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DEMENTIA& ALZHEIMER’S ! Dr. Mohamad Shaikhani.
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CAUSES OF DEMENTIA Variant CJD Kuru Gerstmann-Sträussler-Scheinker disease Sporadic Creutzfeldt-Jakob disease (CJD) Prion diseases  Post-encephalitic Whipple's disease Subacute sclerosing panencephalitis Syphilis HIV Infective Anoxia/carbon monoxide poisoning Heavy metal poisoning Thiamin deficiency B 12  deficiency Alcohol Toxic/nutritional Communicating/non-communicating 'Normal pressure' hydrocephalus Hydrocephalus  Punch-drunk syndrome Chronic subdural haematoma Post-head injury Traumatic Sarcoidosis Multiple sclerosis Inflammatory Paraneoplastic syndrome (limbic encephalitis) Primary cerebral tumour Secondary deposits Neoplastic  Mitochondrial encephalopathies Leucodystrophies Huntington's disease Wilson's disease Pick's disease Dystrophia myotonica Cortical Lewy body disease Progressive supranuclear palsy Others (e.g. cortico-basal degeneration) Alzheimer's disease Degenerative/inherited  Cerebral vasculitis Amyloid angiopathy Multiple emboli Diffuse small-vessel disease Vascular Rare Unusual Common Type
 
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DIAGNOSTIC  CRITERIA  FOR DEMENTIA OF THE ALZHEIMER TYPE (DSM-IV, APA, 1994) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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AD: Pathology ,[object Object],[object Object],[object Object]
Senile Plaques ,[object Object],[object Object],[object Object],[object Object],[object Object]
Neurofibrillary Tangles ,[object Object],[object Object],[object Object],[object Object]
 
 
 
 
 
clinical diagnosis of Alzheimer’s Disease A)Definite Alzheimer’s Disease B) Probable Alzheimer’s Disease C) Possible Alzheimer’s Disease
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[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
MILD COGNITIVE IMPAIRMENT  CRITERIA  (Amer.  Acad. Neurology) (Petersen et al., 2001 – Neurology 56:1133) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MILD COGNITIVE IMPAIRMENT  progression: 25 GDS 3 71 NYU 12 Isolated memory loss 74 Seattle 6 CDR 0.5 72 MGH 15 Questionable dementia 66 Columbia 14 Memory Impairment 74 Toronto 12 MCI 81 Mayo Annual conversion rate to AD % Criteria Mean Age Study
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“ Distinguishing Features of Cortical & Subcortical Dementia” Psychomotor retardation Forgetfulness Cognitive dilapidation Impaired insight Poor strategy formulation Aphasia- Amnesia Visuospatial disorder Poor abstraction Aculculia Apraxia Agnosia- loss of the power to recognize the import of sensory stimulus.  Intellectual Functions Subcortical Cortical
“ Distinguishing Features of Cortical & Subcortical Dementia” Depression (rarely, mania) Indifference   Personality/Emotions Subcortical Cortical
“ Distinguishing Features of Cortical & Subcortical Dementia” Dysarthria   Normal (until late)   Speech Subcortical Cortical
“ Distinguishing Features of Cortical & Subcortical Dementia” Abnormal (parkinsonian, chorea, dystonia, etc.) Normal (until late)   Motor Subcortical Cortical
“ Distinguishing Features of Cortical & Subcortical Dementia” Thalamus basal ganglia rostral brainstem Neocortical association areas&hippocampus Anatomy Subcortical Cortical
Mixed dementias  cortical & subcortical structures are involved
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Factors involved in   Multi-infarct  Dementia(vascular dementia)
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Factors involved in  Slow virus  Dementia
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Three  important facts about  Dementia syndrome or pseudodementia:
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3 important effects of depression
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Differentiate  primary depression  &  primary dementia  by  History !
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Differentiate Depression & Dementia by  clinical testing
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2 facts of  Normal Pressure hydrocephalus
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High risk for  Subdural Hematoma
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Symptoms of  Subdural H
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[object Object],[object Object],[object Object],[object Object]
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Available Screening Tests ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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AD: Treatment No cure for AD Limited therapy to help symptoms or to slow progression Therapies to improve symptoms: Enhancement of cholinergic system Increase dietary choline: little effect on cognition  AChE inhibitors: small cognitive enhancing effect
Anticholinesterases, such as donepezil, rivastigmine & galantamine, or NMDA (N-methyl-D-aspartate receptor antagonists (memantine) appear to improve cognitive function to some extent in Alzheimer's disease
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Clin Neuro Dementia Alz Lec.

