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The Course Of Alzheimer’s Disease

Genetic Risk Factors For Alzheimers

Alzheimers Disease Simulation, RN Continuing Education Course Example

Studies show that several genes carry an increased risk of developing Alzheimers disease. The most common gene believed to be connected to dementia is the APOE4 gene, but over 20 other genes may also increase Alzheimers risk by some degree. Only a small percentage of Alzheimers cases are attributable to genetics, and the genetic risk factors vary depending on race.

Stage : Normal Outward Behavior

Alzheimerâs disease usually starts silently, with brain changes that begin years before anyone notices a problem. When your loved one is in this early phase, they won’t have any symptoms that you can spot. Only a PET scan, an imaging test that shows how the brain is working, can reveal whether they have Alzheimer’s.

As they move into the next six stages, your friend or relative with Alzheimer’s will see more and more changes in their thinking and reasoning.

Managing Alzheimer’s Disease Behavior

Common behavioral symptoms of Alzheimers include sleeplessness, wandering, agitation, anxiety, and aggression. Scientists are learning why these symptoms occur and are studying new treatments drug and nondrug to manage them. Research has shown that treating behavioral symptoms can make people with Alzheimers more comfortable and makes things easier for caregivers.

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Alzheimers Disease A Brief History

This Course

Video Transcript

Health professionals and students, family caregivers, friends of and affected individuals, and others interested in learning about dementia and quality care will benefit from completing the course. Led by Drs. Nancy Hodgson and Laura Gitlin, participants will acquire foundational knowledge in the care of persons with Alzheimerâs Disease and other neurocognitive disorders.

I felt this course expanded the information I already understand regarding dementia care. I have already implemented several things learned from this course in the memory care unit I lead in a SNF.

I really learned so much in this course that will help me towards the care for my mother and also about how the country I live in helps towards improving on Dementia care for so many others.

From the lesson

About Dementia

In this module, we introduce learners to dementia. We present a socio-ecological framework for understanding the live experience of dementia and by which this course is organized. We discuss the global impact, pathophysiology, and stages of dementia.

  • Nancy Hodgson, PhD, RN, FAAN

    Adjunct Instructor

Sex As A Biological Variable

Stages of Alzheimer

Women represent two-thirds of Alzheimers cases, making them more likely to develop dementia. Women also have risk factors that are unique to them and do not affect the male population. Estrogen has a positive effect on brain health, and when estrogen decreases during menopause, the brain becomes more susceptible to dementia. Additionally, high blood pressure during pregnancy may raise the risk of dementia later in life.

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How Is Alzheimers Disease Diagnosed

Doctors use several methods and tools to help determine whether a person who is having memory problems has Alzheimers disease.

To diagnose Alzheimers, doctors may:

  • Ask the person and a family member or friend questions about overall health, use of prescription and over-the-counter medicines, diet, past medical problems, ability to carry out daily activities, and changes in behavior and personality.
  • Conduct tests of memory, problem solving, attention, counting, and language.
  • Carry out standard medical tests, such as blood and urine tests, to identify other possible causes of the problem.
  • Perform brain scans, such as computed tomography , magnetic resonance imaging , or positron emission tomography , to support an Alzheimers diagnosis or to rule out other possible causes for symptoms.

These tests may be repeated to give doctors information about how the persons memory and other cognitive functions are changing over time.

People with memory and thinking concerns should talk to their doctor to find out whether their symptoms are due to Alzheimers or another cause, such as stroke, tumor, Parkinsons disease, sleep disturbances, side effects of medication, an infection, or another type of dementia. Some of these conditions may be treatable and possibly reversible.

In addition, an early diagnosis provides people with more opportunities to participate in clinical trials or other research studies testing possible new treatments for Alzheimers.

Stage : Mild Cognitive Impairment

Persons at this stage manifest deficits which are subtle, but which are noted by persons who are closely associated with the person with mild cognitive impairment. The subtle deficits may become manifest in diverse ways. For example, a person with mild cognitive impairment may noticeably repeat queries. The capacity to perform executive functions also becomes compromised. Commonly, for persons who are still working in complex occupational settings, job performance may decline. For those required to master new job skills, such as a computer or other machinery, decrements in these capacities may become evident.

MCI persons who are not employed, but who plan complex social events, such as dinner parties, may manifest declines in their ability to organize such events. This may be an early stage of Alzheimers, however, it is important for the person to seek medical help as soon as possible, to determine if a broad variety of medical conditions may be causing or contributing to the persons difficulties. Blood tests and an MRI of the brain should be obtained to assist in determining if the individual has MCI due to Alzheimers and whether there are other causes or contributing conditions to the persons cognitive decline.

Some MCI persons may manifest concentration deficits. Many persons with these symptoms begin to experience anxiety, which may be overtly evident.

