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92-618: The study began in 1994 and was originally focused on research into Alzheimer's . However, it soon became apparent that most centenarians did not have Alzheimer's even though other forms of dementia were common, so it transitioned into finding out why some people can live to 100 and others do not. Some findings included that centenarians had natural advantages, including large platelet size. Studies for genes managed to identify only one major gene associated with longevity. Researchers are now investigating more detailed genetic analysis including epigenetics . Formerly located at Harvard University ,

184-406: A proteolytic process which causes APP to be divided into smaller fragments. Although commonly researched as neuronal proteins, APP and its processing enzymes are abundantly expressed by other brain cells. One of these fragments gives rise to fibrils of amyloid beta, which then form clumps that deposit outside neurons in dense formations known as amyloid plaques. Excitatory neurons are known to be

276-651: A 0 to 7 scale to evaluate different ADLs based on the level of assistance required. A score of 7 indicates that the individual is independent, while a score of 0 signifies that the individual cannot perform the activity without assistance. The specific breakdown of the scale is shown below: 7 - Complete Independence 6 - Modified Independence 5 - Supervision or Setup 4 - Minimal Assistance 3 - Moderate Assistance 2 - Maximal Assistance 1 - Total Assistance 0 - Activity Does Not Occur Instrumental activities of daily living (IADLs) are not essential for basic day-to-day functioning, but they enable an individual to maintain

368-470: A consequence of aging, the brains of people with Alzheimer's disease have a greater number of them in specific brain regions such as the temporal lobe . Lewy bodies are not rare in the brains of people with Alzheimer's disease. Alzheimer's disease has been identified as a protein misfolding disease , a proteopathy , caused by the accumulation of abnormally folded amyloid beta protein into amyloid plaques, and tau protein into neurofibrillary tangles in

460-456: A decline from a prior level of function and the diagnosis requires ruling out other common causes of neurocognitive decline. Advanced medical imaging with computed tomography (CT) or magnetic resonance imaging (MRI), and with single-photon emission computed tomography (SPECT) or positron emission tomography (PET), can be used to help exclude other cerebral pathology or subtypes of dementia. On MRI or CT, Alzheimer's disease usually shows

552-404: A generalized or focal cortical atrophy, which may be asymmetric. Atrophy of the hippocampus is also commonly seen. Brain imaging commonly also shows cerebrovascular disease, most commonly previous strokes (small or large territory strokes), and this is thought to be a contributing cause of many cases of dementia (up to 46% cases of dementia also have cerebrovascular disease on imaging). FDG-PET scan

644-409: A large scale study conducted on 6,245,282 patients has shown an increased risk of developing Alzheimer's disease following COVID-19 infection in cognitively normal individuals over 65. Alzheimer's disease is characterised by loss of neurons and synapses in the cerebral cortex and certain subcortical regions. This loss results in gross atrophy of the affected regions, including degeneration in

736-402: A level of independence in a community. Occupational therapists often evaluate IADLs during patient assessments. The American Occupational Therapy Association identifies 12 types of IADLs, which may be performed individually or as co-occupations with others. Occupational therapists evaluate and use therapeutic interventions to rebuild the skills required to maintain, regain, or increase

828-532: A measure of health in later life that does not focus exclusively on specific ailments . Unlike studies investigating specific disease outcomes, research employing ADL assessments is sensitive to a wider range of health effects, including those with lower levels of impact. ADL is measured on a continuous scale, which simplifies the research process. Sidney Katz conducted a study of 64 hip fracture patients over an 18-month period, collecting comprehensive data on their treatments, progression, and outcomes. Analysis of

920-435: A mechanism of cell death in brain cells affected with tau tangles. Exactly how disturbances of production and aggregation of the beta-amyloid peptide give rise to the pathology of Alzheimer's disease is not known. The amyloid hypothesis traditionally points to the accumulation of beta-amyloid peptides as the central event triggering neuron degeneration. Accumulation of aggregated amyloid fibrils , which are believed to be

1012-459: A nutrition consultation, can include chopping, mincing, pureeing, or adding thickeners to make swallowing easier. For patients with visual impairments , a clock face analogy is commonly used to describe the position of meal items. When not contraindicated by dysphagia, straws are provided to help prevent spills. For individuals on suicide watch, meals are provided in plastic or paper containers accompanied by plastic utensils (excluding knives), and

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1104-524: A patient's mental state, affecting their reactions to change and possibly leading to behaviors such as fussiness or capriciousness. Providing care with patience, tact, concentration, discipline, and compassion is crucial to building trust with patients, maintaining their confidence, and supporting the success of their treatment and recovery. Because nursing care requires a great deal of attention and energy, nursing staff in some countries are often required to have national license as nurses, such as having passed

