Transcript Program with audio - Saint Anselm College

This online program is available until December 31, 2017
In order to receive contact hours, you must:
1) Listen to entire program
2) Complete the post-test and the evaluation
3) Once you have submitted your evaluation, you will then
be sent your certificate of completion.
Thank you!
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The presenter has no financial or other
interest in any commercial company which
could influence the content of this
presentation.
There is no commercial support for this
program .
The planning committee has nothing to
disclose.
Jo Ann Jordan, M.Ed., RN
Dementia Consultant/Educator
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Objectives:
◦ Describe the signs and symptoms of AD.
◦ Discuss the incidence of the disease and the
significance within the healthcare system.
◦ Differentiate AD from normal aging other causes of
memory loss.
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Slower thinking – speed of recall, speed of
learning
Difficulty paying attention – concentration,
distraction, changes in vision, hearing and
other physical functions which affect
attention.
Transmission or retrieving information –
increased need for memory cues.
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High risk conditions that contribute to
memory difficulties in older adults:
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Fatigue
Grief
Depression
Medication side effects
Alcohol
Vision and hearing loss
Diet (malnutrition)
Illness/infection
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Benign forgetfulness
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Orientation is in tact
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Mood appropriate to the situation
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Speech, thinking and intelligence in tact
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D drug reactions
E emotional problems
M metabolic & endocrine disorders
E eyes and ears
N nutrition issues
T tumors that may be removed
I Infections
A arteriosclerosis causes*
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Involves the time that precedes full on AD
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Lasts about 7 years before it begins to interfere with ADLs.
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Approximately 10-20% of the population experience MCI
after age 65.
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Two sub-types:
◦ Amnestic – significant memory problems, 7-10 yrs progression to
most common type of AD.
◦ Nonamnestic – problems with decision making, language,
navigation and execution of tasks. May be a for runner of other
types of dementias
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Source- AD Cooperative Study, January 2012 No. 38.
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Progressive decline in cognitive functions
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Thinking
Remembering
Reasoning
Judgment
Impulse control
Abstract thinking
Language
 Of sufficient severity to interfere with a person’s daily
function.
 NOT a disease but a group of symptoms which accompany a
disease or condition which affects the brain.
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The most common form of dementia
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Initially involves parts of the brain that control
thought, memory and language
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Insidious and progressive (7-10 years)
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Cause is unknown – probably is not one single
cause but several factors
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Nearly 70% of all dementia diagnoses are AD.
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NOT a normal part of aging.
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Alzheimer’s disease (A.D.):
◦ Progressive, insidious, ultimately fatal, disorder in
which certain types of nerve cells in particular areas
of the brain degenerate and die for unknown
reasons
◦ The two "hallmark" Alzheimer lesions observable at
autopsy – first described by German
neuropsychiatrist Alois Alzheimer in 1906 – are
amyloid plaques and neurofibrillary tangles.
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51 year-old woman who
showed signs of extreme
jealousy
Rapid decrease in memory;
couldn’t find her way around
her apartment
Carried objects back and
forth and then hid them
Total disorientation to time
and place
Reading and writing severely
impaired
Language difficulties: called
a cup a “milk pourer”
Lingered for 4.5 years before
death
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Number of people with AD doubles every 5
years beyond age 65 – eventually 50% of
persons over 85.
Family history – risk factor
◦ Early onset familial AD – rare (age 30-60) is
inherited
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Late onset – more common form
◦ No obvious inheritance pattern
◦ ApoE gene – everyone has this gene which helps
carry cholesterol in the blood.
 15% of people have the form that increases the risk of
AD
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5.4 million of Americans of all ages have AD
◦ 5.1 million age 65 and over – AD
◦ 200,000 under 65 - early onset AD
◦ 500,000 under 65 – AD or another dementia
◦ One in eight persons age 65 and over (13%) has AD
◦ 6th leading cause of death
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Every 69 seconds, someone in America
develops Alzheimer’s disease.
By mid-century someone will develop AD
every 33 seconds
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If no cure is found, 10 million “baby
boomers” will develop Alzheimer’s disease.
Are you a “boomer” or will you be providing
care for “boomers”!
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Aging – in most people symptoms appear
after age 60
Genetics – family hx – there are some earlyonset forms, usually linked to a specific gene
defect which may appear as early as 30 years
old.
Health history
◦ History of head trauma
◦ Vascular disease
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Memory loss
Difficulty performing tasks
Problems with language
Disorientation to time and place
Poor/decreased judgment
Problems with abstract thinking
Misplacing things
Change in mood or behavior
Changes in personality
Loss of initiative
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Common patterns of symptom progression.
Important: Not everyone will experience the
same symptoms or progress at the same rate.
Framework is based upon 7 stages.
Changes in:
◦ Cognition (thinking)
◦ Affect (emotions and feelings)
◦ Physical condition
◦ Barry Reisburg, MD , 1984
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Importance of utilization of a “framework” or
staging:
Identify remaining functional abilities
Determine realistic expectations
Establish goals for the patient
Provide support, care planning and treatment consistent
with cognitive abilities and expectations
◦ Reduce trial and error approach
◦ Provide each patient with the opportunity to achieve and
maintain their highest level of function for as long as
possible
◦ Promote consistent understanding and knowledge for all
staff, all disciplines within the healthcare system.
