1. C8 Alzheimer's Disease: An Overview

2. Objectives Describe nerve cell interaction in the Human Brain
Examine Alzheimer's Disease
Discuss the stages of Alzheimer's
Summarize the risk factors of Alzheimer's
Explain the role of imaging in the diagnosis process 
Discuss different treatments options
Identify the prognosis of Alzheimer's

3. Thesis Statement
Alzheimer's disease is a multifaceted disease that currently has no cure; however early diagnosis through medical imaging and neurological testing provide therapeutic options that can increase a person's lifespan and delay complications that coincide with this condition.

4. ABOUT ALZHEIMER'S DISEASE
Most common form of Dementia
Neurodegenerative disease
6th leading cause of death US
5 million Americans are currently afflicted
No cure

5. Human Brain Nerve Cell Interaction
Signal moves from dendrites down the axon
Connects with another nerve cell at the synapse where neurotransmitters are released
Specific function is produced

6. Nerve Cell Disruption
With Alzheimer's Disease signals do not travel normally through the nerve cells due to:
Plaque -sticky buildup of pieces of beta-amyloid protein that disrupts the signal interaction between the nerve cells
Tangle - tau protein gets twisted causing this transport system to fail
As tangle and plaque numbers increase, the individual progresses through the stages of Alzheimer's.

7. Stages of Alzheimer's Preclinical Stage of AD
Can last years to decades before diagnosis
The start of the formation of plaques and tangles in the brain
Before signs and symptoms are recognizable. 

8. Stages of Alzheimer's
Mild Cognitive Impairment (MCI)
Memory Slips 
Poor Judgement
Family and friends notice changes
Symptoms of MCI may remain stable for years, progress to Alzheimer's disease or another type of dementia, or improve over time
*About 8 of every 10 people with MCI go on to develop Alzheimer's disease within 7 years.

9. Stages of Alzheimer's Mild AD Thought process disturbances
Behavior disturbances
Memory loss
Personality changes 
Misplace objects
Difficulty with problem solving

10. Stages of Alzheimer's Moderate AD Dependent on daily help
Forget personal detail about life
Increased confusion
Repeat information
Unable to recognize people
Unable to control bladder or bowel movements
Aggressive behavior

11. Stages of Alzheimer's Severe AD Disorientation
Loss of verbal communication skills
Require care for daily needs
Loss of motor function

12. Risk factors AGE The most significant risk factor.
After the age of 65, the risk of Alzheimer’s doubles every five years. After age 85, the risk reaches to nearly one-third.
FAMILY HISTORY OF DEMENTIA
If an individual has one or more family members with AD, the risk of developing it increases. 
VASCULAR PROBLEMS
Damage to a person’s vascular system especially in the brain can lead to Alzheimer’s Disease

13. Diagnosing Alzheimer's
Blood Work
Neurolgoical Testing to test reflexes, memory, responses, memory, or other cognitive issues.
Brain Imaging – structurally and functionally
Genetic Testing
         
Brain imaging and neurological testing are the two major tests performed to diagnose Alzheimer's.

14. Computed tomography (CT)
Structural imaging
Computed tomography (CT)
Structural imaging looks at brain atrophy.
Atrophy of the hippocampal region is the main area of focus which is located in the posterior area of the brain.
The image on the far left shows significant atrophy throughout the brain.
Normal Brain CT
AD Brain CT

15. Magnetic Resonance Imaging (MRi)
Structural imaging (cont.)
Magnetic Resonance Imaging (MRi)
MRI uses magnetism
MRI better tissue quality
MRI more expensive so not always available to patients
MRI is the better option for visualizing small details of brain tissue for Alzheimer's if it is available to the patient.
This image shoes significant brain atrophy in the Alzheimer's brain compared to the normal brain. 