1196-447: A person's condition declines, they often withdraw from family and society . Gradually, bodily functions are lost, ultimately leading to death. Although the speed of progression can vary, the average life expectancy following diagnosis is three to twelve years. The cause of Alzheimer's disease is poorly understood. There are many environmental and genetic risk factors associated with its development. The strongest genetic risk factor

1288-660: A person's independence in all Activities of Daily Living may have diminished due to physical or mental health conditions, injuries, or age-related impairments. Physical therapists employ exercises to help patients maintain and improve independence in ADLs. The exercise program is tailored to the patient's specific deficits, which may include walking speed, strength, balance, and coordination. A slow walking speed has been linked to an increased risk of falls; thus, exercises that enhance walking speed are crucial for safer and more functional ambulation . After initiating an exercise program, it

1380-429: A poorer quality of life or be unsafe in their current living conditions; therefore, they may require the help of other individuals and/or mechanical devices. Examples of mechanical devices to aid in ADLs include electric lifting chairs, bathtub transfer benches and ramps to replace stairs. Basic ADLs consist of self-care tasks that include: The Functional Independence Measure (FIM) is a tool developed in 1983 that uses

1472-409: A reduced risk of deep vein thrombosis , fewer pressure ulcers , and less functional decline . To protect the patient's head from injury during repositioning, a pillow is commonly placed at the head of the bed. To move a bedridden patient up in bed, caregivers utilize either a friction-reducing sheet or a draw sheet . A bed bath involves using a bath blanket to cover the patient, ensuring that only

1564-537: A role in the pathology of Alzheimer's disease. Inflammation is a general marker of tissue damage in any disease, and may be either secondary to tissue damage in Alzheimer's disease or a marker of an immunological response . There is increasing evidence of a strong interaction between the neurons and the immunological mechanisms in the brain. Obesity and systemic inflammation may interfere with immunological processes which promote disease progression. Alterations in

1656-465: A time. However, for patients for whom rolling to the side is contraindicated, such as those recovering from hip replacement surgery, the process is modified. These patients are assisted into a sitting position while the caregiver makes the top half of the bed. Once completed, the patient is then helped to lie back while the bottom half of the bed is made. To maintain self-esteem, patients are involved as much as possible in their care. Their preferences for

1748-612: A wide range of disabilities. Others like the Spinal Cord Independence Measure are designed to evaluate participants in a specific type of disability. Most models of health care service use ADL evaluations in their practice, including the medical (or institutional) models, such as the Roper–Logan–Tierney model of nursing , and the resident-centered models, such as the Program of All-Inclusive Care for

1840-561: Is APOEε4 . APOEε4 is one of four alleles of apolipoprotein E (APOE). APOE plays a major role in lipid-binding proteins in lipoprotein particles and the ε4 allele disrupts this function. Between 40% and 80% of people with Alzheimer's disease possess at least one APOEε4 allele. The APOEε4 allele increases the risk of the disease by three times in heterozygotes and by 15 times in homozygotes . Like many human diseases, environmental effects and genetic modifiers result in incomplete penetrance . For example, Nigerian Yoruba people do not show

1932-488: Is a medical hypothesis that just as the fetus goes through a process of neurodevelopment beginning with neurulation and ending with myelination , the brains of people with Alzheimer's disease go through a reverse neurodegeneration process starting with demyelination and death of axons (white matter) and ending with the death of grey matter. Likewise the hypothesis is, that as infants go through states of cognitive development , people with Alzheimer's disease go through

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2024-496: Is about 90% heritable. Familial Alzheimer's disease usually implies two or more persons affected in one or more generations. Early onset familial Alzheimer's disease can be attributed to mutations in one of three genes: those encoding amyloid-beta precursor protein (APP) and presenilins PSEN1 and PSEN2 . Most mutations in the APP and presenilin genes increase the production of a small protein called amyloid beta (Aβ)42, which

2116-529: Is available and can be examined histologically for senile plaques and neurofibrillary tangles. There are three sets of criteria for the clinical diagnoses of the spectrum of Alzheimer's disease: the 2013 fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5 ); the National Institute on Aging - Alzheimer's Association (NIA-AA) definition as revised in 2011; and

2208-491: Is believed to occur when abnormal amounts of amyloid beta (Aβ), accumulating extracellularly as amyloid plaques and tau proteins , or intracellularly as neurofibrillary tangles , form in the brain, affecting neuronal functioning and connectivity, resulting in a progressive loss of brain function. This altered protein clearance ability is age-related, regulated by brain cholesterol, and associated with other neurodegenerative diseases. The cause for most Alzheimer's cases

