NR 507 Week 7 Discussion

Sample Answer

Differentiating between Alzheimers disease and frontal-temporal dementia is important. The plurality of Alzheimer’s patients occur in those over the age of 75 (Maclin et al., 2019). Per this article, Alzheimers disease often progresses slowly with deficits in memory and activities of daily living. Ultimately Alzheimers disease can become fatal when patient aspirates due to dysphagia. Conversely, temporal frontal lobe dementias are more commonly seen with patients under 65 years of age (Maclin et al., 2019). Changes in social behavior and communication difficulties are predominate with frontal temporal dementia.

Alzheimer’s disease progresses from asymptomatic to complete dependency. From our case study, our patient is 76 year old male which fits the demographic of an Alzheimer’s patient. His wife reported that he has been engaged in wandering, trouble completing activities of daily living, and making poor judgements. His diagnostic tests are also consistent with Alzheimer’s dementia with a mini mental state examination (MMSE) score of 12 out of 30. The mini-mental state examination is an objective screening tool to help differentiate mild, moderate, and severe Alzheimers (Marin et al., 2022).

The article noted that wandering has a high concordance with objective deficits found in the MMSE. Another screening tool is MRI evaluation of the hippocampus, amygdala, and lateral ventricular spaces (Coupe et al., 2022). With advancing Alzheimers the hippocampus and amygdala shrink while the ventricles enlarge. In our case study there is evidence of hippocampus atrophy. The case study patient is showing evidence of moderate Alzheimers deficit.

The old model of beta-amyloid plaques being the cause versus a symptom of Alzheimer disease was strengthened by an influential study in 2006 published in Nature by Dr. Sylvain Lesne (Pillar, 2022). The article noted that in 2022, the NIH invested $1.6 billion into research related to this model and pharmaceuticals to address removing the buildup of these plaques to treat Alzheimers. The article is the culmination of six months of investigation into the 2006 research by Dr. Matthew Schrag which demonstrated that many of the evidential images used to connect beta-amyloid to Alzheimers were fraudulent (Pillar, 2022).

In the years since that article was published, it has been cited by 2300 scholarly articles. One of the newest FDA approved pharmaceuticals, Simulfilam, was also based on this theory. Pillar noted that while the drug successfully reduced plaque deposits, Simulfilam was found to be ineffective to address the symptoms of Alzheimer’s dementia like many pharmaceuticals before it (2022). An alternative model for Alzheimers is insulin resistance which one article noted has a detrimental effect on the blood brain barrier (Sedzikowska & Szablewski, 2021). The article noted that insulin receptors are highest in the hippocampus, frontal cortex and other brain regions involved in memory and learning.

Sezikowska & Szablewski noted that similar to type II diabetes, insulin resistance in the brain prevents neurons from being responsive to insulin (2021). This may decrease the metabolism of neurons of the brain leading to dysfunction and death of these tissues. Thus the theory was raised that Alzheimer’s disease is akin to type III Diabetes.

References

• Coupe, P., Manjon, J., Mansencal, B., Tourdias, T., Catherine, G. & Planche, V. (2022). Hippocampal-amygdalo-ventricular atrophy score Alzheimer disease detection using normative and pathological lifespan models. Human Brain Mapping, 43(10), 3270 – 3282. DOI 10.1002/hbm.25850
• Maclin, J., Wang, T. & Xiao S. (2019). Biomarkers for the diagnosis of Alzheimer’s disease, dementia Lewy body, frontal-temporal dementia, and vascular dementia. General Psychiatry, 32(1), e100054. DOI 10.1136/gpsych-2019-100054
• Morin, P, Li, M., Wang, Y., Aguilar, B, Berlowitz, D., Monfared, A., Irizarry, M., Zhang, Q, & Xia, W. (2022). Clinical staging of Alzheimer’s disease concordance of subjective and objective assessment in the Veteran’s Affairs Healthcare System. Neurology and Therapy,11(3), 1341 – 1352. DOI 10.1007/s40120-022-00379-z
• Piller, C. (2022). Blots on a field? Science, 377 (6604), 358 – 363. DOI 10.1126/science.ade0209
• Sedzikowska, A. & Szablewski, L. (2021). Insulin and insulin resistance in Alzheimer’s disease. International Journal of Molecular Sciences, 22(18),9987. DOI 10.3390/ijms22189987