Alzheimer's Disease (Dementia) Nursing: Symptoms, Treatment, Stages, Pathophysiology NCLEX

hey everyone it's sarah register nurse rn.com and in this video i'm going to be going over alzheimer's disease and as always whenever you get done watching this youtube video you can access the free quiz that will test you on this content so let's get started alzheimer's disease is a chronic brain disease that is a type of dementia and it's actually the most common form of dementia and the reason it occurs is because neurons which are specialized nerve cells in your brain which help you do almost everything that you do on a daily basis from form new memories learn new things solve problems make judgment calls even with your language being able to understand language that's spoken to being able to actually speak it they lose the ability to communicate with one another and then eventually they die so why does this happen well it actually happens over a period of time and the reason it does is because of a couple things that i really want you to remember because it's going to be the foundation for understanding the pathophysiology of alzheimer's well we have the development of plaques specifically beta amyloid plaques and these plaques like to form outside of the neuron and when they do that they're going to really impede communication between neuron to neuron and other structures then we have the development of neurofibrillary tangles and these tangles like to form within the neuron itself so over time this is going to happen and then whenever you have a patient who's in the late stage of alzheimer's disease the most severe stage what can result is that this brain tissue can shrink and we have brain atrophy so over time as this happens the result is you're going to see a progressive loss meaning it's going to get worse over time where they're going to start to lose their memory they're going to start having learning problems that you won't be able to problem solve have judgment calls communicate with you they'll have behavior changes they can have severe depression mood swings and then eventually towards the middle stage to the severe stage they're going to lose the ability to have self-care so they're going to be totally dependent on a caregiver now let's look at some interesting facts about alzheimer's disease so according to the cdc they say that this is the fifth leading cause of death among adults ages 65 or older also in 2021 it was estimated that 6.2 million americans lived with alzheimer's disease now this is actually expected to increase by 2060 they say that 14 million people could be living with this disease so as you can see this is a huge deal and as healthcare providers we really have to be familiar with this disease now women are more likely than men to develop alzheimer's disease and the reason for this they say is because women tend to live longer than men and hispanics and african americans tend to have a higher risk for developing this disease now in regards to signs and symptoms most patients don't start showing signs and symptoms until they're over the age of 60. however in some patients this is not the case they may start showing signs and symptoms a lot earlier now risk factors for alzheimer's disease include having a family history so they have a genetic link or they're older so their age their gender their female or they smoke they're diabetic or have heart disease now there's various stages of alzheimer's disease you can start out just having mild cognitive impairment go all the way to the severe late stage and it's really dependent on the patient how fast they're going to go through each stage and i'm going to be going over the stages a little bit later in the lecture and the exact cause of alzheimer's disease is not fully understood they know that there's plaques and tangles but there's still a lot that we need to learn about this disease and there's currently no cure but there are medications available to help decrease symptoms when we talk about the pathophysiology of this disease we first have to go back and look at the neuron so you have billions of neurons in your brain and these neurons help you function and they're very busy all the time they're constantly communicating with each other sending electrical signals and releasing neurotransmitters to help communicate their messages so let's look at this healthy neuron here look at its parts and how a message is sent throughout a neuron so protruding off of the neuron is a very important structure called the dendrite now dendrites they remind me of tree branches that are just hanging out waiting for something to land on it and in this case with the dendrite here it's waiting for an electrical signal to come to it so the dendrites receive electrical signals from let's say other neurons and they take that electrical signal and take it to the cell body of the neuron the cell body has a nucleus and it's going to process that message that it just received so here you can see a neuron sending the message to the dendrite so here we have the axon with the axon terminals and then a synapse which releases a neurotransmitter so the neurotransmitter is what really communicates that message that needs to be sent to this other neuron and there's different types of neurotransmitters in your body so these little chemical messengers can send exciting messages or they can send inhibitory messages some neurotransmitters actually have the properties of being able to do both so two neurotransmitters i want you to remember are called acetylcholine and glutamate because whenever i go over the medications used to treat alzheimer's disease it will make sense how these medications affect these two neurotransmitters so we have the message sent up through our dendrite it's hit our cell body now