The Peculiarities Of Alzheimers Disease

Abstract

Alzheimers is a progressive degenerative disease that ultimately leads to death due to the degeneration and plaque build up within the brain. Memory is an important aspect of daily life and for performing every day activities and when that is hindered it could be detrimental to the individual and how they are able to function throughout their life. Alzheimers may be hard to initially diagnose due to some believing that it is just due to older age but after performing tests and detecting specific biomarkers the provider is able to diagnose Alzheimers. Some genetic and environmental influences increase the risk in getting Alzheimers disease. Since Alzheimers is a progressive degenerative disease the patients will pass away within a few years of being diagnosed. Although the lifespan is not as long as one would generally hope, it can always be ensured that their life quality and care is the best that they deserve. A study was conducted for this research project on an Alzheimers patient and how many times she would forget that she just made a statement and would repeat herself. This research used a qualitative experimental design and also includes a small interview with the patients primary caregiver.

Alzheimers Disease

Memory is what allows one to complete small tasks throughout the day that generally does not require much thought to complete it. Short-term and long-term memory both plays part in day-to-day life and when one is hindered it could cause many issues for an individual. Alzheimers disease (AD) is a progressive neurodegenerative disease that accounts for most individuals who suffer with dementia after the age of 65 (Amoroso, 2018). Neurodegenerative symptoms such as dementia and cognitive impairment precede the diagnosis of Alzheimers. Life for individuals who suffer from Alzheimers may notice that daily tasks become more difficult, they may misplace things, have difficulty with time and place, and much more. Memory is an important aspect when it comes to Alzheimers disease and after some time individuals who suffer may not have the capabilities to form new memories. By identifying and understanding the early stages of AD can aid in future disease-modifying treatments (Amoroso, 2018). The purpose of this research aims to bring awareness to AD and the effects that it has on one the affected every day life.

Literature Review

Alzheimers starts at small memory changes then progresses to dementia then eventually death. Diagnosis is generally occurs in individuals after the age of 65 (Ulep, Saraon, & Mclea, 2018). The diagnosis generally starts off with analyzing any changes in memory, then doing a full medical, psychiatric, and substance abuse history. If a patient suffers from HIV, Lyme disease, and Syphilis it has been shown to increase ones chances of dementia (Neugroschl & Wang, 2011). A physical and neurological exam must me done to also rule out any other possible diseases or disorders that one may suffer from. Some screenings such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA) may be done as well the MoCA is more sensitive and useful for diagnosing moderate and severe dementia (Neugroschl & Wang, 2011). In order to have a definite diagnosis of AD specific biomarkers must be obtained such as structural and functional imaging, cerebrospinal fluid analysis (CSF), and amyloid positron emission tomography (PET Scan) (Ulep, et al., 2018). By performing more in depth procedures allow more accuracy in diagnosis. By analyzing CSF fluid, biomarkers are detectable 15-20 years before the initial symptoms present themselves (Ulep, et al., 2018). Depending on when one gets diagnosed and how early they get diagnosed for example, Mild AD (early stage), moderate AD (middle stage), and severe AD (late stage), will determine the next steps for that patient and the care that is needed for them in following.

By analyzing imaging of the brain it allows providers to see any dysfunction that may be going on with the brain. If one suffers from AD their brain will show amyloid plaques and neurofibrillary tangles. Alzheimers characteristics are the degeneration and death of neurons. When one views a brain scan there may be atrophy of certain region and appear to be shrunken and damaged. According to, Foundations of Behavioral Neuroscience (2014), by Neil R. Carson, Amyloid plaques are extracellular deposits that consist of a dense core of protein known as ²-amyloid, surrounded by degenerating axons and dendrites, along with activated microglia and reactive astrocytes, cells that are involved in destruction of damaged cells and Neurofibrillary tangles consist of dying neurons that contain intracellular accumulations of twisted filaments of hyperphosphorylated atu protein. AD causes excessive amounts of phosphate ions to attach to the strand of the tau protein, which change its molecular structure. In a normal brain, amyloid is found in the extracellular space around neurons, but during Alzheimers irregular forms of amyloid clump together and deposit and plaque. Accumulation of plaque can be seen within the cerebral cortex of patients (Carson, 2014). Plaques within the brain disrupt normal cell function, which eventually results in a disruption of communication with neurons, loss of function, and cell death.

