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Neurobiological Bases of Alzheimer’s Disease

Abdul Momoh

Central Connecticut State University

PSY 450-02

Dr. Silvia Corbera Lopez

1 December 2024
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Neurobiological Bases of Alzheimer’s Disease

Introduction

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by a

decline in cognition, loss of memory, and disturbances in behaviour, all associated with

advanced age. Since AD is the most prevalent cause of dementia, it has broad ramifications

impacting the person, family, and community as a whole. Knowledge of its neurobiological

underpinning is necessary for understanding the development of effective treatments and

appropriate resourcing of those affected. The paper discussed behavioral symptoms, underlying

brain systems and neurotransmitters, treatment interventions, and community resources about

AD in discussing future research directions.

Behavioral and Psychological Symptoms of Alzheimer’s Disease

Alzheimer's Disease (AD) is characterized by a continuum of behavioral and

psychological symptoms that progress with the disease. In its earliest stages, people affected by it

often need help remembering things but forget recent conversations or misplaced things.

However, rates of these lapses are frequently associated with mild, subtle changes in executive

functioning, such as the inability to plan, organize, or solve problems. Patients may also be

irritable, depressed, or anxious because they know they are becoming increasingly cognitively

tricky.

At more advanced stages of AD, subtle memory changes emerge and worsen; people

have difficulty remembering personal history or new information, recognizing relatives, or

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recovering from mislaid items such as car keys. Common behavioral symptoms include

wandering, agitation, restlessness, disruptions in the circadian rhythms, and resulting sleep

disturbances. Behaviors and Psychological Symptoms of Dementia (BPSD), which are

collectively characterized by hallucinations, paranoia, and delusions, increase caregiver stress

and complicate management (Cerejeira et al., 2021).

AD pathology typically progresses temporally and clinically; it is known as a treatable

dementia that devastatingly unfolds into late-stage AD — profound cognitive decline, severe

memory loss, and a near total dependence on caregivers for basic activities of daily living

(ADLs). Sometimes, it is filtered out, and patients are bedridden. However, sometimes such as

apathy and aggression can be coexistent, making the caregiving process more confusing.

The progressive degeneration of those areas of the brain that shape memory, reasoning,

and emotion regulation leads to these symptoms — the hippocampus and prefrontal cortex.

Patients present and suffer in different ways, and all deserve to be on top of their game regarding

individualized care approaches. Improvement in the quality of life for patients and caregivers

depends on addressing BPSD through pharmacological and non-pharmacological interventions.

An in-depth understanding of these symptoms is a strong basis for developing more effective

treatment strategies and support systems.

Brain Systems and Neurotransmitters in Alzheimer’s Disease

Generally, AD is a progressive neurodegenerative disorder characterized by widespread

neurological alterations in those brain systems responsible for memory, cognition, and

behaviour. Maximum involvement is seen in the hippocampus, the structure in the limbic system,
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which is rather very important for forming new memories and navigation based on spatial

memory. In the early stage, hippocampal atrophy is associated with profound neuronal loss,

impairing short-term memory and the consolidation of new information.

During the illness, atrophy extends into the cerebral cortex, with increased frontal and

temporal lobes involvement. The frontal lobe controls judgment and decision-making, reasoning,

and impulse control; it shows less activity concerning executive dysfunction and personality

changes. The temporal lobe, especially the medial temporal structures, is associated with

significant cell loss, further contributing to memory and language processing impairments.

Neurochemical imbalance is another characteristic feature of AD. There is a significant

disruption of the cholinergic system using the neurotransmitter acetylcholine (ACh).

Acetylcholine plays an important role in attention, learning, and memory; this neurotransmitter

has been found at very low levels because of the degeneration of cholinergic neurons in the basal

forebrain (Sian et al., 2024). Such a deficit forms the basis of many of the cognitive symptoms

seen in AD.

Excess glutamate release is associated with excitotoxicity, which facilitates neuronal

death and is also demonstrated by glutamatergic dysfunction. These pathologic hallmarks, beta-

amyloid plaques, and tau protein tangles disrupt synaptic communication and cause free-radical

injury and inflammation.

Such neurotransmitter imbalances are targeted pharmacologically. For example,

acetylcholinesterase inhibitors, donepezil, increase ACh levels; the NMDA receptor antagonists,

Memantine, control glutamate activity. Learning how the brain systems and neurotransmitters
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are affected allows scientists to design better therapies for symptoms and underlying disease

mechanisms.