it needs to go down through the axon the axon carries that message away from the cell body then it goes hits axon terminals you have the synapse you have neurotransmitters released now this can send a signal these these neurons can send signals to other neurons they can send them to muscles they can send them to glands it's whatever they're targeting with their little neurotransmitter message so in order for all this to work beautifully you have to have healthy neurons that are free from any weird debris inside of them or any debris outside that could be impeding this communication so our body knows this and it has these cool cells that hang out around the neuron to help protect the cell's integrity one type of cell i want you to be familiar with is called a microagula microagula like to hang out around the neuron and they have many functions but one main function they have is that they go around surveilling the neurons environment and if they see any dangerous debris or chemicals or anything like that they go and they eat it so to remove it so they play a role in inflammation now in patients who have alzheimer's disease unfortunately their neurons aren't healthy like this they instead have problems where they're not being able to communicate with each other so they lose the ability to thrive and live and instead they die so why does this happen well it's due to the formation of beta amyloid plaques and neurofibrillary tangles so first let's take a look at these plaques these plaques are found outside of the neuron and they congregate together and the reason we call them beta amyloid plaques is because they're made up of beta amyloid and they really impede communication among the neurons they set off inflammation with these microagula cells which makes it worse for the neuron and then the neuron can eventually die now what happens in alzheimer's disease is it tends to start in the inside central and over the years it will spread out where it will hit the cerebral cortex so how in the world do these plaques get here well to help us understand that let's take a look at the cell membrane in the nerve cell so crossing this cell membrane is a protein called amyloid precursor protein and as this protein crosses over enzymes from outside the cell membrane and inside the cell membrane cause this protein to break down into small pieces of peptides now normally these peptides that have broken off from this amyloid precursor protein will be metabolized and removed from outside the neuron but in alzheimer's disease the enzyme that is helping the beta amyloid peptide to break off isn't working right so large strands are left over which are not metabolized right and they are beta amyloid peptides so these beta-amyloid peptides start to congregate together in between these neurons and create plaques over time then there's the development of neurofibrillary tangles and these tangles like to hang out on the inside of the neuron whereas the plaques were on the outside so these tangles are also made up of a special type of protein called tau now towel is really important for helping provide structure to the microtubules so let's take a look at the microtubules so here is an example of a microtubule at the top we have a healthy neuron it's microtubule has a nice shape it's intact but the one on the bottom this is a diseased neuron due to alzheimer's disease and the microtubule is not intact it's like falling apart so the microtubules play a vital role in delivering nutrients throughout that neuron and help giving it shape however in alzheimer's disease these towel proteins they quit working and they change this microtubule so this causes this microtubule to fall apart and when this falls apart guess what's going to happen it's going to affect how nutrients is being delivered throughout that neuron and that's going to cause a neuron to get sick and become unhealthy and then because of this these tile proteins they are no longer providing structure to this microtubule so they're just hanging out and they start to clump together and this is what forms these tangles and these tangles will affect how the neuron works on the inside and will eventually die so as i pointed out before when these neurons start dying this is really going to affect brain tissue and this is going to cause the brain tissue to shrink and atrophy so now let's review the parts of the brain because it's going to make a whole lot more sense whenever you're seeing these certain signs and symptoms presenting in a patient with alzheimer's disease if you know what areas of the brain are affected and what they normally should be doing so your brain can be divided into certain sections based on its function now in alzheimer's disease brain changes start occurring way before the patient actually starts having signs and symptoms and it tends to start in this middle deep part of the brain one structure that's affected early on is called the hippocampus and your hippocampus is responsible for you learning new things in your memory so forming new memories and your spatial memory like navigating around or finding objects that you've placed somewhere also affected is the interhinal area and this is responsible for you understanding time again memory a sense of direction and the amygdala and this is responsible for your emotional memory so how you respond to the environment so as you can see we have memory here in this part of the brain so that is why in those early parts of alzheimer's you start to see memory changes in the patient they start out subtly and then they gradually progressively get worse where the patient will no longer have any memory at all now as the disease progresses and more plaques and tangles form within neurons of the brain it's going to spread and it's going to affect a huge