Alzheimer’s Disease Learning Guide What it is Complications Treatment Prevention and research Caring for the AD client What it is
Alzheimer’s disease (AD) is the most common form of dementia. More than 4
million Americans have AD. The disease is characterized by memory loss, language deterioration, poor judgment, and an indifferent attitude.
Dementia is a brain disorder that seriously affects a person’s
ability to carry out daily activities. It involves the parts of the brain that control thought, memory, and language. Healthy brain tissue dies or deteriorates, causing a steady decline in memory and mental abilities.
AD is not the only form of dementia. Doctors diagnose Alzheimer’s disease by
doing tests to eliminate all the other possible reasons for the person’s symptoms. If no other cause is found, usually a diagnosis of Alzheimer’s is given.
AD causes progressive degeneration of the brain. It may start with slight memory
loss and confusion, but eventually leads to severe, irreversible mental impairment that destroys a person’s ability to remember, reason, learn, and imagine. Usually, family members notice gradual—not sudden—changes in a person with AD.
As AD progresses, symptoms become serious, and family
members usually seek medical help. Progression from simple forgetfulness to severe dementia might take five to ten years or longer.
People with mild AD may live alone and function fairly well.
People with moderate AD may need some type of assistance. People with advanced AD generally require total care.
Think of the way electricity travels along wires from
a power source to the point of use. Messages travel through the brain in a similar way, but they are carried by chemicals instead of wires. Information travels through the nerve cells in the brain so we can remember, communicate, think, and perform activities.
Researchers have found that people with AD have
lower levels of the chemicals that carry these important messages from one brain cell to another. In addition, people with AD have many damaged or dead nerve cells in areas of the brain that are vital to memory and other mental abilities. Although the person’s mind still contains memories and knowledge, it may be impossible to find and use the information in the brain because of AD.
Abnormal structures called plaques and tangles are another characteristic of AD.
Plaques. It is believed that plaque deposits form between brain cells early in
Tangles. This refers to the way that brain cells become twisted, causing
These structures block the movement of messages through the brain, causing
memory loss, confusion, and personality changes. The person with AD has no control over these symptoms and cannot be held responsible for behavior problems. Complications
Most people with AD die from another illness, not from AD.
In advanced AD people lose the ability to do normal activities and care for their own needs. They may have difficulty eating, going to the bathroom, or taking care of their personal hygiene. They may wander away, get lost, or become injured. They may develop
complicating health problems such as pneumonia, infections, falls, and fractures.
There is no cure. Medications are available that may slow AD, lessening the
symptoms, but they are unable to stop or reverse the disease. These include tacrine (Cognex), donepezil (Aricept), rivastigamine (Exelon), and galantamine (Reminyl).
Medicines are sometimes ordered to help with symptoms such as sleeplessness,
wandering, anxiety, agitation, and depression.
Prevention and research
There is no known way to prevent AD. Researchers continue to look for ways to
It is believed that lifelong mental exercise
and learning may create more connections between nerve cells and delay the onset of dementia. People should be encouraged to learn new things and stay mentally active as long as possible. Caring for the AD client
AD progresses at a different rate with each person. It is important to focus on things
that the person with AD can still do and enjoy. All persons with AD need unconditional love and constant reassurance, no matter what stage of the disease they are in. You will recognize these signs in many clients with AD:
Increasing and persistent forgetfulness.
Difficulty performing familiar activities such as brushing teeth or bathing.
Personality changes such as irritability, anxiety, pacing, and restlessness.
Depression. Depression may show itself in some of these ways:
x Anxiety—this can be caused by noise, feeling rushed, and by large groups.
Pacing and agitation. Agitation often is a symptom of underlying illness or pain. Medication can also cause agitation, as can changes in the environment.
Disorientation, delusions, or hallucinations. A person with hallucinations sees, hears, or feels things that are not there. A person with delusions believes strongly in something that is not true, such as believing that he has been captured by enemies.