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Primary and most important rationale for
staging:
◦ To AVOID …..”Excess disability”
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Stage 1 – no impairment, no memory
problems
Stage 2 – very mild cognitive decline – may be
normal age-related changes or earliest signs
of AD
◦ Mild memory loss and lapses
◦ Forgetting familiar words or names, location of
keys, eyeglasses
◦ Problems not evident during a medical exam
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Stage 3 – Mild cognitive decline – early stage
– can be diagnosed in some people
◦ Friends, family, co-workers begin to notice
deficiencies.
◦ Problems with memory or concentration may be
measurable during medical testing or interview
◦ Common problems –
 Word or name finding
 Decreased ability to remember names when introduced
to people
 Performance issues – social or work related
 Reading retention
 Decline in ability to plan/ organize
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Stage 4 – moderate cognitive decline – mild or
early stage AD
◦ Decrease in “short-term” memory
◦ Decreased knowledge of recent occasions or current
events
◦ Impaired ability to perform challenging mental
arithmetic (counting backwards by 7’s)
◦ Careful medical interview detects clear-cut deficiencies.
◦ Decreased capacity to perform complex tasks – planning
dinner, paying bills, managing finances
◦ Reduced memory of personal history
◦ May seem subdued and withdrawn
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Stage 5 – moderately severe cognitive decline
(moderate or mid-stage AD)
◦ Major gaps in memory and deficits in cognitive function.
◦ Some assistance with day to day activities becomes
essential.
◦ May be unable to recall important details
◦ Confusion regarding where they are, date, day or
season.
◦ Need assistance choosing proper clothing.
◦ Usually retains substantial knowledge about themselves
and knows own name and name of spouse or children.
◦ Usually no assistance required with eating or using the
toilet.
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Stage 6 – severe cognitive decline
(moderately severe or mid-stage AD)
Memory difficulties worsen
Personality changes may emerge
Need for extensive assistance with ADLs
May lose most awareness of recent experiences and
events
◦ Recollect personal hx imperfectly
◦ Occasionally forget the name of spouse or primary
caregiver
◦ Experience disruption of normal sleep/waking cycle
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Stage 7 – very severe cognitive decline (severe
or late stage AD)
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Final stage
Loss of ability to respond to their environment
Loss of the ability to speak
Ultimately loss of ability to control movement
Incontinence
Need for support for sitting
Reflexes become abnormal and muscles grow rigid
Swallowing is impaired
Susceptible to injuries and infections
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Complete history and physical exam
Psychiatric evaluation
Neurological evaluation
Lab work – Thyroid, CBC, B12 levels, etc.
Scan
Spinal tap
With the above evaluation = 95% accuracy in
dx
Autopsy - for definite dx
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Neurochemical transmitters
◦ Acetylcholine - neurochemical substance found
decreased in brains of persons with Alzheimer’s
disease. Lack of Acetylcholine is believed to
further disrupt the transmission of messages
between neurons.
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Donepezil (Aricept)
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Rivastigmine (Exelon)
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Galantamine (Razadyne, formerly known as
Reminyl)
…are prescribed to treat mild to moderate AD
symptoms
◦ Act by stopping or slowing the action of
acetylcholinesterase – an enzyme that breaks down
acetylcholine (neurotransmitter).
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Namenda – (Memantine)
◦ the only glutanmate pathway modifier
◦ Glutanmate – aids in learning and memory
◦ Used in combination with AChE Inhibitors
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The drugs maintain some people’s abilities to
carry out ADLs and may maintain some
thinking, memory or speaking skills.
They may help with certain behavioral
symptoms
HOWEVER…they do not stop or reverse AD
and appear to help for only months to a few
years.
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Genetics factors
Neuro-transmitters
Inflammation
Factors which influence programmed cell
death in the brain
Roles of tau, beta amyloid in plaques and
tangles (focus of most current research)
Role of cholesterol metabolism
Oxidation
Improvement in early diagnosis, scans
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Lowering homocysteine (amino acid related to
heart disease) – use of folic acid, B12 and B6
Lowering cholesterol levels – cholesterol involved
in formation of plaques – use of statins
Lowering blood pressure – use of antihypertensives
Exercise
Education
Controlling inflammation
Nonsteroidal anti-inflammatory drugs - NSAIDs
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Use of the person’s retained strengths,
memories and abilities:
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Emotional memories
Sensory appreciation
Primary motor skills
Procedural memory/habitual skills
Long-term memory
Sense of humor
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As people age, one of the greatest fears is the
loss of one’s memory.
Memory is the link to our past, present and
future.
From time to time everyone experiences memory
loss, but information is eventually retrieved.
Continuing to enhance your understanding of
memory, the changes that may occur with
“normal” aging and the conditions which are
reversible and irreversible will improve the care
and support you provide to our aging population.
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Thank you for participating in this program.
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Jo Ann Jordan, M.Ed., RN