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 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 first person who discovered the disease, AD was named after him.

1. BY- DR PUNITH P

7.  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
 Alzheimer’s disease (AD) is the most common form of dementing illness,
and the prevalence of AD increases with each decade of life

8. AD affects multiple areas of cognition and is
characterized by a gradual onset with a slow,
progressive decline.
 The etiology of AD is unknown, and current
pharmacotherapy neither cures nor arrests the
pathophysiology.
Survival following AD onset is estimated to be 3 to
20 years, with an average of 8 years after the onset
of symptoms

9.  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 first person who
discovered the disease, AD was named after him

10. 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.

11.  AD is the most common cause of dementia. AD unassociated with any other
pathology accounts for 50% to 60% of cases of late life cognitive dysfunction.
• Approximately 4.5 million Americans have AD. By the year 2050, 1 in 5
people will be older than age 65 years, and the number of AD patients is
projected to be 13.2 million. Most cases present in persons older than age 65
years, but approximately 5% of cases occur in persons younger than age 65
years. Onset can be as early as age 40 years, resulting in the arbitrary age
classifications of early onset (ages 40 to 64 years) and late-onset (ages 65
years and older).
•

12. 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
Increasing age is the greatest risk factor for AD. The
prevalence of AD increases exponentially with age,
affecting approximately 7% of individuals ages 65 to 74
years, 53% of those ages 75 to 84, and 40% of persons ages
85 years and older.

15. The exact etiology of AD is unknown; however, several
genetic and environmental causes have been explored as
potential causes of AD
However, several factors are thought to be implicated in
this disease.

16. a) Acetylcholine.
b) Somatostatin.
c) Substance P.
d) Norepinephrine

17.  Cigarette smoking.
 Certain Infections.
 Metals, industrial or other toxins.
 Use of cholesterol lowering drugs (statin).

18. Oxidized LDL receptor 1 and 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.

19. a) Down's syndrome.
b) Family History.
c) Chronic high BP.
d) Head injuries.
e) Gender.
f) Smoking and Drinking

20. 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.

21. The signature lesions in AD are neuritic plaques and
neurofibrillary tangles (NFTs) located in the cortical areas and
medial temporal lobe structures of the brain.
 Along with these lesions, degeneration of neurons and synapses,
as well as cortical atrophy, occurs. Plaques and NFTs may also be
present in other diseases, even in normal aging, but there is a
much higher concentration of plaques and NFTs in patients with
AD.
 Several mechanisms have been proposed to explain these
changes in the brain, including βAP aggregation and deposition
leading to the formation of plaques; hyperphosphorylation of tau
protein leading to NFT development, inflammatory processes;
dysfunction of the neurovasculature; oxidative stress; and
mitochondrial dysfunction

25. In its original form, the amyloid cascade
hypothesis proposed that altered APP processing
drove βAP production, βAP gave rise to plaques,
plaques induced neurodegeneration, and this
neuronal loss resulted in the clinical dementia
syndrome typical of AD.

26. Plaques are made up of small peptides 39-43 aminoacids
in length called amyloid beta
Amyloid beta is a fragment derived from the larger
amyloid precursor protein- atrans membrane protein with
several functions by the action of y subunit of secretase
enzyme

30. Tau protein provides structural support to microtubules, the cell’s
transportation and skeletal support system.
When tau filaments undergo abnormal phosphorylation at a specific
site, they cannot bind effectively to microtubules, and the microtubules
collapse.
Without an intact system of microtubules, the cell cannot function
properly and eventually dies.
The density of the NFTs correlates well with the severity of the
dementia, because they are a hallmark of neuronal death

33. GENERAL : The patient may have vague memory
complaints initially, or the patient’s significant other
may report that the patient is “forgetful.”
Cognitive decline is gradual over the course of illness.
Behavioral disturbances may be present in moderate
stages.
Loss of daily function is common in advanced stages.

35. Confusion
• disturbances
in short-term
memory
• problems
with attention
and spatial
orientation
• personality
changes
• language
difficulties
• unexplained
mood swings

36. Cognitive
■ Memory loss (poor recall and
losing items)
■ Aphasia (circumlocution and
anomia)
■ Apraxia
■ Agnosia
■ Disorientation (impaired
perception of time and unable to
recognize familiar people)
■ Impaired executive function
Noncognitive
 Depression, psychotic symptoms
(hallucinations and delusions)
 Behavioral disturbances
(physical and verbal aggression,
 motor hyperactivity,
uncooperativeness, wandering,
repetitive
 mannerisms and activities, and
combativeness)
Functional
 Inability to care for self
(dressing, bathing, toileting, and
eating)

37. Psychiatric assessments.
• Mental status examination and neuro psychological assessment.
• Laboratory tests.
• Brain imaging .
* CT scan * MRI * PET * SPECT
• CSF Examination
• Electro-encephalogram (EEG)
• Electromyogram

38. ■ Rule out vitamin B12 and folate deficiency
■ Rule out hypothyroidism with thyroid function
tests
■ Blood cell counts, serum electrolytes, liver
function tests

39. A family member often first brings memory complaints to the attention
of a primary care clinician.
• At present the only way to definitively diagnose AD is through direct
examination of brain tissue at autopsy or biopsy.
• Several criteria have been developed for the detection and diagnosis of
dementia, including the following;
• Mini Mental Status Examination (MMSE,)

40. • Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text
Revision (DSM-IV-TR) criteria. • The Agency for Healthcare Research
and Quality (AHRQ) Guidelines.
• TheAmerican Academy of Neurology Guidelines
• The National Institute of Neurological Disorders and Stroke
(NINDS) criteria.
• The National Institute of Neurological Communicative Disorders
and
• Stroke (NINCDS).
• The Alzheimer’s Disease and Related Disorders Association
(ADRDA) Criteria.

42. Acetylcholinesterase inhibitors -prevent the breakdown of
acetylcholine, a chemical messenger important for learning
and memory
eg. Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Razadyne)

43. N-Methyl d-aspartate Receptor Antagonist (NMDA)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375899/
• Eg:Memantine – blocks the NMDA receptor and inhibit
their overstimulation by glutamate (neurotransmitter)
• Antidepressents.
 • Anxiolytics.
 • Antipsychotics.
• Anticonvulsants

44. • Behavioral approach
• Emotion oriented approach -Remnisence therapy -
Validation therapy -supportive psychotherapy -sensory
integration -stimulated presence therapy
• Cognition oriented approach
• Stimulation oriented approach

45. 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

46. • 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.

47. • 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.

48. 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

49.  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.