Alzheimer's Disease (Abnormal Psychology)

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Alzheimers DiseaseAbnormal Psychology
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Content

• Introduction
• 10 Signs and Symptoms
• Causes
• Treatment
• References

(Trezvuy, 2020)
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IntroductionAlzheimer's Awareness Ribbon is
PurpleWorld Alzheimer's Month is September
World Alzheimer's Day is 21 September

• The campaign was launched in 2012, so the 9th
  World Alzheimer Month is in 2020
• (World Alzheimers Month, 2020)

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Alzheimers Disease (AD)

• It is named with Dr. Alois Alzheimer, who first
  found on a post-mortem, and then termed the
  condition in 1906 (MacGrill, 2020)
• It is the most common cause of dementia,
• A general term for memory loss and cognitive
  abilities that restrict with independent function
  everyday (Alzheimer's Association, 2020a and
  Nall, 2017)
• It is in the category of neurocognitive
  disorders, which lead to impaired mental function
  (Krause, 2018)
• It is aging abnormally (World Health
  Organization, 2020)

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Alzheimers Disease (AD)

• It covers about 60 - 80 (Alzheimer's
  Association, 2020b)
• The 6th leading cause of death in the US, and the
  5th among adults aged 65 years or older (Heron,
  2013)
• Around 50 million people have dementia in the
  worldwide (World Health Organization, 2020)
• The National Health and Morbidity Survey 2018 of
  Malaysia stated that those aged 60 years and
  above are 8.5 have dementia
• It was significant in those living far from the
  city areas, females, those with poor education,
  and lower class society (Institute for Public
  Health, 2019)

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10 Signs and Symptoms

• (Centers for Disease Control And Prevention, 2019
  
• and Alzheimer's Association, 2020c)

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1 Memory Loss that Disrupts Daily Life

• Problem

• Thought

• Normal

• Forgetting events, repeating yourself or
  depending on more aids to help you not to forget
  (like sticky notes or reminders)

• --- Have I taken medicine?

• At times forgetting names or appointments, but
  recalling them later

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2 Challenges in Planning or Solving Problems

• Problem

• Thought

• Normal

• Struggling to pay bills or cook recipes you have
  used for many years

• --- How should I solve this problem?

• Seldom make mistakes when managing finances or
  household bills

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3 Difficulty Completing Familiar Tasks

• Problem

• Thought

• Normal

• Struggling to drive places, use a cell phone, or
  do shopping

• --- How to use this mobile phone?

• Seldom need help to use microwave settings or to
  record a TV show

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4 Confusion with Time or Place

• Problem

• Thought

• Normal

• Losing track of dates, or cannot remember where
  they are or how they reached there

• --- What is this place?

• Forget the day of the week but remembering it
  later

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5 Trouble Understanding Visual Images and Spatial
Relationships

• Problem

• Thought

• Normal

• Struggling to balance or judge distance, or
  easily dropping things quite often

• --- Is this place far or near to me?

• Vision changes due to cataracts

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6 New Problems with Words in Speaking or Writing

• Problem

• Thought

• Normal

• Struggling to follow or join a conversation, or
  having trouble with vocabulary

• --- How to write the word again?

• Sometimes having trouble finding the right word

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7 Misplacing Things and Losing the Ability to
Retrace Steps

• Problem

• Thought

• Normal

• Placing car keys anywhere or struggling to search
  something

• --- Where are the keys?

• Misplacing things rarely and retracing steps to
  search them

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8 Decreased or Poor Judgment

• Problem

• Thought

• Normal

• Struggling to pay attention to hygiene or poor
  money management

• --- Ah, the car nearly hits me!

• Seldom make a bad decision or mistake, like not
  changing the oil in the car

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9 Withdrawal from Work or Social Activities

• Problem

• Thought

• Normal

• Struggling to follow a favorite team or activity

• --- What are they chatting about?

• From time to time feeling bored in family or
  social commitments

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10 Changes in Mood and Personality

• Problem

• Thought

• Normal

• Becoming anxious, confused, depressed, fearful or
  suspicious

• --- What is going on now?

• Making very specific ways of doing things and
  getting angry easily when a routine is interrupted

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Causes

• Brain Tour Visual Guide
• Brain Imaging Studies
• Alzheimers Seven Stages

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Causes

• AD develops because of the death of brain cells
  in a neurodegenerative condition
• The brain tissue has a loss of connection between
  the nerve cells, or neurons, causing information
  cannot pass easily around inside the brain
• Abnormal increase levels of tiny deposits
  (plaques and tangles) develop on the nerve tissue
  
• Plaques are made from a protein called
  beta-amyloid, grow between the dying brain cells
• Tangles are made from another protein called tau,
  appear within the nerve cells
• It is not clear why these changes occur
• (MacGrill, 2020)

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Brain Tour Visual Guide- To show what happens in
the process of developing AD

• (Alzheimer's Association, 2020d)