2300-435: Is complex and focuses on asymptomatic individuals; the latter two stages describe individuals experiencing symptoms. The core clinical criteria for MCI is used along with identification of biomarkers, predominantly those for neuronal injury (mainly tau-related) and amyloid beta deposition. The core clinical criteria itself rests on the presence of cognitive impairment without the presence of comorbidities. The third stage

2392-477: Is defined as wagered support of 20 or more hours a week for people with impairments. A 2008 review suggested that personal assistance may offer benefits to some elderly individuals and their informal caretakers. Further research is required to evaluate the efficiency of different personal assistance models and their overall costs. In community residential care settings, it is essential for personal assistants, doctors, and nurses to recognize that illness can alter

2484-405: Is disrupted in Alzheimer's disease, though it remains unclear whether this is produced by or causes the changes in proteins. Smoking is a significant Alzheimer's disease risk factor. Systemic markers of the innate immune system are risk factors for late-onset Alzheimer's disease. Exposure to air pollution may be a contributing factor to the development of Alzheimer's disease. Retrogenesis

2576-526: Is divided into probable and possible AD dementia. In probable AD dementia there is steady impairment of cognition over time and a memory-related or non-memory-related cognitive dysfunction. In possible AD dementia, another causal disease such as cerebrovascular disease is present. Neuropsychological tests including cognitive tests such as the mini–mental state examination (MMSE), the Montreal Cognitive Assessment (MoCA) and

2668-547: Is frequently seen as a prodromal stage of Alzheimer's disease. Amnesic MCI has a greater than 90% likelihood of being associated with Alzheimer's. In people with Alzheimer's disease, the increasing impairment of learning and memory eventually leads to a definitive diagnosis. In a small percentage, difficulties with language, executive functions, perception ( agnosia ), or execution of movements ( apraxia ) are more prominent than memory problems. Alzheimer's disease does not affect all memory capacities equally. Older memories of

2760-513: Is from an allele of apolipoprotein E . Other risk factors include a history of head injury , clinical depression , and high blood pressure . The progression of the disease is largely characterized by the accumulation of malformed protein deposits in the cerebral cortex , called amyloid plaques and neurofibrillary tangles . These misfolded protein aggregates interfere with normal cell function, and over time lead to irreversible degeneration of neurons and loss of synaptic connections in

2852-756: Is important to maintain the routine. Otherwise, the benefits will be lost. For frail patients, regular exercise is vital in preserving functional independence and preventing the need for external assistance or placement in a long-term care facility. Skills in assisting with ADLs are required in nursing and other professions, such as nursing assistants in hospitals, nursing homes, assisted living facilities, and other long-term care settings. This includes assisting in patient mobility, such as repositioning an activity-intolerant patient in bed. Hygiene assistance may involve giving bed baths and helping with urinary and bowel elimination. Personal care assistants are required to adhere to established standards of care. Personal assistance

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2944-406: Is known to target the hippocampus which is associated with memory , and this is responsible for the first symptoms of memory impairment. As the disease progresses so does the degree of memory impairment. The first symptoms are often mistakenly attributed to aging or stress . Detailed neuropsychological testing can reveal mild cognitive difficulties up to eight years before a person fulfills

3036-453: Is named after German psychiatrist and pathologist Alois Alzheimer , who first described it in 1906. Alzheimer's financial burden on society is large, with an estimated global annual cost of US$ 1   trillion. It is ranked as the seventh leading cause of death worldwide. Given the widespread impacts of Alzheimer's disease, both basic-science and health funders in many countries support Alzheimer's research at large scales. For example,

3128-561: Is not required for the diagnosis but it is sometimes used when standard testing is unclear. FDG-PET shows a bilateral, asymetric, temporal and parietal reduced activity. Advanced imaging may predict conversion from prodromal stages (mild cognitive impairment) to Alzheimer's disease. FDA-approved radiopharmaceutical diagnostic agents used in PET for Alzheimer's disease are florbetapir (2012), flutemetamol (2013), florbetaben (2014), and flortaucipir (2020). Because many insurance companies in

3220-427: Is still mostly unknown, except for 1–2% of cases where deterministic genetic differences have been identified. Several competing hypotheses attempt to explain the underlying cause; the most predominant hypothesis is the amyloid beta (Aβ) hypothesis. The oldest hypothesis, on which most drug therapies are based, is the cholinergic hypothesis , which proposes that Alzheimer's disease is caused by reduced synthesis of

