CASE 2

GROUP 2
1. Putri Michaela. A
2. Ika amalia
3. Imron
4. Uswatul
5. Zaqia hanum
Case
A 54-year-old black woman is referred to the neurology clinic by her
general practitioner for evaluation of memory problems. The patient is
brought to the clinic by family members who are concerned that she
has been forgetful in the past year. They report that she has difficulty in
recalling birthdays and anniversaries and is not managing common
household tasks such as cooking and paying bills. The patient's sister
had onset of dementia in her early 40s and was institutionalised
because she was unable to care for herself. The patient was last seen
by her primary care physician 3 months ago, when she had a routine
work-up, which was reported to be unremarkable. Neurological examination
revealed no significant abnormalities. Neuropsychological testing
demonstrated severe impairment in executive function, deficits in visuo-spatial
testing, and delayed speed of processing information. Mini-Mental State \
Examination (MMSE) score is 20/30.
Key word
1. A 54-year-old black woman
2. Memory problems
3. Forgetful in the past year
4. The patient's sister had onset of dementia in her early 40s
5. The patient was last seen by her primary care physician 3 months
ago
6. Neurological examination revealed no significant abnormalities
7. Neuropsychological testing demonstrated severe impairment in
executive function, deficits in visuo-spatial testing, and delayed
speed of processing information
8. Mini-Mental State Examination (MMSE) score is 20/30
Problem
Memory problems
Hypothesis
A 54-year-old black woman is referred to the
neurology clinic by her general practitioner for
evaluation of memory problems due to
ALZHEIMER'S DISEASE
Definition
Alzheimer’s disease is a degenerative brain disease
and the most common cause of dementia. Dementia
is also caused by other diseases and conditions. It is
characterized by a decline in memory, language,
problem-solving and other cognitive skills that
affects a person’s ability to perform everyday
activities.
Cause
A small percentage of Alzheimer’s cases (an estimated 1
percent or less)develop as a result of mutations to any of three
specific genes. A genetic mutation is an abnormal change in the
sequence of chemical pairs that make up genes. These mutations
involve the gene for the amyloid precursor protein (APP) and the
genes for the presenilin 1 and presenilin 2 proteins. Those inheriting
a mutation to the APP or presenilin 1 genes are guaranteed to
develop Alzheimer’s. Those inheriting a mutation in the presenilin 2
gene have a 95 percent chance of developing the disease.
Individuals with mutations in any of these three genes tend to
develop Alzheimer’s symptoms before age 65, sometimes as early
as age 30, while the vast majority of individuals with Alzheimer’s
have late-onset disease, occurring at age 65 or later.
symptom
The following are common symptoms of Alzheimer’s:
 Memory loss that disrupts daily life.

 Challenges in planning or solving problems.

 Difficulty completing familiar tasks at home, at work or at leisure.

 Confusion with time or place.

 Trouble understanding visual images and spatial relationships.

 New problems with words in speaking or writing.

 Misplacing things and losing the ability to retrace steps.

 Decreased or poor judgment.

 Withdrawal from work or social activities.

 Changes in mood and personality, including apathy and depression

Risk Factor
 Age
 Apolipoprotein E (APOE)-e4 Gene
 Family History
 Mild Cognitive Impairment (MCI)
 Cardiovascular Disease Risk Factors
 Education
 Social and Cognitive Engagement
 Traumatic Brain Injury (TBI)
Diagnosis
 Obtaining a medical and family history from the individual,
including psychiatric history and history of cognitive and
behavioral changes.
 Asking a family member or other person close to the
individual to provide input about changes in thinking skills or
behavior.
 Seeking input from a specialist, such as a neurologist.
 Conducting cognitive tests and physical and neurologic
examinations.
 Having the individual undergo a magnetic resonance
imaging (MRI) scan, which can help identify brain changes,
such as a tumor, that could explain the individual’s
symptoms.
Treatment of Alzheimer’s Disease
 Pharmacologic Treatment
Pharmacologic treatments employ medication to slow or
stop an illness or treat its symptoms. Six drugs have been
approved by the U.S. Food and Drug Administration (FDA)
that temporarily improve symptoms of Alzheimer’s disease
by increasing the amount of chemicals called
neurotransmitters in the brain. The effectiveness of these
drugs varies from person to person. However, none of the
treatments available today for Alzheimer’s disease slows or
stops the damage to neurons that causes Alzheimer’s
symptoms and eventually makes the disease fatal.
 Non-Pharmacologic Therapy
Non-pharmacologic therapies are those that employ
approaches other than medication, such as music therapy and
reminiscence therapy (therapy in which photos and other familiar items
may be used to elicit recall). As with current pharmacologic therapies,
non-pharmacologic therapies have not been shown to alter the course
of Alzheimer’s disease.
Non-pharmacologic therapies are often used with the goal of
maintaining or improving cognitive function, the ability to perform
activities of daily living, or overall quality of life. They also may be
used with the goal of reducing behavioral symptoms such as
depression, apathy, wandering, sleep disturbances, agitation and
aggression.
 Systematic reviews of published research on non-
pharmacologic therapies have found that some, such as
exercise and cognitive activity (for example, gardening, word
games, listening to music and cooking) show promise. However,
few non-pharmacologic therapies have been tested in
randomized controlled studies, which provide the strongest
evidence of whether a therapy is effective. In randomized
controlled studies, participants are randomly assigned to
receive a therapy or not receive a therapy, and results from
the two groups are compared. Additional research on non-
pharmacologic therapies is needed to better evaluate their
effectiveness.
THANKS YOU 