1ASSESS THE KNOWLEDGE AND ATTITUDE REGARDING ALZHEIMER’S DEMENTIA AMONG ADULTS IN NANCHIYAMPALAYAM AT DHARAPURAM WITH A VIEW OF CONDUCTING AN AWARENESS PROGRAMME ON PREVENTION OF ALZHEIMER’S DEMENTIA DISSERTATION SUBMITTED TO THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY, CHENNAI IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING 2009-2011 2A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE REGARDING ALZHEIMER’S DEMENTIA AMONG ADULTS IN NANCHIYAMPALAYAM AT DHARAPURAM WITH A VIEW OF CONDUCTING AN AWARENESS PROGRAMME ON PREVENTION OF ALZHEIMER’S DEMENTIA APPROVED BY DISSERTATION COMMITTEE ON ______________ RESEARCH GUIDE :- Prof. Mrs. Vijayarani Prince, _____________________ M.Sc(N)., M.A., M.A., M.Phil(N)., Principal, Bishop’s College of Nursing, Dharapuram. – 638 656, Tamil Nadu. CLINICAL GUIDE:- Mrs. Kalaiselvi, M.Sc(N)., _____________________ Department of Mental Health Nursing, Bishop’s College of Nursing, Dharapuram. – 638 656, Tamil Nadu. MEDICAL EXPERT:- Dr.C. Rajendran MBBS., DPM, _____________________ Civil surgeon Psychiatrist Tamilnadu Medical Service ESI Hospital Coimbatore. DISSERTATION SUBMITTED TO THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY, CHENNAI IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING 2009-2011 3A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE REGARDING ALZHEIMER’S DEMENTIA AMONG ADULTS IN NANCHIYAMPALAYAM AT DHARAPURAM WITH A VIEW OF CONDUCTING AN AWARENESS PROGRAMME ON PREVENTION OF ALZHEIMER’S DEMENTIA Certified Bonafide Project Work Done By Miss.D.Shalini M.Sc., Nursing II Year Bishop’s College of Nursing Dharapuram. _________________________ _________________________ Internal Examiner External Examiner COLLEGE SEAL DISSERTATION SUBMITTED TO THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY, CHENNAI IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING 2009-2011 4ACKNOWLEDGEMENT I am whole heartedly grateful to the God almighty who strengthened, accompanied and blessed me throughout the study. I extend my heart full thanks and gratitude to the Management, Bishop’s College of Nursing for providing an opportunity to undergo to uplift my professional life. With deep sense of gratitude, I express my sincere thanks to our beloved principal, Prof. Vijayarani Prince M.Sc(N)., M.A., M.A., M.Phil (N) Bishop’s College of Nursing for her expert guidance, thoughts , comments, invaluable suggestions ,constant encouragement and support throughout the period of study. I express my thanks to Mr. John Wesley, Administrator, Bishop’s College of Nursing for given me an opportunity to study in this esteemed institution. It gives me immense pleasure to thank with deep sense of gratitude to the research guide Mrs.Kalaiselvi, M.Sc (N)., Reader, Department of Mental Health Nursing for her Valuable Suggestions, encouragement, perfect direction, pensive correction, personal interest, constant support and prayers till the completion of the study. 5I would like to extend my deepest gratitude to Associate Professor, class co-ordinator, Prof.Mrs. Glory Suramanjary, M.Sc(N)., for her expert guidance, constant support and untiring efforts in the area of research kindled my spirit and enthusiasm to go ahead and to accomplish this study successfully. My immense thanks to librarians of Bishop’s College of Nursing for their Co-operation in procuring books when needed. I express my genuine gratitude and obligation to Dr. Duraisamy Ph.D., (stat)., for his suggestion in analysis presentation of data. I extend my gratitude to Mr. P. Sampath, M.A., M.Ed., (English) for his valuable English editing. I extent my thanks to Mrs.Sivaranjani, M.A., M.Ed., (Tamil) for his valuable Tamil editing. I extend my heartful thanks to Mr. Vijay Kumar, Vijay Xerox, and Dharapuram for their kind co-operation in typing my thesis. I continue to be indebted to all for their support, guidance and care who directly and indirectly involved in my progress of work and for the successful completion of this thesis. 6 CONTENT CHAPTER TITLE PAGE NO I II III (i)INTRODUCTION Background of the Study Need for the study Statement of the problem Objectives of the study Operational definitions Assumptions Hypotheses Delimitations Projected outcome (ii)CONCEPTUAL FRAMEWORK REVIEW OF LITERATURE PART-I Over view of Alzheimer’s dementia PART-II Studies related to prevalence and incidence of Alzheimer’s dementia. Studies related to Alzheimer’s dementia. Studies related to knowledge and attitude regarding Alzheimer’s dementia METHODOLOGY Research approach Research design Setting of the study Population Sample Criteria for sample selection Inclusion Criteria Exclusion Criteria 1-19 1 4 11 11 12 13 14 14 14 15 20-51 20 38 43 47 52-58 52 52 52 52 53 53 7 CHAPTER TITLE PAGE NO IV V VI Sample size Sampling technique Instrument Description of the instrument Scoring procedure Validity and reliability of the tool Pilot study Data collection procedure Plan for data analysis Protection of human subjects DATA ANALYSIS AND INTERPRETATION DISCUSSION SUMMARY , CONCLUSION IMPLICATIONS Nursing service Nursing education Nursing administration Nursing research RECOMMENDATIONS LIMITATIONS BIBLIOGRAPHY References APPENDICES 53 53 53 53 54 55 56 56 58 58 59-86 87-93 94-97 96 96 97 97 97 97 98-102 i-ixxvii 8LIST OF TABLES Table No. Title Page No. 1 2 3 4 5 6 7 8 Frequency and percentage distribution of demographic variables Frequency and percentage distribution of knowledge regarding Alzheimer’s dementia among adults. Area wise analysis scores for knowledge regarding Alzheimer’s dementia Frequency and percentage distribution of attitude regarding Alzheimer’s dementia among adults. Mean and standard deviation regarding knowledge and attitude of Alzheimer’s dementia among adults Correlation of the knowledge and attitude scores of adults regarding Alzheimer’s dementia. Association of knowledge regarding Alzheimer’s dementia among adults with their selected demographic variables. Association of attitude regarding Alzheimer’s dementia among adults with their selected demographic variables. 61-62 74 76 77 79 80 81-83 84-86 9LIST OF FIGURES FIGURE NO TITLE PAGE NO 1 Conceptual frame work 19 2 Percentage distribution of adults according to their age 65 3 Percentage distribution of adults according to their sex 66 4 Percentage distribution of adults according to their marital status 67 5 Percentage distribution of adults according to their religion 68 6 Percentage distribution of adults according to their type of family 69 7 Percentage distribution of adults according to their education 70 8 Percentage distribution of adults according to their family monthly income 71 9 Percentage distribution of adults according to their occupation 72 10 Percentage distribution of adults according to their Health information resources. 73 11 Percentage distribution of knowledge scores regarding Alzheimer’s dementia among adults 75 12 Percentage distribution of attitude scores regarding Alzheimer’s dementia among adults 78 10LIST OF APPENDICES APPENDIX CONTENT PAGE NO A Letter seeking permission for conducting the study i B Letter seeking for experts opinion for content validity ii C List of experts of validation iii D Certificate for Validity iv E Certificate for English editing ix F Certificate for Tamil editing x G Nanchiyampalayam area map xi H Structured teaching programme ♦ English ♦ Tamil xii-xlviii I Structured interview schedule ♦ English ♦ Tamil xlix-lxix J Answer key lxx K Photos lxxii L Pamphlets M Notice 11ABSTRACT Dementia - one of the world's fastest growing disease. Alzheimer’s dementia is a primary cognitive impairment disorder characterized by progressive deterioration of cognitive functioning, with the end result that the person may not recognize once familiar people, places and things. The ability to walk and talk is absent in the final stage. A study was done to assess the knowledge, and attitude regarding Alzheimer’s dementia among adults in Nanchiyampalayam at Dharapuram with a view of conducting an awareness programme on prevention of Alzheimer’s Dementia. The conceptual frame work used was based on Modified (2002) Pender’s health promotion Model. Descriptive survey design was adopted and Non probability systematic sampling technique was used to select 100 samples for the study. Structured interview schedule was used to assess the knowledge and attitude regarding Alzheimer’s dementia among adults. The data gathered were analyzed using descriptive and inferential statistics. The mean score of knowledge and attitude are 10.03(SD±3.4) and 48.62(SD±5.2). The correlation co-efficient of knowledge and attitude is (r=0.55) which is positively correlated. Significant association was found between adults knowledge with education, type of family, health resources and significant association was found between adults attitude with Education. 12 Awareness programme conducted for 2 days and pamphlets distributed in an groups regarding Alzheimer’s dementia among adults which will help them to disseminate the knowledge to others and practice preventive measures. 13 14 15 16 17 18 19 20 CHAPTER - I INTRODUCTION “Nothing is more beautiful than cheerfulness in an old face” 21 -Richter BACKGROUND OF THE STUDY As standards of living improve across the globe, people are living longer, and the world’s population is aging rapidly. Although the proportions of people age 60 or more years are smaller in the “developing” countries than in the “developed” countries, the stress numbers of older adults will by 2020 be much larger in the low and middle income countries of the world than in the attluent countries. Thus, depression and dementia will soon become major public health problems in countries such as India. Anguli M.G.,(2009) Dementia is defined by a loss of previous levels of cognitive, executive and memory function in a state of full alertness. Bourgeois et..al., (2003). Once dementia is diagnosed, patients must undergo complete medical and neurological workup, because 10 to 15 present of all patients with dementia have a potentially reversible condition if treatment is initiated before permanent brain damage occurs. Sadock .S (2003). Alzheimer's disease is often called a family disease, because the chronic stress of watching a loved one slowly decline affects everyone." The neurodegenerative disease can span anywhere from two to 20 years and turn a fully functioning adult or senior citizen into a helpless individual. The McGowan Institute for Regenerative Medicine points 22out that "today, home-based care for Alzheimer patients may entail tremendous economic, emotional and even psychological costs. Family caregivers often give up time from work and forego pay to spend 47 hours per week on average with an affected loved one who frequently cannot be left alone." In many ways, the effects of Alzheimer's disease on the family can be as devastating as its effects on the patient Antuono E.D.,(2009) Prevention of dementia is the attempt to avoid developing dementia. Although no cure for dementia is available, there are many ways to decrease the risk of acquiring dementia in the first place, including both lifestyle changes and medication. Alzheimer’s association (2009) Detection and treatment of hypertension in patients with dementia including Alzheimer’s disease is important, as prevention of stroke and silent cerebrovascular disease may slow down the course of cognitive decline in Alzheimer’s disease. Skoog I et.al.,(2006) Dementia drastically affects daily life and everyday personal activities. Often the disease is associated with behavioural symptoms, personality change and numerous clinical complications, increasing the risk for urinary incontinence, hip fracture, and – most markedly – dependence on nursing care. Thus, it is not surprising that the costs of care for patients with dementia are immense. Berr et. al.,(2005) 23 Family care giver alliance,(2005) states that, an accurate diagnosis begins a process of education for caregivers and families. So that needs can be met and resources located and put to use through education and the use of available resources, families can learn new skills to handle shifting care needs regarding dementia. "With every second ticking by, dementia costs the UK 539 pounds. We can't afford to ignore the true cost of dementia to society as a whole. We must tackle this huge challenge head on. We need to invest in dementia services, research, support and training and use what money is being spent more effectively. Planning now will save lives and money in the future. This new research shows that the government is failing to support people with dementia and their carers. Dementia will place an intolerable strain on our health and social care system unless the right services and support are in place." - Neil Hunt, chief executive of the Alzheimer's Society.,(2009) 24NEED FOR THE STUDY Alzheimer’s disease International., (2010) stated that now there are an estimated 35.6 million people with dementia world wide. By 2050’it is projected that this figure will have increased to over 115 million. Much of the increase will be in developing countries. Already 58% of people with dementia live in developing countries, but by 2050 this will rise to 71%. The fastest growth in the elderly population is taking place in china, India, and their south Asian and western pacific neighbours. Alzheimer Scotland Association of Dementia., (2009) stated that Dementia - one of the world's fastest growing diseases and it is fast becoming "everyone's problem." A look at the facts and statistics surrounding dementia clearly show that it is a massive issue, possibly a medical catastrophe in the making, with no easy solution. Indeed, the numbers and statistics surrounding dementia are staggering. Worldwide, there are now an estimated 24 million people living with some form of dementia. Without a major medical breakthrough in the fight against dementia, this number could jump to as many as 84 million who have age-related memory loss by the year 2040. A new case of dementia arises every seven seconds, with the number of people with dementia set to double every 20 years. The report comes nearly 100 years after the first identification of Alzheimer’s disease and estimates that 24.3 million people currently have dementia worldwide. In Scotland 63,000 people have dementia and this is expected to rise to 137,059 by 2040. 25Although there are a number of forms of dementia, Alzheimer's is the most common, and most well-known, of the age-related memory loss diseases. Currently, more than five million Americans suffer from Alzheimer's, and it is the seventh leading cause of death in the U.S. About 13% of Americans over the age of 65 have Alzheimer's and half of those over age 85 will develop Alzheimer's or a closely related dementia. 1 China: 5 Million 2 The European union: 5 Million 3 USA: 2.9 million 4 Japan 1.1 million 5 Russia: 1.1. million 6 Indonesia: 1.1 million It is estimated that there are currently 24.3 million people with dementia in the world, with 4.6 million new cases of dementia annually. The number of people attached is set to double every 20 years with 42.3 million living with dementia in 2020 and 81.1 million living with dementia by 2040. There are currently 700,000 people in the UK with dementia that is one in every 88 people. By 2021, the figure is expected to rise to 940,110, before reaching 1,735,087 in 2051. The predicted figure means dementia will affect the lives of around one in three people either as a sufferer, or as a career or relative, and it is a rise of 154% from the present day. There is no cure for dementia, and those with the condition need increasing care as the disease progresses so the costs for looking after people with dementia could cost billions each year. The expected rise is due to the UK's ageing population, as well as conditions such as 26high cholesterol and blood pressure, and lack of exercise which are all thought to increase the risk. Currently one in 20 people over 65, and one in five over 80 have a form of dementia, with two thirds of those affected having Alzheimer's disease. Marshall.C, ( 2009) Alzheimer's Association, the National Center for Health Statistics and the Center for Disease Control,(2010) stated that, Health analysts estimate that in just five years the number of Americans with Alzheimer's will jump to 7.7 million and by 2050 the number is projected to more than double to 16 million. Alzheimer’s society.,(2010) states that the numbers of people with dementia is expected to double in the next 20 years with associated costs rising faster. Delaying the onset of dementia by five years could reduce deaths directly attributable to dementia by 30,000 a year. A report from the Hindu newspaper - R.Prasad., (2009) Stated that in Tamil Nadu,7.5 % of people in Chennai have affected with Alzheimer’s dementia and 10.6% of the people were attack by Alzheimer’s dementia in Vellore. Alzheimer’s disease is mostly seen in older people but very occasionally it develops in middle age, occasionally in the 30’s (about 10% of all Alzheimer’s cases). People over the age of 65 are most frequently affected. The incidence of Alzheimer’s disease increases with age and by the age of 85 years nearly half of all people are affected by the disease. Kennard C.,(2009) 27Men and women who have high blood pressure in middle age are at increased risk of Alzheimer’s disease, studies confirm. And seniors with memory problems are similarly more likely to develop Alzheimer’s and other forms of dementia, whether they have high blood pressure or not. The large and ongoing Canadian Study of Health and Aging shows that seniors with high blood pressure who have problems in organizing their thoughts and making decisions, despite having intact memories, are at increased risk of Alzheimer’s as well. The researchers looked at the seniors for five years. They found that Alzheimer’s disease and other forms of dementia developed in about 60 percent of those who had memory problems, regardless of whether they had high blood pressure or blood pressure that was under control. Netzer W.J.,(2010) Caring for one person with late-onset dementia costs an average of 25,472 pounds per year. At the present time, the bulk of this cost is met by the person with dementia and their families. The researchers found that there were "marked variations" in the levels of provision and spending across the UK, and that care and support is "delivered piecemeal and in an inefficient fashion." Label L .,(2009) Dementia related to Alzheimer’s disease is placing substantial medical, social, psychological, and financial burdens on patients, their families, and their communities. Persons with Alzheimer’s disease require both “formal” medical and social services and “informal” services, usually provided by family members. Rice D et.al.,(1993) 28 Mirsha S, Fight against dementia: Awareness programs in Mumbai (2010) states that , “There is growing evidence indicating that certain medical conditions - such as high blood pressure, diabetes and obesity - may increase the risk of dementia whereas a healthy lifestyle may reduce the risk. Furthermore, aggressive management of vascular risk factors may slow the progression of vascular dementia and Alzheimer's disease. “Every year, in September, we go in for highly visible programs for a week to coincide with the World Alzheimer’s Day function. But this is not enough for the “Fight against Dementia.” The programs confirm the fact that awareness of dementia and Alzheimer’s is very low in India. Some people do not understand what “Alzheimer’s” is. Given that the name does not sound Indian, they think that this is some problem/ disease found only in the Western countries and has nothing to do with India. Many have never even heard the name. …awareness is essential for early diagnosis, and this lack of awareness delays any help the patient or family can get Poor awareness is very unfortunate, because awareness is essential for early diagnosis, and this lack of awareness delays any help the patient or family can get. As our focus is to reach out to as many elders as possible, we present dementia in the context of topics that concern elders, so that the audience is able to understand and participate effectively. 