chunk of the brain known as the cerebral cortex and the cerebral cortex is that outside layer that surrounds the cerebrum so it can be divided into different lobes based on their functions so you have the parietal lobe you have the frontal lobe the temporal lobe and the occipital lobe and each lobe has its own little thing it does for instance the frontal lobe is responsible for thinking speaking memory and movement the parietal lobe is responsible for language and touch occipital lobe is vision and color perception and the temporal lobe is responsible for hearing learning and feelings so as you see with the function of each of these lobes as alzheimer's progresses and affects these lobes the patient's going to have signs and symptoms that correlate with the function of each load for instance the frontal lobe if it's being really affected the patient's going to have problems thinking speaking with memory and movement or the product they're going to have issues with language so in terms of signs and symptoms let's look at some important terms that you want to remember for exams and in practice that are used to describe some signs and symptoms that may be displayed in a patient with alzheimer's disease so alzheimer's disease starts with a unfortunately all these terms start with a and they end in ia so the first one is apraxia apraxia is where the patient can't perform certain motor movements so let's say they need to brush their teeth well they just don't possess the ability to perform those motor skills needed to pick up that toothbrush put the toothpaste on the toothbrush rinse it underwater and then brush their teeth they can't do that they need help next we have aphasia aphasia is where they can't understand speech or create it so you may be talking to them giving them some instructions or something or telling them about something but they just don't understand those words so sometimes it's helpful to have a card that is showing on an image of what you need them to do that sometimes can help with communication and how i remember the meaning of this word is remember phrase like with speech you utter a phrase or someone says a phrase and that helps me remember aphasia because you have it sort of looks like phrase in there then we have agnosia magnosia is where the patient can't recognize objects people or interpret their senses and there's different types of agnosia so with this some patients may not recognize uh a spoon that you're giving them they don't really know what it's for or people they've normally seen or their senses for instance they have the sensation they need to use the bathroom like urinate but they don't really know what to do with it so they're incontinent or you give them some food to eat and they can't really they don't recognize what it is that they're eating their senses are affected and how i remember this is look at recognize you have the gn and we have agnosia so gn you're not being able to recognize then we have amnesia and this is memory loss i cannot recall memories maybe they don't know who they are what their birthday is their address etc and then lastly we have anomia and nanomia is where they can't recall the names of objects so let's say you have an apple in front of them they've seen it before but they don't know what it is they can't pull from their brain file oh this is an apple they don't can't connect that and how i remember this is you have name nam and then nom it's sort of similar to that now let's look at the stages of alzheimer's disease because this is going to help us see those other signs and symptoms that present in each stage first we have pre-clinical alzheimer's disease and this is where changes are occurring in the brain but no symptoms are noted and this can happen over years next is mild cognitive impairment and this is where the patient starts to have memory changes that are subtle but it doesn't affect their activities they may start forgetting recent commitments new people they've met or conversations they've had recently and they start to get confused on places and time and they may report you know something just doesn't feel right in my brain it's like i can't think clearly and this stage can last for several years next is mild alzheimer's disease and this is early stage alzheimer's this is typically when patients are diagnosed with alzheimer's disease they're going to start having mild forgetfulness that is noticed by the patient family members and friends and it's beginning to affect some parts of their functioning they're going to have short-term memory problems like they're going to frequently lose objects can't remember new material they've just learned maybe start having trouble at their jobs learning new things they'll start repeating themselves and asking the same questions over and over language problems can start like they're trying to talk to you but they forget a word and they may start having mental instability which is going to be recognized by family members like depression confusion having sleep problems things that just isn't normal for the patient now the thing with this stage is that they can still function and be independent what's going on with them in their brain isn't affecting their ability to live out life but during this time if the patient's diagnosed knows they have alzheimer's this is when the nurse wants to go over with the patient about the progression of the disease and tell the patients time to start planning for the future and incorporating family members as they want to like discussing end-of-life care estate planning and so forth and this sage lasts a couple of years next is moderate alzheimer's disease the middle stage now this is when things start to change confusion now sets in that affects the patient's ability to function and they're