ALZHEIMER’S DISEASE

1. ALZHEIMER’S DISEASE ALZHEIMER’S DISEASE The brain killer

2. Alzheimer's disease: Alzheimer's disease (AD) is a slowly progressive disease of the brain that is characterized by impairment of memory and eventually by disturbances in reasoning, planning, language, and perception In US, for every 70 seconds someone develops alzheimer’s and it is 6 th leading cause of death

4. STAGES OF AD Preclinical AD • Signs of AD are first noticed in the entorhinal cortex, then proceed to the hippocampus. • Affected regions begin to shrink as nerve cells die. • Changes can begin 10-20 years before symptoms appear. • Memory loss is the first sign of AD.

5. Stages cont.. • AD spreads through the brain. The cerebral cortex begins to shrink as more and more neurons stop working and die. • Mild AD signs can include memory loss, confusion, trouble handling money, poor judgment, mood changes, and increased anxiety. • Moderate AD signs can include increased memory loss and confusion, problems recognizing people, difficulty with language and thoughts, restlessness, agitation, wandering, and repetitive statements. Mild to Moderate AD

6. Stages cont.. Severe AD • In severe AD, extreme shrinkage occurs in the brain. Patients are completely dependent on others for care. • Symptoms can include weight loss, seizures, skin infections, groaning, moaning, or grunting, increased sleeping, loss of bladder and bowel control. • Death usually occurs from aspiration pneumonia or other infections. Caregivers can turn to a hospice for help and palliative care.

7. Risk factors: • Age: Alzheimer's disease increases substantially after the age of 70 and may affect around 50% of persons over the age of 85 • The likelihood of developing alzheimer’s disease doubles every • 5.5 years from 65-85 years of age

8. Risk factors cont. . • Genetic risk factors for • Alzheimer's disease • High blood pressure (hypertension) • Coronary artery disease • Diabetes • Possibly elevated blood cholesterol

9. Warning signs: • Memory loss • Challenges in planning or solving problems • Difficulty completing familiar tasks at home, • at work or at leisure • Confusion with time or place • Trouble understanding visual images and spatial • relationships

10. New problems with words in speaking or writing • Misplacing things and losing the ability to retrace steps • Decreased or poor judgment • Withdrawal from work or social activities • Changes in mood and personality

11. It is shown that patients with Alzheimer's disease (AD) are better able to remember new verbal information when it is provided in the context of music even when compared to healthy, older adults

12. CAUSES: 1. Reduced synthesis of the neurotransmitter acetylcholine (cholinergic hypothesis) 2. Initiation of large-scale aggregation of amyloid, leading to generalisedneuroinflammation 3. tau protein abnormalities initiate the disease cascade 4. Herpes simplex virus type 1 has also been proposed to play a causative role in people carrying the susceptible versions of the apoEgene 5.Loss of locus ceruleuscells 6. pro-NGF accumulation

13. 7. Oxidative stress caused by free radicals

14. Plaques – deposits of the protein beta-amyloid that accumulate in the spaces between nerve cells Tangles – deposits of the protein tau that accumulate inside of nerve cells

15. Major facts: • Smoking after age 65 increases your chances of developing Alzheimer’s by 79% • Obesity in midlife makes you 3 ½ times more likely to experience Alzheimer’s • Diabetes makes you twice as likely to develop Alzheimer’s • Genetics account for only 25% of Alzheimer’s cases • Chronic stress may quadruple your risk Survival rates vary from 2 to 20 years from onset of the disease

16. Diagnosis: • Medical history • Medication history • Mood evaluation • Mental status exam • Complete physical exam • Appropriate laboratory tests • Neurological exam • Imaging procedures

17. Treatments: • Antioxidants • Alzheimer’s Vaccine • Non-steroidal Anti-inflammatory Drugs (NSAIDs) • Statins • Estrogen • Ginkgo Biloba • Omega-3 Fatty Acids

18. CARE GIVING CARE GIVING

19. Drugs: Donepezil Galantamine Rivastigmine Mamantine Tacrine Drugs: Donepezil Galantamine Rivastigmine to improve memory

20. Prevention: • Diabetes • Hypertension • High cholesterol • Heart disease • Obesity • Chronic Stress • Poor quality or insufficient sleep • Sedentary lifestyle • Liver and kidney disease • Smoking, alcohol, drug use • Head injury • Toxic insults to your brain

21. Strategies for preventing AD: • Get plenty of exercise • Eat a brain-healthy diet • Keep your mind active • Sleep regularly and restfully • Learn to relax • Protect your brain

22. BIOMARKERS • Biochemical biomarkers: • Beta-amyloid measured in cerebrospinal fluid • Tau protein measured in cerebrospinal fluid • Neural thread protein/AD7C-NTP measured in cerebrospinal • fluid and in urine

23. Genomic biomarkers • Apolipoprotein E epsilon 4 • Amyloid precursor protein • Presenilin-1, -2

24. Imaging biomarkers • Pittsburgh compound B (PiB) • 18F-AV-45 (PET imaging with flobetatir) • All these biomarkers are reliable predictors and indicators of disease process

25. Thank u Biswajeet