Alzheimer's y Parkinson dis..ppt

1,910 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,910
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
33
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Alzheimer's y Parkinson dis..ppt

  1. 1. Alzheimer’s Disease
  2. 2. Background <ul><li>First description in 1907 </li></ul><ul><li>51 year old woman with a 4 1/2 year course of progressive dementia </li></ul><ul><li>Autopsy: Neurofibrillary tangles, severe loss of cortical neurons </li></ul><ul><li>AD = senile dementia </li></ul><ul><li>Molecular approaches </li></ul>
  3. 3. Epidemiology <ul><li>Age: strong risk factor 47.2% for 85 years </li></ul><ul><li>14 million individuals with AD by 2040 </li></ul><ul><li>Family history of dementia (70) </li></ul><ul><li>Head Trauma </li></ul><ul><li>Cardiovascular diseases </li></ul>
  4. 4. Etiology and Pathogenesis <ul><li>Not known : many theories </li></ul><ul><li>Pathologic: neuronal degeneration and death in specific brain areas that leads to gradual decline in memory and other cognitive functions </li></ul><ul><li>Chronic process </li></ul><ul><li>Deficiency of growth factors or excess of excitatory Aas. </li></ul><ul><li>Intracellular calcium, free radicals, abnormal proteins </li></ul>
  5. 5. Etiology and Pathogenesis <ul><li>Genetic defect </li></ul><ul><li>Systemic metabolic defect </li></ul><ul><li>Slow or latent virus disorders </li></ul><ul><li>Toxins </li></ul><ul><li>Combination </li></ul>
  6. 6. Genetics <ul><li>Proximal region of chromosome 21 locus (early onset) </li></ul><ul><li>Chromosome 19 locus (late onset) </li></ul><ul><li>Correlation with Down’s syndrome </li></ul>
  7. 7. Neurochemistry <ul><li>Loss of cholinergic markers </li></ul><ul><li>choline acetyltransferase </li></ul><ul><li>acetylcholinesterase </li></ul><ul><li>acetylcholine synthesis is diminished </li></ul><ul><li>Loss in Nucleus basalis of Meynert </li></ul><ul><li>Presynaptic adrenergic deficit (neocortex) </li></ul><ul><li>Loss of serotonin and peptides </li></ul>
  8. 8. Clinical Features <ul><li>Dementia: major health problem </li></ul><ul><li>Symptom complex: more than 70 entities </li></ul><ul><li>Reversible or irreversible </li></ul><ul><li>AD: most common in adults </li></ul><ul><li>4 million persons in the US </li></ul><ul><li>Fourth leading cause of death </li></ul>
  9. 9. Diagnostic Criteria <ul><li>Dementia: clinical and neuropsychological testing </li></ul><ul><li>Deficits in two or more cognitive functions </li></ul><ul><li>Progressive worsening of memory and other cognitive function, such as abstract thinking , judgement, problem solving , language, perception, and ability to learn new skills </li></ul>
  10. 10. Diagnostic Criteria <ul><li>No disturbance of consciousness </li></ul><ul><li>Onset between ages 40 and 90 </li></ul><ul><li>Abscence of others systemic or brain disorders responsible for the memory loss </li></ul><ul><li>Diagnostic accuracy 90% </li></ul>
  11. 11. Clinical Picture <ul><li>Early decline in recent memory </li></ul><ul><li>Loss of judgement and abstract thinking </li></ul><ul><li>Impaired language and discalculia </li></ul><ul><li>Disorientation </li></ul><ul><li>Loss of personality </li></ul><ul><li>Apathy and lethargy </li></ul><ul><li>Behavior problems </li></ul>
  12. 12. Neurologic Examination <ul><li>Few subtle abnormalities </li></ul><ul><li>Cranial nerves:Olfactory identification deficit </li></ul><ul><li>Primitive reflexes (grasp, tonic foot, palmomental) </li></ul><ul><li>Language abnormalities ( 100%) </li></ul><ul><li>Impaired word finding (anomia) </li></ul>