29Our role in these programs is to spread awareness, and not to diagnose whether or not a member of the audience (or their relative) has dementia. Definitely, we are not authorized to label someone as a dementia patient. For people facing problems, we encourage them to contact the nearest psychiatrist if they (or their family members) display any of the symptoms we have discussed. We hope that with such programs, awareness of dementia will increase and people will be able to get diagnosed earlier and get help for both the patients and their families”. Alzheimer's disease Care giving Advisory Board April 8., (2009) stated that, Conduct a range of educational programs targeting allied health Professionals, community programs, and the public at-large about Alzheimer's disease. Create awareness campaigns and training programs to alert individuals who encounter aging populations. International alliance for patient’s organizations (2010), The theme for World Alzheimer's Day September 21, 2010 is 'Dementia: It's time for action!' IAPO Member Alzheimer's Disease International have developed materials and activities that will focus on the need for governments and the general public to take any action they can to raise awareness of dementia and improve service provision for people with dementia and their carers. "This research highlights the desperate need for dementia to be made a national priority. Current levels of services and support for people with dementia and carers are clearly inadequate. Dementia is 30one of the main causes of disability later in life ahead of cancer, cardiovascular disease and stroke, yet funding for dementia research is significantly lower than these other conditions. Even delaying the onset of dementia by five years would halve the number of related deaths, saving nearly 30,000 lives annually." Martin Knapp.,(2009) Awareness about the symptoms and risk factors of Alzheimer’s disease is crucial in seeking timely medical help for the patients. The focus of initiatives this year, shifts on the importance of diagnosing the disease early, which is the only way to control some of its life-altering symptoms and impede the progression of the disease to a certain extent. Muppala S.C.,(2010) Jang Y et.al., (2004) done a study to assess Knowledge of Alzheimer’s Disease, Awareness of Services Among Korean American Elders, Method of study Using data from 675 Korean American elders (mean age = 70.2, SD = 6.87). The mean score on the knowledge regarding Alzheimer’s dementia was 7.01 (SD ±1.45) Results were Greater knowledge of AD is predicted by higher levels of education and acculturation. Feelings of shame associated with family members having AD are more likely to be reported by individuals with lower levels of education, acculturation, and knowledge of AD. The study findings underscore the pivotal role of education and acculturation in predicting knowledge of AD, feelings of shame, and awareness of AD-related services. 31Now a days Alzheimer’s dementia is one of the major problem affecting the old age population. The investigator observed that the people in the community has less awareness about prevention of Alzheimer’s dementia. The researcher felt the need to assess the knowledge and attitude of adults regarding Alzheimer’s dementia and to conduct an awareness programme on prevention of Alzheimer’s dementia which will help them to understand the preventive measures. STATEMENT OF THE PROBLEM A descriptive study to assess the knowledge and attitude regarding Alzheimer’s Dementia among adults in Nanchiyampalayam at Dharapuram with a view of conducting an awareness programme on prevention of Alzheimer’s Dementia. OBJECTIVES OF THE STUDY 1. To assess the level of knowledge regarding Alzheimer’s dementia among adults. 2. To assess the level of attitude regarding Alzheimer dementia among adults. 3. To find the correlation between knowledge and attitude score of adults regarding Alzheimer’s dementia. 4. To find the association between level of knowledge regarding Alzheimer’s dementia among adults with their selected demographic variables. 5. To find the association between level of attitude regarding Alzheimer’s dementia among adults with their selected demographic variables. 32OPERATIONAL DEFINITIONS Knowledge: Information and awareness acquired through experience or education. Elliott J (2002) In this study, it refers to the level of understanding of adults about the Alzheimer’s dementia which is measured by structured knowledge questionnaire and it’s scores. Attitude: It means a way of thinking or feeling about some one or some thing. Elliott J (2002) In this study, it refers to pattern of mental views or opinion of adults regarding Alzheimer’s dementia which is measured by 5 point likert scale and it’s scores. Alzheimer Dementia: A primary cognitive impairment disorder characterized by progressive deterioration of cognitive functioning, with the end result that the person may not recognize once familiar people, places and things. The ability to walk and talk is absent in the final stage. Varcarols E M et .al., (2006) 33Adults: Young adult is generally a person between the ages of 20-40,a person in the middle adulthood stage is between the ages of 40-65. Erikson E.,(1950) The people who are in the age group of 30 – 60 years, both male and female. Awareness programme on prevention of Alzheimer dementia: A plan of future events or things to be done. Elliott J (2002) In this study it refers to the planned and systematic way of importing information regarding prevention of Alzheimer’s dementia. This programme is conducted in Nanchiyampalayam community centre. This programme was planned priorly and informed to the people in Nanchiyampalayam .The education regarding prevention of Alzheimer’s dementia was explained to group members with the use of posters, charts, models, and pamphlets were distributed which includes definition, causes, stages and clinical manifestations, management and preventive measures such as exercise, diet, and life style modification behavior from 9.00am to 5.00pm for two days. ASSUMPTIONS 1 Adults may have less knowledge regarding Alzheimer’s dementia. 2 Adults may have unfavorable attitude regarding prevention of Alzheimer’s dementia. 3 Nurses has the responsibility to create awareness and give health related informations. 34RESEARCH HYPOTHESES: H1 There will be a significant correlation between knowledge and attitude scores of adults regarding Alzheimer’s dementia. H2 There will be a significant association between knowledge scores regarding Alzheimer’s dementia among adults with their selected demographic variables. H3 There will be a significant association between attitude scores regarding Alzheimer’s dementia among adults with their selected demographic variables. DELIMITATIONS: The study delimited to , 100 samples 5 weeks of data collection PROJECTED OUTCOME: At the end of the study the adults are expected to have increased level of knowledge and develop positive attitude towards Alzheimer’s dementia. It will help the adults disseminate knowledge to others and accepts affected persons in a positive way. 35(ii) CONCEPTUAL FRAME WORK Nola J Pender’s Health Promotion Model (2002 – Revised) The health promotion (HPM) proposed by Nola J Pender (1982; revised, 2002) was design to be a “Complementary counterpart to models of health protection”. It defines health as a positive, dynamic state not merely the absence of disease. Health promotion is directed at increasing a client’s level of well being. The health promotion model describes the multi dimensional nature of persons as they interact within their environment to pursue health. The model focuses on the following areas. Individual characteristics & experiences Behavior specific knowledge and affect Behavior out come INDIVIDUAL CHARACTERISTICS / EXPERIENCES i). Prior related behavior According to the theory, prior related behavior describes frequency of the similar behavior in the past. Direct and indirect effects on the likelihood of engaging in health promoting behaviors. In this study, adults knowledge and attitude regarding Alzheimer’s dementia are assessed. ii) Personal Factors : According to the theory, personal factorsare categorized as biological ,psychological and socio-cultural , these factors are predictive of a given behavior being considered. 36 In this study, adults biological factors such as age, sex, and sociocultural factors such as occupation, type of family, family monthly income, religion, type of health information resources are assessed. BEHAVIOUR SPECIFIC COGNITIONS AND AFFECT a)Perceived benefit: According to the theory, anticipated positive out comes that will occur from health behavior. In this study adults will gain knowledge and positive attitude regarding prevention of Alzheimer’s dementia after conducting awareness programme. b) Perceived barriers: According to the theory, perceived barriers action is anticipated, imagined or real blocks and personal costs of understanding a given behavior. In this study, adults are having lack of knowledge, ignorance and lack of motivation are acting as barriers. c). Perceived self efficacy:- According to the theory, judgment of personal capability to organize and execute a health – promoting behavior. Perceived self efficacy influences barriers to action so higher efficacy result in lowered perceptions of barriers to the performance of the behavior. In this study, the adults realize the importance of prevention of Alzheimer’s dementia. 37d). Activity related affect :- According to the theory, activity related affect describes subjective positive or negative feelings that occur before, during and following behavior based on the stimulus properties of the behavior itself. Activity related affect influences perceived self – efficacy, which means the more positive the subjective feeling, the greater the feeling of efficacy. In turn, increased feelings of efficacy can generate further positive affect. In this study, it is conceptualized that the adults existing knowledge and attitude regarding Alzheimer’s dementia is assessed. e). Inter personal influences :- According to the theory, Cognition concerning behaviors, belief, or attitudes of the others. Interpersonal influences include; norms (expectations of significant others), social support (instrumental and emotional encouragement) and modeling (various learning through observing others engaged in a behavior). Primary sources of interpersonal influences are families, peers, and health care providers. In this study, researcher influencing the adults to attend awareness programme on prevention of Alzheimer’s dementia (definition, causes, clinical manifestations, stages, preventive measures. f). Situational influence :- According to the theory, personal perceptions and cognitions of any given situation or context that can facilitate or impede behavior. In this study, the adults are in need to maintain the health status in order to prevent Alzheimer’s dementia. 38BEHAVIORAL OUTCOME i). Immediate change of practice low control to high control According to the theory, Competing demands are those alternative behavior over which individuals have low control, because there are environmental contingencies such as work or family care responsibilities. Competing preference are alternative behavior over which individual exert relatively high control, such as choice of ice cream or apple for a snack. In this study, the adults may accept to follow the measures to maintain the prevent Alzheimer’s dementia. ii) Commitment to plan action :- According to the theory, the concept of intention and identification of a planned strategy leads to implementation of health behavior. In this study, the adults will make decision to follow the healthy measures to maintain the prevent Alzheimer’s dementia. iii). Health promoting behavior :- According to the theory, health promoting behavior is an endpoint or action outcome directed toward attaining positive health out comes such as optimal well – being, personal fulfillment and productive living. In this study, the adults are gained knowledge, and attitude regarding prevention Alzheimer’s dementia. 39 INDIVIDUAL CHARACTERISTICS AND EXPERIENCES BEHAVIOUR SPECIFIC COGNITION & AFFECT BEHAVIOUR OUTCOME PERSONAL FACTORS DEMOGRAPHIC VARIABLES BIOLOGICAL FACTORS • Age • Sex SOCIOCULTURAL FACTORS • Education • Occupation • Type of family • Monthly income • Type of health information resources PERCEIVED BENEFIT • Prevention of Alzheimer’s dementia • Healthy living PERCEIVED BARRIERS Lack of knowledge Moderately favorable attitude ACTIVITY RELATED AFFECT Existing level of knowledge and attitude regarding prevention of Alzheimer’s a dementia INTERPERSONAL INFLUENCES Awareness programme on prevention of Alzheimer’s dementia including definition, causes, clinical manifestations, stages, management and preventive measures is conducted with posters, chart, pamphlets, and models for 2 days. COMMITMENT TO PLAN OF ACTION The adults identify the Benefit & make decision to follow the measures to prevent Alzheimer’s dementia STUATIONAL INFLUENCES Adults need to modify the life style situations of diet, exercise, sleep patter & relaxation. PERCEIVED SELF EFFICACY Realize the important of prevention of Alzheimer’s dementia PRIORRELATED BEHAVIOR • Assessment of knowledge regarding Alzheimer’s dementia with structured knowledge interview schedule and scored as adequate, moderately adequate and inadequate knowledge. • Assessment of attitude regarding Alzheimer’s dementia with five point likert scale and scored as favorable, moderately favorable, and unfavorable attitude. IMMEDIATE CHANGE OF PRACTICE The adults accepts to follow the measures to prevent the Alzheimer’s dementia HEATH PROMOTION BEHAVIOR Adults become aware regarding Alzheimer’s dementia & follow the preventive measures Fig.1 : MODIFIED, PENDERS HEALTH PROMOTION MODEL [REVISED (2002)] 40CHAPTER – II REVIEW OF LITERATURE This chapter includes review of literature for this study which is organized under the following headings. PART – I i) Overview of Alzheimer’s Dementia PART – II i) Studies related to prevalence and incidence of Alzheimer’s dementia. ii) Studies related to Alzheimer’s dementia iii) Studies related to knowledge and attitude regarding Alzheimer’s dementia PART – I i) OVERVIEW OF ALZHEIMER’S DEMENTIA Definition: A primary cognitive impairment disorder characterized by progressive deterioration of cognitive functioning, with the end result that the person may not recognize once familiar people, places and things. The ability to walk and talk is absent in the final stages. Varcarols E.M et. al., Dementia is defined as a reduction or impairment of multiple cognitive abilities, including memory, sufficient to interfere with self-maintenance, work, or social relationships. Weiner (1996)., 41Causes and Risk factors of Alzheimer’s dementia: • Age The greatest known risk factor for Alzheimer’s is advancing age. Most individuals with the disease are age 65 or older. The likelihood of developing Alzheimer’s doubles about every five years after age 65. After age 85, the risk reaches nearly 50 percent. One of the greatest mysteries of Alzheimer's disease is why risk rises so dramatically as we grow older. • Heart diseases People with the risk factors of heart disease - hypertension, high cholesterol, and poorly controlled diabetes - also have a higher risk of developing Alzheimer's.Sometimes these factors have nothing to do with lifestyle, i.e. if you have high blood pressure for another reason, have diabetes type 1, or are susceptible to high blood cholesterol despite being the right weight, exercising, etc., good control and treatment of the condition helps minimize the risk of developing Alzheimer's • Academic level There is some data showing a higher risk of developing Alzheimer's among people with lower educational qualifications, compared to highly qualified individuals . However, nobody really knows why. • Processed foods and fertilizers (nitrates) A study carried out by researchers at Rhode Island Hospital found a significant link between increased levels of nitrates in our environment and food, with increased deaths from diseases, including 42Alzheimer's, diabetes and Parkinson's. The study looked at progressive increases in human exposure to nitrates, nitrites and nitrosamines through processed and preserved foods as well as fertilizers. • Smoking and Alcohol Use: Several recent studies have found that smoking significantly increases the risk of mental decline and dementia. People who smoke have a higher risk of atherosclerosis and other types of vascular disease, which are also considered dementia risk factors and may be the underlying causes for the increased dementia risk. • Atherosclerosis: Atherosclerosis is the buildup of plaque - deposits of fatty substances, cholesterol, and other matter - in the inner lining of an artery. Atherosclerosis is a significant risk factor for vascular dementia, because it interferes with the delivery of blood to the brain and can lead to stroke. Strokes are one of the major dementia risk factors. • Genetics/Family History: Researchers have discovered a number of genes that increase the risk of developing dementia. Although people with a family history of dementia are generally considered to be at heightened risk of developing the disease themselves, many people with a family history never develop the disease, and many without a family history of the disease do get it. In most cases, it is still impossible to predict a specific person's risk of the disorder based on family history alone. However, genetics and family history has been found to be one of the dementia risk factors to consider. • Diabetes: Diabetes is one of the dementia risk factors for vascular dementia. It is also a known risk factor for atherosclerosis and stroke, both of which contribute to vascular dementia. People who 43suffer severe or repeated head injuries are at increased risk of developing dementia. It is possible that a head injury may trigger the disease process in susceptible individuals. • Head trauma: There may be a strong link between serious head injury and future risk of Alzheimer’s, especially when trauma occurs repeatedly or involves loss of consciousness. Protect your brain by buckling your seat belt, wearing your helmet when participating in sports, and “fall-proofing” your home. Other dementia risk factors are untreated infectious and metabolic disease and substance abuse, brain tumors, kidney failure, liver disease, thyroid disease, and vitamin deficiencies (B12, folic acid, thiamine),A history of episodes of clinical depression , Strokes, Obesity. Alzheimer's Association (2010) Classification of alzheimer’s dementia: According to ICD – 10 classification, this Alzheimer’s dementia is comes under the classification of F00 – F09. Stages of Alzheimer’s dementia : Stage 1: No cognitive impairment Unimpaired individuals experience no memory problems and none are evident to a health care professional during a medical interview. 