Alzheimer's disease is a progressive disorder that causes brain cells to waste away (degenerate) and die. Alzheimer's disease is the most common cause of dementia — a continuous decline in thinking, behavioral and social skills that disrupts a person's ability to function independently.
Symptoms: Amnesia; Dementia
Diseases or conditions caused: Dementia
Pathophysiology
Pathology
BPharm 2nd Semester
MPharm
Therapeutics
MBBS
A presentation about Alzheimer's disease, it's definition, it's etiology, its mechanism of development as well as actual treatment and developing treatments.
A guideline for discontinuing antiepileptic drugs in seizure-free patients – ...Dr. Rafael Higashi
Aula apresentada por Dr. Rafael Higashi, médico neurologista sobre quando retirar droga antiepilética. A guideline for discontinuing antiepileptic drugs in seizure-free patients – Summary Statement
Alzheimer's disease is a progressive disorder that causes brain cells to waste away (degenerate) and die. Alzheimer's disease is the most common cause of dementia — a continuous decline in thinking, behavioral and social skills that disrupts a person's ability to function independently.
Symptoms: Amnesia; Dementia
Diseases or conditions caused: Dementia
Pathophysiology
Pathology
BPharm 2nd Semester
MPharm
Therapeutics
MBBS
A presentation about Alzheimer's disease, it's definition, it's etiology, its mechanism of development as well as actual treatment and developing treatments.
A guideline for discontinuing antiepileptic drugs in seizure-free patients – ...Dr. Rafael Higashi
Aula apresentada por Dr. Rafael Higashi, médico neurologista sobre quando retirar droga antiepilética. A guideline for discontinuing antiepileptic drugs in seizure-free patients – Summary Statement
Alzheimer's is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer's disease accounts for 60 to 80 percent of dementia cases.
Several types of depression such as bipolar disorder, seasonal effective disorder and sub forms of major depressive disorder
are known to be associated with deviations in the circadian system, alterations that are crucial to the etiology of these pathologies. Therefore, entrainment of circadian rhythms is regarded as a promising basis for treatment. The rules for successful synchronization by melation are outlined. Differences of phase resetting within the phase response curve are emphasized. Moreover, deviations from classic pharmacological thinking are underlined. When appropriately timed, relatively low doses are suffi cient for entrainment, whereas increases of doses may reduce rather than improve the success of resynchronization. Immediate-release formulations are suffi cient and recommendable, since they generate synchronizing signals that are favorable with regard to their time structure, whereas extended actions as desired in classic pharmacology of antidepressants may prevent successful entrainment. The assessment of circadian deviations prior to the development of an individual therapeutic strategy is of utmost importance for knowing whether phase advances or delays are required and also for avoiding concomitant symptomatic treatment with drugs that cause opposite effects, such as lithium, which extends the circadian period and should not be used in patients who anyway have developed an abnormally long period.
The Effects of Alzheimer on AmericaBackgroundAlzheimer’s dis.docxmehek4
The Effects of Alzheimer on America
Background
Alzheimer’s disease is known to affect the brain, cells, and nerves, nervous and psychic-emotional system. Alzheimer’s is the progressive disorder which results in the loss of cognitive abilities. It is the most concerned structure of dementia. As of today, there is still no clue to why or what causes this disorder, but there are ample ideas and suggestions for this disorder.
One of the most relevant symptoms of Alzheimer’s disease is the reduction of the ability to interpret your sensory perceptions and to understand the meaning of things. There is no current treatment, but there are drugs that are been used to slow down its progression.
In 1906, Alexander Alois described this disorder as a pathological presenile of dementia. It is believed that by the 2015, there will be a diagnosis of 5.3 million with Alzheimer’s disease which will eventually cause death.
Alzheimer’s disease is a progressive neurodegenerative disorder leading to sever cognitive, memory and behavioral impairment.
Significance
This proposal is to show how and why there are research done on Alzheimer’s disease. This disease affects 500 million people in the U.S. This is known as the aging disease.
The testing of Alzheimer’s is important because it is a way to find the cause of it and ways to prevent it or either slows down the progression rate in AD.
The diagnosis of Alzheimer’s disease is an important research because it contributes to helping our aging America and onset of Dementia. Alzheimer’s could be cause by other significant disease that may be at bay in our mind and body.
The significance of this proposal is to give insight on ways to prevent AD. It may also be a cure for it as well as what causes it. It also details where in the brain Alzheimer’s may begin in its early stages.
