18 Dec 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’s disease is a slowly progressive neurodegenerative disease and is characterized by the accumulation of amyloid-beta plaques and tau tangles in the brain that cause the death of neurons and brain shrinkage. The pathological changes impact the hippocampus and cerebral cortex leading to memory impairment, intellectual deterioration, and behavior changes. Neuroinflammation and oxidative stress contribute to the aggravation of neuronal damage (Tiwari et al., 2019). As the disease progresses, it affects the quality of life and eventually results in significant deficits in cognitive and motor skills, implying that people diagnosed with the disease require considerable care and assistance.
Causes
Risk Factors (genetic/ethnic/physical)
· Accumulation of amyloid-beta plaques in the brain
· Formation of neurofibrillary tangles in the brain
· Neuroinflammation
· Oxidative stress
· Age (people above 65 years)
· Family history of Alzheimer’s
· Genetic mutations (e.g., APOE-e4 allele)
· Cardiovascular diseases (e.g., hypertension, diabetes)
· Ethnicity (higher prevalence 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?
· Memory loss that disrupts daily life
· Problems with planning and problem-solving.
· Confusion with time or place
· Difficulty completing familiar tasks
· Poor judgment and decision-making
· Changes in mood, personality, or behavior
Alzheimer’s disease commonly impacts the nervous system by causing gradual deterioration of cognitive abilities, memory, and behavior. It also affects the cardiovascular system due to the associated risk factors including hypertension and diabetes. The musculoskeletal system is affected by motor impairments that lead to falls and fractures. Its later stages may lead to problems in swallowing thus resulting in conditions such as malnutrition and aspiration pneumonia. Next, the immune system is affected since it is weakened thus, making the patient prone to infections. Some of the implications are memory deterioration, difficulty in carrying out routine tasks, frequent falling, weight loss, pneumonia, and increased helplessness that requires constant care (Breijyeh & Karaman, 2020).
3. What are other potential diagnosis that present in a similar way to this diagnosis (differentials)?
Potential diagnosis for Alzheimer’s includes:
· Vascular dementia
· Lewy body dementia
· Frontotemporal dementia
· Normal pressure hydrocephalus
· Mixed dementia
· Vitamin B12 deficiency
· Depression
· Hypothyroidism
· Chronic traumatic encephalopathy
· 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: Through MRI or CT scan to identify brain atrophy and rule out other causes such as tumors or strokes
Blood tests: To rule out vitamin deficiencies (e.g., B12), thyroid dysfunction, and infections
Cognitive tests: Such as Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA)
Cerebrospinal fluid (CSF) analysis: To detect levels of amyloid-beta and tau proteins
Genetic testing: For APOE-e4 allele (if family history is significant)
Neuropsychological testing: To assess the cognitive functions.
5. What treatment options would you consider? Include possible referrals and medications.
Medications
Cholinesterase inhibitors (such as donepezil and rivastigmine)
NMDA receptor antagonist (e.g., memantine)
Antidepressants and antipsychotics for behavioral symptoms (e.g., sertraline, risperidone)
Non-pharmacological interventions
Cognitive therapy and rehabilitation
Occupational therapy
Physical exercise programs
Social engagement activities
Possible Referrals
A Neurologist for specialized care
Psychiatrist for managing behavioral symptoms
Physical therapist for mobility and balance training
Dietitian for nutritional support
Social worker or case manager for assistance with 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