44Stage 2: Very mild cognitive decline Individuals at this stage feel as if they have memory lapses, especially in forgetting words or names or the location of keys, eyeglasses, or other everyday objects. But these problems are not evident during a medical examination or apparent to friends, family or co-workers. Stage 3: Mild cognitive decline Friends, family or co-workers begin to notice deficiencies. Problems with memory or concentration may be measurable in clinical testing or discernible during a detailed medical Interview. Common difficulties include: ♦ Word- or name-finding problems noticeable to family or close associates. ♦ Decreased ability to remember names when introduced to new people ♦ Performance issues in social or work settings noticeable to family, friends or co-workers ♦ Reading a passage and retaining little material ♦ Losing or misplacing a valuable object ♦ Decline in ability to plan or organize 45Stage 4: Moderate cognitive decline At this stage, a careful medical interview detects clear-cut deficiencies in the following areas: ♦ Decreased knowledge of recent occasions or current events ♦ Impaired ability to perform challenging mental arithmetic-for example, to count backward from 100 by 7s ♦ Decreased capacity to perform complex tasks, such as marketing, planning dinner for guests or paying bills and managing finances. ♦ Reduced memory of personal history ♦ The affected individual may seem subdued and withdrawn, especially in socially or mentally challenging situations Stage 5: Moderately severe cognitive decline Major gaps in memory and deficits in cognitive function emerge. Some assistance with day-to-day activities becomes essential. At this stage, individuals may: ♦ Be unable during a medical interview to recall such important details as their current address, their telephone number or the name of the college or high school from which they graduated ♦ Become confused about where they are or about the date, day of the week, or season. ♦ Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s. 46♦ Need help choosing proper clothing for the season or the occasion. ♦ Usually retain substantial knowledge about themselves and know their own name and the names of their spouse or children. Usually require no assistance with eating or using the toilet Stage 6: Severe cognitive decline Memory difficulties continue to worsen, significant personality changes may emerge and affected individuals need extensive help with customary daily activities. At this stage, individuals may: ♦ Lose most awareness of recent experiences and events as well as of their surroundings. ♦ Recollect their personal history imperfectly, although they generally recall their own name. ♦ Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces. ♦ Need help getting dressed properly; without supervision, may make such errors as putting pajamas over daytime clothes or shoes on wrong feet. ♦ Experience disruption of their normal sleep/waking cycle. ♦ Need help with handling details of toileting (flushing toilet, Wiping and disposing of tissue properly) ♦ Have increasing episodes of urinary or fecal incontinence ♦ Experience significant personality changes and behavioral symptoms, including suspiciousness and delusions (for example, believing that their caregiver is an impostor); hallucinations 47(seeing or hearing things that are not really there); or compulsive, repetitive behaviors such as hand-wringing or tissue shredding ♦ Tend to wander and become lost. Stage 7: Very severe cognitive decline This is the final stage of the disease when individuals lose the ability to respond to their environment, the ability to speak and, ultimately, the ability to control movement. ♦ Frequently individuals lose their capacity for recognizable speech, although words or phrases may occasionally be uttered. ♦ Individuals need help with eating and toileting and there is general incontinence of urine. ♦ Individuals lose the ability to walk without assistance, then the ability to sit without support, the ability to smile, and the ability to hold their head up. ♦ Reflexes become abnormal and muscles grow rigid. ♦ Swallowing is impaired. -Alzheimer’s association., (2005) 48 SIGNS OF NORMAL CHANGE VS. EARLY ALZHEIMER’S SYMPTOMS Normal Early Alzheimer’s disease Can’t find your keys Routinely place important items in odd places Search for casual names and words Forget names of family and common objects Briefly forget conversation details Frequently forget entire conversations Can’t find a recipe Can’t follow recipe directions Forget to write down a check Can no longer manage checkbook Cancel a date with friends Withdraw from usual interests Miss an occasional right turn Get lost in familiar places - Wayne M et.al.,(2010) Diagnosis According to ICD – 10, the following features are required for the diagnosis 1. Evidence of decline in both memory and thinking, sufficient, though to impair personal activities of daily living. 2. Memory impairment typically affects the registration, storage, and retrieval of new information, but previously learned material (remote memory) may also be lost, particularly in later stage. 3. Thinking is impaired the flow of ideas reduced and the designing capacity is also impaired. 4. Presence of class consciousness (coconsciousness can be impaired if delirium is also present). 5. Duration of at least 6 months. ICD-10 Diagnostic criteria 49Diagnostic tests: Blood tests - if the patient has a thyroid disorder or vitamin deficiency. Neuropsychological testing - this involves an extensive assessment of cognitive (thinking) and memory skills. These types of tests are extremely useful in detecting Alzheimer's as well as other dementias early on. MRI (magnetic resonance imaging) scan - A powerful magnetic field is created by passing an electric current through the wire loops. The final product is a 3-D image representation of the area being examined; which in this case would be the brain. PET (positron emission tomography) scan - uses radiation, or nuclear medicine imaging, to produce 3-dimensional, color images of the functional processes within the human body. It is very useful in helping the diagnosis of Alzheimer's disease. CT (computerized tomography) scan - this device uses digital geometry processing to generate a 3-dimensional (3-D) image of the inside of an object. Alzheimer’s Association (2010) Management: Medical management: Alzheimer's is a terminal disease. This means it has no cure and will end in death. However, there are various medications which can help slow down the progression of the disease, and others that can improve the signs and symptoms, such as sleeplessness, wandering, depression, anxiety and agitation. 50 Cholinesterase inhibitors This drug improve the levels of neurotransmitters in the brain. The medication contains a chemical that inhibits the cholinesterase enzyme from breaking down the neurotransmitter acetylcholine - resulting in an increase in both the neurotransmitter's level and duration of action. Cholinesterase inhibitors are prescribed to treat problems related to memory, thinking, language, judgment and other thought processes. Memantine This medication protects brain cells from damage caused by glutamate, a chemical messenger. It is used to treat moderate to severe stages of Alzheimer's. Some doctors prescribe memantine along with a cholinesterase inhibitor. Examples include Axura, Akatinol, Namenda, Ebixa and Abixa, and Memox. Memantine is prescribed to improve memory, language, reason, attention, and the ability to carry out simple tasks. ACE Inhibitors – ACE inhibitors that affect the brain by crossing the blood-brain barrier, may reduce inflammation that could contribute to the development of Alzheimer's disease. Stem cells Scientists at UC Irvine showed that neural stem cells can rescue memory with advanced Alzheimer's disease, raising hopes of a potential treatment for humans. 51 Insulin Insulin could protect against damage to brain cells key to memory. Treating Alzheimer's disease with insulin, or with drugs to boost its effect, may help people with the condition. Alzheimer's Association(2010) Complications of Alzheimer’s dementia: People with Alzheimer's disease progressively lose the ability to care for themselves. This makes them more susceptible to accidents and health problems: Pneumonia This becomes a significant risk when patients start losing their ability to swallow properly. Food and drink often go down the wrong way - down the air passages into the lungs, rather than into the digestive system. If food or drink gets into the lung there is a risk of pneumonia. Urinary tract infection When the patient becomes incontinent it may be necessary to place a urinary catheter. This increases the risk of urinary tract infections. Urinary tract infections can become very serious and life threatening. Injuries – Disorientation and wandering are common symptoms of Alzheimer's. Patients are much more likely to fall and fracture a bone or sustain a head injury. The risk is greater if they have sleeping problems and get up in the night and wander about while others are asleep. Wayne M et.al., (2010) 52Prevention of alzheimer’ s dementia: Prevention and delay strategy 1: Get moving According to a recent Mayo Clinic review, no single lifestyle choice has as much impact on aging and Alzheimer’s disease as exercise. In a 2009 review of literature from the International Journal of Clinical Practice, scientists documented that over time, physical activity effectively reduces the probability of Alzheimer’s disease and other dementias. Additional research shows those with existing cognitive problems and dementia receive a protective benefit from regular exercise. Exercise at a moderate pace-for at least 30 minutes five times per week. Just five workouts every seven days can reduce your risk of Alzheimer’s by as much as 35%. When serious brain damage has already occurred, brisk walking and other cardiovascular exercise can slow further injury. Build muscle to pump up your brain-moderate levels of weight and resistance training not only increase muscle mass, they maintain cognitive health. Combining aerobics and strength work is better than either activity alone. Add 2-3 strength sessions will reduce risk of Alzheimer’s is cut in half. Think movement-those who are physically active throughout life have improved cognitive forecasts. Gardening, cleaning house, and taking the stairs build brain-healthy movement throughout the day. Look for opportunities to walk, bend, stretch, and lift way to vitality. 53Prevention and delay strategy 2: Eat a brain-healthy diet In Alzheimer’s disease, inflammation and insulin resistance injure neurons and inhibit communication between brain cells. In Freedom from Disease, Alzheimer’s is described as “diabetes of the brain,” and a growing body of information suggests a strong link between metabolic disorders and the signal processing systems. In addition, the American Academy of Neurology recently warned elevated cholesterol in 40 years of age increases the risk of Alzheimer’s dementia. Eating habits that reduce inflammation and promote normal energy production are brain-healthy. Follow a Mediterranean diet. Control inflammation by eating foods rich in Omega 3 fatty acids, cold water fish, nuts, whole grains, and abundant fresh produce. Avoid tran’s fats, full-fat dairy products, and red meat. Maintain consistent levels of insulin and blood sugar. Eat several small meals throughout the day. Avoid packaged, refined, and processed foods, especially those high in sugars and white flour, which rapidly spike glucose levels and inflame the brain. Eat across the rainbow. Emphasize fruits and vegetables across the color spectrum to maximize protective anti-oxidants and vitamins. Daily servings of berries and green leafy vegetables should be part of a plant-centered, brain protective regimen. 54 Drink tea daily. Drinking 2-4 cups daily has proven benefits. Although caffeine can inhibit stress reduction and become addictive, moderate coffee drinkers also enjoy reduced cognitive risks. Consider supplementing your diet. Vitamins, herbs, and amino acids may provide additional brain protection. Folic acid, vitamin B12, vitamin D, and fish oils are believed to preserve and improve memory. Prevention and delay strategy 3: Build brain reserves According to the 2008 Wall Street Journal review “Neurobics and Other Brain Boosters,” an active, stimulated brain reduces your odds of developing Alzheimer’s. Those who remain engaged in activities involving multiple tasks, requiring communication, interaction, and organization, who continue learning, and constantly challenge their brains earn the greatest protection. Cross-training with these brainpower activities will keep your mind sharp: Set aside time each day to learn something new - read a good book, study a foreign language, play a musical instrument. The greater the novelty and challenge, the larger the deposit in your brain reserves. Practice memorization - start with something short and progress to the 50 U.S. capitals. Create rhymes and patterns to strengthen your memory connections. 55 Solve riddles and work puzzles - brain teasers and strategy games provide great mental exercise and build capacity to form and retain cognitive associations. Prevention and delay strategy 4: Sleep to restore memory Brain needs regular, restful sleep to process, store, and recall information. Nightly deprivation not only leaves cranky and tired, but according to memory experts Dr. Andrew Weil and Dr. Gary Small, poor sleep can significantly damage your brain and central nervous system. Establish a regular sleep schedule. Going to bed and getting up at the same time reinforces natural circadian rhythms. Brain’s clock responds to regularity, and long term disruption has been associated with heart disease, cancer risks, and cognitive problems. Set the mood. Reserve your bed for sleep (and sex), take a hot bath, and dim the lights. Brisk evening exercise, comfortable temperatures, and white noise machines can also signal your brain that it’s time for deep restorative sleep. Stop snoring. Alcohol, smoking, sedating drugs, excess weight, high blood pressure, and clogged nasal passages can rock the timbers. Snoring may signal sleep apnea, a respiratory condition that threatens your heart and mind. A new study from the University of California at San Diego estimates seventy to eighty percent of Alzheimer’s patients experience sleep apnea. Wayne M et.al.,(2010) 56Prevention and delay strategy 5: Learn to relax and manage stress According to USC’s Dr. Vincent Fortanasce, lifelong stress can double or quadruple your chances of Alzheimer’s disease, yet simple daily tools can minimize its effects. The harmful stress hormone cortisol hampers nerve cell growth and connection and accelerates cognitive decline, premature aging, depression, diabetes, and other assaults on your brain. Breathing exercises- Stress alters breathing rates and impacts brain oxygen levels. Turn off your stress response with quiet, deep, abdominal breathing. From momentary inhale, hold, and exhale sequences to guided group exercises, restorative breathing is powerful, simple. Schedule daily relaxation activities - From a walk in the park or petting, guided imagery, or yoga, make relaxation a priority. Keeping cortisol under control requires regular effort. Stay connected - We are social creatures, and the most connected fare better on tests of memory and cognition. Developing a strong support system through family, friends, exercise groups, clubs, and volunteer activities improves mood and slows cognitive decline. Nourish inner peace - Most scientists acknowledge a strong mind-body connection, and various studies associate personal spiritual activities with better cognitive aging. Regular meditation, prayer, reflection, and religious practice may immunize you against the damaging effects of stress. 