Alzheimer’s disease (AD) was first described in 1907; currently, it constitutes approximately 70% of all dementia cases. The prevalence of the disease in the US in 2007 was about 5 million cases. However, it is projected to at least double by 2050. The risk factors for AD are age, female gender, genetic factors, and history of dementia. In the present case study, questions about the disease will be answered on the basis of case scenario of 86-year old Mrs. Brown. The patient was diagnosed with AD 12 years ago and more recently patient’s physical and mental health deteriorated rapidly. Patient’s husband, Mr. Brown has been her primary caregiver but he is not able to cope with caregiving any longer. The discussion will include pathophysiology of the disease, signs and symptoms, medications used to treat AD and other conditions present in the patient, diagnostic methods used to diagnose AD, and information given to the care giver.
Alzheimer’s disease (AD) was first described in 1907 by Alois Alzheimer. It constitutes approximately 70% of all dementia cases. The prevalence of the disease in the US in 2007 was about 5 million cases. However, it is projected to at least double by 2050. The risk factors for AD are age, female gender, genetic factors, and history of dementia. (Castellani, Rolston, & Smith, 2010) In the present case study the questions associated with the case of AD in Mrs. Brown will be answered.
Mrs. Brown presents with many behavioral disturbances that are associated with AD. According to Mr. Brown, Mrs. Brown has lost the interest in the activities she liked before. This refers to the personality changes often seen in AD patients. Mr. Brown also mentions that Mrs. Brown becomes disoriented and gets lost. This is a symptom of behavioral disturbance as well. Patients with AD tend to wander and exhibit excessive walking behavior. Furthermore, individuals with AD have often sleep disturbances. Mr. Brown mentioned that common sleep disturbance, disruption in the day-night cycle, has been experienced by Mrs. Brown. Lastly, the agitation and aggression (verbal or physical) towards the family members is a very common in AD patients. (Müller-Spahn, 2003) In addition, the difficulties with memory, such as remembering appointments, birthdays, names of family members are the key signs of the AD (Galvin & Sadowsky, 2012).

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There are three forms of AD, the early onset AD, early-onset familial AD, and late-onset AD. The early-onset familial AD has been linked to the mutations in the three genes (APPI14, PSEN1, PSEN2) located on the chromosome 21. The development of the most common form of the AD, the late-onset AD has been linked to gene APOE4 on chromosome 19. As a consequence, pathological changes in the brain including the formation of neuritic plaques that contain a core of the amyloid-beta protein, the formation of neurofibrillary tangles, and degradation of basal forebrain cholinergic neurons with the loss of acetylcholine occur. The inability to process and clear amyloid precursor protein leads to accumulation of toxic fragments of the amyloid-beta protein. This buildup of intermediates results in formation of diffuse neuritic plaques, disruption of nerve impulse transmission, and eventually death of the neuron. Furthermore, the protein that binds microtubules in neurons detaches and forms a neurofibrillary tangle, which contributes to the death of neurons. The loss of neurons results in brain atrophy and loss of neurotransmitters leads to cognitive and behavioral impairments. (Sugerman & Huether, 2012, p. 359)

The medication Donepezil hydrochloride/Aricept 10 is used for the treatment of AD. The active substance, donepezil hydrochloride, is a reversible inhibitor of the enzyme acetylcholinesterase. Since the pathogenesis of some of the cognitive and behavioral symptoms of AD has been attributed to the cholinergic neurotransmission deficiency, donepezil hydrochloride exerts its therapeutic effects by enhancing the cholinergic neurotransmission. In particular, donepezil hydrochloride increases the concentration of acetylcholine through the reversible inhibition of its hydrolysis by acetylcholinesterase. (www.drugs.com)

The diagnosis of dementia or mild cognitive impairment is done on the basis of history provided by the patient/care giver and cognitive examination. Further, imaging using [18F]fluorodeoxyglucose-positron emission tomography (FDG-PET) allows examining regional brain dysfunction. FDG-PET has a sensitivity of about 90% for AD. It also helps to distinguish AD from other pathologies. (Knopman, 2012) In addition to FDG-PET, computed tomography (CT) and magnetic resonance imaging (MRI) can be used for brain examination. These methods will show the loss of brain volume. AD biomarkers in circulation can be used for diagnosis as well. For example, α2-Macroglobulin, complement factor H, and Aβ42 can be examined in the plasma. Cerebrospinal fluid (CSF) biomarkers including Aβ42, t-tau, p-tau, p-tau/Aβ42, and t-tau/Aβ42 can be used for AD diagnosis. Lastly, in urine, neural thread protein can be examined. (Anoop, Singh, Jacob, & Maji, 2010) Therefore, the diagnostic tests for AD diagnosis include imaging, blood and urine test as well as CSF examination.

Metformin 500 mg is prescribed for individuals with type 2 diabetes mellitus. Therefore, it is possible that Mrs. Brown is taking Metformin to control the blood glucose levels. (‘Metformin’, n.d.) Verapamil is a calcium channel blocker and it modulates the influx of calcium across the arterial smooth muscle cell membrane thus relaxes the muscles in the heart and blood vessels. Mrs. Brown might be using Verapamil SR 180 for hypertension, angina or arrhythmia. Mrs. Brown takes the extended release version of the Verapamil. (‘Verapamil’, n.d.) Synthroid (levothyroxine) is prescribed as a replacement hormone in cases where the thyroid gland is not producing enough of thyroid hormone. Mrs. Brown may use Synthroid for her hypothyroidism or to prevent goiter. (‘Synthroid’, n.d.) The low dose aspirin (Aspirin 81 mg) can be used to prevent myocardial infarction, cerebrovascular accidents or angina. Mrs. Brown might be using it for her chest pain. (‘Aspirin’, n.d.)

Since Mr. Brown is considering looking for permanent placement in a nursing home for Mrs. Brown, he has to be informed about the procedures associated with the transition to residential care. It has been found that admission to the nursing home can increase behavioral symptoms such as agitation, and decrease cognition (Sury, Burns, & Brodaty, 2013). Thus, Mr. Brown has to be made aware of these temporary exacerbations of the disease. However, until the placement has been found, the husband should be instructed on the medication regimen, designing daily routines for his wife, ensuring the safe environment, and taught how to effectively communicate with Mrs. Brown.

In the present case study the questions related to AD were answered. The discussion included pathophysiology of the disease, signs and symptoms, medications used to treat AD and other conditions present in the patient, diagnostic methods used to diagnose AD, and information given to the caregiver.