peer review

Type: Article Review

Subject: Advanced Physiology and Pathophysiology

Subject area: Nursing

Education Level: Masters Program

Length: 1 pages

Referencing style: APA

Preferred English: US English

Spacing Option: Double

Instructions: 2 peer review

Charles Review #1

Differentiating between Alzheimers disease and frontal-temporal dementia is important. The plurality of Alzheimer’s patients occur in those over the age of 75 (Maclin et al., 2019). Per this article, Alzheimers disease often progresses slowly with deficits in memory and activities of daily living. Ultimately Alzheimers disease can become fatal when patient aspirates due to dysphagia.  Conversely, temporal frontal lobe dementias are more commonly seen with patients under 65 years of age (Maclin et al., 2019). Changes in social behavior and communication difficulties are predominate with frontal temporal dementia.

Alzheimer’s disease progresses from asymptomatic to complete dependency. From our case study, our patient is 76 year old male which fits the demographic of an Alzheimer’s patient. His wife reported that he has been engaged in wandering, trouble completing activities of daily living, and making poor judgements. His diagnostic tests are also consistent with Alzheimer’s dementia with a mini mental state examination (MMSE) score of 12 out of 30. The mini-mental state examination is an objective screening tool to help differentiate mild, moderate, and severe Alzheimers (Marin et al., 2022).  The article noted that wandering has a high concordance with objective deficits found in the MMSE.  Another screening tool is MRI evaluation of the hippocampus, amygdala, and lateral ventricular spaces (Coupe et al., 2022). With advancing Alzheimers the hippocampus and amygdala shrink while the ventricles enlarge.  In our case study there is evidence of hippocampus atrophy.  The case study patient is showing evidence of moderate Alzheimers deficit.

The old model of beta-amyloid plaques being the cause versus a symptom of Alzheimer disease was strengthened by an influential study in 2006 published in Nature by Dr. Sylvain Lesne (Pillar, 2022). The article noted that in 2022, the NIH invested $1.6 billion into research related to this model and pharmaceuticals to address removing the buildup of these plaques to treat Alzheimers. The article is the culmination of six months of investigation into the 2006 research by Dr. Matthew Schrag which demonstrated that many of the evidential images used to connect beta-amyloid to Alzheimers were fraudulent (Pillar, 2022). In the years since that article was published, it has been cited by 2300 scholarly articles. One of the newest FDA approved pharmaceuticals, Simulfilam, was also based on this theory. Pillar noted that while the drug successfully reduced plaque deposits, Simulfilam was found to be ineffective to address the symptoms of Alzheimer’s dementia like many pharmaceuticals before it (2022). An alternative model for Alzheimers is insulin resistance which one article noted has a detrimental effect on the blood brain barrier (Sedzikowska & Szablewski, 2021). The article noted that insulin receptors are highest in the hippocampus, frontal cortex and other brain regions involved in memory and learning.  Sezikowska & Szablewski noted that similar to type II diabetes, insulin resistance in the brain prevents neurons from being responsive to insulin (2021).  This may decrease the metabolism of neurons of the brain leading to dysfunction and death of these tissues. Thus the theory was raised that Alzheimer’s disease is akin to type III Diabetes.

 Compare and contrast the pathophysiology between Alzheimer's disease and frontotemporal dementia.

Alzheimer’s disease is a neurodegenerative disease, and it is the most common type of dementia. The disease involves the part of the brain that controls thought, memory, and language. Brain changes can occur years before symptoms appear. Its progress can be slow and hard to notice at the beginning. Usually, patients will start from mild memory loss and progress to a more severe stage like difficulty carrying on a conversation and/or response to environments. Alzheimer’s disease can happen in a younger population, but most cases happen among people over 65. Age is one of the best-known risk factors, but the disease is not a normal part of aging. The exact cause of Alzheimer’s disease is not completely understood by scientists yet, but it is believed that it’s due to multiple risk factors like genetics, diet, lifestyle, environment, etc. (CDC, 2020). In a classic Alzheimer’s disease, MRI or other highly sensitive computerized tomography scans would show mesial temporal lobe atrophy. Neuropathologically, it is found that the disease is caused by plaque formation of extracellular amyloid beta proteins and neurofibrillary tangles of accumulated hyperphosphorylated tau proteins (Yarns et al., 2022).

A brain’s frontal lobe refers to the brain area behind the forehead, and the temporal lobe refers to the area behind the ears. Frontotemporal dementia is due to progressive nerve cell loss in these affected regions. Many different types of diseases can cause frontotemporal degeneration. The most two common ones are brain disorders involving protein tau and protein TDP43. Deterioration in behavior, personality, and/or difficulty with producing or comprehending language are the primary symptoms of frontotemporal dementia (Alzheimer’s Association, 2023).

There are some key differences between Alzheimer’s disease and frontotemporal dementia. Age can be an important clue. Alzheimer’s disease mostly happens in older age while frontotemporal dementia is most common in people between 40-60 years old. Memory loss, hallucination/delusion, and spatial disorientation are more common in Alzheimer’s disease. Behavior/personality changes are more common in frontotemporal dementia. In terms of language, patients with frontotemporal dementia will suffer from difficulty understanding or formulating words in spoken language, while patients with Alzheimer’s disease will more have difficulty finding the correct words or remembering names. Although depends on the stage of the disease, symptoms of these two brain disorders can be cross-matching. Individualized testing should be performed and evaluated (Alzheimer’s Association, 2023).

2. Identify the clinical findings from the case that supports a diagnosis of Alzheimer's disease.  

In this case scenario, the patient is 76 years old and is experiencing “getting lost in the neighborhood”, “being brought home by neighbors”, “allowing unknown individuals into the house”, “trouble dressing”, and “trouble balancing checkbook”. The patient has a family member (father) who had Alzheimer’s disease; MMSE scored 12/30; MRI showed hippocampal atrophy. All of the findings are compliant with the diagnosis of Alzheimer’s disease: older age, memory loss, family history, no difficulty organizing language (defending himself reasonably with an angry attitude), MRI indicated hippocampal atrophy, and MMSE showed moderate dementia.

3. Explain one hypothesis that explains the development of Alzheimer's disease

There are many hypotheses regarding the development of Alzheimer’s disease. Vitamin E deficiency is one of them. Vitamin E is considered to be a potent antioxidant and anti-inflammatory agent. Its plausibility of various biological functions can influence the neurodegenerative process. Studies have shown that there is decreased circulating plasma vitamin E level in patients who have Alzheimer’s disease. Vitamin E protects the cell membrane from oxidative damage and may influence gene expression. But its biological functions may vary according to the relevant isoform. Studies have shown inconsistency in the results of different isoforms. Absorption and contradiction in vitamin E supplements are other areas that need more investigation.  Despite the strong association between vitamin E and the development of Alzheimer’s disease, more clinical evidence will be needed to be conclusive (Declan et al., 2019).

4. Discuss the patient's likely stage of Alzheimer's disease.

According to Alzheimer’s Association (2023), the disease can be classified as early-stage Alzheimer’s (mild), middle-stage Alzheimer’s (moderate), and late-stage Alzheimer’s (severe). Signs and symptoms in the early stage include finding the right words, remembering names, misplacing valuable objects, trouble planning/organizing, etc.; the middle stage includes forgetting personal history, mood withdrawing, needing help dressing, showing increased tendance of wondering and lost, etc.; late stage include requiring around the clock assistance, difficulty communicating, experiencing physical disabilities, etc. This patient is likely in the moderate stage of Alzheimer's disease.