alzheimers

Question 1

What pathophysiological mechanisms underpin Alzheimers and the associated pain response?

Answer 1

AD neuropathology is characterised by the extracellular accumulation of Aβ peptide and intracellular aggregation of hyperphosphorylated tau (Calderon-Garcidueñas & Charles Duyckaerts, 2018). The underlying neuropathology of amyloid plaques and neurofibrillary tangles progress undetectable for decades and eventually results in an irreversible loss of neurones in the cerebral cortex and hippocampus (Murray & Murray, 2007).

In some cases, patients may have familial disease, in which there is a genetic defect that results in the increased activity of γsecretases which is involved in the accumulation of senile plaques (Murray & Murray, 2007). 


PAIN
There doesn’t seem to be any pain directly associated with AD, however, individuals with AD are at greater risk of having or developing other painful ailments such as osteoarthritis, pressure sores, skin tears, and constipation (NICE, 2015).

Question 2

What dysfunctions may AD result in?

Answer 2

AD is characterised by the gradual onset of symptoms at a relentlessly progressive course.

• Early symptoms most prominently involve difficulties remembering recent events and forming new memories, and these are often accompanied by visuospatial and language problems.
• As the disease progresses, individuals slowly lose the ability to perform the activities of daily living, such as managing finances and driving a car.
• Eventually, attention, verbal ability, problem solving, reasoning, and all forms of memory become seriously impaired.
• Personality changes associated with the progression of AD may include increased apathy, anger, dependency, aggressiveness, and occasionally inappropriate sexual behavior; paranoid thinking is also not uncommon. In the latter stages of this disorder, individuals may be mute, completely confused, and bedridden.


Roth, Greenberg, and Pomara (2007).

Question 3

What modifiable and non-modifiable risk factors influence Alzheimer’s?

Answer 3

Non-modifiable
* 
Genetic mutation to the genes that modulate the activity of γsecretases (NICE, 2015)

Modifiable
* Smoking (NICE, 2015)
* Lack of physical activity (NICE, 2015)
* Alcohol consumption (NICE, 2015)
* Poor diet (NICE, 2015)
* Being overweight or obese (NICE, 2015)
* Loneliness (NICE, 2015)

* Sleep disturbance has also been identified as a contributing factor (Thakur et al., 2018).

Question 4

What is the prognosis for Alzheimer’s?

Answer 4

AD is a terminal illness. Generally speaking, following diagnosis, the progression of the disease is swift individuals will live for three-to-eleven years. However, it is not uncommon for patients with AD to live for a further 20 years post-diagnosis.

It is important to note that individuals with AD often have other comorbidities and the cause of mortality is rarely the direct result of AD.

Question 5

What were the key findings of Muir & Abebaw (2009) regarding the impact of cognitive impairment on rehab from femoral neck fractures (with critical analysis)?

Answer 5

• Chronic and acute cognitive impairment are independent risk factors for a poorer outcome after hip fracture.
• The behavioural and cognitive impairment can affect an individual’s ability to participate effectively in rehabilitation thereby impacting on the delivery of care.

Critical Analysis
* Journal: Geriatric Physical Therapy (IF = 3.5)
* Design: SR