57Prevention and delay strategy 6: Protect your brain By the time Alzheimer’s disease appears, irreversible damage has already occurred. Preventing and delaying Alzheimer’s includes three protective tips: Avoid toxins - Among the most preventable risk factors for Alzheimer’s disease are smoking and heavy drinking. Not only does smoking increase the odds for those over 65 by nearly 79%, researchers at Miami’s Mt. Sinai Medical Center warn that a combination of these two behaviors reduces the age of Alzheimer’s onset by six to seven years. Stop smoking at age, the brain benefits from improved circulation almost immediately. Brain changes from alcohol abuse can only be reversed early. Wear a helmet - and limit distractions. A National Institute of Health study suggests head trauma at any point in life significantly increases your risk of Alzheimer’s. Dr. Andrew Weil cautions that repeated hits in sports activities including football, soccer, and boxing, or single traumatic injuries from bicycle, skating, or motorcycle accidents make Alzheimer’s disease more likely in later life. Preserve your brain by wearing properly fitting helmets, buckling the seatbelt. Avoid activities that compete for attention like driving with cell phones and running with your MP3 player. A moment’s distraction can lead to a brain-injury. Create a brain-safe environment - Scientists continue to examine links between neurodegenerative diseases like Alzheimer’s and exposure to environmental contaminants. UCLA’s Memory Center Director Gary Small warns that lead, pesticides, mold, and 58other substances in the environment may damage the brain. Studies on the impact of electromagnetic energy from cell phones are still debated. Although definitive links to Alzheimer’s can be elusive, making choices that limit chronic exposure to environmental harm makes good sense. Wayne M et.al., (2010) PART – II i) STUDIES RELATED TO PREVALANCE AND INCIDENCE OF ALZHEIMER’S DEMENTIA: James B.D and Schneider J.A., (2010) done a study to investigate the incidence of Alzheimer’s dementia among US population. 1,150 persons at least 90 years old in 2003 were enrolled, who had at least one follow-up over 4 years. The authors found that the incident rate of dementia increased exponentially, from 12.7% per year for 90 to 94 year olds, to 21.2% per year for 95 to 99 year olds, to 40.7% per year for persons aged 100 years and older. Esquivel C .A et .al., (2004) done a study to investigate the Prevalence of dementia and Alzheimer's disease in elders of nursing homes and a senior center of Durango City, Mexico. One hundred and fifty-five residents of two nursing homes and 125 attendees of a senior center were examined for dementia and Alzheimer's disease. All subjects were tested by the mini-mental state examination, Diagnosis of Alzheimer’s dementia was based on the DSM-IV criteria. Socio-demographic characteristics from each participant were also obtained. Residents of nursing homes found to suffer from dementia were 25 out of 155 (16.1%). Eighteen of them (11.6%) had Alzheimer’s dementia. 59 Wimo.A et. al., (2010) done a survey to identify the prevalence of Alzheimer’s dementia. The prevalence rate was 6% for adults aged 65 years and older. The researcher also estimated 66% of people with dementia lived in underdeveloped and developing countries and he stated that the rate of dementia was expected to rise to more than 70% by 2040. Llibre, L.D et .al., (2008) done a study on A Community-Based Study among Elderly Residents in the Havana Citymunicipality of Playa. A two-phase, cross-sectional, door-to-door study was conducted in the municipality targeting all persons aged ≥65 years, achieving a 96.4% response rate (n=18,351). Folstein Mini Mental State Examination (MMSE), Hughes Clinical Dementia Rating (CDR) and a structured interview on risk factors were applied. DSM-IV, criteria were used to determine diagnosis, Dementia prevalence was 8.2% of adults aged ≥65 years, with a slight predominance in males. The most frequent cause of dementia was Alzheimer’s disease. Bowirrat A et. al.,(2009) done a study on Prevalence of Alzheimer's type dementia in an elderly Arab population. The target population, aged 60 years or older, comprised 821 persons (362 males) were examined for symptoms of dementia (DSM-IV criteria), using a semistructured questionnaire for collection of demographic and medical data. Age, gender, and education-specific prevalence rates were calculated for this population and compared to those obtained in other studies. Alzheimer’s dementia was diagnosed in 20.5% of this population. Its prevalence increased steeply with age, from 8% among those younger than 70 years to 33% among those aged 70–79 and 51% among those 80 years or older. Illiteracy was very common in this 60population, and strongly associated with higher prevalence of Alzheimer’s dementia (27% vs. 4%, P < 0.001). Alzheimer’s dementia was more prevalent among females than males (25% vs. 15%, P < 0.001). However, illiteracy was also significantly more frequent among women (96% vs. 42%, P < 0.001). Busko M., (2008) done a study to investigate Prevalence of Alzheimer's Disease in Beijing, China. The studies looked at individuals who were living in the community who were age 60 years and older (n=1331). The researchers went to people's homes and performed a Mini-Mental State Exam (MMSE). The researchers used Diagnostic and Statistical Manual of Mental Disorders, (DSM-III) . The researcher found that prevalence rate is increased from 6.9% to 12.1%. Saldanha D et .al., (2010) done an epidemiological study of dementia in Maharashtra, Pune. The number of people over 65 years numbered 6721 and 2145 of them were randomly selected for a door-to-door survey. Each participant underwent a brief mental state examination and CSI-D (community screening instrument - dementia), Radio imaging investigation was also carried out to quantify the deficit. Findings revealed that prevalence of dementia in the sample population of elderly aged above 65 years was 4.1%. Socio-demographic factors which conferred a statistically higher risk for dementia were identified to be older age, low socio-economic status, low level of education, presence of family history. 61 Raina S et .al., (2008) done a study on Prevalence of dementia among Kashmiri migrants, the population aged 60 years and above. A cross-sectional survey was conducted among the elderly population. They developed and used a Kashmiri version of the Mini-Mental State Examination as the test instrument, A functional ability questionnaire was also administered to the subjects. A neurologist carried out the examinations. A sample comprising 200 subjects (95 males and 105 females) were evaluated. The prevalence of dementia is 6.5% among the Kashmiri population aged 60 years and above, which is higher than that reported from other parts of India. Das S .K et .al., (2005) done a cross-sectional population-based epidemiological study on a stratified randomly selected sample from the city of Kolkata to study the prevalence of major neurological disorders. Two- stage house-to-house survey was done the first stage was undertaken by a field team consisting of four field workers and a neuropsychologist. Screening questionnaire based on National Institute of Mental Health and Neuro Sciences (NIMHANS) protocol was used. In the second stage a neurologist examined all the screened positive cases. A total of 52,377 subjects participated in the study. Findings shows that 87.82 % of them were diagnosed as Alzheimer’s dementia. Vas C.J et. al.,(2004) done a 3-year epidemiological survey for dementia in an urban community-resident population in Mumbai , India. 30,000 subjects aged 40 years or more, 24,488 (male = 11,875; female = 12,613) were selected. Persons were screened for cognitive functioning using a modified and translated version of the Mini-Mental State Examination. Diagnoses were made using the DSM-IV diagnostic criteria. Subjects were also rated on the Clinical Dementia Rating (CDR) 62scale and assessed for activities of daily living. One hundred five subjects with dementia were identified in this population of 24,488 persons. The prevalence rate for dementia in those aged 40 years and more was 0.43% and for persons aged 65 and above was 2.44%. The overall prevalence rate for Alzheimer's disease (AD) in the population was 0.25%, and 1.5% for those aged 65 years and above. AD (n = 62; 65%) was the most common cause of dementia. There were more women (n = 38) than men (n = 24) in the AD group. Increasing age was associated with a higher prevalence of the dementia syndrome in general as well as AD specifically. Shaji S et. al., (2005) done a study to investigate Prevalence of dementia in an urban population in Kerala, India .A door-to-door survey was conducted in the city of Kochi (Cochin) to identify residents aged 65 years using cluster sampling. 1934 people screened with the Mini-Mental State Examination, diagnoses was done according to DSM-IV criteria. Identified cases were categorised by ICD-10 criteria. Prevalence of dementia was 33.6 per 1000 (95% CI 27.3-40.7). Alzheimer's disease was the most common type (54%). Family history of dementia was a risk factor for Alzheimer's disease. Jotheeswaran A.T.,(2005) done a 3-Year Follow-up Study conducted by 10/66 dementia research group in Chennai, India. Results shows that 54 people with dementia of whom 25 (46.3%) had died, double the mortality rate among those with dementia. There was clear evidence of clinical progression and increased needs for care. 63ii) STUDIES RELATED TO ALZHEIMER’S DEMENTIA Ferandez et.al.,(2010) done a study on Behavioural and psychological symptoms of dementia (BPSD) are non-cognitive symptoms commonly associated to Alzheimer's disease (AD). A cross-sectional, observational and multicenter study was conducted at 115 centres in Spain. Patients suffering from AD with higher and lower BPSD scores (ADAS-Noncog score 26-50 and ≤25, respectively) were included. Demographic and clinical data were collected, and dementia severity was assessed by the Mini Mental State Examination (MMSE) [mild 27-21, moderate 20-11, severe ≤10]. The use of ADAS-Noncog in clinical practice was also explored.A total of 1014 patients (463 with higher and 551 with lower BPSD scores) were included (mean age 77 ± 7 years, 65% women). Almost all patients (90%) had BPSD at inclusion, 17% of which reported psychotic outbreaks. The most prevalent symptoms were lack of concentration (56%), tremors (56%), depression (44%), lack of cooperation (36%), and delusions (32%). Lack of concentration and appetite change significantly correlated with MMSE (p = 0.0472 and p = 0.0346, respectively). shows that patients with AD have a high prevalence of noncognitive symptoms, and that cognitive impairment and BPSD are correlated. Kar N., (2009) Conducted a study to identify the Behavioral and psychological symptoms of dementia and their management. This study reported prevalence of behavioural and psychological symptom of dementia ranges from 50% - 100%. Life time risk of new psychiatric disturbances is nearly 100%. Behavioral and psychological symptom of dementia sever in 36.6% of the patients, moderate in 49.3% and mild in 14.1%. 64 Kienlen L P., (2009) done a study on Connecting Money Management Skills and Alzheimer's dementia in Alzheimer’s Disease Research Center at the University of Alabama at Birmingham. Research reveals two new warning signs of Alzheimer's disease, involving money management skills and memory problems (mild cognitive impairment). The participants in this study were 76 older people with no memory problems, and 87 older people with mild memory problems but no symptoms of dementia (mild cognitive impairment). Participants were given a money management test at the beginning of the study, and then again after one year. The money management test was designed to assess skills involving counting coins, making grocery purchases, understanding and using a checkbook, understanding and using a bank statement, preparing bills for mailing, and detecting fraud situations. After one year, 25 of the 87 people with mild cognitive impairment had developed Alzheimer’s-type dementia. The study findings showed that declining money management skills are detectable in patients with mild cognitive impairment in the year prior to developing Alzheimer’s disease. Shea T.B et.al.,(2009) Neurodegeneration Research University of Massachusetts, demonstrating that drinking apple juice helped mice perform better than normal. The team demonstrated that mice receiving the human equivalent of 2 glasses of apple juice per day for 1 month produced less of a small protein fragment, called "beta-amyloid" that is responsible for forming the "senile plaques" that are commonly found in brains of individuals suffering from Alzheimer's disease. 65 Hill C et. al., (2009) done a study about Diabetes and Alzheimer's Disease diabetes in mid-life was found to be associated with an increased risk of developing Alzheimer's in later life. The study tested more than 2,000 men for blood glucose levels at age 50 and then tested them again approximately 32 years later. Those with insulin problems at age 50 were almost 1.5 times more likely to develop Alzheimer's dementia. Links have been found between diabetes and mild cognitive impairment (MCI) as well. Their conclusion was that blood glucose levels and levels of beta amyloid in the brain interacted in such a way that damaged the brain's blood vessels. Monique M.B. Breteler, (2008) done a study on People who have had depression are more likely to develop Alzheimer's disease than people who have never had depression, in Erasmus University Medical Center in Rotterdam, the Netherlands. The study involved 486 people age 60 to 90 who had no dementia. Of those, 134 people had experienced at least one episode of depression that prompted them to seek medical advice. The participants were followed for an average of six years. During that time 33 people developed Alzheimer's disease. People who had experienced depression were 2.5 times more likely to develop Alzheimer's disease than people who had never had depression. The risk was even higher for those whose depression occurred before the age of 60; they were nearly four times more likely to develop Alzheimer's than those with no depression. One theory was that depression leads to loss of cells in two areas of the brain, the hippocampus and the amygdala, which then contributes to Alzheimer's disease. The study also assessed whether the participants had symptoms of depression at the start of the study. 66 Arendash G.W et. al., (2006) done study on Caffeine Reduce Risk of Alzheimer's Disease. According to research caffeine intake not only appears to protect against Alzheimer's but may actually help those who already have the disease. Researchers reported that five cups of coffee a day could protect humans in the same way that the caffeine equivalent appears to have in the study of mice. In a controlled study experiment using Alzheimer's mice, one group of mice had caffeine added to their drinking water. The memory of mice who drank the caffeinated water was roughly similar to mice to had no Alzheimer's. Researchers also found that levels of beta-amyloid proteins reduced in mice who drank caffeine. Beta-amyloid proteins aggregate into plaques within the brain and are present in the brains of people with Alzheimer's disease. Some interesting results were also obtained when researchers gave caffeine to aged Alzheimer's mice who already had high levels of beta-amyloid protein in their brains. It was discovered that caffeine reduced the levels of beta-amyloid already present in the brain. This could suggest that coffee drinking is beneficial in people with Alzheimer's dementia. Fishel MA et al.,(2005)done a study on High insulin level raises risk for Alzheimer disease. Inflammation is shown to be a pathogenetic factor for Alzheimer disease in Newcastle University. In a randomized crossover trial, sixteen healthy adults with mean age, 68.2 years received infusions of saline or insulin on separate mornings. The researchers found that Insulin increased CSF levels of F(2)-isoprostane and cytokines (both P<.01), as well as plasma and CSF levels of Abeta42.Thus, moderate hyperinsulinemia [high insulin level] can elevate inflammatory markers and Abeta42 in the periphery and the brain, thus high insulin level can increase the risk of Alzheimer disease. 67 iii) STUDIES RELATED TO KNOWLEDGE AND ATTITUDE REGARDING ALZHEIMER’S DEMENTIA: Pfizer Inc et .al., (2010) done a study to update current knowledge, attitudes and behaviours towards Alzheimer's disease in Europe. Responses were analysed from 1,000 members of the general public 500 physicians who treat patients with Alzheimer's disease 250 caregivers 50 payers. A 30-minute internet-based questionnaire was issued between April-May 2009 to participants to assess their opinion and perception on issues relating to aging and dementia. A majority of caregivers (60%) and the general public (68%) did not know, or did not believe that there were effective treatments for Alzheimer's disease. Most carers expressed negative feelings about their role (difficult, 59%; exhausting, 55%; demanding, 46%; stressful, 45%; frustrating, 40%; and depressing, 36%). Caregivers and the general public felt they had insufficient information about the benefits of treatment and care, although more than half the general public, caregiver and physician responders agreed that early treatment could delay the progression of the disease. Anderson L.A et.al., (2008) done a study to assess the Public's Perceptions about Cognitive Health and Alzheimer's Disease among the U.S. Population. They found 10 eligible surveys and abstracted data concerning the public's knowledge, beliefs, concerns, and sources of information. Based on the findings from the surveys, most adults were found to be aware of Alzheimer's disease but lacked specific information about the disease and its treatments. Most respondents did not perceive themselves as being very knowledgeable about Alzheimer's disease. 