Disease Paper

I.Introduction

In 1960, a psychiatrist and neurologist named Dr. Louis Alzheimer discovered a progressive neurological disorder, which he called Alzheimer's a neurodegenerative disease.  While performing an autopsy on his patient, August Deter, Dr. Alzheimer observed abnormally tangled masses in the brain. He also observed tangled bundles of fibers in his brain. These pathological findings were later considered to be the defining characteristic of Alzheimer's disease. (Martini et al., 2020).

The most common type of dementia in the world is Alzheimer's disease, accounting for 60-80% of all dementia cases. The effects of this disease include cognitive decline, memory impairment, and the inability to perform daily tasks. According to the Alzheimer's Association (2025), more than six million people in the United States are living with Alzheimer's disease, and if no treatment is found, that number will triple by 2050. The disease has a significant financial, emotional, and psychological impact on families and caregivers. In addition to the human toll, the economic burden is substantial. In the United States, the cost of caring for people with Alzheimer's and other dementias is estimated to be $345 billion by 2023.

II. Body

a. Signalment History [HX]

Alzheimer's primarily targets older adults, with most cases occurring over the age of 65. However, early-onset Alzheimer's can also affect people as young as 30 and is primarily caused by genetic mutations in the PSEN1, APP, or PSEN2 genes. (Hardy & Selkoe, 2002). Women are more likely to develop the disease than men, which is attributed to their longer life expectancy. The disease is more prevalent in African American and Hispanic populations than in white and non-Hispanic populations. It is thought that socioeconomic inequalities and differences in access to health care are the causes. (Mayeda et al., 2016). The main risk factors that can increase the likelihood of developing Alzheimer's include, age, low education level, family history, gen allele of apolipoprotein E, traumatic brain injury, and cardiovascular diseases such as high blood pressure and diabetes. (Corder et al., 1993).

b. Clinical Signs

Destruction of cholinergic neurons in the medulla and cerebral cortex is a key feature in the progression of this disease (Peterson et al., 2018). Clinical manifestations of Alzheimer's disease occur in different stages, including early, middle, and late stages. Symptoms of the disease in the early stage include perception (agnosia), execution of movements (apraxia) , mild memory loss include (episodic memory), facts learned (semantic memory), and implicit memory, difficulty finding words, inability to reason, reduced attention span, mild confusion, and inability to learn new things. (Martini et al., 2020; Alzheimer's Association, 2025). In addition, people with Alzheimer's disease are unable to perform executive functions such as planning and organizing their tasks.

As the disease progresses to the intermediate stages, specific neurological and cognitive symptoms appear in the patient, including increasing confusion about place and time, language problems (aphasia) and incorrect word substitutions (paraphasias) such as word-finding difficulties, mood disorders such as irritability, depression, biting, anxiety, inability to make safe decisions, and visual-spatial disturbances that make driving dangerous. (Dubois et al., 2014). This disease leads to the accumulation of protein deposits in the cerebral cortex (picture.1) called beta-amyloid and neurofibrillary tangles. These tangled accumulations disrupt normal cell function (picture. 2,3). Over time, they lead to irreversible destruction of neurons and the destruction of synaptic connections (picture. 5) (Alzheimer’s Association, 2025).

In the final stages, patients become completely dependent on caregivers. Clinical complications that occur in the final stages of Alzheimer's disease include profound memory loss, such that they are not even able to recognize their family members. Loss of motor skills, such as walking and sitting upright. Urinary incontinence. Dysphagia or difficulty swallowing leads to reduced brain intake and, in some cases, aspiration pneumonia. Lack of communication can lead to muteness and loss of communication with others. (Johns Hopkins Medicine, 2023). In this stage some symptoms like pressure ulcers or pneumonia, and paradoxical appear lucidity immediately before death (Alzheimer’s Association, 2025).

Neuropsychiatric symptoms are common throughout Alzheimer's disease, including depression, confusion, hallucinations, and delirium (Jack et al., 2010). These neurological disorders are associated with structural and functional changes in the hippocampus, entorhinal cortex, and cerebral cortex, critical areas for memory and higher-level cognitive functions (Jack et al., 2010; Hardy & Selkoe, 2002). Identifying these cases at an early stage may indicate rapid disease progression. (Livingston et al., 2020).

c. Differential Diagnosis [DDX]

Because Alzheimer's symptoms overlap with those of other disorders, it is important to make an accurate diagnosis and differentiate them. Here are some conditions that mimic Alzheimer's disease: Vascular dementia (VaD), which is caused by damage to the blood vessels in the brain. This type of dementia often occurs after a gradual decline. (Kalaria, 2016). Lewy Body Dementia (LBD) is another disease whose symptoms overlap with Alzheimer's disease and is associated with visual hallucinations, Parkinson's, and REM sleep disorders. (McKeith et al., 2017).