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How Does Alzheimer’s Disease Affect The Brain

Scientists continue to unravel the complex brain changes involved in Alzheimers disease. Changes in the brain may begin a decade or more before symptoms appear. During this very early stage of Alzheimers, toxic changes are taking place in the brain, including abnormal buildups of proteins that form amyloid plaques and tau tangles. Previously healthy neurons stop functioning, lose connections with other neurons, and die. Many other complex brain changes are thought to play a role in Alzheimers as well.

The damage initially appears to take place in the hippocampus and the entorhinal cortex, which are parts of the brain that are essential in forming memories. As more neurons die, additional parts of the brain are affected and begin to shrink. By the final stage of Alzheimers, damage is widespread and brain tissue has shrunk significantly.

Clinical Stages Of Alzheimers Disease

Alzheimers Disease Clinical Case MD DO Continuing Education Course

Alzheimers disease is a characteristic process with readily identifiable clinical stages. These clinical stages exist in a continuum with normal aging processes. The clinical stages of AD can be described in alternative ways. For example, they can be described globally or they can be described in terms of constituent elements, referred to as clinical axes. One of these clinical axes, functioning and self-care, is particularly useful in describing the progression of AD. However, many conditions, particularly in aged persons, can interfere with functioning apart from AD. For these and other reasons, functioning changes alone do not adequately describe the progress of AD. However, the combination of global changes and their functional concomitants can provide a clear map or the progress of AD. This clinical map is enriched by noting the common behavioral concomitants of the stages. However, the behavioral and mood manifestations of AD are much more diverse than the cognitive and functional features of the disease progression. Globally, seven major stages from normality to most severe AD are identifiable. Functionally, 16 stages and sub-stages corresponding to the global stages are recognizable. These global and functional clinical stages and sub-stages of aging and AD are summarized as follows.

Stage 1: Normal

Stage 2: Normal aged forgetfulness

Stage 3: Mild cognitive impairment

Stage 4: Mild Alzheimers disease

Stage 5: Moderate Alzheimers disease

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Stages Of Alzheimer Disease

The stages of Alzheimer disease usually follow a progressive pattern. But each person moves through the disease stages in his or her own way. Knowing these stages helps healthcare providers and family members make decisions about how to care for someone who has Alzheimer disease.

Preclinical stage. Changes in the brain begin years before a person shows any signs of the disease. This time period is called preclinical Alzheimer disease and it can last for years.

Mild, early stage. Symptoms at this stage include mild forgetfulness. This may seem like the mild forgetfulness that often comes with aging. But it may also include problems with concentration.

A person may still live independently at this stage, but may have problems:

  • Remembering a name

  • Staying organized

The person may be aware of memory lapses and their friends, family or neighbors may also notice these difficulties.

Moderate, middle stage. This is typically the longest stage, usually lasting many years. At this stage, symptoms include:

  • Increasing trouble remembering events

  • Problems learning new things

  • Trouble with planning complicated events, like a dinner

  • Trouble remembering their own name, but not details about their own life, such as address and phone number

  • Problems with reading, writing, and working with numbers

As the disease progresses, the person may:

Physical changes may occur as well. Some people have sleep problems. Wandering away from home is often a concern.

Severe, late stage. At this stage, a person:

How Important Are The Stages Of Dementia

The stages of dementia are just a guide and there is nothing significant about the number three. Equally, dementia doesnt follow an exact or certain set of steps that happen in the same way for every person with dementia.

It can be difficult to tell when a persons dementia has progressed from one stage to another because:

  • some symptoms may appear in a different order to the stages described in this factsheet, or not at all
  • the stages may overlap the person may need help with some aspects of everyday life but manage other tasks and activities on their own
  • some symptoms, particularly those linked to behaviours, may develop at one stage and then reduce or even disappear later on. Other symptoms, such as memory loss and problems with language and thinking, tend to stay and get worse with time.

It is natural to ask which stage a person is at or what might happen next. But it is more important to focus on the person in the present moment. This includes their needs and how they can live well, and how to help them with this.

For more support on living well with dementia see The dementia guide: living well after diagnosis or Caring for a person with dementia: a practical guide .

And for more information about treatment and support for the different types of dementia go to the following pages:

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Stage : Moderately Severe Decline

Your loved one might start to lose track of where they are and what time it is. They might have trouble remembering their address, phone number, or where they went to school. They could get confused about what kind of clothes to wear for the day or season.

You can help by laying out their clothing in the morning. It can help them dress by themselves and keep a sense of independence.

If they repeat the same question, answer with an even, reassuring voice. They might be asking the question less to get an answer and more to just know you’re there.

Even if your loved one can’t remember facts and details, they might still be able to tell a story. Invite them to use their imagination at those times.

Stage : Very Mild Changes

What is Alzheimer

You still might not notice anything amiss in your loved one’s behavior, but they may be picking up on small differences, things that even a doctor doesn’t catch. This could include forgetting words or misplacing objects.

At this stage, subtle symptoms of Alzheimer’s don’t interfere with their ability to work or live independently.