3312-513: Is the Aβ oligomerization rather than the fibrils that may be the cause of this disease. Mice expressing this mutation have all the usual pathologies of Alzheimer's disease. The tau hypothesis proposes that tau protein abnormalities initiate the disease cascade. In this model, hyperphosphorylated tau begins to pair with other threads of tau as paired helical filaments . Eventually, they form neurofibrillary tangles inside neurons. When this occurs,

3404-522: Is the main component of amyloid plaques . Some of the mutations merely alter the ratio between Aβ42 and the other major forms—particularly Aβ40—without increasing Aβ42 levels in the brain. Two other genes associated with autosomal dominant Alzheimer's disease are ABCA7 and SORL1 . Alleles in the TREM2 gene have been associated with a three to five times higher risk of developing Alzheimer's disease. A Japanese pedigree of familial Alzheimer's disease

3496-536: Is usually clinically diagnosed based on a person's medical history , observations from friends or relatives, and behavioral changes. The presence of characteristic neuropsychological changes with impairments in at least two cognitive domains that are severe enough to affect a person's functional abilities are required for the diagnosis. Domains that may be impaired include memory (most commonly impaired), language, executive function , visuospatial functioning, or other areas of cognition. The neurocognitive changes must be

3588-758: The Katz ADL scale , the Older Americans Resources and Services (OARS) ADL/IADL scale, the Lawton IADL scale, and the Bristol Activities of Daily Living Scale . In the domain of disability, measures have been developed to capture functional recovery in performing basic activities of daily living. Amongst them, some measures like the Functional Independence Measure are designed for assessment across

3680-572: The NCLEX . Nursing care is usually divided into general and specialized care. Particular difficulties arise when caring for the severely ill. A healthy workspace is an important factor. If caregivers are mistreated or burnt out, it can lead to residents being neglected and mistreated. Patients who are immobile should be repositioned at least every two hours to prevent the development of pressure ulcers, commonly known as bed sores . Repositioning hospitalized patients also offers additional benefits, such as

3772-570: The brain . A probable diagnosis is based on the history of the illness and cognitive testing , with medical imaging and blood tests to rule out other possible causes. Initial symptoms are often mistaken for normal brain aging . Examination of brain tissue is needed for a definite diagnosis, but this can only take place after death . No treatments can stop or reverse its progression, though some may temporarily improve symptoms. A healthy diet, physical activity, and social engagement are generally beneficial in aging, and may help in reducing

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3864-428: The differential diagnosis of Alzheimer's disease and other diseases. Interviews with family members are used in assessment; caregivers can supply important information on daily living abilities and on the decrease in the person's mental function . A caregiver's viewpoint is particularly important, since a person with Alzheimer's disease is commonly unaware of their deficits . Many times, families have difficulties in

3956-468: The hippocampus . However, Alzheimer's disease may occur without neurofibrillary tangles in the neocortex . Plaques are dense, mostly insoluble deposits of beta-amyloid peptide and cellular material outside and around neurons . Neurofibrillary tangles are aggregates of the microtubule-associated protein tau which has become hyperphosphorylated and accumulate inside the cells themselves. Although many older individuals develop some plaques and tangles as

4048-610: The microtubules disintegrate, destroying the structure of the cell's cytoskeleton which collapses the neuron's transport system. A number of studies connect the misfolded amyloid beta and tau proteins associated with the pathology of Alzheimer's disease, as bringing about oxidative stress that leads to neuroinflammation . This chronic inflammation is also a feature of other neurodegenerative diseases including Parkinson's disease , and ALS . Spirochete infections have also been linked to dementia. DNA damages accumulate in Alzheimer's diseased brains; reactive oxygen species may be

4140-619: The temporal lobe and parietal lobe , and parts of the frontal cortex and cingulate gyrus . Degeneration is also present in brainstem nuclei particularly the locus coeruleus in the pons . Studies using MRI and PET have documented reductions in the size of specific brain regions in people with Alzheimer's disease as they progressed from mild cognitive impairment to Alzheimer's disease, and in comparison with similar images from healthy older adults. Both Aβ plaques and neurofibrillary tangles are clearly visible by microscopy in brains of those with Alzheimer's disease, especially in

4232-529: The Elderly (PACE). Pervasive computing technology was considered to determine the wellness of the elderly living independently in their homes. The framework of the intelligent system consists of monitoring important daily activities through the observation of everyday object usage. The improved wellness indices helped in reducing false warnings related to the daily activities of elderly living. ADL evaluations are increasingly used in epidemiological studies as

