Alzheimer's Disease & Dementia — Nursing Care

Alzheimer's disease is the most common cause of dementia, accounting for 60-80% of cases. It follows a progressive, irreversible pattern of cognitive decline through predictable stages. In early (mild) disease, the client has short-term memory loss, misplaces objects, and gets lost in familiar places — safety risks center on medication management and driving. In moderate disease, aphasia, apraxia, and agnosia emerge: the client can't name objects, can't perform learned motor tasks, and can't recognize familiar faces. Wandering peaks here, making this the highest-risk stage for elopement. Sundowning — increased confusion and agitation in late afternoon — is managed with structured routines, adequate lighting, and limiting stimulation, not restraints. In severe (late) disease, the client is bedbound and nonverbal; priorities shift to aspiration prevention, skin integrity, and comfort care. Nursing assessment uses standardized tools like the Mini-Mental State Exam (MMSE; score ≤23 suggests cognitive impairment) or the Montreal Cognitive Assessment (MoCA). Reality orientation works in early stages; validation therapy is preferred in moderate-to-severe stages because correcting a confused client increases agitation. Communication should be simple, one-step commands with yes/no questions. Environmental safety — locked units, ID bracelets, consistent routines, and decluttered spaces — is the nurse's primary intervention across all stages.