going to need help safety is a main issue with this patient along with helping them with their self-care and medical needs so their judgment is going to start to become lapsed they are going to have major safety issues getting lost um doing a thing called wondering which i'm going to go over in the nursing interventions they will forget how to cook or use objects with hygiene they need help with the bathroom how to dress especially depending on the weather they may not pick the right outfits confusing family members having sleep problems major mental instability where they have episodes of anger and anxiety and hallucinations so during this stage the patient is active they can get up and move around but they don't have the cognitive ability to make sure that they're doing the appropriate things without getting hurt also caregivers may start recognizing a phenomenon called sun downer syndrome and as a nurse i have seen this this is absolutely real and as the day draws closer to evening the patient will start to get confused they may become more agitated they'll start hallucinating and just get really restless so this stage for the caregiver is a very intense time because the patient must be monitored at all times and requires a lot of supervision and care and this stage of alzheimer's is actually the longest stage of all then lastly we have the severe alzheimer's disease stage called late stage and this is where symptoms are very severe a lot of times they're no longer able to participate in life like have language communication will be very minimal with limited motor activities they're going to spend much of their time in bed sitting staring they can start to have problems with swallowing eating and they're going to need constant care during this time now because they start having issues with swallowing like called dysphagia they are at huge risks for lung infections like pneumonia a lot of times patients develop this so the patient needs to be evaluated by a speech language pathologist to see if they may need a feeding tube or their liquids need to be thickened or their food consistency should be altered to help protect those lungs now interacting with a patient during this stage is just as important as interacting with them before they progress to this stage but communication does change a little bit because like i said they're going to have minimal communication skills so using non-verbal communication like it's facial expression body gestures is good using touch as needed and just providing a calming relaxing environment for the patient during the day like with music promotes good quality care now let's talk about testing for alzheimer's disease so with this disease brain changes are occurring in the brain before signs and symptoms even start manifesting themselves so early detection is key for patients so they can prepare and potentially get on any medications that can help manage symptoms because remember there's no cure at this time for alzheimer's so with alzheimer's you have to rule out any other condition that could be causing this cognitive problem in this patient for instance brain tumors could do this stroke brain injury and so forth so a series of tests have to be performed because there's really no one conclusive or even two tests that say hey this person has alzheimer's disease we have to look at a whole variety of tests to determine that so first one thing that can be done it's very easy not invasive at all it's called a cognitive assessment and this is where the patient is asked questions to test their memory judgment and thinking also mental evaluation can be done along with diagnostic imaging for instance they can do an mri or a ct scan look at the brain make sure there's no tumors or a stroke has occurred and they can order an amyloid pet scan this scan can look for those beta amyloid plaques in the brain also biomarkers can be identified in the body so one way we can do that is to do a spinal tap so they'll go in they will remove cerebral spinal fluid csf from the patient and test it for those proteins that we just went over in the patho see if those are present and recently the nih just reported in february of 2022 that there's a new blood test available that can test for those beta amyloid proteins so that's really exciting in addition genetics has seen can be used but this is really more for research so it can test for apo lipo protein e and see what their apoe status is and the thing with this is that just if a patient gets a positive result doesn't necessarily mean they're going to go on to develop alzheimer's now let's look at the nurses role with alzheimer's disease so as a nurse you're going to be playing a role throughout all the stages of alzheimer's from helping a patient identify potential signs and symptoms of alzheimer's to medication to how the disease progresses educating the patient and the caregiver and identifying and helping the caregiver determine when they need times for breaks what resources they have available for them like respite care so all stages are important but the most trying stages of alzheimer's disease is that middle stage to that late stage the middle stage of patient is active but they have impaired judgment and memory and they require immense supervision to protect their safety and help them with their self-care and then the late stage they need total care so to help us remember our role as a nurse because the middle stage is so involved we're going to remember the seven m's first is memory as we've discussed throughout everything the patient one of their first signs and symptoms is going to be memory and it's going to progress as it gets worse because the big memory areas of the brain are being affected especially early on so as your role what you're going to be doing is you're