Literature Review
Alzheimer’s is the most common form of dementia. It is assumed to grow as the population of the aging grows. So far there is no treatment to stop the growth of AD. The growth of AD gets worsen due to the cognitive ability, functional ability and behavioral and mood changes. Alzheimer’s has signs of mood changes, depression, anger and confusion when changes happen. Someone of normal aging process will exhibit decrease in coordinator and movement whereas AD recipient will exhibit halting in movement or coordination and loss of balance.
The criterion for diagnosis of AD is definite, probable, and possible. Definite syndrome is histopathological confirmed. Probable has two cognitive deficits and severity of deficits. Possible has atypical awareness. There will be more updates to include brain imaging and peripheral biomarkers. These interventions may have some evidence to reduce or delay the onset of Alzheimer disease and dementia. It could possibly change the effect of normal aging on the brain activity. Physical exercise has been suggested to reduce the risk of dementia by lessen deterioration and cognitive deficit by reversal. It ...
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.
Learn about coma/lethergy/stupor/lockdown syndrome
Unconscious.
In psychiatry, it is always difficult to distinguish the different reduce level of conscious states from catatonia.
This presentation shows more light about coma and how we differentiate it from other forms
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Alzheimer's is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer's disease accounts for 60 to 80 percent of dementia cases.
Several types of depression such as bipolar disorder, seasonal effective disorder and sub forms of major depressive disorder
are known to be associated with deviations in the circadian system, alterations that are crucial to the etiology of these pathologies. Therefore, entrainment of circadian rhythms is regarded as a promising basis for treatment. The rules for successful synchronization by melation are outlined. Differences of phase resetting within the phase response curve are emphasized. Moreover, deviations from classic pharmacological thinking are underlined. When appropriately timed, relatively low doses are suffi cient for entrainment, whereas increases of doses may reduce rather than improve the success of resynchronization. Immediate-release formulations are suffi cient and recommendable, since they generate synchronizing signals that are favorable with regard to their time structure, whereas extended actions as desired in classic pharmacology of antidepressants may prevent successful entrainment. The assessment of circadian deviations prior to the development of an individual therapeutic strategy is of utmost importance for knowing whether phase advances or delays are required and also for avoiding concomitant symptomatic treatment with drugs that cause opposite effects, such as lithium, which extends the circadian period and should not be used in patients who anyway have developed an abnormally long period.
The Effects of Alzheimer on AmericaBackgroundAlzheimer’s dis.docxmehek4
The Effects of Alzheimer on America
Background
Alzheimer’s disease is known to affect the brain, cells, and nerves, nervous and psychic-emotional system. Alzheimer’s is the progressive disorder which results in the loss of cognitive abilities. It is the most concerned structure of dementia. As of today, there is still no clue to why or what causes this disorder, but there are ample ideas and suggestions for this disorder.
One of the most relevant symptoms of Alzheimer’s disease is the reduction of the ability to interpret your sensory perceptions and to understand the meaning of things. There is no current treatment, but there are drugs that are been used to slow down its progression.
In 1906, Alexander Alois described this disorder as a pathological presenile of dementia. It is believed that by the 2015, there will be a diagnosis of 5.3 million with Alzheimer’s disease which will eventually cause death.
Alzheimer’s disease is a progressive neurodegenerative disorder leading to sever cognitive, memory and behavioral impairment.
Significance
This proposal is to show how and why there are research done on Alzheimer’s disease. This disease affects 500 million people in the U.S. This is known as the aging disease.
The testing of Alzheimer’s is important because it is a way to find the cause of it and ways to prevent it or either slows down the progression rate in AD.
The diagnosis of Alzheimer’s disease is an important research because it contributes to helping our aging America and onset of Dementia. Alzheimer’s could be cause by other significant disease that may be at bay in our mind and body.
The significance of this proposal is to give insight on ways to prevent AD. It may also be a cure for it as well as what causes it. It also details where in the brain Alzheimer’s may begin in its early stages.
Literature Review
Alzheimer’s is the most common form of dementia. It is assumed to grow as the population of the aging grows. So far there is no treatment to stop the growth of AD. The growth of AD gets worsen due to the cognitive ability, functional ability and behavioral and mood changes. Alzheimer’s has signs of mood changes, depression, anger and confusion when changes happen. Someone of normal aging process will exhibit decrease in coordinator and movement whereas AD recipient will exhibit halting in movement or coordination and loss of balance.
