Alzheimer's Disease

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Definition/Description

Alzheimer's Disease is characterized by cortical atrophy and loss of neurons, particularly in the parietal and temporal lobes. Also with loss of brain mass there is an enlargement of the ventricals of the brain.² The changes in the brain tissue slowly cause changes in the person. Often it results in Alzheimer's dementia, however some people progress differently.

Prevalence

Approximately 4 - 4.5 million people have Alzheimer's Disease in the United States and about 8 million affected around the world. It is expected that by 2050 that number will have increased almost three fold to around 13.2 million. The known prevalence is 6% in people over the age of 65, 20% in people over the age of 80, and more than 95% in those 95 years of age.¹

Characteristics/Clinical Presentation

The progression of Alzheimer's Disease is continuous and generally does not fluctuate or improve. Often times the early symptoms can be missed or overlooked because they can be misinterpreted as signs of the natural aging process.

Stages of Alzheimer's Disease²

Stage 1

• memory loss
• lack of spontaneity
• subtle personality changes
• disorientation to time and date

Stage 2

• impaired cognition and abstract thinking
• restlessness and agitation
• wandering, "sundown syndrome"
• inability to carry out activities of daily living
• impaired judgment
• inappropriate social behavior
• lack of insight, abstract thinking
• repetitive behavior
• voracious appetite

Stage 3

• emaciation, indifference to food
• inability to communicate
• urinary and fecal incontinence
• seizures
  
  

Associated Co-morbidities

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Medications

Below is a list of some commonly used medications use in the treatments of the symptoms of Alzheimers. There is also the use of other treatments such as antioxidants, anti-inflammatory agents, and estrogen replacement therapy in women to prevent or delay the onset of the disease.²

Commonly Used Medications for Alzheimer's Disease¹

Donepezil - (Aricept) has only modest benefits, but it does help slow loss of function and reduce caregiver burden. It works equally in patients with and without apoipoprotein E4. It may even have some advantage for patients with moderate to severe Alzheimer's Disease.

Rivastigmine - (Exelon) targets two enzymes (the major one, acetylcholinesterase, and butyrylcholinesterase). This agent may be particularly beneficial for patients with rapidly progressing disease. This drug has slowed or slightly improved disease status even in patients with advanced disease. (Rivastigmine may cause significantly more side effects than donepezil, including nausea, vomiting, and headache.)

Galantamine - (Reminyl) Galantamine not only protects the cholinergic system but also acts on nicotine receptors, which are also depleted in Alzheimer's Disease. It improves daily living, behavior, and mental functioning, including in patients with mild to advanced-moderate Alzheimer's Disease and those with a mix of Alzheimer's and vascular dementia. Some studies have suggested that the effects of galantamine may persist for a year or longer and even strengthen over time.

Tacrine - (Cognex) has only modest benefits and has no benefits for patients who carry the apolipoprotein E4 gene. In high dosages, it can also injure the liver. In general, newer cholinergic-protective drugs that do not pose as great a risk for the liver are now used for Alzheimer's.

Memantine - (Namenda) targeted at the N-methyl-dasparate receptor, is used for moderate to severe Alzheimer's.

Selegiline - (Eldepryl) is used for treatment of Parkinson's disease, and it appears to increase the time before advancement to the next stage of disability.

Diagnostic Tests/Lab Tests/Lab Values

There are no lab values or tests that can be used to give the diagnosis of Alzheimer's. It is a diagnosis of exclusion essentially and the diagnosis can only be truely confirmed by a cerebral biopsy, or autopsy. The presence of dementia is needed for the diagnosis, and is established by the results of a Mini - Mental State Examination, Blessed Dementia Test, or a similar mental status test. Also there should be no disturbance in consciousness, onset between ages 40 and 90 years, most often after the age of 65, and absence of systemic or brain disorders that could account for the memory or cognitivie deficits. To determine that there are no other diseases that can be causing the symptoms some tests can be done such as brain imaging, CT scan, and MRI.

Causes

There is no know cause of Alzheimer's Disease.

Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports

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Recent Related Research (from Pubmed)

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http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1xONNp6hzwmbFtho8j3NkZprYu6eCHOfsB1HYiGUxIrEvzXs3W

References

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1. Goodman C, Fuller K. Pathology Implications for the Physical Therapist. St. Louis, Missouri: Saunders Elsevier; 2009.

2. Porth C. Pathopysiology Concepts of Altered Health States. Philadelphia PA: Lippincott & Wilkins; 2005.

3. Goodman C, Snyder T. Differential Diagnosis for Physical Therapists Screening for Referal. St. Louis, Missouri: Saunders Elsevier; 2007.

4. Alzheimer's Association. 2010. Available at: http://www.alz.org/index.asp . Accessed March 1, 2010.

5. Alzheimer's Disease Fact Sheet. U.S. National Institutes of Health National Institute on Aging. 2010. Available at: http://www.nia.nih.gov/Alzheimers/Publications/adfact.htm . Accessed March 1, 2010.