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23 Cards in this Set
- Front
- Back
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Alzheimers Disease (AD) Stats.
Prevalence; ...%(60-70), .....%(>80) |
Commonest of primary dementing illnesses (Autopsy - 50%). 2%,20%.
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AD Diagnosis
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Can only completely be made at pathology. In life can only diagnose dementia of the Alzheimer's type (DAT)
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AD aetiology
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Majority arise sporadically, rare early onset (gene mutation) High risk and early onset (40s) in down syndrome patients
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Clinical features of DAT: Onset
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Insidious (gradual), 1-2 years prior to diagnosis
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Clinical features of DAT: Course
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slow deterioration; years, occasionally plates in deterioration. Death (M) yrs after onset 8.5, range 2-25 yrs
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3main phases in AD disease progress
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Phase1: 2-3 yrs, Phase2: more rapid progress of deterioration Phase3: terminal phase
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Phase1: 2-3 yrs
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- failing mem (amnestic presentation). - muddled inefficiency in ADLs. - spatial disorientation. mood disturbance (agitated, apathetic)
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Phase2: more rapid progress of deterioration Phase3
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- itellect and personality deteriorate. - focal symptoms appear. - disturbance of pasture of gait (increased muscle tone) - possible; delusions/hallucinations
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Phase3: terminal phase
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- profound apathy. - eventually lose neurobiological function. -bodily wasting occurs
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Course of neuropathological changes (amnestic)
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Commence in hippo/MTL --> spread posteriorly to parietal cortex --> spreads to involve frontal cortex
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Clinical pattern of cog impairment in DAT (amnestic presentation). 1. Initial
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MTL impairment (due to hip & MTL involvement). Anterograde mem impaired. Retrograde mem intact.
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Clinical pattern of cog impairment in DAT (amnestic presentation). 2.
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Wernicke type aphasia due to spread into posterior TL. Word finding difficulties, fluent grammatical speech. Visuospatial deficits and topographical disorientation. Dyspraxia, agnosia & acalculia
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Clinical pattern of cog impairment in DAT (amnestic presentation). 3.
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Behave change due to spread of disease into fl- APATHY (most common), agitation. eventually all neocortex affected generalised impairment in all domains. (MUST see functional impact for diagnosis of dementia)
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Operational criteria for diagnosis of AD: 1 Probable AD
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- deficits in 2 or more areas of cognition; amnestic presentation (most common); nonamnestic pres (language, visuospatial, exact function) - progressive worsening of men +/other cog functions - no disturbance of consciousness. -onset 40-90yrs. In the absence of other causes. Bio markers.
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Operational criteria for diagnosis of AD: 2 Possible AD
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- made on the basis of dementia syndrome if have variations in onset, presentation +/ clinical course. - can be made in press of anther disorder which is considered to NOT be the course of dementia.
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Operational criteria for diagnosis of AD: 1 Definite AD
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Histopathological evidence of AD obtained from biopsy or autopsy
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Pathology AD
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- greatly atrophied brain. - extensive degeneration of neurones. - accompanying glial cell proliferation. - extensive amounts of senile plaques. - extensive amounts of neurofibrally triangles
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Cortical atrophy
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degeneration of brain cells
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Senile plaques
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extracellular deposits of amyloid in the gray matter of the brain.
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Neuropathological features
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- occur naturally in ageing brian (not as much as in AD). - intensity of NP features correlates with severity of dementia. - inter-indidual variability amongst patients
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Treatment & Prevention of AD
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Pharmacological- extend QOL - No confirmed prevention
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MK
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76 yr old women. Depressive symptoms masked AD. Eventually diagnosed.
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AD .............. syndrome, due to impaired ....... structures. As pathology spreads- involvement of associated................domains becomes noticeable.
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Dementing, MTL, cognitive.
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