Treating Alzheimer’s Disease

Alzheimer’s Disease Summary Alzheimer’s disease is a neurodegenerative condition that is associated with memory loss and cognitive impairment. People having Alzheimer’s disease experience memory loss, behavioral and cognitive impairment. The exact causative agent is not known, but a number of risk factors for its development have been elucidated. The factors include old age, family history, genetics, head injury, and gender. Alzheimer’s disease can be familial or sporadic. Familial form of the disease develops early while sporadic form usually develops in people above 65 years of age.

Definitive diagnosis of Alzheimer’s disease is through autopsy. However, clinical diagnosis can be done by physical and historical examination, neuropsychological assessment, and radiographic procedures.

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Radiographic procedures are increasingly becoming important in the diagnosis of Alzheimer’s disease. Alzheimer’s disease causes shrinkage of the brain tissue, particularly the hippocampus and temporal lobe. Radiography also examines the distinguishing characteristics of the disease such as decrease in the metabolic rate of the brain. Examples of radiographic procedures that can be employed in providing differential diagnosis of dementias are magnetic resonance imaging, computed tomography and positron emission tomography.

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3 Alzheimer’s disease

Introduction Alzheimer’s disease is a form of dementia, a neurodegenerative disorder characterized by loss of memory and cognitive function. The symptoms may progress to an extent of hindering the person from leading a normal life. Alzheimer’s disease therefore is a condition that affects the brain and alters one’s personality, ability to recall, learn, think, and relate to others (Turkington & Mitchell, 2010).

Etiology of Alzheimer’s disease The definitive cause of Alzheimer’s disease is not well known, but several risk factors have been identified as etiologic agents. These factors include both environmental and genetic factors. Factors such as old age, family background, overweight, high blood pressure, and traumatic head injuries are identified as major risk factors for development of Alzheimer’s disease. Other factors include conditions such as Down syndrome, inflammation agents, insulin resistance, and tissue integrity (Turkington & Mitchell, 2010).

Genetic factors Mutations of proteins such as amyloid precursors and presenilin genes have been linked to early onset familial Alzheimer’s disease while another gene known as apolipoprotein E has been shown to determine the disease processes in people who are over 65 years of age. These genetic factors increase the rate at which beta-amyloids are deposited, forming plaques, and also accelerate the phosphorylation of tau proteins forming tangles. Early onset of Alzheimer’s disease has been linked to gene mutations. The genes involved are the “amyloid precursor protein (APP) gene on chromosome 21, the presenilin-1 gene on chromosome 14, and the presenilin-2 (PS2) gene on chromosome 1” (Turkington & Mitchell, 2010, p. 238). These genes

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cause synthesis of more of beta-pleated proteins which are toxic to neurons, with subsequent loss of neuronal communication. Apolipoprotein E genes are also associated with significant risk of Alzheimer’s disease.

Insulin resistance Insulin resistance leads to reduced glucose metabolism in the brain. Disruptions of the metabolic rate of insulin is associated with increased alterations of the nerve cells, hence development of Alzheimer’s disease (Agronin, 2007).

Infection The beta pleated proteins are antimicrobial, hence their accumulation in the case of Alzheimer’s disease is correlated to a defense mechanism. Studies have also shown Alzheimer’s disease to be related to pathogenic microorganisms such as herpes virus and spirochetes (Agronin, 2007).

Depression Depression can cause degeneration of neurological tissue, loss of memory and cognitive ability. Therefore, people suffering from depression are at an increased predisposition to develop Alzheimer’s disease (Agronin, 2007).

Brain injury Violent head injuries can cause brain trauma. Brain injury has been shown to cause increased concentration of amyloid precursor proteins, accelerated cellular synthesis of betapleated proteins and their subsequent release from the cells. All these increase the risk of developing Alzheimer’s disease (Turkington & Mitchell, 2010).

Environmental factors

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Environmental factors also interplay with genetic constitution of an individual, causing altered protein synthesis. This is particularly in connection with the sporadic type of Alzheimer’s disease which develops at advanced ages and occurs without clear genetic inheritance patterns.

The alteration can be through addition of a methyl group to DNA or modification of RNA without affecting the DNA sequence. For example, exposure to lead causes elevated oxidative stress as a result of generation of particles that change the way methylation occurs (Agronin, 2007).

Biochemical factors Biochemical factors such as deficit of hormones, inflammation, and oxygen deficits also influence the development of Alzheimer’s disease.

Symptoms of Alzheimer’s disease Alzheimer’s disease progresses through four stages, namely; preclinical, mild, moderate, and severe. Each of these stages has unique pathologic changes and symptoms. In the early disease process, degeneration of nerve cells occurs in the section of the brain concerned with memory, resulting to loss of memory. Short term memory thus gets affected first, with remote memory also deteriorating over time. The cerebral cortex also is affected, thus impeding language, thought, cognition, and ability to make decisions (Turkington & Mitchell, 2010).

