• Presenilin 1 (PSEN1) on chromosome 14 • Presenilin 2 (PSEN2) on chromosome 1
Genetic counseling may be helpful for children of people with early-onset AD. Even though there is no guarantee that the person will develop AD, understanding if they carry the genetic markers will provide them with an opportunity to commit to healthy lifestyle choices. Mutations on the following genes may play a role in developing early-onset AD. • Amyloid precursor protein on chromosome 21 Cause and effect: Environment With the increase in the number of AD patients and the realization that there are limited curative solutions, researchers are looking at the impact of the environment on dementia (Zhou et al., 2021). Causation is not known, but air pollution causes oxidation of the brain that appears to lead to inflammation. Other aspects of the environment, such as green space, have shown to be calming for people with AD. This could be due to the positive factors from green space
Children of parents with AD should, at a minimum, ensure that they make appropriate lifestyle choices. Children of parents with early-onset AD may be at a higher risk of developing the disease and should undergo appropriate genetic counseling to identify any mitigating opportunities and to learn lifestyle choices that may stave off symptoms. that include social connectedness, outdoor physical activity, and engagement in gardening activities. (Seaton, 2020) Healthcare Consideration: A third of AD attributes include inactivity, poor diet, education, smoking, chronic conditions, and mental health (Zhou et al., 2021). Researching social determinants of health such as the environment is imperative in exploring root causes.
ATTRIBUTES OF ALZHEIMER’S DISEASE
A diagnosis of AD or other dementia can be an illogical challenge. It is important to recognize that professional attributes and care include a sense of compassion, empathy, patience, and understanding. While symptoms can be addressed, management of AD is fluid and can be long term, especially because there is no cure (Shin & Habermann, 2022). If a person exhibits AD/dementia symptoms, trained providers may perform the following tests and examinations (on Table 3) to diagnose and determine a care plan, if necessary. Table 3. Test/Examinations Used to Diagnose AD Examination Protocol Examination/Test Complete physical examination • Check reflexes • Evaluate muscle tone/ strength • Sit to stand • Evaluate gait Neurological examination • Evaluate balance, coordination • Responsiveness to hearing and sight Blood labs • Complete blood count (CBC) • Check liver function • Glucose • Thyroid function • HIV
For patients with AD symptoms, receiving a diagnosis can improve their quality of life, giving them the chance to plan and share their thoughts (Wollney et al., 2022). About 34% of patients receive their diagnosis from their primary care physician (PCP), and 48% of patients receive their diagnosis from a specialist. Many symptomatic people do not receive a diagnosis. This can be due to the inaccessibility to a specialist, complacency, a lack of education, and a poor or nonexistent support network. Care partners and caregivers play an integral role in obtaining a proper diagnosis. Primary care physicians may be reluctant to provide a patient with a dementia diagnosis (Wollney et al., 2022). Some physicians lack training in this area and are uncomfortable with the few effective pharmacological therapies available. Other challenges include cultural/language barriers and a lack of education about the benefits of an early diagnosis. Self-Assessment Quiz Question #10 Which statement pertaining to providers and an AD diagnosis is true? a. Providers always have a full picture and history of patients’ manifesting AD symptoms. b. There are indications that primary care providers are reluctant to provide a patient with a dementia diagnosis. c. Physicians are comfortable with the treatments available to treat AD. d. Patients are better off seeing the physician alone. Once a patient does receive an AD diagnosis, they may experience the following emotions (Alzheimer’s Association, 2022). • Anger • Resentment
• Electrolytes • Folate test • Vitamin B12 concentration • Evaluate severity of brain degeneration • Deep insight into brain— looking for tumors, nerve damage, unusual marking • Measure/evaluate brain wave activity
• Relief • Denial • Depression • Fear • Social isolation • Grief
CT scan
Magnetic resonance imaging (MRI)
Addressing basic needs—lonely, angry, hungry, and/or tired—can provide insight for caregiver response. Patients in the earlier stages of AD may feel as though they are losing control of their environment. They may also be in denial, and their behavior may change. The middle stages of AD include anger and agitation as the person becomes frustrated and loses their ability to reason as well as think critically and logically. They may express shame and paranoia.
Electroencephalogram (EEG)
Positron emission tomography (PET)
• Unveil AD amyloid proteins
Note: Adapted from Alzheimer’s Association (2022)
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Book Code: SWUS1525
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