CASE STUDY: Family Member with Alzheimer’s Disease: Mark and Jacqueline
Mark and Jacqueline have been married for 30 years. They have grown children who live in another
state. Jacqueline’s mother has moved in with the couple because she has Alzheimer’s disease.
Jacqueline is an only child and always promised her mother that she would care for her in her old
age. Her mother is unaware of her surroundings and often calls out for her daughter Jackie when
Jacqueline is in the room. Jacqueline reassures her mother that she is there to help, but to no avail.
Jacqueline is unable to visit her children on holidays because she must attend to her mother’s daily
needs. She is reluctant to visit friends or even go out to a movie because of her mother’s care needs
or because she is too tired. Even though she has eliminated most leisure activities with Mark,
Jacqueline goes to bed at night with many of her caregiving tasks unfinished. She tries to visit with
her mother during the day, but her mother rejects any contact with her daughter. Planning for the
upcoming holidays seems impossible to Mark, because of his wife’s inability to focus on anything
except her mother’s care.
Jacqueline has difficulty sleeping at night and is unable to discuss plans even a few days in
advance. She is unable to visit friends and is reluctant to have friends visit because of the
unpredictable behavior of her mother and her need to attend to the daily care.
Reflective Questions
1. How do you think this situation reflects Jacqueline’s sense of role performance?
2. How do you think that Jacqueline may be contributing to her own health?
e the capacity to shift from mutualist to commensal to parasite depending on the state of activation of the host, co-infection or localizations. Microbiota induces protective immune response by different mechanism to modulate the immune response. Firstly, they compete for nutrients, produce antimicrobial molecules and metabolites that affect the survival and virulence of pathogens. Furthermore, they also Promote the production of antimicrobial peptides by epithelial cells and reinforce tight junctions that directly affect pathogen growth or survival. In addition, microbiota also modulate the function of dendritic cells and other innate cells both locally and systemically so that it promotes the induction of effector T and B cells responses against pathogens.21
Mucosal firewall:
Microbiota minimize contact between microorganisms and the epithelial cell surface by maintaining homeostatic relationship with the host which further limits tissue inflammation and microbial translocation. This segregation is accomplished by the using epithelial cells, mucus, IgA, antimicrobial peptides and immune cells which are collectively known as “Mucosal firewall”.22 Each component of “mucosal firewall” performs different functions. Firstly, mucus acts as a primary barrier and it limits the contact between the microbiota and host tissue and thereby prevents microbial translocation.23 Epithelial cells also play an important role in limiting exposure to the commensal microbiota by producing antimicrobial peptides.24Tissue resident macrophages helps in eliminating translocating microbiota. Limitation of Microbiota is also done by CD103+ CD11b+DCs congesting to the mLN from the lamina propria but they do not penetrate deep and it leads to differentiation of commensal specific regulatory cells (Treg) Th17 cells and IgA producing B cells. Microbiota specific lymphocytes also traffic to Peyer’s Patches where Treg can further promote class switching and IgA generation against commensals.25
Formation of feedback loops:
Microbiota influence innate immunity by forming feedback loops. This loops are being regulated by various layers of intestinal wall and they perform three steps for stimulating innate immunity. Firstly, they recognize pattern recognition receptors like Toll-like receptors, the nucleotide-binding oligomerization like receptors, the RIG-I-like receptors, the C-type lectin receptors, the absent in melanoma 2 like receptors and the OAS like receptors. Then they mediate transcriptional response of the host; and, finally secrete effector molecules to mediate the immune response. The advantage of using such confined feedback loops is that the inflammatory response can be limited to the epithelial layer as they do not involve entire tissues or multiple organs. This loops involve communication between epithelial, myeloid and lymphoid cells using cytokines such as IL-18, IL-22, IL-23 and chemokines for mediating immune response.26
Transcriptional reprogramming:
Microbiota influence the activity of the innate immune system by transcriptional reprogramming. Transcriptional reprogramming involves expression of genes that are involves the host nutrient absorption and processing, barrier functions, gut motility, intestinal immune responses, angiogenesis and the metabolism of xenobiotics. Constituents of the microbiota have been involved in the regulation of ubiquitin signaling, protein neddylation, the nuclear translocation of transcription factor and vesicle trafficking.27Hooper et al, in their study found that reprogramming of intestinal gene expression was done by animals that were colonized with