Alzheimer's Disease
Pathophysiology
Alzheimer's disease is a progressive degenerative disease of the brain which results in memory loss, confusion, impaired judgement, personality changes, disorientation, and loss of language skills. It is most common in people older than 65, and its incidence increases in people older than 80.
Cause and Incidence The cause of Alzheimer's is unknown; however, several factors are thought to be implicated in this disease. These include neurochemical factors, such as deficiencies in the neurotransmitter acetylcholine, somatostatin, substance P, and norepinephrine; environmental factors; and genetic immunologic factors. A family history of Alzheimer's disease and the presence of Down syndrome are two established risk factors. The brain tissue of people with Alzheimer's has three hallmark features: neurofibrillary tangles, neuritic plaques, and granulovasclular degeneration. Examination of the brain after death also reveals that it has atrophied, weighing less than 1,000 grams compared with a normal brain weight of about 1,380 grams.
Signs and Symptoms
**Intellectual loss Memory loss (initially cannot remember recent evenets but can recall early life events) Loss of sense of time Poor decision-making ability Loss of trtain of thought during conversations Requires repetitive giving of directions Inability to perform arithmetic calculations Shortened attention span Inability to recognize family and friends
**Personality or affective loss Personality changes Apathy, loss of initiative Anxiety, fear, blligerence, stubbornness Suspicion, progressing to paranoia Loss of sense of humor Insensitivity to others Inattentiveness Conversation changes (slow speech, loss of words, use of cliches) Easily fatigued Reactive depression Crying spells Lethargy Neglect of self-care Nocturnal wandering
**Advanced stage Apathy, muteness Inability to recall recent or remote events Disorientation/confusion Inability to perform activities of daily living Incontinence
Stages of Functional Loss
Stage I: Early confusion
* Forgetful, loses things
* Expresses awareness of loss (depression can be common)

Stage II: Late Confusion
* Increased difficulty with money management, work, driving, housekeeping, and shopping
* Social withdrawal from clubs and routinge activities with friends
* Depression, increased fatigue
* Denies symptoms but may state, "I feel like I'm losing my mind"
* May require placement in an adult care center, or if living alone, may need to move into a residential care center

Stage III: Ambulatory dementia
* Increased loss of activities of daily living
* Worsening of symptoms as day progresses
* Withdrawal from family and friends
* Appears unaware of losses
* Increasd behaviors of disorientation and agitation (nocturnal wakefulness: wandering, pacing: agitation, belligerence)
* Speech and writing difficult to understand

Stage IV: Late-stage dementia
* No longer ambulates: cannot remember to eat, swallow, or chew
* Little purposeful activity
* No recognition of caregivers or family
* Muteness or possibly spontaneous screaming
* Incontinent: may be totally dependent for physical hygiene
* Becoming increasingly vegetative

Treatment There is no known cure. Although there is not a specific treatment available, prescribed treatment is directed toward controlling the symptoms and providing physiologic and psychological support for the patient and family to enhance their ability to cope with the progressively deteriorating effects of the disease.
Pharmaceutical Treatment for Alzheimer's Disease
Acetylcholinesterase Inhibitors-cognitive function
Drug: Donepril (Aricept)
Action: Allow more acetylcholine in neuron receptors, increases cognitive