Difficulties with abstract thinking or complex tasks. Balancing a checkbook, recognizing and understanding numbers, or reading may be impossible. These suggestions will help you care for a client with AD: Structure. Serenity and stability reduce behavior problems. When a person with AD becomes upset, the ability to think clearly declines even more.
o Plan the schedule to match the person’s normal, preferred routine. o Find the best time of day to do things, when the person is most capable.
Keep familiar objects and pictures around.
Bathing. Some people with AD won’t mind bathing. For others it is a confusing,
frightening experience. Plan the bath close to the same time
every day. Be patient and calm. Allow the client to do as much of
the bath as possible. Never leave the client alone in the bath or
shower. A shower or bath may not be necessary every day—try a sponge or partial bath some days. Dressing. Allow extra time so the client won’t feel rushed. Encourage the client to do as much of the dressing as possible. Eating. Some clients will need encouragement to eat, while others will eat all the time. A quiet, calm atmosphere may help the client focus on the meal. Finger foods will help those who struggle with utensils. Incontinence. Set a routine for taking the client to the bathroom, such as every three hours during the day. Don’t wait for the client to ask. Many people with AD experience incontinence as the disease progresses. Be understanding when accidents happen. Communication. When talking, stand where the client can see you. Use simple sentences and speak slowly. Focus attention with gentle touching if permitted. Environment. Make the environment familiar and safe. Set the water heater no higher than 120°. Keep medicines and any potentially dangerous items out of reach. Exercise. This helps clients improve their motor skills, functional abilities, energy, circulation, stamina, mood, sleep, and elimination.
Avoid pushing the client to exercise, but provide
encouragement. Give simple instructions. Mild stretching exercises are good. Demonstrate how to tense and release muscle groups in sequence, keeping the order the same each time. Exercise or walk at the same time each day. A daily walk may reduce wandering.
Night ritual. Behavior is often worse at night. Create a ritual that is calming. Soothing music is helpful for some. Leave a night light on to reduce confusion and restlessness. Ideas for dealing with difficult behaviors Sundown syndrome. Many clients with AD are more agitated, confused, or restless in the late afternoon or early evening.
Research shows the following things help:
Leave lights on and shut out the darkness by closing blinds and shades. Provide more activity earlier in the day. This will use up energy, reducing stress. Schedule essential activities and appointments early in the day. Encourage an afternoon nap every day. This reduces
Play classical music on a portable radio or tape/CD player
through headphones or earpieces. This shuts out disturbing noises and soothes the client.
Warm, relaxing baths, foot soaks, or massages may help. Reduce activity and distractions toward the end of the day. Discourage evening visits and outings. Avoid overstimulation. Turn off the television or radio before speaking to a client. Keep the client well hydrated by offering plenty of water throughout the day.
Hiding, hoarding, and rummaging. These common problems can be disturbing to caregivers and to others the AD client lives with. Try these strategies:
Lock doors and closets. Put a sign that says “No” on places you want to keep the person out of, such as
Watch for patterns. If a client keeps taking the same thing, give him one of his
Don’t leave things lying around in the open; put things away neatly. Make duplicates of important items like keys and eyeglasses.
Keep the person’s closet open so she can see her
things in plain view. When the client can see at all times that she still has her everyday items, she may not feel the need to go looking for them.
Designate an easily reached drawer as a rummage
drawer. Fill it with interesting, harmless items like old keys on chains, trinkets, or plastic kitchen implements. Allow the client to rummage freely in this drawer.
Look through waste cans when something is lost and before emptying them. Clients with AD tend to have favorite hiding places for things. Look for patterns.
Most behaviors have a reason. Look for the reason for the behavior before responding. Repetition. A person with AD can become fixated on a task and repeat it over and over without stopping. Pacing, turning lights on and off, or washing hands repeatedly are examples of this. As long as the activity isn’t dangerous, there is nothing wrong with letting the person continue doing it. When the time comes that the client must be asked to stop, try these tips:
Say “stop,” firmly but quietly. Touch the person gently. Lead the person by the arm away from the activity. Point out something distracting. Say “Thank you for folding all those towels. Now let’s go to dinner.”
