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The Aging Brain and the Development of Alzheimer’s Dementia

Jordan O. McCoy
School of Nursing, James Madison University
NSG325: Concepts in Aging
Professor Janelle Garman
November 14, 2021
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Abstract

Aging has wide-ranging effects on all human body systems, including the brain. This paper

describes the physiological changes that occur with aging that put older adults at increased risk

for developing dementia, specifically Alzheimer’s disease. Some of these changes include

cerebral vascular disease, inflammation, and higher rates of comorbidities, such as diabetes and

hypertension. Four recent peer-reviewed journal articles and the Alzheimer’s Association 2021

report were examined to understand what happens in the aging brain, how it contributes to the

development of Alzheimer’s disease, and the standards of care and best practices for providing

nursing care to this population.

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The Aging Brain and the Development of Alzheimer’s Dementia

According to the Alzheimer’s Association (2021), it is estimated that approximately 11%

of individuals in the United States aged 65 or older have dementia. There are several different

types of dementia, but Alzheimer’s disease is known to be the most common. Though dementia

is one of the most common diseases impacting older adults, it is not considered a normal part of

aging (Alzheimer’s Association, 2021). Previously, Alzheimer’s dementia was thought to be

caused solely by the formation of neurofibrillary plaques and tangles, but increasing evidence is

suggesting that the underlying pathology in many cases may be related to other common age-

related changes, including arteriosclerosis, atherosclerosis, and microstrokes (Boyle et. al, 2018).

In fact, the research of Boyle and her colleagues (2018) demonstrated that while approximately

41% of Alzheimer’s cases were attributable to the plaques and neurofibrillary tangles, the

remaining cases were primarily attributed to some combination of other pathologies, such as

cerebral vascular disease, Lewy bodies, macroscopic infarcts, and sclerosis of the Hippocampus

—all pathologies more commonly seen in the elderly.

The changes in the brain that lead to Alzheimer’s disease typically occur slowly over

many years, making the older adult more susceptible to the disease (Boyle et. al, 2018). For

example, current research suggests that the incidence of arteriosclerosis and atherosclerosis,

which are both exceedingly common in the elderly population, contribute to the development of

Alzheimer’s independently of different pathologies associated with AD, such as neurofibrillary

tangles and plaques (Arvanitakis et al., 2016). The more severe the degree of arteriosclerosis and

atherosclerosis, the higher the risk of Alzheimer’s disease and dementia (Arvanitakis et al.,

2016).
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Non-physician healthcare providers, including geriatric nurses, play an important role in

the early detection and diagnosis of Alzheimer’s disease. Geriatric nurses are uniquely

positioned to identify the early signs of cognitive impairment in patients living in the community

or in long-term care facilities, as they often have more frequent interactions and trusting

relationships than their physician counterparts (Maslow & Fortinsky, 2018). Within their scope

of practice, geriatric nurses should educate older adults and their families about brain health,

cognitive impairment, and the diagnostic evaluation process, use brief mental status screening

tests, encourage follow-through on the ordered diagnostic evaluations, and provide resources and

support to patients and their families upon official diagnosis of dementia. Utilizing non-

physicians in this process incorporates a patient-centered care model by recognizing the special

relationships often formed between gerontological nurses and older adult patients at risk for

Alzheimer’s disease and other dementias (Maslow & Fortinsky, 2018).

Person-centered care is well-established as the gold standard of care provided to

individuals and families who have been diagnosed with Alzheimer’s dementia (Fazio et. al,

2018). Person-centered care is a holistic approach that emphasizes caring for patients as

individuals by focusing on interpersonal relationships, choices, and maintaining dignity to

promote a higher quality of life and the best possible outcomes for persons with dementia and

their families (Fazio et al., 2018). It challenges the one-size-fits-all approach in traditional

medicine of treating dementia as a rigid disease with universal treatment plans, and is a core

component of the Alzheimer’s Association’s Dementia Care Practice Recommendations

(Alzheimer’s Association, 2021). At the core of providing person-centered care, nurses should

form relationships with clients and their families as individuals, focusing on providing care

through the lens of the patient, taking into account their likes and interests, and should seek out
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opportunities for engagement that are meaningful to each individual patient. These approaches

all work towards fostering a caring, nurturing relationship that builds trust and results in the most

favorable outcomes for patients and their families (Fazio et al., 2018).

Understanding the underlying pathology that contributes to the development of

Alzheimer’s disease is crucial to effective pharmacological treatment of the disease and to

predicting the progression of the disease in older adults (Boyle et al, 2018). Disease-modifying

therapies targeting the neurofibrillary tangles and plaques may benefit the 41% of Alzheimer’s

patients with that pathology, but that approach ignores the large percentage whose Alzheimer’s is

due to age-related disease such as arteriosclerosis and atherosclerosis (Boyle et al, 2018). Nurses

can play a significant role in promoting healthy behaviors in older adults, ensuring early and

accurate diagnosis, and encouraging follow through with the prescribed treatment plan. Lastly,

where pharmacological therapy fails to deliver, providing patient-centered care can help ease the

burden on patients and families and lead to more optimal outcomes for these clients.
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References

Arvanitakis, Z., Capuano, A. W., Leurgans, S. E., Bennett, D. A., & Schneider, J. A. (2016).

Relation of cerebral vessel disease to alzheimer's disease dementia and cognitive function

in elderly people: A cross-sectional study. The Lancet Neurology, 15(9), 934–943.

https://doi.org/10.1016/s1474-4422(16)30029-1

Boyle, P. A., Yu, L., Leurgans, S. E., Wilson, R. S., Brookmeyer, R., Schneider, J. A., &

Bennett, D. A. (2018). Attributable risk of alzheimer's dementia attributed to age-related

neuropathologies. Annals of Neurology, 85(1), 114–124. https://doi.org/10.1002/ana.25380

Fazio, S., Pace, D., Flinner, J., & Kallmyer, B. (2018). The fundamentals of person-centered care

for individuals with dementia. The Gerontologist, 58(suppl_1), S10–S19.

https://doi.org/10.1093/geront/gnx122

Alzheimer's Association. (2021). 2021 Alzheimer’s Disease Facts and figures. Retrieved October

8, 2021, from https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf.

Maslow, K., & Fortinsky, R. (2018). Non-physician care providers can help to increase detection

of cognitive impairment and encourage diagnostic evaluation for dementia in community

and residential care settings. The Gerontologist, 58, S20–S31. doi:10.1093/geront/gnx171.