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ALZHEIMER’S DISEASE
BY- DR. ARMAAN SINGH
Although we do experience minor changes in our memory and thinking as we age, these changes do not affect daily functioning or the ability to live independently.
Memory changes are a normal part of the aging process—it's common to have less recall of recent memories and to be slower remembering names and details.
Alzheimer’s disease is not a normal part of aging or “just what happens when we get old.” If Alzheimer’s was part of the natural aging process, then every person over 65 years of
age would have Alzheimer’s disease.
WHAT IS NORMAL AGING?
Source: About.com Health's Disease and Condition, Carrie Hill, PhD
Source: MSN Health, Healthwise, http://health.msn.com/health-topics/aging/articlepage.aspx?cp-documentid=100097440
A person might forget part of an experience.
A person who forgets something will eventually remember the information.
A person can follow instructions without difficulty.
A person is able to use notes or reminders.
A person can still manage their own personal care (bathing, dressing, grooming, etc.).
A person is able to manage their finances.
A person with Alzheimer’s disease will forget the whole experience.
A person with Alzheimer’s won't recall the information at a later time.
A person with Alzheimer’s disease is less and less able to follow instructions over time.
A person with Alzheimer’s gradually become less able to benefit from memory aids or forgets to use them.
A person with Alzheimer’s loses the ability to engage in these kinds of tasks.
A person is unable to track spending, pay bills, manage savings/checking accounts.
EXAMPLES
Source: About.com Health's Disease and Condition, Carrie Hill, PhD
Normal Aging Not Normal Aging
BRIEF HISTORY Alois Alzheimer, a German physician, is
credited with being the first to describe AD. In 1906, Dr. Alzheimer observed a patient,
Auguste Deter, in a local asylum who exhibited strange behaviors. He followed her care and noted her memory loss, language difficulty and confusion.
After her death at the age of 51 he examined her brain tissue. The slides showed what are now known as plaques and tangles that are recognized as Alzheimer’s disease.
In 1911, Doctors were using Dr. Alzheimer’s research to base diagnosis.
In the 1960’s British pathologists determined that AD was not a rare disease of the young but rather what had been termed “senility.”
In the 1990’s researchers identified that the beta amyloid protein was a factor in AD.
Alois Alzheimer
Auguste Deter
WHAT IS ALZHEIMER’S DISEASE?
Alzheimer’s is a progressive, degenerative and incurable neurological brain disease that causes deterioration of brain nerve cells and ultimately death.
The deterioration is caused by:a build up of abnormal substances called
amyloid plaques (an insoluble protein deposit);
And neurofibrillary tangles.
PLAQUES AND TANGLES
Healthy neurons help guide nutrients and molecules from the cell body to the ends of the axon and back.
Plaques form when protein pieces called beta-amyloid clump together. Beta-amyloid comes from a larger protein found in the fatty membrane surrounding nerve cells.
Beta-amyloid is chemically "sticky" and gradually builds up into plaques .
Neurofibrillary tangles (NFTs) which are found inside neurons, are abnormal collections of a protein called tau .
In AD, when NFT’s build up nutrients and other essential supplies can no longer move through the cells, which eventually die.
Source: Alzheimer’s Association: http://alz.org/alzheimers_disease_4719.asp Brain Tour
Axon – conducts nerve signal
Neuron-transmits to brain
Dendrites – signal receiver
Communication
INSIDE THE BRAIN
In the Alzheimer brain:The cortex shrivels up,
damaging areas involved in thinking, planning and remembering.
Shrinkage is especially severe in the hippocampus , an area of the cortex that plays a key role in formation of new memories.
Ventricles (cerebrospinal fluid-filled spaces within the brain) grow large
Source: Alzheimer’s Association: http://alz.org/alzheimers_disease_4719.asp Brain Tour
Cortex
Hippocampus
Ventricles
Source: Image from the Alzheimer’s Society of Saskatchewan with permission from Alzheimer’s Broken Brain.
Alzheimer’s Brain Normal Brain
Dementia is a set of signs and symptoms, not a disease. Dementia is characterized by memory loss, changes in mood and
communication difficulties.
Types of diseases with the symptom of dementia are: Alzheimer’s disease
Most common. Vascular dementia
stroke related, 2 nd most common type of dementia Dementia with Lewy Body
Lewy bodies are deposits of a protein called alpha-synuclein that form inside the brain’s nerve cells. Affects memory, concentration, speech.