Confusion. Don’t try to enter the person’s world by pretending to see or hear the things they seem to see or hear. Help the person stay grounded in reality by patiently using some of these techniques:
Ask questions with yes/no answers. Make positive statements that let the person know what you want. For example,
say, “Stand still” instead of, “Don’t move.”
Give the person a limited number of choices. Lay out clothes in advance. Keep the wardrobe simple, and try these things:
o Avoid buttons and zippers if possible. o Use Velcro fastenings and elastic waistbands. o Limit the number of colors in the wardrobe. o Eliminate
Use memory aids, such as posting a list of the daily routine or
putting up a large calendar and clock. Other aids include:
o Put name tags on important objects. o Use pictures to communicate if the person doesn’t
o Make memory books with pictures of important
o Post reminders about chores or safety measures. o Put a sign that says “No” on things the person shouldn’t touch. o Paint the bathroom door a bright color, and put a brightly colored seat
cover on the toilet. These will remind the person where to go.
Give simple, precise instructions. Reduce distractions during a task. Give only as
Say the person’s name and make eye contact to get his attention before touching
Reassure the person if needed, but don’t needlessly distract a client who is doing
Each step of a process should be handled as a separate task. Instead of saying,
“It’s time for your bath,” say “Take off your shoes. That’s good. Now take off your socks.”
Allow plenty of time for every task. If the person can’t complete a task, praise her for what she has accomplished
Wandering. First, find out if the client needs something. Look for patterns in the wandering and possible reasons, such as time of day, hunger, thirst, boredom, restlessness, need to go to the bathroom, medication side effect, overstimulation, or looking for a lost item. Perhaps the client is lost or has forgotten how to get somewhere. Help meet the client’s need and keep him or her safe by trying these things:
Remind the client to use the bathroom every two hours. Have healthy snacks and a pitcher of water readily available. Provide a quiet environment away from noise, distraction, and glaring light. Provide a purposeful activity such as folding clothes or dusting. Provide an outlet such as a walk, a social activity, a memory book, or classical
Give the client a stuffed animal to cuddle. Keep lights on at night. Try using different shoes on the person. Some people wander when they are
wearing shoes but not when they are wearing slippers.
Use alarms, bells, or motion sensors. Bed alarms are flat strips laid under the
sheets that sound when the person gets up. Outside doors should have bells or alarms that sound when opened. Motion sensors can be used in hallways.
If the client is in a home or facility with stairs, porches, or decks, child safety
gates should be used to block these. Two gates can be used for height.
Use child-resistant locks on doors and windows. Put a black mat on the ground in front of outside doors, or paint the porch black.
Clients with AD often will not step into or over a black area.
If possible, the person should carry or wear some form of identification, such as
an ID bracelet that looks like jewelry but is engraved with the person’s name, address, and phone number.
Educate neighbors on what to do if they find a wandering client. Call the police if an AD client wanders away.
Aggression and agitation. First be sure that the person is not ill or in physical pain, such as from an infection or injury. Then try these suggestions:
x Reduce triggers such as noise, glare, television, or too many tasks.
x Check for hunger, thirst, or a full bladder.
x Make calm, positive, reassuring statements. Use soothing words.
x Change the subject or redirect the person’s attention.
x Give the person a choice between two options.
x Don’t argue, raise your voice, restrain, criticize,
x Don’t take it personally if accused or insulted.
“I’m sorry you are upset; I will stay until you feel better.” Don’t say, “I’m not trying to hurt you.”
x Encourage calming activities that have a purpose.
Sorting and folding laundry, dusting, polishing,
vacuuming, watering plants, and other quiet, repetitive tasks can be soothing.
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