SALEM DOES NOT
REMEMBER
Group F
Week 7
2013-2014
Summary of the case
- Salem, 66 years old , businessman.
- 18 months ago , started to be forgetful.
- Five days ago ; he w...
Objectives
1. Physiology of memory
2. Dementia :
- Definition
- Causes + Pathophysiology
*Infection related to HIV Dementi...
PHYSIOLOGY OF MEMORY
Definition :
Memory is the ability to retain and to recall personal
experiences, information, and var...
There is no single memory center in
the brain
WHAT IS DEMENTIA?
Is the loss of mental functions such as thinking, memory, and
reasoning that is severe enough to interfe...
Causes
• Degenerative disease such as

Alzheimer's, Parkinson's and Huntington's.
• Vascular disease, such as stroke  mul...
Infections related to AIDS dementia
complex (ADC)
• Patients with concomitant hepatitis C virus (HCV)

infection may have ...
Dementia & Down Syndrome: Is there
Any Relationship ?! ..
• As with all adults, advancing age also

increases the chances ...
*Scientists think that the increased
risk of dementia in individuals with
Down syndrome may also result from
the extra gen...
Dementia: Signs & Symptoms ..
While symptoms of dementia can vary greatly, at least
two of the following core mental funct...
Dementia: Examples ! ..
People with dementia may have problems with:• Short-term memory
• keeping track of a purse or wall...
Pay Attention that .. 
Many dementias are progressive, meaning
symptoms start out slowly and gradually get worse.

HOWEVE...
WHAT IS THE DEFINITION OF
CONFUSION ?
What are the causes of
confusion ?
What is forgetfulness /forgetting?
• Forgetting (retention loss) refers to apparent loss of

information already encoded a...
Why do we forget?
There are two simple answers to this question.
• First, the memory has disappeared - it is no longer
ava...
Causes of Forgetfulness
Common causes of forgetfulness:
a.
Lack of Sleep
b. Medications. Tranquilizers,
antidepressants, s...
Types
Alzheimer
dementia

Vascular
dementia

DLB

Mixed
dementia

Parkinson’s
disease

Pick disease

CJD

Hydrocephalus
PATHOPYHSIOLOGY OF ALZHEIMER’S DISEASE
AUTOPSY FINDINGS IN ALZHEIMER’S DISEASE
Protective Factors
• Diet
• Physical & social activities
• Educational & Intellectual stimulation
• Caffeine
• Smoking

• ...
Epidemiology
• AD is the fifth-leading cause of death for those age 65 &

older.
• One in nine ( >65yr) Americans has AD.
...
Investigation for dementia
• Imaging studies
Table 371-5 The Mini-Mental Status Examination

Points

Orientation
•

Mental assessment

Name: season/date/day/month/year...
Wechsler Memory Scale
It is made up of seven subtests:
1.
2.
3.
4.
5.
6.
7.

Spatial Addition
Symbol Span
Design Memory
Ge...
http://www.pearsonassessments.com/NR/rdonlyres/BBB89AF8-CF8F-4E74-A374B59471B3223D/0/WMSIV_Writer_Report_21yrMale.pdf
Role of neuropsychologist in dementia
• Neuropsychologists are uniquely qualified to provide

dementia diagnosis and follo...
Management of Alzheimer
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  • Confusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and having difficulty paying attention, remembering, and making decisions.Confusion may come on quickly or slowly over time, depending on the cause. Many times, confusion is temporary. Other times it is permanent and not curable. It may be associated with delirium or dementia.Confusion is more common in the elderly, and often occurs during a hospital stay.Some confused people may have strange or unusual behavior or may act aggressivelyAlcohol intoxicationBrain tumorConcussionFeverFluid and electrolyte imbalanceHead trauma or head injuryIllness in an elderly personIllness in a person with existing neurological disease such as a strokeInfectionsLack of sleep (sleep deprivation)Low blood sugarLow levels of oxygen (for example, from chronic lung disorders)MedicationsNutritional deficiencies, especially niacin, thiamine, vitamin C, or vitamin B12SeizuresSudden drop in body temperature (hypothermia)
  • There are many reasons we forget things and often these reasons overlap. Like in the example above, some information never makes it to LTM. Other times, the information gets there, but is lost before it can attach itself to our LTM. Other reasons include decay, which means that information that is not used for an extended period of time decays or fades away over time. It is possible that we are physiologically preprogrammed to eventually erase data that no longer appears pertinent to us.
  • PET images obtained with the amyloid-imaging agent Pittsburgh Compound-B ([11C]PIB) in a normal control (left); three different patients with mild cognitive impairment (MCI, center); and a mild AD patient (right). Some MCI patients have control-like levels of amyloid, some have AD-like levels of amyloid, and some have intermediate levels. AD, Alzheimer's disease; MCI, mild cognitive impairment; PET, positron emission tomography.
  • Axial T1-weighted MR images through the midbrain of a normal 86-year-old athlete (A) and a 77-year-old man with AD (B). Note that both individuals have mild sulcal widening and slight dilation of the temporal horns of the lateral ventricles. However, there is a reduction in hippocampal volume in the patient with AD (arrows) compared with the volume of the normal-for-age hippocampus (A).
  • Week 7 presentation

