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Alzheimer’s Disease

Brooke Hildt and Jim Hutchins

Overview

Alzheimer’s disease is a progressive neurological disorder that affects memory, thinking, and behavior. It begins with a biological process involving the buildup of abnormal proteins in the brain, including amyloid plaques and neurofibrillary tangles, which gradually leads to the death of brain cells. This ongoing damage to brain tissue results in a steady decline in cognitive abilities and is the leading cause of dementia.

Signs & Symptoms

  • Memory loss
  • Poor judgement & reasoning
  • Difficulty planning & performing familiar tasks
  • Trouble concentrating
  • Changes in personality & behavior

Diagnosis

The diagnosis of Alzheimer’s disease typically involves a combination of approaches to assess brain function and rule out other conditions. Memory and cognitive testing are used to evaluate thinking skills, while imaging techniques such as PET scans, MRIs, and CT scans help detect changes in brain structure and activity. A physical and neurological exam is performed to assess reflexes, coordination, and overall neurological health. In some cases, genetic testing may be considered, especially when there is a family history of the disease. Blood tests, including a complete blood count (CBC), comprehensive metabolic panel (CMP), and thyroid-stimulating hormone (TSH) levels, are conducted to rule out other causes of symptoms. Additionally, analysis of cerebrospinal fluid (CSF) can provide important biomarkers associated with Alzheimer’s disease.

Treatment

Unfortunately, Alzheimer’s disease is an incurable degenerative neurological process, so focusing on symptomatic management and patient support is of best practice. Various medications have been developed to assist with symptom management and help to slow disease progression.  Cholinesterase inhibitors work to boost levels of cell-to-cell communication in the brain. Memantine (Namenda) is used to slow the progression of symptoms. Additional treatments including lecanemab-irmb (Leqembi) and donanemab-azbt (Kisunla), work to prevent amyloid plaques in the brain from clumping. Beyond medication, it is important to create a safe and supportive environment for individuals living with Alzheimer’s disease. Social engagement, meaningful activities, regular exercise, and proper nutrition all contribute to maintaining cognitive function and improving quality of life. 

Risk Factors

  • Advanced age, typically 65 years of age and older
  • Family history & genetics
  • Down syndrome
  • Female sex
  • Traumatic brain injury
  • Heavy alcohol use
  • Poor sleep patterns
  • Unhealthy lifestyle & heart health

Case Study 

58-year-old woman referred for further evaluation and management of progressive cognitive dysfunction with a 4-year history of progressive cognitive symptoms including difficulties recalling recent events and information, difficulties sustaining attention and learning new tasks, temporal disorientation, and difficulties finding words to express her thoughts.
Clinical interview revealed that the patient had become increasingly withdrawn from family and friends. Patient stated over the year prior to evaluation she developed an array of neuropsychiatric symptoms including depression, anxiety, and recurrent well-formed visual hallucination of unfamiliar people in her house. Additional history revealed that the patient’s husband observed her to have periods of being in a “trance-like” state, as well as drowsiness and nightmares, slowed gait, tremors, and decreased coordination.
Mental status examination revealed apparent psychomotor slowing. Neurological examination revealed hypomimia, saccadic intrusions during smooth-pursuit eye movements, and slow hypophonic speech. MRI demonstrated a mild degree of T2 hyper-intense signal changes in the periventricular, subcortical and juxtacortical white matter. EEG demonstrated mild intermittent bitemporal irregular slowing with no focal or generalized epileptiform features.
Confirmed diagnosis of Alzheimer disease. Patient was started on transdermal rivastigmine, melatonin, and sertraline- notable reductions in her visual hallucinations and fluctuation in attention and alertness as well as decreased insomnia were reported. Patient’s clinical status deteriorated steadily despite early symptomatic improvements, two years after her initial behavioral neurology evaluation she required full-time supervision and assistance with regular activities. In subsequent months, patient was transitioned to a memory care unit and later a skilled nursing facility where she passed at age 63, 5 years after the initial behavioral neurology presentation and 9 years after the onset of symptoms.

License

Advanced Neuroscience Copyright © by Jim Hutchins; Kobe Christensen; and Cody Zundel. All Rights Reserved.

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