Neural function and disorders

Alzheimer’s disease is an incurable progressive dementia disorder with multifarious degeneration of neurons in the late stages of an adult’s life. It is characterized by two main features; extracellular deposits of amyloid protein plaques that contribute to senile plaques and intracellular neurofibrillary tangles. The plaques develop in the hippocampus, a brain structure that is involved in making memories and in other parts of the cerebral cortex that aids in thinking and decision making. The disease leads to cognitive and behavioral problems that negatively affects social lives and occupation of the patients (Kumar & Ekavali, 2017).

Advanced age is a risk factor for Alzheimer’s disease. At 85 years old, RM’s risk for developing Alzheimer’s is about 50%. Her family history shows that her mother and sister died of Alzheimer’s disease.  Other predispositions include hypertension. Being widowed, RM could be socially isolated and this poses as a risk factor (Ali, 2012).

The Mini-Mental Status Exam has eight categories, namely; complex commands, repetition, language, recall, attention and calculation, registration, and orientation to place and time.  This assessment questionnaire is used to measure cognitive impairment in diagnosis of dementia. A score of 18 out of 30 indicates that RM is moderate cognitive impairment (Kumar & Ekavali, 2017)..

RM’s medications include; donepezil, irbesartan, and rosuvastatin. Donepezil acts as a reversible acetyl cholinesterase inhibitor. The drug is used to increase acetylcholine through reversible inhibition of its hydrolysis by acetylcholinesterase, consequently enhancing cholinergic function. Irbesartan, used for hypertension, competitively binds with angiotensin at the AT1 receptor subtype. Rosuvastatin reduces plasma cholesterol levels and prevents cardiovascular disease through inhibition of hydroxymethylglutaryl-coenzyme A reductase. (HMG-CoA). The enzyme catalyzes the conversion of HMG-CoA to mevalonic acid.

Alzheimer’s has symptoms similar to other diseases. Diagnostic tests are useful in distinguishing the diseases. Physical and neurological exam checks the overall neurological health of the patient by testing reflexes, balance, hearing and sight, muscle tone and strength as well as coordination. Laboratory tests are conducted to rule out thyroid disorders and deficiencies that may cause memory loss. Mental status and psychological testing will assess memory, whereas brain imaging will be used to identify brain disorders associated with Alzheimer’s (Ali, 2012).

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Vascular dementia is cognitive impairment that is caused by cerebrovascular disease and brain injury which may be large vessel or small vessel dementia.  In large vessel, atherosclerosis of intra and extracranial vessels lead to local thromboembolism causes multiple large and small infarcts in parts of major cells. Its risk factors include age, sex, genetics and inflammation.

It is easy to mistake Alzheimer’s disease and depression because of similar symptoms. These symptoms include loss of interest in activities that were enjoyable before, problems with memory, social withdrawal, and impaired concentration. A thorough physical examination exam and physiological evaluation is essential in making a distinction. An assessment to establish history of the symptoms particularly focusing on depressive symptoms common in depression, family history to determine a history of depression, and frontal symptoms related to dementia such as disinhibition, perseverance and decreased initiative. Feelings of worthlessness and suicide are more associated with depression rather than dementia. Neuroimaging would be useful to establish contribution of vascular pathology to mood apathy (Kumar & Ekavali, 2017)..

Alzheimer’s has three stages; mild, moderate, and severe Alzheimer’s disease. In the first stage, the patient experiences loss of memory and impaired attention span, and impaired attention span. She will start forgetting words and may get lost often even in familiar places. They may dress inappropriately, have decreased motivation and repeat statements or questions. In the second stage, the initial stages become more severe. The patient also suffers from impaired muscle control and incontinence. In the final stage, the patient suffers from almost total memory loss and would require help in their daily activities. They may become unresponsive to stimuli as the brain loses the ability to control basic functions (Ali, 2012).

Family should be included in counselling of Alzheimer’s patients. Studies establish that AD caregivers are likely to undergo stress as a result of their interaction. The caregivers should be educated on information about AD, care planning, management of the patient, and management of stress (Beinart, Weinman, Wade & Brady, 2012).