4324-614: The International Working Group criteria as revised in 2010. Three broad time periods, which can span decades, define the progression of Alzheimer's disease from the preclinical phase, to mild cognitive impairment (MCI), followed by Alzheimer's disease dementia. Eight intellectual domains are most commonly impaired in AD— memory , language , perceptual skills , attention , motor skills , orientation , problem solving and executive functional abilities, as listed in

4416-521: The Mini-Cog are widely used to aid in diagnosis of the cognitive impairments in AD. These tests may not always be accurate, as they lack sensitivity to mild cognitive impairment, and can be biased by language or attention problems; more comprehensive test arrays are necessary for high reliability of results, particularly in the earliest stages of the disease. Further neurological examinations are crucial in

4508-611: The Study is now located at Boston University and led by Dr. Tom Perls . In 2006, an offshoot, the New England Supercentenarian Study, was begun. A study of gene tests of hundreds of centenarians reported in July 2010 that genetics plays an extremely important role in deciding who reaches that age. Centenarians rarely develop diseases of aging, and are more likely to bounce back from diseases. Led by Perls,

4600-751: The US National Institutes of Health program for Alzheimer's research, the National Plan to Address Alzheimer’s Disease, has a budget of US$ 3.98 billion for fiscal year 2026. In the European Union , the 2020 Horizon Europe research programme awarded over €570 million for dementia-related projects. The course of Alzheimer's is generally described in three stages, with a progressive pattern of cognitive and functional impairment . The three stages are described as early or mild, middle or moderate, and late or severe. The disease

4692-533: The United States do not cover this procedure, its use in clinical practice is largely limited to clinical trials as of 2018 . Assessment of intellectual functioning including memory testing can further characterise the state of the disease. Medical organizations have created diagnostic criteria to ease and standardise the diagnostic process for practising physicians. Definitive diagnosis can only be confirmed with post-mortem evaluations when brain material

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4784-424: The area being washed is exposed at any given time. This practice maintains privacy and keeps the patient warm. Typically, the eyes are cleansed first, using water without soap to prevent irritation. Each eye should be cleaned from the inner corner near the nose outward, to avoid transferring debris to the tear duct . A clean section of the cloth is used, or the cloth is rinsed before cleaning the second eye, to prevent

4876-416: The bed is raised to assist in voiding or defecating. For individuals with one side weaker than the other (e.g., due to a stroke), it is recommended to dress the weaker side first using the stronger arm. Conversely, when undressing, the stronger side should be undressed first. When making an occupied bed, for instance for patients who cannot or have difficulty getting out of bed, the bed is made one side at

4968-437: The brain. Late-onset Alzheimer's is about 70% heritable . Genetic models in 2020 predict Alzheimer's disease with 90% accuracy. Most cases of Alzheimer's are not familial , and so they are termed sporadic Alzheimer's disease. Of the cases of sporadic Alzheimer's disease, most are classified as late onset where they are developed after the age of 65 years. The strongest genetic risk factor for sporadic Alzheimer's disease

5060-404: The brain. Plaques are made up of small peptides , 39–43  amino acids in length, called amyloid beta. Amyloid beta is a fragment from the larger amyloid-beta precursor protein (APP) a transmembrane protein that penetrates the cell's membrane . APP is critical to neuron growth, survival, and post-injury repair. In Alzheimer's disease, gamma secretase and beta secretase act together in

5152-523: The cell to the ends of the axon and back. A protein called tau stabilises the microtubules when phosphorylated , and is therefore called a microtubule-associated protein . In Alzheimer's disease, tau undergoes chemical changes, becoming hyperphosphorylated; it then begins to pair with other threads, creating neurofibrillary tangles and disintegrating the neuron's transport system. Pathogenic tau can also cause neuronal death through transposable element dysregulation. Necroptosis has also been reported as

5244-539: The clinical criteria for diagnosis of Alzheimer's disease. These early symptoms can affect the most complex activities of daily living . The most noticeable deficit is short term memory loss, which shows up as difficulty in remembering recently learned facts and inability to acquire new information. Subtle problems with the executive functions of attentiveness , planning , flexibility, and abstract thinking , or impairments in semantic memory (memory of meanings, and concept relationships) can also be symptomatic of

5336-534: The data revealed that the patients perceived as most independent were able to perform a range of basic activities, from the more complex task of bathing to the simpler one of feeding themselves. Based on these findings, Katz developed a scale to evaluate a patient's capacity for living. This scale was first published in the 1963 Journal of the American Medical Association and has been cited over 1,000 times since its publication. Although

