Pathophysiology of Chronic Diseases: Stroke, Dementia, Parkinson's, and Multiple Sclerosis

This article provides an overview of the pathophysiology, etiology, signs and symptoms, available therapies, preventive measures, and prognosis of chronic diseases such as stroke, dementia, Parkinson's, and multiple sclerosis. It discusses the incidence and prevalence of these diseases, their underlying causes, and the impact they have on individuals. The article also highlights the available treatment options and preventive measures that can be taken to manage these conditions. Overall, it aims to provide a comprehensive understanding of these chronic diseases and their implications.

Running head: PATHOPHYSIOLOGY
Pathophysiology
Name of the Student
Name of the University
Author Note

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PATHOPHYSIOLOGY
Introduction:
With the global burden of disease, the need of efficient management of chronic disease is
intensifying. The health statistics of United States suggested that a chronic disease is
persisting more than 3 months or more which cannot be prevented by vaccines or cured by
medication. 88% of Americans over 65 years of age have at least one chronic disease where
they shows health damaging behaviors particularly tobacco use, lack of physical activity
and poor eating habits. This paper will discuss incidence and prevalence, Etiology of the
disease and pathogenesis, signs and symptoms , possible therapy and prognosis in following
paragrpahs.
Cerebrovascular disease and stroke:
The cerebrovascular disease is leading cause of death after ischemic heart disease where it
ranked second leading cause of disease. There are two main type of stroke suchg as ischrmic
becsuse of lack of blood flow and hemorrhagic because of bleeding. The prevalence of
cardiovascular disease and stroke is roughly 3% of the adult population where incidence of
the disease is 30 to 120 of 100000 per years for 35 to 44 years and the incidence for 65 to
74 is 670 to 970 of 100000 per year. Ischemic stroke is more prevalent compared to
hemorrhagic stroke where In 2017 there were more than 56,000 new cases and
recurrent strokes were registered. 65% of them were survivor are suffering from major
disabilities (Love, Seth, and Scott Miners).
Etiology of stroke :
The etiology of stroke include :
 Hypertension
 Atherosclerosis
 Hyperlipidemia
 Cardiovascular disease
 Family history
 dyslipidemia,
 Diabetes
 Tobacco consumption

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 Gender ( men are more prone to this disease compared to women)
Pathogenesis of the disease:
Cerebrovascular disease and stroke occur when blood supply of the brain is interreupted or
reduced because of the factors discussed above. The lower blood supply resulted in lack of
oxygen supply in the brain which further facilitate the death of brain cells and isxchemic
stroke. On the other hand, gemorrhagic stroke can be caused by arteriovenous malformation
when blood vessels of brain burst s and leaks blood into surroundings brain and a thrombosis
occur in brain.
Signs and symptoms:
People may experience
1. Muscular: difficulty in walking, paralysis with weak muscles ,problem with coordination
, stiff muscles
2. Visual : blurred vision and loss of vision
3. Speech: difficulty in speaking and speech loss
4. Whole body: fatigue , vertigo
Therapies available:
 The patient may be administrated with tPA (tissue plasminogen activator ) a potent
clot busting drug injected to a vein arm.
 The patient may be reffered to stroke rehabilitation where physicians, physiologist ,
neurologist, physiotherapist , counsellor involve in management of side effects of
stroke
Preventive measures:
 Lower blood pressure
 Exercise
 Moderate alcohol consumption
 Quit smoking
 Lose weight

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 Treat atrial fibrillation
Prognosis :
It is depends on the type of stroke, degree and duration and obstruction. The poor prognosis
observed in case of hemarrhegic stroke compred to ischemic stroke (Santos et al).
Dementia:
Incidence and prevalence:
The world health organization suggested that dementia; especially Alzheimer is developed
in every 3 seconds. Approximately 46.8 million are living with Alzheimer in 2015 and the
number of people living with Alzheimer is close to 50 million in 2017. In middle and lower
income countries it will rise up to 68%. Every year more than 500000 new cases have been
reported worldwide where incident is increasing by 11% eery year (Skillbäck et al).
Etiology of the disease:
The Alzheimer caused by a combination of genetic, lifestyle and environmental factors that
impacted the brain over time. The etiology include:
 aging
 family history
 presence of certain genes
 presence of cardiovascular disease
 smoking
 undergoing repetitive brain injury
 Exposure to environmental contaminants such as toxic metals, pesticides and
industrial chemicals.
Pathogenesis of the disease:
Alzheimer’s disease is an irreversible and progressive brain disorder where tangles of
fibrwrs ( neurofibrillary tangles) and plaques or abnormal clumps are observed in brain.
The loss of connection in neurons of different parts of brain observed. The initial damage
observed in hippocampus which spread throughout the brain and cause brain tissue to shrunk.

