Alzheimer’S Disease Final Draft

Alzheimer’s Disease

Temporal Lobe

What do you think of when you hear the word Alzheimer’s?

• What does the disease mean to you?

• What do you associate it with?

• Any personal experiences?

Video

What is Alzheimer's Disease?

Alois Alzheimer(1864-1915)

“We must not be satisfied to force it into the existing group of

well know disease patterns”

Research Tracks and Understanding

1. Neurochemical Neurotransmitters

2. Pathognomic Lesions

Neurotic Plaque

Neurofibrillary Tangles

3. Molecular Genetic Approach

Mendelian Cloning Strategies

Neurotransmitters Possible selective neurotransmitter loss?

Plaques and Tangles

Temporal Lobe

Vital Structures

Hippocampus

Amygdala

Temporal Lobe Functions

Visual and Auditory Input

Sensory Input

Memory Consolidation

Damage and Lesions in Temporal Lobe

• Verbal impairment• Word recognition• Visual impairment• Verbal memory deficiencies

• Visual impairment• Word formation• Musical memory

Process of Diagnosis

• Patient History• Cognitive assessment tests• Physical Examination• Brain Imaging

Patient History

Look for 10 Signs of Early Detection:

1. Memory changes that disrupt daily life

2. Challenges in planning or solving problems

3. Difficulty completing familiar tasks

4. Confusion with time or place

5. Trouble Understanding visual images and spatial relationships

Patient History

6. New problems with language

7. Misplace things

8. Decreased or poor judgment

9. Withdrawal from work or social activities

10. Changes in mood or Personality

Goal of Patient History

Rule out other possible causes• Example 1: Vitamin B 12 deficient• Example 2: Depression

Cognitive Assessment Tests

• Mini Mental Status Exam• Blessed Dementia Scale• Short Portable Mental Status Questionnaire

Mini Mental Status Exam

Asks patient questions about the present:• What is the date?• Where are we now?

-Mathematical Calculations

-Three Step Directions

-Read and follow a command

-Reproduce a figure by drawing

Mini Mental Status Exam

Score Evaluation:• Each exercise has a value of 1,3 or 5 points• Perfect score is 30• Score under 20 points raises concern of

dementia

• Similar questioning involved in Short Portable Mental Status Questionnaire (SPMSQ)

Blessed-Dementia Scale

Look for changes in:• Performance of every day activities• Habits• Personality• Interests• Drive

Short Portable Mental Status Questionnaire

Ask patient simple questions about: • What is the day of the week? • What is the name of this place? • What is your phone number?

Physical Examination

• Biomarkers• Urinalysis• CT Scan or MRI of brain

Biomarkers

Measure for variance from norm in:• Electrolyte imbalance• Vitamin deficiencies• ApoE4 gene • Tau protein • Aß42

Urinalysis

• Physical color and appearance• Microscopic appearance• Chemical appearance

Brain Imaging

Looking for evidence of:• Stroke• Bleeding around the brain• Brain tumor• Normal pressure hydrocephalus

(excess of brain fluids)

Types of Brain Imaging

• Positron Emission Tomography (PET)• CT Scan• MRI

Positron Emission Tomography (PET)

CT Scan

CT Scan: Medial Temporal Lobe

Brain Imaging: MRI(Magnetic Resonance Imaging)

Types of MRI used for AD:• MRI• Functional MRI

MRI

Normal Brain

AD Brain

Functional MRI

Functional MRI of AD versus Normal Control

Burton et al. (2008)

Can MRI distinguish AD from other forms of dementia?

Burton et al. (2008)

Found distinguishing characteristics based on size:•Lewy Bodies•VCI

Confirm A Case: Autopsy

• 100% proven diagnostic of AD

Overview of Current Treatments

• Cholinergics

• Antioxidants

• Statins

• Anti-inflammatory drugs

• Memantine

Music Therapy

• Music as a Nursing Intervention for Residents with Alzheimer’s Disease in Long-Term Care (Sambandham & Schirm, 1995)

• Underwent music therapy sessions which included music the patients preferred

Music Therapy

• Patients with the most severe impairments displayed greater improvements in memory and reminiscence abilities as compared to patients with less severe impairment

• Can be used to minimize effects of AD until more definitive treatments are discovered

Behavioral Enrichment/Antioxidant Treatment

• Proteomic identification of brain proteins in the canine model of human aging following a long-term treatment with antioxidants and a program of behavioral enrichment: Relevance to Alzheimer’s disease (Opii et. Al 2006)

• Tested beagles for the effects of behavioral enrichment and inclusion of antioxidants in diet on Alzheimer’s Disease symptoms

Behavioral Enrichment/Antioxidant Treatment

• Behavioral enrichment types– Social Enrichment : Animals housed in pairs– Environmental Enrichment : Toys provided– Physical Enrichment : Providing outdoor walks– Cognitive Enrichment : Continuous cognitive testing

• Diets were identical with the exception of antioxidants and mitochondrial cofactor additions to enriched diet

• Groups were either both controlled, both enriched, or one factor enriched and on controlled

Behavioral Enrichment/Antioxidant Treatment

• Results of enrichment treatments– Significantly less oxidation and increased

expression of important proteins which correlated with improved cognitive function

New thoughts on the word Alzheimer’s?

• What does the disease mean to you?

• What do you associate it with?

• Any personal experiences?