5428-478: The demyelinating disease, multiple sclerosis , and Alzheimer's disease have been reported. The association with celiac disease is unclear, with a 2019 study finding no increase in dementia overall in those with celiac disease while a 2018 review found an association with several types of dementia including Alzheimer's disease. Studies have shown a potential link between infection with certain viruses and developing Alzheimer's disease later in life. Notably,

5520-591: The detection of initial dementia symptoms and may not communicate accurate information to a physician. Supplemental testing can rule out other potentially treatable diagnoses and help avoid misdiagnoses. Common supplemental tests include blood tests , thyroid function tests , as well as tests to assess vitamin B12 levels, rule out neurosyphilis and rule out metabolic problems (including tests for kidney function , electrolyte levels and for diabetes ). MRI or CT scans might also be used to rule out other potential causes of

5612-556: The distribution of different neurotrophic factors and in the expression of their receptors such as the brain-derived neurotrophic factor (BDNF) have been described in Alzheimer's disease. Alzheimer's disease (AD) can only be definitively diagnosed with autopsy findings; in the absence of autopsy, clinical diagnoses of AD are "possible" or "probable", based on other findings. Up to 23% of those clinically diagnosed with AD may be misdiagnosed and may have pathology suggestive of another condition with symptoms that mimic those of AD. AD

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5704-423: The early stages of Alzheimer's disease. Apathy and depression can be seen at this stage, with apathy remaining as the most persistent symptom throughout the course of the disease. Mild cognitive impairment (MCI) is often found to be a transitional stage between normal aging and dementia . MCI can present with a variety of symptoms, and when memory loss is the predominant symptom, it is termed amnestic MCI and

5796-517: The elderly. Younger children often require help from adults to perform ADLs, as they have not yet developed the skills necessary to perform them independently. Aging and disabilities, affecting individuals across different age groups, can significantly alter a person's daily life. Such changes must be carefully managed to maintain health and well-being. Common activities of daily living (ADLs) include feeding oneself, bathing, dressing, grooming, working, homemaking, and managing personal hygiene after using

5888-462: The fact that people with trisomy 21 (Down syndrome) who have an extra gene copy almost universally exhibit at least the earliest symptoms of Alzheimer's disease by 40 years of age. A specific isoform of apolipoprotein, APOE4 , is a major genetic risk factor for Alzheimer's disease. While apolipoproteins enhance the breakdown of beta amyloid, some isoforms are not very effective at this task (such as APOE4), leading to excess amyloid buildup in

5980-413: The following are present: no genetic evidence, decline in both learning and memory, two or more cognitive deficits, and a functional disability not from another disorder. The NIA-AA criteria are used mainly in research rather than in clinical assessments. They define AD through three major stages: preclinical, mild cognitive impairment (MCI), and Alzheimer's dementia. Diagnosis in the preclinical stage

6072-452: The fourth text revision of the DSM (DSM-IV-TR). The DSM-5 defines criteria for probable or possible AD for both major and mild neurocognitive disorder. Major or mild neurocognitive disorder must be present along with at least one cognitive deficit for a diagnosis of either probable or possible AD. For major neurocognitive disorder due to AD, probable Alzheimer's disease can be diagnosed if

6164-412: The individual has genetic evidence of AD or if two or more acquired cognitive deficits, and a functional disability that is not from another disorder, are present. Otherwise, possible AD can be diagnosed as the diagnosis follows an atypical route. For mild neurocognitive disorder due to AD, probable Alzheimer's disease can be diagnosed if there is genetic evidence, whereas possible AD can be met if all of

6256-401: The major producers of amyloid beta that contribute to major extracellular plaque deposition. Alzheimer's disease is also considered a tauopathy due to abnormal aggregation of the tau protein . Every neuron has a cytoskeleton , an internal support structure partly made up of structures called microtubules . These microtubules act like tracks, guiding nutrients and molecules from the body of

6348-399: The major source of this DNA damage. Sleep disturbances are seen as a possible risk factor for inflammation in Alzheimer's disease. Sleep disruption was previously only seen as a consequence of Alzheimer's disease, but as of 2020 , accumulating evidence suggests that this relationship may be bidirectional . The cellular homeostasis of biometals such as ionic copper, iron, and zinc

6440-492: The most cognitively demanding activities. Progressive deterioration eventually hinders independence, with subjects being unable to perform most common activities of daily living. Speech difficulties become evident due to an inability to recall vocabulary , which leads to frequent incorrect word substitutions ( paraphasias ). Reading and writing skills are also progressively lost. Complex motor sequences become less coordinated as time passes and Alzheimer's disease progresses, so

