The Alzheimer’s disease is that painful journey, which makes elderly people or perhaps other less longevity, memory loss could be gradually to zero, ie unable to remember who they are, which is painful as well as for the patient and family, but there’s a light on the road since a group of scientists have made progress against this disease.

Thus, in separate groups one in France and one in England managed to discover three genes, which may make it easier for the prevention of Alzheimer’s type that usually strikes the elderly people, decreasing by at least twenty percent the extent of disease in potential carriers.

Scientists with the discovery of new genes, have diagnosed the disease becomes worse when the brain swells which have found a solution with a gene called CR1.

Thus, this is a huge blow to Alzheimer’s, but not the ultimate and still seeking to know the root cause, so you can diagnose a possible treatment to help the lives of millions of people suffering from this painful disease.

The brain is the largest and most voluminous body of the head, consisting of over 15,000 million specific nerve cells, called neurons.

Neuron, morphologically. It consists of 3 parts:
A) SOMA: The starry body of the cell.
B) Axon: It is the main extension and connecting with other neurons.
C) Dendrites: They are responsible for receiving the information from the axons of other neurons.

However, the neuron can be activated by itself?, Well no, as any engine needs its liquid element.      The neuron secretes a chemical mediators known by the name of neurotransmitters. These are what activate the neuron transmitting the messages and information from one neuron to another.

But the brain to function properly, needs not only nerve cells and the smooth functioning of neurotransmitters. Also need to be well supplied by blood, using either oxygen and glucose and has the enzymes (which are proteins) required for the biochemical reactions that will allow interneuronal transmission of information. (See Annexes 1 and 2 outline the normal brain and then the cerebral cortex in Alzheimer’s disease.)

Causes of Alzheimer’s disease, incidence and risk factors.
The cause of Alzheimer’s disease is unknown, but is not part of the normal aging process. Have been ruled out earlier theories regarding the accumulation of aluminum, lead, mercury and other substances in the body.

Biological Factors:
The neurons that control memory and thinking are impaired, interrupting the passage of messages between them. These cells develop distinct changes: senile plaques and neurofibrillary bundles (degeneration of brain tissue).

The cortex of the brain (the main source of intellectual functions) are atrophy, shrink and the spaces in the center of the brain become enlarged, thus reducing its surface.

The second significant finding is a high concentration of sticky protein called beta amyloid, which forms patches called neuritic plaques.

Inflammatory Response
Some researchers believe that beta amyloid fragments may break loose oxygen free radicals (normal chemical in the body that cause various processes are harmful when produced in excess). One of these processes may be the inflammatory response in which the immune system releases antibodies whose mission is to combat harmful agents, but, if produced in excess, can damage body cells themselves.

Genetic Factors
Researchers are closer to identifying defective genes responsible for Alzheimer’s early onset, a rare but extremely aggressive form of the disease

The brain tissue shows “neurofibrillary tangles” (twisted fragments of protein within nerve cells that clog), “neuritic plaques” (abnormal clusters of dead nerve cells and dying, other brain cells and protein) and “senile plaques” ( areas where products have accumulated around protein dead neurons). Although these changes occur to some extent in all brains with age, there are many more in the brains of people with Alzheimer’s disease.

The destruction of nerve cells (neurons) leads to a decrease in neurotransmitters (substances secreted by a neuron to send a message to another neuron), whose right balance is critical to the brain. The three neurotransmitters commonly affected by Alzheimer’s disease are acetylcholine, serotonin and norepinephrine, acetylcholine is the most affected.

By causing both structural and chemical changes in the brain, Alzheimer’s disease appears to disconnect areas of the brain that normally work together.

Approximately 4 million Americans currently suffer from Alzheimer’s disease. The most important risk factors for dementia are older age and family history of dementia. The greater the person, the greater the risk of developing this disease.

About 10% of people over 70 have significant memory problems and about half of these are caused by Alzheimer’s disease. The number of people with the disease doubles every decade after age 70 and having a close blood relative who developed AD increases your risk. Because women live longer than men, are more likely to develop it.

Two types of Alzheimer’s disease, the early onset and late onset. In the first, symptoms appear before 60 years, and in some cases, early onset disease runs in families and involves autosomal dominant, inherited mutations that may be the cause of the disease. So far, three genes have been identified early onset, which is the least common, comprising only 5 and 10% of cases.

Alzheimer’s disease late onset, which is the most common type, develops in people 60 years or more and is believed to be less likely to occur in families. Alzheimer’s disease late onset may occur in some families, but the role of genes is less direct and definitive. It is possible that these genes may not cause the problem itself, but simply increase the probability of formation of plaques and tangles or other diseases related to Alzheimer’s disease in the brain.

Only 10% of Alzheimer type dementia are hereditary (familial AD). For this diagnosis to be counted more than one affected member (usually 3 or more members) with a diagnosis of certainty, ie a pathological confirmation.