going to be reorienting the patient often you're going to be reminding them how to do certain certain things or people that they have forgot that what comes in handy with that is using imagery little picture cards to help identify rooms identify objects throughout the house or even identify people and you want to keep patient during this time the patient may be repeating themselves a lot asking the same questions over and over so you have to be patient keep things simple they love to do tasks and keeping them busy is a great way for them to use those muscles and to use their mind and just to stay focused as much as they can so when you give them a task give them something that's simple do it in one step instead of several steps and whenever they do forget do not scold them or belittle them this could cause agitation and cause them to have an emotional outburst and become really upset next is movement a patient who has alzheimer's disease it's very important that we help them stay as independent as much as their disease allows because we want them to maintain their motor functions and their upper body strength and lower body strength so we want to make sure that they're following routines as they start getting into those advanced stages we are going to have to guide them in doing their morning care their breakfast tulatine activities throughout the day have periods of exercise but also have periods of rest and exercise is very important for them getting outside getting with that sunlight making sure they have exposure to that because that has shown to decrease sun downers a little bit and then it helps burn off that energy which can decrease them wanting to wonder about and become restless and it's important that they play fun easy games that can help with their memory like for instance jigsaw puzzles or playing cards anything that's simple for them to do then we have mental health so patients with alzheimer's disease can have frequent mood swings one day they may be happy in a great mood the next day they may be angry and agitated and then the next day they may just be very quiet and depressed looking so we have to respond accordingly and whenever they are having those outbursts we have to be calm and we have to be understanding and some of these patients can actually get violent so it's good again to maintain those routines so we want to distract them as much keep them busy but also give them periods of rest we don't want to hurry them to make them hurry up because that will make them agitated and we want to be familiar with sundowners i mentioned this a little bit earlier so again this is where the patient as you notice when it starts to become evening they will start to get more confused they may start wondering more hallucinating and becoming very restless and agitated so as a nurse you want to be familiar with some triggers of this so things that can trigger sun downing is just exhaustion they didn't get enough rest throughout the day they're sick they've started a new medication or they are experiencing low lighting where they're not really getting outside a lot and getting the sunlight they think that getting enough sunlight is really good for our body because it helps reset our internal clocks because that might be getting messed up in the brain so to help with this what you want to do is during those evening hours you want to limit noise you want to make a relaxing stress-free environment avoid giving the patient caffeine at night because it can make it worse make sure they follow a routine schedule during the day and there was exercise but there was also periods of rest and that they avoid taking long late naps now sometimes patients will have hallucinations and these are really real for them because remember when we're looking at cerebral cortex a lot of those areas contain where we pick up our senses so the patient may be seeing things hearing things feeling things or tasting things that are not there so what you want to do is you want to remain calm you want to reassure the patient that you're there and do some things that could help decreases so if this is happening at night you want to make sure that there's nothing in the room that's creating shadows because that can amplify a potential visual hallucination so make sure it's well-lit and to remove any reflective items that could potentially be amplifying that hallucination that the patient may be seeing and then next is maintain safety so as alzheimer's progresses judgment is going to become more poor so we have to eliminate things that could potentially hurt the patient like driving hiding keys very important we don't want them to hurt themselves or hurt others cooking can become dangerous if they do it unsupervised and anything they really do needs to be very simple and not use any tools where they could hurt themselves or others now one thing with safety we have to watch out for is wondering and this is where the patient can become lost in a familiar or unfamiliar environment and this is because they've lost the ability to recognize places and people and keep time so you know the patient may start out in the backyard and then all of a sudden they're not there anymore and they're gone and no one can find them and this really does happen where older adults we have to issue alerts to find them because they have wandered away and they've had dementia so as a nurse you want to educate the caregiver for signs and symptoms that this patient may be at risk for wondering and this includes that they start getting lost or forget about certain places that they're normally familiar with they're taking longer than normal to return from a place or even having trouble finding rooms in their own house also they're talking about going somewhere that they used to always go or visit