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A Complex Case of Major Neurocognitive Disorder: Alzheimer’s Disease

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Complex Clinical Conundrums in Psychiatry

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Abstract

Major neurocognitive disorder (MND) is a term that has been incorporated in DSM-5 to replace the term dementia. MND is a clinical syndrome characterized by global cognitive decline from the previous level of functioning as evidenced in the loss of one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptomotor, or social cognition). Occurring in clear sensorium, this decline interferes with the individual’s ability to be independent. MND is a public health issue with significant impact on patients, their families, and the community. Dementia is already an epidemic in the developed countries (Murray and Lopez, The Lancet, 349(9064):1498–1504, 1997). In more than 50% of cases of major neurocognitive disorders, Alzheimer’s disease is the cause (Alzheimer’s Association 2011). The pathology of AD is clearly defined to consist of neuritic plaques (NP), neurofibrillary tangles (NFT), and subsequent neuronal loss, which are present in a typical distribution in the brains of the afflicted patients. The two most common risk factors for AD are advanced age and family history of dementia.

The following case illustrates complex presentation in a female patient with early onset of symptoms from around 49 years of age. The genetic factors and clinical, ethical, and legal challenges will be illustrated.

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Abbreviations

Aβ42:

42-amino acid beta-amyloid

AD:

Alzheimer’s disease

ADLs:

Activities of daily living

APOE:

Apolipoprotein E

APP:

Amyloid precursor protein

CSF:

Cerebrospinal fluid

CT:

Computed tomography

DSM:

Diagnostic and Statistical Manual

MAPT:

Microtubule-associated protein tau

MCI:

Minimal cognitive impairment

MRI:

Magnetic resonance imaging

NFT:

Neurofibrillary tangles

NP:

Neuritic plaques

PIB:

Pittsburgh compound B

PSEN:

Presenilin

SPECT:

Single photon emission computed tomography

References

  1. The Alzheimer Disease and Frontotemporal Dementia Mutation Database. Available online www.molgen.ua.ac.be/ADmutations, provides up-to-date information on various genes involved in AD.

  2. Arnold SE, Hyman BT, Flory J, Damasio AR, Van Hoesen GW. The topographical and neuroanatomical distribution of neurofibrillary tangles and neuritic plaques in the cerebral cortex of patients with Alzheimer’s disease. Cereb Cortex. 1991;1(1):103–16.

    Article  CAS  PubMed  Google Scholar 

  3. Blennow K, de Leon MJ, Zetterberg H. Alzheimer’s disease. Lancet. 2006;368(9533):387–403.

    Article  CAS  PubMed  Google Scholar 

  4. Berger JT, DeRenzo EG, Schwartz J. Surrogate decision making: reconciling ethical theory and clinical practice surrogate decision making. Ann Intern Med. 2008;149(1):48–53.

    Article  PubMed  Google Scholar 

  5. Bertram L, Lill CM, Tanzi RE. The genetics of Alzheimer disease: back to the future. Neuron. 2010;68(2):270–81.

    Article  CAS  PubMed  Google Scholar 

  6. Braak H, Braak E. Neuropathological stageing of Alzheimer-related changes. Acta Neuropathol. 1991;82(4):239–59.

    Article  CAS  PubMed  Google Scholar 

  7. Breitner JC, Murphy EA, Folstein MF, Magruder-Habib K. Twin studies of Alzheimer’s disease: an approach to etiology and prevention. Neurobiol Aging. 1990;11(6):641–8.

    Article  CAS  PubMed  Google Scholar 

  8. Breitner JCS, Wyse BW, Anthony JC, Welsh-Bohmer KA, Steffens DC, Norton MC, et al. APOE-ε4 count predicts age when prevalence of AD increases, then declines the cache county study. Neurology. 1999;53(2):321.

    Article  CAS  PubMed  Google Scholar 

  9. Burlá C, Pessini L, Siqueira JE, Nunes R. Aging and Alzheimer’s disease: reflections on the loss of autonomy and the challenges of care. Revista Bioética. 2014;22(1):85–93.

    Article  Google Scholar 

  10. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.

    Article  CAS  PubMed  Google Scholar 

  11. Clarfield AM. The decreasing prevalence of reversible dementias: an updated meta-analysis. Arch Intern Med. 2003;163(18):2219–29.

    Article  PubMed  Google Scholar 

  12. Derence K. Dementia-specific respite: the key to effective caregiver support. N C Med J. 2005;66(1):48–51.

    PubMed  Google Scholar 

  13. Drzezga A, Grimmer T, Henriksen G, Mühlau M, Perneczky R, Miederer I, et al. Effect of APOE genotype on amyloid plaque load and gray matter volume in Alzheimer disease. Neurology. 2009;72(17):1487–94.

    Article  CAS  PubMed  Google Scholar 

  14. Greenberg SM, Vonsattel JP, Segal AZ, Chiu RI, Clatworthy AE, Liao A, et al. Association of apolipoprotein E ϵ2 and vasculopathy in cerebral amyloid angiopathy. Neurology. 1998;50(4):961–5.

    Article  CAS  PubMed  Google Scholar 

  15. Iqbal etal. Mechanisms of tau- induced neuro – degeneration. Acta Neuropathaol. 2009;118:53–69.

    Google Scholar 

  16. Jongsma K, van de Vathorst S. Advance directives in dementia research: the opinions and arguments of clinical researchers− an empirical study. Research ethics. 2015;11(1):4–14.