6532-408: The natural process of aging" (p. 918), there was an implicit generalization, from their sample of older persons with fractured hips to all older persons. Porter emphasizes the possible disease-specific nature of ADLs (being derived from hip-fracture patients), the need for an objective definition of ADLs, and the possible value of adding additional functional measures. A systematic review examined

6624-445: The neurotransmitter acetylcholine . The loss of cholinergic neurons noted in the limbic system and cerebral cortex, is a key feature in the progression of Alzheimer's. The 1991 amyloid hypothesis postulated that extracellular amyloid beta (Aβ) deposits are the fundamental cause of the disease. Support for this postulate comes from the location of the gene for the amyloid precursor protein (APP) on chromosome 21 , together with

6716-586: The order of consuming their meal items are respected. Condiments are provided, and food is prepared according to each patient's preferences. Adequate liquid is supplied with the meal. Necessary aids such as dentures , hearing aids , and glasses are put in place before mealtime. Oral hygiene is important after eating and includes brushing teeth, cleaning dentures, and using mouthwash. For those with dysphagia , patients must be placed on aspiration precautions. The feeding rate and bite sizes are tailored to each patient's tolerance. Dietary modifications, as recommended by

6808-500: The patient are securely tucked in to prevent the formation of wrinkles, which can contribute to skin breakdown. A top sheet and a blanket are then placed over the bed, with the corners neatly mitered. Wound dressings can be categorized into several types, including hydrocolloid, hydrogel, alginate, collagen, foam, transparent, and cloth dressings. Several evaluation tools are available to assess Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), including

6900-582: The person from home care to other long-term care facilities . During the final stage, known as the late-stage or severe stage, there is complete dependence on caregivers. Language is reduced to simple phrases or even single words, eventually leading to complete loss of speech. Despite the loss of verbal language abilities, people can often understand and return emotional signals. Although aggressiveness can still be present, extreme apathy and exhaustion are much more common symptoms. People with Alzheimer's disease will ultimately not be able to perform even

6992-457: The person with Alzheimer's is usually capable of communicating basic ideas adequately. While performing fine motor tasks such as writing, drawing, or dressing, certain movement coordination and planning difficulties ( apraxia ) may be present; however, they are commonly unnoticed. As the disease progresses, people with Alzheimer's disease can often continue to perform many tasks independently; however, they may need assistance or supervision with

7084-450: The person's life ( episodic memory ), facts learned ( semantic memory ), and implicit memory (the memory of the body on how to do things, such as using a fork to eat or how to drink from a glass) are affected to a lesser degree than new facts or memories. Language problems are mainly characterised by a shrinking vocabulary and decreased word fluency , leading to a general impoverishment of oral and written language . In this stage,

7176-519: The relationship between dose of APOEε4 and incidence or age-of-onset for Alzheimer's disease seen in other human populations. Only 1–2% of Alzheimer's cases are inherited due to autosomal dominant effects, as Alzheimer's is highly polygenic. When the disease is caused by autosomal dominant variants, it is known as early onset familial Alzheimer's disease , which is rarer and has a faster rate of progression. Less than 5% of sporadic Alzheimer's disease have an earlier onset, and early-onset Alzheimer's

7268-594: The reverse process of progressive cognitive impairment . According to one theory, dysfunction of oligodendrocytes and their associated myelin during aging contributes to axon damage, which in turn generates in amyloid production and tau hyperphosphorylation . An in vivo study employing genetic mouse models to simulate myelin dysfunction and amyloidosis further reveal that age-related myelin degradation increases sites of Aβ production and distracts microglia from Aβ plaques, with both mechanisms dually exacerbating amyloidosis. Additionally, comorbidities between

7360-843: The risk of cognitive decline and Alzheimer's. Affected people become increasingly reliant on others for assistance, often placing a burden on caregivers . The pressures can include social, psychological, physical, and economic elements. Exercise programs may be beneficial with respect to activities of daily living and can potentially improve outcomes. Behavioral problems or psychosis due to dementia are sometimes treated with antipsychotics , but this has an increased risk of early death. As of 2020, there were approximately 50 million people worldwide with Alzheimer's disease. It most often begins in people over 65 years of age, although up to 10% of cases are early-onset impacting those in their 30s to mid-60s. It affects about 6% of people 65 years and older, and women more often than men. The disease

7452-809: The risk of falling increases. During this phase, memory problems worsen, and the person may fail to recognise close relatives. Long-term memory , which was previously intact, becomes impaired. Behavioral and neuropsychiatric changes become more prevalent. Common manifestations are wandering , irritability and emotional lability , leading to crying, outbursts of unpremeditated aggression , or resistance to caregiving. Sundowning can also appear. Approximately 30% of people with Alzheimer's disease develop illusionary misidentifications and other delusional symptoms. Subjects also lose insight of their disease process and limitations ( anosognosia ). Urinary incontinence can develop. These symptoms create stress for relatives and caregivers, which can be reduced by moving

