Alzheimer’s Disease

History
In 1901 that German
psychiatrist
AloisAlzheimer
identified the first case
of what became known
as Alzheimer's Disease
(AD) in a fifty-year-old Alois Alzheimer's patient
Auguste D in 1902. Hers
woman he called was the first described
case of what became known
Auguste D. Alzheimer as Alzheimer's disease. [2]

followed her until she

died in 1906, when he
 Script - History
In 1901 German psychiatrist Alois Alzheimer
identified the first case of what became known
as Alzheimer's Disease in a fifty-year-old woman
he called Auguste D. Alzheimer followed her
until she died in 1906, when he first reported the
case publicly.


For most of the twentieth century, the diagnosis

of Alzheimer's disease was reserved for
individuals between the ages of 45 and 65 who
developed symptoms of dementia. The
terminology changed in 1977 after a medical
conference developed a specific criteria for
symptoms and stages. This eventually led to the
diagnosis of Alzheimer's Disease independently
 Stages

Stage 1 Unimpaired individuals experience no memory problems and none are evident to a health care professional during a medical interview.

Stage 2 Individuals may feel as if they have memory loss and lapses, especially in forgetting familiar words or names or the location of keys, eyeglasses or
other everyday objects. But these problems are not evident during a medical examination or apparent to friends, family or co-workers.

Stage 3 Friends, family or co-workers begin to notice deficiencies. Problems with memory or concentration may be measurable in clinical testing or
discernible during a detailed medical interview. Common difficulties include: Word- or name-finding problems noticeable to family or close
associates, Decreased ability to remember names when introduced to new people; Performance issues in social or work settings noticeable to
family, friends or co-workers; Reading a passage and retaining little material; Losing or misplacing a valuable object; Decline in ability to plan or
organize.

Stage 4 At this stage, a careful medical interview detects clear-cut deficiencies in the following areas: Decreased knowledge of recent occasions or current
events; Impaired ability; to perform challenging mental arithmetic-for example, to count backward from 75 by 7s; Decreased capacity to perform
complex tasks, such as planning dinner for guests, paying bills and managing finances; Reduced memory of personal history; The affected
individual may seem subdued and withdrawn, especially in socially or mentally challenging situations.

Stage 5 Major gaps in memory and deficits in cognitive function emerge. Some assistance with day-to-day activities becomes essential. At this stage,
individuals may: Be unable during a medical interview to recall such important details as their current address, their telephone number or the name
of the college or high school from which they graduated; Become confused about where they are or about the date, day of the week or season;
Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s; Need help choosing proper
clothing for the season or the occasion; Usually retain substantial knowledge about themselves and know their own name and the names of their
spouse or children; Usually require no assistance with eating or using the toilet.

Stage 6 Memory difficulties continue to worsen, significant personality changes may emerge and affected individuals need extensive help with customary
daily activities. At this stage, individuals may: Lose most awareness of recent experiences and events as well as of their surroundings; Recollect
their personal history imperfectly, although they generally recall their own name; Occasionally forget the name of their spouse or primary caregiver
but generally can distinguish familiar from unfamiliar faces; Need help getting dressed properly; without supervision, may make such errors as
putting pajamas over daytime clothes or shoes on wrong feet; Experience disruption of their normal sleep/waking cycle; Need help with handling
details of toileting (flushing toilet, wiping and disposing of tissue properly); Have increasing episodes of urinary or fecal incontinence; Experience
significant personality changes and behavioral symptoms, including suspiciousness and delusions (for example, believing that their caregiver is an
impostor); hallucinations (seeing or hearing things that are not really there); or compulsive, repetitive behaviors such as hand-wringing or tissue
shredding; Tend to wander and become lost.

Stage 7 This is the final stage of the disease when individuals lose the ability to respond to their environment, the ability to speak and, ultimately, the ability
to control movement; Frequently individuals lose their capacity for recognizable speech, although words or phrases may occasionally be uttered;
Individuals need help with eating and toileting and there is general incontinence of urine; Individuals lose the ability to walk without assistance, then
the ability to sit without support, the ability to smile, and the ability to hold their head up. Reflexes become abnormal and muscles grow rigid.
Swallowing is impaired.
 Script - Stages
There are seven distinctive stages relating


to Alzheimer’s. They are typically linked to

the degenerative qualities of the disease. It
progresses in each individual at different
rates and not all sufferers experience the
same types of stages or symptoms.
 Symptoms
Early Stage symptoms:


• Inability to acquire new memories;

• Difficulty in recalling recently observed
facts.


