I. Pathophysiology
a. Cognitive disorder characterized by impaired memory,
language, thinking, and perception
b. Dementia of the Alzheimer’s type (DAT) (Hausman, 2006;
Nelson-Marsh, 2005)
i. Characterized by structural and chemical changes in the
brain, causing a steady and global decline in function
ii. Degenerative process occurring primarily in the cells
located at the base of the forebrain that sends information
to the cerebral cortex and hippocampus
iii. Decrease in acetylcholine production reduces the amount
of neurotransmitter released to cells in the cortex,
hippocampus, and nucleus basalis, resulting in a disruption
of memory processes.
iv. Enzyme required to produce acetylcholine is dramatically
reduced, especially in the area of the brain where neuritic
plaques and neurofibrillary tangles occur in the greatest
v. Formation of plaques composed of beta-amyloid and tangles
appears to be related to the cholesterol-transporting
protein, apolipoprotein-E (ApoE).
c. Vascular dementia
i. Referred to as multi-infarct, post-stroke dementia, or vascular
cognitive impairment, resulting in decreased blood
flow to parts of the brain
ii. Multiple infarcts to various areas of the brain result in a
pattern of intermittent deterioration determined by the
area of the brain that is affected.
II. Classification
a. Alzheimer’s and vascular dementia are irreversible and
share common symptomology and therapeutic intervention.
i. Alzheimer’s disease accounts for 70% of dementia
ii. Vascular dementia accounts for 17% of cases.
b. Criteria for dementia diagnosis (Alzheimer’s Association,
i. Decline in memory and at least one of the following
cognitive abilities
1. Coherent speech, understand spoken or written
2. Recognize or identify objects, assuming intact sensory
3. Execute motor activities, assuming intact motor
abilities, sensory function, and comprehension of the
required task
4. Abstract thinking, make sound judgments, plan, and
carry out complex tasks
ii. Decline in cognitive abilities must be severe enough to
interfere with daily life.

III. Etiology
a. DAT: Exact cause unknown; most likely due to multiple
factors rather than a single cause (Alzheimer’s Association,
i. Lifelong process—incidence increases with longevity,
and changes in the brain may develop decades before
the onset of dementia
ii. Genetics—familial pattern four times greater than
general population (Nelson-Marsh, 2005)
1. Familial or early-onset Alzheimer’s is linked to
defects on genes on chromosome 1, 14, or 21 with
some families exhibiting a pattern of inheritance
suggesting possible autosomal dominant gene
transmission (Kuljis, 2007).
2. Down syndrome: presents with an extra chromosome
21; may have a relationship to Alzheimer’s disease
a. At autopsy, both disorders have many of the same
pathophysiological changes.
b. High percentage of individuals with Down syndrome
who survive to adulthood develop
Alzheimer’s lesions by age 50 (Alvarez, 2008).
3. Studies suggest that autoantibodies are produced in
the brain, reflecting a possible alteration in the body’s
immune system.
iii. Proposed risk factors: Studies to date have not supported
causal relationship; however, various factors that have
been suggested include head trauma, low educational
level, cigarette smoking, cholesterol-reducing drugs
(statins), and ingestion of aluminum.
b. Vascular dementia
i. Predisposing factors: various diseases and conditions
that interfere with blood circulation, including cerebral
and systemic vascular disease, hypertension, cerebral
hypoxia, hypoglycemia, cerebral embolism, and severe
head injury
IV. Statistics (Alzheimer’s Association, 2008; Centers for
Disease Control and Prevention [CDC], 2008)
a. Morbidity: In 2008, an estimated 5.2 million people in the
United States were living with Alzheimer’s disease; it is
projected that 10 million baby boomers will develop
Alzheimer’s in their lifetime.
b. Mortality: DAT is the sixth-leading cause of death—72,914
Americans died in 2006.
c. Cost: In 2005, $112 billion was spent in direct medical
costs to Medicare and Medicaid for Alzheimer’s and other
dementias and $36.5 billion in indirect costs to businesses; it
is estimated that 9.8 million family, friends, and neighbors
provided 8.4 billion hours of unpaid care, a contribution
valued at $89 billion.

Care Setting
Client is cared for primarily in the home or assisted
living/extended care; however, inpatient care may be
required for treatment of other health problems.

Related Concerns
End-of-life/hospice care,
Extended care,
Psychosocial aspects of care,
Total nutritional support: parenteral/enteral feeding,

Nursing Priorities
1. Provide safe environment and prevent injury.
2. Promote socially acceptable responses and limit inappropriate
3. Maintain reality orientation and prevent sensory deprivation
or overload.
4. Encourage participation in self-care within individual
5. Promote coping mechanisms of client/SO(s).
6. Support client and family in grieving process.
7. Provide information about disease process, prognosis,
and resources available for assistance.

Discharge Goals
Not indicated in home or community setting. Following
inpatient care, based on underlying condition requiring

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