เสนอDementia

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dementia

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เสนอDementia

  1. 1. What is dementia?
  2. 2.  
  3. 3.
  4. 4.  vascular dementia) Global hypoxic ischemic injury)  Alzheimer disease) (neurofibrillary tangles NFTs (senile plaques SPs)
  5. 5.  2-10 1-3 Alzheimer’s disease: AD) Vascular dementia: VaD)  96
  6. 6. 1. normal ageing change) 2. mild cognitive impairment : MCI) 3. delirium) 4. depression: pseudodementia) 5.
  7. 7.
  8. 8.  1.  2.  3.  4.
  9. 9.    basic activities of daily living : basic ADL)  (instrumental activities of daily living : instrumental ADL) 
  10. 10. DSM IV American Psychiatric Association. Diagnostic and statistical manual of mental disorders , th edition. DSM-IV-TR. Washington, D.C: American Psychiatric Association;
  11. 11. 1. memory impairment)  aphasia)  apraxia) motor system extrapyramidal system  agnosia)  disturbance of
  12. 12.   delirium) 
  13. 13.  DEMENTIA  Drug toxicity  Emotional disorder  Metabolic endocrine disorder  Eye and Ear disorder  Nutritional disorder (thiamine, folate, B and B deficiency) / Normal pressure hydrocephalus  Tumor (primary secondary brain tumor) Trauma  Infection  Arteriosclerosis (vascular dementia) Alcohol  hydrocephalus) VDRL reversible arrestable dementia)
  14. 14.  - - Alzheimer's Association. 2010 Alzheimer's disease facts and figures. Alzheimer's & Dementia. Mar 2010;6:158-194.
  15. 15.  hydrocephalus; 
  16. 16.
  17. 17.  motor sign) tone) hyperreflexia) spastic gait, hemiplegic gait, parkinsonian gait posture abnormality) stooped posture) extended posture) movement
  18. 18.  corticobulbar tract, corticospinal tract extrapyramidal pathway subcortex  Subcortical  cortical cortical AD frontotemporal dementia (FTD)
  19. 19.   complete blood count (CBC), chemistry panel (renal function tests, liver function test), electrolyte, Calcium, thyroid function test , B folate level ESR , Urinalysis, Toxicology, CXR, Heavy metal screen, HIV test, Syphilis serology, CSF examination, EEG, PET or SPECT
  20. 20.  biomarkers CSF presemilin , presenilin amyloid precursor protein mutation Apolipoproteint E-  MoCA test, DemTect, BNA, GPCOG MS
  21. 21. 4  cognitive dysfunction)   
  22. 22.  Mini Mental Status Examination MMSE) 8 Time oreintation) 5 Place oreintation) 5 Registration) 3 Attention and calculation) 5 serial sevens) world Recall) 3 Language) 2 1
  23. 23.  30 25
  24. 24.  CT) MRI) infarction) CT) white matter) MRI) T1, T2 signal)
  25. 25.   1. estrogen replacement therapy ( , NSAID  2. acetylcholinesterase inhibitors)
  26. 26.  3. psychosis) (1) (2) (3) neuroleptic drug) 2 haloperidol (Haldol) risperidone (Risperdal) quetiapine (Seroquel) 15 1-2 olanzapine (Zyprexa) 2.5
  27. 27.  4. Anxiety) “ ”  1) Buspirone (BuSpar) 5 2  2) Benzodiazepines Xanax  3) trazodone 50
  28. 28.  5. Depression  1) slow down  2)  3) 30 5 2  4) cognitive therapy  (5)  6) phototherapy)
  29. 29.  (1) Selective serotonin reuptake inhibitors (SSRI) Sertraline (Zoloft) 25-50 Paroxetine (Paxil) 10-20 (2) Tricyclic antidepressants  SSRI (selective serotonin reuptake inhibitor)
  30. 30.  6..  Diphenhydramine (Benadryl) 25-50 Chloral hydrate (500-1000 Zolpidem 5-10
  31. 31.  7.  oxybutynin (Ditropan) 2.5 – 5 tolterodine (Detrol) 2  Parkinsonism levodopa carbidopa NSAID ) 
  32. 32.    
  33. 33.
  34. 34.  3   
  35. 35.  ( )  / 
  36. 36.  
  37. 37.  1. 2. / / / 3. 4.   
  38. 38.  Folstein MF, Folstein SE, McHugh PR (1975). Mini-mental state. A practical method for grading the cognitive state of patients for the clinician". J of Psychiatric research 1975; 12 (3): 189– 98. doi:10.1016/0022-3956(75)90026-6.PMID 1202204.   Jellinger KA. Morphologic diagnosis of "vascular dementia" - a critical update. J Neurol Sci. Jul 15 2008;270(1-2):1-12. [Medline].  Jellinger KA. The pathology of "vascular dementia": a critical update. J Alzheimers Dis. May 2008;14(1):107-23. [Medline].  Alzheimer's Association. 2010 Alzheimer's disease facts and figures. Alzheimer's & Dementia. Mar 2010;6:158-194. [Medline]  Savva GM, Wharton SB, Ince PG, Forster G, Matthews FE, Brayne C. Age, neuropathology, and dementia. N Engl J Med. May 28 2009;360(22):2302-9. [Medline].  Green RC, Roberts JS, Cupples LA, Relkin NR, Whitehouse PJ, Brown T, et al. Disclosure of APOE genotype for risk of Alzheimer's disease. N Engl J Med. Jul 16 2009;361(3):245-54. [Medline].  Weintraub D, Rosenberg PB, Drye LT, et al. Sertraline for the Treatment of Depression in Alzheimer Disease: Week-24 Outcomes. Am J Geriatr Psychiatry. Feb 2010;18(4):332- 40. [Medline].

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