CCS Alzheimer's Dementia

1. Affects 15% of people over age 65. Occurs in Down's syndrome pts at younger ages (30-40). Gradually progressive, neurofibrillary tangles.
2. Alzheimer's disease: senile degenerative dementia (50%-90 of dementia pts) - Loss of cortical tissue (cerebral atrophy) with increased senile plaques.
3. Criteria for the clinical diagnosis of probable Alzheimer's disease * Dementia established by clinical examination and documented by the Mini-Mental State Examination, include: Blessed Dementia Scale, or some similar examination and confirmed by neuropsychologic tests.
4. Deficits in two or more areas of cognition. Progressive worsening of memory and other cognitive functions No disturbance of consciousness * Onset between ages 40 and 90, most often after age 65 * Absence of systemic disorders or other brain diseases that could account for the progressive deficits in memory cognition Lab.

• Orders: CBC, Lytes, TFTs, PRP all normal. UA toxicology -ve.
• CT: Evidence of cerebral atrophy with progression documented by serial observation MRI shows changes highly suggestive of Alzheimers - tangled spaghetti patches.
• Certain dx: not till autopsy - on PM see structural changes, abnormal proteins in brain biopsy. See shrinkage < neurons in cognitive areas of brain. Early Signs: subtle loss of memory.
• Person neglect, ADL. Gradual loss continues. Loss of communication skills. Later: ultimate loss of short and long term memory. Normal life span. May have good physical health.
• Med Intervention: No real medical therapy. Nursing support primary. Med Rx: Donepezil (Aricept) 5-10 mg tablet /dayTacrine (Cognex) Not a cure. Does not appear to stop progression as was hoped. Acts to increase amount of acetylcholine in brain to improve memory. Helps to improve in a minority of patients.
• Side effects: Hepatic failure, GI, abd. Pain, skin rash. Rivastigmine tartrate (Exelon) 6-12 mg cap/day Premarin for ladies Multivitamins 1 tb qd po Aspirin For vascular dementia Other supportive med Rx therapy for agitation: antidepressants, antipsychotic, sleeping aids. Nursing focus: Safety, Help maintain function as long as possible, Care for caregiver.
• Continuing Care: Medicare doesn't cover custodial long term. Must become impoverished to go on medicaid. Few families able to cope with entire trajectory of the illness.
• Nursing home care essential for some. As for Alzheimer: Remember, on the exam, when ever you counsel it takes 5 minutes for it. - Social services consult- counsel, no driving- counsel, advance living will- reassure patient/family- counsel medical alert bracelet.

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