ALZHEIMER

FERAS SALEH ALSHEHRI

Description
Introduction of Alzheimers disease

Pathophysiology of AD
Types of AD
Causes
Symptoms
ASSESSMENT
Diagnosis
Lap test
Management and Treatment
Complication
References & Sources
Projected Prevalence of AD
INTRODUCTION:
Alzheimers disease (AD) is an irreversible, progressive brain
disease that slowly destroys memory and thinking skills and,
eventually, the ability to carry out the simplest tasks of daily
living. In most people with AD, symptoms first appear after
age 60.
Alzheimer's disease is characterized by the formation of large
numbers of abnormal features in the brain called plaques and
tangles. Plaques are dense deposits of protein that build up
over time between brain cells. Tangles are twisted fibers of
protein that develop inside brain cells. It is believed that
plaques and tangles can block communication between brain
cells and play a role in brain cell degeneration and brain cell
death.
PATHOLOGY/PATHOPHYSIOLOG
Y OF AD:
Pathophysiology studies changes in function of an organ or tissue caused by a disease or an injury. Two
main pathophysiological changes in the brain found in Alzheimer's disease: plaques and tangles.
Plaques
Plaques are abnormal accumulations of the protein beta-amyloid in the brain, inflammation around these
plaques leads to the death of nearby brain cells
Tangles
Tangles occur when strands of the protein tau, which gives brain cells their shape, becomes twisted; this
pathophysiological change causes affected cells to die. Some people are genetically predisposed to
developing tau that twists.
Features
It is not known, whether the processes that causes plaques and tangles are related.
Effects
The pathophysiological changes of the brain in Alzheimer's disease lead to dementia, the slow, progressive
(increasingly worse over time) loss of brain function. This affects memory, learning and behavior

TYPES OF AD:

Mild Alzheimers Disease
As Alzheimers disease progresses, memory loss continues and changes in other cognitive abilities appear.
Problems can include getting lost, trouble handling money and paying bills, repeating questions, taking longer to
complete normal daily tasks, poor judgment, and small mood and personality changes. People often are
diagnosed in this stage.
Moderate Alzheimers Disease
In this stage, damage occurs in areas of the brain that control language, reasoning, sensory processing, and
conscious thought. Memory loss and confusion increase, and people begin to have problems recognizing family
and friends. They may be unable to learn new things, carry out tasks that involve multiple steps (such as getting
dressed), or cope with new situations. They may have hallucinations, delusions, and paranoia, and may behave
impulsively.
Severe Alzheimers Disease
By the final stage, plaques and tangles have spread throughout the brain and brain tissue has shrunk
significantly. People with severe Alzheimers cannot communicate and are completely dependent on others for
their care. Near the end, the person may be in bed most or all of the time as the body shuts down.
CAUSES:

We dont yet fully understand what causes AD, but it is clear that it develops because of a complex series
of events that take place in the brain over a long period of time.
Genetics play a role in some people with AD.
A rare type of AD, called early-onset AD, affects people ages 30 to 60. Some cases of early-onset AD,
called familial AD, are inherited.
Familial AD is caused by mutations (permanent changes) in three genes. Offspring in the same
generation have a 50-50 chance of developing familial AD if one of their parents had it.
Genetic factors do appear to increase a persons risk of developing the disease. This increased risk is
related to the apoliprotein E (APOE) gene.
Nutritious diet, exercise, social engagement, and mentally stimulating pursuits.


SYMPTOMS OF ALZHEIMERS DISEASE:

Alzheimers disease can affect different people in different ways, but the most common symptom pattern begins
with
Gradually, thinking and judgment become more difficult.
Progressive difficulty in communication and severe deterioration in memory, language, and motor function result
in a loss of coordination and an inability to write or speak.
Personality changes (restlessness, irritability) and nocturnal awakenings are common.
Patients also exhibit loss of eye contact, a fearful look, wringing of the hands, and other signs of anxiety.
In advanced Alzheimers, people need help with bathing, dressing, using the bathroom, eating and other daily
activities.
In the final stages of the disease lose their ability to communicate, fail to recognize loved ones and
become bed-bound and reliant on 24/7 care


