DementiaDementia

Zheng dongmingZheng dongming

What is denmentia ?What is denmentia ?

Dementia refers to an Dementia refers to an acquired,genneralized,persisting and often acquired,genneralized,persisting and often progressive impairment of intelligence that progressive impairment of intelligence that affects the content,but not the level,of affects the content,but not the level,of conciousnessconciousness..

Age: 60 1% Age: 60 1%

85 40% 85 40%

But dementia is not aging.But dementia is not aging.

Diseases that can cause Diseases that can cause dementiadementia

Degenerative disease:Alzheimer’diseaseDegenerative disease:Alzheimer’disease

Nondegenerative disease:vascular dementiaNondegenerative disease:vascular dementia

Alzhemier’disease(AD)Alzhemier’disease(AD)

The most frequent cause of dementiaThe most frequent cause of dementia described by Alzhemier in 1907described by Alzhemier in 1907 more female than malemore female than male familial AD :autosomal dominant familial AD :autosomal dominant

inheritanceinheritance

Etiology and pathogenesisEtiology and pathogenesis

The cause of Alzheimer's Disease is not fully understood. It The cause of Alzheimer's Disease is not fully understood. It is believed there may be is believed there may be genetic (hereditary) factorsgenetic (hereditary) factors involved.(APP,PS1,PS2,ApoE)involved.(APP,PS1,PS2,ApoE)

With the disease, there is a striking deficiency of a With the disease, there is a striking deficiency of a substance called substance called acetylcholineacetylcholine in the brain in the brain.(ChAT).(ChAT) Acetylcholine is required for the normal functioning of the Acetylcholine is required for the normal functioning of the brain cells and, as levels of the chemical decrease, plaques brain cells and, as levels of the chemical decrease, plaques form creating bundles of fibers (neurofibrillary tangles).form creating bundles of fibers (neurofibrillary tangles).

Environmental factorsEnvironmental factors may also have an influence on the may also have an influence on the progress of the disease, but the extent of this is not fully progress of the disease, but the extent of this is not fully known.known.

Pathology Pathology

Senile Senile plaques:characteristic plaques:characteristic changechange

neurofibrilary neurofibrilary tangles,NFTstangles,NFTs

granulovacuolar granulovacuolar degenerationdegeneration

loss of neuronloss of neuron crebral amyloid crebral amyloid

angiopathyangiopathy

Clinical findingsClinical findings

Memory impairmentMemory impairment:: impairment of recent memory is typically impairment of recent memory is typically

the first sign of Alzheimer’s disease----the first sign of Alzheimer’s disease----often noticed only by family members.often noticed only by family members.

progress gradually.progress gradually.

Clinivcal findingsClinivcal findings

Cognitive impairmentCognitive impairment:: aphasiaaphasia disorientation to time , disorientation to time ,

place,visuospatial,lost easy.place,visuospatial,lost easy. acaculiaacaculia apraxiaapraxia unable to learn,work,social activityunable to learn,work,social activity

Clinical findingsClinical findings

Psychiatric symptomsPsychiatric symptoms:: depression,apathydepression,apathy delirium,euphoriadelirium,euphoria paranoiaparanoia hallucinations,delusionhallucinations,delusion insomniainsomnia

Cliniacal findingsCliniacal findings

Restless, agitatedRestless, agitated lost of social gracelost of social grace no pyramidal signs no pyramidal signs seizureseizure extraspyramidal signs:Parkinson syndromsextraspyramidal signs:Parkinson syndroms

Investigative studiesInvestigative studies

CT,M RI show cortical atrophy,enlarged CT,M RI show cortical atrophy,enlarged ventricles.ventricles.

Mini-mental state examination MMSEMini-mental state examination MMSE WAIS-RCWAIS-RC CDR,BBS,HISCDR,BBS,HIS

Diagnosis of NINCDS-Diagnosis of NINCDS-ADRDAADRDA

Probable:age,exclusion othersProbable:age,exclusion others possiblepossible definitivedefinitive

Diferrential diagnosis:

1.MCI

2.depression

3.dementia of other causes

National Institute of Neurological and Communicative National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) and the Alzlieimer's Disease Disorders and Stroke (NINCDS) and the Alzlieimer's Disease and Related Diseases Association (ADRDA) proposed :and Related Diseases Association (ADRDA) proposed :

(l) Dementia defined by clinical examination, the Mini-Mental (l) Dementia defined by clinical examination, the Mini-Mental Scale, the Blessed Dementia Scale, or similar mental status Scale, the Blessed Dementia Scale, or similar mental status examination.examination.

(2) Age of patient (over 40 years).(2) Age of patient (over 40 years). (3) Deficits in two or more areas of cognition and progressive (3) Deficits in two or more areas of cognition and progressive

worsening of memory and other cognitive functions--such as worsening of memory and other cognitive functions--such as language, perception, and motor skills (praxis).language, perception, and motor skills (praxis).

(4) Absence of disturbed consciousness.(4) Absence of disturbed consciousness. (5) Exclusion of other brain diseases.(5) Exclusion of other brain diseases.

treatmenttreatment

No effective method.No effective method. AChE inhibitor:Tacrine,donepezilAChE inhibitor:Tacrine,donepezil symptomatic therapysymptomatic therapy rehabilitationrehabilitation

Prognosis Prognosis

Death from inanition or infection generally Death from inanition or infection generally occur 5~10 years after the first symptom.occur 5~10 years after the first symptom.