ALZHEIMER’S DISEASEGregor Alfonsin C. Pondoyo

What is it?

Alzheimer’s disease is a type of dementia that is progressive and is accompanied by “profound effects on memory, cognition, and ability for self-care” (Smeltzer et al, 2008).

most common form of dementia among 65 years old and above

constitutes at least half of all dementias progressive decline in two or more areas

of cognition: memory and language calculation and visuospatial perception constructional praxis judgement, abstraction, or personality (Black

and Hawks, 2004)

Epidemiology

in 1996 4 million people were diagnosed with the disease in the US (Tavee and Sweeney, 2010)

more women are affected than men in a ratio of 2:1

Age is a very important risk factor

As of 2006, Alzheimer’s disease in the US is considered the 7th leading cause of death and the primary cause of it are intercurrent illnesses such as pneumonia for those who have suffered advanced Alzheimer’s disease hence immobility and difficulty swallowing (Anderson, 2010).

In a worldwide prevalence, DOH estimated that 11 million people suffer and about 5% of people reaching 65 are affected while 15-25% of people reaching 85 are affected.

“Today more than 5.5 million Americans have Alzheimer’s...” (Barglow, 2010)

Essential Anatomy and Physiology

Human nervous system major conductor of the body as it governs its

varied functions like exerting control over glands, organs and muscles

controls, the urination, defecation, sleeping and waking time, the osmotic concentration of the blood, the rate of breathing and heart beat, and even the blood pressure

Important Higher Function of the Nervous System

processing of information that helps us to remember, think, and judge, making us humans highly superior from other species

I think; therefore I am

Rene Descartes

Nervous system consists of two divisions

central nervous system or the CNS

peripheral nervous system or the PNS

ZOOM

Two Divisions of PNS

To be specific, the nervous system has three major functions to wit: sensory, integrative,

and motor (Herlihy and Maebius, 2000)

The sensory nerves gather information from the environment (either internal or external) and carry them to the CNS.

Integrative (processing of information like thinking)

Motor

There is conversion of the previously planned action into actual action and this function is the motor function.

What makes up the Nervous System?

Neurons

Neuroglia

Neurotransmitters

The Human Brain

Cerebrum

Diencephalon

Cerebellum

Brain Stem

Limbic system

Hippocampus

Etiology

Important Predisposing Factors

Age the frequency of the disease increases to 20-

40% of the population over 85 years of age (Fauci et al, 2009)

Positive health history of Alzheimer’s disease in the family

Genetic Links

Sporadic AD (most common)

genetic and environmental factors

Familial AD (FAD)

autosomal dominant form of disease which means that it needs 1 parent to let the gene be passed on to the next generation

...”Diabetes Mellitus, high cholesterol, elevated homocysteine, low exercise are risk factors of AD” (Fauci et al., 2009).

(Morhan, 2008)

It is important to remember that the precise cause of this condition however is

still not thoroughly known.

Plaque Formation

Pathogenesis

Neurofibrillary tangles

PET scan

The Progression

Alzheimer’s Disease Diagram

Oxidative Stress(Further) insulin resistance

Hyperlipidemia

Lipid Peroxidation

Hyperglycemia

Cardiovascular Diseases

Alpha and Gamma Secretase

APP will then be cut either by:

Predisposing FactorsAgeGenetic Factor (family history)Gender (women)DMDown syndromeSmall head size

Precipitating factorStroke (brain attack)Head InjuryProlonged loss of consciousness (as in drowning)Low exercise and cigarette smokingLower levels of educationHigh blood pressureHigh cholesterol levelsHigh homocysteine levels

Increased ROS (free radicals) and RNS

Damages proteins, lipids, DNA

VITAMIN E

Cellular starvation

PET will show hypomebolism

Non-usage of neuron

Nerve Impulse Blocking

Atrophy

CELL DEATH

Acetylcholine not transported

Plaque build up (esp. In hippocampus and cerebral

cortex)

Depletion of intrinsic antioxidants

(Chronic) Inflammation

Amplification of oxidative stress

Generation of more free radicals

Disrupts microtubules

Nutrient transport system goes awry

Cleared in the brain

Continuous productionClings between nerve synapse

Not cleared in the brain

Clumping effect

Harmless P3 Protein fragment

42 Amino Acid

Beta and Gamma Secretase

40 Amino Acid Tau hyperphosphorylation

Tau protein pair up

Form helical shape

Clump together

Neurofibrillary tangles formed

Microscopy but only after death or AUTOPSY

CT scan and/ MRI will show reduction in size of brain, widened indentations, enlarged cerebral ventricles

Cholinesterase Inhibitors

Motor neuron involvement

Paralysis

Susceptibility to other complications

Death

From mild forgetfulness to inability to generate short term memory to inability to perform ADL to loss of long term memory and the capability to do abstract thinking, reason, do arithmetical procedures, to inability to talk, move and recognize place, time, and person around.

 Legend: Phenomenon

  

Manifestation

  

Management

 

Consecutively: Direction of Pathogenesis; Manifestation; Management; Direction of a Possible Phenomenon

What's good for your heart is good for your head! Choosing to eat well and exercise can help reduce your risk for developing Alzheimer's (Alzheimer Society Columbia, 2010).

