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  © 2008
  University of Idaho
  All rights reserved.
  Psychology Dept.
  University of Idaho
  Design - P&D  CTI

As part of this aging process, as we see in slide three, we undergo a variety of neurological changes.  Most people, as we can see here, showed mild memory and cognitive decreases as they age.  We also get reductions in visual spatial ability, verbal fluency, overall general intelligence, and a wide variety of other disorders as well.  We also have a variety of physiological changes.  In addition to that, as we see in slide four, we have less erect posture, you’re stride length is shorter, we have slower reflexes and on and on.  In addition, brain weight may actually decrease over time as neurons die, and enzymes that synthesize many of the neurotransmitters we have also decrease as well.

Regardless, as we see in slide five; most reductions of all these problems do not seriously impair your quality of life for the most part.  Further, most people die with relatively minimal major problems that are out there, provided they don’t have some other major disorder. 

One of the problems that we have relates to what we call the senile dementias.  As we see in slide six, these involve loss of memory or cognition severe enough to interfere with your social or occupational function.  For senile dementias to be diagnosed, they must show at least two things: You must have some kind of memory loss, and you must have problems in either language, problem solving, attention perception, or other areas.

Now there’s a wide variety of disorders that can cause dementias and listed in slide seven.  Some of these are common and include disorders such as Alzheimer’s and cardiovascular disease.  But there are a variety of other disorders that can cause dementia as well.  These include tumors, thyroid disease and other disorders as well.

Alzheimer’s disease is one of these most common disorders that cause dementias, and as we see in slide eight, it is the most common cause of dementia.  It affects 7% of all people older than 65 and it affects 40% of people older than 80.  Five million people currently have Alzheimer’s in the United States, and it’s estimated within the next 25 years (due to the baby boomers), it will reach at least 15 million people. Consequently, the cost for treating this problem will increase as well.  You will hear me say over and over again, get a good long- term care plan developed now so when you are older, you will not have problems in finding a place to live.  However, most symptoms of Alzheimer’s disease usually occur about age 70.  However, some may develop earlier and there may be also a family history of Alzheimer’s as well. 

There are a variety of symptoms associated with Alzheimer’s disease.  As we can see in slide nine, you can have a wide variety of different problems, including problems with memory, problem solving, visual spatial, judgment, abnormal behaviors, etc.  Some individuals even develop hallucinations and delusions which are classic psychotic symptoms for other disorders such as schizophrenia.  So oftentimes, when an individual has these problems and similar kinds of disorders, the physician has to rule out other disorders before you can be diagnosed with Alzheimer’s. 

The prognosis, as we see in slide 10, is not good.  In general, as in all patients, basically your medical and physical functioning is going to become impaired.  This impairment is going to continue to become more and more severe as time goes on until ultimately, you could be bedridden, in a coma, and basically dying in bed.  Further, you can live there for quite a while before you actually do die.  There’s no real test available to detect Alzheimer’s disease while a person is living, although several are undergoing clinical testing.  Usually the diagnosis of Alzheimer’s disease is done at autopsy.  Usually pathologists look for plaques or other types of problems in the brain.  .

There’s a wide variety of brain damage that occurs in Alzheimer’s disease and a lot of this brain damage is listed on slide 11.  As we can see, the damage can occur in the neocortex, in the entorhinal area, hippocampus, thalamus and a wide variety of other structures as well.  The consequence of all this, as we see in slide 12, is that we can get memory loss.  This is primarily due from damage to the entorhinal cortex, the hippocampus, and also the medial temporal gyres.  We can also get damage in the limbic cortex, in the amygdale.  So, as we know from previous lectures, that when you do that, you develop emotional problems as well. 

As we see in the next slide, there’s a wide variety of different damage that can occur with Alzheimer’s disease.  The first major type is cell damage (shown on slide 13).  Here, you get damage to glutaminergic neurons, interneurons, and other types of neurons as well.  In addition to that, the cytoskeleton of the cell often becomes damaged.  Often the result of that damage is what we call neurofibulary tangles.  These ultimately impair axonal transport and cause other problems as well.  Ultimately, the consequence for this damage is that the cell dies.   As a result, the person no longer has that cell and over time, fewer and fewer cells.  This results in lower brain weight and on and on.

In addition to that, we also have a variety of substances that are called amyloid deposits that are occurring in Alzheimer’s patients.  These are the classic markers for the disease.  These occur throughout the brain and involve particular types of brain proteins.  However, they can also occur in blood vessels as well.  The consequence of these deposits is that you have major deposits of plaques that cause cell death and other problems.

What is the treatment for Alzheimer’s?  Well, first of all, there is no cure.  What we usually do is treat symptomatically.  So, what we do is treat the memory problems, or we treat the psychotic behavior with particular types of drugs.  However, newer treatments may be more positive and help us out in the future

There’s a variety of drugs that are currently given to Alzheimer’s patients and these are listed in slide 16.  All of these can help stop the symptoms from becoming worse.  However, as time progresses, you continue to have the symptoms regardless of the medication that you’re on.  Ultimately, the person continues to deteriorate.

One of the particular interesting things comes from vitamin E.  Vitamin E appears to delay the onset of some symptoms in Alzheimer’s.  In addition to that, as we see in slide 17 and probably you might have heard of this, there’s a variety of now what are called cholinesterase inhibitors.  What these do is block the breakdown of achetocholine.  Studies indicate these have a modest effect of delaying the symptoms of Alzheimer’s, and they work with some behavioral problems as well.  However, they only work for a limited time.  So, they are not cures for the disorder.

So in conclusion, what we need to do and remember is that in order to diagnose a person with Alzheimer’s, what you want to do is identify the person very early.  As a result of you can get some particular drugs in you to help reduce and decrease the progression.  However, the progression will continue to occur.  In addition to that, you need to get plenty of help and support in place before the person actually goes into the major symptoms of Alzheimer’s.  So, you need to have multiple helpers when you are taking care of someone with the disorder.  Ultimately most people with Alzheimer’s are going to have to go into a long-term care facility.  We call these facilities nursing homes in the politically correct place that we have today.  However, long-term care facilities are very, very important, and they help a lot of people. The problem is, is that long term care facilities are expensive, thus it’s very, very important for you to have a long term care plan in place for you or your parents for later on.   Oftentimes this disorder will impact you or someone that you know.  So, be prepared out there in the future to deal with this problem. 

In general, Alzheimer’s and other mental disorders that we have in relation to memory, etc., are very, very debilitating.  They also cause lots of problems, and they’re expensive to deal with.  In our next section, we begin to talk about some other types of disorders such as tumors and movement disorders, so until then, we hope you are enjoying the section.