68 Park M.H et .al., (2007) done a study to assess the high rates of cognitive dysfunction and the knowledge regarding risk factors for Alzheimer’s dementia among general public in Korea. A total of 2767 randomly selected subjects were questioned on their knowledge of risk factors for Alzheimer’s dementia. The most common stated risk factor was being older (59.6%), followed by head trauma (33.6%) and cerebrovascular disease (30.4%). Predictors for a worse knowledge of the risk factors for Alzheimer’s dementia were being older, a lower level of education, lower economic status and the attitude that dementia is not curable. So public health education on the basic concepts of Alzheimer’s dementia should be targeted at this population. Sullivan et.al., (2007) done a study to assess Knowledge of Alzheimer's Disease Among Patients, Carers, and Non carer Adults . Misconceptions, Knowledge Gaps, and Correct Beliefs. A modified version of the Alzheimer's Disease Knowledge (ADK) test was administered to 13 carers, 20 non carer older adults, and 10 people with Alzheimer’s dementia. Overall level of knowledge in the 3 groups was quite poor. Although carers had significantly greater AD knowledge than noncarers or patients, carers correctly answered approximately 50% of items only. Future educational interventions could be tailored to address the knowledge needs of each of the groups identified in this study. Connell et.al.,(2007) done a study to assess racial differences in knowledge and attitudes about Alzheimer’s dementia among adults. Data from 1176 adults aged 35 years and over (48.6% White, 25.7% Black, and 25.8% Hispanic) obtained via telephone interview. Overall, the results suggest that misconceptions about Alzheimer’s dementia 69remain among large segments of the population that Alzheimer’s dementia remains a source of significant concern, and that continued efforts are needed to educate the public about this disease. Thompson D.G et.al., (2007) done a study to assess current knowledge after attending the Alzheimer's Disease Education Program among health care workers in hispan .Health care workers who completed both pretest and post-test measures indicated an increase in both knowledge about Alzheimer's, and demonstrated positive changes in self-reported patient care behaviors. Wortmann M et. al.,(2006) have done a study on Evolving attitudes to Alzheimer’s disease among the general public and caregivers in Europe. In the IMPACT survey, approximately 1000 members of the general public and 250 caregivers in 5 European countries (France, Germany, Italy, Spain, and the United Kingdom) completed a 30-minute, Web-based questionnaire. Similarly, although most respondents in the 2 groups recognized that early signs and symptoms of AD are difficult to detect, caregivers were more skeptical of the abilities of both primary physicians and specialists to detect these early signs and symptoms. In terms of treatment, caregivers were less convinced of the effectiveness of treatment beyond the early stages of AD and more likely to agree that current treatments are associated with side effects. Respondents in both groups had a negative view of their government’s investment in AD, but caregivers, particularly those in France, Spain and the United Kingdom, were more likely to feel that their government acts as a barrier to treatment. Some survey respondents from the 2 groups also had a negative view of their governments’ attempts to raise awareness of AD and make its treatment 70a high priority. Overall, comparison of responses from these 2 groups suggests that caregivers’ personal experiences of AD profoundly affect their attitudes and perceptions surrounding the disease. Jang Y et.al., (2004) done a study to assess Knowledge of Alzheimer’s Disease, Awareness of Services Among Korean American Elders, Method of study Using data from 675 Korean American elders (mean age = 70.2, SD ± 6.87). The mean score on the knowledge regarding Alzheimer’s dementia was 7.01 (SD ±1.45) Results were Greater knowledge of AD is predicted by higher levels of education and acculturation. Feelings of shame associated with family members having AD are more likely to be reported by individuals with lower levels of education, acculturation, and knowledge of AD. The study findings underscore the pivotal role of education and acculturation in predicting knowledge of AD, feelings of shame, and awareness of AD-related services. Pucci1 E et.al., (2002) done a study to study to evaluate relatives’ attitudes towards informing patients with Alzheimer’s dementia about their diagnosis at university hospital Italy. Methods used for the study is the closest relatives of each of 71 subjects diagnosed for the first time as having Alzheimer’s dementia were interviewed, using a semi structured questionnaire. Forty three (60.6%) relatives spontaneously requested that patients not be fully informed. After being interviewed, nobody thought that the patient should be given all the information. Justifications were related to the fear of the onset or worsening of depressive symptoms in the patient. 71Roberts J.S et.al.,(2002) done a study to investigate differences between African Americans and whites in their beliefs, knowledge, and information sources regarding Alzheimer’s dementia. They distributed a written questionnaire through professional organizations and meetings in the southeastern United States, yielding a sample of 452 adults (61% white,39% African American; 78% female; mean age 47 years; 33% with family history of Alzheimer’s dementia). The questionnaire assessed the following illness beliefs factual knowledge, sources of information, and perceived subjective threat of Alzheimer’s dementia. The mean knowledge score of whites is 4.6 and African Americans is 3.1. In comparison to whites, African Americans showed less awareness of facts about Alzheimer’s dementia, reported fewer sources of information, and indicated less perceived threat of the disorder. Werner.P.,(2001) conducted study to assess the family care givers, knowledge about Alzheimer’s Disease. Two hundred and twenty informal caregivers of an elderly person suffering from Alzheimer’s disease were recruited. Knowledge was assessed by using a questionnaire including 17 item examining general knowledge symptoms, treatment and services. Over all low level of knowledge well found, especially in items related to the prevalence, causes and symptom of the disease. 72CHAPTER – III RESEARCH METHODOLOGY Methodology of the study includes approach and Design of the study, setting, criteria for sample selection, sampling technique, sample size, instruments and scoring procedure, developing and testing of the tool, method of data collection and plan for analysis of the data. RESEARCH APPROACH: The research approach is based on Descriptive approach. RESEARCH DESIGN: The research design was non experimental descriptive survey design, to assess the knowledge and attitude of Alzheimer’s dementia among adults. SETTING OF THE STUDY The study was conducted in Nanchiyampalayam urban community in Dharapuram. It is 3 kms away from Dharapuram. Total number of population in the Nanchiyampalayam is 6770. This area consists of 7 streets. The adult population including male and female (is 872). The main occupation of the people of Nanchiyampalayam is coolie, mill workers, and goes for work in Textile companies at Tirupur. POPULATION The population for this study is adults who are residing in Nanchiyampalayam. 73SAMPLE The adults who are in the age group of 30-60 years who are residing in Nanchiyampalayam. CRITERIA FOR SAMPLE SELECTION a). INCLUSION CRIERIA ∗ Both male and female. ∗ Adults who are available during the data collection period. b). EXCLUSION CRITERIA ∗ Adults who are sick. ∗ Adults who are having hearing impairments. SAMPLING a. Sample size: The sample size for this study was 100 adults who met inclusion criteria were selected as samples. b. Sampling technique The non probability systematic sampling technique was used to select the samples. The first sample was selected by convenient of the researcher and every 3rd house was selected by non probability systematic sampling technique to cover larger area. INSTRUMENT AND SCORING PROCEDURE: A). DESCRIPTION OF THE TOOL: The instrument consist of three parts PART – I It consists of demographic variable such as age, sex, marital status, and religion, Type of the family, education, monthly income, occupation, and health information resources. 74PART – II It consists of structured interview schedule includes 25 multiple choice questions on knowledge which includes definition, causes, signs and symptoms, management, prevention and complication regarding Alzheimer’s dementia. PART – III It consist of five point Likert scale which consist of 15 statements to assess the attitude regarding Alzheimer’s dementia with five responses which includes 11 positive and 4 negative statements. B). SCORING PROCEDURE PART – I I The Structured interview schedule consists of 25 multiple choice questions on knowledge which includes definition, causes, signs and symptoms, management, prevention and complication scored such as 3,4,3,6,8and 1 respectively. Each question has got four options. Each right answer was scored 1 and each wrong answer was scored 0. Total score is 25. The scores were interpreted as follows Level of Knowledge Score Percentage % Inadequate Moderately adequate Adequate 0-8 9-16 17-25 0-33 34-66 67-100 PART – III The five point likert scale consists of 15 statements. Each has 5 responses such as strongly agree, agree, uncertain, disagree and strongly disagree. 75The scores were measured as follows Response Positive scoring Negative scoring Strongly agree Agree Uncertain Disagree Strongly disagree 5 4 3 2 1 1 2 3 4 5 Level of attitude Score Percentage % Unfavorable Moderately favorable Favorable 0-25 26-50 51-75 0-33 34-66 67-100 VALIDITY AND RELIABILITY VALIDITY The validity of the tool was established in consultation with guide and 4 experts in the field of psychiatric nursing and one expert in psychiatry medicine. RELIABILITY i). Structured interview schedule: The reliability of the structured interview schedule was established by testing for stability and internal consistency. Stability was assessed by test retest method where Karl Pearson correlation of coefficient formula was used. The value was found to be reliable (r=0.9). Internal consistency was assessed by split half method where spearman’s brown prophecy was used. The value was found to be reliable(R=0.9). Hence the structured interview schedule was found to be reliable. 76ii) 5 point Likert scale The reliability of the five point Likert scale was established by testing for stability and internal consistency. Stability was assessed by test retest method, Karl Pearson formula was used. The value was found to be reliable (r=0.9). The internal consistency was assessed by Cronbach’s alpha method. The value was found to be reliable(r=0.8). PILOT STUDY Pilot study was conducted in kamarajapuram for a period of seven days. The investigator obtained written consent from the leaders of the community and oral permission obtained from the samples. The purpose was explained to the samples. Pilot study was conducted to 10 adults in kamarajapuram. The non probability systematic sampling technique was used to select the samples, 2-3 samples were collected per day. The demographic variables was collected and knowledge of adults on Alzheimer’s dementia was assessed by using structured interview schedule and attitude was assessed by using five point likert scale through interview for 45 minutes to 1 hour. Data was analyzed by using descriptive and inferential statistics. The findings of the pilot study showed that mean knowledge score was 11.5(SD±3.9) and mean attitude score was 41.5(SD±10.6). There was a positive correlation(r=0.9) between knowledge and attitude. It showed they were having inadequate knowledge and unfavorable attitude regarding Alzheimer’s Dementia. DATA COLLECTION PROCEDURE The data collection was done in Nanchiyampalayam, Dharapuram. The data was collected for a period of 5 weeks from 100 samples. Before conducting the study written permission was obtained from the leaders of the community. 77 The purpose of the study was explained to the subjects prior to the study and oral consent was obtained. The samples were interviewed by the researcher those who met the inclusion criteria were selected by using non probability systematic sampling technique. The investigator introduced about the study and rapport was established. The structured interview schedule was used to assess knowledge and five point likert scale was used to assess the attitude, regarding Alzheimer’s Dementia by interview for 45 minutes to one hour. The investigator collected the data from 4 to 5 samples per day. From each street 10 to 15 samples were collected. The data was analyzed by using statistical measurements. The date and time of awareness programme was informed by distributing notice to all houses in Nanchiyampalayam. After the data collection, awareness programme on prevention of Alzheimer’s Dementia was conducted for two days from 9.00am to 5.00pm in the community centre using audiovisual aids like posters, models, and charts to explain about what is Alzheimer’s dementia, causes, and stages of Alzheimer’s dementia, management, prevention of Alzheimer’s dementia. On the first day 62 adults were attended the programme and the second day 56 members were attended. Pamphlets were distributed to all who attended the programme. 78PLAN FOR DATA ANALYSIS The descriptive and inferential statistics were used for data analysis. Sl. No. Data analysis Method Remarks 1. Descriptive statistics Frequency, percentage To describe the demographic variables of adults. Frequency, mean, standard deviation. To assess the level of knowledge and attitude regarding Alzheimer’s dementia among adults. Karl Pearson correlation To determine the relationship between knowledge and attitude score regarding Alzheimer’s dementia, among adults. 2. Inferential statistics Chi square test To find the association between level of knowledge and attitude among adults with their selected demographic variables. PROTECTION OF HUMAN SUBJECTS The proposed study was conducted after approval of dissertation committee. The written permission was obtained from the leaders of the Nanchiyampalayam community at Dharapuram. Oral consent of samples was obtained before collecting the data. Assurance was given to them that confidentiality of each individual would be maintained. 79CHAPTER-IV DATA ANALYSIS AND INTERPRETATION This chapter deals with the analysis and interpretation of the data collected to assess the knowledge and attitude of adults regarding Alzheimer’s dementia. Data were collected from 100 adults in Nanchiyampalayam using structured interview schedule and five point Likert scale. The data were obtained, analyzed, and presented under the following headings. ORGANIZATION OF DATA: The data has been described and organized as follows, SECTION A: Description of demographic variables. SECTION B: a) Frequency and percentage of knowledge scores of adults regarding Alzheimer’s dementia. b) Area wise knowledge scores regarding Alzheimer’s dementia. SECTION C: Frequency and percentage of attitude scores of adults regarding Alzheimer’s dementia. SECTION D: a) Mean and standard deviation regarding Alzheimer’s dementia. b) Correlation of knowledge scores with attitude scores regarding Alzheimer’s dementia. 80SECTION E: Association of knowledge scores on Alzheimer’s dementia among adults with their selected demographic Variables. SECTION F: Association of attitude scores on Alzheimer’s dementia among adults with their selected demographic Variables. 81SECTION–A : DESCRIPTION OF DEMOGRAPHIC VARIABLES Table: 1 : Frequency and percentage distribution of adults according to their demographic variables n = 100 SL. No Demographic Variables Frequency Percentage (%) 1 1.1 1.2 1.3 Age (in years) 30-40 41-50 51-60 49 30 21 49 30 21 2 2.1 2.2 Sex Male Female 29 71 29 71 3 3.1 3.2 Marital status Married Unmarried 94 6 94 6 4 4.1 4.2 4.3 Religion Hindu Christian Muslim 75 20 5 75 20 5 5 5.1 5.2 Type of family Nuclear family Joint family 72 28 72 28 82 6 6.1 6.2 6.3 6.4 6.5 Education No formal education Primary High school Higher secondary Graduates 28 22 24 12 14 28 22 24 12 14 7 7.1 7.2 7.3 7.4 Family Monthly Income Below Rs 1000 Rs 1001-3000 Rs 3001-5000 Rs 5000 and above 19 45 20 16 19 45 20 16 8 8.1 8.2 8.3 8.4 8.5 Occupation Self employee Government job Private job Daily wages Un employed 32 11 14 35 8 32 11 14 35 8 9 9.1 9.2 9.3 9.4 9.5 Health information resources Television News paper Radio Health personal No resources 45 24 4 22 5 45 24 4 22 5 83Table 1 showed the distribution of adults according to their demographic variables of age, sex, marital status religion, type of family, education, family monthly income, occupation, health information resources. Distribution of adults according to their age depicts that highest percentage (49%) of adults were in the age group of 30-40 years and (30%) of them were in 41-50 years and least percentage (21%) of them were in 51-60 years of age. (Fig 2) Distribution of adults according to their sex depicts majority (71%) were females and least percentage (29%) were Males. (Fig 3) Distribution of adults according to their marital status depicts most of adults (94%) were married and (6%) of them were unmarried. (Fig 4) Distribution of adults according to their religion depicts Majority (75%) of adults were Hindus, (20%) of adults were Christian and least (5%) of adults were Muslims. (Fig 5) Distribution of adults according to their type of family depicts majority (72%)of adults belongs to nuclear family and least percentage (28%) of the adults belongs to joint family. (Fig 6) Distribution of adults according to their education depicts (28%) of adults had no formal education, (22%) of the adults studied primary education, (24%) of the adults studied high school education, (12%) of 84the adults studied higher secondary education and (14%) of the adults were graduates . (Fig 7) Distribution of adults according to their family monthly income depicts highest percentage (45%) of them belongs to the income group of Rs1001-3000 whereas (20%) of them were earning Rs 3000-5000. However (19%) belongs to the income group of less than Rs 1000 and 16% of the adults were earning more than Rs 5000 per month. (Fig 8) Distribution of adults according to their occupation depicts highest percentage (35%) of them were daily wages whereas (32%) of them were self employee. However (11%) were government employee and (14%) of them were private employee whereas least percentage (8%) of them were unemployed. (Fig 9) Distribution of adults according to their health information resources depicts highest percentage (45%) of the adults had health information from television programmes, whereas (24%) had health information from newspaper. However (22%) of the adults had health information from health personnel and least percentage ( 4%) of them had health resource information from radio and (5%) of them had no health information resources. (Fig 10) 8549%30%21%010203040506070809010030-40 41-50 51-60PERCENTAGE AGE Fig : 2 Percentage distribution of adults according to their age. 8671%29%MaleFemale SEX Fig : 3 Percentage distribution of adults according to their sex 876%94%MarriedUnmarried MARITAL STATUS Fig : 4 Percentage distributions of adults according to their Marital status. 8875%20%5%0102030405060708090100PERCENTAGEHindu Christian Muslim RELIGION Fig: 5 Percentage distributions of adults according to their religion. 