As the disease advances, symptoms
include:
• Confusion;
• Irritability and aggression;
• Mood swings;
• Language breakdown;
• Long-term memory loss;
• Social withdrawal;
• Sundowning.
 Script - Symptoms
At the initial onset of Alzheimer’s symptoms there can be no symptoms at all.
Some may seem a “little forgetful” – like anyone…where are my keys, what am
I supposed to do today; however, the next stages typically articulate the path
of the degenerative nature of the disease.
The next most noticeable symptoms are that sufferers begin to lose “nouns”

(ex. They know what a table is, and that they’re sitting at one, but they cannot
say “table”. They also begin to experience noticeable mood swings that
indicate irritability, anxiety, depression and typically begin placing items in
unexpected places (ex. Car keys in the refrigerator). They begin to relate more
to the past and lose focus of current events and their recent personal
experiences. Also there is a loss of interest in previously enjoyable activities or
hobbies.
In later stages symptoms become more apparent and require increased

medication and physical assistance. Sufferers begin to lose a sense of their

own identity and may look into a mirror and think they see someone else.
They lose a sense of time of day and date and begin to wander or obsess about
things they can control in their environment. Some later experience
Sundowning in which a markedly increased level of anxiety occurs in the
evening.
Very late stages AD patients will begin having episodes where they believe

they are living their past…when they were a child, when they were parents of
young children. Women frequently will think they are pregnant and about to
give birth or having menstruation. Men will defer to memories of professional
experience and talk about having to be in a meeting or an important
Causes - Plaques and
Tangles

Im a g e o f se n ile p la q u e s se e n in
th e ce re b ra l co rte x o f a p e rso n
w ith A lzh e im e r's d ise a se o f p re -
se n ile o n se t.

M icro sco p y im a g e o f a
n e u ro fib rilla ry ta n g le ,
co n fo rm e d b y h yp e r-
p h o sp h o ryla te d ta u p ro te in .
Script - Causes – Plaques and
Tangles
Two abnormal structures called plaques and tangles are prime
suspects in damaging and killing nerve cells. Plaques and
tangles were among the abnormalities that Dr. Alzheimer saw
in the brain of Auguste D.
 Alzheimer’s Plaques

Enzymes act on Amyloid Precursor Protein and break it into fragments.

The beta-amyloid fragments then form plaques .
 Script - Causes - Plaques


Plaques form when protein pieces called

beta-amyloid (BAY-tuh AM-uh-loyd) clump
together. Beta-amyloid comes from a
larger protein found in the fatty membrane
surrounding nerve cells.
Beta-amyloid is chemically "sticky" and

gradually builds up into plaques.

The most damaging form of beta-amyloid

may be groups of a few pieces rather than

the plaques themselves. The small clumps
may block cell-to-cell signaling at
synapses. They may also activate immune
system cells that trigger inflammation and
devour disabled cells.
 Alzheimer’s Tangles

Changes in tau protein lead to the disintegration of microtubules

in brain cells.
 Script - Causes Tangles
Tangles destroy a vital cell transport system
made of proteins. This electron microscope
picture shows cells with some healthy areas and
other areas where tangles are forming.
In healthy areas the transport system is

organized in orderly parallel strands somewhat

like railroad tracks. Food molecules, cell parts
and other key materials travel along the
“tracks.”
A protein called Tau helps the tracks stay

straight.
In areas where tangles are forming tau protein

collapses into twisted strands called tangles.

The tracks can no longer stay straight. They fall

apart and disintegrate.

•
 Brain Comparison
In the Alzheimer brain:


• The cortex shrivels up,

damaging areas
involved in thinking,
planning and
remembering.
• Shrinkage is especially
severe in the
hippocampus, an
area of the cortex
that plays a key role
in formation of new
memories.
• Ventricles (fluid-filled
spaces within the
brain) grow larger.
 Script - Brain Comparison
Here is a view of how massive cell loss
changes the whole brain in advanced
Alzheimer's disease. This slide shows a
crosswise "slice" through the middle of the
brain between the ears.
In the Alzheimer brain:

• The cortex shrivels up, damaging areas

involved in thinking, planning and
remembering.
• Shrinkage is especially severe in the
hippocampus, an area of the cortex that
plays a key role in formation of new
memories.
• Ventricles (fluid-filled spaces within the
brain) grow larger.
 PET Scan Comparison

Healthy Brain Alzheimer ’ s Brain

 Script – PET Scan
Here is a PET scan image comparing a healthy
brain and a brain of a person with AD showing a
significant decline in function of the temporal
lobe. This damage directly effects auditory
perception and the hippocampus which plays a
key role in the formation of long-term memory.
•
 Alzheimer’s Factors
A g e
Fa m ily H isto ry
H e a d Tra u m a
H e a rt D ise a se
A lco h o lA b u se
To b a cco U se
In a ctivity
C h o lin e rg ic H yp o th e sis
Former President Ronald
A m ylo id H yp o th e sis


Reagan suffered an episode

Ta u H yp o th e sis of head trauma in July
1989, five years prior to his
diagnosis of AD.
 Script – AD Factors
Age


Advancing age is the number one risk factor for developing Alzheimer’s disease. One


out of eight people over the age of 65 has Alzheimer’s disease, and almost one out of
every two people over the age of 85 has Alzheimer’s. The probability of being
diagnosed with Alzheimer’s nearly doubles every five years after age 65.


Family History


People who have a parent or sibling that developed Alzheimer’s disease are two to


three times more likely to develop the disease than those with no family history of
Alzheimer’s. If more than one close relative has been affected, the risk increases even
more.


