Alzheimer's disease

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Introduction

Alzheimer's disease (AD), is characterized by declines in cognition, function, and behavior.

These declines often start with memory loss of recent events (Tahami Monfared et al., 2022).

Epidemiology

Approximately 50 million people worldwide have dementia because of the ageing population. In
2018, Alzheimer's Disease International predicted that there were roughly 50 million dementia
sufferers globally, with that number expected to triple by 2050. The number of people living
with dementia is expected to reach 152 million worldwide by the middle of this century, with the
most significant growth expected in nations with low and medium incomes. Facts and numbers
from 2020 on Alzheimer's disease suggest that by 2050, there may be 13.8 million more AD
patients in the United States than AD patients today (age 65 or older). 4.4% of all fatalities were
related to dementia (all causes), making it the fifth most common cause of death worldwide
2016. Dementia-related deaths have risen gradually over time because of population ageing and
growth. In 2013, the average age of death in Europe for AD dementia-related fatalities was 45.2
per 100,000. From 2004 to 2011, the crude mortality rate for deaths in Canada with AD dementia
as the primary cause increased from 10.1 to 11.5 per 100,000 for males and from 24.4 to 25.4 per
100,000 for women (Zhang et al., 2021).

Etiology and risk factors

Although there are several causes of Alzheimer's dementia, becoming older is a major one. A
lifetime of environmental, social, psychological, and biological influences contributes to its
development. Autosomal dominant mutations often cause early-onset familial Alzheimer's (AD),
but most cases are sporadic. An increased incidence of AD is also linked to obesity and
overweight. Body mass index (BMI) and dementia risk are age-dependently correlated. An
increased risk of AD in old age is linked to high serum total cholesterol levels. The risk of AD
has also been associated with nutritional and dietary factors, such as increased dietary or
supplemental antioxidant intake, higher adherence to a Mediterranean diet, and elevated serum
levels of vitamin B12, folate, and homocysteine. The most significant risk is from cardiovascular
disease, specifically peripheral arterial disease. According to neuropathological research,

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dementia syndrome may be influenced by cerebrovascular lesions, atherosclerosis, and
neurodegenerative alterations in the brain (Qiu et al., 2009).

Pathophysiological processes

AD is a long, progressive disease course that starts in the brains of those affected years before
any clinical signs are seen. These pathophysiological modifications include the formation of
toxic forms of amyloid-(A), the formation of neurofibrillary tangles of hyperphosphorylated tau
protein, and neurodegeneration that may be triggered by unchecked activation of microglia in the
brain that releases neurotoxins and inflammatory factors. From modest memory lapses to
profound and impairing loss of cognition and memory, people with these alterations may not
exhibit any symptoms or clinical indicators. Additional neuropsychiatric symptoms may appear
as AD advances, such as confusion, disorientation, mood swings, hostility or agitation, and
eventually delusion or hallucination in later stages (Tahami Monfared et al., 2022).

Clinical manifestations and complications

In AD, hallucinations and delusions are frequent, and 67% of patients experience psychotic
symptoms. Atypical antipsychotics have replaced traditional antipsychotics but have several
adverse side effects. Agitation in AD is frequently linked to psychosis, anxiety, and disinhibition
and is a sign of a more accelerated decline, more institutionalization, and earlier death.

Apathy, the most common NPS associated with Alzheimer's disease (AD), is also associated
with cortical dysfunction, abnormalities in cholinergic and dopaminergic function, high levels of
beta and phospho-tau in the CSF, and abnormalities in cholinergic and dopaminergic function.
Depression is a standard indicator of AD and a factor in the progression of dementia from
cognitive function to MCI. Depression is linked to dementia and sleep problems as well. (Lanctôt
et al., 2017).

Diagnostics

 The clinical assessment, which comprises a cognitive and physical examination, is the
cornerstone of the AD diagnosis.
 Blood tests are carried out to rule out any illnesses that could produce cognitive
problems.

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  Structural imaging is advised to rule out structural problems and offer reliable diagnostic
data.
 An AD diagnosis is supported by F-fluorodeoxyglucose (FDG) PET hypometabolism in
the parietal-temporal association regions, posterior cingulate, and precuneus (Scheltens et
al., 2016).

Interview question

1. What is the age of the individual being interviewed? What is the relationship of the
individual to you?

The age of the individual is 64. He is Neighbour.

2. How long have they had the disorder?

From last 5 years

3. What clinical manifestations of the disorder do the individual experience? How does it
compare to what you discovered in your resources?

Depression along with dementia.

4. What complications of the disorder does the individual experience? How does this
compare to what you discovered in your resources?

He faced sleeping problem.

5. What other medical conditions/disorders has the individual been diagnosed with? Do
their other medical conditions have any effect on the chosen disorder?

Cardio vascular and hypertension, yes

6. How does the disease affect the individual’s daily living/activities?

He became Antisocial.

7. How does the disease/disorder affect the individual’s outlook on life?

He feels tired and hopeless.

8. What did you learn from interviewing the individual?

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I have learned about Alzheimer diseases in detail.

REFERENCES

Qiu, C., Kivipelto, M., & von Strauss, E. (2009). Epidemiology of Alzheimer's disease: occurrence,
determinants, and strategies toward intervention. Dialogues in clinical neuroscience, 11(2), 111–128.
https://doi.org/10.31887/DCNS.2009.11.2/cqiu

Lanctôt, K. L., Amatniek, J., Ancoli-Israel, S., Arnold, S. E., Ballard, C., Cohen-Mansfield, J., ... & Boot, B.
(2017). Neuropsychiatric signs and symptoms of Alzheimer's disease: New treatment paradigms.
Alzheimer's & Dementia: Translational Research & Clinical Interventions, 3(3), 440-449.

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Scheltens, P., Blennow, K., Breteler, M. M., De Strooper, B., Frisoni, G. B., Salloway, S., & Van der Flier,
W. M. (2016). Alzheimer's disease. The Lancet, 388(10043), 505-517.

Tahami Monfared, A. A., Byrnes, M. J., White, L. A., & Zhang, Q. (2022). Alzheimer’s disease:
epidemiology and clinical progression. Neurology and therapy, 11(2), 553-569.

Zhang, X. X., Tian, Y., Wang, Z. T., Ma, Y. H., Tan, L., & Yu, J. T. (2021). The epidemiology of Alzheimer’s
disease modifiable risk factors and prevention. The journal of prevention of Alzheimer's disease, 8, 313-
321.