Families are asked to study pathology requiring brain of his family as a right to know the final diagnosis and as a contribution to the genetics of Alzheimer’s research, knowledge of the disease and the advancement of science to find causes and cures .

How people survive with Alzheimer’s Disease?

People diagnosed with Alzheimer’s can survive from 2 to 20 years from onset of first symptoms (memory loss). Decreases in life expectancy, but providing appropriate care, with emphasis on hygiene and adequate medical care to patients, improving quality of life and can survive for many years both at home and in institutions.

Normally his death can not be predicted until very advanced state. It is common for patients in terminal Alzheimer’s lose weight, have difficulty swallowing, walking and talking, and urinary and fecal incontinence. Lying can adopt a fetal position. Succumb to frequent and repeated urinary infections or bronchopulmonary.

Alzheimer’s disease is a progressive brain disorder characterized by degenerative changes in cortical nerve cells and brain nerve endings. This process produces an irreversible deterioration of memory and destruction of intellectual functions. The causes are unknown, the most common causes are shuffled autoimmune disease, a virus, genetic disease and neurotransmitter deficiency. The main risk factor is age, the onset is insidious, it can affect individuals of up to 40 years, the disease will progress to total disability.

Rating:
The occurrence and severity of symptoms varies among individuals, is characterized by memory loss, intellectual deterioration and personality change. is classified into three stages: Beginner, intermediate and final phase. The initial indicators are mild, but the main sign is the loss of short-term memory, the diagnosis may take years or even diagnosed in the next stage of the disease. In the half-stage patients have trouble recognizing objects and things, to perform activities or to launch or skills she used to communicate. In the final stage are absent memory and intellectual capacidd. In the final stage the patient is in a vegetative state.

Memory:
Initially the loss is mild, usually consisting of an inability to retain newly acquired information. The individual may forget dates and losing things, how to use common tools and objects, while maintaining coordination to implement them. The individual may be lost in the home or family environments, and gradually losing the ability to recognize or name objects or remember the names of their relatives.

Objectives of Nursing: Helping the caregiver / aa monitor the patient’s behavior caused by mental deterioration, and to take measures to compensate for dementia.

Nursing interventions:
1 .- To provide the patient a consistent environment and routine, to help work with their limited capacities.
2 .- Avoid redirect the patient more than once in every encounter with him, to avoid the frustration that can lead to being unable to remember.
3 .- Allow patient behaviors, such as the objects and vagrancy acaparación always taking place in a safe environment.
4 .- To evaluate the patient for signs and symptoms of depression.
5 .- To avoid the turmoil and unrest of the patient must maintain the structured environment, consistent and easy to follow a routine for the patient can make an album of pictures to remember the past, promoting physical activity and art therapy .
6 .- Place labels with the names of objects and rooms, to help remember your name and function.
7 .- To provide clues to the identity of objects and tasks.
8 .- Put a clock and a calendar in his room and place an “X” days gone by, to help you remember the correct date.
9 .- Make a list of daily activities.

* Deterioration of verbal communication relcionado with cognitive deterioration in the state:
Nursing Goals: Establish a verbal and nonverbal communication as efficient as possible and understand their needs as his dementia increases and deterioration of verbal skills.
Posts:
1 .- Go to the patient in an open, friendly and relaxed.
2 .- Discuss with the patient tone of voice low and clear.
3 .- Identify and always look directly at the patient.
4 .- To provide a relaxed and heartening, to avoid noise and distractions.
5 .- Rate nonverbal behavior, facial expression, body language, posture, gestures, etc …
6 .- Explain this activity using short sentences. When giving instructions to ensure splitting the tasks into small units and understandable. Use simple gestures, point to objects or use the show if possible.
7 .- Be sure to have your attention.
8 .- Listen to the patient and included in the conversation.
9 .- Identify behaviors agendas, namely the realization of a certain behavior to ask for something, write to better understand its significance for the patient.
10 º .- Encourage the patient to describe past situations or stories.

* High risk of injury related to lack of awareness of environmental hazards secondary to cognitive deficits:
Nursing Goal: To ensure patient safety as it loses its ability to control potential hazardous environmental factors.
Nursing interventions:
1 .- Guiding the patient on the surrounding environment.
2 .- Place the bed rails.
3 .- Keep him unhindered environment, ensure that there is enough light to prevent falls in the dark.
4 .- Avoid using space heaters, stoves, etc …
5 .- Use of shoes with nonslip soles.
6 .- Watch for signs of pain issued by the patient.
7 .- Maintain a calm and without major changes.

* Faecal incontinence associated with memory loss:
Nursing Goal: Reduce the number of episodes of fecal incontinence and continence aumertar of sphincters.
Nursing interventions:
1 .- Showing the location of the toilet, if it is necessary to identify the door with a drawing of a toilet to help you find it.
2 .- Assess bowel habits, take him to the bathroom at the same time every day often defecate.
3 .- To assess the non-verbal indicators of the patient before the need to defecate.
4 .- After removal help clean the perianal area.

