2. Background
- First description in 1907
- 51 year old woman with a 4 1/2 year course of progressive
dementia
- Autopsy: Neurofibrillary tangles, severe loss of cortical
neurons
3. Epidemiology
- Age: strong risk factor 47.2% for 85 years
- 14 million individuals with AD by 2040
- Family history of dementia (70)
4. Etiology and Pathogenesis
- Not known : many theories
- Pathologic: neuronal degeneration and death in specific brain
areas that leads to gradual decline in memory and other cognitive
functions
- Deficiency of growth factors or excess of excitatory Aas.
- Intracellular calcium, free radicals, abnormal proteins
5. Etiology and Pathogenesis
- Systemic metabolic defect
- Slow or latent virus disorders
6. Genetics
- Proximal region of chromosome 21 locus(early onset)
- Chromosome 19 locus(late onset)
- Correlation with Downs syndrome
7. Neurochemistry
- Loss of cholinergic markers
- choline acetyltransferase
- acetylcholine synthesis is diminished
- Loss in Nucleus basalis of Meynert
- Presynaptic adrenergic deficit (neocortex)
- Loss of serotonin and peptides
8. Clinical Features
- Dementia: major health problem
- Symptom complex: more than 70 entities
- Reversible or irreversible
- AD: most common in adults
- 4 million persons in the US
- Fourth leading cause of death
9. Diagnostic Criteria
- Dementia: clinical and neuropsychological testing
- Deficits in two or more cognitive functions
- Progressive worsening of memory and other cognitive function,
such as abstract thinking , judgement, problem solving , language,
perception, and ability to learn new skills
10. Diagnostic Criteria
- No disturbance of consciousness
- Onset between ages 40 and 90
- Abscence of others systemic or brain disorders responsible for
the memory loss
11. Clinical Picture
- Early decline in recent memory
- Loss of judgement and abstract thinking
- Impaired language and discalculia
12. Neurologic Examination
- Cranial nerves:Olfactory identification deficit
- Primitive reflexes (grasp, tonic foot, palmomental)
- Language abnormalities ( 100%)
- Impaired word finding (anomia)
13. Neurologic Examination
- Decline in intellectual function
- Mean survival time is 8.1 years
- Range of survival 1 to 20 years
14. Diagnostic tests
- No definitive diagnostic test for AD
- Blood count,Electrolytes, Ca, Phosphorus, renal, liver and
thyroid function, Vit B12 and folic acid levels, drug screen
15. Diagnostic tests
- CT and MRI: Cerebral atrophy and ventricular enlargement, other
lesions
- PET: Reduced regional CBF and glucose and oxygen metabolism in
the parietal and temporal lobes
- Neuropsychological testing
16. Differential Diagnosis
- Diffuse Lewy Body Disease
- Parkinsons plus syndromes
17. Neuropathology
18. Treatment
- Taking care of the patient and to avoid systemic
complications
19. Parkinsons Disease 20. Background
- Involuntary tremulous motion, with lessenedmuscularpower, in
parts not in action and even when supported; with a propensity to
bend the trunk forward, and to pass from a walking to a running
pace, thesenses and intellect uninjured
- No reference to rigidityor to slowness of movement
21. Epidemiology
- The disease begins between 40 and 70
- Predisposing: Trauma, emotional upset, overwork, exposure to
cold
- Half million patients affected
- 1% population over 50 years is affected in the US
22. Clinical Picture
- Resting tremor (pill rolling)
- Poverty and slowness of voluntary movement
23. Differential Diagnosis
- Post-encephalitic (Von Economo)
- Striatonigral degeneration
- Progressive supranuclear palsy
24. Pathology
- Loss of pigmented cells in the susbtantia nigra (PR)
- Lewy bodies (eosinophilic cytoplasmic inclusions)
- Depletion of striatal dopamine
25. Staging
- I: Unilateral involvement
- II: Bilateral involvement, without postural abnormalities
- III: Bilateral with mild postural imbalance, independent
life
- IV: Bilateral, instability, dependent
26. Treatment
27. Treatment
