Post on 21-Dec-2015
transcript
AD
• Can be divided into Early Onset (< 60) and Late Onset (>60).
• Perhaps two different etiologies
• After age 65, the number of cases doubles every 5 years.
• 3% of people 65-74 have the disease
• Approx. 50% of people over 85 have the disease.
GRADING SYSTEM
Grade 1 (top row of 4 images) corresponds to mild cerebral atrophy and ventricular dilatation. Note this degree of change may be assessed as compatible with normal
aging. Thus, grade 1 accomodates scoring of brains from nondemented control subjects with minimal or no gross neuropathology.
Grade 2 (middle row of 4 images) corresponds to moderately severe cerebral atrophy and ventricular dilatation. Note widening of sulci, rounding of frontal horns, and
expansion of the area of the body and 3rd ventricle. Grade 3 (bottom row of 4 images) corresponds to severe cerebral atrophy and
ventricular dilatation. Dramatic shrinkage of gyri, gaping of some sulci, and extreme ventricular dilatation is obvious. Note also the white matter area is markedly
diminished from the amount noted in grade 1 brains.
Plaques
• Extracellular• Contain A-beta (sequence cleaved from
APP)• Metals (aluminum, zinc)• Immunoglobulin G• Amyloid P• apoE• ETC….over 30 other proteins
Tangles
• Intracellular
• Bundles of long unbranched elements that form a fibrous twisted pair of filaments
• Consist of tau protein (a protein that ordinarily stabilizes cellular microtubules)
• Are somewhat correlated with degree of dementia – post-mortem.
1- Memory 2- Orientation3- Judgment4- Community Affairs5- Home & Hobbies6- Personal Care
Axis of Diagnosis
Impairment Level and CDR Score (0, 0.5, 1, 2, 3)
None0
Questionable0.5
Mild 1
Moderate2
Severe3
Memory
No memory loss or slight inconsistent forgetfulness
Consistent slight forgetfulness; partial recollection of events; "benign" forgetfulness
Moderate memory loss; more marked for recent events; defect interferes with everyday activities
Severe memory loss; only highly learned material retained; new material rapidly lost
Severe memory loss; only fragments remain
Orientation
Fully oriented
Fully oriented except for slight difficulty with time relationships
Moderate difficulty with time relationships; oriented for place at examination; may have geographic disorientation elsewhere
Severe difficulty with time relationships; usually disoriented to time, often to place
Oriented to person only
Judgment
& Problem
Solving
Solves everyday problems & handles business & financial affairs well; judgment good in relation to past performance
Slight impairment in solving problems, similarities, and differences
Moderate difficulty in handling problems, similarities, and differences; social judgment usually maintained
Severely impaired in handling problems, similarities, and differences; social judgment usually impaired
Unable to make judgments or solve problems
Communit
y Affair
s
Independent function at usual level in job, shopping, volunteer and social groups
Slight impairment in these activities
Unable to function independently at these activities although may still be engaged in some; appears normal to casual inspection
No pretense of independent function outside homeAppears well enough to taken to functions outside a family home
No pretense of independent function outside home Appears too ill to be be taken to functions outside a family home
Home and
Hobbies
Life at home, hobbies, and intellectual interests well maintained
Life at home, hobbies, and intellectual interests slightly impaired
Mild but definite impairment of function at home; more difficult chores abandoned; more complicated hobbies and interests abandoned
Only simple chores preserved; very restricted interests, poorly maintained
No significant function in home
Personal
Care
Fully capable of self-care Needs prompting
Requires assistance in dressing, hygiene, keeping of personal effects
Requires much help with personal care; frequent incontinence