About Alzheimer’S Disease Most Widely Recognized Type of Dementia
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Alzheimer’s disease is one of the predominant neurological disease, with global increase. It is a progressive neuronal loss related to various etiologies with multiple neurodegeneration disease. It is a serious brain disorder that impacts daily living through memory loss and cognitive changes. Alzheimer’s is a degenerative disease, progressing from mild forgetfulness to widespread neurological impairment and ultimately death. (Mendiola, eta al,. 2016).
Chemical and structural changes in the brain gradually destroy the ability to create, remember, learn, reason, and relate to others. As critical cells die, drastic personality loss occurs and body systems fail. Alzheimer’s disease is characterized by various etiologies which comprises of: oxidative stress, mitochondrial impairment, neuro-inflammation, synaptic dysfunction, and blood-brain barrier disruption. These are as the result of abnormal accumulation of amyloid plaques and tau protein aggregation in intracellular neuro fibrillary tangles , that result in synaptic and neuronal loss, leading to cognitive dysfunction. (McCance and Huether,2019).
The pathophysiology of AD is routed in many hypothesis: Amyloid Hypothesis, Tau Hypothesis, Cholinergic Hypothesis, Mitochondrial Cascade Hypothesis, Metabolic Hypothesis, and Vascular Hypothesis, but for the purpose of this paper, I will discuss two main Amyloid and Tau Hypothesis.
Alzheimers disease is characterized by abnormal clumps called senile plaques and irregular knots known as neurofibillary tangles of brain cell.The plaque is an abnormal accumulation of protein called amyloid. This hypothesis suggest that the plaque forms because the normal process that clears this plaque has failed or become defective. Neurofibillary tangles are skeins of another abnormal protein found inside the cell, which developed because of abnormal process or disruption of protein found inside the cell. This tangle prevents the normal functioning of the nerve cells. The tangle and plaques then take over the healthy brain tissue, destroying the blood brain barrier and devastating the brain and destroying the intellectual function. ( Mendiola, Précoma, Rodríguez, Berumen, & García, 2016).
Tau proteins are found mainly in neurons located at chromosome 17 and is involve in polymerization and micro tubule stabilization. phosphorylation modulates key function of Tau in regulating microtubule dynamics, axonal transport and neurit outgrowth. Disruption of phosphorylation results in tau dysfunction and toxic loss or gain in function. Loss of normal tau function will result to pathological alteration of cytoskeleton affecting normal cellular and axonal transport. Deposition of Tau protein results in insoluble aggregates and loss of tau function, leading to microtubule instability and promoting neurodegeneration seen in AD. (Sayad, & Zumrut. 2017).
Alzheimer’s disease is caused by a combination of genetic and environmental factors with associated risk factors which include: Traumatic Head Injury: deposition of Amyloid beta and T pathology following minor or major head injury, and elevated serum homocystein and neuro Inflammation
Genetic Mutations: Changes in DNA controlled by epigenetic factors as well as hereditary changes have been associated with AD. There are other genetic mutations induced by factors such as β-amyloid precursor protein, may induce changes in mitochondrial pathways, protein degradation, free radical and oxidative stress control, and immune system functions. These genetic mutations affect cell function, allowing apoptosis and inducing neuro degeneration.
Protein Degradation: Extracellular and intracellular protein misfolding and in neuro fibrillary tangles induce a second brain reaction and toxic molecule formation, as oxidative stress, inducing cell dysfunction. Degradation of large misfolded proteins through authophagy induce more damage to the cell by generating toxic molecules and oxidative stress.
Oxidative Stress and Toxic Molecules: Mitochondria enzymes which control the concentration of reactive oxygen, when these enzymes fail, the generation of toxic molecules by oxidative stress induces different reactions which in the other hand induce mitochondria dysfunctions and decreased ATP calcium homeostasis compromise, membrane lipid peroxidation, and mitochondria permeability, fragmentation and dysfunction with increase in free radicals and oxidative stress, causing neuro degeneration in AD.
Neuro-Inflammatory Processes: The complexity and chronic activation action of the immune system in the central nervous system leads to over expression of pro-inflammatory cytokines and TNF-α, which impair phagocytosis and affect cell survival and generate an oxidative environment, promoting neurodegeneration through the apoptosis pathway. (Mendiola, eta al,. 2016; Sayad and Zumrut. ( 2017). Alzheimer’s is a slow progressive degenerative disease, with onset between 40 and 90 years old.
The first symptom is often a loss of memory (amnesia), manifested initially by minor distractions which increase, with difficulty remembering events and performing daily routine activities. As the disease progresses, the person experience confusion, personality and behavior changes, impaired judgment, difficulty finding words, finishing thought and following direction. These people may be unaware of there intellectual failing
Neurological involvement extends with associative cortex frontal and temporo-parietal, leading to more severe cognitive impairment (confusion, irritability, aggression, mood, and emotions, executive functions and language) and the loss of long-term memory. Destruction of neurons continues until the loss of autonomic functions. Deficits in two or more cognitive areas such as memory, judgment or calculation. Progressive deterioration of memory and other cognitive functions. Absence of disorders of consciousness such as delirium, presence of aphasia, apraxia . Eventually individual with alzheimer’s disease completely loss sense of caring for themselves, loss of speech agitation restlessness depresion and disorientation and must be confines to bed.(Mendiola, eta al,. 2016; Sayad & Zumrut, 2017. McCance & Huether, 2019).
Alzheimer’s is a progressive slow degenerative disease affecting almost all organs from motor skill, cognitive intellectual to speech and activities of daily living.Understanding clinical manifestation of AD, and capitalizing on this knowledge will impact how I treat and care for my patients as a nurse practitioner. Ms B is an 87 years old woman with Alzheimer’s and under our home health care for past 5 years. Since then she has deteriorated becoming more confused forgetful and lacking in her ability to perform activities of daily living. Understanding of the clinical manifestation of Alzheimer’s and that manifested by Ms B, will greatly impact how I care for my patients as a nurse practitioner.
There is clear indication from the clinical manifestation of Alzheimer that care of a patient with Alzheimer’s require patience and flexibility aimed at reducing frustration and distraction as well as creating a safe environment. These key pints are required not just in Ms B as an Alzheimer’s patients but to all individuals with any type of chronic illness. The progressive deteriorating situation in Alzheimer’s disease, creates the understanding that as the disease progresses, the individual’s ability to manage daily tasking declined, it is important to consider practical tips that help in maintaining a sense of independent and dignity as they become dependent.
Reducing frustration and agitation is expected as task become difficult, at this point is is important to limit challenge and ease frustration, establishing routine help make each day less agitating and confusion, avoiding underestimating of there ability to learn and follow routines. As a nurse practitioner,understanding the clinical manifestation of Alzheimer has impacted my knowledge of how it is important to schedule there medical appointment when they are most alert and at there convenience hours. It impacted my understanding that things and consultation may take longer, to allow more time for task or intervals between schedule to prevent rushing patients and to allow time to listen and discuss there problem as well as given them options or choices when necessary and to ask if she prefer example her medication in liquid or tablet.
It is important as a nurse practitioner to provide instructions and teaching in a simple non complicated clear manner. Reducing any environmental distractions will encourage focus. It is most obvious that understanding the clinical manifestations of Ms B Alzheimer’s condition will greatly impact my care as a nurse practitioner in all aspect of her care continuum. (Mendiola, eta al,. 2016, McCance & Huether,2019).