Familial history and genetics have shown play roles within Alzheimers, studies have shown that numerous mutations of two presenilin genes found on chromosomes 1 and 14 also produce AD (Carson, 2014). One gene that consistently is shown to be associated with onset AD is apolipoprotein E gene (Bekris, Yu, Bird, & Tsuang, 2010). For example, if a parent is a carrier of apolipoprotein E gene it puts their child at higher risk for having Alzheimers. Family members with apolipoprotein E comes in many different variations and depending on the variation that one has will determine the percentage of risk they have for developing AD. Females who carry the apolipoprotein E gene are at a higher risk of developing AD versus men who carry the disease (Bekris, et al., 2010). Through studies and by analyzing genetics within individuals it is evident that genetics play a role and may increase risk in developing AD.

The environment that one lives in can influence certain organisms within their body and the body adapts to its external environment. Many environmental factors have been linked in increasing the risk of AD such as, metals, air pollution, pesticides, chronic psychological stress, starvation, hyperthermia/hypothermia, and brain trauma (Wainaina, Chen, & Zhong, 2014). Depending on the environment that one grew up in the brain will adapt and release different hormones from the hypothalamus to better adapt to the situations surrounding them. If an individual suffers from a stroke or a traumatic brain injury (TBI) it increases their chances of having some type of dementia due to the damage that has been done. External factors also affect neuronal mechanisms and activate the autonomic system, cerebrovascular dysfunction, glial activation, metals malmetabolism, kinase/phosphatase imbalance, and much more are the main mechanisms involved in the effects of environmental factors for AD (Wainaina, et al., 2014). If one is predisposed to a higher risk of AD due to genetic factors, by avoiding some environmental factors it could possible decrease their risk of getting AD.

Due to AD being a progressive deteriorating disease there is no cure but only symptomatic treatments. The symptomatic treatments attempt to counterbalance the neurotransmitter disturbance that occurs. Some treatments include, cholinesterase inhibitors for mild to moderate AD and memantine for severe AD (Yinnapoulou & Papageorgiou, 2013). According to Tabers Medical Dictionary (2017), cholinesterase inhibitors prevent the degradation of the neurotransmitter acetylcholine that is involved in memory and learning and memantine is used to slow the decline in cognitive function. As reviewed previously, a related factor of AD is degradation of acetylcholine and by inhibiting it allows a slower breakdown and slower memory and learning loss. The delirium and constant confusion often can cause frustration and depression on the patients so some antipsychotic and antidepressant treatments can be used along with the other pharmacologic treatments (Yinnapoulou & Papageorgiou, 2013). By decreasing the frustration and depression within the patients is highly beneficial for patient along for the caregivers of that patient. Studies have shown that systolic and diastolic hypertension is associated with cognitive impairment, so by administering antihypertensive it can decrease the incidence of cognitive impairment (Massoud & Gauthier, 2010). Although it is not possible to be completely cured from AD, the treatments that are available can decrease the symptoms and even slow down the progression of AD.

Discussion

This research study has shown that Alzheimers is a complex disease that affects the one who suffers with the disease along with the caretakers. When Alzheimers initially occurs, the onset could be missed or confused for another disease. The brain structure and function of one who has Alzheimers can be distinguished by observing scans for specific biomarkers specifically within the cerebral cortex. Many studies have been conducted and have shown that genetic and environmental factors increase the risk for one to have Alzheimers disease. Although for many there is no treatment and pass away a few years after diagnosis the way of living does not always have to be viewed negatively. Through caring for a patient who suffers from Alzheimers it is evident that the quality of living in the beginning is not very different but after time more deterioration occurs. Many of those who care for individuals who suffer from Alzheimers view it as a burden (Riepe, et al., 2009). Regardless of what a individual may be going through their life should never be considered a burden in my opinion, they did not ask to have the disease. Usually patients have impaired awareness and are unable to make decisions or make right judgments in certain situations (Riepe, et al., 2009). With the patient that was studied it was evident that many times she would forget what was discussed or stated just shortly before. A couple of times the patient got confused and would speak about her family and worrying about when she needs to return to then, she often worried about packing up her items to go home, and many times she would forget that she was in California and would be unaware of where she was and how she was going to return to California. The way that I approached responding to her whenever she got confused was just by softly remind her where she was and that she was at home already. I found that by reminding her that her son is coming home would quickly put her to ease. Although the Alzheimers is slowly going to get worse, her life that she has and her life that she lived will always remembered for her loved ones and everyone who cares for her would continue to present her with patience and love.