Brain Imaging Studies - A brief idea of how
inside the AD's brain looks like

• MRI Brain with T1 and VBM
• PET Scans Amyloid PET, Tau PET, FDG-PET and
  PiB-PET

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Normal vs Alzheimer's Brain
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Healthy vs Alzheimer's Brain (Keep Memory Alive,
2020)
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MRI Brain

• Top row
• Healthy brain
• Bottom row
• Advanced AD brain
• Severe volume loss
• Enlarged ventricles
• Loss of volume in the gyri and hippocampus
• (Koran, 2019)

Sagittal
Coronal
Axial
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Under the Microscope
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More About Plaques
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More About Tangles
In healthy areas
In areas where tangles are forming
Tau collapses into twisted strands called tangles
Orderly, parallel strands for providing key
materials to the cells
The strands cannot stay straight and disintegrate
Tau helps to keep the strands straight
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Amyloid PET - Plaques
PET Scans

• To check the brain deposition for amyloid plaques
• Amyloid PET
• (Jack, 2017a)
• To check the neurofibrillary tangles for
  pathologic tau
• Tau PET
• (Jack, 2017b)

Tau PET - Tangles
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PET Scans for Tau and Amyloid(University of
California at Berkeley, 2016)
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T1-Weighted MRI, FDG-PET and PiB-PET Images of
Four Representative Participants

• Notes
• (A) 64yo female AD pt with Aß deposition on
  PiB-PET and AD type of hypometabolism on
  FDG-PET
• (B) 76yo female MCI subject with Aß deposition
  on PiB-PET and AD type of hypometabolism on
  FDG-PET
• (C) 78yo female AD pt with -PiB and FTD type of
  hypometabolism
• (D) 71yo male AD patient with -PiB and
  non-specific hypometabolism on FDG-PET.
• FDG, F-18 fluorodeoxyglucose PiB, Pittsburgh
  compound B PET, positron emission tomography
  AD, Alzheimers disease MCI, mild cognitive
  impairment FTD, frontotemporal dementia Aß
  deposition, beta-amyloid deposition pt, patient.
• (Zhang et al., 2017)

There is a difference when comparing
from Participant A with moderate AD to
Participant D with mild AD
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Alzheimers Seven Stages

• Stage 1 - (Normal) No symptoms, but there might
  be strong family history
• Stage 2 - (Normal aged forgetfulness) The
  earliest symptoms appear
• Stage 3 - (Mild cognitive impairment) Mild
  physical and mental impairments appear, like
  lowered memory and focus, are noticeable by their
  close ones
• Stage 4 - (Mild AD) Memory loss and the inability
  to perform daily tasks
• Stage 5 - (Moderate AD) Need help from loved ones
  or caregivers
• Stage 6 - (Moderately severe AD) May need help
  with eating and putting on clothes
• Stage 7 - (Severe AD) May be a loss of speech and
  facial expressions
• Moving through these stages, they will need more
  support from a caregiver
• (Herndon MFA, 2018 and Kaufman, 2020)

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Progression Plaques and tangles (blue areas)
spread through the cortex
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Voxel-based Morphometry (VBM) of MRI Brain (Gray
Matter)

• VBM analysis showed obvious atrophy in medial
  temporal structures at the mild cognitive
  impairment (MCI) stage initially.
• As AD develops from early stage to late stage,
  atrophy of medial temporal structures becomes
  more noticeable.
• (Matsuda, 2013)

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Treatment

• Can live 4 - 8 years on average after diagnosis,
  but the longest is 20 years (Alzheimers
  Association, 2020e)
• Currently, there is no known cure, because AD is
  an irreversible progressive disease, which means
  the symptoms will be worsen day by day (Herndon
  MFA, 2018, and Centers for Disease Control and
  Prevention, 2020)
• The support is available to help the condition
  includes (Alzheimer's Society, 2020)
• Drug treatments
• In the mild (early) or moderate (middle) stages,
  a drug like donepezil (e.g., Aricept),
  rivastigmine (e.g., Exelon) and galantamine
  (e.g., Reminyl) will be prescribed to temporarily
  ease symptoms, or slow down their progression
• Without drugs treatments
• Keeping mentally, physically and socially active
  can have a very positive impact
• In Malaysia, support can be received from
  Alzheimers Disease Foundation Malaysia (ADFM)
  and Caring With You (Homage, 2020)

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References

• Alzheimer's Association. (2020a). What is
  dementia? Retrieved from https//www.alz.org/alzhe
  imers-dementia/what-is-dementia
• Alzheimer's Association. (2020b). What is
  Alzheimer's? Retrieved from https//www.alz.org/al
  zheimers-dementia/what-is-alzheimers
• Alzheimer's Association. (2020c). 10 early signs
  and symptoms of Alzheimer's. Retrieved from
  https//www.alz.org/alzheimers-dementia/10_signs
• Alzheimer's Association. (2020d). Brain tour Part
  2. Retrieved from https//www.alz.org/alzheimers-
  dementia/what-is-alzheimers/brain_tour_part_2
• Alzheimers Association. (2020e). Stages of
  Alzheimers. Retrieved from https//www.alz.org/al
  zheimers-dementia/stagestextOn20average2C2
  0a20person20with,any20signs20of20the20diseas
  e.

