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Alzheimer’s Disease I

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    Alzheimers Disease

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    History

    In 1901 that GermanpsychiatristAloisAlzheimeridentified the first caseof what became knownas Alzheimer's Disease(AD) in a fifty-year-old

    woman he calledAuguste D. Alzheimerfollowed her until she

    died in 1906, when he

    Alois Alzheimer's patient.Auguste D in 1902 Hers

    was the first describedcase of what became known

    .as Alzheimer's disease [ ]2

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    Script - History

    In 1901 German psychiatrist Alois Alzheimeridentified the first case of what became knownas Alzheimer's Disease in a fifty-year-old womanhe called Auguste D. Alzheimer followed her

    until she died in 1906, when he first reported thecase publicly.

    For most of the twentieth century, the diagnosis

    of Alzheimer's disease was reserved forindividuals between the ages of 45 and 65 whodeveloped symptoms of dementia. Theterminology changed in 1977 after a medicalconference developed a specific criteria for

    symptoms and stages. This eventually led to thediagnosis of Alzheimer's Disease independently

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    Stages

    Stage 1 Unimpaired individuals experience no memory problems and none are evident to a health care professional during a medical interview.

    Stage 2 Individuals may feel as if they have memory loss and lapses, especially in forgetting familiar words or names or the location of keys, eyeglasses oother everyday objects. But these problems are not evident during a medical examination or apparent to friends, family or co-workers.

    Stage 3 Friends, family or co-workers begin to notice deficiencies. Problems with memory or concentration may be measurable in clinical testing ordiscernible during a detailed medical interview. Common difficulties include: Word- or name-finding problems noticeable to family or closeassociates, Decreased ability to remember names when introduced to new people; Performance issues in social or work settings noticeable tofamily, friends or co-workers; Reading a passage and retaining little material; Losing or misplacing a valuable object; Decline in ability to plan ororganize.

    Stage 4 At this stage, a careful medical interview detects clear-cut deficiencies in the following areas: Decreased knowledge of recent occasions or currenevents; Impaired ability; to perform challenging mental arithmetic-for example, to count backward from 75 by 7s; Decreased capacity to performcomplex tasks, such as planning dinner for guests, paying bills and managing finances; Reduced memory of personal history; The affectedindividual may seem subdued and withdrawn, especially in socially or mentally challenging situations.

    Stage 5 Major gaps in memory and deficits in cognitive function emerge. Some assistance with day-to-day activities becomes essential. At this stage,individuals may: Be unable during a medical interview to recall such important details as their current address, their telephone number or the namof the college or high school from which they graduated; Become confused about where they are or about the date, day of the week or season;Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s; Need help choosing properclothing for the season or the occasion; Usually retain substantial knowledge about themselves and know their own name and the names of theirspouse or children; Usually require no assistance with eating or using the toilet.

    Stage 6 Memory difficulties continue to worsen, significant personality changes may emerge and affected individuals need extensive help with customary

    daily activities. At this stage, individuals may: Lose most awareness of recent experiences and events as well as of their surroundings; Recollecttheir personal history imperfectly, although they generally recall their own name; Occasionally forget the name of their spouse or primary caregivebut generally can distinguish familiar from unfamiliar faces; Need help getting dressed properly; without supervision, may make such errors asputting pajamas over daytime clothes or shoes on wrong feet; Experience disruption of their normal sleep/waking cycle; Need help with handlingdetails of toileting (flushing toilet, wiping and disposing of tissue properly); Have increasing episodes of urinary or fecal incontinence; Experiencesignificant personality changes and behavioral symptoms, including suspiciousness and delusions (for example, believing that their caregiver is aimpostor); hallucinations (seeing or hearing things that are not really there); or compulsive, repetitive behaviors such as hand-wringing or tissueshredding; Tend to wander and become lost.

    Stage 7 This is the final stage of the disease when individuals lose the ability to respond to their environment, the ability to speak and, ultimately, the abilitto control movement; Frequently individuals lose their capacity for recognizable speech, although words or phrases may occasionally be uttered;

    Individuals need help with eating and toileting and there is general incontinence of urine; Individuals lose the ability to walk without assistance, thethe ability to sit without support, the ability to smile, and the ability to hold their head up. Reflexes become abnormal and muscles grow rigid.Swallowing is impaired.

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    Script - Stages

    There are seven distinctive stages relatingto Alzheimers. They are typically linked tothe degenerative qualities of the disease. It

    progresses in each individual at differentrates and not all sufferers experience thesame types of stages or symptoms.

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    SymptomsEarly Stage symptoms:

    Inability to acquire new memories;

    Difficulty in recalling recently observedfacts.

    As the disease advances, symptomsinclude:

    Confusion;

    Irritability and aggression;

    Mood swings;

    Language breakdown;

    Long-term memory loss;

    Social withdrawal;

    Sundowning.