Cortical defects like “apraxia, acalculia, and visualpatial dysfunction” (Popp, 2007, p. 69) emerge with the progress of the disease process.

Apraxia becomes evident when the affected person cannot do routine chores like combing hair. Acalculia is manifested by inability of the person to keep accounts or maintaining other things like checkbooks. Visuospatial disorders emerge in form of victim losing orientation of the body position. This leads to emotional disturbance, hence the patient easily gets angered,

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frustrated and agitated. People with Alzheimer’s disease experience communication problems as conversation language is disturbed. In the course of the disease process, the person experiences behavioral alteration. The mood of the patient changes and the person may develop anxiety and depression at the initial stage of the disease (Turkington & Mitchell, 2010). The advanced phase of the disease may be characterized by manifestation of symptoms such as “delusions, hallucinations, and psychosis” (First & Tasman, 2011, p. 128). Other symptoms evident in late stages include shaking, alteration of posture, inability to control urination, and seizures.

Radiographic diagnosis of Alzheimer’s disease Besides histological examination and neuropsychological testing, radiographic procedures can also be employed in the diagnosis of Alzheimer’s disease. Radiographic procedures are noninvasive techniques. Some of the radiographic techniques used in diagnosis include computed tomography, magnetic resonance imaging, and positron emission tomography.

Computed tomography and magnetic resonance imaging can be used to study the brain so as to exclude other forms of dementia. A computer tomography scan can generate pictures of the brain and can indicate abnormal increase of some sections of the brain. Magnetic resonance imaging also produces brain images just like computed tomography, but the images are clearer. Magnetic resonance imaging utilizes magnets and radio frequencies to generate images. Positron emission tomography can be used to examine brain structure and the disease mechanisms, hence complimenting computed tomography and magnetic resonance imaging (Aitchison, 2009).

Patient preparation for radiographic procedure The patient is prepared differently depending on the type of radiographic procedure. The patient may be required to wear a gown or cloths which are not tight and having no metal

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fasteners. The radiologist also inquires about the existence of any major health issues, for example kidney failure.

In case of magnetic resonance imaging, the patient’s allergic response to contrast material is evaluated. Brain radiography must not be carried out on patients with brain aneurism clips.

Any other jewelry must not be worn because of the potential of interfering with the process.

When carrying out a computer aided tomography scan involving contrast media, the patient should be advised to fast for at least three hours before the procedure is done. Conditions such as being pregnant and allergic must be evaluated. The patient is also advised against taking medications which might cause thinning of blood such as aspirin. The patient is advised to stop using this medication five days prior to the procedure, if it is safe to do so. The procedure should be explained to the patient and their next of kin. The potential benefits and risks are also clearly highlighted. Laboratory tests are also done to assess the functioning of vital organs (Pretorius & Solomon, 2010).

What the radiographer needs to know in producing radiographs The radiologist needs to be aware of the appropriateness of the procedure in aiding diagnosis. Radiography is very beneficial in assessing Alzheimer’s condition when someone has had symptoms of the disease for about a year and when symptoms appear in people less than 65 years of age. It is also important in the diagnosis when dementia is associated with risk factors that indicate the involvement of the brain and blood vessels. If the medical history of the patient indicates a focal lesion, radiographic techniques also become important (Pretorius & Solomon, 2010).

It is also important for the radiographer to review the history of the patient. This history should cover previous health history, mental status, the person’s family history, identity, present

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medical status, and information regarding any symptoms the patient may be experiencing. This information will assist in assessing any health issues and devising a diagnostic plan.

The radiologist needs to be aware of the amyloid proteins characteristic of normal aging process and other dementias besides Alzheimer’s disease. These proteins, called diffuse plaques, do not have modified dendrites and glial cells; but in Alzheimer’s disease, the plaques contain modified forms of dendrites and glia. Neurofibrillary tangles do not uniquely indicate Alzheimer’s disease because they are also found in diseases not etiologically related to Alzheimer’s disease. The manifestation of symptoms is related to degeneration of brain and occurs gradually. Accumulation of plaque first occurs in the entorhinal cortex, then proceeds to hippocampus and finally diffuses across the entire cortex (Pretorius & Solomon, 2010).

Radiographic image criteria for examination of Alzheimer’s disease Computed tomography applies x-ray technology in generating images for diagnosis by rotating all over the area under investigation. The images are processed into two-dimension, thus helping in differential diagnosis by delineating other diseases that cause dementia like Parkinson’s lymphoma and stroke among others. Computed tomography can also show areas of the brain which have increased, hence indicating whether one has Alzheimer’s disease.