Treatment Interventions for Alzheimer’s Disease

Treatment interventions in AD are meant to manage symptoms and slow the disease

process since the cure has yet to be found. Current treatment approaches integrate

pharmacological, non-pharmacological, and experimental techniques for treating cognitive

decline and behavioral symptoms.

However, the pharmacological treatments of AD are limited to acetylcholinesterase

inhibitors (e.g., donepezil, rivastigmine) and NMDA receptor antagonists (e.g., Memantine).

Acetylcholine inhibitors increase acetylcholine levels, improving memory and cognitive

function. On the other hand, Memantine regulates glutamatergic activity to protect from

excitotoxicity and neuronal damage (Chapter 5, 2021). Although these drugs offer symptomatic

relief, they are only effective in the early and moderate stages of the disease.

Equal importance is the non-pharmacological interventions: Cognitive stimulation

therapy (CST), reminiscence therapy, and physical exercise programs, all widely documented to

improve cognitive functioning and emotional well-being; behavioral therapies like music therapy

and art therapy, both able to reduce agitation and improve mood; education and support given to

caregivers, thus providing them with increased skills in the management of problem behavior

and relieving them from their burden.

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Community and Scientific Resources for Alzheimer’s Disease

Scientific Resources: Scientific resources to understand and address Alzheimer's disease

are much needed for research development in addition to the treatment of the disease. Many

organizations, such as the National Institute on Aging and the Alzheimer's Association, provide

educational resources, research funding, and advocacy programs. The NIA participates in studies

regarding AD's molecular and cellular mechanisms, investigating innovative treatments,

including immunotherapy targeting amyloid-beta plaques.

Community Resources: Available resources within the community improve the quality

of life of persons with AD and caregivers. That is where the Alzheimer's Association provides

support, such as training programs for caregivers, 24/7 helplines, and specially adapted education

on managing behavioral and psychological symptoms of dementia (BPSD) behaviors.

Community-based initiatives include memory cafes or adult day care to share social activities

and take respite from caregiving. According to Hameed and Agyapong (2020), peer support

groups nurture emotional resilience and engender a sense of belonging among caregivers.

These technology resources support patient autonomy and provide numerous means for

the caregiver to monitor health and safety. Local healthcare providers specializing in geriatrics

and neurological care provide diagnostics and treatment. Together, these are powerful resources

that provide a support network to address the medical, social, and emotional challenges

associated with AD. This network needs to be strengthened through policy advocacy and funding

to meet the growing demand and rise in prevalence globally.

Summary and Conclusions

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Alzheimer's is an exceedingly complex disease and a significant burden to the family and

society in general, let alone to the patients themselves. This paper has reviewed the symptoms,

neurobiological underpinnings of the disease, treatment interventions, and resources available in

AD management. Memory loss, cognitive decline, and BPSD occur as a result of structural and

functional disruption to the brain. Amyloid plaques, tau tangles, and neurotransmitter imbalance

underpin its pathology. These insights further developed the pharmacological treatments of

cholinesterase inhibitors and NMDA receptor antagonists, most with symptomatic treatments.

Future anti-amyloid and anti-tau therapies offer promise regarding disease-modifying effects but

need further validation.

Future research will focus on biomarker-based early detection, personalized medicine,

and new therapies targeted at the etiology. Genetics, neuroimaging, and artificial intelligence

may offer game-changing new opportunities for diagnosis and treatment. The other key issues to

be addressed in the global reduction of the burden of AD are the increase in access and

utilization of community resources and the decrease in disparity in care. Such collaboration by

scientists, clinicians, and policymakers will lead to a better understanding of AD and active

strategies for combating it. In this respect, the continued effort will make genuine the aspiration

of better outcomes for those affected by Alzheimer's Disease.

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References

Cerejeira, J., Lagarto, L., & Mukaetova-Ladinska, E. B. (2021). Behavioural and psychological

symptoms of dementia. Frontiers in Neurology, 3.

https://doi.org/10.3389/fneur.2012.00073

Chapter 5—Practical application of treatment strategies. (2021). Substance Abuse and Mental

Health Services Administration (US). https://www.ncbi.nlm.nih.gov/books/NBK576542/

Hameed, A., & Agyapong, V. I. O. (2020). Peer support in mental health: A literature review.

JMIR Mental Health, 7(6), e15572. https://doi.org/10.2196/15572

Sian, J., Youdim, M. B. H., Riederer, P., & Gerlach, M. (2024). Biochemical anatomy of the

basal ganglia and associated neural systems. NIH.gov; Lippincott-Raven.

https://www.ncbi.nlm.nih.gov/books/NBK27905/