8928%72%Nuclear familyJoint family TYPE OF FAMILY Fig : 6 Percentage distribution of adults according to their type of family 90EDUCATION28%22% 24%12% 14%0102030405060708090100No formaleducationPrimary High school Highersecondary GraduatesPercentage of Adults Fig : 7 Percentage distribution of adults according to their education 91 FAMILY MONTHLY INCOME Fig: 8 Percentage distributions of adults according to their Income 16%20%45%19%0102030405060708090100Below Rs 1000 Rs 1001-3000 Rs 3001-5000 Rs 5000 and above 92OCCUPATION8%35%14%11%32%0102030405060708090100Self employee Government job Private job Daily wages Un employedPercentage of Adults Fig : 9 Percentage distribution of adults according to their occupation 93HEALTH INFORMATION RESOURCES45%24%4%22%5%0102030405060708090100Television News paper Radio Health personal No resourcesPercentage of Adults Fig 10 Percentage distribution of adults according to their health information resources 94SECTION B: FREQUENCY AND PERCENTAGE OF KNOWLEDGE SCORES OF ADULTS REGARDING ALZHEIMER’S DEMENTIA a) Table 2: Frequency and percentage of knowledge scores of adults regarding Alzheimer’s dementia n = 100 Level of knowledge F % Adequate Knowledge 2 2 Moderately Adequate Knowledge 47 47 Inadequate Knowledge 51 51 Total 100 100 Table: 2 showed that (51%) of them had inadequate knowledge (47%) had moderately adequate knowledge and (2%) of adults had adequate knowledge regarding Alzheimer dementia. 95 2%47%51%0102030405060708090100Adequate Knowledge Moderately AdequateKnowledge Inadequate Knowledge Fig 11 Percentage distributions of knowledge scores of adults regarding Alzheimer’s dementia 96b) Table: 3 Area wise analysis of knowledge on Alzheimer’s dementia among adults. Sl. No Areas in knowledge questions Score Mean Mean percentage SD 1. 2. 3. 4. 5. 6. Definition Causes Sings and symptoms Management Prevention Complications 3 4 3 6 8 1 1.39 1.35 0.65 2.09 4.26 0.29 46.33 33.75 21.66 34.83 53.25 29 0.8 0.8 0.6 1.1 1.9 0.4 Total 25 10.03 40.12 Table: 3 Showed that the area wise analysis of mean, mean percentage, SD of knowledge score of Alzheimer’s dementia revealed that the highest mean score in the area of prevention is 4.26 (SD±1.9) 53.25%,where as in the area of signs and symptoms showed the lowest mean score 0.65(SD±0.6)22% and the other areas revealed in the definition 1.39(SD±0.8)46%, causes 1.35 (SD±0.8) 33.75%, management 2.09(SD±1.1)36.16%, complications 0.29(SD±0.4)29%. The total mean knowledge score was 10.03 97Section-C : FREQUENCY AND PERCENTAGE OF ATTITUDE SCORE OF ADULTS REGARDING ALZHEIMER’S DEMENTIA. Table 4: Frequency and percentage distribution of attitude scores of adults regarding Alzheimer’s dementia. n=100 Level of attitude F % Favorable attitude 30 30 Moderately favorable attitude 70 70 Unfavorable attitude - - Total 100 100 Table 4 showed that majority 70% had moderately favorable attitude, whereas 30% of them had favorable attitude and no one had unfavorable attitude regarding Alzheimer’s dementia. 9830%70%Favorable attitude Moderately favorable attitude Fig: 12 Percentage distributions of attitude scores of adults regarding Alzheimer’s dementia 99Section –D : CORRELATION OF KNOLEDGE SCORES WITH ATTITUDE SCORES REGARDING ALZHEIMER’S DEMENTIA AMONG ADULTS. a) Table – 5 : Mean, SD of Adult’s knowledge & Attitude score on Alzheimer’s dementia among adults. n=100 S. No Variable Mean Standard deviation Mean Percentage (%) 1. 2. Knowledge Attitude 10.03 48.62 3.4 5.2 40.12 64.8 The table 5 shows that mean score of adult’s knowledge & Attitude regarding Alzheimer dementia is 10.03(SD ±3.4) and 48.62(SD±5.2). 100b) Table 6: Correlation of knowledge and attitude scores among adults regarding Alzheimer dementia n=100 S. No Variable Mean scores Co Efficient of co – relation Table Value 1 Knowledge 10.03 2 Attitude 48.62 0.55 0.1946 df=98 (p<0.05) Table 6 showed that there is a positive correlation (r = 0.55) of knowledge and attitude regarding Alzheimer’s dementia among adults. 101SECTION –E : ASSOCIATION OF KNOWLEDGE SCORES REGARDING ALZHEIMER DEMENTIA WITH THEIR SELECTED DEMOGRAPHIC VARIABLES. Table 7: Association of knowledge scores regarding Alzheimer dementia with their selected demographic variables n= 100 Level of knowledge Adequate Moderately adequate Inadequate Demographic Variables No % No % No % X2 Table Value Inference 1 1.1 1.2 1.3 Age 30-40 years 41-50 years 51-60 years 2 0 0 2 0 0 27 12 8 27 12 8 20 18 13 20 18 13 2.127 (df=1) 3.841 (N.S) 2 Sex 2.1 Male 0 0 16 16 13 13 0.827 3.841 (N.S) 2.2 Female 2 2 31 31 38 38 (df=1) 3 3.1 3.2 Marital status Married Unmarried 2 0 2 0 46 1 46 1 46 5 46 5 0.120 (df=1) 3.841 (N.S) 4 4.1 4.2 4.3 Religion Hindu Christian Muslim 2 0 0 2 0 0 34 11 2 34 11 2 39 9 3 39 9 3 1.155 (df=4) 9.488 (NS) 102 5 5.1 5.2 Type of Family Nuclear Joint 0 2 0 2 33 14 33 14 39 12 39 12 5.246 (df=1) 3.841 (S) 6 6.1 6.2 6.3 6.4 6.5 Education No formal Primary High school Higher secondary Graduates 0 0 0 0 2 0 0 0 0 2 9 12 10 7 9 9 12 10 7 9 19 10 14 5 3 19 10 14 5 3 19.879 (df=8) 15.50 (S) 7 7.1 7.2 7.3 7.4 Family Monthly Income(Rs) BelowRs1000 Rs 1001-3000 Rs 3001-5000 Rs 5000 and above 2 0 0 0 2 0 0 0 4 22 11 10 4 22 11 10 13 23 9 6 13 23 9 6 1.93 (df=1) 3.841 (N.S) 8 8.1 8.2 8.3 8.4 8.5 Occupation Self employee Government Private Daily wages No employment 0 0 0 1 1 0 0 0 1 1 11 6 12 15 3 11 6 12 15 3 21 5 2 19 4 21 5 2 19 4 13.00 (df=8) 15.50 (N.S) 103 9 9.1 9.2 9.3 9.4 9.5 Health information resources Television News paper Radio Health personal No resources 0 0 1 0 1 0 0 1 0 1 21 12 0 13 1 21 12 0 13 1 24 12 3 9 3 24 12 3 9 3 20.55 (df=8) 15.50 (S) NS = Not Significant S = Significant P < 0.05 Table: 7 showed the Chi square value were calculated to find out the association between knowledge among adults with their demographic variables of age, sex, marital status, religion, family type education, family monthly income, occupation health resources. It was found that there was association with knowledge scores and education(X2=19.879), type of family(X2=5.246), health information resources(X2=20.55) of the adults, whereas no association was found between knowledge of adults and selected demographic variables such as age, sex, religion, occupation, family monthly income . 104SECTION-F: ASSOCIATION OF ATTITUDE SCORES AND SELECTED DEMOGRAPHIC VARIABLES OF ADULTS. Table-8 : Association of attitude scores with their selected demographic variables. n=100 Level of attitude Favorable Moderately Favorable Un Favorable Demographic Variables No % No % No % X2 TableValue Inference 1 1.1 1.2 1.3 Age 30-40 years 41-50 years 51-60 years 15 10 5 15 10 5 34 20 16 34 20 16 - - - - - - 0.015 df(1) 3.841 (N.S) 2 Sex 2.1 Male 10 10 18 18 - - 0.602 3.841 (N.S) 2.2 Female 20 20 52 52 - - df(1) 3 3.1 3.2 Marital status Married Unmarried 27 3 27 3 67 3 67 3 - - - - 1.21 df(1) 3.841 (N.S) 4 4.1 4.2 4.3 Religion Hindu Christian Muslim 22 6 2 22 6 2 53 14 3 53 14 3 - - - - - - 0.244 df(2) 5.991 (N.S) 5. 5.1 5.2 Type ofFamily Nuclear family Joint family 18 12 18 12 54 16 54 16 - - - - 3.05 df(1) 3.841 (N.S) 105 6 6.1 6.2 6.3 6.4 6.5 Education No formal Primary High school Higher secondary Graduates 6 2 9 4 9 6 2 9 4 9 22 21 15 7 5 22 21 15 7 5 - - - - - - - - - - 14.642 df(4) 9.488 (S) 7 7.1 7.2 7.3 7.4 Family Monthly Income Below Rs 1000 Rs 1001-3000 Rs 3001-5000 Rs 5000 and above 5 13 6 6 5 13 6 6 14 32 14 10 14 32 14 10 - - - - - - - - 0.297 df(1) 3.841 (N.S) 8 8.1 8.2 8.3 8.4 8.5 Occupation Self employee Government Private Daily wages No employment 8 5 7 7 3 8 5 7 7 3 24 6 7 28 5 24 6 7 28 5 - - - - - - - - - - 5.64 df(4) 9.488 (N.S) 1069 9.1 9.2 9.3 9.4 9.5 Health information resources Television News paper Radio Health personal No resources 14 7 1 7 1 14 7 1 7 1 13 17 1 16 5 13 17 1 16 5 - - - - - - - - - - 1.17 df(4) 9.488 (N.S) NS = Not Significant S = Significant P < 0.05 Table 8 showed Chi Square values were calculated to find out the association between the attitude of adults with their age, Sex, Marital status, family monthly income, Religion, type of family, occupation, Education, health information resources. It was found that there was association with attitude scores and education(X2=14.642) of the adults whereas no association was found between attitude of adults and selected demographic variables such as age, sex, marital status, religion, occupation, type of family, family monthly income, health information resources. 107CHAPTER – V DISCUSSION The discussion chapter deals with description of sample characteristics and objectives of the study. The aim of this present study was to assess the knowledge and attitude regarding Alzheimer’s dementia among adults in Nanchiyampalayam at Dharapuram. Description of demographic variables of adults Percentage distribution of adults according to the age majority of the adults (49%) were belong to group of 30-40 years, 41-50 years adolescents were (30%) and (21%) of adults were in 51-60 years. This finding is consistent with the findings of Roberts J.S et al., (2002) who reported that 80% of adults were in the age group of 30-40 years. Percentage distribution of adults according to their sex shows that there were (29%) Males and (71%) were females. The study findings is also consistent with the findings of Jang Y et.al., (2004) who reported that (58.8%) of females participated in the study. Percentage distribution of adults according to their marital status the majority of adults (94%) married and (6%) of adults unmarried. 108 The study findings is consistent with the findings of Jang Y et.al., (2004)who reported that (23.7%) of participants were unmarried in the study. Percentage distribution of adults according to their religion the highest (75%) were Hindus, (20%) of adults were Christian and (5%) of adults were Muslims. Percentage distribution of adults according to their type of family majority of the adults (72%) belong to nuclear family, (28%) of the adults belong to joint family. Percentage distribution of adults according to their education there were (28%) adults who had no formal education, (22%) of the adults studied primary education, (24%) of the adults studied secondary education, (12%) of the adults studied higher secondary education and (14%) were graduates. Percentage distribution of adults according to their monthly income (19%) of adults earning below Rs 1000 and (45%) of adults earning Rs1001-3000 and (20%) had income Rs 3001-5000 and (16%) of adults belongs to Rs 5001 and above income group. Percentage distribution of adults according to their occupation (32%) of adults were self employee and (11%) were government employee and (14%) of them were private employee and (35%) of them were daily wages and (8%) of them were unemployed. 109 Percentage distribution of adults according to their health resources the majority of the adults (45%) had health information from television programs, (24%) of adults had health information from newspaper and (4%) of the adults had health information from radio programs, (22%) of the adults had health information from health personnel and (5%) of them had no health resources. The findings of the study were discussed according to the objectives as follows: 1. Assess the level of knowledge regarding Alzheimer’s dementia among adults. 2. Assess the attitude regarding Alzheimer’s dementia among adults. 3. Find the Correlation between the knowledge scores and attitude scores regarding Alzheimer’s dementia among adults 4. Find the Association between the knowledge scores regarding Alzheimer dementia with their selected demographic variables. 5. Find Association between the attitude regarding Alzheimer dementia with their selected demographic variables. FIRST OBJECTIVE ASSESS THE LEVEL OF KNOWLEDGE REGARDING ALZHEIMER’S DEMENTIA AMONG ADULTS. The assessment of knowledge regarding Alzheimer’s dementia among adults, findings showed that (51%) had inadequate knowledge (47%) had moderately adequate knowledge and (2%) of adults had adequate knowledge regarding Alzheimer’s dementia. Table 2 revealed that there was a need for awareness programme for adults regarding Alzheimer’s dementia. Area wise analysis showed that mean score of 110definition is 1.39(SD±0.8), causes 1.35(SD±0.8), in signs and symptoms 0.65(SD±0.6), in management 2.09(SD±1.1), in prevention 4.26(SD±1.9), in complications 0.29(SD±0.4). The study findings is consistent with the study of Jang Y et.al., (2004) done a study to assess Knowledge of Alzheimer’s Disease, Awareness of Services Among Korean American Elders. The mean score on the knowledge regarding Alzheimer’s dementia was 7.01 (SD ±1.45) SECOND OBJECTIVE ASSESS THE ATTITUDE REGARDING ALZHEIMER’S DEMENTIA AMONG ADULTS. The assessment of attitude regarding Alzheimer’s dementia among adults, study findings showed that (30%) had favorable attitude, (70%) had moderately favorable attitude. The table 2 revealed that there was a need for awareness programme for adults regarding Alzheimer’s dementia. The study finding is consistent with the study of Wortmann M et. al.,(2006) have done a study on Evolving attitudes to Alzheimer’s disease among the general public and caregivers in Europe. Overall, comparison of responses from these 2 groups suggests that caregivers’ personal experiences of AD profoundly affect their attitudes and perceptions surrounding the disease. 111THIRD OBJECTIVE FIND THE CORRELATION BETWEEN THE KNOWLEDGE SCORES AND ATTITUDE SCORES REGARDING ALZHEIMER’S DEMENTIA AMONG ADULTS There is a positive correlation (r = 0.55) of knowledge and attitude regarding among adults. Further it could be infered that knowledge and attitude depends on each other. The finding of the study was consistent with the study of Pfizer Inc et .al. (2010) done a study to update current knowledge, attitudes and behaviors towards Alzheimer's disease in Europe. Responses were analysed from 1,000 members of the general public 500 physicians who treat patients with Alzheimer's disease 250 caregivers 50 payers. A majority of caregivers (60%) and the general public (68%) did not know, or did not believe that there were effective treatments for Alzheimer's disease. Most carers expressed negative feelings about their role (difficult, 59%; exhausting, 55%; demanding, 46%; stressful, 45%; frustrating, 40%; and depressing, 36%). Caregivers and the general public felt they had insufficient information about the benefits of treatment and care, although more than half the general public, caregiver and physician responders agreed that early treatment could delay the progression of the disease. Hence, H1 – there will be a significant correlation between knowledge and attitude scores of adults regarding Alzheimer’s dementia is accepted. 112FOURTH OBJECTIVE FIND THE ASSOCIATION BETWEEN THE KNOWLEDGE SCORES REGARDING ALZHEIMER DEMENTIA WITH THEIR SELECTED DEMOGRAPHIC VARIABLES. Chi square values were calculated to find out the association of the level of knowledge of adults with their demographic variables. It showed that there was significant association found with level of knowledge and demographic variables such as, type of family (X2=5.246), education(X2=19.879), and health information resources (X2=20.55). Demographic Variables such as Age, Sex, Marital status, Religion, Income had no significant association with knowledge scores. The finding of the study was consistent with the study of, Moon Ho Park (2007) who had conducted a study to assess the knowledge of risk factors of Alzheimer’s dementia among 2767 geriatrics. The study findings showed a significant association between knowledge scores regarding Alzheimer’s dementia with the demographic variable education (χ2 = 10.3). The finding of the study was also consistent with the study of Jung Y (2007), to explore predictors of knowledge of Alzheimer’s disease among 675 Korean American elders. The study findings showed a significant association between knowledge scores regarding Alzheimer’s dementia with the demographic variable such as education. 113Hence, H2 – There will be a significant association between knowledge scores regarding Alzheimer’s dementia among adults with their selected demographic variables is rejected except education, type of family, health information resources. FIFTH OBJECTIVE FIND THE ASSOCIATION BETWEEN THE ATTITUDE SCORES REGARDING ALZHEIMER DEMENTIA AMONG ADULTS WITH THEIR SELECTED DEMOGRAPHIC VARIABLES. Chi square values were calculated to find out the association of the attitude of adults with their demographic variables. It showed that there was significant association found with level of attitude and demographic variable only with education(X2=14.642). Other demographic variable such as Age, Sex, Marital status, Religion, Type of family, Income, Health information Sources had no association between attitude and demographic variables. The finding of the study was consistent with the study of Pfizer Inc et al (2010). The study findings showed that there was a significant association between attitude scores regarding Alzheimer’s dementia with the demographic variable education. Hence H3- There will be significant association between attitude scores regarding Alzheimer’s dementia among adults with their selected demographic variables is rejected except education. 114CHAPTER – VI SUMMARY, CONCLUSION, IMPLICATION, RECOMMENDATIONS AND LIMITATIONS This chapter is divided in to five aspects Summary of the study Conclusion Implication for nursing Recommendations Limitations SUMMARY OF THE STUDY The focus of the study was to assess the knowledge and attitude regarding Alzheimer’s Dementia among adults in Nanchiyampalayam at Dharapuram. The design used for the present study was non experimental descriptive design. The conceptual frame work was based on modified Nola J Pender’s Health Promotion Model (2002-Revised). The samples were selected by non probability systematic sampling technique and were assessed for level of knowledge and attitude regarding Alzheimer’s Dementia using structured interview schedule and five point Likert scale. The data were analyzed using descriptive statistics and inferential statistics. The study findings revealed that out of hundred samples there was inadequate knowledge and moderately favorable attitude regarding Alzheimer’s Dementia present. Major findings of the study ♦ Out of hundred samples, most of the adults (49%) were in the age group of 30-40 years 115♦ Majority(71%) were females ♦ Most of the adults were (94%) married ♦ Majority (75%) of the adults were Hindus ♦ Most of them (72%) belonged to nuclear family ♦ Majority (28%)of the adults had no formal education ♦ Majority (45%) of them belonged to the monthly income group of Rs1001-3000 ♦ Majority(35%) of them were daily wages ♦ Majority (45%) of the adults had health information from television. ♦ Majority (51%) had inadequate knowledge regarding Alzheimer’s dementia ♦ Low level of knowledge was present in the areas of definition1.39 (SD±0.8), causes1.35 (SD±0.8), signs and symptoms 0.65 (SD±0.6), management 2.09 (SD±1.1), prevention 4.26 (SD±1.9), complications 0.29 (SD±0.4). ♦ Majority (70%) had moderately favorable attitude regarding Alzheimer’s dementia. ♦ Positive correlation(r = 0.55) was found knowledge, attitude regarding Alzheimer’s dementia among adults. ♦ There was significant association was found with knowledge (p≤ 0.05) and demographic Variables such as Education ( 2χ =19.879), type of family ( 2χ =5.246), and health information resources ( 2χ =20.55). ♦ There was significant association was found with attitude (p≤ 0.05) and demographic Variable Education( 2χ =14.642). 