A 43-year-old female patient with Down syndrome was brought
in for an examination after she was found wandering the grounds of the assisted
living where she lived. When confronted, the patient had no recollection of
where she was, or who the individual that found her was. This patient had been
having increased difficulty with everyday tasks. It is likely that this patient
had Alzheimer’s disease, which is a form of dementia characterized by a
progressive breakdown of the brain. Alzheimer’s disease accounts for 60-80% of
all dementia cases (Alzheimer’s Association Staff, 2018).
The anatomical structures affected by
Alzheimer’s disease are the cerebrum and hippocampus. The hippocampus has a
role in new memory formation (WebMD, 2018). The neocortex is where the brain
stores semantic memory. It contains six different layers, which each have their
own unique neuronal makeups, and are the greater part of the cerebral cortex.
The layers in order from first to last are: molecular, external granular,
external pyramidal, internal granular, internal pyramidal, and the multiform
layer. The first three layers are known as the supragranular layer (Swenson,
Long term synaptic potentiation is the result
of synapses in the hippocampus being activated for extended periods of time
leading to alterations of the neural circuits in the brain. These altercations
allowed for improved memory formation and retrieval. Long term synaptic
depression decreases the number of the synapses activated for an extended
period of time which, consequently, decreases the alterations of the neural
circuit. Long term synaptic depression and long term synaptic potentiation are
a form a neural homeostasis. Long term synaptic depression makes long term
synaptic potentiation more effective by weakening synapses so that they do not
become overly efficient. If synapses are activated for too long, it can inhibit
the synthesis of new information which will negatively impact memory and
learning (Bliss & Collingridge, 1993).
While there is no one test to diagnose Alzheimer’s disease,
there are steps that can be taken to get a clearer picture of the case. The
first step that a physician should take is to look through the patient’s
medical history. If there is a family history of the disease, there is a higher
chance they will develop the disease, than a patient with no family history of
the disease. The next steps to take would be to evaluate the mental status of
the patient, and to perform physical and neurological exams. One of the best
ways to diagnose Alzheimer’s is through biomarkers. Changes in the biomarkers
can indicate the progression and stage of the disease. Biomarker changes are
measured by CT scans, MRI, and PET scans if a contrast agent is used. In the
severe stages of Alzheimer’s, this can help indicate high levels of amyloid
plaques and neurofibrillary tangles, as well as show a decrease in the
patient’s neuronal integrity (Perrin et al.,
The Alzheimer’s Association published a list of symptoms
that healthcare providers should watch for when trying to determine if a
dementia patient has Alzheimer’s. The first sign is the patient experiencing
memory loss that is disruptive to their everyday life. The second sign is
trouble with completing common tasks at home or work. The third major sign of Alzheimer’s
is when a patient is at a complete loss of where they are and the time.
Overall, the patient in this case study has all three of the major symptoms for
Alzheimer’s (Alzheimer’s Association Staff, 2018).
Potential underlying causes of Alzheimer’s would be age,
genetics, lifestyle, and environmental factors. Geneticist’s helped identify
genes associated with Alzheimer’s. One gene researchers have found is
apolipoprotein e4 (APoE4); however, not everyone that has this gene will
develop Alzheimer’s (Mayo Clinic Staff, 2017). Individuals with Down syndrome
are at an increased risk for Alzheimer’s because of their extra chromosome. The
signs and symptoms of Alzheimer’s often appear 10-20 years earlier in people
with Down syndrome (Mayo Clinic Staff, 2017).
Alzheimer’s cannot be treated; however, the symptoms can be
improved. Medications such as cholinesterase inhibitors, memantine, and
antidepressants can be prescribed to help patients control the symptoms. A safe
environment is crucial for Alzheimer’s patients. It can be created by setting a
schedule and putting items back in the same place after every use. Lastly, it
is important that the patient exercises and eats a balanced diet (Mayo Clinic
The patient would be diagnosed with Alzheimer’s disease.
This was due to the fact that she was unable to remember where she was, and who
she was with. She also began needing increased assistance with everyday tasks. All
these symptoms led to the conclusion that her cerebrum was being affected by
Alzheimer’s Association Staff. 2018. 10 Early Signs and
Symptoms of Alzheimer’s. Alzheimer’s Association. https://www.alz.org/10-signs-symptoms-alzheimers-dementia.asp
Accessed January 23, 2018.
Bliss, T. V., & Collingridge, G. L. 1993. A synaptic
model of memory: long-term potentiation in the hippocampus. Nature. 361(6407):
Mayo Clinic Staff. 2017. Alzheimer’s Disease. Mayo
January 25, 2018.
Perrin, R. J., Fagan, A. M., & Holtzman, D. M. 2009.
Multimodal techniques for diagnosis and prognosis of Alzheimer’s disease. Nature.
Swenson, Rand. 2006. Chapter 11 – The Cerebral Cortex. Review
of Clinical and Functional Neuroscience – Swenson. https://www.dartmouth.edu/~rswenson/NeuroSci/chapter_11.html
Accessed January 23, 2018.
WebMD. 2018. Areas of the Brain Affected by Alzheimer’s and
Other Dementias. WebMD. https://www.webmd.com/alzheimers/areas-of-the-brain-affected-by-alzheimers-and-other-dementias
Accessed January 24, 2018.