Keep in mind that these symptoms might not be Alzheimer’s at all, but simply normal changes from aging.

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How Quickly Does Dementia Progress

The speed at which dementia progresses varies a lot from person to person because of factors such as:

  • the type of dementia for example, Alzheimers disease tends to progress more slowly than the other types
  • a persons age for example, Alzheimers disease generally progresses more slowly in older people than in younger people
  • other long-term health problems dementia tends to progress more quickly if the person is living with other conditions, such as heart disease, diabetes or high blood pressure, particularly if these are not well-managed
  • delirium a medical condition that starts suddenly .

There is no way to be sure how quickly a persons dementia will progress. Some people with dementia will need support very soon after their diagnosis. In contrast, others will stay independent for several years.

Very Mild Impairment Or Common Forgetfulness

Alzheimers disease mainly affects older adults over the age of 65. At this age, its common to have slight functional difficulties such as forgetfulness.

But for people with stage 2 Alzheimers, this decline will happen more quickly than it will for similarly aged people without Alzheimers. For example, a person may forget familiar words, a family members name, or where they placed something.

Caregiver support: Symptoms at stage 2 wont interfere with work or social activities. Memory troubles are still very mild and may not be apparent to friends and family.

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What Will You Achieve

  • Summarise why all conversation needs to focus on memories that someone with Alzheimer’s has left
  • Describe ways to trigger memories for someone with Alzheimer’s
  • Develop strategies for determining the age the person with Alzheimer’s is living in their mind
  • Describe ways to make a person with Alzheimer’s feel like everything is okay in this moment
  • Identify three questions to ask yourself before correcting or contradicting a person with Alzheimer’s
  • Explain how your mood affects the mood of someone with Alzheimer’s

The Placebo Group Simulation Approach: An Alternative To Long

Alzheimers Disease & Dementia Care | USMx on edX

René Spiegel presented his teams’ development work on the placebo group simulation approach , a novel clinical study design for use in long-term trials with putative disease-course altering drugs for use in AD. The PGSA is intended to circumvent a major limitation of randomized placebo-controlled double-blind clinical trial designs that is, the need to expose prodromal AD patients at high risk for dementia to extended placebo treatment, which may result in problems with patient recruitment , questions about the representativeness of study samples and ethical issues.

The PGSA uses stochastic modeling to forecast predefined endpoints and trajectories of neuropsychological outcomes from the data that are routinely available at the outset of clinical trials: basic demographic, biological and neuropsychological data for all study participants. These model-based, forecasted endpoints and trajectories of the study sample constitute the background – the simulated placebo group – against which potential drug effects can be contrasted.

Figure 1

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Creating A New Composite Score For Optimizing Responsiveness To Decline In Early Ad And Very Early Ad

Suzanne Hendrix has proposed empirically derived composite outcome scores that optimize the power for measuring clinical disease progression for trials in MCI and pre-MCI populations . The goal of this work is to improve the responsiveness of clinical outcomes to disease progression in early stages of AD, with the expectation that this will give treatments the best chance for showing an effect. The proposed composite outcome scores for MCI utilize items from standard AD instruments, such as the ADAS-cog, but rather than summing all item scores they use an optimization algorithm to select and weigh the items that are declining most in the population of interest, excluding items that are not yet declining in these early AD populations.

Beyond Memory Loss: How To Handle The Other Symptoms Of Alzheimer’s

There is a lot of talk about the emotional pain patients and caregivers suffer when a loved one loses memories to Alzheimers. But what about the other symptoms? Here are tips from a Johns Hopkins expert on what to watch for and how to manage.

#TomorrowsDiscoveries: From Dysfunctional Cells to Disease Dr. Rong Li

Dr. Li and her team investigate how cells consolidate their damaged proteins and prevent them from spreading freely, in order to understand how to better treat diseases such as Alzheimers and ALS. Another of their interests is how chromosomes are divided up when one cell becomes two. Learning more about how the process can go wrong could lend insight into cancer development.

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Research Shows Two Of Every Five Cases Of Alzheimers And Related Dementias Are Preventable According To Credible Peer

Not every risk factor for Alzheimers and related dementias is within our control. But many are, and its estimated that a person can reduce their risk for dementia by about one -third if they address those modifiable risk factors. Dementia and Alzheimers disease dont follow a one-size-fits-all diagnostic process. Some people who have multiple risk factors never develop the condition, while other adults with relatively few risk factors still end up living with dementia. Alzheimers disease is the most common type of dementia, followed by vascular dementia. Other types of dementia include Lewy body dementia, frontotemporal dementia, and mixed dementia.

The most well-known symptom of dementia is memory loss, but it also frequently causes mood and behavior changes and challenges with language. People living with dementia usually require long-term care and have a reduced ability to perform daily tasks.

Theres no exact science for estimating a persons dementia risk. However, researchers have identified several risk factors that affect the likelihood of a person developing dementia as they age. Consider the following factors, but remember, there is no way to determine someones exact risk level.

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