116CONCLUSION The present study assessed the knowledge and attitude regarding Alzheimer’s Dementia among adults. The results showed that 51% had inadequate knowledge and 47% had moderately adequate knowledge and 2% had adequate knowledge. In attitude 70% had moderately favorable attitude and, 30% had favorable attitude. The mean knowledge and attitude scores are 10.03(SD ±3.4) and 48.62(SD±5.2). The study findings concluded that the awareness programme will play an important role in improving the knowledge and attitude of adults regarding Alzheimer’s dementia. IMPLICATIONS The findings of the study have certain important implications for nursing service, education, administration and nursing research. Nursing Service 1. Mental health promotion is a vital function of the nurse and psychiatric nurse can organize for mass education in community regarding Alzheimer’s dementia using different AV aids. 2. Nurse as the change agent, can introduce the various preventive measures to prevent Alzheimer’s dementia. Nursing Education Imparting the concepts of preventive measures of Alzheimer’s dementia to nursing students. Nursing students must be encouraged to utilize knowledge on preventive measures to give health education in the hospitals, and community. 117Nursing Administration Nurse administrators can organize in service education programmes in prevention of Alzheimer’s dementia in all health sectors. To organize awareness camps on special days. Nursing Research The study findings can effectively be utilized by the emerging researchers. The study findings can be a baseline for further studies to build upon. RECOMMENDATIONS 1. Similar study can be replicated on larger samples there by findings can be generalized to a large population settings. 2. Experimental studies can be conducted with intervention to improve their knowledge and attitude. 3. A comparative study can be conducted in urban and rural areas. LIMITATION It was more time consuming to explain about Alzheimer’s dementia among adults because of difference in their understanding. 118 BIBLIOGRAPHY BOOK REFERENCE 1. Basavanthappa, B.T.(2009). Nursing research (2nd ed.). New Delhi: Jaypee brothers. pp 23,46,58. 2. Basavanthappa,B.T.(2007) Psychiatric mental health nursing (1st ed). New delhi: Jaypee publications.pp 579-591. 3. Blazer, D.(2003).Geriatric text book of clinical psychiatry(4th ed.). California :The American psychiatric publishing. pp1535-1550. 4. Boyd, M .A. (2008).Psychiatric nursing contemporary practice (4th ed). New Delhi: lippincott Williams and wilkins.pp 719-746. 5. Carson,V.B,et.al.(1996).Mental Health Nursing The nurse-patient journey (1sted.). Philadelphia: W.B.Sounders company.pp 519-524 6. Eliopoulos, C.(1997).Gerontological nursing (4th ed.). Philadelphia: lippincott, pp 643-664 7. Frisch, N.C et.al.(2006). Psychiatric mental health nursing (3rd ed). Haryara sanat primter.pp 816-822 8. 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Skoog, I and Gustafson, D.(2006) Update on hypertension and Alzheimer's Disease. Neurological Research ,289(1),605-611 38. Sullivan, et.al. (2001). Providing education about Alzheimer's disease .Aging and Mental Health,5(1), 5-13. 39. Shaji, K.S et al.(2005) Prevalence of dementia in an urban population in Kerala. Indian journal of psychiatry, 49(2),78-80 40. Shea, T. B.(2009). Apple Juice Can Delay Onset Of Alzheimer's Disease. ScienceDaily , 24, 41. Thompson, G et.al., (2009) Ethnic Differences in Beliefs Regarding Alzheimer Disease Among Dementia Family Caregivers. American Journal of Geriatric Psychiatry. 17(11) ,925-933 42. Werner, P.(2000). Correlates of family caregivers' knowledge about Alzheimer's disease. The Official Journal of the International College of Geriatric Psychoneuropharmacology, 8(30). 58-59 122NET REFERANCE: 43. http://www.nia.nih.gov/alzheimers -- Alzheimer's Disease Education and Referral Center (U.S. National Institute on Aging) 44. http://www.alz.org -- Alzheimer's Association 45. http://www.alzfdn.org -- Alzheimer's Foundation of America 46. http://www.alz.co.uk -- Alzheimer's Disease International 47. http://www.ninds.nih.gov -- National Institute of Neurological Disorders and Stroke 48. http://www.aan.com -- American Academy of Neurology 49. http://www.medicalert.org -- Medic Alert 50. http://www.clinica ltrials.gov -- Find clinical trials APPENDIX A 123 124APPENDIX - B LETTER SEEKING EXPERT’S OPINION FOR VALIDITY OF TOOLS From Miss. D. Shalini, M.Sc (Nursing) II year, Bishop’s College of Nursing, Dharapuram. To Respected Madam/Sir, SUB : Requisition for content validity of tool I am M.Sc., (Nursing) second year student of Bishop’s College of Nursing, Dharapuram, under Dr. M.G.R Medical University, Chennai. As a partial fulfillment of my M.Sc (N) Degree Programme, I am conducting a research on “A Study To Assess the level of knowledge and attitude regarding Alzheimer’s Dementia among adults in Nanchiyampalayam at Dharapuram with a view of conducting an awareness programme on prevention of Alzheimer’s Dementia" One of the initial steps of the research study is to develop a tool.I am sending the above stated for content validity and for your expert and valuable opinion. I will be very thankful to return it to the undersigned. Your’s sincerely, (D.SHALINI) Encl : 1. Certificate of content validity 2. Statement of problem, objectives, operational definition, hypothesis 3. Description of the tool and tool for data collection 4. Self addressed envelope Principal 125APPENDIX - C PSYCHIATRIC MENTAL HEALTH NURSING LIST OF EXPERTS OF VALIDATION 1) Dr.Ramachandra, M.Sc(N).,Ph.D Principal of College of Nursing, NIMHANS, Bangalore. 2) Mrs.Sumathi, M.Sc(N).,Ph.D., Nursing Tutor, NIMHANS, Bangalore. 3) Mrs. Meera Saravanan, M.Sc(N)., Professor PSG College of Nursing Coimbatore. 4) Mr. Laxmanan Psychologist, Vazhikatti mental health & research centre, Coimbatore. 5) Dr.Rajendran, MBBS., DPM(Psy)., Psychiatrist Naveen Psychiatrist Hospital, Coimbatore. 126APPENDIX - D CERTIFICATE FOR VALIDITY 127 128 129 130 131APPENDIX – E 132APPENDIX – F 133APPENDIX – G xiiAPPENDIX – H AWARENESS PROGRAMME ON PREVENTION OF ALZHEIMER’S DEMENTIA Topic : Prevention of Alzheimer’s dementia Number of audience : 100 Teaching method : lecture cum method Audio visual aids : posters, pamplets, chart, models. Date : 1.07.2010,2.07.2010 Time : 9.00am -5.00pm Place : Nanchiyampalayam Name of the researcher D.Shalini CENTRAL OBJECTIVE The audience will require knowledge regarding prevention of Alzheimer’s dementia and develop positive attitude and skill in managing Alzheimer’s dementia. xiii SPECIFIC OBJECTIVES At the end of awareness programme audience will be able to , define alzheimer’s dementia enumerate the causes and risk factors list down the stages of alzheimer’s dementia identify signs of normal change and early alzheimer’s symptoms understand the diagnostic tests explain the medical management describe the preventive stratergies list down the complications xiv Time Specific objectives Audience will be able to content AV Aids Evalu ation define alzheimer’s dementia Introduction: Dementia (meaning "deprived of mind") is a serious cognitive disorder. It may be static, the result of a unique global brain injury or progressive, resulting in long-term decline in cognitive function due to damage or disease in the body beyond what might be expected from normal aging Definition: A primary cognitive impairment disorder characterized by progressive deterioration of cognitive functioning, with the end result that the person may not recognize once familiar people, places and things. The ability to walk and talk is absent in the final stages. - Varcarols E M et al Lecture cum Discussion xv enumerate the causes and risk factors causes and risk factors of Alzheimer’s dementia: • Age The greatest known risk factor for Alzheimer’s is advancing age. Most individuals with the disease are age 65 or older. The likelihood of developing Alzheimer’s doubles about every five years after age 65. After age 85, the risk reaches nearly 50 percent. • Heart diseases People with the risk factors of heart disease - hypertension, high cholesterol, and poorly controlled diabetes - also have a higher risk of developing Alzheimer's. Lecture cum Discussion xvi • Academic level There is some data showing a higher risk of developing Alzheimer's among people with lower educational qualifications, compared to highly qualified individuals . • Processed foods and fertilizers (nitrates) . The study looked at progressive increases in human exposure to nitrates, nitrites and nitrosamines through processed and preserved foods as well as fertilizers. Smoking and Alcohol Use: Several recent studies have found that smoking significantly increases the risk of mental decline and dementia. People who smoke have a higher risk of atherosclerosis and other types of vascular disease, which are also considered dementia risk factors and may be the underlying causes for the increased dementia risk. xvii Atherosclerosis: Atherosclerosis is the buildup of plaque - deposits of fatty substances, cholesterol, and other matter - in the inner lining of an artery.. Strokes are one of the major dementia risk factors. Genetics/Family History: Researchers have discovered a number of genes that increase the risk of developing dementia. Although people with a family history of dementia are generally considered to be at heightened risk of developing the disease themselves, many people with a family history never develop the disease, and many without a family history of the disease do get it. Cholesterol: High levels of low-density lipoprotein (LDL), the so-called bad form of cholesterol, appear to significantly increase a person's risk of developing vascular dementia. Some research has also linked high cholesterol to an increased risk of AD. Diabetes: Diabetes is one of the dementia risk factors for vascular dementia. It is also a known risk factor for xviii atherosclerosis and stroke, both of which contribute to vascular dementia. People who suffer severe or repeated head injuries are at increased risk of developing dementia. It is possible that a head injury may trigger the disease process in susceptible individuals. • Head trauma: There may be a strong link between serious head injury and future risk of Alzheimer’s, especially when trauma occurs repeatedly or involves loss of consciousness. Protect your brain by buckling your seat belt, wearing your helmet when participating in sports, and “fall-proofing” your home Clinical feateres of Alzheimer’s dementia: Dementia is a chronic organic mental disorder characterized by the following features. 1 Impairement of intellectual functions. 2 Impairement of memory (predominantly of recent memory, especially in early stages) xix list down the stages of alzheimer’s dementia 3 Deterioriation of personality with lack of personal care. 4 Impairment of all functions occurs globally, cause interferes with day to day activities and interpersonal relationship. 5 Impairement of abstract thinking. 6 There is no impairment of consciousness. 7 The course of dementia can be progressive stationary or reversible. Stages of Alzheimer’s dementia : Stage 1: No cognitive impairment Un impaired individuals experience no memory problems and none are evident to a health care professional during a medical interview. Stage 2: Very mild cognitive decline Individuals at this stage feel as if they have memory lapses,especially in forgetting words or names or the location of keys,eyeglasses, or other Lecture cum discussion xx everyday objects. But these problems are noevident during a medical examination or apparent to friends, family or co-workers. Stage 3: Mild cognitive decline * Friends, family or co-workers begin to notice deficiencies. Problems with memory or concentration may be measurable in clinical testing or discernible during a detailed medical interview. Common difficulties include: *Word- or name-finding problems noticeable to family or closeassociates *Decreased ability to remember names when introduced to newpeople *Performance issues in social or work settings noticeable to family, friends or co-workers xxi *Reading a passage and retaining little material *Losing or misplacing a valuable object *Decline in ability to plan or organize Stage 4: Moderate cognitive decline At this stage, a careful medical interview detects clear-cut deficiencies in the following areas: *Decreased knowledge of recent occasions or current events *Impaired ability to perform challenging mental arithmetic-for example, to count backward from 100 by 7s *Decreased capacity to perform complex tasks, such as marketing, planning dinner for guests or paying bills and managing finances *Reduced memory of personal history *The affected individual may seem subdued and xxii withdrawn, especially in socially or mentally challenging situations Stage 5: Moderately severe cognitive decline Major gaps in memory and deficits in cognitive function emerge.Some assistance with day-to-day activities becomes essential. At this stage, individuals may: *Be unable during a medical interview to recall such important details as their current address, their telephone number or the nameof the college or high school from which they graduated *Become confused about where they are or about the date, day of theweek, or season *Have trouble with less challenging mental arithmetic; for example,counting backward from 40 by 4s or from 20 by 2s *Need help choosing proper clothing for the season or the occasion *Usually retain substantial knowledge about themselves and know their own name and the names of xxiii their spouse or children *Usually require no assistance with eating or using the toilet Stage 6: Severe cognitive decline Memory difficulties continue to worsen, significant personalitychanges may emerge and affected individuals need extensive help with customary daily activities. At this stage, individuals may: *Lose most awareness of recent experiences and events as well as of their surroundings *Recollect their personal history imperfectly, although they generally recall their own name *Occasionally forget the name of their spouse or primary caregiverbut generally can distinguish familiar from unfamiliar faces *Need help getting dressed properly; without supervision, may make such errors as putting pajamas over daytime clothes or shoes on wrong feet xxiv *Experience disruption of their normal sleep/waking cycle *Need help with handling details of toileting (flushing toilet,wiping and disposing of tissue properly) *Have increasing episodes of urinary or fecal incontinence *Experience significant personality changes and behavioral symptoms,including suspiciousness and delusions (for example, believing that their caregiver is an impostor); hallucinations (seeing or hearingthings that are not really there); or compulsive, repetitive behaviors such as hand-wringing or tissue shredding *Tend to wander and become lost Stage 7: Very severe cognitive decline This is the final stage of the disease when individuals lose the ability to respond to their environment, the ability to speak and, ultimately, the ability to control movement. *Frequently individuals lose their capacity for recognizable speech,although words or phrases may occasionally be uttered xxv understand the diagnostic tests *Individuals need help with eating and toileting and there isgeneral incontinence of urine *Individuals lose the ability to walk without assistance, then theability to sit without support, the ability to smile, and the ability to hold their head up. Reflexes become abnormal and musclesgrow rigid. Swallowing is impaired. Diagnostic tests: Blood tests - to see if the patient has a thyroid disorder or vitamin deficiency. Neuropsychological testing – . It can take several hours. These types of tests are extremely useful in detecting Alzheimer's as well as other dementias early on. MRI (magnetic resonance imaging) scan – A powerful magnetic field is created by passing an electric current through the wire loops. PET (positron emission tomography) scan – Lecture cum Discussion xxvi list down the complications A PET scan that measures uptake of sugar in the brain significantly improves the accuracy of diagnosing a type of dementia often mistaken for Alzheimer's disease CT (computerized tomography) scan - this device uses digital geometry processing to generate a 3-dimensional (3-D) image of the inside of an object. Complications of Alzheimer’s dementia : People with Alzheimer's disease progressively lose the ability to care for themselves. This makes them more susceptible to accidents and health problems: • Pneumonia - this becomes a significant risk when patients start losing their ability to swallow properly. Food and drink often go down the wrong way - down the air passages into the lungs, rather than into the digestive system. If food or drink gets into the lung there is a risk of pneumonia. • Urinary tract infection - when the patient becomes incontinent it may be necessary to place a urinary Lecture cum Discussion xxvii catheter. This increases the risk of urinary tract infections. Urinary tract infections can become very serious and life threatening. • Injuries - disorientation and wandering are common symptoms of Alzheimer's. Patients are much more likely to fall and fracture a bone or sustain a head injury. The risk is greater if they have sleeping problems and get up in the night and wander about while others are asleep. Malnutrition is one of major complication of alzheimer’s dementia xxviii describe the preventive stratergies Prevention of alzheimer’ s dementia: Prevention and delay strategy #1: Get moving! According to a recent Mayo Clinic review, no single lifestyle choice has as much impact on aging and Alzheimer’s disease as exercise physical activity effectively reduces the probability of Alzheimer’s disease. These tips will maximize your exercise plan: • Exercise at a moderate pace-for at least 30 minutes five times per week. Just five workouts every seven days can reduce your risk of