What Is Alzheimer’s Disease?

Alzheimer disease is a progressive neurological disease that causes memory loss and cognitive deficits. Named after Dr, Alois Alzheimer who first discovered the disease in 1901, Alzheimer affects around 5 million people in the United States (What Is Alzheimer’s Disease? | National Institute on Aging (nih.gov). This disease, also a form of dementia, eventually goes on to affect how a person carries out daily task. Symptoms are mild in the beginning stages and gradually becomes severe over time. Although there is no cure now, there are pharmacological and non- pharmacological treatment that can slow down the progression in some individuals.

What Is Alzheimer’s Disease?

Alzheimer’s gradually leads to behavioral changes and the forgetfulness of those around that are important to them. This brain disorder causes atrophy to brain cells, and they soon begin to waste away ( Alzheimer’s disease: A matter of blood-brain barrier dysfunction? – PubMed (nih.gov). In normal brain function neurons are interconnected by synapses in order to transmit information to on another. In Alzheimer’s disease two lesions are formed in the brain. The lesions are called tangles and plaques. Plaques are formed when amyloid beta proteins and when in abundance, combines and causes plaque ( Alzheimer’s disease: A matter of blood-brain barrier dysfunction? – PubMed (nih.gov).  Tangles are formed when Tau proteins in microtubules detached. Since the microtubules are the skeleton of the neurons, once the tau proteins dissociate the neurons dies. The accumulation of the tau proteins become tangles. Tangles and plaques spreads throughout the brain and causes the brain to decrease in size ( Alzheimer’s disease: A matter of blood-brain barrier dysfunction? – PubMed (nih.gov).  As the progression lesions occur the Alzheimer’s disease grows from mild to severe stages. 

As brain cells begin to die, Alzheimer’s leads to significant brain shrinkage. Clinical manifestation of this disease is broken into 3 stages:  early, middle stage and later stage (What Is Alzheimer’s Disease? | National Institute on Aging (nih.gov). Initial stages also called the early-stage, clinical signs are they may forget about conversations thatbwere had or events, misplace items, forget names of places and objects, trouble thinking of words, poor judgment. Lastly, they may find it difficult to make decisions. In the middle stage there is an increase in confusion, wandering, forgetting what time of the day it is, delusions and feeling paranoid around familiar people may occur. They have problems with speech or language, mood swings, anxiousness, and agitation. In the later stages symptoms become more severe. They began to have difficulty swallowing, changes position, urinary and bowel incontinence, and gradual loss of speech.

Medical professionals assess and diagnosis Alzheimer’s based on signs and symptoms since there is not a single diagnostic method. Neurological functions are assessed along with medical history and ruling out of other diseases (What Is Alzheimer’s Disease? | National Institute on Aging (nih.gov). Labs and MRI scan are also apart of diagnostic process. 

Reference for ALZ

U.S. Department of Health and Human Services. (2017, May 17). What Is Alzheimer’s Disease? National Institute on Aging. https://www.nia.nih.gov/health/what-alzheimers-disease.

Montagne, A., Zhao, Z., & Zlokovic, B. (2017, October 23). Alzheimer’s disease: A matter of blood-brain barrier dysfunction? The Journal of experimental medicine. https://pubmed.ncbi.nlm.nih.gov/29061693/.

Diabetes Mellitus is a growing health problem in the United States. Over 30 million American suffer from diabetes mellitus (Reinberg, 2018). This condition is characterized by elevated levels of glucose in the blood. Although glucose is used to energize our cells in our body, too much can lead to diabetes. There are 2 types of Diabetes mellitus. Type 1 refers to as when pancreas cells are destroyed it will not be able to produce insulin. In Type 2 diabetes, the pancreas does not produce enough insulin, or it will resist insulin. Out of both types, type 2 is more common than type 1.

The pathophysiology of diabetes deals with the pancreas. The pancreas is composed of cells called islets of langerhans. Inside islets there are beta cells and beta cells secrete insulin in response to when its glucose in the blood stream (Da Silva Xavier, 2018). Insulin instructs the body to store glucose to reduce levels in the blood stream. When insulin is not released, glucose does not enter the cells. In turn, this process will starve the cells of energy. In type 1 diabetes the body is not capable of making an adequate amount of insulin. It is considered an autoimmune disease; therefore, the body is attacking the beta cells in the pancreas (Da Silva Xavier, 2018). The lower amount of beta cells left the less amount of insulin that would be produced. When the body does not produce insulin, glucose tends to build up in the bloodstream. In type 2 diabetes the pancreas has stopped making an adequate amount of insulin. Thus, the body is not responding to the lowered level. Cells in the body needs insulin to activate the uptake of the glucose. Since the cells are no longer responding, these cells are called insulin resistance (Yaribeygi et al., 2019). In both types of diabetes, glucose builds ups and causes hyperglycemia. 