* Disruption of patterns of urinary elimination related to memory loss:
Nursing objectives: To evaluate the existence of the acute symptoms of incontinence and, if necessary, a scheme of bladder retraining.
Nursing interventions:
1 .- To evaluate the patient for causes of acute incontinence, infection, retention, or delirium.
2 .- Make sure the patient knows the toilet situation, if necessary put in the closet door with a drawing to help locate the patient.
3 .- To evaluate the presence of non-verbal codes that indicate the need to urinate.
4 .- To evaluate the model of patient evacuation and use the information to plan an evacuation plan.
5 .- Limiting fluid intake at night.
6 .- After verifying that urination is dry the perianal area to help maintain skin integrity.
7 .- To evaluate the type of incontinence and infection ruled out and see if it is treatable.
8 .- Starting bladder retraining.

* Disruption of sleep pattern associated with anxiety and confusion secondary to cognitive deficits:
Nursing Goals: To reduce the sleep disorder.
Nursing interventions:
1 .- Space activities throughout the day interspersed rest periods.
2 .- Avoid that patients fall asleep during the day, using short trips, planned activities.
3 .- The patients who sleep during the day should endeavor to do so sitting in the chairs instead of the bed to remind them that there should not be sleeping.
4 .- Avoid the use of restraints because they often increase the fiscal turmoil.
5 .- Provide a quiet, no noise and no lights at night.
6 .- Admin when anxiolytics and sedatives may be prescribed.
7 .- Establish a bedtime routine, and ensuring compliance.
8 .- To teach the patient how to perform relaxation techniques.

* Lack of self in the elimination, grooming, hygiene, clothing and evacuation-related weakness, impairment of motor control and memory loss.
Purpose of Nursing: Helping the patient to perform the tasks themselves.
Nursing interventions:
1 .- To evaluate the failure of dressing, feeding, bathing, etc …
2 .- To evaluate the physical and cognitive patient.
3 .- Teach the family and the caregiver to provide care.
4 .- To provide care to the patient totally dependent on aid and not be totally dependent.
5 .- Provide step by step instructions for the patient to make the maximum number of tasks on its own.
6 .- In the bath use a stool in the shower, to promote self-care.
7 .- To dress and undress the patient is recommended shoes without laces, or loose clothing presndas closures with pressure, with Velcro closures and elastic waistband, avoid buttons and belts.
8 .- To assist the patient to dress, putting the clothes in the order they should wear.
9 .- To assist the patient at mealtimes, allowing her to eat alone, providing straws, special cups, cutlery with large handles adequate.
10 .- An outline plan of escape to avoid urinary incontiencia.

* Alteration of processes due to family crisis caused by the chronic illness of a family, disruption of family life and changing roles within the family:
Nursing Goal: Reduce family conflict and increase the capacity of the caregiver
Nursing interventions:
1 .- Encourage the carer and family to express their feelings, frustrations and problems.
2 .- Provide support, understanding and safety to their families.
3 .- To assist the caregiver to learn the responsibilities that just assume.
4 .- To refer to the family to social services to help with home care.
5 .- Encourage the carer to use the services of home help.
6 .- Advise relatives or friends to interpret their behavior as a reflection of the disease process.
7 .- Advise caregivers to continue to keep his friends and attending social events.
8 .- Advise family participation in a self-help group local or national.

* Social isolation (patient and family) related to the anxiety felt by the disability and loss of memory and the impossibility of leaving alone:
Nursing Goal: Avoid social isolation of the patient and family.
Nursing interventions:
1 .- To evaluate the patient’s ability to communicate and the level of social isolation of the family.

2 .- Discuss with the patient’s family the opportunity to have friends that offer support and help.
3 .- Identify alternative systems of support for the family so the caregiver can maintain a social life.

* Anxiety-related changes or real or perceived threats:
Nursing Goal: The patient will decrease their anxiety.
Nursing interventions:
1 .- Give the patient time to express their fears, escuchalo with respect.
2 .- To help reduce anxiety by establishing a fluid communication, avoid changing room and provide an environment with few changes.
3 .- During hospitalization ask relatives to bring familiar objects.
4 .- Help to find lost objects.
5 .- avoid forcing too many tasks to perform.
6 .- Avoid limited visiting hours for relatives.

* High risk of violence associated with irritability, frustration and confusion secondary to degeneration of cognitive thought:
Nursing Goal: Patient will demonstrate control of their behavior in the absence of violence.
Nursing interventions:
1 .- Ask the caregiver to explain how to behave and that is usually done to calm down.
2 .- Monitor the patient for signs of increased anxiety.
3 .- Reduce environmental stimuli such as noise and light.
4 .- To document the signs, symptoms, precipitating factor, time, etc …