The criterion for diagnosis of AD is definite, probable, and possible. Definite syndrome is histopathological confirmed. Probable has two cognitive deficits and severity of deficits. Possible has atypical awareness. There will be more updates to include brain imaging and peripheral biomarkers. These interventions may have some evidence to reduce or delay the onset of Alzheimer disease and dementia. It could possibly change the effect of normal aging on the brain activity. Physical exercise has been suggested to reduce the risk of dementia by lessen deterioration and cognitive deficit by reversal. It ...
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.
Learn about coma/lethergy/stupor/lockdown syndrome
Unconscious.
In psychiatry, it is always difficult to distinguish the different reduce level of conscious states from catatonia.
This presentation shows more light about coma and how we differentiate it from other forms
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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2. INTRODUCTION
ALZHEIMER DISEASE (AD) IS A
NEURODEGENERATIVE DISORDER MARKED BY
COGNITIVE AND BEHAVIORAL IMPAIRMENT
THAT SIGNIFICANTLY INTERFERES WITH SOCIAL
AND OCCUPATIONAL FUNCTIONING. IT IS AN
INCURABLE DISEASE WITH A LONG PRECLINICAL
PERIOD AND PROGRESSIVE COURSE. IN AD,
PLAQUES DEVELOP IN THE HIPPOCAMPUS, A
STRUCTURE DEEP IN THE BRAIN THAT HELPS TO
ENCODE MEMORIES, AND IN OTHER AREAS OF
THE CEREBRAL CORTEX THAT ARE INVOLVED IN
THINKING AND MAKING DECISIONS. WHETHER
PLAQUES THEMSELVES CAUSE AD OR WHETHER
THEY ARE A BY-PRODUCT OF THE AD PROCESS
REMAINS UNKNOWN. THE FOLLOWING IMAGE
DEPICTS ONE OF THE CARDINAL NEUROIMAGING
FINDINGS IN AD – HIPPOCAMPAL ATROPHY.
4. HISTORY
IN 1901, A GERMAN PSYCHIATRIST NAMED ALOIS
ALZHEIMER OBSERVED A PATIENT AT THE FRANKFURT
ASYLUM NAMED MRS. AUGUSTE D. THIS 51-YEAR-OLD
WOMAN SUFFERED FROM A LOSS OF SHORT-TERM
MEMORY, AMONG OTHER BEHAVIORAL SYMPTOMS
THAT PUZZLED DR. ALZHEIMER.
DR. ALZHEIMER SENT HER BRAIN AND HER MEDICAL
RECORDS TO MUNICH, WHERE HE WAS WORKING IN
THE LAB OF DR. EMIL KRAEPLIN. BY STAINING
SECTIONS OF HER BRAIN IN THE LABORATORY, HE
WAS ABLE TO IDENTIFY AMYLOID PLAQUES AND
NEUROFIBRILLARY TANGLES.
7. PATHOPHYSIOLOGY
Considerable attention has been devoted to elucidating the composition of SPs and
NFTs to find clues about the molecular pathogenesis and biochemistry of AD. The main
constituent of NFTs is the microtubule-associated protein tau . In AD,
hyperphosphorylated tau accumulates in the perikarya of large and medium pyramidal
neurons. Somewhat surprisingly, mutations of the tau gene result not in AD but in some
familial cases of frontotemporal dementia.
Since the time of Alois Alzheimer, SPs have been known to include a starchlike (or
amyloid) substance, usually in the center of these lesions. The amyloid substance is
surrounded by a halo or layer of degenerating (dystrophic) neurites and reactive glia
(both astrocytes and microglia).
AD affects the 3 processes that keep neurons healthy: communication, metabolism,
and repair. Certain nerve cells in the brain stop working, lose connections with other
nerve cells, and finally die. The destruction and death of these nerve cells causes the
memory failure, personality changes, problems in carrying out daily activities, and
other features of the disease.
8. Alzheimer disease biomarkers may follow a sequential pattern in
the brain, according to a study of AD biomarker trajectories. The
study included both symptomatic and asymptomatic carriers of
autosomal dominant gene mutations linked to AD, including APP,
PSEN1, and PSEN2. Researchers did not address tauopathy.
Results show that amyloid deposition in the brain occurs first,
followed by a decline in glucose metabolism and then structural
brain atrophy. The rate of Ab accumulation was significantly
higher in mutation carriers compared to noncarriers, and was
found to begin more than 2 decades before the expected onset of
dementia. In carriers, metabolism began to decrease at a mean
of 14.1 years before expected symptom onset, and structural
changes in the brain began 4.7 years before expected symptom
onset. It is important to note that only about 1% of patients with
AD have an autosomal dominant mutation, so results may not be
generalizable to sporadic AD.
