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
SALEM DOES NOT
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
- He was diagnosed with Alzheimer
1. Physiology of memory
2. Dementia :
- Causes + Pathophysiology
*Infection related to HIV Dementia
* Link with down syndrome
- Signs and Symptoms
* Forgetfulness ( Definition + Causes )
* Confusion ( Definition + Causes )
* Alzheimer ( Pathophysiology + Findings in Autopsy)
- Protective factors ( remeber ; higher education , estrogen , smoking ..etc)
- Investigation ( MSE + MMSE , imaging modalities ; PET )
* Weschler scale
*Role of a neuropsychologist
* Pharmacological management of Alzheimer
* Principles of drug use in elderly
- Complications + progression
PHYSIOLOGY OF MEMORY
Memory is the ability to retain and to recall personal
experiences, information, and various skills and habits.
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
• Degenerative disease such as
Alzheimer's, Parkinson's and Huntington's.
• Vascular disease, such as stroke multi-infarct
• Toxic reactions, like excessive alcohol or drug use.
• Nutritional deficiencies, like vitamin B12 and folate
• Infections, such as AIDS dementia complex and
• Certain types of hydrocephalus.
• Head injury.
• Genetic mutations
Infections related to AIDS dementia
• Patients with concomitant hepatitis C virus (HCV)
infection may have a worse cognitive status than do those
without and therefore a worse prognosis.
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).
*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
*One of the many questions
researchers hope to answer
about Down syndrome is
why some people develop
dementia symptoms and
others don't ?!
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:
• Communication and language
• Ability to focus and pay attention
• Reasoning and judgment
• Visual perception
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.
Pay Attention that ..
Many dementias are progressive, meaning
symptoms start out slowly and gradually get worse.
Many people have memory loss issues — this does
not mean they have Alzheimer's or another dementia
WHAT IS THE DEFINITION OF
What are the causes of
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
Why do we forget?
There are two simple answers to this question.
• First, the memory has disappeared - it is no longer
• Second, the memory is still stored in the memory system
but, for some
reason, it cannot be retrieved.
Causes of Forgetfulness
Common causes of forgetfulness:
Lack of Sleep
b. Medications. Tranquilizers,
antidepressants, some blood
Stress and anxiety
Age related changes in memory
• - Aging
• AD is the fifth-leading cause of death for those age 65 &
• One in nine ( >65yr) Americans has AD.
• Almost two-thirds of Americans with Alzheimer’s are
• By 2050, the incident of AD will be 3-fold to 13.2 million.
Table 371-5 The Mini-Mental Status Examination
5 (1 for each name)
5 (1 for each name)
Identify three objects by name and ask patient to
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 the three objects presented earlier
3 (1 for each object)
Name pencil and watch
2 (1 for each object)
Repeat "No ifs, ands, or buts"
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
Ask patient to write a sentence
Ask patient to copy a design (e.g., intersecting
Wechsler Memory Scale
It is made up of seven subtests:
General Cognitive Screener
Verbal Paired Associates
A person's performance is reported as five Index Scores:
Visual Working Memory
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