Frontotemporal dementia a rare disorder that affects the frontal lobes and the
temporal lobes (sides) of the brain. Affects behavior, personality and memory later.
Wernicke-Korsakoff syndrome most common cause is alcoholism, but the syndrome can
also be associated with AIDS, cancers.
SO WHAT IS DEMENTIA?
In a few cases, dementia is caused by a problem that can be treated. Once treated, the symptom of dementia often disappears. Examples include:
Having an underactive thyroid gland (hypothyroidism) can cause difficulty with concentration and forgetfulness.
Vitamin B12 deficiency. B12 supports the function and development of the brain, nerves, blood cells, and many other parts of the body.
Dehydration – severe dehydration causes confusion. Malnutrition – prevents the brain from functioning properly. Urinary Tract Infections – a type of infection that affects brain function. In some, depression can cause memory loss; often referred to as
Pseudodementia. Medications - Taking some medicines together may cause symptoms that look
like dementia. This includes prescribed, over the counter, herbals, vitamins and supplements.
DEMENTIA…NOT
Source: WebMD http://www.webmd.com/alzheimers/tc/dementia-topic-overview
Source: About.com http://alzheimers.about.com/od/diagnosisofalzheimers/a/reversible.htm
Mild cognitive impairment (MCI) is a condition in which a person has problems with memory, language, or another mental function severe enough to be noticeable to other people and to show up on tests, but not serious enough to interfere with daily life.
Individuals with MCI have an increased risk of developing Alzheimer’s disease over the next few years, especially when their main problem is memory.
Not everyone diagnosed with MCI goes on to develop Alzheimer’s. There is currently no treatment for MCI approved by the FDA.
WHAT IS MILD COGNITIVE IMPAIRMENT?
Source: Alzheimer’s Association: www.sanalz.org
Age – Biggest risk factor 10% of individuals over the age 65 will have AD. After age 85, the risk reaches nearly 50 percent.
Family History Research has shown that those who have a parent, brother or sister
with Alzheimer’s are more likely to develop Alzheimer’s. The risk increases if more than one family member has the illness.
Genetics – Risk Genes Deterministic Genes
RISK FACTORS
Source: Alzheimer’s Association San Diego Chapter – www.sanalz.org
Risk Genes
Risk genes increase the likelihood of developing a disease but do not guarantee it will happen. APOE-e4 is one of three common forms of the APOE (apolipoprotein) gene. Everyone inherits a copy of some form of APOE from each parent. Those who inherit one copy of APOE-e4 have an increased risk of developing
Alzheimer’s. Those who inherit two copies have an even higher risk, but not a certainty. In addition to raising risk, APOE-e4 may tend to make symptoms appear at a younger
age than usual.
RISK FACTORS
Source: Alzheimer’s Association San Diego Chapter
Deterministic Genes/Early Onset :directly cause a disease, guaranteeing that anyone who
inherits them will develop the disorder.Scientists have found rare genes that directly cause
Alzheimer’s in only a few hundred extended families worldwide.
This type is known as “familial Alzheimer’s disease”, and many family members in multiple generations are affected. True familial AD accounts for less than 5% of the cases.
RISK FACTORS
Mild or Early Stage Friends, family or co-workers begin to notice deficiencies. Some common
difficulties include: Word finding problems Decreased ability to remember names Performance issues in social or work settings Reading a passage and retaining little material Losing or misplacing a valuable object Decline in ability to plan or organize
STAGES OF AD
Source: National Alzheimer’s Association
Moderate or Middle Stage Major gaps in memory and deficits in cognitive function emerge. Some
assistance with day-to-day activities becomes essential. Some common difficulties include: Inability to recall important details such as their current address, their telephone
number. Confused about where they are or about the date, day of the week or season. Need help choosing proper clothing for the season or the occasion. May have increasing episodes of urinary or fecal incontinence and need assistance
with toileting and personal care. Lose most awareness of recent experiences and events as well as of their
surroundings. Tend to wander and become lost. Experience significant personality changes and behavioral symptoms.
including suspiciousness and delusions (for example, believing that their caregiver is an impostor)
hallucinations (seeing or hearing things that are not really there) compulsive, repetitive behaviors such as hand-wringing or tissue shredding
STAGES OF AD
Source: National Alzheimer’s Association
Severe or Late Stage This is the final stage of the disease when individuals lose the ability to
respond to their environment, the ability to speak and, ultimately, the ability to control movement. Frequently individuals lose their capacity for recognizable speech, although
words or phrases may occasionally be uttered. Need full assistance with eating and toileting and there is general
incontinence. Individuals lose the ability to:
walk without assistance sit without support ability to hold their head up Reflexes become abnormal and muscles grow rigid Swallowing is impaired
STAGES OF AD
Source: National Alzheimer’s Association
WHAT IS IT LIKE WITH AD?