an old acquaintance and wondering seems to get worse during that early evening whenever they're starting to get more confused and restless so you want to be familiar with the triggers that could trigger them to wonder so you want to avoid unfamiliar crowded places also needing a basic need like they need a drink or they need to use the bathroom can do it or if they're just trying to do a routine that they've always done before so trying to help them maintain their routines can decrease this now there are some interventions you can educate the caregiver on how to promote safety during wandering periods and to help you remember that remember the word wonder w is for wear a medical identification bracelet or a gps tracking device there's many companies that offer different plans for this there's watches available or even a device that fits in the shoe a is for avoid stressful unfamiliar places like crowds or loud areas that can confuse and stress the patient out which can cause wondering n is for needs met so make sure their bathroom food and liquid needs are met d displaced signs that provide cues to the patient like label the rooms of the house on their doors and place reminders or warning signs e exercise is very important they need an organized day that provides periods of activities that they enjoy and if they do wonder create a safe place for them to walk around and do this and then lastly r is for remove access to doors or windows by keeping them locked with alarms and obscure the locks and alarms to hide them plus also hide car keys then the next m is maximize communication so as the disease progresses the patient will start to have more and more problems communicating and you're going to have to tailor the way that you communicate based on their ability to communicate and remember even in that late stage where there's like minimal communication you still need to communicate with that patient because they're human they still need to feel loved and they need a loving environment so here are some tips that you want to keep in mind when you're communicating with a patient with alzheimer's disease and the mnemonic to help us remember those tips is patient p is for pick one question or instruction step to give out a time and you may have to repeat as necessary so whenever you ask them questions don't use open-ended questions that require them to have a lot of thought you want to ask questions that have a yes or no answer and let me give you an example let's say it's breakfast time and you ask the patient here's an open-ended one what would you like to drink for breakfast well that requires that they think and have to determine what do i drink for breakfast instead use a close-ended question that says do you want orange juice for breakfast that requires a yes or no and if they said no move to another drink like milk or if they said yes there you go they have their drink a is for avoid correcting or arguing so whenever you get mad or argue your non-verbal body language will show it even though you don't really know it's showing it so whenever you're talking in an increased tone or have an angry facial expression this could cause stress to the patient with alzheimer's and it could cause them to become scared or agitated so always be aware of that t is for take time for patients who respond and speak eyes identify yourself directly in front of the patient rather than behind so whenever you're going to talk to a patient with alzheimer's you want to make sure that you go directly in front of them you don't come from the side or the back because that could scare them and they could react in a very impulsive way e is for eye contact on eye level rather than standing above them this could make them feel intimidated and plus whenever you do this it lets them know you're interested in communicating n is for nonverbal communication is helpful especially in that late stage so whenever you're communicating with someone with severe alzheimer's you may have to act it out point or use images t is talk in a normal tone that is clear and slow not too fast or loud and to eliminate outside noise so that patient can concentrate and hear what you're saying next is medical needs so we want to make sure we're meeting the patient's hygiene needs and that they're receiving regular baths grooming themselves regularly they're having good mouth care and if they're incontinent a lot of times these patients are incontinent of urine and stool so we want to make sure that they're going to the bathroom at a routine time to have ample time to try to use the bathroom and check that skin make sure it's not breaking down and that they're dressing appropriately because they lack the judgment to be able to say oh it's going to snow today i better wear something warm or it's going to be 90 degrees today i better wear something light and plus they may have problems buttoning zipping or buckling their outfits so we want to make sure that they are wearing something that's easy to put on next is hydration this is a big thing because these patients can lose the ability to interpret the sensation of thirst like they're getting the thirst signal but they don't really know what to do with it or they forget to go get something to drink or they don't know where to find it at so we want to make it really easy for them to have access to refreshment you want to make sure that you are measuring how much they're taking in because whenever they become dehydrated that can increase confusion and make it worse and offer them a wide variety of liquids not just water juice but get creative make a smoothie or a popsicle or something like that that they enjoy next is nourishment eating weight loss is a big thing with alzheimer's patients because a lot of times they don't feel like eating they have