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Case Study 9 (17.2)
Nina Fainter
Lakeview College of Nursing
N309
March 25, 2012

Case Study 9 (17.2)
1.	Claudine is in stage three of cognitive decline. She is experiencing mild cognitive decline. Friends and family may begin to notice difficulties of her remembering names or correct words. It’s also noted that she can’t remember recipes from memory that she once knew and is having difficulty setting the table even with the help of her daughters (Alzheimer’s (e), 2010). 

2.	Dementia is identified by cognitive deficits that involve memory impairment and disturbance of other areas of cognition such as aphasia, apraxia, or agnosia. It also involves the disturbance of executive functioning, behavior, and physical functioning. Often other co-morbidities coexist with dementia making the diagnosis of dementia and the form of dementia difficult. A common form of dementia is Alzheimer’s but also there is vascular dementia and dementia with Lewy bodies. Alzheimer’s disease affects four to five millions Americans and by the year 2050 it is suspected that 13.2 million people will have this disease. Dementia is present in almost 5% of individuals over the age of 65 with global prevalence reaching 24.3 million, and six million new cases developing each year (Fletcher, 2008). 

3.	Three websites that Claudine’s family may obtain information on Alzheimer’s disease are:
PubMed Health- http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001767/ 
Alzheimer’s Association- http://www.alz.org/
National Institutes of Health- http://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-fact-sheet

4.	The ten warning signs for Alzheimer’s disease that the family would find on the website would include:
•	Memory loss that is common in the early stages of Alzheimer’s disease. This type of memory loss would typically include things such as forgetting names and appointments but remembering them later. 
•	Difficulty in planning and solving problems such as when working with numbers or following a recipe. They may take longer to do a task and have difficulty concentrating. 
•	Difficulty completing tasks at home, at work, or at leisure such as driving to a familiar location. Many times they need help with usual routines and tasks. 
•	Confusion with time and place such as dates and seasons. If something is not happening presently they may not understand it. 
•	Trouble understanding visual images and spatial relationships. Vision problems may sometimes be an early sign of Alzheimer’s. Sometimes they have difficulty with tasks such as reading and many times have difficulty with perception. 
•	New problems with words in speaking or writing such as stopping in the middle of a conversation and repeating themselves. Sometimes they may struggle to find the right words or with vocabulary. 
•	Misplacing things and losing the ability to retrace steps. Many times someone with Alzheimer’s will put things in places they do not belong or will lose things.
•	Decreased or poor judgment such as in handling money and in self-hygiene. 
•	Withdrawal from work and social activities because they may not be able to keep up with activities or may not remember how to complete the activity.
•	Changes in mood and personality such as confusion, suspicious, fearful, and anxious (Alzheimer’s (a), 2009).  

5.	When being examined for Alzheimer’s disease Claudine should see a physician and possibly a specialty doctor such as a neurologist (Alzheimer’s (f), 2012). 

6.	Claudine’s family may expect to receive a cholinesterase inhibitor to help treat symptoms of her Alzheimer’s disease. These medications help prevent the breakdown of acetylcholine which aid in learning and memory. They delay symptoms from worsening anywhere from 6-12 months in half of the people who take them and are typically well tolerated. Memantine is a medication used in moderate to severe Alzheimer’s. Sometimes cholinesterase inhibitors and Memantine are taken together. Memantine helps to regulate glutamate activity which also aids in learning in memory. It also delays symptoms from worsening but it may cause more side effects than cholinesterase inhibitors. Sometimes Vitamin E is prescribed to help protect brain cells and body tissue. It may interact with other medications so it should never be taken unless under the supervision of a physician (Alzheimer’s (c), 2012). 

7.	There are two main types of respite services to assist with people dealing with Alzheimer’s disease. In-home care services help the individual with personal care and bathing. They also provide company and supervision of activities, assistance with dressing, toileting, and exercising. There are services to help with laundry, shopping, and cooking and also to help with medications or other medical services. The other option is adult day care. Meals and transportation are typically arranged and activities are often planned. If choosing an adult day care center it would be wise to find out the hours and services provided, programs offered, if they are trained to deal with dementia patients, what health care professionals are there throughout the day, and the safety they provide (Alzheimer’s (d), 2007).

8.	Using an adult day care center will give Mr. Everett the time to run errands but also to relax. If he is exhausted then he may not be helping Mrs. Everett to the best of his ability. So it may be beneficial for him to use this time to relax and accomplish other tasks. In addition, this gives her the opportunity to have social interaction with other individuals and to participate in activities such as discussion groups and exercise programs. She will be working with trained individuals that support her strengths and independence (Alzheimer’s (b), 2004). 

9.	When considering leaving a person with Alzheimer’s alone three questions that should be considered are: “Does this person wander and become disoriented?”, “Does this person recognize a dangerous situation”, and “Does this person know how to get help?” (National, 2010).
10.	To promote safety in the entryway of the home the family should remove any throw rugs and use nonskid wax or texture strips on hardwood floor to reduce the risk of slipping and falling (National, 2010). 

11.	The best way to handle this situation would be to tell Claudine the truth but in a simple way. She doesn’t need a lot of detail because that may only confuse her more. Lieing to her and making excuses may also add to confusion. It also does not treat her with respect or like an adult.

References
Alzheimer’s Association (a). (2009). 10 Signs of Alzheimer’s. Retrieved from http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp

Alzheimer’s Association (b). (2004, October). Adult day centers. Retrieved from http://www.alz.org/national/documents/topicsheet_adultday.pdf

Alzheimer’s Association (c). (2012). Medications for memory loss. Retrieved from http://www.alz.org/alzheimers_disease_standard_prescriptions.asp

Alzheimer’s Association (d). (2007). Respite care. Retrieved from http://www.alz.org/living_with_alzheimers_respite_care.asp

Alzheimer’s Association (e). (2010). Seven stages of Alzheimer’s. Retrieved from http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp

Alzheimer’s Association (f). (2012). Tests for Alzheimer’s disease and dementia. Retrieved from http://www.alz.org/alzheimers_disease_steps_to_diagnosis.asp

Fletcher, K. (2008, January). Dementia nursing standard of practice protocol: Recognition and management of dementia. Hartford Institute o Geriatric Nursing. Retrieved from http://consultgerirn.org/topics/dementia/want_to_know_more

National Institute of Aging. (2010). Home safety for people with Alzheimer’s disease. Retrieved from http://www.nia.nih.gov/alzheimers/publication/home-safety-people-alzheimers-disease/general-safety-concerns