Dementia? Why Is Alzheimer Disease Based On A Diagnosis Of Exclusion?

1. What is dementia? Why is Alzheimer disease based on a “diagnosis of exclusion”? What diagnostic tests would be ordered to determine if Ella’s dementia could be caused by Alzheimer’s disease?
Dementia: Grossman and Porth (2014) define dementia as a group of symptoms caused by disorders that affect the brain. Another name for dementia is, nonnormative cognitive decline, which can be induced by any disorder that irreversibly damages large areas of the cerebral hemispheres or subcortical areas (memory and learning). Dementia is not a specific disease just a set of characteristic symptoms. People with dementia may have personality changes, lose their ability to solve problems, control emotions, may become agitated, and even see things that
One of Ella’s children brought her a new pair of slippers to wear in the nursing home. A minute after she received them, Ella could not remember the exchange and asked what they were doing on her bed. What part of the brain has largely been affected to produce this behavior, and what is the pathophysiology involved?
Grossman and Porth (2014), states that neurochemical changes in the brain are effected by Alzheimer’s disease and are the main cause of memory loss. Particularly, the level of choline acetyltransferase activity in the cortex and hippocampus is decreased. This is an enzyme that is required in order for acetylcholine (a memory neurotransmitter) to be synthesized, making the decrease in choline acetyltransferase enzymes quantitatively related to a large number of neuritic plaques (Grossman & Porth, 2014). According to the Alzheimer’s Association (n.d.b), the cortex shrivels up damaging the areas involved with thinking, planning, and remembering; the hippocampus (part of the cortex) also shrinks, which plays an imperative role in the formation of new memories.
References
Alzheimer's Association. (n.d.b). Inside the brain: Alzheimer's brain tour. Retrieved from https://www.alz.org/research/science/alzheimers_brain_tour.asp Grossman, S., & Porth, C. M. (2014). Pathophysiology: Concepts of altered health
Loss of short term memory, denial of memory loss, language difficulty, and behavioral changes are all symptoms of the disease. Initial changes are subtle and as the disease progresses they enter a moderate stage of disease which may last several years and is marked by more global impairments of cognitive function. This moderate stage includes complications such as: degenerative changes in higher cognitive functioning needed for problem solving, spatial relationships, and language. Depression may begin to occur at this stage due to an awareness of deficits. Extreme confusion, lack of insight, disorientation, and the inability to carry out activities of daily living. Personal hygiene begins to be neglected and language begins to become impaired because it is difficult to remember and retrieve words. Behavioral changes can include agitation, sleep problems, restlessness, and wandering, aggression, and suspiciousness. Some may be abusive to others or become hostile. People at this stage are unable to live alone and need to be supervised and assisted in making decisions. Severe Alzheimer disease is the last stage of the disease process. It carries several extreme complications such as: a loss in ability to respond to the environment. Patients become total care and are bedridden most of the time related to the loss of almost