  13. 13. Neurologic Examination <ul><li>Apraxia </li></ul><ul><li>Myoclonic jerks </li></ul><ul><li>Decline in intellectual function </li></ul><ul><li>Mean survival time is 8.1 years </li></ul><ul><li>Range of survival 1 to 20 years </li></ul>
  14. 14. Diagnostic tests <ul><li>No definitive diagnostic test for AD </li></ul><ul><li>Differential diagnosis </li></ul><ul><li>Blood count, Electrolytes, Ca, Phosphorus, renal, liver and thyroid function, Vit B12 and folic acid levels, drug screen </li></ul><ul><li>EEG: Non specific </li></ul>
  15. 15. Diagnostic tests <ul><li>CT and MRI: Cerebral atrophy and ventricular enlargement, other lesions </li></ul><ul><li>PET: Reduced regional CBF and glucose and oxygen metabolism in the parietal and temporal lobes </li></ul><ul><li>Neuropsychological testing </li></ul>
  16. 16. Differential Diagnosis <ul><li>Vascular Dementia </li></ul><ul><li>Pick’s Disease </li></ul><ul><li>Diffuse Lewy Body Disease </li></ul><ul><li>Parkinson’s plus syndromes </li></ul><ul><li>Mass lesions </li></ul><ul><li>Metabolic causes </li></ul>
  17. 17. Neuropathology <ul><li>Severe cortical atrophy </li></ul><ul><li>NFT formation </li></ul><ul><li>Neuron loss </li></ul><ul><li>Altered neuritic process </li></ul><ul><li>Senile plaques </li></ul>
  18. 18. Treatment <ul><li>Non specific </li></ul><ul><li>Taking care of the patient and to avoid systemic complications </li></ul><ul><li>Rivastigmine (Exelon)??? </li></ul>
  19. 19. Parkinson’s Disease
  20. 20. Background <ul><li>James Parkinson in 1817 </li></ul><ul><li>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 </li></ul><ul><li>No reference to rigidity or to slowness of movement </li></ul>
  21. 21. Epidemiology <ul><li>The disease begins between 40 and 70 </li></ul><ul><li>Predisposing: Trauma, emotional upset, overwork, exposure to cold </li></ul><ul><li>Familial cases (5%) </li></ul><ul><li>Half million patients affected </li></ul><ul><li>1% population over 50 years is affected in the US </li></ul>
  22. 22. Clinical Picture <ul><li>Resting tremor (pill rolling) </li></ul><ul><li>Rigidity </li></ul><ul><li>Poverty and slowness of voluntary movement </li></ul><ul><li>Expressionless face </li></ul><ul><li>Festinating gait </li></ul><ul><li>Stooped posture </li></ul><ul><li>Infrequency of blinking </li></ul><ul><li>Dementia </li></ul>
  23. 23. Differential Diagnosis <ul><li>Parkinson’s syndromes </li></ul><ul><li>Post-encephalitic (Von Economo) </li></ul><ul><li>Toxic </li></ul><ul><li>Drug induced </li></ul><ul><li>Vascular </li></ul><ul><li>Traumatic </li></ul><ul><li>Striatonigral degeneration </li></ul><ul><li>Progressive supranuclear palsy </li></ul><ul><li>Mass lesions </li></ul>
  24. 24. Pathology <ul><li>Loss of pigmented cells in the susbtantia nigra (PR) </li></ul><ul><li>Lewy bodies (eosinophilic cytoplasmic inclusions) </li></ul><ul><li>Depletion of striatal dopamine </li></ul>
  25. 25. Staging <ul><li>Hoehn and Yahr scale </li></ul><ul><li>I: Unilateral involvement </li></ul><ul><li>II: Bilateral involvement, without postural abnormalities </li></ul><ul><li>III: Bilateral with mild postural imbalance, independent life </li></ul><ul><li>IV: Bilateral, instability, dependent </li></ul><ul><li>V: Severe </li></ul>
  26. 26. Treatment <ul><li>L-dopa- Carbidopa </li></ul><ul><li>Bromocriptine </li></ul><ul><li>Lisuride and pergolide </li></ul><ul><li>Amantadine </li></ul><ul><li>Deprenyl </li></ul><ul><li>Anticholinergic drugs </li></ul>
  27. 27. Treatment <ul><li>Thalamotomy </li></ul><ul><li>Pallidotomy </li></ul><ul><li>Grafts </li></ul><ul><li>Striatum </li></ul><ul><li>Substantia nigra </li></ul>

×