Lifestyle Factors


Although age and family history are out of our control, scientists have also identified
several lifestyle factors that can influence a person’s risk of developing Alzheimer’s
disease. A connection has been found between serious head injury and future
development of Alzheimer’s.
• Former President Ronald Reagan suffered an episode of head trauma in July 1989,
 Treatment
Acetylcholinesterase


(AChE) Inhibitors
• Donepezil (Aricept)
• Galantamine (Razadyne)
• Rivastigmine (Excelon/Patch)
 Glutamate Blockers
• Memantine (Akatinol, Axura,
Exiba/Abixa, Memox,
Namenda)
Antidepressants


(SSRI’s)
• Zoloft
• Paxil
• Seroquel
 Antipsychotics
• Risperdal
• Haldol
 Script -Treatments
 The major treatment for symptoms of AD is medication.
Cognitive therapies such as activities that engage and socially
involve suffers are beneficial, but most often medications are
used to alleviate and control symptoms. There are several types
of primary medications used currently but there are many
promising therapies on the horizon.
 Most prescribed for alleviating symptoms are
Acetylcholinesterase(AChE) inhibitors (most commonly known
brand name is Aricept) are used to reduce the rate at which
acetylcholine is broken down thereby increasing the number of
cholinergic neurons.
 Glutamate is an excitatory neurotransmitter of the
nervous system. In excessive amounts in the brain it causes cell
death through a process called excitotoxicity . Mematine (most
known brand is Namenda) blocks glutamine overstimulation.
 Antidepressants (primarily SSRI’s) and antipsychotic
drugs are modestly useful in reducing aggression, anxiety and
mood swings in Alzheimer's patients with behavioral problems.
 Prognosis
M o rta lity R a te C o m p a riso n s in th e U n ite d S ta te s b e tw e e n 2 0 0 0 - 2 0 0 6

e a se Typ e

Po p u la tio n in th e th o u sa n d s
 Script - Prognosis
Alzheimer's disease mortality is on the rise with a
rapidly aging baby boomer population, Alzheimer's
will continue to impact more lives. From 2000-
2006, Alzheimer's disease deaths increased 46.1
percent, while other selected causes of death
decreased.
The prevalence of AD in the United States is

growing steadily and currently affects around five

million Americans. Due to the strong association
between age and the incidence of Alzheimer’s
disease, the aging of the population has significant
implications for the resources needed to care for
these individuals.
Direct and indirect costs of caring for an

Alzheimer's patient averages between $18,000

and $77,500 per year in the United States.

 References
 http://www.alz.org/alzheimers_disease_facts_figures.asp
 http://www.aw-bc.com/applace/
 http://alzheimers.about.com/od/familyandfriends/a/alz_celebs.htm
 http://archives.cnn.com/2000/ALLPOLITICS/stories/07/16/alzheimers.reagan/
http://


www.alzheimersrxtreatment.com/learnaboutalz.html?source=google&HBX_PK=alzheimer's&HBX_OU=50&o=50:23060039|165867467|4
 http://en.wikipedia.org/wiki/Acetylcholinesterase
http://www.namenda.com/sections/about-alzheimers-disease/?


WT.srch=1&RF?WT.srch=1&PlacementGUID=62E0F2E7-8677-4CBD-BF8C-B49E80E79E98
 http://en.wikipedia.org/wiki/Alzheimer's_disease
 http://un.org/esa/population/publications/wpp2006/WPP2006_Highlights_rev.pdf
 http://ajp.psychiatryonline.org/cgi/content/full/158/5/704
 http://www.mayoclinic.com/health/alzheimers/AZ00015
 http://www.cdc.gov/excite/ScienceAmbassador/ambassador_pgm/lessonplans/Valo-Wabler_Alz.pdf
http://www.everydayhealth.com/senior-health/alzheimers/recognizing-the-symptoms.aspx?xid=g_&s_kwcid=TC|6122|alzheimer's%20gra


4457945592&gclid=CO-m-7jr9aICFREeDQodbEaVkw
 http://www.alz.org/documents_custom/report_alzfactsfigures2010.pdf
 http://www.sciencedaily.com/releases/2007/11/071101122822.htm
 http://www.alzinfo.org/alzheimers-disease-treatment-information.asp

•
 Images
1. http://health.msn.com/health-topics/mental-health/slideshow.aspx?cp-documentid=100234109&imageindex=2
2. http://en.wikipedia.org/wiki/File:Auguste_D_aus_Marktbreit.jpg
3. http://www.icarastudy.com/index.aspx?t=goo_alz_adgroup1_ad4&kw=alzheimer's&gclid=COXMit3z9aICFUcz5wodKg-Viw
4. http://www.alzheimersrxtreatment.com/learnaboutalz.html?source=google&HBX_PK=alzheimer's&HBX_OU=50&o=50:23060039|165867467|468
5. http://en.wikipedia.org/wiki/File:TAU_HIGH.JPG