Alzheimer’s Disease

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Alzheimer’s disease(AD) is a neuropsychological disorder in which the death of brain cells causes memory loss and cognitive decline. AD is the number one cause of Dementia. Symptoms of this disease begin slowly and get worse over time.

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There has been a major rise in the cases of dementia over the past decade and cases are expected to double by 2050. There is no current evidence supported treatments yet, because there is no found way to reverse the death of brain cells. There are currently no disease-modifying drugs available for AD, but some options may reduce the symptoms and help improve quality of life. Therapeutic interventions are available to make it easier for people to live with the disease.

Introduction/Background

Alzheimer’s disease was first discovered in 1906 by Doctor Alois Alzheimer. Dr. Alzheimer had a patient that was brought in to the hospital because of personality change, memory loss, behavioral changes, and inability to comprehend simple things. Dr. Alzheimer saw the patient for a few years until her death in 1906. Dr. Alzheimer performed an autopsy on the patient, where he discovered important factors of the brain that are still used today. Dr. Alzheimer found a number of pathological conditions, including shrinking of the cortex and the presence of neurofibrillary tangles and neuritic plaques. With that information he diagnosed the patient with senile dementia a serious disease of the cerebral cortex, which is known today as Alzheimer’s disease. Alzheimer’s disease is now classified as a degenerative disease characterized by the death of nerve cells in several areas of the brain. The most obvious symptom of AD is memory loss. Usually those who develop the disease are over 65 years old.

DSM-V Classification of Alzheimer’s Disease

In the DSM-V Alzheimer’s Disease is classified as a neurocognitive disorder. Neurocognitive disorders are classified to begin with delirium, followed by the syndromes of major neurocognitive disorders, mild neurocognitive disorders, and their etiological subtypes. In these neurocognitive disorders, the impaired cognition was never present until the symptoms appear. The DSM V diagnostic criteria for Alzheimer’s is as follows: A. The criteria are met for major or mild neurocognitive disorder, B. There is insidious onset and gradual progression of impairment in one or more cognitive domains, C. Criteria is met for either probable or possible Alzheimer’s disease is met. The DSM V also states Beyond the neurocognitive disorder (NCD) syndrome (Criterion A), the core features of major or mild NCD due to Alzheimer’s disease include an insidious onset and gradual progression of cognitive and behavioral symptoms (Criterion B). The typical presentation is amnestic (i.e., with impairment in memory and learning). Unusual nonamnestic presentations, particularly visuospatial and logopenic aphasie variants, also exist. At the mild NCD phase, Alzheimer’s disease manifests typically with impairment in memory and learning, sometimes accompanied by deficits in executive function. At the major NCD phase, visuoconstructional/perceptual motor ability and language will also be impaired, particularly when the NCD is moderate to severe. Social cognition tends to be preserved until late in the course of the disease. A level of diagnostic certainty must be specified denoting Alzheimer’s disease as the “”probable”” or “”possible”” etiology (Criterion C). Probable Alzheimer’s disease is diagnosed in both major and mild NCD if there is evidence of a causative Alzheimer’s disease gene, either from genetic testing or from an autosomal dominant family history coupled with autopsy confirmation or a genetic test in an affected family member. For major NCD, a typical clinical picture, without extended plateaus or evidence of mixed etiology, can also be diagnosed as due to probable Alzheimer’s disease. For mild NCD, given the lesser degree of certainty that the deficits will progress, these features are only sufficient for a possible Alzheimer’s etiology. If the etiology appears mixed, mild NCD due to multiple etiologies should be diagnosed. In any case, for both mild and major NCD due to Alzheimer’s disease, the clinical features must not suggest another primary etiology for the NCD (Criterion D).

Brain regions and neurochemical pathways involved in Alzheimer’s Disease

While developing Alzheimer’s Disease connections are destroyed between the cells in the brain, as the cells die in the cortex, it begins to shrink. The hippocampus is located in the cortex which is responsible for new memories being formed. Because of this damage to the cortex the symptoms of loss of memory, intelligence, judgment, and behavior begin to appear. When looking at the brain regions and neurochemical pathways involved in Alzheimer’s disease we first look at the what occurs in the brain when developing AD. The main pathological features found in the autopsies of AD brain are neuritic plaques, Neurofibrillary tangles, and synaptic loss. Alzheimer’s disease begins with destroying neurons and their connections in parts of the brain involved in memory, including the entorhinal cortex and hippocampus. It later affects areas in the cerebral cortex responsible for language, reasoning, and social behavior. Eventually, many other areas of the brain are damaged. Over time, a person with Alzheimer’s gradually loses his or her ability to live and function independently. Alzheimer’s disease is fatal. Most brain changes are not detectable until after death, and an autopsy is able to be performed. Many molecular and cellular changes take place in the brain of a person with Alzheimer’s disease. Areas of the brain attacked by AD include the Hippocampus, the hypothalamus, the amygdala, the cerebellum, the frontal lobe, the parietal lobe, the occipital lobe, the corpus callosum, and the thalamus.

Symptoms of Alzheimer’s Disease

Mild

According to the national institute of aging Alzheimer’s disease progresses in several stages: preclinical, mild (sometimes called early-stage), moderate, and severe (sometimes called late-stage). In the beginning stage of AD known as the mild stage, a person may seem to be healthy but they begin to have trouble in everyday functions. At the early stage the individual is usually still able to detect that they are having some problems. This stage usually lasts about 2-4 years. Early symptoms include memory loss, poor judgment, taking longer to complete normal daily tasks, repeating questions, trouble handling money and paying bills, wandering and getting lost, losing or misplacing things, and mood and personality changes. The disease is able to be diagnosed at this stage because the symptoms are pretty clear and usual.

Moderate

Gradually the symptoms begin to worsen and supervision and care of the individual become necessary. This stage can range from 2-10 years. This stage of AD symptoms includes increased memory loss and confusion, inability to learn new things, difficulty talking, reading, and writing, difficulty organizing thoughts, shortened attention span, hallucinations, paranoia, delusions, impulsive behavior, restlessness, and outbursts of anger.

Severe

The ending stages of AD result in death. This stage lasts about 1-3 years. Since the brain is no longer able to function properly, the individual can no longer do just about anything for themselves. The ending symptoms of AD include the inability to communicate, weight loss, seizures, skin infections, difficulty swallowing, increased sleeping, and loss of bowel and bladder control. Luckily, there are medications that aid the individual with the symptoms of AD.

Therapies being utilized to treat Alzheimer’s Disease

Currently there is no cure for AD, but there are many therapies to assist and make the lives of those living with AD more comfortable. Therapies include drug therapy to help the symptoms of AD, and quality of life care. According to the National Institute of Aging Current approaches focus on helping people maintain mental function, manage behavioral symptoms, and slow down the symptoms of disease. Although there are medications that slow down some symptoms, there are no medications that actually stop the disease.

The treatment for the mild stage of AD includes a medication called cholinesterase which helps prevent the breakdown of acetylcholine. The treatment for the moderate stage of AD includes a medication called Namenda which helps regulate glutamate. Anxiety and depression medications are also given to help with the symptoms. Antipsychotics are also given to help with the hallucinations and paranoia. After the medications, the best treatment for someone with AD is a safe place where they can be when they are no longer able to do anything for themselves.

Research today

Much research is being done these days for AD. The Alzheimer’s Association has tons of different research funds in finding more causes, treatments, medications, and cures for AD. Because of the major increase of cases of AD and its expectancy to double by 2050, research is only getting bigger and more funded, which will hopefully amount to a cure of this disease.

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