Alzheimer . pptx- Second Year Diploma level

Introduction Alzheimer along with etiopathogenesis , clinical manifestation, management and pathophysiology

1. Alzheimer Presented by – darshana S. varma

2. Alzheimer’s Definition- It is chronic neurodegenerative diseases which characterized by dementia, loss motivation , mood swings, disorientation , short term memory loss and problems with language It generally begins in people over 65 years of age . The mean survival time is usually between 3-10yr after diagnosis

3. Stages of Alzheimer’s - Sr no Stages Common symptoms 1 Pre-dementia Short term memory loss 2 Early stage Decreased verbal fluency , impaired reasoning , decreased perception ad movement 3 Moderate Speech difficulty decreased reading and writing skills, motor in coordination and long-term memory loss 4 Advanced stage Complete loss of speech , mobility and muscle mass. Patient is bedridden and becomes vulnerable to infection , especially pneumonia

4. pathophysiology Due to the Etiological factor Changes occur in the proteins of the nerve cells of the cerebral cortex Accumulation of neurofibrillary tangles and plaques Granulo vascular degeneration Loss of cholinergic nerve cells Loss of memory , function and cognition

5. Etiopathogenosis- Genetic factor- Gene mutation due to metabolic , lifestyle or environmental factors which may leads to disruptions of innervation to primary motor or sensory cortices and cerebellum ii. This leads to disrupting neuronal communication Amyloids hypothesis- Accumulation of excess beta amyloids protein in the brain forming amyloid plaques on neurons or synapses Tau hypothesis – Neurofibrillary tangles due to accumulation of tau protein inside cell bodies Cholinergic hypothesis- According to this hypothesis , AD is caused by to reduced synthesis of Ach

6. Clinical manifestation- Common symptoms related to cognitive ( trouble remembering, learning new things ) impairment- Memory loss Language impairment Temporal and spatial disorientation ( difficulty in finding one's way in time and space) Impaired of executive function and judgement ( ability to think about what you think about, and to have awareness of your own awareness) Non- cognitive impairment- Behaviour changes;- Apathy (lack of interest , enthusiasm or concern) Agitation, aggression, irritability Mood disorder ( eg -symptoms of depression) Anxiety

7. Continue… iv. Mutism (inability to speak) Hallucinations and paranoia (  type of mental illness) Hyposmia ( a reduced ability to smell and detect odours) Insomnia ( inability to sleep) Myoclonus (spasmodic jerky contraction of groups of muscles ) Seizures Urinary incontinence

8. Diagnosis- The diagnosis is primarily based on presence of typical degenerative syndrome. MRI finding of hippocampal atrophy ( an early characteristic of Alzheimer's disease .) Amyloid positron emission tomography (PET) scan ( valuates cognitive impairment caused by  amyloid  plaques in patients) Cerebrospinal fluid amyloid and tau levels may help in diagnosis of AD in a patient with typical clinical presentation AD can only be confirmed via. neurohistopathological examination ( diagnosis of diseases of the nervous system) , which is possible only after the death of patient (post mortem)

9. Management- Risk factor associated with AD are- Unavoidable factors; Age ,family history (genetic factor) or having a specific gene like apolipoprotein E.) Avoidable or modifiable factors Daibetes High BP Low educational and occupational attainment Prior head injury Sleep apne

10. Non pharmacological Supportive measures- Lifestyle modifications Follows regular sleep schedule Maintain a familiar environment Remove ambient noise Physical activity ; improves physical strength which slow function decline Cognitive rehabilitation which includes memory training to support memory retention and strategies to compensate for Cognitive and functional decline

11. pharmacological Cholinesterase inhibitor N-methyl-D- aspartrate (NMDA)-receptor Eg -Donepezil, rivastigmine, eg - memantine Galantamine, tacrine