Pathophysiology of Alzheimer’s Disease Essay

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Alzheimer’s disease (AD) is an irreversible illness of the brain that kills and weakens brain neurons involved in thinking, memory, and other abilities. It is a progressive illness which symptoms and functionality get worse over time. It has no cure, but symptoms can be managed to combat the progression making it easy for the patient (Khan et al., 2018). The study will discuss the pathophysiology of Alzheimer’s disease, such as risk factors, cellular involvement, genetic influences, and the interventions of the available therapy’s pharmacological Interventions.

Table 1: Concept map

Concept map

Janet Riley can use the Acetylcholinesterase inhibitors (AChEI) as pharmacological intervention. There are Acetylcholinesterase inhibitors available: glutamine, Rivastigmine, and donepezil (Akıncıoğlu & Gülçin, 2020). These agents are based on research that shows people with Alzheimer’s disease have a deficit in cholinesterase production that leads to dysfunctions of the cortical cholinergic. The cholinesterase inhibitors inhibit the action and optimize the Ach levels available for postsynaptic simulants. The cholinesterase inhibitors improve the symptoms of Alzheimer’s but are not involved with any alterations of its natural clinical course. Due to this, the intervention is considered a symptomatic treatment for the Alzheimer disease.

Table 2: Pharmacological Interventions

Drug	Mechanism of action	Risk and benefits	Risks	*Mono vs. combination therapy.
Aricept	It is licensed for the treatment of mild to moderate-severe AD. Aricept aims to prevent the last cycle of disease to ensure that the acetylcholine does not break down. (Wang et al., 2018) There is a repeated cycle in the brain as when the acetylcholine is produced, it transmits the message, and then acetylcholinesterase is broken-down, which the Aricept aims to prevent. The brain gets enough acetylcholine that facilitate the availability of messages between the brain cells.	Reduces the psychotic symptoms of the disease, such as hallucinations and behavioral problems, with patients inhibiting mild to moderate. It improves the patient’s mood as they are able to interact and cope with other individuals as well as carry out their basic daily activities such as switching off the television or picking up a phone (Wang et al., 2018). It improves functionality as patients are capable of doing normal activities and mental processing such as memory and thinking.	The side effects, especially at the beginning of treatment or when the dose has been increased. The most Diarrhoea Headaches Feeling sick Muscle cramps Hallucinations Aggressive behaviors	Combination therapy is better as it improves cognitive functions, behavioural symptoms, and psychological symptoms (Wang et al., 2018). There have been remarkable results when Aricept is combined with memantine.
Exelon	Exelon, also known as Rivastigmine, is part of drugs from cholinesterase inhibitors. It acts by blocking the functions of acetylcholinesterase in a reverse manner (Wang et al., 2018). Through inhibiting this enzyme, it prevents the breaking down of the neurotransmitter acetylcholine, which aids in increasing brain activities. Also, the drug inhibits both AChE and butyl cholinesterase, enhancing the chronological functions and breaking down acetylcholine, thus increasing the duration of actions of the neurotransmitter acetylcholine (Wang et al., 2018).	Exelon does not cure Alzheimer’s disease but helps manage its symptoms and other benefits. It improves the awareness, memory functionality, and the ability to perform daily duties. It restores the balance of neurotransmitters, which are the natural substances in the brain	Diarrhoea Vomiting Nausea	A few research studies have shown that Exelon interacting with other cholinesterase inhibitors improves the patient. The Exelon treatment works as a monotherapy (Wang et al., 2018). The combination therapy did not show much difference from the monotherapy studies as both treatments showed similar results of reduction of non-aggressive agitated behaviours and improved cognitive functions
Razadyne (galantamine)	It is a cholinesterase inhibitor. It acts by blocking the acetylcholinesterase preventing the destruction of the acetylcholine (Akıncıoğlu & Gülçin, 2020). By doing so, the acetylcholine levels increase, increasing the concentration of brain levels. Razadyne also works by inhibiting both muscle and brain acetylcholinesterase, increasing the cholinergic tone.	It helps in improving the behavioral symptoms, activities of daily living, global functionality, and cognitive functions. It also helps in stress response, learning, attention levels, sleep, and sensory information. However, since AD is a progressive neurodegenerative disease, Razadyne does not alter the process.	Hypotension Convulsions respiratory depression Vomiting Nausea Gstrointestinal cramping bradycardia	Razadyne is mostly used as a combination therapy with memantine. The therapy shows a significant improvement of cognitive function compared to monotherapy. This is because when the two drugs are paired, there is the involvement of the cholinergic and glutamatergic systems that strongly implicates the cognitive impairments (Akıncıoğlu & Gülçin, 2020).
Memantine	Memantine is a drug from the N-methyl-D-aspartate receptor used to treat moderate to severe dementia (Matsunaga et al., 2018). It works differently from the other drugs as its mechanism of action works by blocking the effects of glutamate, a neurotransmitter in the brain that influences neuron excitability and excessive stimulation in AD. Memantine is considered a first-line drug since it is an effective treatment with minimal side effects	The drug inhibits calcium influx into cells due to the N-methyl-D-aspartate receptor. It results in improving Alzheimer’s disease from the central nervous symptoms and cognition functioning (Matsunaga et al., 2018). It also enhances neuronal synaptic plasticity, which improves memory and acts against the neuroprotectant, which is involved In neurons destructions caused by the excitatory neurotransmitters (Matsunaga et al., 2018).	Constipation Dizziness Confusion Aggression depression, Headache Dizziness High doses of the drugs decreasing the neuronal synaptic plasticity, which is involved in the memory and learning process.	Memantine is considered a combination therapy In the treatment of Alzheimer’s (Matsunaga et al., 2018). The cholinesterase inhibitors such as the Redmayne and Aricept can be added as it has shown further beneficial effects on the behavior symptoms, cognitive functionality, and global functions.

A good communication plan is required to ensure that the information delivery to Janet Riley’s family is well perceived. It is important for the family to be involved as it ensures optimal functioning and patients’ quality of life. Firstly, the family needs to be explained the disease and its effects. They need to understand how Alzheimer’s functions: the risk factors, the symptoms, available treatments, mechanism actions of these drugs, and the benefits and risks of the treatment. Secondly, as a health practitioner, I will share resources concerning the issue. The resources include educational material from organizations of the Alzheimer’s associations and support groups. Lastly, I will educate them on assisting the patient in their regular activities. The communication plan will result in them enquiring about the future directions on the medication treatment. To respond to this, I will explain how therapeutical treatments that aim to alter the neuropathological changes in Alzheimer’s disease are showing significant results.

References

Akıncıoğlu, H., & Gülçin, İ. (2020). Potent acetylcholinesterase inhibitors: potential drugs for Alzheimer’s disease. Mini reviews in medicinal chemistry, 20(8), 703-715.

Khan, H., Amin, S., Kamal, M. A., & Patel, S. (2018). Flavonoids as acetylcholinesterase inhibitors: Current therapeutic standing and future prospects. Biomedicine & Pharmacotherapy, 101, 860-870.

Matsunaga, S., Kishi, T., Nomura, I., Sakuma, K., Okuya, M., Ikuta, T., & Iwata, N. (2018). The efficacy and safety of memantine for the treatment of Alzheimer’s disease. Expert opinion on drug safety, 17(10), 1053-1061.

Wang, Y., Li, Y., Yang, W., Gao, S., Lin, J., Wang, T.,… & Hu, H. (2018). Ginsenoside Rb1 inhibit apoptosis in rat model of Alzheimer’s disease induced by Aβ1-40. American journal of translational research, 10(3), 796.

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