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1. ADVANCING HEALTH EQUITY IN
ALZHEIMER’S DISEASE
DR. (PROF.) SMRITI . G. SOLOMON
PRINCIPAL
INDEX NURSING COLLEGE INDORE

2. Introduction
 Alzheimer disease is a neurodegenerative disease that
causes progressive and disabling impairment of
cognitive functions including memory,
comprehension, language, attention, reasoning, and
judgment. There is no cure for Alzheimer disease,
although there are symptomatic treatments and
supportive measures available.

3. Difference between
Dementia and Alzheimer’s Disease
 Dementia is a term
used to address a
collection of symptoms,
some forms of
dementia are known to
be temporary,
reversible and cured
with proper and timely
medication.
 Alzheimer’s is a
degenerative brain
disease that is caused
by complex brain
changes following
brain cell damage,
which cannot be
reversed or cured.

4.  Dementia describes a
group of symptoms
associated with a decline
in memory, reasoning or
other thinking skills.
 The most common early
symptom of
Alzheimer’s is trouble in
remembering new
information because the
disease typically impacts
the part of the brain
associated with learning
first.

5.  A person can get affected
by Dementia during any
stage of life.
 Many causes - Stroke,
thyroid issues, vitamin
deficiencies, reactions to
medications, and brain
tumors and brain injury.
 Potentially reversible -
some forms of dementia
can be reversed and
managed, such as those
caused by drugs/alcohol &
metabolic disorders.
 Known risk factor for
Alzheimer’s is increasing
age, Alzheimer's disease is
more likely to occur in
elderly ages.
 Unknown cause - Amyloid
cascade hypothesis" is most
widely discussed and
researched hypothesis
today.
 Irreversible - there are no
drugs that can cure
Alzheimer's.

6. • A vital brain cell transport system collapses
when a protein called tau twists into tiny fibers.
These fibers are called Neurofibrillary tangles.
These damaged tangles remains of microtubules.

7. •Accumulation of beta amyloid, an insoluble
protien, which forms sticky patches
(neurotic plaques) surrounded by debris of
dying neurons.

8. • Significant loss of neurons and volume in brain
regions devoted to memory and higher mental
functioning

9. Stages of Alzheimer’s Disease
 As Alzheimer’s progresses, individuals commonly experience
multiple types of symptoms that change with time.
 Mild Alzheimer’s Dementia :
 Most people are able to function independently in many areas
but are likely to require assistance with some activities to
maximize independence and remain safe
 Handling finances and paying bills may be especially
challenging
 They may need more time to complete common daily tasks.
 They may still be able to drive, work and participate in their
favorite activities

10. Moderate Alzheimer’s Dementia
 In the moderate stage of Alzheimer’s dementia,
individuals experience:
More problems with memory and language
 Become confused
Find harder to complete multistep tasks such as
bathing and dressing.
 They may become incontinent at times,
They may start having personality and behavioral
changes, including suspiciousness and agitation.
They may also begin to have problems recognizing
loved ones.

11. Severe Alzheimer’s Dementia
 In the severe stage of Alzheimer’s dementia:
Individuals’ ability to communicate verbally is greatly
diminished
They are likely to require around-the-clock care
Individuals become bed-bound that can result in organ
failure
Difficulty in swallowing
Aspiration pneumonia, it is a contributing cause of
death among many individuals with Alzheimer’s.

12. ASSESSMENT
 A good history and physical examination are the keys
to diagnosis:
Take a history from the family and caregivers as some
patients may lack insight into their disease.
Obtain a good assessment of functional abilities like
activities of daily living.
A complete physical examination with a detailed
neurological exam and mental status examination is
needed to evaluate disease stage and rule out other
conditions.
All follow-up visits should include a full mental status
examination to evaluate disease progression and
development of neuropsychiatric symptoms.

13. EVALUATION
 Complete blood count (CBC), complete metabolic
panel (CMP), thyroid-stimulating hormone (TSH),
vitamin B12 are usually checked to rule out other
causes.
 MRI or CT brain can help to identify other causes of
dementia like stroke or tumors. Dilated lateral
ventricles and widened cortical sulci, especially in the
temporal area are typically seen in Alzheimer disease.
 Volumetric MRI shows shrinkage in the medial
temporal lobe.
 Brain imaging techniques are used to detect core
features of Alzheimer disease, that are amyloid
plaques and neurofibrillary tangles.

