Pathophysiology of Alzheimer’s Disease

Alzheimer’s disease is a slow, chronic, and insidious disease that works its way into its manifestations for years. It is the most common form of dementia, which is a term used for severe memory loss that will interfere with daily living (What is Alzheimer’s?). Alzheimer’s is much more than forgetting to turn off the stove after cooking, but may begin this way.

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This disease begins its progression by causing little things to slip the mind of the person suffering from the disease, and can lead to forgetting to bring in the groceries, getting lost on the way home, or even forgetting a loved one. This disease is not only hard for the patient, but can take a toll on the patient’s family and can lead to very difficult and emotional times for the family. It is extremely important to understand signs and symptoms of Alzheimer’s disease and to understand the pathophysiology behind the disease to better prepare and notice the onset of the disease in patients and loved ones alike.

Pathophysiology

The pathophysiology of Alzheimer’s is important to know so that early signs may be noticed and understood, and so that it may be treated correctly, not only medically, but therapeutically. It is known that as the body ages, the structures in the body and the functions that once worked properly may slow down or stop working as time goes on. One of the functions that begin to deteriorate with age is the blood brain barrier, which acts as a semipermeable membrane in the brain to regulate what enters and what exits the brain. It is important to regulate what comes into the brain, but issues occur more often when this barrier does not allow wastes to exit the brain. The body has ways of allowing wastes to get removed from the brain, but this will begin to deteriorate with age just as other functions deteriorate with time. The wastes staying in the brain begin to play a vital role in the onset of Alzheimer’s (Nizari, Romero, & Hawkes, 2017).

Etiology and Risk Factors

There are many risk factors that may lead to Alzheimer’s disease, and unfortunately there are very few modifiable risk factors which makes this disease very difficult to avoid. One of the main risk factors of Alzheimer’s is age. Most people with Alzheimer’s are found to be above age 65. Patients who are under age 65 and develop Alzheimer’s are diagnosed with Early Onset Alzheimer’s. It is unknown why some people develop Alzheimer’s earlier than others, but it is rare (Graff-Radford, 2017). It has been found in a population based study that females are more likely to develop Alzheimer’s (Cheng, Tsao, Su, Sung, Tai, & Kung, 2018). The same study also found that there are some modifiable factors that may lead to Alzheimer’s, including diabetes mellitus, hypertension, and hyperlipidemia, which may be prevented through a healthy diet and regular exercise (Cheng, Tsao, Su, Sung, Tai, & Kung, 2018). History of Alzheimer’s disease in the family also makes a great impact on development of this particular form of dementia (Cheng, Tsao, Su, Sung, Tai, & Kung, 2018).

Manifestations. The beginning signs and symptoms of Alzheimer’s disease begin with forgetting small things, such as forgetting to turn off the lights in the house before leaving. These beginning symptoms can also involve misplacing items, such as putting the car keys in the refrigerator. In the beginning it is easy to laugh it off and move on, but as the disease progresses it becomes apparent that something more severe than an occasional slip up is occurring. In early stages, patients with Alzheimer’s will begin developing short term memory loss, such as forgetting something that was just said moments ago (What is Alzheimer’s?). Memory issues are not the only signs of developing Alzheimer’s. There are also manifestations of dysphagia, dysphasia, and trouble with walking or balance (What is Alzheimer’s?). It is important to remember that the person developing these symptoms may not be aware, and may deny any symptoms. Oftentimes the family will see the symptoms before the patient does, and should search for help to keep this loved one from developing more issues in a shorter amount of time (What is Alzheimer’s?).

Complications. Complications of this disease do not only involve health related issues, but include complications from the patient being put in danger due to the lack of memory and cognitive function. Patients with Alzheimer’s may forget to turn off the stove at night after cooking, which can put the patient at risk of starting a fire, which also puts others at risk. These patients may also forget to eat or drink, which brings up risk of dehydration and malnutrition. Development of malnutrition is common with Alzheimer’s patients, and patients with other forms of dementia, and can lead to a quicker progression of the disease (Sun, Wen, Zhou, & Ding, 2017).

Diagnostics. There are multiple ways for a doctor to determine whether or not the patient is suffering from Alzheimer’s disease. After obtaining a thorough history of the patient and the family history, the doctor will then undergo a series of functional tests. The tests are to test neurological function and include testing reflexes, coordination, eye movement, speech, and sensation (Medical Tests). The doctor may also perform mental status testing which include tests such as a Mini-Mental State Exam or an MMSE, or a Mini-Cog test (Medical Tests). The MMSE test is a scoring system that is rated from 0-30, and is based off of a number of questions that the doctor may ask to determine cognitive function and memory. The lower the score, the more severe the case of Alzheimer’s is (Medical Tests). The Mini-Cog test is another way of looking at cognitive function and memory by remembering a list of objects and repeating them in a short amount of time, or drawing a clock with the numbers 1-12 in the appropriate area, and putting arrows to show the time that the doctor has stated (Medical Tests). Finally, the doctor may order brain imaging tests such as a Magnetic Resonance Imaging, or an MRI. The doctor may also choose to do a computed tomography, more commonly known as a CT scan. These tests help to rule out other possible issues that may be leading to loss of cognitive function, such as a stroke or a tumor that may be affecting the brain (Medical Tests).

Conclusion

Alzheimer’s disease can be an extremely difficult one to see a loved one develop, and can be frustrating to develop as well. It is important to know the history of family members to understand possible risk factors, and allowing preparation and prevention over time. It is also important to take care of the body through regular exercise and healthy diet, as this can affect the brain drastically, and lead to modifiable risk factors that may lead to Alzheimer’s. Looking for signs at an early stage may help slow the process of brain deterioration through this form of dementia, but there is still no cure at this time. Remember to be patient with loved ones and patients who may be dealing with the progression of this disease, and understand that this is very difficult on both sides. Therapeutic communication through this process can be one of the best treatments for all people affected by this.

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