11 Jan Concept Map: Alzheimer’s Disease

1. Describe the pathophysiology of the primary diagnosis in your own words. What are the patient’s risk factors for this diagnosis?

Pathophysiology of Primary Diagnosis

Alzheimer disease is a progressive neurodegenerative disease and gradually progressing and is distinguished by the multiplexing of amyloid-beta plaques and tau tangles in the cranium which kill neurons and make the Crain shrink. The pathological alterations affect the hippocampus and cerebral cortex with resultant memory loss, intellectual decline and behavioral alterations. The neuronal damage is aggravated by neuroinflammation and oxidative stress (Tiwari et al., 2019). The disease impacts the quality of life as it advances, and in the end, it leads to severe shortages in cognitive and motor functions, indicating that individuals with the diagnosis should be provided with considerable support and help.

Causes

Risk Factors (genetic/ethnic/physical)

· Building of deposits of amyloid-beta in the brain.

· Development of neurofibrillary tangles in the brain.

· Neuroinflammation

· Oxidative stress

· Age (people above 65 years)

· Familiar history of Alzheimer.

· Genetic mutations (e.g. APOE-e4 allele)

· Heart diseases (e.g. high blood pressure, diabetes)

· Ethnicity (increased in African Americans and Hispanics)

· History of head trauma

· Sedentary lifestyle

2. What are the patient’s signs and symptoms for this diagnosis? How does the diagnosis impact other body systems and what are the possible complications?

Signs and Symptoms – Common presentation

How does the diagnosis impact each body system? Complications?

· Daily life disruption on memory loss.

· Issues connected to planning and problem-solving.

· Confusion with time or place

· Problem with the accomplishment of familiar tasks.

· Lack of good judgment and decision making.

· Mood, personality or behavior change.

The nervous system is usually affected by the Alzheimer disease, with its progressive decline of mental faculties and memory, as well as of behavior. It also has an impact on the cardiovascular system in terms of the risk factors associated with it such as hypertension and diabetes. Motor impairments impact the musculoskeletal system that results in falls and fractures. Its subsequent phases can cause difficulties in swallowing thereby causing malnutrition and aspiration pneumonia. Then, it impacts the immune system as it becomes weakened thereby putting the infected individual at risk of contracting infections. Among the effects, memory loss, inability to perform daily activities, frequent falls, loss of weight, pneumonia, and helplessness that has to be looked after all the time are included (Breijyeh and Karaman, 2020).

3. What are other potential diagnosis that present in a similar way to this diagnosis (differentials)?

Alzheimer possible diagnosis of inclusion involves:

· Vascular dementia

· Lewy body dementia

· Frontotemporal dementia

· Normal pressure Hydrocephalus.

· Mixed dementia

· Vitamin B12 deficiency

· Depression

· Hypothyroidism

· Traumatic brain injury: chronic.

· Wernicke-Korsakoff syndrome

4. What diagnostic tests or labs would you order to rule out the differentials for this patient or confirm the primary diagnosis?

· Neuroimaging: By MRI or CT scan to determine the atrophy of the brain and exclude the other causes like tumor or strokes.

· Blood tests: To exclude the presence of vitamin deficiencies (e.g., B12), diabetes of the thyroid, and infections.

· Cognitive tests: Mini-Mental state examination (MMSE), Montreal cognitive assessment (MoCA) etc.

· Cerebral spinal fluid (CSF) examination: To identify amyloid -beta and tau protein concentration.

· Genetic testing: When family history is noteworthy: APOE-e4 allele.

· Neuropsychological testing: To determine the cognitive functions.

5. What treatment options would you consider? Include possible referrals and medications.

Medications

· Cholinesterase inhibitors (ex: donepezil and rivastigmine)

· Non-memantine drugs (NMDA receptor antagonist)

· Behavioral symptoms (e.g., sertraline, risperidone) antidepressants and antipsychotics.

Non-pharmacological interventions

· Cognitive therapy and rehabilitation.

· Occupational therapy

· Physical exercise programs

· Activities of social engagement.

Possible Referrals

· A Neurologist to provide special treatment.

· Behavioral symptoms psychiatrist.

· Mobility and balance mobility trainer physical therapist.

· Nutritional support nurse.

· Social worker or case manager to help in the care planning and resources.

References

Breijyeh, Z., & Karaman, R. (2020). Comprehensive review on Alzheimer’s disease: causes and treatment. Molecules, 25(24), 5789. Doi: 10.3390/molecules25245789

Tiwari, S., Atluri, V., Kaushik, A., Yndart, A., & Nair, M. (2019). Alzheimer’s disease: pathogenesis, diagnostics, and therapeutics. International journal of nanomedicine, 5541-5554. Doi: 10.2147/IJN.S200490