ASSESSMENT : history
Ask both the patient & a reliable informant - about the patients: - Current condition - Medical history - Current medications & medication history -
Patterns of alcohol use or abuse - Living arrangements
ASSESSMENT: PHYSICAL
Examine:
Neurologic status - Mental status - Functional status
Include:
Quantified screens for cognition
e.g., Folsteins MMSE, Mini-Cog - Neuropsychological testing
ASSESSMENT: BRAIN IMAGING
Use imaging when:
Onset occurs at age < 65 years
Symptoms have occurred for < 2 years
Neurologic signs are asymmetric
Clinical picture suggests normal-pressure hydrocephalus
Consider:
Noncontrast computed topography head scan
Magnetic resonance imaging
Positron emission tomography
DIAGNOSIS/DIAGNOSTI
C TESTS
No specific test that can detect AD. Variety of tests evaluates the brain and can rule out other causes of
. depression or dementia vascular Alzheimer's disease symptoms, such as
The diagnostic process begins with
Taking a thorough personal and family history, including symptoms, and completing a physical examination. A
neurological exam evaluates the nerves and nervous system and such functions as reflexes, sensation,
movement, balance, coordination, vision, and hearing.
(MMSE), evaluates mental function by assessing the answers provided to a state examination mental - Mini
series of questions.
Imaging tests CT and MRI provide information about the structure of the brain
Diagnostic criteria for Alzheimer's disease
1- Dementia is present.
2- History, physical and mental status examinations are consistent with Alzheimer's disease.
3- Screening blood tests (CBC, BUN, calcium, liver function, thyroid function, vitamin B
12
and others as
indicated) and review of medications do not reveal any major untreated cause of cognitive impairment.
4- Brain imaging study (CT or MRI) is normal or shows atrophy (some authorities do not recommend
neuroimaging studies except in uncertain cases).

DIAGNOSTIC TESTS USE IN THE DIAGNOSIS
OF ALZHEIMER'S DISEASE INCLUDES:
Urine tests
Blood tests
Neuropsychological tests
Memory tests
Cognitive tests
Brain scans
Brain CT scan
Brain MRI scan
scan Brain PET
: MANAGEMENT AND TREATMENT
Primary goals: to enhance quality of life & maximize functional performance by improving
cognition, mood, and behavior

Nonpharmacologic

Pharmacologic

Specific symptom management

Resources

NON PHARMACOLOGICal
Cognitive enhancement
Individual and group therapy
Regular appointments
Communication with family, caregivers
Environmental modification
Attention to safety

PHARMACOLOGIC
Cholinesterase inhibitors: donepezil, rivastigmine, galantamine
Other cognitive enhancers: estrogen, NSAIDs, ginkgo biloba, vitamin E
Antidepressants
Antipsychotics

SYMPTOM MANAGEMENT
Sundowning
Psychoses (delusions, hallucinations)
Sleep disturbances
Aggression, agitation
Hypersexuality
RESOURCES FOR MANAGING
DEMENTIA
Attorney for will, conservatorship, estate planning
Community: neighbors & friends, aging & mental health networks, adult day care, respite
care, home-health agency
Organizations: Alzheimers Association, Area Agencies on Aging, Councils on Aging
Services: Meals-on-Wheels, senior citizen centers
COMPLICATIONS

Complications of Alzheimer's Disease may include:
Memory loss
Sleeplessness
Agitation
) Disorganization Wandering (see
Anxiety
Chronic brain failure

: REFERENCES
http://www.aafp.org/afp/981101ap/sloane.html
http://www.wrongdiagnosis.com/a/alzheimers_disease/intro.htm
disease.html - alzheimer_s - _pathophysiology 5780227 ://www.ehow.com/facts_ http
.html 1365 /p 1001 / 2003 http://www.aafp.org/afp/
. www.pdr.net (with password) at: 2003 Physicians' desk reference. Accessed May
http://www.etymonline.com/index.php?term=Alzheimer's+disease
NICE issues guidance on drugs for Alzheimer's disease. National Institute for Clinical Excellence. Accessed April 2003
14406 www.nice.org.uk/article.asp?a= at:
CA.pdf - FullReport - http://www.caalz.org/PDF_files/Guideline
http://www.vhct.org