    Article  Google Scholar 

  17. Hope T, Savulescu J, Hendrick J. Medical ethics and law: the core curriculum. London: Churchill Livingstone/Elsevier; 2003.

    Google Scholar 

  18. Jellinger KA, Paulus W, Wrocklage C, Litvan I. Effects of closed traumatic brain injury and genetic factors on the development of Alzheimer’s disease. Eur J Neurol. 2001;8(6):707–10.

    Article  CAS  PubMed  Google Scholar 

  19. Knopman DS, DeKosky ST, Cummings JL, Chui H, Corey–Bloom J, Relkin N, et al. Practice parameter: diagnosis of dementia (an evidence-based review) Report of the quality standards subcommittee of the american academy of neurology. Neurology. 2001;56(9):1143–53.

    Article  CAS  PubMed  Google Scholar 

  20. Larson EB, Shadlen MF, Wang L, McCormick WC, Bowen JD, Teri L, Kukull WA. Survival after initial diagnosis of Alzheimer disease. Ann Intern Med. 2004;140(7):501–9.

    Article  PubMed  Google Scholar 

  21. Lockhart A. Imaging Alzheimer’s disease pathology: one target, many ligands. Drug Discov Today. 2006;11(23):1093–9.

    Article  CAS  PubMed  Google Scholar 

  22. Mattsson N, Insel PS, Palmqvist S, Portelius E, Zetterberg H, Weiner M, et al. Cerebrospinal fluid tau, neurogranin, and neurofilament light in Alzheimer’s disease. EMBO Mol Med. 2016;8(10):1184–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer’s disease report of the NINCDS-ADRDA work group* under the auspices of department of health and human services task force on Alzheimer’s disease. Neurology. 1984;34(7):939.

    Article  CAS  PubMed  Google Scholar 

  24. Montine TJ, Phelps CH, Beach TG, Bigio EH, Cairns NJ, Dickson DW, et al. National institute on aging–Alzheimer’s association guidelines for the neuropathologic assessment of Alzheimer’s disease: a practical approach. Acta Neuropathol. 2012;123(1):1–11.

    Article  CAS  PubMed  Google Scholar 

  25. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: Global burden of disease study. Lancet. 1997;349(9064):1498–504.

    Article  CAS  PubMed  Google Scholar 

  26. Ranginwala NA, Hynan LS, Weiner MF, White CL. Clinical criteria for the diagnosis of Alzheimer disease: still good after all these years. Am J Geriatr Psychiatry. 2008;16(5):384–8.

    Article  PubMed  Google Scholar 

  27. Ratnavalli E, Brayne C, Dawson K, Hodges JR. The prevalence of frontotemporal dementia. Neurology. 2002;58(11):1615–21.

    Article  CAS  PubMed  Google Scholar 

  28. Schulz R, Beach SR. Caregiving as a risk factor for mortality: the caregiver health effects study. JAMA. 1999;282(23):2215–9.

    Article  CAS  PubMed  Google Scholar 

  29. Schulz R, Martire LM. Family caregiving of persons with dementia: prevalence, health effects, and support strategies. Am J Geriatr Psychiatry. 2004;12(3):240–9.

    Article  PubMed  Google Scholar 

  30. Silverman JM, Smith CJ, Marin DB, Mohs RC, Propper CB. Familial patterns of risk in very late-onset Alzheimer disease. Arch Gen Psychiatry. 2003;60(2):190–7.

    Article  PubMed  Google Scholar 

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“The authors have nothing to disclose.”

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Authors and Affiliations

  1. Department of Psychiatry, Northern Ontario School of Medicine Psychiatry Department, Sudbury, ON, Canada

    Popuri M. Krishna MB, BS, DPM, MD, DABPN, FRCPC & Kuppuswami Shivakumar MD, MPH, MRCPsych(UK), FRCPC

  2. University of Western Ontario, Woodstock General Hospital University of Western Ontario, Woodstock, ON, Canada

    Shabbir Amanullah MD, DPM, FRCPsych(UK), CCT,FRCPC

Authors
  1. Popuri M. Krishna MB, BS, DPM, MD, DABPN, FRCPC
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  2. Kuppuswami Shivakumar MD, MPH, MRCPsych(UK), FRCPC
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  3. Shabbir Amanullah MD, DPM, FRCPsych(UK), CCT,FRCPC
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Corresponding author

Correspondence to Popuri M. Krishna MB, BS, DPM, MD, DABPN, FRCPC .

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Editors and Affiliations

  1. Department of Psychiatry, Northern Ontario School of Medicine Psychiatry Department, Sudbury, Ontario, Canada

    Kuppuswami Shivakumar

  2. Woodstock General Hospital, Woodstock Ontario, University of Western Ontario, London, Ontario, Canada

    Shabbir Amanullah

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Krishna, P.M., Shivakumar, K., Amanullah, S. (2018). A Complex Case of Major Neurocognitive Disorder: Alzheimer’s Disease. In: Shivakumar, K., Amanullah, S. (eds) Complex Clinical Conundrums in Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-70311-4_1

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  • DOI: https://doi.org/10.1007/978-3-319-70311-4_1

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