A 43-year-old female patient with Down syndrome was broughtin for an examination after she was found wandering the grounds of the assistedliving where she lived.
When confronted, the patient had no recollection ofwhere she was, or who the individual that found her was. This patient had beenhaving increased difficulty with everyday tasks. It is likely that this patienthad Alzheimer’s disease, which is a form of dementia characterized by aprogressive breakdown of the brain. Alzheimer’s disease accounts for 60-80% ofall dementia cases (Alzheimer’s Association Staff, 2018). The anatomical structures affected byAlzheimer’s disease are the cerebrum and hippocampus. The hippocampus has arole in new memory formation (WebMD, 2018). The neocortex is where the brainstores semantic memory. It contains six different layers, which each have theirown unique neuronal makeups, and are the greater part of the cerebral cortex.
The layers in order from first to last are: molecular, external granular,external pyramidal, internal granular, internal pyramidal, and the multiformlayer. The first three layers are known as the supragranular layer (Swenson,2006). Long term synaptic potentiation is the resultof synapses in the hippocampus being activated for extended periods of timeleading to alterations of the neural circuits in the brain. These altercationsallowed for improved memory formation and retrieval. Long term synapticdepression decreases the number of the synapses activated for an extendedperiod of time which, consequently, decreases the alterations of the neuralcircuit. Long term synaptic depression and long term synaptic potentiation area form a neural homeostasis. Long term synaptic depression makes long termsynaptic potentiation more effective by weakening synapses so that they do notbecome overly efficient. If synapses are activated for too long, it can inhibitthe synthesis of new information which will negatively impact memory andlearning (Bliss & Collingridge, 1993).
While there is no one test to diagnose Alzheimer’s disease,there are steps that can be taken to get a clearer picture of the case. Thefirst step that a physician should take is to look through the patient’smedical history. If there is a family history of the disease, there is a higherchance they will develop the disease, than a patient with no family history ofthe disease. The next steps to take would be to evaluate the mental status ofthe patient, and to perform physical and neurological exams.
One of the bestways to diagnose Alzheimer’s is through biomarkers. Changes in the biomarkerscan indicate the progression and stage of the disease. Biomarker changes aremeasured by CT scans, MRI, and PET scans if a contrast agent is used. In thesevere stages of Alzheimer’s, this can help indicate high levels of amyloidplaques and neurofibrillary tangles, as well as show a decrease in thepatient’s neuronal integrity (Perrin et al.
,2009). The Alzheimer’s Association published a list of symptomsthat healthcare providers should watch for when trying to determine if adementia patient has Alzheimer’s. The first sign is the patient experiencingmemory loss that is disruptive to their everyday life. The second sign istrouble with completing common tasks at home or work. The third major sign of Alzheimer’sis when a patient is at a complete loss of where they are and the time.Overall, the patient in this case study has all three of the major symptoms forAlzheimer’s (Alzheimer’s Association Staff, 2018).
Potential underlying causes of Alzheimer’s would be age,genetics, lifestyle, and environmental factors. Geneticist’s helped identifygenes associated with Alzheimer’s. One gene researchers have found isapolipoprotein e4 (APoE4); however, not everyone that has this gene willdevelop Alzheimer’s (Mayo Clinic Staff, 2017). Individuals with Down syndromeare at an increased risk for Alzheimer’s because of their extra chromosome.
Thesigns and symptoms of Alzheimer’s often appear 10-20 years earlier in peoplewith Down syndrome (Mayo Clinic Staff, 2017). Alzheimer’s cannot be treated; however, the symptoms can beimproved. Medications such as cholinesterase inhibitors, memantine, andantidepressants can be prescribed to help patients control the symptoms. A safeenvironment is crucial for Alzheimer’s patients. It can be created by setting aschedule and putting items back in the same place after every use.
Lastly, itis important that the patient exercises and eats a balanced diet (Mayo ClinicStaff, 2017).The patient would be diagnosed with Alzheimer’s disease.This was due to the fact that she was unable to remember where she was, and whoshe was with. She also began needing increased assistance with everyday tasks. Allthese symptoms led to the conclusion that her cerebrum was being affected byAlzheimer’s disease.