Alzheimers Disease Kynnera Stephenson Lubbock Christain University Introduction

Alzheimer’s Disease Kynnera Stephenson Lubbock Christain University

Introduction � Alzheimer’s disease is the most common cause of dementia in the elderly � Alzheimer’s disease is characterized by progressive, incurable, terminal cognitive decline that can occur in middle or old age and where symptoms gradually worsen over a number of years � Alzheimer’s disease is the 6 th leading cause of death in the US

Introduction � Alzheimer’s disease accounts for 50 – 80 percent of dementia cases � Annual treatment of Alzheimer’s disease cost is $100 billion � Alzheimer’s disease has no current care, but symptoms can be treated

Pathophysiology � The brain of an Alzheimer’s disease patient shows marked atrophy � Alzheimer’s disease affects the 3 processes that keep neurons healthy: communication, metabolism and repair � Alzheimer’s disease is loss of neurons and the presence of two main microscopic neuropathological hallmarks: extracellular amyloid plaques and intracellular neurofibrillary tangles that accumulate in the brain and kill brain cells

Pathophysiology � These abnormal protein fragments start in the hippocampus, the part of the brain where memories are first formed � Over time these plaques and tangles slowly destroy the hippocampus making it harder to form new memories � The plaques and tangles then spread into different regions of the brain, killing cells and compromising function. This spreading around is what causes the different stages of Alzheimer’s disease � The progression to mild forgetting to death is slow and steady and takes place over an average of 8 -10 years

Patient Presentation � Alzheimer’s disease progresses through distinct stages: mild, moderate and severe � In mild Alzheimer’s disease, signs may include: v. Memory loss v. Confusion about the location of familiar places v. Taking longer to complete normal daily tasks v. Trouble handling money and paying bills v. Compromised judgment v. Loss of spontaneity v. Mood and personality changes with increased anxiety

Patient Presentation � In moderate Alzheimer’s disease, symptoms may include: v. Increased memory loss and confusion v. Shortened attention span v. Problem recognizing friends and family v. Difficulty with language; problems with reading and writing v. Difficulty organizing thoughts and thinking logically v. Restlessness, agitation, anxiety, wandering v. Hallucinations, delusions, suspiciousness or paranoia v. Perceptual-motor problems

Patient Presentation � In severe Alzheimer’s disease: v. Person cannot recognize family or loved ones v. Person cannot communicate in any way v. Sense of self seems to vanish v. Weight loss v. Seizure, skin disorders, difficulty swallowing v. Groaning, moaning, grunting v. Increased sleeping v. Lack of bladder and bowel control

Patient Presentation

Diagnosis

Diagnosis of Alzheimer’s Disease � There is no single test that proves a person has Alzheimer’s disease � A diagnosis is made through a complete assessment that considers all possible causes v. Medical history v. Physical exam v. Neurological exam v. Mental status test v. Brain imaging

Diagnosis

Diagnosis

Intervention � There is no drug treatments available that can cure Alzheimer’s disease � Medications abate or improve symptoms, temporarily slowing down the progression and various symptoms associated with Alzheimer’s disease � Acetylcholine is a key neurotransmitter in the brain signaling short term memory and learning. It is broken down by the enzyme acetylcholinesterase which is in excess in the Alzheimer’s disease brain � Glutamate is the most common neurotransmitter in the brain involved in learning and memory. Dying brain cells in Alzheimer’s disease release excess amount of glutamate that causes harm to the brain by over-stimulating healthy brain cells

Intervention � The choice of drug for any given patient is mostly determined by the stage of the disease with donepezil, rivastigmine and galantamine prescribed for mild to moderate Alzheimer’s disease and memantine for moderate or severe Alzheimer’s disease � Other cognitive enhancers are estrogen, vitamin E, NSAIDS, ginkgo biloba, antidepressants, antipsychotics

Intervention Non-Pharmacological � Cognitive enhancement such as mental activities; crossword puzzles and brainteasers should be kept within a reasonable level of activity � Individual and group therapy � Environmental modification � Regular appointments � Communication with family and caregivers

Patient Education � It is essential to involve patient family and others who will play a supporting role when counseling a patient with Alzheimer’s � It is important to emphasize that the patient will experience sadness and anger as well as those who support the patient � A dialogue must be open regarding the patient’s wishes when he or she is no longer able to make necessary choices, when symptoms become more pronounced

Patient Education � Patient should continue to engage in activities they enjoy doing since maintaining an optimal quality of life is key � Ensure that the patient has a safe environment

Prevention � There are no proven modalities for preventing Alzheimer’s disease, but evidence primarily epidemiology, suggest that healthy lifestyle can reduce the risk of developing the disease. � The following may be protective: v. Physical activity v. Exercise v. Cardio-respiratory fitness

Conclusion � Dementia is common in older adults but is NOT an inherent part of aging � Alzheimer’s disease is the most common type of dementia � Primary treatment goal is to enhance quality of life, maximize function by improving cognition, mood and behavior

References Cash, C. J. , & Glass, A. (2011). Alzheimer’s Disease. Family Practice Guidelines (pp. 443 -444). New York, NY: Springer. � Mc. Cance, L. K. , Huether, E, S. , Brashers L. V. , & Rote S, N. (2010). Alzheimer’s Disease. In S. Clark, C. C. Jones, & C. Ketchum (Eds. ), Pathophysiology: The Biologic Basis for Disease in Adults and Children (pp. 553 -556). Philadelphia, PA: Elsevier � Shan, Y. (2013). Treatment of Alzheimer's disease. Primary Health Care, 23(6), 32 -38. �