Question

1. search for a medical condition( choose the disease that you want) related to the nervous system.
2. write an essay explaining:

1. What causes the disorder?
2. Where is the disorder developed?
3. Which structure(s) or organ(s) are affected by this disorder?
4. There’s a group more susceptible to acquire the condition? [i.e. Hispanics, females, boys, people between 35 to 55 years old]
5. Symptoms
6. Diagnosis
7. Treatment
   1. Procedures
   2. Medicines
8. Prevention (if there is available)
9. Indicate the references using APA format. (You must have at least three trustworthy sources).

Answer 1

Alzheimer's disease is a progressive neurodegenerative disease resulting in decline in cognitive functions together with declining activities of daily living ( ADL) and behavioural disturbances.

Pathology :-

- The pathological process consists principally of neuronal loss, principally in the temporoparietal cortex but also in the frontal cortex together with an inflammatory response to the deposition of senile and neurofibrillary tangles.

- Senile plaques and neurofibrillary tangles are regarded as hallmark of Alzheimer's disease though they may also be present with normal aging.

- Other pathologic features include synaptic degeneration, accumulation of abnormal lysosomes and mitochondria , neuronal loss and glia - mediated inflammation.

Aetiology :-

- The exact aetiopathogenesis is not known.

- Three hypothesis include cholinergic hypothesis ( reduced acetylcholine) , amyloid hypothesis and tau hypothesis.

Potential acquired risk factors for Alzheimer's disease are below :-

- Ageing

- Family history of Alzheimer's disease

- Reduced reserve capacity of brain

- Diet :- Reduced consumption of fish, increased consumption of dietary fat.

- Head injury

- Risk factors associated with vascular disease are Hypercholesterolemia, Hypertension, Smoking, obesity and Diabetes.

Clinical features :-

- It is an insidious onset disease.

- There is a gradual decline in ADL that ultimately leads to profound disability and dependence on others.

- There is an impaired ability to learn new things and recall previously learnt information. An inability to retain recently acquired information is typically the initial symptoms whereas memory for remote events is relatively spared until late.

- Impairment of semantic memory ( knowledge of public events, words and of the associations between concepts) , working memory ( ability to manipulate short term memory representations ) and executive functions ( coordination of multiple cognitive processes) are often present.

- A decline in language function and increased difficulty with names and understanding what is being said.

- An impaired ability to carry out motor activities despite intact motor function

- Failure to recognise or identity objects despite intact sensory function.

- Other features include behavioural problems, psychotic symptoms and depression.

Laboratory investigations :-

- Common investigations are blood chemistry, complete blood count, tests for syphilis, serum levels of vitamin B12 and thyroid functions.

- A CT head is usually done to exclude an intracranial pathology. An MRI may show atrophy in the hippocampus , mesial and lateral temporal , isthmus cingulate and orbitofrontal areas. It is required to detect presence of white matter ischaemic lesions indicating vascular dementia.

Diagnosis :-

- Criteria for a diagnosis of clinically probable Alzheimer's disease are the presence of an episodic memory deficit in combination with impairment of at least one other cognitive domain. Frequently affected domains at an early stage are executive functions and word findings. There must be a significant impact on Activity of Daily Living ( ADL).

- MMSE is useful in the initial evaluation of patients with suspected dementia.

- Cognitive aging ( age- related cognitive decline) refers to age related decline that selectively affects specific cognitive processes, including delayed recall, processing speed and executive functions.

Management :-

Cognitive deficits :-

- Cholinesterase inhibitors provide modest improvement in symptoms and reduction in the rate of cognitive decline. They inhibit acetylcholinesterase , the enzyme that degrades acetylcholine in the synaptic cleft, thereby increasing the availability of acetylcholine.These drugs include donepezil, rivastigmine , galantamine and tacrine.

- In moderate to severe cases, memantine , an NMDA antagonist may be added to Cholinesterase inhibitors. It is believed to protect neurons from glutamate - mediated excitotoxicity.

Co- morbid conditions :-

- Optional management should be provided for any co- morbid conditions including visual or hearing deficits, dental problems and other common medical illnesses.

Behavioural problems :-

- Treatment of associated behavioural problems by non- pharmacologic and pharmacologic Interventions ( psychotropic agents) should be prescribed. Atypical antipsychotic drugs ( risperidone and olanzapine) are preferred for the management of psychosis. For depression serotonin- reuptake inhibitors ( e.g. citalopram, escitalopram and sertraline) are used.

Education :-

- Education of caregiver is very important in patients with Alzheimer's disease.