Sources Alzheimer's Disease – Pathophysiology (2010). Medicine Encyclopedia. Retrieved on November 26, 2010 from

http://medicine.jrank.org/pages/80/Alzheimer-s-Disease-Pathophysiology.html   Alzheimer’s Disease: Overview of Diagnostic Tests (2005). Cleaveland Clinic.org. Retrieved on December 4, 2010 from

http://www.cchs.net/health/health-info/docs/2300/2346.asp?index=9176 Alzheimer’s Disease (2006, December 17). Great Controversies in Neurobiology. Retrieved on December 3, 2010 from

https://wiki.brown.edu/confluence/display/BN0193S04/Project+Group+3   Alzheimer’s Disease (2006). Republic of the Philippines, Department of Health. Retrieved on November 20, 2010 from

http://www.doh.gov.ph/faq/show/489.html Alzheimer’s Disease (n.d.) Medicine. Web-books.com. Retrieved on December 8, 2010 from

http://www.web-books.com/eLibrary/Medicine/Neurological/Alzheimer.htm#Top Anderson, Heather S. (2010, July 22). Alzheimer’s Disease. Medscape. Retrieved on December 8, 2010 from

http://emedicine.medscape.com/article/1134817-overview APP (2010, November 7). Genetics Home Reference. Retrieved on December 5, 2010 from http://ghr.nlm.nih.gov/gene/APP Arrasate, Montserrat, Mitra, Siddhartha, Schweitzer, Erik S., Segal, Mark R., and Finkbeiner, Steven (2004, October 14). Inclusion body

formation reduces levels of mutant huntingtin and the risk of neuronal death. Nature Publishing Group. Retrieved on December 7, 2010 from https://wiki.brown.edu/confluence/download/attachments/11719/Nature-Huntingtin's.pdf?version=1&modificationDate=1165777192000

Askari, Famia (2009). Alzheimer’s: research on prevention, management and care. Retrieved on December 7, 2010 from http://www.medlink-uk.org/Site/documents/Alzheimers2010/AskariF.pdf

Barglow, Raymond (2010, February 25). Alzheimer’s Disease- How Long Before We Find a Cure? The Berkley Daily Planet. Retrieved on December 5, 2010 from http://www.berkeleydailyplanet.com/issue/2010-02-25/article/34707?headline=Alzheimer-s-Disease-How-Long-Before-We-Find-a-Cure-

Black, Joyce M. and Hawks, Jane H. (2004). Medical-Surgical Nursing: Clinical Management for Positive Outcomes volume 2. 7 th edition. Elsevier. Philippines. page 2162-2170

Brain Structures and Their Functions (2005, June 3). Serendip. Retrieved on November 12, 2010 from http://serendip.brynmawr.edu/bb/kinser/Structure1.html

Bruton, Linda J (2007, February 20). Alzheimer's Disease Diagnostic Tests and Tools. Retrieved on December 2, 2010 from http://ezinearticles.com/?Alzheimers-Disease-Diagnostic-Tests-and-Tools&id=454483

Caimi, G., Carollo, C., and Lo Presti, R. (2003). Oxidative Stress and Diabetes Mellitus. Retrieved on December 6, 2010 from http://www.medscape.com/viewarticle/463121_4

Castellani, Rudy J., Lee, Hyoung-gon, Perry, George, and Smith, Mark A. (2006). Antioxidant protection and neurodegenerative disease: The role of amyloid-f3 and tau. American Journal of Alzheimer's Disease and Other Dementias, Volume 21, Number 2, March/April 2006. Retrieved from https://wiki.brown.edu/confluence/download/attachments/11719/neuro.pdf?version=1&modificationDate=1162759321000

 

Chronic Inflammation (n.d.). FlameEz.com. Retrieved on December 2, 2010 from http://www.flameez.com/inflammation Fauci, Anthony S., Braunwald, Eugene, Kasper, Dennis L., Hauser, Stephen L., Longo, Dan L., Jameson, J. Larry, and Loscalzo, Joseph (2009).

Harrison’s Manual of Medicine 17th Edition. New York: McGraw Hill Medical pages 2478, 2540, 2541   Hesselink, John R. (2008). THE TEMPORAL LOBE & LIMBIC SYSTEM. UCSD Neuroradiology. Retrieved on December 8, 2010 from

http://spinwarp.ucsd.edu/NeuroWeb/Text/br-800epi.htm Inflammation: Chronic (n.d.). Life Extension.org. Retrieved on December 1, 2010 from http://www.lef.org/protocols/prtcl-146.shtml Morhan, Simona D., Chong, Zhao-Zhong, and Maiese, Kenneth (2008). Oxidative Stress and Diabetes. Harlem Children Society. Retrieved on

December 8, 2010 from http://www.harlemchildrensociety.org/misc/StudentInfo/MorhanSimona/paper_morhan.pdf Nordqvist, Christian (2009, June 31). What is Alzheimer’s Disease? What Causes Alzheimer’s Disease? Medical News Today. Retrieved on

