Alzheimer's Disease: NCLEX Study Guide
I. Pathophysiology
• Definition: A progressive, irreversible, degenerative
neurological disease and the most common cause of
dementia in older adults.
• Key Hallmarks (Seen on Autopsy):
◦ Amyloid Plaques: Clumps of a protein fragment
called beta-amyloid that build up between nerve
cells.
◦ Neurofibrillary Tangles: Twisted fibers of a pro-
tein called tau that build up inside nerve cells.
• Result: These hallmarks cause nerve cell damage
and death, leading to brain shrinkage (atrophy), par-
ticularly in the hippocampus and cortex, which are
critical for memory and cognition.
• Neurotransmitter Deficit: A significant decrease in
acetylcholine, a key neurotransmitter for memory,
learning, and attention.
II. Stages of Alzheimer's Disease
1. Mild (Early Stage)
• Symptoms: Forgetfulness, especially of recent events
or names; difficulty finding the right word; losing or
misplacing objects; mild problems with planning or
organization. The person may be aware of their
memory lapses.
• Nursing Focus: Patient education, safety, and pro-
moting independence.
2. Moderate (Middle Stage)
• Symptoms: Confusion and memory loss worsen. Diffi-
culty with sequential tasks (dressing, managing fi-
, nances), problems recognizing family/friends, wan-
dering, sundowning (increased confusion in late af-
ternoon/evening), personality/behavior changes (agi-
tation, aggression, paranoia), repetitive behaviors,
poor judgment.
• Nursing Focus: Safety is paramount. Managing be-
haviors, providing a structured environment, and
supporting caregivers.
3. Severe (Late Stage)
• Symptoms: Loss of ability to communicate coher-
ently, recognize self/family, or perform ADLs. Re-
quires total care. May lose physical abilities (walking,
sitting, swallowing). Increased risk of infections (es-
pecially aspiration pneumonia), incontinence, and
complications of immobility.
• Nursing Focus: Palliative and comfort care, skin in-
tegrity, nutrition (possible feeding tube), preventing
complications.
III. Key Nursing Assessments & Interventions
A. Safety (Highest Priority!)
• Wandering: Use alarms (door, bed), secure the unit,
provide supervised walking paths, and ensure the pa-
tient has an ID bracelet.
• Injury Prevention: Remove clutter, lock up
chemicals/medications, use night lights, lower bed
height, install grab bars.
• Elopement Risk: Place patient in a room near the
nurses' station.
B. Communication
• Always approach from the front and identify yourself.
, • Use a calm, reassuring tone and simple, direct sen-
tences.
• Ask one question at a time; offer simple choices.
• Use nonverbal cues (smile, gentle touch).
• Do not argue or try to reorient to reality if it causes
agitation. Use validation therapy—acknowledge their
feelings. (e.g., If they ask for their deceased mother,
say, "You must miss your mother very much. Tell me
about her.")
C. Managing Behavioral Symptoms
• Sundowning: Maintain a consistent routine, discour-
age napping, provide adequate lighting, and reduce
noise and stimulation in the evening.
• Agitation/Aggression: Identify and remove triggers
(pain, hunger, fatigue, overstimulation). Speak
calmly, provide a quiet space, and redirect attention
to a pleasant activity.
• Catastrophic Reactions: An overreaction to a seem-
ingly minor stressor. Respond by staying calm, re-
ducing stimuli, and speaking in a low, soothing voice.
D. Promoting Independence & Cognition
• Encourage independence in ADLs for as long as
safely possible.
• Maintain a consistent, predictable routine.
• Use reminiscence therapy (looking at old photos) to
promote self-esteem.
• Provide cognitive stimulation (simple puzzles, listen-
ing to music from their era).
E. Caregiver Support
• Caregiver role strain is a major nursing diagnosis.
• Provide resources: respite care, support groups, edu-
cation on the disease process.
I. Pathophysiology
• Definition: A progressive, irreversible, degenerative
neurological disease and the most common cause of
dementia in older adults.
• Key Hallmarks (Seen on Autopsy):
◦ Amyloid Plaques: Clumps of a protein fragment
called beta-amyloid that build up between nerve
cells.
◦ Neurofibrillary Tangles: Twisted fibers of a pro-
tein called tau that build up inside nerve cells.
• Result: These hallmarks cause nerve cell damage
and death, leading to brain shrinkage (atrophy), par-
ticularly in the hippocampus and cortex, which are
critical for memory and cognition.
• Neurotransmitter Deficit: A significant decrease in
acetylcholine, a key neurotransmitter for memory,
learning, and attention.
II. Stages of Alzheimer's Disease
1. Mild (Early Stage)
• Symptoms: Forgetfulness, especially of recent events
or names; difficulty finding the right word; losing or
misplacing objects; mild problems with planning or
organization. The person may be aware of their
memory lapses.
• Nursing Focus: Patient education, safety, and pro-
moting independence.
2. Moderate (Middle Stage)
• Symptoms: Confusion and memory loss worsen. Diffi-
culty with sequential tasks (dressing, managing fi-
, nances), problems recognizing family/friends, wan-
dering, sundowning (increased confusion in late af-
ternoon/evening), personality/behavior changes (agi-
tation, aggression, paranoia), repetitive behaviors,
poor judgment.
• Nursing Focus: Safety is paramount. Managing be-
haviors, providing a structured environment, and
supporting caregivers.
3. Severe (Late Stage)
• Symptoms: Loss of ability to communicate coher-
ently, recognize self/family, or perform ADLs. Re-
quires total care. May lose physical abilities (walking,
sitting, swallowing). Increased risk of infections (es-
pecially aspiration pneumonia), incontinence, and
complications of immobility.
• Nursing Focus: Palliative and comfort care, skin in-
tegrity, nutrition (possible feeding tube), preventing
complications.
III. Key Nursing Assessments & Interventions
A. Safety (Highest Priority!)
• Wandering: Use alarms (door, bed), secure the unit,
provide supervised walking paths, and ensure the pa-
tient has an ID bracelet.
• Injury Prevention: Remove clutter, lock up
chemicals/medications, use night lights, lower bed
height, install grab bars.
• Elopement Risk: Place patient in a room near the
nurses' station.
B. Communication
• Always approach from the front and identify yourself.
, • Use a calm, reassuring tone and simple, direct sen-
tences.
• Ask one question at a time; offer simple choices.
• Use nonverbal cues (smile, gentle touch).
• Do not argue or try to reorient to reality if it causes
agitation. Use validation therapy—acknowledge their
feelings. (e.g., If they ask for their deceased mother,
say, "You must miss your mother very much. Tell me
about her.")
C. Managing Behavioral Symptoms
• Sundowning: Maintain a consistent routine, discour-
age napping, provide adequate lighting, and reduce
noise and stimulation in the evening.
• Agitation/Aggression: Identify and remove triggers
(pain, hunger, fatigue, overstimulation). Speak
calmly, provide a quiet space, and redirect attention
to a pleasant activity.
• Catastrophic Reactions: An overreaction to a seem-
ingly minor stressor. Respond by staying calm, re-
ducing stimuli, and speaking in a low, soothing voice.
D. Promoting Independence & Cognition
• Encourage independence in ADLs for as long as
safely possible.
• Maintain a consistent, predictable routine.
• Use reminiscence therapy (looking at old photos) to
promote self-esteem.
• Provide cognitive stimulation (simple puzzles, listen-
ing to music from their era).
E. Caregiver Support
• Caregiver role strain is a major nursing diagnosis.
• Provide resources: respite care, support groups, edu-
cation on the disease process.
