Question

Choose from one of the following conditions and explore the preventative measures, risks, symptoms, diagnosis, corrective actions (if available), management, and epidemiology: Osteoporosis, Arthritis (Rheumatoid, Osteo, Gout), Diabetes, Hashimotos Disease, Graves, Disease, Alzheimer’s Disease, Lupus, Fibromyalgia, Polycystic Ovarian Syndrome (PCOS), Uterine Prolapse, Painful Bladder Syndrome/Interstitial Cyst, Vulvar Cancer, Vulvodynia, Vulvitis, Endometriosis, and Ovarian Cancer. 250 words at least

Answer 1

Alzheimer's disease is a chronic, irreversible neurodegenerative disorder and the most common type of dementia accounting for 60 to 80 percent of all dementia cases. It usually starts in late middle age or in old age (common in 65 years or more) due to the degeneration of brain neurons especially in the cerebral cortex and amyloid deposition resulting in progressive loss of memory, impaired thinking, disorientation, and changes in personality and mood.

It is not a normal part of aging and gets worse over time

The disease was first described by Dr. Alois Alzheimer, a German physician, in 1906 and named after him.

Incidence:

About 10 percent of men and women aged 65 years or more and nearly 50 percent of those 85 years and older may have the disease. About More than 5 million Americans have Alzheimer’s disease and impacting more than 15 million family members, friends and caregivers. It is estimated that by mid-century, the number of people living with Alzheimer's dementia in the United States may grow to 13.8 million.

Causes and pathogenesis:

The exact cause of Alzheimer's disease is not yet fully understood. Alzheimer's disease is thought to be caused by the abnormal build-up of proteins (amyloid), which form plaques in and around brain cells. Deposits of other protein ‘tau’ form tangles within brain cells. The presence of these plaques and bundles start to destroy more connections between the brain cells, which makes the condition worse.

There's is also a decrease in the level of neurotransmitters involved in sending messages between brain cells. The level of neurotransmitter acetylcholine is particularly low in the brains of people with Alzheimer's disease. Over time, different areas of the brain shrink. Degeneration and loss of cholinergic nerve cells result in loss of memory, function and cognition.

Although it's not known exactly what causes this process to begin, but they begin many years before symptoms appear

Risks factors:

Several factors are associated with Alzheimer's disease.

· Increasing age- the greatest known risk factor for Alzheimer’s is increasing age. Most individuals with the disease are 65 and older. One in nine people in this age group and nearly one in two among people aged 85 and older have Alzheimer’s.

· Family History- Research has shown that those who have a parent, brother or sister with Alzheimer’s are more likely to develop the disease than individuals who do not. The risk increases if more than one family member has the illness.

· Gender: it is twice more women than men over 65 have Alzheimer’s disease. Exact reasons are not known but a possible reason is women on average live longer than men and Alzheimer’s in women may also be linked to loss of the hormone estrogen after menopause.

· Head injuries There appears to be a strong link between serious head injury and future risk of Alzheimer’s

· The risk of developing Alzheimer’s or vascular dementia appears is increased by many conditions that damage the heart and blood vessels. These include chronic hypertension and high cholesterol, heart disease, diabetes, stroke, smoking and drinking, exposure to heavy metals, industrial or other toxins, use of cholesterol-lowering drugs (statin).

Signs And Symptoms:

Alzheimer’s disease typically progresses slowly in three general stages: early, middle and late (sometimes referred to as mild, moderate and severe in a medical context). Since Alzheimer’s affects people in different ways there is the varying degree of symptoms.

Person experiences memory loss, difficulty in performing familiar tasks, problems with language, disorientation to time and place, poor or decreased judgment, problems with abstract thinking, misplacing things, changes in mood or behavior, changes in personality, loss of initiativeness.

The disease may cause a person to become confused, get lost in familiar places, misplace things or difficulty in recalling, trouble with language, personality changes and unexplained mood swings.

Diagnostic tests :

There is no single test that proves a person has Alzheimer’s. The workup is designed to evaluate overall health and identify any conditions that could affect how well the mind is working. When other conditions are ruled out, the doctor can then determine if it is Alzheimer’s or another dementia.

· Detailed patient history and Information from family and friends

· Physical, functional, and neurological assessment and Mental status examination

· Laboratory tests like

1. Blood cell count, serum electrolyte and LFT

2. Serum vit B12 and folic acid

3. Rule out hypothyroidism with TFT tests

· Other diagnostic tests: CT, PET or MRI scans may aid diagnosis.

· CSF Examination

· Electro-encephalogram (EEG)

· Electromyelogram (EMG)

Currently, the clinical diagnosis of Alzheimer’s Disease is based on the National Institute of Neurological Disorders and Stroke—Alzheimer’s Disease and Related Disorders Association (NINCDS–ADRDA) criteria. That is based on the appearance of clinical symptoms, but by this time when Alzheimer’s Disease pathology has progressed sufficiently so, they fail to detect subjects at the preclinical stage.

Management:

There is no cure for Alzheimer's disease. Aim of treatment is symptom improvement and enhance the quality of life and daily activities and behavior.

There is no way to stop the underlying death of brain cells. But pharmacological and nonpharmacological treatments may help with both cognitive and behavioral symptoms

Pharmacological intervention

· Acetylcholinesterase inhibitors -They act by preventing the breakdown of acetylcholine, a neurotransmitter important for learning and memory eg. Donepezil (Aricept) Rivastigmine (Exelon) Galantamine (Razadyne)

· N-Methyl d-aspartate Receptor Antagonist (NMDA)– acts by blocking the NMDA receptor and inhibit their overstimulation by glutamate (neurotransmitter) ) Eg:Memantine

· Anxiolytics

· Antipsychotics

· Anticonvulsants

· Antidepressents

Psychosocial intervention

• Behavioral approach

• Emotion oriented approach -Reminiscence therapy -Validation therapy -supportive psychotherapy -sensory integration -stimulated presence therapy

• Cognition oriented approach

Nonpharmacological measures

· Regular follow up and communication with family and caregivers

· Environmental modification to ensure safety

· Exercise, yoga

Preventative measures:

As there is no known identifiable cause prevention is not possible. However modifiable factors may be useful like management of blood pressure, obesity management, avoiding smoking and alcohol.

Prognosis

The early stages of Alzheimer's disease are difficult to diagnose. A definitive diagnosis is usually made once cognitive impairment compromises daily living activities, although the person may still be living independently. He will progress from mild cognitive problems, such as memory loss through increasing stages of cognitive and non-cognitive disturbances, eliminating any possibility of independent living.

Life expectancy of the population with the disease is reduced. The mean life expectancy following diagnosis is approximately seven years. Disease features significantly associated with reduced survival are an increased severity of cognitive impairment, decreased functional level, history of falls, and disturbances in the neurological examination.

Other coincident diseases such as heart problems, diabetes or history of alcohol abuse are also related with shortened survival. While the earlier the age of onset, the higher will be total survival years. Men have a less favourable survival prognosis than women.

The disease is the underlying cause of death in 70% of all cases. Pneumonia and dehydration are the most frequent immediate causes of death.