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Dementia and Alzheimer's Disease in Older Adults - Coggle Diagram
Dementia and Alzheimer's Disease in Older Adults
Dementia: A general term for significant cognitive decline interfering with daily living activities.
Alzheimer's Disease (AD): The most prevalent type of dementia (at least 2/3 of cases in 65+). A neurodegenerative condition with insidious onset, progressive impairment of memory, comprehension, language, attention, reasoning, and judgment.
Onset: Late-onset AD (LOAD) after 65; Early-onset AD (EOAD) before 65 (5% of cases, more aggressive).
Epidemiology: Incidence doubles every 5 years after 65. Prevalence increases from 10% after 65 to 40% after 85. Slightly higher incidence in women after 85.
Pathophysiology:
Accumulation of abnormal neuritic plaques (amyloid beta-peptide) and neurofibrillary tangles in the brain.
Loss of neurons, especially cholinergic neurons.
Cholinergic Hypothesis: Reduced acetylcholine levels.
Amyloid Hypothesis: Elevated Aβ42 peptides lead to amyloid aggregation and neuronal toxicity.
Major Risk Factors:
Age (most significant), cardiovascular diseases, obesity/diabetes, traumatic head injury, depression, smoking, family history (10-30% increased risk with 1st degree relative), APOE e4 allele.
Protective Factors: Higher education, estrogen use (in women), anti-inflammatory agents, leisure activities (reading, music), healthy diet, regular aerobic exercise.
Stages:
Preclinical: Asymptomatic but with lab evidence (low amyloid, high tau in CSF).
Mild Cognitive Impairment (MCI): Memory or non-memory impairments but functions independently. 10% progress to dementia per year.
Dementia: Incapacitating memory impairment, anomia, paraphasic errors, visuospatial decline, delusions (20-40%), disruptive behaviors (50%), sleep-wake cycle disruption.
Diagnosis: History (from family/caregiver), physical/neurological exam, MMSE/MOCA/Mini-Cog, brain imaging (MRI, PET, SPECT), blood tests, CSF analysis (beta-amyloid, tau proteins).
Treatment (Symptomatic, no cure):
Cholinesterase Inhibitors (for mild-mod AD): Donepezil (medication of choice), Rivastigmine (oral/transdermal), Galantamine. Side effects: nausea, vomiting, diarrhea, bradycardia.
Memantine (for mod-severe AD): Slows intracellular calcium accumulation. Side effects: dizziness, headache, constipation. Can be combined with cholinesterase inhibitors.
Other: Avoid anticholinergics and benzodiazepines. Use caution with antipsychotics (risk of stroke, mortality). Brexpiprazole (FDA approved 2023 for agitation).
Nursing Management & Patient Education
Improving Cognitive Function: Assess cognitive status, orient to environment, use assistive devices (glasses, hearing aids), eliminate background noise, maintain routine.
Promoting Safety: Lock away sharp objects/chemicals, double lock doors, use bed alarms, provide non-slip shoes, never leave unattended in later stages.
Managing Confusion/Anxiety: Maintain consistent schedule, avoid overstimulation, use distraction techniques, provide rest periods, validate feelings.
Improving Communication: Face the patient, speak slowly/clearly, use short sentences, allow time to respond, use nonverbal cues, avoid speaking loudly unless hearing impaired.
Promoting Self-Care: Allow patient to perform as much as possible, provide step-by-step instructions, use Velcro fasteners, establish toileting schedules.
Promoting Mobility & Sleep: Perform ROM exercises, reposition q2h, avoid walkers/canes (cannot use properly), establish bedtime routine, manage sundowning (keep patient up during the day).
Managing Wandering: Allow wandering within safe boundaries, use bed alarms/pressure mats, install deadbolt locks, avoid restraints, assess for thirst/hunger/pain.
Enhancing Family Coping: Assess family knowledge/fatigue, teach energy-conserving techniques, provide community resources (respite care), consult social worker.
Prognosis & Complications
Prognosis: Average life expectancy of 4-8 years after diagnosis (some live up to 20 years). Pneumonia is the most common cause of death.
Complications:
Mental/Behavioral: Depression, agitation, delirium (sundowning), wandering.
Physical: Infections (respiratory, urinary), aspiration pneumonia, dehydration, malnutrition, falls, bladder/bowel problems