ALZHEIMER DISEASE

Dr.Bushra rani
DPT-(SMC)
MS-RIU)
 INTRODUCTION
Alzheimer's disease is a degenerative
brain disorder of unknown etiology which
is the most common form of dementia,
that usually starts in late middle age or in
old age, results in progressive memory
loss, impaired thinking, disorientation,
and changes in personality and mood.
There is degeneration of brain neurons
especially in the cerebral cortex and
presence of neurofibrillary tangles and
plaques containing beta-amyloid cells
 ORIGIN OF
ALZHEIMER'S DISEASE
The disease was first described
by Dr. Alois Alzheimer, a German
physician, in 1906. Alzheimer had a
patient named Auguste D, in her
fifties who suffered from what
seemed to be a mental illness. But
when she died in 1906, an autopsy
revealed dense deposits, now called
neuritic plaques, outside and
around the nerve cells in her brain.
Inside the cells were twisted
strands of fiber, or neurofibrillary
tangles.
Since Dr. Alois Alzheimer's was the Auguste D
first person who discovered the
disease, AD was named after him.
 Meaning
Alzheimer’s disease is a chronic, irreversible

disease that affects the cells of the brain and

causes impairment of intellectual functioning.
Alzheimer's disease is a brain disorder which

gradually destroys the ability to reason,

remember, imagine, and learn.
Comparison of a normal aged brain (left)
and an Alzheimer's patient's brain (right).
Differential characteristics are pointed out
.
INCIDENCE
 About 3 percent of men and women
ages 65 to 74 have AD, and nearly half
of those age 85 and older may have
the disease.

 About 3,60,000 new cases of

Alzheimer’s are diagnosed each
year.
 CAUSES
The cause of Alzheimer’s disease
is not known.
However, several factors are thought
to be implicated in this disease.
 1. NEUROCHEMICAL
FACTORS

a) Acetylcholine.
b) Somatostatin.
c) Substance P.
d) Norepinephrine
 2.ENVIRONMENTAL FACTORS
• Cigarette smoking.

• Certain Infections.

• Metals, industrial or other toxins.

• Use of cholesterol lowering drugs

(statin).
 3 . GENETIC AND
IMMUNOLOGI
Oxidized LDL receptor 1 and
CAL FACTORS
Angiotensin 1-converting enzyme, are tied
to the way the brain cells bind to
Apolipoprotein4 (APOE4) and reduce
buildup of harmful proteins, known as
plaques, in the brain, respectively.
 RISK FACTORS
a) Down's syndrome.
b) Family History.
c) Chronic high BP.
d) Head injuries.
e) Gender.
f) Smoking and Drinking
 PATHOPHYSIOLOGY
• Alzheimer's disease attacks nerves and
brain cells as well as neurotransmitters.
• The destruction of these parts causes clumps
of protein to form around the brain's cells.
These clumps are known as 'plaques' and
'bundles'. The presence of the 'plaques' and
'bundles' start to destroy more connections
between the brain cells, which makes the
condition worse.
 DUE TO THE ETIOLOGICAL FACTORS

CHANGES OCCUR IN THE PROTIENS OF THE NERVE CELLS

OF THE CEREBRAL CORTEX

ACCUMULATION OF NEUROFIBRILLARY TANGLES AND PLAQUES

GRANULO VASCULAR DEGENERATION

LOSS OF CHOLINERGIC NERVE CELLS

LOSS OF MEMORY, FUNCTION AND COGNITION

Microscopy image of a neurofibrillary tangle,
conformed by hyperphosphorylated tau
protein
• Enzymes act on the APP (amyloid precursor protein) and
cut it into fragments. The beta-amyloid fragment is
crucial in the formation of senile plaques in AD
In Alzheimer's disease, changes in tau protein lead to the
disintegration of microtubules in brain cells.
 SIGNS
Ten warning signs of Alzheimer's disease

1) Memory loss
2) Difficulty to performing familiar tasks
3) Problems with language
4) Disorientation to time and place
5) Poor or decreased judgment
6) Problems with abstract thinking
7) Misplacing things
8) Changes in mood or behavior
9) Changes in personality
10) Loss of initiative
 SYMPTOM
• Confusion
S
• disturbances in short-term memory

• problems with attention and spatial orientation

• personality changes

• language difficulties

• unexplained mood swings

 DIAGNOSTIC
TESTS
• Psychiatric assessments.
• Mental status examination and neuro psychological
assessment.
• Laboratory tests.
• Brain imaging .
* CT scan
* MRI
* PET
* SPECT
• CSF Examination
• Electro-encephalogram (EEG)
• Electromyogram
PET scan of the brain of a person with AD showing
a loss of function in the temporal lobe
 PHARMACOLOGICAL
INTERVENTION
• Acetylcholinesterase inhibitors -prevent the
breakdown of acetylcholine, a chemical
messenger important for learning and
memory
eg. Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine
(Razadyne
 N-Methyl d-aspartate Receptor Antagonist
(NMDA)
• Eg:Memantine – blocks the NMDA
receptor and inhibit their overstimulation
by glutamate (neurotransmitter)
• Antidepressents.
• Anxiolytics.
• Antipsychotics.
• Anticonvulsants
 PSYCHOSOCIAL
INTERVENTION
• Behavioral approach
• Emotion oriented approach
• -Remnisence therapy
• -Validation therapy
• -supportive psychotherapy
• -sensory integration snoezelen;
-stimulated presence therapy
• Cognition oriented approach
• Stimulation oriented approach
Caregiving
Since Alzheimer's has no cure and it
gradually renders people incapable of
tending for their own needs, caregiving
essentially is the treatment and must be
carefully managed over the course of the
disease
 Prognosis
• The early stages of Alzheimer's disease are difficult to
diagnose. A definitive diagnosis is usually made once
cognitive impairment compromises daily living activities,
although the person may still be living independently. He
will progress from mild cognitive problems, such as
memory loss through increasing stages of cognitive and
non-cognitive disturbances, eliminating any possibility of
independent living.
• Life expectancy of the population with the disease is
reduced. The mean life expectancy following diagnosis is
approximately seven years. Fewer than 3% of patients
live more than fourteen years. Disease features
significantly associated with reduced survival are an
increased severity of cognitive impairment, decreased
functional level, history of falls, and disturbances in the
neurological examination.
• Other coincident diseases such as heart problems,
diabetes or history of alcohol abuse are also related with
shortened survival. While the earlier the age at onset
the higher the total survival years, life expectancy is
particularly reduced when compared to the healthy
population among those who are younger. Men have a
less favourable survival prognosis than women.
• The disease is the underlying cause of death in 70% of
all cases.Pneumonia and dehydration are the most
frequent immediate causes of death, while cancer is a
less frequent cause of death than in the general
population.
life and may delay the need for facility-based
care.
People with Alzheimer's disease develop other
conditions related to aging. These can include
arthritis, falling, or broken bones. Physical
therapists pay close attention to how the
disease can affect these other health conditions.
Physical therapists are trained to use a variety
of teaching methods, techniques, and unique
approaches to treating people with Alzheimer’s
disease, including:
•Sight, sound and touch cues. The physical
therapist may use sight cues, such as raising
both arms to get a person to stand up. Verbal
cues are short, simple, spoken instructions.
Touch cues might include taking someone's
hand to get them to walk.
•Mirroring. The physical therapist serves as a
"mirror" to show an individual how to move.
For example, to help the person raise his or her
right arm, the physical therapist would raise his
or her left arm.
•Task breakdown. Physical therapists can
break down tasks into short, simple step-by-
step "pieces." This technique can be used, for