Assessment and Management of Alzheimer's Disease

Martha Sparks, PhD, RN, GCNS

Disclosures

Topics in Advanced Practice Nursing eJournal. 2001;1(2) 

In This Article

Abstract

Alzheimer's disease (AD) is a significant medical and social problem for 4 million Americans and their partners, families, and friends. Although medical interventions are limited, environmental, verbal, and behavioral strategies may promote satisfactory management. The advanced practice nurse (APN) plays a significant role in providing education and guidance to patients and caregivers.

Introduction

AD is not a variant of normal aging. Mild cognitive impairment (MCI) and AD are illnesses of forgetfulness. MCI involves forgetting recent events and does not preclude normal daily functioning; however, 6% to 25% of persons with MCI progress to AD each year.[1] AD is medically defined as memory impairment (not due to other physiological conditions, delirium, or another Axis I disorder) with aphasia, apraxia, agnosia, or disturbance in executive functioning causing significant impairment in social or occupational functioning.[2] The onset of AD is gradual. Deterioration is slow and varies from person to person; knowledge and skills are lost in reverse order of development.[3]

There is movement toward a social definition of dementia as an alternative but acceptable reality.[4,5] A cultural change reframing perceptions of dementia and focusing on positive attitudes and beliefs about dementia patients has been suggested.[6] The need-driven dementia-compromised behavior (NDB) model changes the view of AD manifestations from "disruptive" behaviors to "potentially understandable needs" behaviors.[7] The NDB model recognizes that persons with dementia may be unable to meet or express their needs in the same ways they could before they became impaired. In an attempt to make their needs known, they exhibit behavior that is viewed negatively by others. If others would identify the need being expressed, however, the behavior would become understandable. The NDB model is used extensively in nursing homes, but is applicable in any setting.

Even though cognitive changes severe enough to cause impairment are not the result of normal aging, the incidence of AD does increase with age. Prevalence is estimated to be 10% of persons older than age 65 years and 50% of persons older than age 85 years, totaling 4 million persons. That number is expected to increase to 14 million Americans and 22 million individuals worldwide by 2030. The illness trajectory spans 2 to 20 years, and the average length of illness is 8 years.[8] AD is the fourth leading cause of death and accounts for 60% of nursing home admissions.[9]

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