PATHOPHYSIOLOGY
15. THE PATHOLOGIC CHANGES ASSOCIATED WITH AD
BEGIN IN THE ENTORHINAL CORTEX, WHICH IS
NEAR THE HIPPOCAMPUS AND DIRECTLY
CONNECTED TO IT. AD THEN PROCEEDS TO THE
HIPPOCAMPUS, WHICH IS THE STRUCTURE THAT IS
ESSENTIAL TO THE FORMATION OF SHORT-TERM
AND LONG-TERM MEMORIES (SEE THE IMAGES
BELOW). AFFECTED REGIONS BEGIN TO ATROPHY.
THESE BRAIN CHANGES OCCUR DECADES BEFORE
ANY SIGNS OR SYMPTOMS APPEAR.
A PATIENT WITH PRECLINICAL AD MAY APPEAR
COMPLETELY NORMAL ON PHYSICAL EXAMINATION
AND MENTAL STATUS TESTING. AT THIS STAGE,
THERE IS NORMALLY NO ALTERATION IN JUDGMENT
OR THE ABILITY TO PERFORM ACTIVITIES OF DAILY
LIVING.
PRECLINICAL
STAGES 1
16. THE GROWING NUMBER OF PLAQUES AND TANGLES
FIRST DAMAGE AREAS OF THE BRAIN THAT
CONTROL MEMORY, LANGUAGE, AND REASONING
(SEE THE IMAGES BELOW). LATER IN THE DISEASE,
PHYSICAL ABILITIES DECLINE. THIS LEADS TO A
SITUATION IN MILD AD IN WHICH A PERSON SEEMS
TO BE HEALTHY BUT IS ACTUALLY HAVING MORE
AND MORE TROUBLE MAKING SENSE OF THE
WORLD AROUND HIM OR HER. THE REALIZATION
THAT SOMETHING IS WRONG OFTEN COMES
GRADUALLY BECAUSE THE EARLY SIGNS CAN BE
CONFUSED WITH CHANGES THAT CAN HAPPEN
NORMALLY WITH AGING.
MILD
STAGE 2
17. BEHAVIOR IS THE RESULT OF COMPLEX BRAIN
PROCESSES, ALL OF WHICH TAKE PLACE IN A
FRACTION OF A SECOND IN THE HEALTHY BRAIN.
IN AD, MANY OF THESE PROCESSES ARE
DISTURBED, AND THIS IS THE BASIS FOR MANY
DISTRESSING OR INAPPROPRIATE BEHAVIORS.
FOR EXAMPLE, PATIENTS MAY ANGRILY REFUSE
TO TAKE A BATH OR GET DRESSED BECAUSE
THEY DO NOT UNDERSTAND WHAT THE
CAREGIVER HAS ASKED THEM TO DO. IF THEY DO
UNDERSTAND, THEY MAY NOT REMEMBER HOW
TO DO WHAT WAS ASKED.
JUDGMENT AND IMPULSE CONTROL CONTINUE TO
DECLINE AT THIS STAGE. FOR EXAMPLE, TAKING
OFF CLOTHES MAY SEEM REASONABLE TO A
PERSON WITH AD WHO FEELS HOT AND DOES
NOT UNDERSTAND OR REMEMBER THAT
MODERATE
STAGE 3
18. IN THE LAST STAGE, SEVERE AD, PLAQUES AND
TANGLES ARE WIDESPREAD THROUGHOUT THE BRAIN,
AND AREAS OF THE BRAIN HAVE ATROPHIED FURTHER
(SEE THE IMAGES BELOW). PATIENTS CANNOT
RECOGNIZE FAMILY AND LOVED ONES OR COMMUNICATE
IN ANY WAY. THEY ARE COMPLETELY DEPENDENT ON
OTHERS FOR CARE. ALL SENSE OF SELF SEEMS TO
VANISH.
IN END-STAGE AD, PATIENTS MAY BE IN BED MUCH OR
ALL OF THE TIME. DEATH IS OFTEN THE RESULT OF
OTHER ILLNESSES, FREQUENTLY ASPIRATION
PNEUMONIA.
SEVERE
STAGE 4
19. All drugs approved by the US Food and Drug
Administration (FDA) for the treatment of AD modulate
neurotransmitters, either acetylcholine or glutamate. The
standard medical treatment for AD includes cholinesterase
inhibitors (ChEIs) and a partial N -methyl-D-aspartate
(NMDA) antagonist.
