Alzheimers Disease Tessa Dillon Nova Southeastern University Clinical

Alzheimer’s Disease Tessa Dillon Nova Southeastern University Clinical Genetics Teri Doolittle, PA-C, MHP, DHSc August 3, 2008

Incidence l Alzheimer’s Disease (AD) is the most common cause of dementia in older adults l About 25% of AD cases are hereditary l Having a 1 st degree relative with AD = 20% to 25% risk of developing AD Bird, 208, p. 3; National Institute of Health [NIH], 2006

At- Risk Population Early onset AD = 1%-3% of all cases l Early onset Familial AD accounts for 13% of cases l Down’s Syndrome in 40’s l l l Results from Trisomy 21 60% of patients with dementia or AD live in the Western World Bird, 208, p. 3; Blennow, de. Leon, & Zetterburg, 2006; NIH, 2006

Inheritance Patterns l l Early onset familial AD appears to be Autosomal Dominant Late onset familial AD involves multiple susceptibility genes Families with multiple affected members higher incidence Sporadic inheritance caused by combination of aging, genetic predisposition & exposure to environmental agents Bird, 2008, p. 5; Blennow et al. , 2006

Prognosis l Progressive disease l No cure is Available l Treatment is supportive l Includes management of symptoms l Pharmacogenetics shows promise in tailoring drug effectiveness Bird, 2008; Elder, 2007

Course of the Disease Begins with subtle failure of memory l Progress to l l l confusion poor judgment language disturbance Advanced cases result in l l l Agitation Withdrawal Hallucinations Bird, 2008; Blennow, 2006; NIH, 2006

Interdisciplinary Care Factors Nurses provide referral to genetic counselor l Physician & Pharmacologist optimize treatment of symptoms l Psychiatrist & Psychologist for mental & behavioral support l Palliative care from a hospice provider l l Provides needed care for the patient and caregiver in the late stages of AD Smith & Keene, 2007

Case Scenario Mr. Y a 45 -year old computer engineer l Manager of software development unit at a large company l Well respected in community l Married with one female child age 22 l No significant medical history, receives regular annual physicals l Exercises Daily with 30 minute Jog l Burke, Fryer-Edwards, & Pinsky, 2001

Case Scenario continued l l l Mr. Y has been under stress at work Goes on vacation to New York Calls his daughter from Union Square unable to recall what hotel he is staying in He asks his daughter for the name of the hotel and what to do next His boss also describes his work as unsatisfactory States he is making faulty management decisions Burke et al. , 2001

Age 72 healthy Age 90 healthy Three Generation Family History Age 59 severe mental problems Age 48 memory problems Early Onset Alzheimer’s Unaffected individual ? Onset AD age 50 Age 45 New onset confusion Burke et al. , 2001

Punnett Square A a Aa a aa A = Alzheimer’s Trait a = normal memory a Aa aa Based upon the family history the Punnett square reveals that there is 50% chance of each child developing Early onset AD

Role of Nurse in Care l Assessment l l Provide supportive care Explain unfamiliar terms (tests & genetics) Serve as mediator for others involved in care Early Case Findings l l Screen family for possible genetic counseling Refer to community support groups

Interventions l Assistance with rehabilitative efforts l Consult pharmacologist for medication education l Refer to hospice when appropriate

Question One l Pharmacogenetics offers promise to patients who have AD by offering them this? And the ANSWER is: l Customized treatment plan and new medications to slow the symptoms associated with Alzheimer’s disease.

Question Two l If two or more direct family members have AD what are the chances that you will get the disease? And the answer is: l AD is generally Autosomal Dominant l l In early onset there is a 50% chance of inheriting the disease from a direct family member In late onset, the risk is less because of incomplete penetrance and multiple gene mutations.

References Bird, T. (2007, October). Alzheimer disease overview in gene reviews. Retrieved August 3, 2008, from http: //www. ncbi. nlm. nih. gov/bookshelf/br. fcgi? book=g ene&part=alzheimer Blennow, K. , de. Leon, M. , & Zetterberg, H. (2006). Alzheimer’s disease [Electronic version]. The Lancet 368, 387 -403.

References Continued Burke, W. , Fryer-Edwards, K. , & Pinsky, L. (Eds. ). (2001, September). Genetics in primary care (GPC) training program curriculum materials. Retrieved July 29, 2008, from Nova Southeastern University Web. CT Elder, B. (2007). The genetics of chronic disease: A nursing perspective [Electronic version]. The Kansas Nurse 82(10), 3 -5.

References Continued National Institute of Health. (2006, October). Genetics in primary medicine: Alzheimer disease Apo. E genotyping at-aglance. Retrieved August 3, 2008, from http: //www. genetests. org/servlet/access? id=8888892&key=S 5 Vn. Wgvs 6 g. Lf. L &fcn=y&fw=EEG 3&filename=/tools/teaching/ataglance/alzheimer. html Smith, C. & Keene, S. (2007). Hospice care for alzheimer's disease: Caring for the patient, family, and caregivers. The Internet Journal of Geriatrics and Gerontology 3(2). Retrieved August 4, 2008, from http: //www. ispub. com/ostia/index. php? xml. File. Path=journals/ijgg/vol 3 n 2/hospice. xml