7544-471: The scale offers a standardized measure of psychological and biological function, the process of arriving at this assumption has been criticized. Specifically, Porter has argued for a phenomenological approach noting that: Katz et al. (1963) made a claim that became the basis for the ontological assumptions of the ADL research tradition. In their suggestion that there was an "ordered regression [in skills] as part of

7636-427: The simplest tasks independently; muscle mass and mobility deteriorates to the point where they are bedridden and unable to feed themselves. The cause of death is usually an external factor, such as infection of pressure ulcers or pneumonia , not the disease itself. In some cases, there is a paradoxical lucidity immediately before death, where there is an unexpected recovery of mental clarity. Alzheimer's disease

7728-408: The spreading of any organisms. After washing, each area is dried before moving on to the next. Perineal care follows a specific protocol to minimize the transfer of microorganisms. The perineum should be washed from the least contaminated area to the most contaminated area. In females, this involves spreading the labia and washing from the pubic area toward the anal area, never in reverse. For males,

7820-596: The study was funded by the National Institute on Aging 's Division of Geriatrics and Clinical Gerontology. Alzheimer%27s disease Alzheimer's disease ( AD ) is a neurodegenerative disease that usually starts slowly and progressively worsens, and is the cause of 60–70% of cases of dementia . The most common early symptom is difficulty in remembering recent events . As the disease advances, symptoms can include problems with language , disorientation (including easily getting lost), mood swings , loss of motivation , self-neglect , and behavioral issues . As

7912-441: The symptoms – including tumors or strokes. Delirium and depression can be common among individuals and are important to rule out. Activities of daily living Activities of daily living ( ADLs ) is a term used in healthcare to refer to an individual's daily self-care activities. Health professionals often use a person's ability or inability to perform ADLs as a measure of their functional status . The concept of ADLs

8004-437: The tip of the penis is cleansed first, moving away from the urethral opening (meatus). If the male is uncircumcised, the foreskin is gently retracted, washed, and then promptly returned to its original position to prevent restricting circulation. For children, the foreskin is not retracted to avoid injury. A bedpan is used for bed-bound patients for bowel elimination as well as urinary elimination for females. The head of

8096-565: The toilet. A number of national surveys have collected data on the ADL status of the U.S. population. Although basic definitions of ADLs are established, what specifically constitutes a particular ADL can vary for each individual. Cultural background and education level are among the factors that can influence a person's perception of their functional abilities. ADLs are categorized into basic self-care tasks (typically learned in infancy) or instrumental tasks generally learned throughout adolescence. A person who cannot perform essential ADLs may have

8188-650: The toxic form of the protein responsible for disrupting the cell's calcium ion homeostasis , induces programmed cell death ( apoptosis ). It is also known that A β selectively builds up in the mitochondria in the cells of Alzheimer's-affected brains, and it also inhibits certain enzyme functions and the utilisation of glucose by neurons. Iron dyshomeostasis is linked to disease progression, an iron-dependent form of regulated cell death called ferroptosis could be involved. Products of lipid peroxidation are also elevated in AD brain compared with controls. Various inflammatory processes and cytokines may also have

8280-405: The use of sharp objects is permitted only under continuous staff supervision. A fitted sheet is placed over the mattress of a hospital bed. Often, a draw sheet (also known as a lift sheet) is laid on top of the fitted sheet at the center, where it will lie beneath the patient's midsection. The draw sheet is commonly used to assist in lifting or repositioning the patient. Sheets positioned under

8372-493: Was found to be associated with a deletion mutation of codon 693 of APP. This mutation and its association with Alzheimer's disease was first reported in 2008, and is known as the Osaka mutation. Only homozygotes with this mutation have an increased risk of developing Alzheimer's disease. This mutation accelerates Aβ oligomerization but the proteins do not form the amyloid fibrils that aggregate into amyloid plaques, suggesting that it

8464-657: Was originally proposed in the 1950s by Sidney Katz and his team at the Benjamin Rose Hospital in Cleveland, Ohio. Since then, numerous researchers have expanded on the concept of ADLs. For instance, many indexes that assess ADLs now incorporate measures of mobility. In 1969, Lawton and Brody developed the concept of Instrumental Activities of Daily Living (IADLs) to capture the range of activities that support independent living. These are often utilized in caring for individuals with disabilities, injuries, and

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