📌 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