    1. 1. SALEM DOES NOT REMEMBER Group F Week 7 2013-2014
    2. 2. Summary of the case - Salem, 66 years old , businessman. - 18 months ago , started to be forgetful. - Five days ago ; he went for a walk and lost his way home. - He was taking benzodiazepine and methyldopa . - He was HIV –ve - PET : showed hypometabolism in temporal, parietal and frontal lobes. - He was diagnosed with Alzheimer
    3. 3. Objectives 1. Physiology of memory 2. Dementia : - Definition - Causes + Pathophysiology *Infection related to HIV Dementia * Link with down syndrome * Benzodiazepine - Signs and Symptoms * Forgetfulness ( Definition + Causes ) * Confusion ( Definition + Causes ) - Types * Alzheimer ( Pathophysiology + Findings in Autopsy) - Protective factors ( remeber ; higher education , estrogen , smoking ..etc) - Epidemiology - Investigation ( MSE + MMSE , imaging modalities ; PET ) * Weschler scale *Role of a neuropsychologist - Management * Pharmacological management of Alzheimer * Principles of drug use in elderly - Complications + progression
    4. 4. PHYSIOLOGY OF MEMORY Definition : Memory is the ability to retain and to recall personal experiences, information, and various skills and habits.
    5. 5. There is no single memory center in the brain
    6. 6. WHAT IS DEMENTIA? Is the loss of mental functions such as thinking, memory, and reasoning that is severe enough to interfere with a person's daily functioning.
    7. 7. Causes • Degenerative disease such as Alzheimer's, Parkinson's and Huntington's. • Vascular disease, such as stroke  multi-infarct dementia • Toxic reactions, like excessive alcohol or drug use. • Nutritional deficiencies, like vitamin B12 and folate deficiency. • Infections, such as AIDS dementia complex and Creutzfeldt-Jakob disease. • Certain types of hydrocephalus. • Head injury. • Genetic mutations
    8. 8. Infections related to AIDS dementia complex (ADC) • Patients with concomitant hepatitis C virus (HCV) infection may have a worse cognitive status than do those without and therefore a worse prognosis.
    9. 9. Dementia & Down Syndrome: Is there Any Relationship ?! .. • As with all adults, advancing age also increases the chances a person with Down syndrome will develop Alzheimer's disease. • Because people with Down syndrome live, on average, 55 to 60 years, they are more likely to develop youngeronset Alzheimer’s (Alzheimer’s occurring before age 65) than older-onset Alzheimer’s (Alzheimer’s occurring at age 65 or older).
    10. 10. *Scientists think that the increased risk of dementia in individuals with Down syndrome may also result from the extra gene. One of the chromosome 21 genes of greatest interest in the Down syndromeAlzheimer's connection codes amyloid precursor protein (APP). *But despite the presence of these brain changes, not everyone with the syndrome develops Alzheimer's symptoms. *One of the many questions researchers hope to answer about Down syndrome is why some people develop dementia symptoms and others don't ?!
    11. 11. Dementia: Signs & Symptoms .. While symptoms of dementia can vary greatly, at least two of the following core mental functions must be significantly impaired to be considered dementia: • Memory • Communication and language • Ability to focus and pay attention • Reasoning and judgment • Visual perception
    12. 12. Dementia: Examples ! .. People with dementia may have problems with:• Short-term memory • keeping track of a purse or wallet • paying bills • planning and preparing meals • remembering appointments • traveling out of the neighborhood.
    13. 13. Pay Attention that ..  Many dementias are progressive, meaning symptoms start out slowly and gradually get worse. HOWEVER , Many people have memory loss issues — this does not mean they have Alzheimer's or another dementia !
