Introduction
Alzheimer disease is an acquired disorder that leads to behavioral and cognitive impairment (Anderson, 2013). There is significant interference with the social functioning and occupational functioning of the individual. Alzheimer’s disease is a progressive disease and it has no cure (Myers, 2010). There is development of plaques in the hippocampus of the brain, a structure that helps in encoding memory (Myers, 2010). there is also deposition of plaques in other areas of the brain that are involved in thinking and decision making (Anderson, 2013).
Pathophysiology and Clinical Presentation
Pre-Clinical Alzheimer’s disease
In a patient with the pre-clinical form of Alzheimer’s disease, the patient may appear completely normal when a physical examination and a mental state examination are done (Myers, 2010), (NIH, 2013). However, there is already affectation of the brain (NIH, 2013). the antorhinal cortex and the hippocampus have already been affected 10 to 20 years before any physical signs and symptoms begin to appear (Anderson, 2013).
In the Mild form of Alzheimer’s disease, there is memory loss, confusion about the position and location of places that were initially familiar to the individual, taking a longer time to complete daily tasks and activities that the individual usually performs in the past, trouble with calculations which may manifest as trouble when paying bills or handling money, impairment in judgment, loss of the sense of initiative and spontaneity, changes in the mood and personality (NIH, 2013).
In the moderate form of Alzheimer’s disease, the following symptoms can appear (Anderson, 2013). They include a more severe loss of memory and confusion, an attention span that has shortened, difficulty in recognizing faces of individuals that were previously familiar including friends and family members, problems with language; including reading and writing, difficulty with thought organization and logical thinking, difficulty or outright inability to learn new things, difficulty with coping with unexpected situations, repetitive movement or statements, delusions and hallucinations among other things (NIH, 2013). In the severe form of Alzheimer’s disease, the patient is unable to recognize family members or loved ones. they cannot communicate at all (Anderson, 2013). The patient is unable to perform any actions themselves therefore they totally dependent on others for care. they totally lose any sense of self (NIH, 2013). other symptoms include remarkable weight loss, increased duration of sleeping, loss of sphincter control leading to loss of bladder and bowel control, seizures among other things (Anderson, 2013).
In the end-stage Alzheimer’s disease, the patient is bedridden and they usually die as a result of manifestation of other illnesses, like aspiration pneumonia (Anderson, 2013).
Pathophysiology
In Alzheimer’s disease, there is a change in the structure that binds the microtubules of neurons together, called tau, thereby stabilizing them (Anderson, 2013). The chemical change leads to the clumping of the microtubules together, thereby disintegrating the cytoskeleton framework and the transport system of the cell (Anderson, 2013). The clumps are called neurofibrillary tangles. this eventually leads to malfunctions in communication between neural cells and eventual death of those neural cells (Anderson, 2013).
Also, macroscopically, there is atrophy of the cerebral cortex and at the microscopic level; there is deposition of beta-amyloid plaques (Anderson, 2013).
In Alzheimer’s disease, there are three basic processes that are affected. they are communication, repair and metabolism. Some nerve cells in the brain cease to function; afterwards, they lose connections with other nerve cells and eventually die (Robinson, 2013). The memory failure experienced by individuals with Alzheimer’s disease is because of the death of those cells. it also leads to personality changes and problems with carrying out daily activities. In Alzheimer’s disease, there is development of plaques in the hippocampus which aids in the encoding of memories and in other areas of the brain involved in thinking and decision making processes (Myers, 2010). Neurofibrillary tangles are found most times densely distributed in the medial aspect of the temporal lobe of the cerebral cortex. They also affect the entorhinal cortex and the area of the hippocampus most severely (Robinson, 2013).
At the progression of the disease from the mild to moderate form, there is more accumulation of neurofibrillary proteins in many other regions of the cerebral cortex, beginning in the association regions and less in the primary motor and sensory regions (Robinson, 2013).There is also accumulation of plaques in the primary association cortices and in the hippocampus. the neurofibrillary tangles and the plaques have a discrete distribution of a laminar pattern in the cerebral cortex (Robinson, 2013). This indicates an involvement of the corticocortical connections of the cerebral cortex.
Alzheimer’s disease and Memory
In the early stages of Alzheimer’s disease, the patient has a decline in mental functioning which could be mild. however, in the mid-stage of Alzheimer’s disease, major thinking problems and memory loss begins to emerge (Robinson, 2013). the individual forgets important information for instance their home address or even telephone number. there may also be confusion about their whereabouts (Robinson, 2013). In the later stages of Alzheimer’s disease, the individual becomes depressed, agitated or may even have hallucinations. they completely lose the ability to converse and control their movement. they also become incapable of responding the stimulus of their surroundings. personality changes occur in Alzheimer’s disease. one of the things that individuals with Alzheimer’s disease find most challenging is the behavioral changes that accompany it (Robinson, 2013). As there is progressive deterioration of neural cells. in the early stages, the patient may experience changes such as increased irritability, anxiety and Depression. in later stages, however, the patient could experience anger, agitation, aggression, physical or verbal outbursts, emotional distress or even delusions and hallucinations (Robinson, 2013), (Myers, 2010).
In conclusion, Alzheimer’s disease is an evolving disease that affects an individual’s cognitive processes. It is a progressive disease that becomes worse with time. The symptoms may be subtle initially, but as the disease progresses; it takes a more serious toll on the individual’s cognitive functions such that the individual becomes incapable of caring for themselves. It is important that the individual with Alzheimer’s disease or those that are at risk make preparations for the later part of the disease progression once they are diagnosed with it. This will enable such individuals cope well with the disease. And the distress that the disease condition beings on the individual will be reduced to the barest minimum.
References
Myers D (2010). Psychology. 10th ed. New York: Worth Publishers.
Anderson H (2013). Alzheimer Disease. Medscape Reference. Retrieved on 8th December, 2013 from <http://emedicine.medscape.com/article/1134817-overview#showall>
NIH (2013). About Alzheimer's Disease: Symptoms. Retrieved on 8th December, 2013 from <http://www.nia.nih.gov/alzheimers/topics/symptoms>
L Robinson et al (2013). Alzheimer’s Disease: Symptoms, Stages, Diagnosis, and Coping Tips. Retrieved on 8th December, 2013 from <http://www.helpguide.org/elder/alzheimers_disease_symptoms_stages.htm>
