The Alzheimer’s Disease

8/12/2019 The Alzheimers Disease

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The Alzheimers

DiseaseBy:

-Desti Omega R

-Devi Noviana

-Lona Maharani O

-Melanita Hardiyati

-Resti M


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Our

Topic

Case

Case Explaination

KeywordsClinical

Manifestation

Pathophysiology

Definitions Test and Diagnosis

Risk Factors

Outlook (Prognosis)

TreatmentEtiology


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The

Alzhei

mersDiseas

e

Case 32

An 83 years-old women is brought to the clinic by her husband

who was concerned with his wifes memory problems. He noticed

some memory decline a few years ago, but the onset was subtle and

did not interfere with her day-to-day activities. Mainly she has some

difficulty remembering details repeating things, and is being forgetful.

The patient family noticed her gradually increasing memory

problems, particulary over the past year. She is unable to remember

her appointment and relies heavily on writen notes and appointment

books. Resently she got lost while driving and was found by her

family 10 hours later. She was unable to use her cell phone and wasunsure about her home address and phone number. She has also

become more reclusive. She does not enjoy her church activities

anymore and prefers to stay at home most of the time. She does not

want to cook and she is less attentive to her housework. The patient

says that she has always been forgetful. Her medical history is

significant for well-controlled hypertention and a history of

mastectomy secondary to breast cancer diagnosed 20 years ago.

She has no significant story of tobacco or alcohol use. She is

independent with all activities of daily living, but needs assistance

with medication adminitration, banking, and transportation. She is up

to date with her health maintenance and immunization. Her vital

signs and general physical examination are normal.


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An 83 years-old women

Memory problem decline a few years ago

Difficult remembering details repeating things and

being forgetful

Unable to remember her appointment

She does not enjoy her church activities Her medical history is significant for well-controlled

hypertention

History of mastectomy secondary to breast cancer

No significant tobacco and alcohol use

She is up to date about her health maintenance andimmunization

Her vital sign and physical examination are normal


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Cas

eExpla

inatio

n

Component/

System

Complaint/Data Language Focus

Name

Age

SexOccuopation

Marital status

Present complaint

Onset

ENT

RS

CRV

GIS

GUS

CNS

-

83 years-old

Female-

Marriage

Memory problem

A few years ago

-

-

-

-

-

-

Whats your name?

How old are you?

Are you male or female?Whatsyour job?

Are you already have a family?

Whatsbought you along today?

How long have you had them?

Do you have any problem with your

ear, nose, or throat?


respiration? Like cough or

breathless?


heart? Like chest pain?

Do you have stomach pain after

eating something?

Any problem with your waterwork?

Do you feel discomfort when look at

the light?


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Cas

eExpla

inatio

n

Immediate

past history

Another data

Well-controlled

hypertention

Mastectomy secondary tobreast

Difficult remembering

details, repeating things

and being forgetful.

Recently she got lost while

driving.

Unable to use her cell

phone

Unsure about home

address and phone number

Not enjoy her chruch

activities and prefers to stay

at home.

No significant history of

tobacco or alcohol use

Do you have another sickness in

the past?

Do you have another sickness fornow?

Does something you want to tell

again?

Do you ever go somewhere and

get lost?

Can you use your cell phone?

Can you tell me where is your

home is?

Are you enjoy your activities on

chruch?

Are you a tobacco or alcohol

use?


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Definition

ofAlzh

eimers

Alzheimer's disease is a progressive, degenerative disorder that

attacks the brain's nerve cells, or neurons, resulting in loss of

memory, thinking and language skills, and behavioral changes.

Neurology in Clinical Practice.5thed. Philadelphia, Pa: Butterworth-

Heinemann Elsevier; 2008

A degenerative brain disease of unknown cause that is the most

common form of dementia, that usually starts in late middle age

or in old age, that results in progressive memory loss, impairedthinking, disorientation, and changes in personality and mood,

that leads in advanced cases to a profound decline in cognitive

and physical functioning, and that is marked histologically by the

degeneration of brain neurons especially in the cerebral cortex

and by the presence of neurofibrillary tangles and plaques

containing beta-amyloidabbreviationAD; called also

Alzheimer's

Alois(18641915),Germanneurologist


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Etio

logyofAlzheimers

The causes of Alzheimer's are not yet fullyunderstood

Older

Genetic(APOE

epsilon4allele)

Close blood


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Pathophys

iology

Genetic Abnormality

neurotransmittenImmunologyVirus attact

Decreasing metabolism and blood flow in cortex parietale

Atropy brain cells

Tangled neurofibrilloss of cholinergic fibers

in the cerebellum

Abnormality of

neurotransmitten

Decrease in acetylcholine

memory loss, intellectual impairment, behavioral, cognitive

Alzheimers Disease


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Clin

icalManifestations

ClinicalManifestationAlzheimers

MemorySpeaking and

writing

Disorientation andmisinterpreting

spatial relationships

Changes inpersonality and

behavior

Thinking andreasoning

Repeat statement

Depression,social withdrawl

aggresive

Difficultconcentrating and

thinking

What day is it?Seasons?

Have trouble to

identificate object


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Risk

Facto

rs

Risk Factors

Age LifestyleGenetic


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Testandd

iagnos

is

Test and Diagnosis

Physical andneurological exam

Mental statustesting

Lab tests

MRI dan CT-Scann


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Treatment

Drug

Cholinesterase inhibitors.These drugs work by boosting

levels of a cell-to-cell communication chemical depleted in

the brain by Alzheimer's disease. Most people can expect

To keep their current symptoms at bay for a time. Less thanhalf of those taking these drugs can expect to have any

improvement. Commonly prescribed cholinesterase

inhibitors include donepezil (Aricept), galantamine

(Razadyne) and rivastigmine (Exelon). The main side effects

of these drugs include diarrhea, nausea and sleep

disturbances.

Memantine (Namenda).This drug works in another brain

cell communication network and slows the progression of

symptoms with moderate to severe Alzheimer's disease. It's

sometimes used in combination with a cholinesterase

inhibitor.

Exercise

Nutritions


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How quickly AD gets worse is different for each

person. If AD develops quickly, it is more likely

to worsen quickly.

Patients with AD often die earlier than normal,although a patient may live anywhere from 3 - 20

years after diagnosis.

The final phase of the disease may last from a few

months to several years. During that time, the

patient becomes totally disabled. Death usuallyoccurs from an infection or organ failure.


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Con

clusio

n

Alzheimer's disease is a progressive,

degenerative disorder that attacks the brain's nerve

cells, or neurons, resulting in loss of memory,

thinking and language skills, and behavioral

changes.

In Alzheimer's disease, the connections

between brain cells and the brain cells themselves

degenerate and die, causing a steady decline in

memory and mental function.

Current Alzheimer's disease medications and

management strategies may temporarily improve

symptoms. This can sometimes help people with

Alzheimer's disease maximize function and

maintain independence. But because there's no

cure for Alzheimer's disease, it's important to seeksupportive services and tap into your support

network as early as possible.


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TH NKYOU

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The Alzheimer’s Disease