A Comprehensive Overview of the Pathophysiology and Risk Factors for Alzheimers Disorder (AD)
Describe the pathophysiology of the primary diagnosis in your own words. What are the patient’s risk factors for this diagnosis?
| Pathophysiology of Primary Diagnosis | |
| AD is the most common form of dementia. The pathophysiological principle underlining this disorder is the accumulation of neuritic plague and neuronal fibrillary tau tangles in the brain and consequently neurodegeneration. This is preceded by synapse loss and subsequent atrophy of the affected neurons in the entirety of the cerebral cortex. The medial-temporal lobe is often the most affected area. These changes result in significant cognitive function loss over time (Abubakar et al., 2022). | |
| Causes | Risk Factors (genetic/ethnic/physical) |
| AD is a progressive neurodegenerative disorder with multifactorial aetiology. Traumatic head injury, cardiovascular injuries, depression, cerebrovascular accidents, and high levels of homocysteine hormone are believed to cause the disease (Breijyeh & Karaman, 2020). | Several risk factors have been associated with AD. Smoking, Trisomy 21, and family history of AD and other forms of dementia are thought to increase an individual chances of developing the disease. AD is prominent among the elderly. It affects persons of all ethnicities. Incident rates are, however, higher in women than males (Silva et al., 2019). |
What are the patient’s signs and symptoms for this diagnosis? How does the diagnosis impact other body systems, and what are the possible complications?
| Signs and Symptoms – Common presentation | How does the diagnosis impact each body system? Complications? |
| In the early stages, AD will manifest as impaired memory. Cognitive and behavioral manifestations such as depression, insomnia, anxiety, paranoia, and anger may also be apparent. In the later stage, parkinsonian symptoms, extrapyramidal motor signs, and olfactory dysfunction occur. Total dependence and incontinence also manifest. | AD is a progressive neurodegenerative disorder. As the disease progresses, various bodily systems, such as the GI system, immune system, and respiratory systems, are considerably affected. In the GI system, dehydration and malnutrition often occur. In the respiratory system, respiratory failure and subsequent aspiration pneumonia may also occur. The immune system functionalities are also suppressed, increasing the potential for infections. The complications of AD include aspiration pneumonia, incontinence, and malnutrition, among others. |
What is another potential diagnosis that presents in a similar way to this diagnosis (differentials)?
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The potential differentials in AD include Lewy body dementia, frontotemporal lobar degeneration, vascular dementia, and pseudodementia.
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What diagnostic tests or labs would you order to rule out the differentials for this patient or confirm the primary diagnosis?
| Several diagnostic tests can help delineate AD from other differentials. A computed tomography scan of the brain can point toward AD diagnosis. These scans often demonstrate atrophication of the cerebral neurons. CSF analysis for the elevation of beta-amyloid tau tangles elevation may also be suggestive of the disorder. Volumetric magnetic resonance imaging can also help in measuring changes in the brain precisely. Its fining gives insight into the shrinkage of the medial temporal lobe that characterises AD. Other useful imaging techniques that can aid the diagnosis include PET scans and single photon emission computed tomography (SPECT) scans. |
What treatment options would you consider? Include possible referrals and medications.
| AD is a progressive disease with no cure. Current management modalities are targeted at improving the quality of life and lessening symptom severity. The two medication categories utilized include partial N-Methy-D-Aspartate antagonists and cholinesterase inhibitors. Partial NMDA antagonists such as memantine are FDA-approved in the management of moderate to severe disease. It is effective in alleviating depression, psychosis, and anxiety that may manifest in the late stages of the disease (Yiannopoulou & Papageorgiou, 2020). Cholinesterase inhibitors such as galantamine, rivastigmine, and donepezil are FDA-approved in the management of AD. While Donepezil is used in managing the disease in all its stages, galantamine and rivastigmine are preferred in the dementia stage of the disease. Cholinesterase inhibitors raise the level of acetylcholine in the cerebral cortex, enhancing communication between nerves and improving cognitive and memory functions (Yiannopoulou & Papageorgiou, 2020). Since AD is progressive and has no cure, referral to end-of-life care facilities may be necessitated as the disease progresses. Integral to end-of-life care is the recognition of the humanistic aspects of these patients and that their suffering is not their making. |
References
Abubakar, M. B., Sanusi, K. O., Ugusman, A., Mohamed, W., Kamal, H., Ibrahim, N. H., Khoo, C. S., & Kumar, J. (2022). Alzheimer’s disease: An update and insights into pathophysiology. Frontiers in Aging Neuroscience, 14. https://doi.org/10.3389/fnagi.2022.742408
Breijyeh, Z., & Karaman, R. (2020). A comprehensive review on Alzheimer’s disease: Causes and treatment. Molecules, 25(24), 5789. https://doi.org/10.3390/molecules25245789
Silva, M. V., Loures, C. de, Alves, L. C., de Souza, L. C., Borges, K. B., & Carvalho, M. das. (2019). Alzheimer’s disease: Risk factors and potentially protective measures. Journal of Biomedical Science, 26(1). https://doi.org/10.1186/s12929-019-0524-y
Yiannopoulou, K. G., & Papageorgiou, S. G. (2020). Current and future treatments in Alzheimer’s disease: An update. Journal of Central Nervous System Disease, 12, 117957352090739. https://doi.org/10.1177/1179573520907397
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Question 
Describe the pathophysiology of the primary diagnosis in your own words. What are the patient’s risk factors for this diagnosis?
A Comprehensive Overview of the Pathophysiology and Risk Factors for Alzheimer’s Disorder (AD)
| Pathophysiology of Primary Diagnosis | |
| Causes | Risk Factors (genetic/ethnic/physical) |
What are the patient’s signs and symptoms for this diagnosis? How does the diagnosis impact other body systems and what are the possible complications?
| Signs and Symptoms – Common presentation | How does the diagnosis impact each body system? Complications? |
What are another potential diagnosis that presents in a similar way to this diagnosis (differentials)?
What diagnostic tests or labs would you order to rule out the differentials for this patient or confirm the primary diagnosis?
What treatment options would you consider? Include possible referrals and medications.