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Signs and symptoms:
People may experience:
1. Cognitive : mental decline , difficulty in thinking , delusion , disorientation,
forgetfulness, mental confusion and
2. Behavioral: aggression , agitation , irritability
3. Mood : anger , loneliness, personality
4. Psychological: depression, hallucination and depression
Available therapies:
The available therapies include :
 Drugs such as Donepezil (Aricept), Tacrine (Cognex) and Rivastigmine (Exelon).
 exercise activities and day-care programs
 Involvement of support group and services
 Refer to rehabilitation where occupational therapist, physiotherapist and neurologist
may provide the support for faster recovery.
Preventive measures:
 healthy fats consumption
 exercise
 Consumption of food such as trout, nuts, seaweed, and sardines
Prognosis:
Unfortunately, there is currently no cure for Alzheimer's disease and poor prognosis of the
disease where patient survive 8 years (Skillbäck et al).
Parkinson:

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Parkinson’s disease is the second most common age related neurodegenerative disorder after
Alzheimer disease. The prevalence of the disease is range from 41 people per 100,000 and
more than 1900 people per 100000 among older adults than 80years. Incidence of disease
generally increases with the disease and 4 % is diagnosed before 50 years where men are 1.5
times more likely to suffer from the disease (Poewe et al).
Signs and symptoms:
The signs and symptoms include
 Slowed movement
 Rigid muscles
 Impaired posture and balance
 Loss of automatic movements
 Fatigu
 Jaw stiffness
 Blank stares
Therapies available:
While there is no cure for Parkinson best possible treatment for the Parkinson includes:
 Dopamine promoter such as levodopa, carbidopa.
 Anti-depressant
 Cognition –enhancing medication
Refer to rehabilitation where occupational therapist, physiotherapist and neurologist may
provide the support for faster recovery (Poewe et al).
Preventive measure:
 exercise
 Consumption of vegetables and foods

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 Quite smoking and alcohol
Prognosis:
Patient usually begin developed the disease at 60 years where due to poor prognosis many
live between 10 to 20 years after being diagnosed (Poewe et al).
Overview of the Disease
Multiple sclerosis refers to the chronic inflammatory disease that is characterized by
demyelination of the neurons and the degeneration of the neurons are associated with the
nerves of central nervous system (CNS). This disease mainly affects the spinal cord, white
and grey matter of the brain, and optic nerve. It is one of the most common non-traumatic
disease among the middle aged adult and young individuals (Hersh and Fox). While
analysing the MS, it is reported that the there are four type of multiple sclerosis and they are
Relapsing-Remitting MS (RRMS), Secondary-Progressive MS (SPMS), Primary-Progressive
MS (PPMS), Progressive-Relapsing MS (PRMS). RRMS is the most common form of MS
and almost 75-80 per cent of people are diagnosed with the RRMS initially. RRPS generally
has issue of temporary relapses and that may stand for a few days or a weeks. The SPMS is
the condition where the symptoms are detoriated and in this condition issue of relapses are
missing. PPMS is not a common type of MS and PRMS is rare form of MS (Mahad et al.).
Etiology of the Disease
MS is considered as an autoimmune disease and the actual cause of this disease is still
unknown. Like other autoimmune diseases, it is reported that, the immune system of the
body attacks the own tissues and as a result the myelination of the nerve tissues are
destroyed. Due to this, the nerve impulses travel in a slow manner and in some cases the
nerves can also be damaged (Hersh and Fox).
Pathogenesis

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There are two phases that may be associated with the MS. It is reported that, one
unknown soluble factor creates a toxic environment responsible for activating microglia. The
PS is associated with the dynamic and complex interplay in between the CNS resident cells,
immune system. This interplay contributes to the acute inflammation and neurodegeneration
(Hersh and Fox).
Signs and Symptoms
 Weakness and numbness in various limbs of the organization.
 Feeling of electric shock sensation and sudden neck movements
 Lack of coordination
 Blurred vision
 Loss of vision
 Fatigue
 Dizziness
 Slurred speech (Hersh and Fox).
Therapies
There are three oral therpaies approved by FDA and they are Fingolimod ( 0.5mg by
mouth/daily ), Teriflunomide ( 7mg or 14 mg by mouth daily), Dimethyl fumarate ( 240 mg
by mouth daily) (Hersh and Fox).
Prevention
For preventing this disease a few measures can be taken. Such as-
 Maintaining healthy life style and wellness
 Vaccination for MS
Prognosis

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The outcome of MS is very poor and most of the cases it is reported that, the disease
condition is kept untreated (Hersh and Fox).
Conclusion
Hence, it can be concluded that, the all of the aforesaid disease has a very poor
outcome and most of the diseases are making very poor impression on the health of the
population. In a few disease it is very difficult to diagnose the disease and in order to prevent
the diseases a few control measures can be maintained in a serious way.

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References
Hersh Carrie M., Fox, J, R. “Disease Management, Multiple Sclerosis “. Cleveland Clinic.
Retrieved from- http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/
neurology/multiple_sclerosis/ [ Accessed on 3rd June 2019].
Love, Seth, and J. Scott Miners. "Cerebrovascular disease in ageing and Alzheimer’s
disease." Acta neuropathologica131.5 (2016): 645-658.
Mahad, Don H., Bruce D. Trapp, and Hans Lassmann. "Pathological mechanisms in
progressive multiple sclerosis." The Lancet Neurology 14.2 (2015): 183-193.
Poewe, Werner, et al. "Parkinson disease." Nature reviews Disease primers 3 (2017): 17013.
Santos, Cláudia Y., et al. "Pathophysiologic relationship between Alzheimer's disease,
cerebrovascular disease, and cardiovascular risk: a review and synthesis." Alzheimer's &
Dementia: Diagnosis, Assessment & Disease Monitoring 7 (2017): 69-87.
Skillbäck, Tobias, et al. "Cerebrospinal fluid tau and amyloid-β1-42 in patients with
dementia." Brain 138.9 (2015): 2716-2731.