Relevance to the Bible

Alzheimers affects ones memory and recall but there is no scientific study where anyone has been able to prove that it affects their relationship with God. However with that being said, in the book of Daniel 5:21 with the story of what happened to King Nebuchadnezzar, He was driven away from people and given the mind of an animal; he lived with the wild donkeys and ate grass like the ox; and his body was drenched with the dew of heaven, until he acknowledged that the Most High God is sovereign over all kingdoms on earth and sets over them anyone he wishes (NIV).That verse of scripture one could arguably say that it could prove that though you could loose your mind you can still be mentally aware that God exist. Although if one had a relationship with Christ prior to being affected by Alzheimers and after decline in memory one may completely forget Deuteronomy 31:8 states, The Lord himself goes before you and will be with you; he will never leave you nor forsake you. Do not be afraid; do not be discouraged (NIV). With that being said, the Lord knows what is ahead and what he has planned for ones live. If one receives Alzheimers the Lord knew previous to the diagnosis and the Lord knew the heart of the individual prior to the memory loss. He will not leave nor forsake one and although there may be no progression of the relationship it will always be there.

Conclusion

Alzheimers disease is a progressive degenerative disease that when initially diagnosed can be concerning for what is expected in the future. Progressively the ability to perform daily activities, ability to remember names when introduced to new people, the ability to remember what was done that day, and much more disappears. Diagnosis of the disease involves identifying specific biomarkers through structural and functional imaging, CSF analysis, and PET Scans. Some specific biomarkers that would be viewed include amyloid plaques and neurofibrillary tangles. There are studies that have been conducted to show risk factors that are related to AD along with genetic and environmental factors are related to AD. Although there are no treatments for AD there are certain medications that will slow the degeneration and decrease the dementia. When patients have AD it may be scary to the family and patient due to the unknown, but by remembering the life that the patient lived and by knowing that God is in control can aid the family in coping with Alzheimers disease.

References

Alzheimer, Alois. (2017). In Venes, D. (Ed.), Taber’s Medical Dictionary. Available from https://nursing.unboundmedicine.com/nursingcentral/view/Tabers-Dictionary/754160/all/Alzheimer_Alois
Amoroso, N., Rocca, M. L., Bruno, S., Maggipinto, T., Monaco, A., Bellotti, R., & Tangaro, S. (2018). Multiplex networks for early diagnosis of alzheimers disease. Frontiers in Aging Neuroscience,10. doi:10.3389/fnagi.2018.00365
Bekris, L. M., Yu, C., Bird, T. D., & Tsuang, D. W. (2010). Review Article: Genetics of Alzheimer Disease. Journal of Geriatric Psychiatry and Neurology,23(4), 213-227. doi:10.1177/0891988710383571
Carlson, N. R. (2014). Foundations of behavioral neuroscience. Boston: Pearson.
Holy Bible: New International Version. (2005). Grand Rapids, MI: Zondervan.
Massoud, F., & Gauthier, S. (2010). Update on the pharmacological treatment of alzheimers disease. Current Neuropharmacology,8(1), 69-80. doi:10.2174/157015910790909520
Neugroschl, J., & Wang, S. (2011). Alzheimers disease: diagnosis and treatment across the spectrum of disease severity. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine,78(4), 596-612. doi:10.1002/msj.20279
Riepe, M. W., Mittendorf, T., Förstl, H., Frölich, L., Haupt, M., Leidl, R., . . . Schulenburg, M. G. (2009). Quality of life as an outcome in alzheimers disease and other dementias- obstacles and goals. BMC Neurology,9(1). doi:10.1186/1471-2377-9-47
Ulep, M. G., Saraon, S. K., & Mclea, S. (2018). Alzheimer disease. The Journal for Nurse Practitioners,14(3), 129-135. doi:10.1016/j.nurpra.2017.10.014
Wainaina, M. N., Chen, Z., & Zhong, C. (2014). Environmental factors in the development and progression of late-onset alzheimers disease. Neuroscience Bulletin,30(2), 253-270. doi:10.1007/s12264-013-1425-9
Yiannopoulou, K. G., & Papageorgiou, S. G. (2012). Current and future treatments for alzheimers disease. Therapeutic Advances in Neurological Disorders,6(1), 19-33. doi:10.1177/1756285612461679