14. MEDICAL TREATMENT
 Drugs used for the Alzheimer's treatments boost the
performance of chemicals in the brain that carry
information from one brain cell to another. Drugs
include:
Cholinesterase inhibitors
Memantine
 These treatments don't stop the underlying decline
and death of brain cells. As more cells die,
Alzheimer's disease continues to progress.

15. Cholinesterase Inhibitors
 Cholinesterase inhibitors act by increasing the level of
acetylcholine; a chemical used by nerve cells to
communicate with each other and is important for
learning, memory and cognitive functions.
Donepezil can be used in all stages of Alzheimer
disease.
Galantamine and Rivastigmine are used for treatment
of mild to moderate Alzheimer disease only.

16. Memantine
 Memantine blocks NMDA receptors. Memantine
protects the brain from excessive levels of a
neurotransmitter called glutamate, which over
stimulates neurons and can damage them.
 It is used for treating moderate to severe
Alzheimer disease.
 Dizziness, body aches, headache, and constipation
are common side effects.
 It can be taken in combination with cholinesterase
inhibitors.

17. The New Alzheimer's Treatments
1. Strategies aimed at beta-amyloid include:
A. Recruiting the immune system-
 In 2023, the U.S. Food and Drug Administration
(FDA) approved lecanemab (Leqembi) for people
with mild Alzheimer's disease and mild cognitive
impairment due to Alzheimer's disease.
 It is a humanized monoclonal antibodies that prevents
amyloid plaques in the brain from clumping and slow
down cognitive decline in people with early
Alzheimer's disease. They also may remove beta-
amyloid plaques that have formed.

18. B. Research studies are under ways: Experts are
hopeful about developing treatments that can stop or
delay the progression of Alzheimer's
1.Preventing destruction. Saracatinib is now being
tested in Alzheimer's disease. The animals in the study
experienced a reversal of some memory loss. Human
trials for saracatinib as a possible Alzheimer's
treatment are now underway.
2. Keeping tau from tangling
 When a protein called tau, twists into tiny fibers
(tangles), brain cell transport system collapses .
 Researchers are looking at a way to prevent tau from
forming tangles.
 Tau aggregation inhibitors and tau vaccines are
currently being studied in clinical trials.

19. 3. Reducing inflammation
 Alzheimer's causes chronic, low-level brain cell
inflammation. Researchers are studying ways to treat
the processes that lead to inflammation in Alzheimer's
disease. The medicine sargramostim (Leukine) is
currently in research. The medicine may stimulate the
immune system to protect the brain from harmful
proteins.
4. Researching insulin resistance
 Studies are looking into how insulin may affect the
brain and brain cell function. Researchers are studying
how insulin changes in the brain may be related to
Alzheimer's.

20. 5. Studying the heart-head connection
 Growing evidence suggests that brain health is closely linked
to heart and blood vessel health. The risk of developing
dementia appears to increase as a result of many conditions
that damage the heart or arteries. These include high blood
pressure, heart disease, stroke, diabetes and high cholesterol.
A number of studies are exploring how best to build on this
connection.
6. Hormones
 Studies during the 1990s suggested that taking hormone
replacement therapy during perimenopause and menopause
lowered the risk of Alzheimer's disease. But further research
has been mixed. Some studies found no cognitive benefit of
taking hormone replacement therapy. More research and a
better understanding of the relationship between estrogen and
cognitive function are needed.

21. Non-drug Treatments
 Non-drug treatments do not change the underlying
biology of the disease. They are often used with the
goals of maintaining or improving cognitive function,
overall quality of life and engagement, and the ability
to perform activities of daily living.
 Non-drug treatments include physical activity,
memory and orientation exercises, and music- and art-
based therapies.
 Non-drug treatments may be used with a more
specific goal of reducing behavioral and psychological
symptoms such as depression, apathy, wandering,
sleep disturbances, agitation and aggression.

22. Proactive Management of Alzheimer’s Dementia
 Proactive management includes:
Appropriate use of available treatment options.
Effective management of coexisting conditions.
Providing family caregivers effective training in
managing the day-to-day life of the care recipient.
Coordination of care among physicians, other health care
professionals and lay caregivers.
Having opportunities to connect with others living with
Alzheimer through support groups.
Becoming educated about the disease.