Secondary symptoms of AD (eg, depression, agitation,
aggression, hallucinations, delusions, sleep disorders)
can be problematic. Behavioral symptoms are common
and can exacerbate cognitive and functional impairment.
therapy, reversal of excess tau phosphorylation,
estrogen therapy, vitamin E therapy, and free-radical
scavenger therapy. Studies of these therapies have
yielded mostly disappointing results.
TREATMENT
20. MEDICATIONS
Donepezil has shown efficacy in
patients with mild to moderate AD, as
well as moderate to severe AD. It
selectively inhibits
acetylcholinesterase, the enzyme
responsible for the destruction of
acetylcholine, and improves the
availability of acetylcholine.
Donepezil's long half-life provides a
long duration of drug availability for
binding at the receptor sites.
Low- to moderate-affinity
uncompetitive N-methyl-D-
aspartate (NMDA) receptor
(NMDAR) antagonist that
binds preferentially to
NMDAR-operated cation
channels, blocking receptor
only under conditions of
excessive stimulation, with no
effect on normal
neurotransmission
amyloid and binds to aggregated
forms of beta-amyloid; preferentially
binds to parenchymal over vascular
amyloid. The FDA granted
accelerated approval for
aducanumab based on reduction in
amyloid beta plaques observed in
patients treated for Alzheimer
disease.
21. N0VELITY
Aducanumab (Aduhelm™) has received
accelerated approval as a treatment for
Alzheimer’s disease from the U.S. Food and
Drug Administration (FDA). This is the first FDA-
approved therapy to address the underlying
biology of Alzheimer’s disease.
It is the first therapy to demonstrate that
removing beta-amyloid, one of the hallmarks of
Alzheimer’s disease, from the brain is
reasonably likely to reduce cognitive and
functional decline in people living with early
Alzheimer’s.
Now, using a mouse model of Alzheimer's disease, a
team from Yale University in the US may have
figured out why the patches of protein seem relevant
without necessarily being directly responsible.
They found the swelling is formed by a buildup of
lysosomes – little bin-bag-like compartments created
by cells to break down waste and contain it until it
can be removed. These lysosomes clump into
spheroid structures along the axons of brain cells –
the long 'transmission cable' that extends from the
cell's body, and ends in branches of signal-sending
extensions.
Using calcium and voltage imaging of individual
cells, the team were able to show the amount of
signal disruption was linked to the spheroid sizes.
The spheroid swellings remain stable for long
periods of time, so likely continue to disrupt neuron
22. Patients counselling
WHEN COUNSELING PATIENTS FOLLOWING A DIAGNOSIS OF AD, IT IS ESSENTIAL TO
INVOLVE THE PATIENT’S FAMILY AND OTHERS WHO WILL PLAY A SUPPORTING ROLE IN
THE DISCUSSION. IT IS IMPORTANT TO EMPHASIZE THAT NOT ONLY THE PATIENT BUT
ALSO THOSE WHO SUPPORT THE PATIENTS WILL LIKELY EXPERIENCE REACTIONS OF
SADNESS AND ANGER AND THAT THESE ARE NORMAL REACTIONS TO SUCH A
DIAGNOSIS.
AS THE PATIENT’S SYMPTOMS BECOME MORE PRONOUNCED, A DIALOGUE MUST BE
OPENED REGARDING THE PATIENT’S WISHES FOR CARE WHEN HE OR SHE IS NO
LONGER ABLE TO MAKE THE NECESSARY CHOICES. DURABLE POWER OF ATTORNEY
SHOULD BE DISCUSSED, WITH PARTICULAR ATTENTION TO WHO WILL MAKE
DECISIONS FOR BOTH MEDICAL AND FINANCIAL ISSUES. MEDICAL ADVANCE
DIRECTIVES SHOULD BE CONSIDERED WHILE THE PATIENT IS STILL ABLE TO
PARTICIPATE IN THE DECISION-MAKING PROCESS.
THROUGHOUT THE COURSE OF THE DISEASE, FAMILY MEMBERS SHOULD BE CAREFUL
TO SELECT QUALIFIED AND TRUSTWORTHY INDIVIDUALS TO BE INVOLVED IN THE DAY-
TO-DAY MANAGEMENT OF THE PATIENT. CAREGIVERS NEED TO BALANCE ATTENTION
TO THE PATIENT’S PHYSICAL NEEDS WITH MAINTAINING RESPECT FOR THE PATIENT
AS A COMPETENT ADULT, TO THE EXTENT ALLOWED BY THE PROGRESSION OF THE
DISEASE. ANY SUSPICIONS OF ELDER ABUSE SHOULD BE IMMEDIATELY ADDRESSED.