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References

• Alzheimer's Society. (2020). Treatment and
  support of Alzheimer's disease. Retrieved from
  https//www.alzheimers.org.uk/about-dementia/types
  -dementia/treatment-support-alzheimers-disease
• Centers for Disease Control and Prevention.
  (2019). 10 warning signs of Alzheimer's.
  Retrieved from https//www.cdc.gov/aging/healthybr
  ain/ten-warning-signs.html
• Centers for Disease Control and Prevention.
  (2020). Alzheimer's disease. Retrieved from
  https//www.cdc.gov/aging/aginginfo/alzheimers.htm
  l
• Herndon, J., MFA. (2018). Everything you need
  to know about Alzheimers disease. Retrieved from
  https//www.healthline.com/health/alzheimers-disea
  sestages
• Heron M. (2013). Deaths leading causes for 2010.
  National Vital Statistics Reports. 62(6), 194.
  Retrieved from https//www.cdc.gov/nchs/data/nvsr/
  nvsr62/nvsr62_06.pdf
• Homage. (2020). Dementia 101 All you need to
  know. Retrieved from https//www.homage.com.my/car
  e-connect/tips/dementia-101/

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References

• Institute for Public Health (IPH), National
  Institutes of Health, Ministry of Health
  Malaysia. (2019). National Health and Morbidity
  Survey (NHMS) 2018 Elderly Health. Vol. II
  Elderly Health Findings, 2018. Retrieved from
  http//iku.moh.gov.my/images/IKU/Document/REPORT/N
  HMS2018/NHMS2018ElderlyHealthVolume2.pdf
• Jack, C. R. (2017a). Amyloid PET - Plaques
  Picture. Retrieved from https//aspe.hhs.gov/adv
  isory-council-july-2017-meeting-presentation-impli
  cations-biologically-based-definition
• Jack, C. R. (2017b). Tau PET - Tangles Picture.
  Retrieved from https//aspe.hhs.gov/advisory-counc
  il-july-2017-meeting-presentation-implications-bio
  logically-based-definition
• Kaufman, P. (2020). What is Alzheimer's?
  Symptoms, causes, diagnosis, treatment, and
  prevention. Retrieved from https//www.everydayhea
  lth.com/alzheimers-disease/guide/
• Keep Memory Alive. (2020). Picture. Retrieved
  from https//www.keepmemoryalive.org/cc-nevada/alz
  heimers-brain

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References

• Koran, M. E. (2019). Picture. Retrieved from
  https//practicalneurology.com/articles/2019-nov-d
  ec/neuroimaging-and-alzheimers-disease
• Krause, L. (2018). Neurocognitive disorders
  (Organic brain syndrome). Retrieved from
  https//www.healthline.com/health/organic-brain-sy
  ndrome
• Matsuda, H. (2013). Picture. Retrieved from
  https//www.ncbi.nlm.nih.gov/pmc/articles/PMC35701
  39/
• MacGill, M. (2020). Alzheimer's disease
  Symptoms, stages, causes, and treatments.
  Retrieved from https//www.medicalnewstoday.com/ar
  ticles/159442what-is-it
• Nall, R. (2017). Dementia (neurocognitive
  disorders) Types and causes. Retrieved from
  https//www.medicalnewstoday.com/articles/314850

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References

• Trezvuy. (2020). Vector modern ALZHEIMERS DISEASE
  awareness circles desigen Vector. Retrieved
  from https//www.123rf.com/photo_57608871_stock-ve
  ctor-vector-modern-alzheimers-disease-awareness-ci
  rcles-desigen-purple-ribbon-isolated-on-white-back
  groun.html
• University of California at Berkeley. (2016).
  Picture. Retrieved from https//www.psypost.org/
  2016/03/pet-scans-reveal-key-details-alzheimers-pr
  otein-growth-aging-brains-41393
• World Alzheimers Month. (2020). 2020 Campaign
  Materials. Retrieved from https//www.worldalzmont
  h.org/
• World Health Organization (2020). Dementia.
  Retrieved from https//www.who.int/news-room/fact-
  sheets/detail/dementiatextDementia20is20a2
  0syndrome20in,million20new20cases20every20yea
  r.
• Zhang, N., Zhang, L., Li, Y., Gordon, M. L., Cai,
  L., Wang, Y., Xing, M. (2017). T1-weighted MRI,
  FDG-PET and PiB-PET images of four representative
  participants. Picture. Retrieved from
  https//content.iospress.com/articles/journal-of-a
  lzheimers-disease/jad170383

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Thank You!

• Any Questions?