CASE 1

A 72 year old woman who lived on her own was found wandering around her neighborhood at
2 am. The lady was confused and taken to the hospital. She was not able to give a clear history
at the time of admission. The son volunteered that she had been diagnosed by a neurologist as
having early Alzheimer Disease (AD) but had refused to go into a nursing home. She had home
help during the day, and had not previously wandered out of her house. Sometimes, a lady
friend visited and spent the night at her house. In fact, she had appeared relatively normal prior
to the present situation as her son spoke to her on the phone every day of the week. However,
her short-term memory had become worse in recent months. She was on a medication
(Donezepil) for AD. Otherwise, she had no significant medical history. She was kept in the
hospital for a few days, during which time her family physician and neurologist were consulted

1. Explain the biochemical basis for the patients disease

Two abnormal structures called plaques and tangles are the primary suspects in
damaging and killing nerve cells. Plaques are deposits of a protein fragment called beta-
amyloid, a peptide containing 40-42 amino acid residues, which build up in the spaces
between nerve cells. The beta-amyloid that is deposited in the brain in Alzheimer
disease is derived by proteolytic cleavages from the larger amyloid precursor protein.
On the other hand, tangles are twisted fibers of another protein called tau that builds up
inside the cells. These tau proteins are defective form in which they block the action in
the assembly of microtubular structure particularly the axonal microtubules.

REFERENCE:

Harvey, Richard A., Ph. D. (2011). Lippincott's illustrated reviews: Biochemistry. Philadelphia
:Wolters Kluwer Health

http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp