Alzheimer's disease: an animated, cited guide

This page needs JavaScript for its animations. The outline and key answers are below, and every claim in the full version carries a numbered citation.

Not medical advice. Alzheimer's Companion is an educational synthesis of published literature. It does not replace a clinician.

What is in it

What Alzheimer's is Dementia versus Alzheimer's, who it affects, the numbers.
The brain that forgets Where it starts and how it spreads, stage by stage.
Amyloid, animated From one protein cut to a plaque, and the debate about it.
Tau and the tangle How a scaffold protein turns into a tangle and spreads.
Microglia and the lost synapse Inflammation, pruning, and the strongest link to memory loss.
Genes and inheritance APOE, the dominant families, Down syndrome, and what a test means.
Twenty years before symptoms The biomarker cascade, in order.
Stages and symptoms From no symptoms to severe dementia, function by function.
Diagnosis and biomarkers Criteria, scans, spinal fluid, blood tests and screening tools.
The differential Delirium, vascular, Lewy body, frontotemporal and reversible causes.
Cholinesterase inhibitors and memantine Inside the synapse, and what the benefit really is.
Anti-amyloid antibodies over time Lecanemab and donanemab over 18 months, ARIA and the debate.
Beyond memory Agitation, mood, psychosis and sleep, and the drug cautions.
Lowering the risk The 14 modifiable risk factors and what trials show.
Living with dementia and caregiving Planning, safety, caregivers and the end of life.
Nursing care Assessment, giving the medicines, communication, documentation.
Toward a cure The pipeline, prevention trials, and the evidence for each route.
History and people From Auguste Deter in 1901 to the antibodies.
Flashcards and mnemonics Flip cards by topic.
Quiz Questions with explanations.
Glossary Every term, searchable.
Sources Every reference behind the app.

Part 4 · Living, caring, preventing

Nursing care

Four parts of nursing care for a person living with dementia: assessment, giving the medicines, communication and care approaches, and documentation and safety. Each part has an animation or a tool to try, and each claim links to its source.

ScopeThis module describes what guidelines, drug labels and published studies say. It is not a care plan. It does not replace local protocols, your scope of practice, or the prescriber. Where the sources say no dementia-specific evidence exists, the module says so instead of filling the gap.

1 · Assessment

Delirium on top of dementia, hour by hour

Dementia changes over months and years. Delirium changes over hours and comes and goes. When the two overlap, the sudden change can hide inside the slow one. Press play to watch two weeks pass.

Delirium type Overlay

Days

Teaching tool: a schematic curve, not data from any patient.

The 4AT, scored

Teaching tool, not a clinical record

Accuracy: a 2021 meta-analysis (17 studies, 3,702 observations) found pooled sensitivity and specificity of 0.88 each. ⁴⁸⁶ In 785 acute medical patients aged 70 or over, the 4AT had sensitivity 76% and specificity 94%, while the CAM used in routine conditions had 40% and 100%. ⁴⁵⁹

Guidelines differ NICE CG103 (2023 update) names the 4AT when indicators of delirium are present, and the CAM-ICU or ICDSC in critical care. ³⁸⁴ NICE NG97 (2018) suggests the long CAM or the Observational Scale of Level of Arousal for inpatients with cognitive impairment of unknown cause, says instruments alone should not separate delirium from delirium on dementia, and says that when the two cannot be told apart, delirium is treated first. ³⁸³ A 2012 review found only 9 studies, with 50 participants who had delirium on dementia, validating any delirium tool in people with dementia. ³⁶⁷

PAINAD: pain when the person cannot say

Teaching tool, not a clinical record

The rest of the assessment

2 · Giving the medicines

Some checks before a dose are the same every time. Others depend on the situation. Pick a situation to see what the labels and guidance describe, then press play.

Timeline

Schematic, not to scale.

Antipsychotic reduction programmes

Antipsychotics used for distress in dementia carry an increased risk of death, and programmes in the UK and the US set out to cut their use. The bars show the published figures.

3 · Communication and care approaches

What do the reviews find for the best-known approaches? The animation puts the Cochrane findings side by side, then shows two studies of how staff talk and organise care.

Timeline

Effect sizes as reported, with the sign turned so that right always means benefit. Different outcomes, so compare with care.

4 · Documentation and safety

Build an ABC chart entry

An ABC chart records the Antecedent (what came just before), the Behaviour (described as seen and heard) and the Consequence (what happened next). Over many entries, a pattern can point to a need. Choose one of each to assemble a worked entry. The example is fictional.

A Cochrane review of 18 trials found that programmes built on functional analysis, of which ABC recording is the basis, reduced how often challenging behaviour happened and improved caregivers' reactions after the intervention, but not at follow-up. The analysis part could not be separated from the rest of each programme. No study was found that validates the ABC chart itself as a nursing documentation tool in dementia. ³⁶⁴