December 8, 2010 from http://www.medicalnewstoday.com/articles/159442.php Norman, William (2009, November 27). Neuron Glucose Metabolism & Alzheimer's Disease. Retrieved on November 29, 2010 from

http://www.ehow.com/about_5693153_neuron-glucose-metabolism-alzheimer_s-disease.html Nourish- Carbohydrates Fuel Your Brain (2004). The Franklin Institute Online. Retrieved on December 6, 2010 from

http://www.fi.edu/learn/brain/carbs.html Olson, Scott (2008, November 12). What Sugar Does to Your Brain. Retrieved on December 6, 2010 from http://olsonnd.com/what-sugar-does-

to-your-brain/ Oxidative Stress (2010). The Free Dictionary.Retrieved on December 3, 2010 from

http://medical-dictionary.thefreedictionary.com/oxidative+stress Prasad, Kedar N., Cole, William C., and Prasad, K. Che (2002). Risk Factors for Alzheimer’s Disease: Role of Multiple Antioxidants, Non-Steroidal

Anti-inflammatory and Cholinergic Agents Alone or in Combination in Prevention and Treatment. Journal of the American College of Nutrition, Vol. 21, No. 6, 506-522. Retrieved on December 5, 2010 from http://www.jacn.org/cgi/content/full/21/6/506

Rand, James B. (2007). Acetylcholine. WormBook.org. Retrieved on December 6, 2010 from http://www.wormbook.org/chapters/www_acetylcholine/acetylcholine.html

Rienstra, Douwe (November 2006). Medicine For People! Retrieved on December 4, 2010 from http://www.rienstraclinic.com/newsletter/2006/2006Nov.html

Saint Louis University (2009, July 9). Inflammation May Trigger Alzheimer's Disease. ScienceDaily. Retrieved December 9, 2010, from http://www.sciencedaily.com /releases/2009/07/090708181204.htm

Smeltzer, Suzanne C., Bare, Brenda G., Hinkle, Janice L., and Cheever, Kerry H. (2008). Textbook of Medical-Surgical Nursing volume 2. 11th Edition. Lippincott Williams and Wilkins. Philippines. Page 2320-2323

Spies, Petra E., Claassen, Jurgen, Slats, Diane, Rikkert, Marcel, Verbeek, Marcel, and Kessels, Roy (2009, May 10). Cerebrospinal Fluid Tau and Amyloid Beta Proteins Do Not Correlate With Cognitive Functioning in Cognitively Impaired Memory Clinic Patients. CNS Spectrums. Retrieved on December 6, 2010 from http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=2836

Tavee, Jinny and Sweeney, Patrick (2010, August 1). Alzheimer’s Disease. Retrieved on December 4, 2010 from http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/neurology/alzheimers-disease/

Additional Reading Materials

Adams, Amy (2000, September 8). Genes Can Cause Alzheimer’s Disease. Genetic Health. Retrieved on December 8, 2010 from http://www.genetichealth.com/alz_genetics_of_alzheimers_disease.shtml

  Aluminium and Alzheimer’s Disease (September 2008). Alheimer’s Society. Retrieved on December 8, 2010

from http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=99   Alzheimer’s Disease (n.d.). DNA Learning Center Home. Retrieved on November 23, 2010 from

http://www.yourgenesyourhealth.org/alz/whatisit.htm Campbell, Denis (2009, August 4). Middle-aged smokers at higher risk of dementia. The Guardian. Retrieved on

December 7, 2010 from http://www.guardian.co.uk/lifeandstyle/2009/aug/04/middle-aged-smokers-risk-dementia

Champeau, Rachel (2006, May 22). UCLA Study Finds that Simple Lifestyle Changes May Improve Cognitive Function and Brain Efficiency. UCLA Newsroom. Retrieved on December 7, 2010 from http://www.newsroom.ucla.edu/portal/ucla/UCLA-Study-Finds-that-Simple-Lifestyle-7062.aspx?RelNum=7062

George, Kelly (2010, October 26). New study: Smoking can lead to Alzheimer’s and Dementia. Examiner.com Retrieved on December 8, 2010 from http://www.examiner.com/healthy-trends-in-atlanta/new-study-smoking-can-lead-to-alzheimer-s-and-dementia

Healthy Brain (2010). Alzheimer Society Columbia. Retrieved on December 8, 2010 from http://www.alzheimerbc.org/Alzheimer-s-Disease-and-Dementia/Brain-Fitness-Plan.aspx

Lowe, Derek (2010, March 16). Beta-Amyloid: An Antibiotic? In The Pipeline. Retrieved on December 7, 2010 from http://pipeline.corante.com/archives/2010/03/16/betaamyloid_an_antibiotic.php

  Mayo Clinic Staff (2010, August 5). Alzheimer’s Disease, Alzheimer’s genes: Are you at risk? Mayo Foundation

for Medical Education and Research. Retrieved on December 7, 2010 from http://www.mayoclinic.com/health/alzheimers-genes/AZ00047

Sample, Ian (2009, September 6). Alzheimer’s research links three genes to disease. The Guardian. Retrieved on December 7, 2010 from http://www.guardian.co.uk/science/2009/sep/06/alzheimers-disease-genes-research