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Alzheimer's y Parkinson dis..ppt
 

Alzheimer's y Parkinson dis..ppt

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    Alzheimer's y Parkinson dis..ppt Alzheimer's y Parkinson dis..ppt Presentation Transcript

    • Alzheimer’s Disease
    • 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
      • AD = senile dementia
      • Molecular approaches
    • Epidemiology
      • Age: strong risk factor 47.2% for 85 years
      • 14 million individuals with AD by 2040
      • Family history of dementia (70)
      • Head Trauma
      • Cardiovascular diseases
    • 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
      • Chronic process
      • Deficiency of growth factors or excess of excitatory Aas.
      • Intracellular calcium, free radicals, abnormal proteins
    • Etiology and Pathogenesis
      • Genetic defect
      • Systemic metabolic defect
      • Slow or latent virus disorders
      • Toxins
      • Combination
    • Genetics
      • Proximal region of chromosome 21 locus (early onset)
      • Chromosome 19 locus (late onset)
      • Correlation with Down’s syndrome
    • Neurochemistry
      • Loss of cholinergic markers
      • choline acetyltransferase
      • acetylcholinesterase
      • acetylcholine synthesis is diminished
      • Loss in Nucleus basalis of Meynert
      • Presynaptic adrenergic deficit (neocortex)
      • Loss of serotonin and peptides
    • 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
    • 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
    • Diagnostic Criteria
      • No disturbance of consciousness
      • Onset between ages 40 and 90
      • Abscence of others systemic or brain disorders responsible for the memory loss
      • Diagnostic accuracy 90%
    • Clinical Picture
      • Early decline in recent memory
      • Loss of judgement and abstract thinking
      • Impaired language and discalculia
      • Disorientation
      • Loss of personality
      • Apathy and lethargy
      • Behavior problems
    • Neurologic Examination
      • Few subtle abnormalities
      • Cranial nerves:Olfactory identification deficit
      • Primitive reflexes (grasp, tonic foot, palmomental)
      • Language abnormalities ( 100%)
      • Impaired word finding (anomia)
    • Neurologic Examination
      • Apraxia
      • Myoclonic jerks
      • Decline in intellectual function
      • Mean survival time is 8.1 years
      • Range of survival 1 to 20 years
    • Diagnostic tests
      • No definitive diagnostic test for AD
      • Differential diagnosis
      • Blood count, Electrolytes, Ca, Phosphorus, renal, liver and thyroid function, Vit B12 and folic acid levels, drug screen
      • EEG: Non specific
    • 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
    • Differential Diagnosis
      • Vascular Dementia
      • Pick’s Disease
      • Diffuse Lewy Body Disease
      • Parkinson’s plus syndromes
      • Mass lesions
      • Metabolic causes
    • Neuropathology
      • Severe cortical atrophy
      • NFT formation
      • Neuron loss
      • Altered neuritic process
      • Senile plaques
    • Treatment
      • Non specific
      • Taking care of the patient and to avoid systemic complications
      • Rivastigmine (Exelon)???
    • Parkinson’s Disease
    • Background
      • James Parkinson in 1817
      • Involuntary tremulous motion, with lessened muscular power, 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, the senses and intellect uninjured
      • No reference to rigidity or to slowness of movement
    • Epidemiology
      • The disease begins between 40 and 70
      • Predisposing: Trauma, emotional upset, overwork, exposure to cold
      • Familial cases (5%)
      • Half million patients affected
      • 1% population over 50 years is affected in the US
    • Clinical Picture
      • Resting tremor (pill rolling)
      • Rigidity
      • Poverty and slowness of voluntary movement
      • Expressionless face
      • Festinating gait
      • Stooped posture
      • Infrequency of blinking
      • Dementia
    • Differential Diagnosis
      • Parkinson’s syndromes
      • Post-encephalitic (Von Economo)
      • Toxic
      • Drug induced
      • Vascular
      • Traumatic
      • Striatonigral degeneration
      • Progressive supranuclear palsy
      • Mass lesions
    • Pathology
      • Loss of pigmented cells in the susbtantia nigra (PR)
      • Lewy bodies (eosinophilic cytoplasmic inclusions)
      • Depletion of striatal dopamine
    • Staging
      • Hoehn and Yahr scale
      • I: Unilateral involvement
      • II: Bilateral involvement, without postural abnormalities
      • III: Bilateral with mild postural imbalance, independent life
      • IV: Bilateral, instability, dependent
      • V: Severe
    • Treatment
      • L-dopa- Carbidopa
      • Bromocriptine
      • Lisuride and pergolide
      • Amantadine
      • Deprenyl
      • Anticholinergic drugs
    • Treatment
      • Thalamotomy
      • Pallidotomy
      • Grafts
      • Striatum
      • Substantia nigra