16. Functional Magnetic Resonance Imaging (fmri)
Functional imaging
Functional imaging evaluates blood flow and metabolic uptake of the brain.
Used throughout Alzheimer's Disease as a measuring tool throughout the stages.
Functional Magnetic Resonance Imaging (fmri)

17. Positron Emission Tomography (PET)
Functional imaging (cont.)
Uses the radioactive material fludeoxyglucose (FDG) to measure the brains glucose metabolic function.
Positron Emission Tomography (PET)

18. Medication for Memory Aimed to help the memory of affected individual
Acetylcholine is a neurotransmitter in the brain that is pertinent to memory. When one has Alzheimer's this chemical is scarce causing the decline in memory. 
Cholinesterase Inhibitors –  aid in memory by slowing the breakdown of acetylcholine in the brain. 

19. Medication for behavioral symptoms
Medication to suppress symptoms, should only be used as long as the benefits outweigh the risks.
Antipsychotics – suppress hallucinations and paranoia
Antidepressants – help with depression and anxiety
Mood Stabilizers -  aid with agitation and aggression
Benzodiazepines – relaxant to help with calming and sleeping

20. Therapeutic Treatment
Supportive Psychotherapy -- allows individuals with AD to share emotions openly and correspondingly encourages them to maintain daily activities as much as possible.
Memory Training Therapy -- external memory aids to enhance the persons memory function overall
Validation Therapy -- reduces stress levels, helps to finish any unresolved life goals, and facilitates independent living acknowledging feelings and working with the lack of bodily function they now have in the moderate or severe stages of AD.  
Reminiscence Therapy -- allows time to review life events and reorganize the events to help with memory
Reality Orientation -- helps to gain a sense of control and to improve self- esteem by orientating them with the current situation whether that is in assisted living or still in one’s own home

21. Prognosis This is a disease that one dies with, not because of.
Many people suffer with comorbidities with the two most common being:
       - Pneumonia 
       - Cardiovascular Disease
These comorbidities stem from a more sedentary lifestyle that patients endure with losing abilities of daily living.

22. conclusion
With the number of people affected by Alzheimer's increasing, the early detection through imaging and neurological testing can help slow the progression and delay the associated complications that stem from it.

23. references
Deaths from Alzheimer's Disease. Centers for Disease Control and Prevention. Published May 26, Accessed October 1, 2018. 
Alzheimer's and Dementia. Alzheimer's Association. Published Accessed September 24, 2018. 
Mayo Clinic Staff. Alzheimer's disease. Mayo Clinic. Published December 30, Accessed October 1, 2018. 
Mayo Clinic Staff. Alzheimer's stages: How the disease progresses. Mayo Clinic. Published May 17, Accessed October 1, 2018. 
Alzheimer's Disease. Centers for Disease Control and Prevention. Published June 19, Accessed October 1, 2018. 
Diagnosing Dementia. National Institute on Aging. Published December 31, Accessed November 11, 2018. 
Draper B. Chapter 13: The Future. In: Understanding Alzheimer's Disease and Other Dementias. Philadelphia, PA: Jessica Kingsley Publishers; 2013:  
Atrophy. Merriam-Webster. Accessed November 8, 2018. 
Draper B. Chapter 7: Drug Treatments. In: Understanding Alzheimer's Disease and Other Dementias. Philadelphia, PA: Jessica Kingsley Publishers; 2013:  
Draper B. Chapter 8: Psychosocial Treatments. In: Understanding Alzheimer's Disease and Other Dementias. Philadelphia, PA: Jessica Kingsley Publishers; 2013:
Magaki S, Yong WH, Khanlou N, Tung S, Vinters HV. Comorbidity in Dementia: Update of an Ongoing Autopsy Study. Journal of the American Geriatrics Society. 2014;62(9): doi: /jgs  
Mayo Clinic Staff. Mild cognitive impairment (MCI). Mayo Clinic. Published August 23, Accessed October 1, 2018.
What Is Mild Cognitive Impairment? National Institute on Aging. Published May 17, Accessed November 7, 2018.