennow, deLeon, & Zetterburg, 2006; NIH, 2006
Inheritance Patterns

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Early onset familial AD appears to be
Autosomal Dominant
Late onset familial AD involves multiple
susceptibility genes
Families with multiple affected members
higher incidence
Sporadic inheritance caused by combination
of aging, genetic predisposition & exposure
to environmental agents
Bird, 2008, p.5; Blennow et al., 2006
Prognosis
 Progressive
disease
 No cure is Available
 Treatment is supportive
 Includes management of symptoms
 Pharmacogenetics shows promise
in tailoring drug effectiveness
Bird, 2008; Elder, 2007
Course of the Disease
Begins with subtle failure of memory
 Progress to

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
confusion
poor judgment
language disturbance
Advanced cases result in



Agitation
Withdrawal
Hallucinations
Bird, 2008; Blennow, 2006; NIH, 2006
Interdisciplinary Care Factors
Nurses provide referral to genetic
counselor
 Physician & Pharmacologist optimize
treatment of symptoms
 Psychiatrist & Psychologist for mental &
behavioral support
 Palliative care from a hospice provider


Provides needed care for the patient and
caregiver in the late stages of AD
Smith & Keene, 2007
Case Scenario
Mr. Y a 45-year old computer engineer
 Manager of software development unit
at a large company
 Well respected in community
 Married with one female child age 22
 No significant medical history, receives
regular annual physicals
 Exercises Daily with 30 minute Jog

Burke, Fryer-Edwards, & Pinsky, 2001
Case Scenario continued

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Mr. Y has been under stress at work
Goes on vacation to New York
Calls his daughter from Union Square unable
to recall what hotel he is staying in
He asks his daughter for the name of the
hotel and what to do next
His boss also describes his work as
unsatisfactory
States he is making faulty management
decisions
Burke et al., 2001
Age 72
healthy
Age 90
healthy
Three
Generation
Family
History
Age 59 severe
mental problems
Age 48 memory
problems
Early Onset Alzheimer’s
Unaffected individual
?
Onset AD age 50
Age 45 New
onset confusion
Burke et al., 2001
Punnett Square
A
a
Aa
a
aa
A = Alzheimer’s Trait
a = normal memory
a
Aa
aa
Based upon the family history the Punnett
square reveals that there is 50% chance of
each child developing Early onset AD
Role of Nurse in Care

Assessment


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Provide supportive care
Explain unfamiliar terms (tests & genetics)
Serve as mediator for others involved in
care
Early Case Findings


Screen family for possible genetic
counseling
Refer to community support groups
Interventions
 Assistance
with rehabilitative efforts
 Consult pharmacologist for
medication education
 Refer to hospice when appropriate
Question One

Pharmacogenetics offers promise to
patients who have AD by offering them
this?
And the ANSWER is:

Customized treatment plan and new
medications to slow the symptoms
associated with Alzheimer’s disease.
Question Two

If two or more direct family members have
AD what are the chances that you will get
the disease?
And the answer is:

AD is generally Autosomal Dominant


In early onset there is a 50% chance of inheriting
the disease from a direct family member
In late onset, the risk is less because of
incomplete penetrance and multiple gene
mutations.
References
Bird, T. (2007, October). Alzheimer disease overview in
gene reviews. Retrieved August 3, 2008, from
http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=g
ene&part=alzheimer
Blennow, K., deLeon, M., & Zetterberg, H. (2006).
Alzheimer’s disease [Electronic version]. The Lancet
368, 387-403.
References Continued
Burke, W., Fryer-Edwards, K., & Pinsky, L. (Eds.).
(2001, September). Genetics in primary care (GPC)
training program curriculum materials. Retrieved July
29, 2008, from Nova Southeastern University WebCT
Elder, B. (2007). The genetics of chronic disease: A
nursing perspective [Electronic version]. The Kansas
Nurse 82(10), 3-5.
References Continued
National Institute of Health. (2006, October). Genetics in
primary medicine: Alzheimer disease ApoE genotyping at-aglance. Retrieved August 3, 2008, from
http://www.genetests.org/servlet/access?id=8888892&key=S5VnWgvs6gLfL
&fcn=y&fw=EEG3&filename=/tools/teaching/ataglance/alzheimer.html
Smith, C. & Keene, S. (2007). Hospice care for alzheimer's
disease: Caring for the patient, family, and caregivers. The
Internet Journal of Geriatrics and Gerontology 3(2).
Retrieved August 4, 2008, from
http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijgg/vol3n2/hospice.xml