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    Script - SymptomsAt the initial onset of Alzheimers symptoms there can be no symptoms at all.Some may seem a little forgetful like anyonewhere are my keys, what am

    I supposed to do today; however, the next stages typically articulate the pathof the degenerative nature of the disease.The next most noticeable symptoms are that sufferers begin to lose nouns(ex. They know what a table is, and that theyre sitting at one, but they cannotsay table. They also begin to experience noticeable mood swings thatindicate irritability, anxiety, depression and typically begin placing items inunexpected places (ex. Car keys in the refrigerator). They begin to relate more

    to the past and lose focus of current events and their recent personalexperiences. Also there is a loss of interest in previously enjoyable activities orhobbies.In later stages symptoms become more apparent and require increasedmedication and physical assistance. Sufferers begin to lose a sense of theirown identity and may look into a mirror and think they see someone else.They lose a sense of time of day and date and begin to wander or obsess aboutthings they can control in their environment. Some later experienceSundowning in which a markedly increased level of anxiety occurs in theevening.Very late stages AD patients will begin having episodes where they believethey are living their pastwhen they were a child, when they were parents ofyoung children. Women frequently will think they are pregnant and about to

    give birth or having menstruation. Men will defer to memories of professionalexperience and talk about having to be in a meeting or an important

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    Causes - Plaques andTangles

    Im ag e o f sen ile p laq u e s see n in

    the cerebralcortex ofa person-w ith A lzh e im e r's d ise a se o f p re

    .se n ile o n se t

    M icroscop y im ag e of a,n e u rofib rilla ry ta n g le-conform ed by hyp er

    .p h o sp h o ryla te d ta u p ro te in

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    Script - Causes Plaques andTangles

    Two abnormal structures called plaques and tangles are prime.suspects in damaging and killing nerve cells Plaques and.tangles were among the abnormalities that Dr Alzheimer saw

    .in the brain of Auguste D

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    Alzheimers Plaques

    .Enzymes act on Amyloid Precursor Protein and break it into fragments- .The beta amyloid fragments then form plaques

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    Script - Causes - Plaques

    Plaques form when protein pieces calledbeta-amyloid (BAY-tuh AM-uh-loyd) clumptogether. Beta-amyloid comes from a

    larger protein found in the fatty membranesurrounding nerve cells.Beta-amyloid is chemically "sticky" andgradually builds up into plaques.

    The most damaging form of beta-amyloidmay be groups of a few pieces rather thanthe plaques themselves. The small clumpsmay block cell-to-cell signaling atsynapses. They may also activate immunesystem cells that trigger inflammation anddevour disabled cells.

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    Alzheimers Tangles

    Changes in tau protein lead to the disintegration of microtubules.in brain cells

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    Script - Causes Tangles

    Tangles destroy a vital cell transport systemmade of proteins. This electron microscopepicture shows cells with some healthy areas andother areas where tangles are forming.

    In healthy areas the transport system isorganized in orderly parallel strands somewhatlike railroad tracks. Food molecules, cell partsand other key materials travel along thetracks.A protein called Tau helps the tracks stay

    straight.In areas where tangles are forming tau proteincollapses into twisted strands called tangles.The tracks can no longer stay straight. They fallapart and disintegrate.

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    Brain Comparison

    In the Alzheimer brain:

    The cortex shrivels up,damaging areasinvolved in thinking,

    planning andremembering. Shrinkage is especially

    severe in thehippocampus, anarea of the cortex

    that plays a key rolein formation of newmemories.

    Ventricles (fluid-filledspaces within the

    brain) grow larger.

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    Script - Brain Comparison

    Here is a view of how massive cell losschanges the whole brain in advancedAlzheimer's disease. This slide shows acrosswise "slice" through the middle of the

    brain between the ears.In the Alzheimer brain: The cortex shrivels up, damaging areas

    involved in thinking, planning andremembering.

    Shrinkage is especially severe in thehippocampus, an area of the cortex thatplays a key role in formation of newmemories.

    Ventricles (fluid-filled spaces within thebrain) grow larger.

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    Script PET Scan

    Here is a PET scan image comparing a healthybrain and a brain of a person with AD showing asignificant decline in function of the temporallobe. This damage directly effects auditory

    perception and the hippocampus which plays akey role in the formation of long-term memory.

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    Alzheimers Factors

    Former President RonaldReagan suffered an episodeof head trauma in July1989, five years prior to hisdiagnosis of AD.

    A g e Fa m ily H isto ry H ead Traum a H e a rt D ise a se

    A lcoh olA b u se To b a cco U seIn a ctivity C h o lin e rg ic H yp o th e sis A m ylo id H yp o th e sis Ta u H yp o th e sis

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    Script AD FactorsAge

    Advancing age is the number one risk factor for developing Alzheimers disease. Oneout of eight people over the age of 65 has Alzheimers disease, and almost one out ofevery two people over the age of 85 has Alzheimers. The probability of beingdiagnosed with Alzheimers nearly doubles every five years after age 65.

    Family History

    People who have a parent or sibling that developed Alzheimers disease are two tothree times more likely to develop the disease than those with no family history ofAlzheimers. If more than one close relative has been affected, the risk increases evenmore.

