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Alzheimer’s disease. UCHealth. (2023, March 3). https://www.uchealth.org/diseases-conditions/alzheimers-disease/#:~:text=Signs%20and%20symptoms&text=The%20four%20A%27s%20of%20Alzheimer%27s,aphasia%2C%20apraxia%2C%20and%20agnosia.

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The most common type of dementia and involves parts of the brain that control thought, memory, and language.

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Centers for Disease Control and Prevention. (2020, October 26). What is alzheimer’s disease? Centers for Disease Control and Prevention. https://www.cdc.gov/aging/aginginfo/alzheimers.htm#AlzheimersDisease?

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4 A’s of Alzheimers

1. Amnesia: loss of memory

2. Aphasia: loss of ability to express & understand speech

3. Apraxia: loss in voluntary motor skills

4. Agnosia: 5 senses can’t receive or correctly process information

(Uchealth, 2023).

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Accounts for 60 - 80% of all cases of Dementia

Degenerative, irreversible and progressive

Affects the cerebral cortex, specifically the frontal lobe of the brain

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Early-onset: occurs in individuals who are younger than 65

Late-onset: Most common, occurs in individuals ages 65 and older.

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one of the first warning signs of Alzheimer’s disease.

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Alzheimer’s disease is one of the top 10 leading causes of death in the United States. It is considered the most common type of dementia in order adults (2020).

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Involves the parts of the brain that control thought, memory, and language:

Prefrontal Cortex

Hippocampus

Amygdala

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Composed of 4 Gyri

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Involved in working memory

Spatial awareness

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Involved in working memory

Literacy

Numeracy

Attention control

Intersects with the precentral gyrus at Brodmann area 8 to control gaze

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Involved in Motor Inhibition

Speech

It contains Broca's area, which enables transitions between mental imagery and speech

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Controls voluntary motor movement

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Brain Structure embedded within the temporal lobe

It has a major role in learning and long term memory

Works in close association with the Amygdala

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Located within the temporal lobe

Plays an important role in experiencing emotion

Consists of approximately 13 nuclei

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Beta-amyloid

Neurofibrillary tangles

Granulovacuolar degeneration

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Preclinical: no symptoms noted, only pathological changes found if tested

Mild: forgetfulness, subtle memory loss, misplacing items, inability to concentrate, increased anxiety, trouble handling money

Moderate: difficulty remembering past, disorientation, episodes of wondering and getting lost, inability to recognized family and friends, restlessness and agitation

Severe (late-stage): decline in physical abilities such as walking, sitting and eventually swallowing; weight loss, require assistance with daily personal care, and become vulnerable to infections, especially pneumonia

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As soon as you notice certain early warning signs and symptoms (doctor can order blood tests, MRI, CT or PET imaging, perform neurological exams, cognitive and functional assessments).

Once Diagnosed:

Patient has sudden change in mental status or function

Patient can’t eat or sleep

Caregiver is no longer able to care for patient safely at home

Patient is feeling worse and may harm himself or someone else

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An abnormal protein produced in bone marrow that can be deposited in tissue or organs

Overproduction or reduced metabolism

Involved in the formation of neuritic plaques

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Aging (>65), family history gene mutation, hypertension, type 2 diabetes, obesity, traumatic brain injury, sedentary lifestyle

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Abnormally phosphorylated tau proteins

Normally, tau proteins provide structural support for neurons

In disease state, they result in abnormal fiber bundling and neuron death

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Accumulation of large, double membrane bodies within neurons

Occur as a result of neuron shrinkage from plaques and tangles

Widespread degradation leads to gap in neural network

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The exact cause of Alzheimer's is unknown, but it involves progressive loss of Ach-producing neurons and their associated synaptic neurons.

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Mayo Foundation for Medical Education and Research. (2022, June 2). Alzheimer’s prevention: Does it exist? Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/expert-answers/alzheimers-prevention/faq-20058140#:~:text=Are%20there%20any%20proven%20Alzheimer%27s,and%20other%20types%20of%20dementia.

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Approximately 44 million people globally are living with Alzheimer’s disease or a related form of dementia (Norris, 2019).

According to the Alzheimer’s Association, approximately 6.7 million Americans age 65 and older are living with Alzheimer’s in 2023.

Slightly more females are affected

Affects black people about twice as commonly as white people

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Norris, T. L. (2019). Porth’s Essentials of Pathophysiology. Wolters Kluwer.

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Stages of alzheimer’s. Alzheimer’s Disease and Dementia. (n.d.). https://www.alz.org/alzheimers-dementia/stages

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El-Baba, R. M., & Schury, M. P. (2023, May 29). Neuroanatomy, frontal cortex - statpearls - NCBI bookshelf. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK554483/ 

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El-Baba, R. M., & Schury, M. P. (2023, May 29). Neuroanatomy, frontal cortex - statpearls - NCBI bookshelf. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK554483/ 

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U.S. Department of Health and Human Services. (n.d.). What is alzheimer’s disease? National Institute on Aging. https://www.nia.nih.gov/health/what-alzheimers-disease

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Cause is unknown

As of now there aren’t any prevention strategies. However, Dr. Jonathan Graffiti-Radford, MD suggests that there is strong evidence that healthy lifestyle habits can reduce your risk of Alzheimer’s disease (2022).

Healthy lifestyle habits include:

Balanced diet (specifically Mediterranean diet): rich in vegetables, fruits, lean protein, omega-3 fatty acids

Exercise & maintain a healthy weight

Control HTN, high cholesterol and diabetes

Avoid head injury

Treat hearing loss

Smoking cessation

Limit alcohol consumption

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Reversible Indirect-Acting Cholinergic Agonists

Similair agents are galantamine (Razadyne) and rivastigmine (Exelon)

Binds Acetylcholinesterase

Results in increased availability of acetylcholine at cholinergic receptors

Halflife 70 hours; metabolized in the liver; excreted in the urine

Adverse effects: insomnia, fatigue, rash, nausea, vomiting, diarrhea, dyspepsia, abdominal pain, and muscle cramps.

Risk of GI bleeding if used with nonsteroidal anti-inflammatory drugs (NSAIDs)