Now that glucose is abundant in the blood stream it will causes water to travel outside of the cell and into the blood stream as well. These blood vessels are now full of water, therefore causing clinical manifestations such as increased urination (Galicia-Garcia et al., 2020). This will eventually leave the body dehydrated. Other manifestation includes, increase thirst, vision problems, nerve damage, slow healing problems and high risk of infection (CDC, “Diabetes Symptoms” 2021). 

To diagnose diabetes, is to determine the amount of glucose that is floating around in the blood. One diagnostic method is a fasting glucose test. The patient is told not to eat or drink anything, except water for 8 hours. Once the blood sugar is tested, any level over 126 mg/dl is considered diabetic (Galicia-Garcia et al., 2020).  Another diagnostic tool is an oral glucose test. The patient is given glucose, thereafter every 2 hours their blood sugar is measured to check to see how fast their body is getting rid of glucose. Levels over 200 mg/dl is considered diabetic (Galicia-Garcia et al., 2020). HbA1c test measures how much glucose is attached to a hemoglobin. Levels of 6.5% or higher indicate diabetes. This diagnostic test observes if glucose levels have been elevated over the past 3 months.

In type 1 diabetes the only prescribed medication is insulin. For type 2 diabetes, lifestyle changes such as exercise, weight loss, a healthy diet, oral anti diabetic medication, such as metformin can help reverse type 2 diabetes. However, if oral antidiabetic medication does not help, the patient will then need to be treated with insulin. Both type 1 and type 2 will also need monitoring of glucose levels. 

Reference for DM

Reinberg, S. (2018, September 19). 30 Million Americans Now Have Diabetes. WebMD. https://www.webmd.com/diabetes/news/20180919/30-million-americans-now-have-diabetes#:~:text=%22Diabetes%20remains%20a%20chronic%20health%20problem%20in%20this,responsible%20for%20the%20increases%20in%20diabetes%2C%20he%20said.

Da Silva Xavier, G. (2018, March 12). The Cells of the Islets of Langerhans. MDPI. https://www.mdpi.com/2077-0383/7/3/54.

Yaribeygi , H., Farrokhi, F., Butler, A., & Sahebkar, A. (2019, June 23). Insulin resistance: Review of the underlying molecular mechanisms. Journal of cellular physiology. https://pubmed.ncbi.nlm.nih.gov/30317615/.

Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020, August 30). Pathophysiology of Type 2 Diabetes Mellitus. MDPI. https://www.mdpi.com/1422-0067/21/17/6275/htm.

Centers for Disease Control and Prevention. (2021, April 27). Diabetes Symptoms. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/symptoms.html.

COPD

COPD also known as Chronic obstructive pulmonary disease is one of the most common respiratory illness. This disease is made up of multiple illnesses such as chronic bronchitis and emphysema. It involves the airways and limitation of air flow. COPD is treatable and preventable, however, in the United Staes it is the 3rd most common cause of death (CDC – “About COPD” 2021). This disease effects two parts of the lungs; the bronchioles and the alveoli. In a normal situation, as the patient breaths in and out, the alveoli expands and recoils. Those with COPD, during exhalation, air is trapped in the alveoli and there is no recoil process (Leader, 2019). With COPD bronchioles are also affected and the airway is obstructed. Hence, air and gas exchange are not achievable and will cause difficult breathing. 

There is no cure for COPD. Although medications and lifestyle changes can help slow down the progression of the disease. The most common medications for COPD are Bronchodilators. Bronchodilators are inhaled to help open the airways (Leader, 2020). Short acting bronchodilators are ipratropium and albuterol. Long-acting bronchodilators are tiotropium and formoterol. Long-acting bronchodilators should be taken if a person is experiencing symptoms are not. Corticosteroids helps to reduce inflammation in the lungs. Corticosteroids should only be taken in conjunction with a bronchodilator (Leader, 2020). Supplemental oxygen, if needed, is to keep O2 saturation at 88%-92%.  Phosphodiesterase inhibitor, a COPD medication, known as theophylline and Roflumilast helps decrease COPD exacerbations when they occur. 