    Lifestyle Factors

    Although age and family history are out of our control, scientists have also identifiedseveral lifestyle factors that can influence a persons risk of developing Alzheimersdisease. A connection has been found between serious head injury and future

    development of Alzheimers. Former President Ronald Reagan suffered an episode of head trauma in July 1989,

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    Treatment

    Acetylcholinesterase(AChE) Inhibitors Donepezil (Aricept) Galantamine (Razadyne) Rivastigmine (Excelon/Patch)

    Glutamate Blockers Memantine (Akatinol, Axura,

    Exiba/Abixa, Memox,Namenda)

    Antidepressants

    (SSRIs) Zoloft Paxil Seroquel

    Antipsychotics Risperdal

    Haldol

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    Script -Treatments The major treatment for symptoms of AD is medication.

    Cognitive therapies such as activities that engage and sociallyinvolve suffers are beneficial, but most often medications areused to alleviate and control symptoms. There are several typesof primary medications used currently but there are manypromising therapies on the horizon. Most prescribed for alleviating symptoms are

    Acetylcholinesterase(AChE) inhibitors (most commonly knownbrand name is Aricept) are used to reduce the rate at whichacetylcholine is broken down thereby increasing the number ofcholinergic neurons. Glutamate is an excitatory neurotransmitter of thenervous system. In excessive amounts in the brain it causes celldeath through a process called excitotoxicity . Mematine (mostknown brand is Namenda) blocks glutamine overstimulation. Antidepressants (primarily SSRIs) and antipsychoticdrugs are modestly useful in reducing aggression, anxiety andmood swings in Alzheimer's patients with behavioral problems.

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    Prognosis-M orta lity R a te C o m p a rison s in th e U n ite d S ta te s be tw e e n 2 0 0 0 2 0 0 6

    Po p u la tio n in th e th o u san d s

    ase Type

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    Script - Prognosis

    Alzheimer's disease mortality is on the rise with arapidly aging baby boomer population, Alzheimer'swill continue to impact more lives. From 2000-2006, Alzheimer's disease deaths increased 46.1percent, while other selected causes of death

    decreased.The prevalence of AD in the United States isgrowing steadily and currently affects around fivemillion Americans. Due to the strong associationbetween age and the incidence of Alzheimers

    disease, the aging of the population has significantimplications for the resources needed to care forthese individuals.Direct and indirect costs of caring for anAlzheimer's patient averages between $18,000and $77,500 per year in the United States.

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    Referenceshttp://www.alz.org/alzheimers_disease_facts_figures.asp

    http://www.aw-bc.com/applace/http://alzheimers.about.com/od/familyandfriends/a/alz_celebs.htm

    http://archives.cnn.com/2000/ALLPOLITICS/stories/07/16/alzheimers.reagan/

    http://www.alzheimersrxtreatment.com/learnaboutalz.html?source=google&HBX_PK=alzheimer's&HBX_OU=50&o=50:23060039|165867467|

    http://en.wikipedia.org/wiki/Acetylcholinesterase

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    http://en.wikipedia.org/wiki/Alzheimer's_disease

    http://un.org/esa/population/publications/wpp2006/WPP2006_Highlights_rev.pdfhttp://ajp.psychiatryonline.org/cgi/content/full/158/5/704

    http://www.mayoclinic.com/health/alzheimers/AZ00015

    http://www.cdc.gov/excite/ScienceAmbassador/ambassador_pgm/lessonplans/Valo-Wabler_Alz.pdf

    http://www.everydayhealth.com/senior-health/alzheimers/recognizing-the-symptoms.aspx?xid=g_&s_kwcid=TC|6122|alzheimer's%20gr4457945592&gclid=CO-m-7jr9aICFREeDQodbEaVkw

    http://www.alz.org/documents_custom/report_alzfactsfigures2010.pdf

    http://www.sciencedaily.com/releases/2007/11/071101122822.htm

    http://www.alzinfo.org/alzheimers-disease-treatment-information.asp

    Images1. http://health.msn.com/health-topics/mental-health/slideshow.aspx?cp-documentid=100234109&imageindex=2

    2. http://en.wikipedia.org/wiki/File:Auguste_D_aus_Marktbreit.jpg

    3. http://www.icarastudy.com/index.aspx?t=goo_alz_adgroup1_ad4&kw=alzheimer's&gclid=COXMit3z9aICFUcz5wodKg-Viw

    4. http://www.alzheimersrxtreatment.com/learnaboutalz.html?source=google&HBX_PK=alzheimer's&HBX_OU=50&o=50:23060039|165867467|46

    5 htt // iki di / iki/Fil TAU HIGH JPG

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mers.about.com/od/familyandfriends/a/alz_celebs.htmhttp://alzheimers.about.com/od/familyandfriends/a/alz_celebs.htmhttp://www.aw-bc.com/applace/http://www.aw-bc.com/applace/http://www.alz.org/alzheimers_disease_facts_figures.asphttp://www.alz.org/alzheimers_disease_facts_figures.asp

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