Who was the story about?Who were the characters in
the story?What is the story about?Where did the story take
place?When did the story take
place?
WHEN WAS THE LAST TIME YOU NEEDED HELP WITH…?
Bathing Personal care (toileting and
all that goes with it) Getting dressed Brushing your teeth Combing your hair
AnxietyParanoia, suspicionDepressionOutbursts – emotional,
verbal, physical aggression.RummagingPoor grooming, dressing,
hygieneSexually inappropriate
behaviors
Refusal to eatEating non food itemsWandering, pacingHoardingRepetitive behaviors such
as actions, wordInappropriate social
behaviors such as undressing in public, inappropriate conversation with others.
COMMON BEHAVIORS
A process of elimination through testing. 100% diagnosis for AD comes at autopsy when the brain can be examined. Diagnosing AD
Physician will review your medical history Mini Mental Status Exam administered (assesses mental function through a series of
questions) A physical exam will be completed Diagnostic tests will be ordered to rule out other illnesses or deficiencies that mimic memory
loss. Such as: Anemia, malnutrition or certain vitamin deficiencies, excessive use of alcohol, medication side effects, infections, diabetes, kidney or liver disease, thyroid abnormalities, problems with the heart, lung or blood vessels.
Neurological Exam which includes: Reflexes, coordination and balance, muscle tone and strength, eye movement, speech and sensation.
Brain Imaging through: Structural imaging provides information about the shape, position or volume of
brain tissue. Structural techniques include magnetic resonance imaging (MRI) and computed tomography (CT).
Functional imaging reveals how well cells in various brain regions are working by showing how actively the cells use sugar or oxygen. Functional techniques include positron emission tomography (PET) and functional MRI (fMRI).
HOW DO WE KNOW IT IS AD?
There are 2 types of FDA approved drugs to treat the cognitive symptoms of AD. These drugs affect the activity of two different chemicals involved in carrying messages between the brain’s nerve cells. The first type are called Cholinesterase (KOH-luh-NES-ter-ays)
inhibitors and they prevent the breakdown of acetylcholine (a-SEA-til-KOH-lean), a chemical messenger important for learning and memory.
Cholinesterase inhibitors commonly prescribed: Donepezil (Aricept) Rivastigmine (Exelon) Galantamine (Razadyne) Tacrine (Cognex)
The second type is Memantine (Namenda) and this works by regulating the activity of glutamate, a different messenger chemical involved in learning and memory. Memantine:
Approved in 2003 for treatment of moderate to severe Alzheimer's disease.
TREATMENTS
Source: National Alzheimer’s Association www.alz.org
Bad News: You cannot prevent Alzheimer’s disease
Good News: You can help keep your brain sharp with regular social activity; "mental exercise," such as doing crossword puzzles and reading; and physical activity, which increases blood and oxygen flow to the brain and a healthy diet.
PRESERVING COGNITIVE FUNCTION
IMPACT AD is the 7th leading cause of death in the U.S. (Heart Disease is #1) Length of the disease is 3 – 20 years
Currently, there are 5.4 million with AD; SD/Imp Cty=90,000
By 2029 all Baby Boomers (1946-1964) will be at least 65 – 10 million of the 78 million are predicted to develop AD.
More women than men will develop AD Avg life expectancy in 2010 – Women 80.8; Men 75.7 (US Census projection)
2010 Cost of Care is estimated at $172 billion (Healthcare and Long Term Care) Skilled Care:$6K/mo; In Home Care: $3,800/mo; Daycare:$1,500/mo Cost to businesses – lost work time, absenteeism, leaves of absence, quitting work.
In 2009 there were an estimated 10.9 million unpaid caregivers (family, friends Several studies show hours of caregiving range from 21-40; higher number of hours as the
disease progresses. Average age of the caregiver is 51. 60% of the caregivers are female.
Source: National Alzheimer’s Association http://www.alz.org/documents_custom/report_alzfactsfigures2010.pdf