    14. 14. WHAT IS THE DEFINITION OF CONFUSION ? What are the causes of confusion ?
    15. 15. What is forgetfulness /forgetting? • Forgetting (retention loss) refers to apparent loss of information already encoded and stored in an individual's long term memory. • It is a spontaneous or gradual process in which old memories are unable to be recalled from memory storage.
    16. 16. Why do we forget? There are two simple answers to this question. • First, the memory has disappeared - it is no longer available. • Second, the memory is still stored in the memory system but, for some reason, it cannot be retrieved.
    17. 17. Causes of Forgetfulness Common causes of forgetfulness: a. Lack of Sleep b. Medications. Tranquilizers, antidepressants, some blood pressure drugs c. Underactive thyroid d. Alcohol e. Stress and anxiety f. Depression g. Pregnancy Age related changes in memory • - Aging Other causes  Degenerative disorders  Alzheimers  Parkinson  Vascular Dementia  Delirium  Brain Tumor  Stroke  Infections: Meningitis, Encephalitis
    18. 18. Types Alzheimer dementia Vascular dementia DLB Mixed dementia Parkinson’s disease Pick disease CJD Hydrocephalus
    19. 19. PATHOPYHSIOLOGY OF ALZHEIMER’S DISEASE
    20. 20. AUTOPSY FINDINGS IN ALZHEIMER’S DISEASE
    21. 21. Protective Factors • Diet • Physical & social activities • Educational & Intellectual stimulation • Caffeine • Smoking • Anti- inflammatory drugs • Estrogen - HRT
    22. 22. Epidemiology • AD is the fifth-leading cause of death for those age 65 & older. • One in nine ( >65yr) Americans has AD. • Almost two-thirds of Americans with Alzheimer’s are women. • By 2050, the incident of AD will be 3-fold to 13.2 million.
    23. 23. Investigation for dementia • Imaging studies
    24. 24. Table 371-5 The Mini-Mental Status Examination Points Orientation • Mental assessment Name: season/date/day/month/year 5 (1 for each name) Name: hospital/floor/town/state/country 5 (1 for each name) Registration Identify three objects by name and ask patient to repeat 3 (1 for each object) Attention and calculation Serial 7s; subtract from 100 (e.g., 93–86–79–72–65) 5 (1 for each subtraction) Recall Recall the three objects presented earlier 3 (1 for each object) Language Name pencil and watch 2 (1 for each object) Repeat "No ifs, ands, or buts" 1 Follow a 3-step command (e.g., "Take this paper, fold it in half, and place it on the table") 3 (1 for each command) Write "close your eyes" and ask patient to obey written command 1 Ask patient to write a sentence 1 Ask patient to copy a design (e.g., intersecting pentagons) 1 Total 30
    25. 25. Wechsler Memory Scale It is made up of seven subtests: 1. 2. 3. 4. 5. 6. 7. Spatial Addition Symbol Span Design Memory General Cognitive Screener Logical Memory Verbal Paired Associates Visual Reproduction A person's performance is reported as five Index Scores: 1. 2. 3. 4. 5. Auditory Memory, Visual Memory Visual Working Memory Immediate Memory Delayed Memory
    26. 26. http://www.pearsonassessments.com/NR/rdonlyres/BBB89AF8-CF8F-4E74-A374B59471B3223D/0/WMSIV_Writer_Report_21yrMale.pdf
    27. 27. Role of neuropsychologist in dementia • Neuropsychologists are uniquely qualified to provide dementia diagnosis and follow-up because they are specialists in memory and other cognitive functions. • Neuropsychological exam is one of the most sensitive indicators of Alzheimer’s and other dementias. It consists of interviewing the patient, then a close person (spouse/child usually), and then the actual exam. • Also, the neuropsychologist is important for helping the family and caregivers to cope with this added stress to their lives.
    28. 28. Management of Alzheimer
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