Frontotemporal Dementia (FTD) is more commonly seen in younger people (50-65 years old) and is associated with personality changes, impulsivity, language problems, and emotional lability (Bang et al., 2015). Normal Pressure Hydrocephalus (NPH) is associated with gait disturbance, urinary incontinence, and cognitive decline. In this disease, enlarged ventricles are seen on X-ray (Relkin et al., 2005). Major Depression (Pseudodementia) It is another disease with depressive disorders that mimic the symptoms of dementia but improve with treatment of depression (Alexopoulos et al, 2005). Reversible Conditions like vitamin B12 deficiency and hypothyroidism can also cause dementia-like symptoms but are treatable. (Knopman et al., 2001).

d. Diagnostic Tests

Clinical evaluations, laboratory and imaging studies, are necessary to accurately diagnose this condition. Cognitive screenings include a screening of general cognitive function, which is performed with the Mini-Mental State Examination (MMSE). Another assessment, the Montreal Cognitive Assessment (MoCA), is more sensitive to mild cognitive impairment (Nasreddine et al., 2005).

Structural imaging, MRI, and CT scans can also show medial temporal lobe atrophy, hippocampal shrinkage, and ventricular enlargement (Jack et al., 2010). Functional imaging, PET, using beta-amyloid-specific tracers such as Pittsburgh compound (PiB), which shows beta-amyloid deposition, is another method. (Johnson et al., 2013). Diagnosis using biomarkers in cerebrospinal fluid, decreased in amyloid-β42 tau and increased phosphorylated tau (p-tau) levels, indicates Alzheimer's pathology. Plasma p-tau181 and p-tau217 are two promising new agents that have been identified as emerging biomarkers in the blood, and this method is less invasive (Janelidze et al., 2020).

e. Treatment [TX] Options

Although there is currently no cure for Alzheimer's disease, multifaceted treatment strategies are aimed at slowing cognitive decline and managing the disease. Pharmacological (donepezil, rivastigmine, galantamine) treatment involves the use of cholinesterase inhibitors, which improve cholinergic transmission and temporarily stabilize cognitive function (Martini et al., 2020). NMDA receptor antagonist (memantine) is a treatment that used to treat moderate to severe Alzheimer's. It regulates glutamatergic activity and makes the individual resistant to excitotoxicity. Another treatment is Aducanumab (Aduhelm), which was approved by the US Food and Drug Administration (FDA) in 2021. Although this drug targets beta-amyloid plaques, its clinical benefits are still debated due to modest cognitive outcomes (Alzheimer’s Association, 2023). Another non-pharmacological treatment approach is cognitive approaches, including structured exercise programs and social participation, which significantly delay dementia and improve quality of life. Behavioral therapy can also manage anxiety, depression, and sleep disorders (Ngandu et al., 2015).

f. Prognosis [PX] and Prevention

Although the age of onset of Alzheimer's disease and its comorbidities is highly variable, Alzheimer's disease is highly progressive and fatal, with an estimated median survival of 8 to 10 years after diagnosis (Alzheimer’s Association, 2023). In advanced stages of the disease, patient comfort, dignity, and quality of life are of paramount importance. Preventive strategies are also recommended, including cardiovascular health management (e.g., hypertension, diabetes, smoking cessation), dietary interventions such as the Mediterranean diet and MIND have shown effective cognitive protective effects. (Morris et al., 2015). Lifelong learning, regular daily exercise, and cognitive commons reduce the risk of dementia. (Livingston et al., 2020).

g. New Research

Studies over the past 10 years show that research rapidly evolves toward disease-modifying therapies. Therapies such as anti-amyloid and anti-TA in clinical trials, microglial activation by modulating neuroinflammation, CRISPR/Cas9 gene-editing, and antisense oligonucleotides (ASOs) also show promise in correcting or silencing genetic mutations that lead to early-onset Alzheimer's. Newer therapies are also being investigated that target synaptic and neuronal repair mechanisms (DeVos et al., 2017).

h. Alternative Therapies

Complementary and integrative therapies are used as adjuncts. Although these therapies lack strong clinical evidence, some of them, including aromatherapy, acupuncture, and herbal remedies such as ginkgo biloba, are still used. (Raglio et al., 2014). Evidence-based interventions, including music therapy and art therapy, can reduce behavioral symptoms such as agitation and improve emotional well-being in moderate to severe stages. (Raglio et al., 2014).

III.Conclusion:

As a nurse caring for a patient with Alzheimer’s, I find it necessary to take a holistic approach. One that considers emotional and cognitive needs while also involving the family in the plan. There are six specific areas that I discuss with the patient’s family as a nurse. The first step is medication management. I will talk to the patient’s family about medication use, possible side effects, and the use and monitoring of medications such as cholinesterase inhibitors. I will make safety modifications with the family. I will make the space safe by eliminating fall hazards, installing grab bars, labeling rooms, and using door alarms to prevent wandering. I will recommend a balanced diet, such as the Mediterranean diet, to promote brain health and offer solutions for swallowing problems. I will create a structured daily routine for routine and cognitive stimulation, involving the patient in simple cognitive programs such as puzzles, music, or memory therapy. I will provide information to the family about support groups, social resources, and the critical importance of caregiving.

Reflection:

Alzheimer's disease is a very complex and progressive disease. It is a disease that affects not only patients but also their families and caregivers. This study helped me understand the critical role of early diagnosis, interdisciplinary care, emotional support, and education in improving the lives of these patients. I hope that emerging treatments and preventive strategies will pave the way for a cure.

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