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20 Cards in this Set

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Alzheimers disease

Most common dementing illness


approx 50% of all dementias are AD


2% of 65-70yo


20% of 80+




* problem of aging population (baby boomers)


- need support

Diagnoses of AD

Definite diagnosis can only be made on pathology (dead)




in Life - can only diagnose Dementia of the Alzheimer Type (DAT)

Pathology

Examination of tissues (diseased body parts) or bodily fluids




Biopsy vs Autopsy (dead)

Aetiology of AD (causation)

- no genetic link


- rare early onset


- Down syndrome - prone to developing AD earlier (40s)


- no other factors known


-Can have sudden decompensation


* Pathology will not suddenly start developing, but head injury may reveal existing AD

Clinical features of DAT

Onset: 1-2 years before diagnosis

Course: slow deterioration, can plateau


Death= average 8.5 years after onset




3 main phases of DAT

Phase 1: 2-3 years


- failing memory (amnestic)


- muddled inefficiency in ADLs (Activity of daily livings)


-Spatial disorientation (get lost)


-Mood - agitation, apathetic (don't care)




Phase 2: Rapid deterioration


- intellect, personality deteriorate




- Focal symptoms appear:


-- can't sequence motor movements


--cannot recognise visual objects


--forget words


--can't solve math problems




- muscles constantly tense, posture, gait (walk)


- delusions/hallucinations can occur




Phase 3 (terminal stage)


- lack of emotion (apathy)


- bed riden


-lose brain function


-bodily wasting occurs * typically die from pneumonia



McKhann et al Criteria

Criteria for diagnoses of AD


- Probable


- Possible


- Definite

Probable AD

Progressive worsening of memory and or other cognitive functions




- Deficits in 2+ areas of cognition (usually Amnestic)

Possible AD

made on basis of dementia syndrome if onset/presentation/clinical course is not typical




- can be made in presence of another disorder

Definite AD

- Histopathological evidence of AD from biopsy/autopsy



Pathology of definite AD

- atrophied brain (shrink, loss of neurons in frontal/TL)


-increase of glial(support cells)


*extensive amounts of senile plaques, neurofibrillary tangles in Hippocampi/amygdala



Amnestic presentation - changes in brain (AD)

- starts in hippocampus/MTL


-spreads posteriorly/outwards to parietal cortex


-spreads to involve frontal cortex




(eventually whole neocortex/outer brain)



Clinical pattern of DAT - memory impairment

1. MTL memory impairment - Retrograde okay, Anterograde impaired.


2. Posterior TL = Wernicke-type aphasia


- difficulties finding words, fluency of speech


3. Frontal lobes = Apathy




*For diagnoses of AD, ADL must be affected (activities of daily life)

General course of change?

middle, up, forward


Affecting:


memory, words, apathy

Treatment and prevention of AD

- pharm: rebalance of Acetylcholine, but no affect on pathology




- halts deterioration (plateau)




- No clear evidence for preventing AD



AD vs normal aging

cognitive deterioration evident in normal aging, but not as extreme as AD



Case study MK

76, woman


last 2-3 years became more forgetful


- repetitive in general conversation


- needs memory aides?




no other memory difficulties




- had diabetes, hypertension, depression


- on anti-depressant medication


- still depressed




Daughter said her mother didn't have daily memory difficulties, memory improved on antidepressant medication





MK assessment

low IQ, anxious


intact cognitive functioning except memory




Learning unrelated word pairs was impaired.




Severely impaired recall after delay




- no clear evidence of progressive deterioration


-no clear evidence on impact on daily life




CONCLUSION: Mild cognitive impairment



MK review assessment

- memory deteriorating


- functional impact: forgot to give herself insulin injection


- no visuospatial/langauge deficits


-anxiety about her diagnoses continues


- new learning deteriorated


MTL damage - impaired recall unchanged


* deterioration in language


*subtle visuospatial deficit

Implications (brain)

- memory impairment = deteriorating MTL function


- language deficit = affecting posterior TL


- visuospspatial changes = spread to parietal lobes




Diagnoses = DAT


dementia of the Alzheimer Type