Alzheimer’s Disease

1. Alzheimer’s Disease

2. Most common and important degenerative disease of the brain • Shrinkage in size and weight of the brain • Severe degree of diffuse cerebral atrophy that evolve over the years are associated with dementia presenting with this disease

3. Clinical Features • Insidious in onset • Gradual development of forgetfulness  major symptom • Failure in cerebral function manifested disturbances in vocabulary and writing • Amnesia, aphasia, agnosia, and apraxia • Changes in locomotion • Lengthy pre-clinical period  7 years or more • Symptomatic course  5 years or more

4. Korsakoff Amnesic State • Early stages of Alzheimer disease are usually dominated by a disproportionate failure of retentive memory, with integrity of other cognitive abilities • Short and long term memory fails • e.g. impairment of retentive memory to the point that a patient can recall nothing of what he has learned a minute or 2 previously

5. Dysnomia • Forgetting of words esp. proper names • Progresses to a point where fluency is seriously impaired

6. Visuospatial Disturbance • Derangement of parieto-occipital functions • “posterior cortical dementia” • Prosopagnosia, losing one’s way in familiar surrounding, difficulty, inability to interpret a road map, to distinguish right from left, or to park or garage a car, and difficulty in setting the table or dressing are all manifestations of a special ailureto orient the schema of one’s body with that of surrounding space. • Neglect of stimuli in one visual field • Gerstmann syndrome

7. Paranoia and Personality Changes • Most prominent event • May appear before the more obvious memory or language defects announce themselves

8. Vascular dementia • 2nd most common form of dementia after Alzheimer's disease • degenerative cerebrovascular disease that leads to a progressive decline in memory and cognitive functioning • occurs when the blood supply carrying oxygen and nutrients to the brain is interrupted by a blocked or diseased vascular system • higher in men than in women • incidence increases with age

9. Different types of vascular dementia • Stroke-related dementia • Single-infarct dementia • Multi-infarct dementia • Small vessel disease-related dementia • known as sub-cortical vascular dementia • Binswanger's disease (severe form) • Vascular dementia and Alzheimer's disease (mixed dementia)

10. Signs and Symptoms Behavioral signs/symptoms • Slurred speech • Language problems • Abnormal behavior • Wandering or getting lost in familiar surroundings • Laughing or crying inappropriately • Difficulty following instructions • Problems handling money Physical signs/symptoms • Memory problems; forgetfulness • Dizziness • Leg or arm weakness • Lack of concentration • Moving with rapid, shuffling steps • Loss of bladder or bowel control

11. Risk factors • high blood pressure • diabetes • high cholesterol • family history of heart problems • disease in arteries elsewhere in the body • heart rhythm abnormalities • lifestyle factors (overweight/smoking)

12. Treatment and Prevention • taking medication to treat any underlying conditions • control high blood pressure and heart disease • commitment to a healthier lifestyle • stopping smoking, taking regular exercise, healthy diet and drinking alcohol in moderation • receiving rehabilitative support • physiotherapy, occupational therapy and speech therapy

13. Lewy Body Dementia • Characterized by visual hallucinations, parkinsonism, fluctuating alertness, falls and often REM sleep behavior disorders • Dementia can precede or follow the appearance of parkinsonism • Highly susceptible to metabolic perturbation; some may manifest first with delirium precipitated by infection or other systemic disturbance

14. Lewy Body Dementia • Better memory than AD but more severe visuospatial deficits • Key pathologic feature: LEWY BODIES in the cortex, amygdala, cingulate cortex, and substantianigra.