lost the sensation of taste it doesn't really taste good anymore they have trouble swallowing so look for those signs that they're aspirating um whenever they're eating they may start coughing or they're having frequent lung infections like pneumonia that could signal to you hey whenever they're smalling their food it's not going down their food pipe into their stomach it's going into their lungs so if this is happening you want to get with a speech language pathologist who will evaluate them they may need their foods thickened or like their liquids thickened and then their food a softer consistency so they can chew because some patients have issues with chewing so what are some interventions you could educate the family on how to help the patient eat more food one thing that can be implemented is to not try to overwhelm the patient with options so whenever they're served food make sure that you serve one food at a time instead of serving a big plate with lots of food options patient with alzheimer's can just feel very overwhelmed by that and not want to eat also pick healthy options that the patient likes to eat like healthy fats proteins vegetables and fruits and limit sugars and salts and try to find foods that are finger friendly so they can easily pick them up and they're soft and easy to chew so they don't have to use utensils which makes the job a little bit more complicated and to help the patient focus on the meal rather than their environment because a short attention span definitely does present itself you want to make sure that the environment is quiet and that it's well lit so they can see and one thing that's very helpful is if the family member eats with the patient gives them a little bit of social interaction and eats the meal with them that can help promote the patient to eat and then our last m is medications so there's two big groups of medications that can be ordered for a patient with alzheimer's that is cholinesterase inhibitors and nmda antagonists so first let's talk about cholinesterase inhibitors and to help you remember these medications in this group because there's just three of them you want to remember dr g so d is for donepezal r is for rivastigmine and g is for galantamine so these medications inhibit cholinesterase which is an enzyme that helps break down the neurotransmitter acetylcholine so acetylcholine is a neurotransmitter that helps us with thinking and our memory and they have found that in patients with alzheimer's disease that they have low levels of this neurotransmitter because those cholinergic neurons that work with this neurotransmitter don't really work anymore so they hope that by making this more readily available by preventing its breakdown that we can help decrease those signs and symptoms of memory loss now some side effects of these medications include gi upset like nausea vomiting and diarrhea but this can be decreased by administering the medications with food also the patient may report muscle spasms and it can affect the heart by slowing down the heart rate causing bradycardia so you want to measure that heart rate and you want to protect the patient from potential falls because they can have a bradycardic episode and pass out and hurt themselves the next medication group is called nmda antagonists and there's only one medication in this group that's used to treat alzheimer's disease which makes it a little bit easier to remember and it's called memantine and this is used for moderate to severe alzheimer's disease and it can be used in combination with cholinesterase inhibitors now this medication works to affect the neurotransmitter glutamate and glutamate loves to excite neurons so it's an excitatory neurotransmitter so what it does is it works with the nmda receptor and it goes in and it causes calcium to go into that neuron and it fires it up so this is a normal process we like this process to happen because it helps us learn and maintain our mood but if this is happening in excess like it does in alzheimer's disease it can actually lead this neuron to become damaged and die so we really have to tame down those glutamate levels with this medication so this medication is an antagonist it works against these nmda receptors and some side effects of these medications are headache dizziness and constipation so you want to monitor bowel movements and then lastly a new medication those recently came onto the scene is called adukanymab and this medication is given via iv infusion about every four weeks for the early stages of alzheimer's and what this medication does is it decreases beta amyloid plaques that could help increase cognitive functions in patients with early autonomous disease with this the doctor may order diagnostic testing just to confirm that beta amyloid plaques are present and again what were those tests we could use a spinal tap to look at the csf or an amyloid pet scan and some side effects of this medication could be brain bleeding or swelling so brain scans may have to be performed to monitor the brain okay so that wraps up this review and if you'd like to watch more videos in this series you can access the link in the youtube description below

Channel: RegisteredNurseRN

Views: 217,406

Keywords: alzheimers, alzheimers disease, alzheimers nursing, alzheimers nclex, dementia nclex, dementia nursing, alzheimer's disease stages, stages of alzheimers, alzheimers symptoms, alzheimers disease treatment, alzheimers disease pathophysiology, alzheimers disease medications, alzheimers disease nursing interventions, alzheimers disease presentation, tau proteins, beta-amyloid plaques, neuron, neuro nclex, mental health, apraxia, aphasia, anomina, wandering, sundowner's syndrome, agnosia

Id: lql93382Hv8

Length: 40min 46sec (2446 seconds)

Published: Tue Jun 21 2022