🧘Alzheimer’s disease

📌 Alzheimer’s disease

🌷Definition
Is chronic irreversible disease affect brain cell and lead to dementia

  • affect mainly temporal & pariatal lobe
  • frontal lobe also commonly affected

🌷 Epidemiology

  • Most common cause of dementia (50 -60%)
  • age = older than 65
  • increase with age
  • gender = more common in women
  • Death occurs in about 7 yrs

🌷clinical features (see the criteria of dementia above)

10 warning signs

  • memory loss -> affect the job
  • apraxia (Difficulty performing familiar tasks)
  • aphasia (Problems with language)
  • abstract thought impairment
  • Disorientation to time and place (later on become disoriented even to person)
  • Poor judgment
  • Misplacing things
  • Changes in mood or behavior
  • Changes in personality
  • Loss of initiative

🌷 Etiology

  • unknown

🌷 Risk factors
See the picture 👇🏻👇🏻👇🏻

🌷Examination

  • mini mental state

🌷Investigations :

— CT scan or MRI
*enlarge cerebral ventricle
*Disprpportionate atrophy of the medial temporal lobe particularly the volume of the hippocampal formation ( >50%) ,can be seen.
*symmetrical Dilatation of the perihippocampal fissure

— Deficient blood flow in parietal lobes correlated with cognitive decline

— Reduction in choline acetyl transferase

— PET scan
* Reduced metabolism in temporal, parietal and frontal lobes

— biopsy and microscopic ex. (After death -> definitive diagnosis)
*accumulation of amyloid plaques
*Senile plaques
*Neurofibrillary tangles
*Granulovascular degeneration of the neurons
*Anatomic changes in

  • amygdala (response about emotion)
  • hippocampus (response about memory)
  • cortex
  • basal forebrain

🌷Treatment :

  • symptomatic treatment for behavioural and psychological symptoms (psychological support, social support and sometimes medication)
  • anti-dementia medication :
    *mild to moderate -> Cholinesterase inhibitors (e.g. donepezil) -> The effect is roughly equivalent to a 6-month delay in cognitive decline *moderate to severe -> Memantine
  • is is is an NMDA (N-methyl d-aspartate) glutamate receptor antagonist
  • It can also be used if cholinesterase inhibitors are contraindicated or not tolerated.
  • Treatment trials with NSAIDs and folic acid (to lower homocysteine) -> but low supportive evidence

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