Advanced Professional Nurse or Colleague Pathophysiology Synthesis

Alzheimer’s Disease

Alzheimer’s disease is a significant problem in the US, affecting more than 30 million individuals globally and 5.3 million in the US. It is the single leading cause of mortality and is diagnosed alongside more than 70% of individuals with dementia (Thakur et al., 2018). The disease is characterized by the systematic and progressive deposition of amyloid plaques and tangles in the brain, and affected brain centers lead to thinking, behavior, and memory problems- cognitive impairment. Tiwari et al. (2019) note that the loss of intellectual functions interferes with relationships, work, and personal care hence the need for continued supervision and assistance with activities of daily living. The disease burden is higher in older adults above 65, and the risk increases significantly above age 85.

Pathophysiology

The pathophysiology of AD follows the distortion of neuron communication, repair, and metabolism. The etiologies of Alzheimer’s are cholinergic dysfunction, amyloid/tau toxicity, or oxidative stress/mitochondrial dysfunction (Thakur et al., 2018). The etiologies cause neuronal changes that impede communication and impulse conduction. These processes lead to cortical atrophy, forming neurofibrillary tangles and senile plaques. Thakur et al. (2018) note that AD is characterized by an intensified loss of neurons and synaptic functions in distant anatomical loci that results after the loss of conduction following the deposition of the amyloid plagues. After brain cell death, the plagues bind the brain and affect the cells and connective tissue. The death and destruction of the nerve cells, coupled with the accumulation of protein plaques, progressively causes memory failure, personality problems, and trouble with activities of daily living.

Clinical Manifestations

Alzheimer’s disease presents memory impairment as the first sign, often confused with old age symptoms. Individuals have problems learning new memories but often retain old memories. Individuals are irritable, repeat things, misplace items, and have disturbed sleep. The severe symptoms where individuals experience problems with speech, patterns of performing activities, safety issues (such as a burnt house after forgetting they were cooking), and in later stages, they forget everything, including their family members (Tiwari et al., 2019).

Diagnostic tests

Alzheimer’s disease is categorized as definite, probable, or possible depending on the presentation, clinical symptoms, and histological confirmation. Memory loss and other cognitive presentations such as anomia (Dubois et al., 2021). Diagnostic lab tests such as full hemogram and CSF fluid analysis help derive a more definitive diagnosis. Head CT and MRI exclude other causes, such as tumors and infections (Thakur et al., 2018). Other methods targeting the various etiologies mentioned earlier can be used but are unreliable due to the widespread sharing of these symptoms among neurological conditions.

References

Dubois, B., Villain, N., Frisoni, G. B., Rabinovici, G. D., Sabbagh, M., Cappa, S., Bejanin, A., Bombois, s., Epelbaum, s., Teichmann, D. ., Habert, M. D., Nordberg, N.., Blennow., Galasko, D., Stern, Y., Rowe, C. C., Salloway, S., Schneider, L. S., Cummings, J. L., & Feldman, H. H. (2021). Clinical diagnosis of Alzheimer’s disease: recommendations of the International Working Group. The Lancet Neurology20(6), 484-496. https://doi.org/10.1016/S1474-4422(21)00066-1

Thakur, A. K., Kamboj, P., Goswami, K., & Ahuja, K. (2018). Pathophysiology and management of Alzheimer’s disease: An overview. J. Anal. Pharm. Res, 7(1). https://doi.org/10.15406/japlr.2018.07.00230

Tiwari, S., Atluri, V., Kaushik, A., Yndart, A., & Nair, M. (2019). Alzheimer’s disease: pathogenesis, diagnostics, and therapeutics. International journal of nanomedicine, 14, 5541. https://doi.org/10.2147/ijn.s200490

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