Magnetic resonance imaging relies on the osmotic integrity of tissues to demonstrate the anatomy of structures such as the brain. An improved form of magnetic resonance imaging, called functional magnetic resonance imaging examines both the structure and the metabolic activity of the brain. Positron emission tomography also examines the functionality of tissues by monitoring metabolic processes. Patients with Alzheimer’s disease have reduced metabolism hence differentiating it from other brain conditions (Pretorius & Solomon, 2010).

Radiographic manifestations of Alzheimer’s disease

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The major distinguishing features of Alzheimer’s disease are the formation of amyloid plaques and production of neurofibrillatory tangle in the cells. Brain imaging, by computed tomography or magnetic resonance imaging, can help in depicting the anatomy of the brain and also help in assessing brain capacity and any alterations in the structure and size of blood vessels.

Radiographic procedures can be able to demonstrate volume reduction of the “hippocampus and entorhinal cortex” during the initial stages of Alzheimer’s disease. Radiographic techniques, especially the MRI are used to examine change in volume of some areas of the brain.

Alzheimer’s disease causes these areas to undergo atrophy (volume reduction). Therefore diagnosis is based on examining two distinctive characteristics, “mesial temporal lobe atrophy and temporoparietal cortical atrophy” (Aitchison, 2009, p. 176).

Positron emission tomography can be used to provide a differential diagnosis of the diseases that cause memory loss and cognitive impairment. Positron emission tomography can demonstrate glucose metabolism in the brain. Detection of reduced metabolism forms the basis for differential diagnosis. Positron emission tomography can therefore be employed in staging Alzheimer’s disease and other brain disorders before the clinical symptoms appear.

Caring for a patient with Alzheimer’s disease during radiography The radiographer should be aware of the impact of Alzheimer’s disease on the patient and take necessary steps to enhance the safety of the patient. Alzheimer affects the memory and cognitive abilities of an individual. The radiologist should expect such symptoms as aggression, anxiety, emotion outburst, and agitation. The patient may not also be able to communicate and make sound judgments. It is the role of the radiologist during radiography procedures to ensure the comfort and safety of the patient in spite of the symptoms. The care therefore provided should take into account the person’s cognitive impairments (Aitchison, 2009). Throughout the

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radiographic procedure, the radiographer should monitor the patient’s vital signs such as pulse rate and breathing rate. The radiographer also needs to reassure the patient and dispel any anxieties the patient might have. The radiographer should therefore communicate with the patient throughout the entire process.

How Alzheimer’s disease affects an individual Alzheimer’s disease deprives one his or her independence. The changes associated with this condition lead to formation of negative self perception and lower one’s self-esteem. This makes one to feel isolated. The person with this condition may become confused and cannot make sound judgments. As the affected person cannot carry out any duties, the person may experience financial hardships in terms of meeting health care expenses. The progressive changes also bring to an individual anxiety and mood swings such as anger, frustration, and depression (Michel & Michel, 1999).

How Alzheimer’s disease affects family and friends Caring for people affected with Alzheimer’s disease is challenging and the caregivers often become exhausted physically and emotionally. The family members and friends are at higher vulnerability of developing conditions like hypertension, heart diseases, diabetes, and becoming immune compromised. They may also suffer depression and increased stress. The family and friends of the patient therefore undergo financial, emotional and psychological sufferings as they witness their loved one degenerate (Michel & Michel, 1999).

Once a loved one has been diagnosed with Alzheimer’s disease, the family members and friends have to internalize the condition and learn about it as they plan for the future. These caregivers may develop feelings of isolation and may experience grief due to effect of the disease on their beloved. Devastation may also set in on the family members and friends when

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they start considering other options such as nursing care. This is because they make themselves guilt for not being able to provide their patient with the care he or she needs at their home (Michel & Michel, 1999).

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12 References

Agronin, E. M. (2007). Alzheimer disease and other dementias: A practical guide, 2nd ed.

Philadelphia, PA: Lippin Williams & Wilkins.

Aitchison, A. F. (2009). A guide to radiologic procedures, 5th ed. Philadelphia, PA: Elsevier Health science.

First, B. M. & Tasman, A. (2011). Clinical guide to the diagnosis and treatment of mental disorders, 2nd ed. West Sussex: John Wiley & Sons.

Michel, J. & Michel, J. (1999). Management of aging: The University of Geneva experience.

Basel: Karger Publishers.

Popp, A. (2007). A Guide to the primary care of neurological disorders, 2nd ed. New York, NY: Thieme.

Pretorius, S. E. & Solomon, A. J. (2010). Radiology secrets plus, 3rd ed. Philadelphia, PA: Elsevier Health Sciences.

Turkington, C. & Mitchell, R. D. (2010). The Encyclopedia of Alzheimer’s disease, 2nd ed. New York, NY: Infobase Publishing.