  • 1. DEMENTIA& ALZHEIMER’S ! Dr. Mohamad Shaikhani.
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  • 4. CAUSES OF DEMENTIA Variant CJD Kuru Gerstmann-Sträussler-Scheinker disease Sporadic Creutzfeldt-Jakob disease (CJD) Prion diseases Post-encephalitic Whipple's disease Subacute sclerosing panencephalitis Syphilis HIV Infective Anoxia/carbon monoxide poisoning Heavy metal poisoning Thiamin deficiency B 12 deficiency Alcohol Toxic/nutritional Communicating/non-communicating 'Normal pressure' hydrocephalus Hydrocephalus Punch-drunk syndrome Chronic subdural haematoma Post-head injury Traumatic Sarcoidosis Multiple sclerosis Inflammatory Paraneoplastic syndrome (limbic encephalitis) Primary cerebral tumour Secondary deposits Neoplastic Mitochondrial encephalopathies Leucodystrophies Huntington's disease Wilson's disease Pick's disease Dystrophia myotonica Cortical Lewy body disease Progressive supranuclear palsy Others (e.g. cortico-basal degeneration) Alzheimer's disease Degenerative/inherited Cerebral vasculitis Amyloid angiopathy Multiple emboli Diffuse small-vessel disease Vascular Rare Unusual Common Type
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  • 27. clinical diagnosis of Alzheimer’s Disease A)Definite Alzheimer’s Disease B) Probable Alzheimer’s Disease C) Possible Alzheimer’s Disease
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  • 33. MILD COGNITIVE IMPAIRMENT progression: 25 GDS 3 71 NYU 12 Isolated memory loss 74 Seattle 6 CDR 0.5 72 MGH 15 Questionable dementia 66 Columbia 14 Memory Impairment 74 Toronto 12 MCI 81 Mayo Annual conversion rate to AD % Criteria Mean Age Study
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  • 38. “ Distinguishing Features of Cortical & Subcortical Dementia” Psychomotor retardation Forgetfulness Cognitive dilapidation Impaired insight Poor strategy formulation Aphasia- Amnesia Visuospatial disorder Poor abstraction Aculculia Apraxia Agnosia- loss of the power to recognize the import of sensory stimulus. Intellectual Functions Subcortical Cortical
  • 39. “ Distinguishing Features of Cortical & Subcortical Dementia” Depression (rarely, mania) Indifference Personality/Emotions Subcortical Cortical
  • 40. “ Distinguishing Features of Cortical & Subcortical Dementia” Dysarthria Normal (until late) Speech Subcortical Cortical
  • 41. “ Distinguishing Features of Cortical & Subcortical Dementia” Abnormal (parkinsonian, chorea, dystonia, etc.) Normal (until late) Motor Subcortical Cortical
  • 42. “ Distinguishing Features of Cortical & Subcortical Dementia” Thalamus basal ganglia rostral brainstem Neocortical association areas&hippocampus Anatomy Subcortical Cortical
  • 43. Mixed dementias cortical & subcortical structures are involved
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  • 45. Factors involved in Multi-infarct Dementia(vascular dementia)
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  • 47. Factors involved in Slow virus Dementia
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  • 49. Three important facts about Dementia syndrome or pseudodementia:
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  • 51. 3 important effects of depression
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  • 53. Differentiate primary depression & primary dementia by History !
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  • 55. Differentiate Depression & Dementia by clinical testing
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  • 57. 2 facts of Normal Pressure hydrocephalus
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  • 59. High risk for Subdural Hematoma
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  • 61. Symptoms of Subdural H
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  • 70. AD: Treatment No cure for AD Limited therapy to help symptoms or to slow progression Therapies to improve symptoms: Enhancement of cholinergic system Increase dietary choline: little effect on cognition AChE inhibitors: small cognitive enhancing effect
  • 71. Anticholinesterases, such as donepezil, rivastigmine & galantamine, or NMDA (N-methyl-D-aspartate receptor antagonists (memantine) appear to improve cognitive function to some extent in Alzheimer's disease
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