Alzheimer disease and alternative approaches to care a clinical snapshot.

Abstract

B ecause Alzheimer disease (AD) is the most common and, to many, the most feared dementia, patients and their families often choose to include alternative therapies in the treatment plan. Health care providers must be informed about these possible alternatives. Definition: AD, the most common dementia, involves progressive, irreversible deterioration of intellectual abilities. It interferes with social and occupational activities.1 Incidence: AD affects an estimated 4 million people in the United States and usually occurs after age 60.1 Subjective data: Depending on the degree of dementia, the patient may be an unreliable historian; therefore, a reliable family member should be included in the interview.2 The health care provider should document reports of errors in judgment, subtle memory loss, inability to comprehend new information, and whether these changes have been sudden or gradual.3 Objective data: Document the following elements: 1. Response of each area (learning and retaining new information, handling complex tasks, reasoning ability, spatial ability and orientation, language, and behavior) of the Agency for Health Care Policy and Research2 2. Medical history of systemic, psychiatric, and/or neurologic disorders and a history of head trauma 3. Social history of alcohol, tobacco, and drug use 4. Exposure to toxic substances 5. Current prescribed and OTC medications and herbal supplements taken 6. Functional status assessment1 7. Mini Mental State Examination response3 Nursing diagnosis: Altered thought process,4 social isolation Differential diagnosis: Depression, delirium, multiinfarct dementia1 Plan: Herbal—ginkgo biloba increases blood supply to the brain; recommended doses vary according to research,5 but 120-240 mg daily of ginkgo extract for 3-6 months has a small but significant effect on cognitive function in patients with AD.6 Memory and attention also are improved.6 Nutritional—5000 IU of beta-carotene; 100 mcg of selenium twice a day; sufficient intake of vitamins B and E (use cautiously with hypertension and anticoagulants); 250 mg of magnesium5 Acupressure—stimulation of gallbladder increases blood flow to the brain.5 Aromatherapy—mental function is stimulated by rosemary oil; lavender calms agitation.5 Relaxation techniques, such as music, deep breathing, massage, and touch therapy, have been useful.4 Patient education: If side effects occur with ginkgo, stop taking it and notify the primary care provider. Use ginkgo cautiously with aspirin.6 Use objective, scientifically based information rather than manufacturer claims.6 Follow-up: Ascertain that the therapy is being used correctly and for the prescribed period.7 Side-effects of ginkgo include GI upset and headache. Use acetaminophen and ibuprofen (not aspirin) for headaches.6