Reduced gas exchange, inflammation to the lungs and limited airflow which causes high carbon dioxide are all elements of COPD. As inflammations occur and lungs are destroyed from smoking or pollutants, oxygen is not able to get in and CO2 cannot escape (Leader, 2020). If the patient is short of breath, they will need to be given Albuterol to dilate the lungs and airflow. A method called, purse lips breathing helps force air out of the lungs so that air is not trapped which will increase oxygen levels. Huff coughing helps to cough up mucus so that is lessens the risk of a respiratory infection. Difficulty breathing tends to burn a lot of calories with these patients. Patients should be taught diaphragmatic breathing to decrease that energy to not aid in weight loss (Leader, 2021). Eating small, but frequent high calorie and protein meals are other non-pharmacological treatment option. Avoiding air pollution and smoking cessation is especially important to not cause COPD exacerbation. Since bronchioles can become inflamed, corticosteroids help reduce those symptoms. The bronchodilator helps relax bronchiole tubes and open the airway so that the corticosteroid can get through the passageway (Leader, 2020).  This medication helps relieve shortness of breath. Theophylline and Roflumilast functions by giving the diaphragm time to rest when a patient has severe COPD and they are working hard to breath. A tool called an incentive spirometer is also a non-pharmacological treatment option. This tool is useful for COPD patients because it helps measure how much air is inhaled and exhaled. It also helps build up lung function (Leader, 2021). 

Reference for COPD

Centers for Disease Control and Prevention. (2021, June 9). CDC – Basics About COPD – Chronic Obstructive Pulmonary Disease (COPD). Centers for Disease Control and Prevention. https://www.cdc.gov/copd/basics-about.html.

Leader, D. (2019, November 20). How Does COPD Affect the Function of Your Lungs? Verywell Health. https://www.verywellhealth.com/copd-pathophysiology-914745.

Leader, D. (2020, March 9). How Bronchodilators Help Your Breathe Better. Verywell Health. https://www.verywellhealth.com/bronchodilators-914846.

Leader, D. (2020, September 19). How Gas in the Lungs and Other Lung Changes Impact COPD Symptoms. Verywell Health. https://www.verywellhealth.com/copd-lung-changes-914807.

Leader, D. (2021, June 5). Getting Relief From COPD. Verywell Health. https://www.verywellhealth.com/copd-treatment-915040.

Community Acquired Pneumonia

CAP is pneumonia that is acquired outside of a health care setting. CAP is one of the most frequent lower respiratory infections and should be taken seriously. Microbes such as bacteria, fungi or viruses enter the body by aspiration or inhalation and an infection to the lungs (Grant et al., 2021). These microbes travel down the trachea and into the bronchioles until it reaches the alveoli. Although microphages which are a part of our immune system along with the bodies coughing mechanisms try to get rid of these microbes (Grant et al., 2021). However, sometime certain microbes can make its past the body defense system and colonize the lung. These microbes can cause inflammation to the lungs and excess fluid will begins to build up. Thus, causing pneumonia. 

Systemic clinical manifestation of pneumonia includes, feeling unwell, chills, fever, and fatigue. Localize symptoms are chest pain, bloody sputum, productive cough, difficulty breathing and shortness of breath (NATIONAL HEART, LUNG, AND BLOOD INSTITUTE, 2019). In elderly patients they can be confused. Other signs and symptoms are increased heart rate and respiratory rate. 

Pneumonia can be diagnosed when auscultating a patient lung using a stethoscope. lung sounds such as crackles can be overheard which means there is fluid built up. Pneumonia is diagnosed, when we see an elevated white blood cell count after order a CBC (NATIONAL HEART, LUNG, AND BLOOD INSTITUTE, 2019). This informs medical professionals that an infection is preset. A Chest x-ray is ordered to determine if it shows infiltrates in the lungs (NATIONAL HEART, LUNG, AND BLOOD INSTITUTE, 2019). A sputum culture is also collected to determine which microbe is causing the infection so medication can be provided.

If the cause for pneumonia is a bacteria or a parasite, an antibiotic is used. The type of antibiotics used is determined what bacteria is causing the infection. If the cause is a virus, then antiviral is used. Antifungal medications helps when fungus is the cause. Anti-pyrectics medications are used to lower a fever. Analgesics are used for those with muscle aches and chest pain. Rest also aids in treating pneumonia. fluids help to thin out the mucus and help with the dehydration caused by a fever. Oxygen is used when there is hypoxia or respiratory acidosis due to oxygen not getting to the lungs and not allowing CO2 to escape. Due to difficult to breathing, bronchodilators may be ordered to help open their airways. Once the infection goes away, it will be best for the patient to get the pneumococcal vaccine. This will help to decrease the chances of getting pneumonia again. 

Reference for PNA

Grant, R., Morales-Nebreda, L., Markov, N., Swaminathan, S., Querrey, M., Guzman, E., & Abbott, D. (2021, February 5). Circuits between infected macrophages and T cells in SARS-CoV-2 pneumonia. Nature. https://pubmed.ncbi.nlm.nih.gov/33429418/.

U.S. Department of Health and Human Services. (2019, April 9). Pneumonia. National Heart Lung and Blood Institute. https://www.nhlbi.nih.gov/health-topics/pneumonia#:~:text=Pneumonia%20is%20an%20infection%20that%20affects%20one%20or,%28a%20slimy%20substance%29%2C%20fever%2C%20chills%2C%20and%20trouble%20breathing.