Alzheimer’s by as much as 35%. When serious brain damage has already occurred, brisk walking and other cardiovascular exercise can slow further injury. • Build muscle to pump up your brain-moderate levels of weight and resistance training not only Lecture cum Discussion xxixincrease muscle mass, they maintain cognitive health. Combining aerobics and strength work is better than either activity alone. Add 2-3 strength sessions to your weekly routine, and your risk of Alzheimer’s is cut in half if you are over 65. • Think movement-those who are physically active throughout life have improved cognitive forecasts. Gardening, cleaning house, and taking the stairs build brain-healthy movement throughout the day. Look for opportunities to walk, bend, stretch, and lift your way to vitality. Prevention and delay strategy #2: Eat a brain-healthy diet . The American Academy of Neurology recently warned elevated cholesterol in 40’s increases your risk of Alzheimer’s. Eating habits that reduce inflammation and promote normal energy production are brain-healthy. These food xxxtips will keep you protected: • Follow a Mediterranean diet. Control inflammation by eating foods rich in Omega 3 fatty acids, cold water fish, nuts, whole grains, and abundant fresh produce. Avoid transfats, full-fat dairy products, and red meat, but treat yourself to a glass of red wine and a dark chocolate square. • Maintain consistent levels of insulin and blood sugar. Eat several small meals throughout the day. Avoid packaged, refined, and processed foods, especially those high in sugars and white flour, which rapidly spike glucose levels and inflame your brain. • Eat across the rainbow. Emphasize fruits and vegetables across the color spectrum to maximize protective anti-oxidants and vitamins. Daily servings of berries and green leafy vegetables should be part of a plant-centered, brain protective regimen. xxxi• Drink tea daily. Green, white, and are particularly brain-healthy. Drinking 2-4 cups daily has proven benefits. Moderate coffee drinkers also enjoy reduced cognitive risks. • Consider supplementing your diet. Vitamins, herbs, and amino acids may provide additional brain protection. Folic acid, vitamin B12, vitamin D, and fish oils are believed to preserve and improve memory. Prevention and delay strategy #3: Build brain reserves According to the 2008 Wall Street Journal review “Neurobics and Other Brain Boosters,” an active, stimulated brain reduces your odds of developing Alzheimer’s. Those who remain engaged in activities involving multiple tasks, requiring communication, interaction, and organization, who continue learning, and constantly challenge their brains earn the greatest xxxiiprotection. Cross-training with these brainpower activities will keep your mind sharp: • Set aside time each day to learn something new - read a good book, study a foreign language, play a musical instrument. The greater the novelty and challenge, the larger the deposit in your brain reserves. • Practice memorization - start with something short and progress to the 50 U.S. capitals. Create rhymes and patterns to strengthen your memory connections. • Solve riddles and work puzzles - brain teasers and strategy games provide great mental exercise and build your capacity to form and retain cognitive associations. Look for activities that use both sides of your brain…logic and language versus artistic and creative challenges. xxxiii• Practice the 5 W’s - observe and report like a crime detective. Keep a Who, What, Where, When, and Why list of your daily experiences. Capturing visual details keeps your neurons firing. • Follow the road less traveled - take a new route, eat with your other hand, rearrange your computer desktop. Vary your habits regularly to create new brain pathways. . Prevention and delay strategy 4: Sleep to restore memory Brain needs regular, restful sleep to process, store, and recall information. Nightly deprivation not only leaves cranky and tired, but according to memory experts Dr. Andrew Weil and Dr. Gary Small, poor sleep can significantly damage your brain and central nervous system. • Establish a regular sleep schedule. Going to bed and getting up at the same time reinforces natural circadian rhythms. Brain’s clock responds to xxxivregularity, and long term disruption has been associated with heart disease, cancer risks, and cognitive problems. • Set the mood. Reserve your bed for sleep (and sex), take a hot bath, and dim the lights. Brisk evening exercise, comfortable temperatures, and white noise machines can also signal your brain that it’s time for deep restorative sleep. • Stop snoring. Alcohol, smoking, sedating drugs, excess weight, high blood pressure, and clogged nasal passages can rock the timbers. Snoring may signal sleep apnea, a respiratory condition that threatens your heart and mind. A new study from the University of California at San Diego estimates seventy to eighty percent of Alzheimer’s patients experience sleep apnea. • Quiet your inner chatter. When mental dialogues keep awake, get up. Try reading or relaxing in another room for twenty minutes then hop back in. xxxvPrevention and delay strategy 5: Learn to relax and manage stress According to USC’s Dr. Vincent Fortanasce, lifelong stress can double or quadruple your chances of Alzheimer’s disease, yet simple daily tools can minimize its effects. The harmful stress hormone cortisol hampers nerve cell growth and connection and accelerates cognitive decline, premature aging, depression, diabetes, and other assaults on your brain. • Breathing exercises- Stress alters breathing rates and impacts brain oxygen levels. Turn off your stress response with quiet, deep, abdominal breathing. From momentary inhale, hold, and exhale sequences to guided group exercises, restorative breathing is powerful, simple. • Schedule daily relaxation activities - From a walk in the park or petting, guided imagery, or yoga, make relaxation a priority. Keeping cortisol under xxxvicontrol requires regular effort. • Stay connected - We are social creatures, and the most connected fare better on tests of memory and cognition. Developing a strong support system through family, friends, exercise groups, clubs, and volunteer activities improves mood and slows cognitive decline. • Nourish inner peace - Most scientists acknowledge a strong mind-body connection, and various studies associate personal spiritual activities with better cognitive aging. Regular meditation, prayer, reflection, and religious practice may immunize you against the damaging effects of stress. Prevention and delay strategy 6: Protect your brain By the time Alzheimer’s disease appears, irreversible damage has already occurred. Preventing and delaying Alzheimer’s includes three protective tips: • Avoid toxins - Among the most preventable risk xxxviifactors for Alzheimer’s disease are smoking and heavy drinking. Not only does smoking increase the odds for those over 65 by nearly 79%, researchers at Miami’s Mt. Sinai Medical Center warn that a combination of these two behaviors reduces the age of Alzheimer’s onset by six to seven years. Stop smoking at age, the brain benefits from improved circulation almost immediately. Brain changes from alcohol abuse can only be reversed early. • Wear a helmet - and limit distractions. A National Institute of Health study suggests head trauma at any point in life significantly increases your risk of Alzheimer’s. Dr. Andrew Weil cautions that repeated hits in sports activities including football, soccer, and boxing, or single traumatic injuries from bicycle, skating, or motorcycle accidents make Alzheimer’s disease more likely in later life. Preserve your brain by xxxviiiwearing properly fitting helmets, buckling the seatbelt. Avoid activities that compete for attention like driving with cell phones and running with your MP3 player. A moment’s distraction can lead to a brain-injury. • Create a brain-safe environment - Scientists continue to examine links between neurodegenerative diseases like Alzheimer’s and exposure to environmental contaminants. UCLA’s Memory Center Director Gary Small warns that lead, pesticides, mold, and other substances in the environment may damage the brain. Studies on the impact of electromagnetic energy from cell phones are still debated. Although definitive links to Alzheimer’s can be elusive, making choices that limit chronic exposure to environmental harm makes good sense. xxxix SUMMARY so for we have seen the definition of Alzheimer’s dementia, causes and risk factors ,clinical manifestations ,stages of dementia, diagnostic tests, medical management, prevention strategies CONCLUSION Community resources represent any of the services available within a community setting that enhance an individuals quality of life, understanding of a pertinent health issue and ability to cope with the issues at hand. 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Age (in years) a. 30-40 b. 41-50 c. 51-60 2. Sex a. Male b. Female 3. Marital status a. Married b. Unmarried 4. Religion a. Hindu b. Christian c. Muslim d. Others 5. Type of family a. Nuclear b. Joint l 6. Education a. No formal education b. Primary education c. High school education d. Higher secondary education e. Degree holders 7. Income a. <1000 b. 1001-3000 c. 3001-5000 d. 5001and above 8. Occupation a. Self employee b. Government job c. Private job d. Daily wages e. Un employed 9. Type of health information resources a. Television b. News papers & Books c. Radio d. Health personnel e. No resources liSTRUCTURED KNOWLEDGE QUESTIONARRIE SECTION – B Definition 1. What you mean by Alzheimer dementia? a) Clouding of consciousness b) Decline in cognitive function c) Absence of awareness about self d) Increased speech 2. Which group of people is most commonly affected with Alzheimer dementia? a) Middle age b) Adolescence c) Old age d) Children 3 How the Alzheimer dementia will affect? a) Sudden onset b) Insidious onset with slow deterioration c) Moderate in onset d) Fast deterioration Causes and Risk factors of Alzheimer’s dementia 4. Which of the following is the risk factor for Alzheimer dementia? a) Leukemia b) Asthma c) Anaemia d) Hypertension lii5. Which group of people are having risk to develop Alzheimer dementia? a) High socio economic group b) Low socio economic group c) Literate d) Illiterate 6. Which type of body built is having risk to develop Alzheimer dementia? a) Moderate body b) Obese c) Thin body d) Short stature 7. What type of life style will increase the risk of Alzheimer dementia? a) Coolie workers b) Drivers c) White collar job d) Farmer Sings and symptoms 8. Which is early symptom of Alzheimer dementia? a) Difficult with familiar task b) Hyperactivity c) Not able to take the food and fluids d) Sleeplessness liii9. What type of behavioral problems will be present in Alzheimer dementia? a) Telling lies b) Agitation c) Not mingling with others d) Temper tandrum 10. What type of physical symptom will be present in Alzheimer dementia? a) Unsteady gait b) Increased activity c) Fatigue d) Increased body weight Management 11. What is the role of family members in treatment of Alzheimer dementia? a) Isolate the client b) Safety and prevention of accidents c) Complete Bed rest d) Providing High fat diet 12. What type of therapy is useful to improve the mobility of the client with Alzheimer Dementia? a) Psychotherapy b) Behavior therapy c) Occupational therapy d) Recreational therapy liv13. How can we improve the communication process? a) Isolate the patient b) Use simple & short sentence c) Provide dark room d) Give more explanation 14. How the safe environment will be given to the Alzheimer dementia patient? a) Provide restrains to the patient b) Don’t allow the client to come out c) Make the client in bed rest d) Label all the rooms, remove throw rugs and objects 15. How can we improve the sensory function of the patient? a) Provide colorful pictures b) Provide dark room c) Don’t allow the client to come out d) Complete bed rest 16. How can we manage the agitated behavior? a) Restrain the client b) Do not respond to the client c) Do not argue with the client d) Isolate the client lvPrevention 17. What type of Diet will reduce the risk of Alzheimer dementia? a) High fat Diet and high carbohydrate b) High protein and low fat Diet c) High fat and low carbohydrate d) High protein and high fat 18. How can we prevent the Alzheimer dementia? a) Providing high caloric diet b) Maintain the normal Blood pressure c) Restriction of fluids d) Providing more fluid diet 19. Which of the following diet should be avoided to prevent Alzheimer dementia? a) Green leafy vegetables b) Cereals c) Fish d) Beef 20. Which of the following food will makes the brain healthy? a) Meat b) Fish c) Butter d) Beef lvi 21. Which of the following activity makes the brain healthy? a) Bed rest b) Eating c) Engaged in some activities d) Day time sleep 22. How can we prevent the risk of Alzheimer dementia? a) Complete bed rest b) Doing exercises daily for 30 minutes c) Taking non-vegetarian diet daily d) Taking high calorie diet daily 23. What type of exercise helps to prevent Alzheimer dementia? a) Aerobic exercise b) Abdomen exercise c) Heavy exercise d) Pelvic exercise 24. Which of the following measure helps to prevent Alzheimer dementia? a) Preventing injuries in the head b) Taking more cholesterol diet c) Taking more CHO diet d) Withdrawal from the antihypertensive medication. lvii Complications 25. What is the Complication of Alzheimer dementia? a) Liver failure b) Heart failure c) Kidney failure d) Malnutrition lviiiATTITUDE SCALE (5 Point likert scale) S. No Item Strongly agree Agree Un certain Disagree Strongly Disagree 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. *Poor memory is a normal process of aging Alzheimer dementia is a chronic disease Alzheimer dementia is preventable *Alzheimer dementia is curable. Family history of Alzheimer dementia is one of the risk factor for Alzheimer dementia. *If you get dementia nothing can be done about it. Smoking will increase the risk of Alzheimer’s dementia. Misplacing the things frequently is the early symptom of Alzheimer dementia. Early detection of Alzheimer dementia is important. A regular exercise helps to prevent Alzheimer dementia. lix 11. 12. 13. 14. 15. *Vaccine is available for Alzheimer dementia. Depression is frequently associated with Alzheimer dementia. Family support is very important for Alzheimer dementia client. Alzheimer dementia affects the persons quality of life. Relaxation helps to maintain the cognitive function. * Indicates negative questions which scored reverse. lx tiuaWf;fg;gl;l Neh;fhzy; ml;ltiz gphpT - m gq;F ngWNthh;f;fhd mwpTiufs; md;ghdth;fNs cq;fsJ Ra Fwpg;Gfs; gw;wpa jfty;fs; vdf;F Njitg;gLfpd;wd. ePq;fs; nfhLf;Fk; jfty;fs; ,ufrpakhf itf;fg;gLk;. 1. taJ m) 30 - 40 taJ M) 40 - 50 taJ ,) 50 - 60 taJ 2. ghypdk; m) Mz; M) ngz; 3. jpUkzk; epiy m) Mdth; M) Mfhjth; 4. kjk; m) ,e;J M) fpwpQ;Jtk; ,) ,];yhkpak; <) kw;wit 5. 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KJik fhy kwjp Neha; vt;thW ghjpf;fpd;wJ? m) kpf Ntfkhd jhf;Fjy; M) kpjkhd jhf;Fjy; ,) epjhdkhd jhf;Fjy; <) Ntfkhf rPuopjy; 4. fPo;fz;ltw;wpy; KJik kwjp Neha; tUtjw;fhd fhuzp vJ? m) ,uj;j Gw;WNeha; M) M];j;kh ,) ,uj;j Nrhif <) cah; ,uj;j mOj;jk; 5. ve;j tifapdh; KJikfhy kwjp Neha; Vw;gLk; tha;g;G mjpfk;? m) gzf;fhuh;fs; M) Viofs; lxiii ,) gbj;jth;fs; <) gbf;fhjth;fs; 6. ve;jtif cly;thF cilath;fs; KJik fhy kwjp Nehahy; ghjpf;fg;gLfpwdh;? m) eLj;jkhd cly;thF M) cly;gUkdhdth;fs; ,) nkype;j cly;thF <) Fl;ilahf ,Ug;gth;fSf;F 7. ve;j tifahd kf;fSf;F KJik fhy kwjpNeha; tha;g;G mjpfk; cs;sth;fs;? m) $yp njhopyhsh;fs; M) Xl;Leh;fs; ,) Nkyhz;ik njhopyhspfs; ,) tptrhapfs; 8. KJikfhy kwjp Nehapd; Kjy; mwpFwp vJ? m) ed;whf njhpe;j Ntiyfs; nra;tjpy; fbdk; Vw;gLjy; M) mjpf nray;ghL ,) rhpahf czT cz;z KbahJ <) J}f;fkpd;ik 9. KJikfhy kwjp Nehapdhy; elj;ijapy; Vw;gLk; khw;wq;fs; vd;d? m) ngha;NgRjy; M) fpsh;r;rp epiy ,) ahUlDk; gofhky; jdpahf ,Ug;gJ <) Kd;Nfhtk;. 10. KJikfhy kwjp Nehapdhy; clypy; ve;jtifahd khw;wq;fs; Vw;gLk;. m) js;shLk; eil M) mjpf nray;ghL ,) fisg;G (m) Nrhh;T Vw;gLjy; <) cly; vil mjpfhpj;jy; lxiv 11. KJikfhy kwjp Nehapdhy; ghjpf;fg;gl;lth;fspd; FLk;gj;jpdh; vt;tifapy; kwjpNeha; rpfpr;irapy; gq;F ngwyhk;? m) KJikfhy kwjp Nehapdhy; ghjpf;fg;gl;lth;fis jpikg;gLj;Jjy;. M) ghJfhg;ghd kw;Wk; tpgj;Jf;fis jtph;f;fk; gbahd Rw;Wg;Guj;ij Vw;gLj;j Ntz;Lk;. ,) KOikahd Xa;T <) nfhOg;Gr;rj;J mjpfkhd czit nfhLf;f Ntz;Lk;. 12. ve;j tifahd rpfpr;ir nfhLg;Gjd; %yk; KJikfhy kwjp Nehahy; ghjpf;fg;gl;lth;fspd; ,aq;Fk; jd;ikia mjpfg;gLj;jyhk;? m) kdepiy xOq;F rpfpr;ir M) elj;ij xOq;F rpfpr;ir ,) ,af;fgapw;rp <) nghOJNghf;F rpfpr;ir 13. KJik fhy kwjp Nehahy; ghjpf;fg;gl;lth;fspd; njhlh;G nfhs;Sk; jpwd;> NgRk; jpwd; vt;thW mjpf;g;gLj;jyhk;? m) jdpikg;gLj;Jjy; M) vspikahd rpwpa nrhw;nwhlh;fis Ngr Ntz;Lk; ,) ,Ul;liwapy; itf;f Ntz;Lk; <) mjpfkhf tpsf;fpf; $w Ntz;Lk; 14. KJikfhy kwjp Nehapdhy; ghjpf;fg;gl;lth;fSf;F ghJfhg;ghd Rw;Wg;Gwr; #oy; vt;thW nfhLf;fyhk;? m) fl;Lg;ghl;L Kiwfs; %yk; M) KJikfhy kwjp Nehapdhy; ghjpf;fg;gl;lth;fs; tPl;il tpl;L ntspNa tu mDkjpf;f $lhJ. ,) Xa;T nfhLf;f Ntz;Lk;. <) vy;yh miwfspYk; mJ vd;d miw vd;W ngah; vOjp xl;l Ntz;Lk; kw;Wk; $h;ikahd nghUl;fis mq;fpUe;J mfw;w Ntz;Lk;. lxv 15. KJikfhy kwjp Nehahy; ghjpf;fg;gl;lth;fspd; czUk; jpwid vt;thW mjpfg;gLj;jyhk;? m) mjpf tz;zq;fs; epiwe;j glq;fis tPl;by; nghUj;Jjy; M) ,Ul;liwapy; itf;f Ntz;Lk;. ,) tPl;iltpl;L ntspNa nry;y mDkjpf;ff; $lhJ <) jdpikg;gLj;j Ntz;Lk;. 16. KJikfhy kwjp Nehahy; ghjpf;fg;gl;lth;fspd; fpsh;r;rp epiyia vt;thW rhpnra;a Ntz;Lk;? m) Xa;T nfhLf;f Ntz;Lk;. M) mth;fsplk; NgRjy; $lhJ ,) my;irkh; kwjp Nehahy; ghjpf;fg;gl;lth;fsplk; tof;fhLjy; $lhJ. <) jdpikg;gLj;j Ntz;Lk;. 17. ve;jtifahd czT cz;gjpd; %yk; KJikfhy kwjp Neha; tuhky; jLf;fyhk;? m) mjpf nfhOg;G rj;Js;s kw;Wk; mjpf rh;f;fiurj;Jf;fs; czT M) mjpf Gujk; kw;Wk; Fiwe;j nfhOg;G rj;Js;s czT ,) mjpf nfhOg;G kw;Wk; Fiwe;j rh;f;fiurj;Js;s czT <) mjpf Gujk; kw;Wk; mjpf nfhOg;G rj;Js;s czT 18. KJikfhy kwjp Nehia vt;thW tuhky; jLf;fyhk;? m) mjpf fNyhhpfs; epiwe;j czT cz;gjd; %yk; M) ,uj;j mOj;jj;ij rPuhf itg;gjd; %yk; ,) ePh; Mfhuk; nfhLf;f $lhJ. <) mjpf ePh; Mfhuk; nfhLj;jy; lxvi 19. fPo;f;fz;l ve;j czit jtph;g;gjd; %yk; KJikfhy kwjp Neha; tuhky; jLf;fyhk;? m) gr;ir fha;fwpfs; kw;Wk; fPiufs; M) gUg;G tiffs; ,) kPd; tiffs; <) khl;L ,iwr;rp 20. fPo;f;fz;l vt;tif czT %isia MNuhf;fpakhf itf;f cjTfpwJ? m) Ml;L ,iwr;rp M) kPd; ,) ntz;nza; <) khl;L ,iwr;rp 21. fPo;f;fz;ltw;wpy; vt;tifahd nray;fs; %isia MNuhf;fpahf;Fk;? m) Xa;T M) czT cz;Zjy; ,) VjhtJ xU Ntiyapy;

India.

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India.

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