Pathophysiology of the Alzheimer’s Type Dementia.

Marisol Arroyo, age 23 y.o., and unmarried, accompanies her mother, Julia, who is a 68 y.o., divorced Latina female, to her appointment with her primary care Nurse Practitioner. Both Marisol and her mother, who live together, have noted that her ever-present forgetfulness seems to be worsening. Just yesterday she walked to the corner store for a few items, which she obtained, but even though she had been to this store many times over the years, she found herself unable to get home without directions.

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Marisol also notes that her mother’s hygiene is changing, that she is becoming more and more quarrelsome, and that she forgets information she had been told as little as 10 minutes earlier. The Nurse Practitioner is attempting to rule out whether this patient may have some form of dementia or delirium.Pathophysiology of the Alzheimer’s Type Dementia.

In this discussion:

Describe and discuss the unique pathophysiology of Dementia of the Alzheimer’s Type.
If this patient is diagnosed with Alzheimer’s dementia, describe and discuss with your colleagues a potential clinical course, and prognosis for her.
Describe and discuss your plan of care for this patient with both short-term and long-term plans considering current social supports and health-care access.
Include citations from the text or the external literature in your discussion posts.Pathophysiology of the Alzheimer’s Type Dementia.

Pathophysiology of the Alzheimer’s Type Dementia
The pathophysiology of dementia in AD(Alzheimer’s Disease) is attributed to intracellular and extracellular deposits of beta-amyloid resulting in the loss of neurons and synapses and gross brain atrophy (Tiwari et al., 2019). The amyloid hypothesis and prion mechanism explain the ways intracellular neurofibrillary tangles and extracellular beta-amyloid deposits cause neurological damage. The hypothesis postulates that continuous accumulation of beta-amyloid in the brain causes a multifaceted cascade of subsequent death of neuronal cells, neuronal synapse loss, and continuous deficits in neurotransmitters (Tiwari et al., 2019). These events result in cognitive deficits involving visuospatial, language, and memory functions.Pathophysiology of the Alzheimer’s Type Dementia.
Potential Clinical Course and Prognosis
During the initial clinical stages, the patient will experience deficits in memory, attention, executive functioning, verbal abilities, and visuospatial functions. However, the patient’s procedural memory and sensory-motor ability will remain intact, with mild impairment in the primary memory (Tiwari et al., 2019). The decline in cognitive function will start with unifunctional then global deficits. Her performance in all cognitive functioning areas will decline quickly and the most impaired abilities will be those of the lateral temporal and medial lobes, while abilities of the frontal lobes will be less impaired. The intensity and frequency of neuropsychiatric symptoms will increase as the cognitive function decreases and a rapid decline will result in mortality (Tiwari et al., 2019). The average survival period from diagnosis will be seven years.Pathophysiology of the Alzheimer’s Type Dementia.
Plan of Care
The best plan of care for this patient is to provide support and safety measures. The patient can obtain support from close family members as caregivers. To ensure safety, Alzheimer’s Association (2015) recommends the use of signal-monitoring systems and ensuring that her home environment is familiar, cheerful, and bright. Since there is no cure for dementia of Alzheimer’s type, it will be important to prescribe cholinesterase inhibitors to improve the patient’s memory and cognitive functioning. The most preferred cholinesterase inhibitor is donepezil 5mg PO OD for 4-6 weeks since it is a single day dosing and well-tolerated. Based on the recommendations provided by Alzheimer’s Association (2015), this dosage will increase gradually depending on functional improvement. If there will be no improvement, treatment will stop and the patient enrolled for end of life care.Pathophysiology of the Alzheimer’s Type Dementia.

References
Alzheimer’s Association, (2015). Alzheimer’s & Dementia: Diagnosis, assessment & disease monitoring.
Tiwari, S., Atluri, V., Kaushik, A., Yndart, A., & Nair, M. (2019). Alzheimer’s disease: pathogenesis, diagnostics, and therapeutics. International Journal of Nanomedicine, 14, 5541.

Pathophysiology of the Alzheimer’s Type Dementia.