Dementia is a set of conditions, medically diagnosed, and leading to recognized and measurable behavioral changes in an individual. Dementia of the Alzheimer’s type is a chronic cognitive disorder that is manifested in impairment of either short-term or long-term memory or even both. It has a slow onset and its etiology is unknown, although many speculate that genetics may play a role as well as the decrease in acetylcholine which is a neurotransmitter that is used to carry electrical impulses from the axon of one cell to the dendrite of another. The number of neurotransmitters have been found in the brain tissue of patients with dementia and Alzheimer’s. Alzheimer’s disease accounts for about 70% of dementia cases. Over 4 million people are currently diagnosed as having Alzheimer’s disease.
There is not a specific age of onset although it usually occurs in late adulthood. People are living longer now and for this reason, the number of Alzheimer’s cases is on the rise. It is a neurological disorder of the brain that can cause overwhelming anxiety for both those affected and family members of those affected. In Alzheimer’s disease, normal brain tissue is replaced by neuritic plaques which basically just take up space. These brain lesions will inevitably cause death. Various bodily functions begin to be altered depending on the part of the brain affected. Usually as the disease progresses, bladder control will be lost as well as the ability to swallow.
The brain lesions will often times trigger the onset of seizures. Cognitive symptoms of Alzheimer’s disease include alteration in language, ability to solve problems, and even the inability to make appropriate decisions. This may often times be the most difficult symptom for nurses and care providers to deal with legally. In the long run, patients will experience complete memory loss and aphasia. Non-cognitive changes include unexplained movements, urinary and fecal incontinence, aggression, and/or agitation. There is currently no known therapeutic treatment that can stop the progression of dementia and Alzheimer’s disease.
In caring for the Alzheimer’s patient, the staff must remember to refer to the patient by name and not by calling them “sweetie” or “honey”. A patient has a right to maintain dignity. If dementia is diagnosed early enough, it is advisable for the patient to designate a decision-maker which will help designate that patient’s assets. Quality of life in patients with dementia is a big ethical topic that becomes very important in the late stages of dementia. During late stage dementia, ability to express pain or discomfort may be altered. In these patients verbal references to pain are absent, not because they’re not experiencing any pain but because they may not know how to express the degree of pain that they are experiencing. Because of this, regular administration of pain medications are often prescribed (Refer to article #1: discomfort protocol). Oftentimes, family members find themselves in a bind between providing care until the very end of life or requesting the cessation of life-sustaining measures (Refer to article #2: euthanasia and assisted suicide).
Assessment should include family history, social history, memory (long-term and short-term),behavioral responses such as wandering, suicide risks, appearance, speech, and hallucinations. Oftentimes, a family member is needed to assist with subjective data as the patient may not remember some things. Sometimes, out of frustration, a person with Alzheimer’s will fabricate stories or details. This is believed to be a defense mechanism. They are in denial about having loss of memory.
Nursing diagnoses include:
-altered thought processes related to dementia.
-impaired physical mobility.
-alteration in nutrition related to neurological deficits in swallowing.
-self care deficit.
Goals should include ability to comply with treatment plan and ability to satisfy self-care requirements. Interventions for the Alzheimer’s patient focus on keeping the patient comfortable, nourished, and hydrated. Oftentimes, a patient will request a priest, rabbi, or minister to visit and offer religious support. In late stage Dementia and Alzheimer’s disease, comfort is usually one of the primary goals of the care team, since death is inevitable (refer to article #3: music and dementia). It is important to speak to these patients slowly and clearly. Many times they are able understand what is being said when spoken to at a slower pace.
In summary, Alzheimer’s Disease and Dementia are often secondary diagnoses and because of this, they are often overlooked in the management of care and proper treatment of patients with other diagnoses. Alzheimer’s Disease does not discriminate. Nobody asks to have Alzheimer’s so it is important to remember that patients do not always act out the way they want to. Sometimes they just can’t help it.