Dementia
痴呆Jie Ming Shen, M.D., Ph.D.
Department of Neurology
Ruijin Hospital, SSMU
Defenition• A syndrome of acquired cognitive
and behavioral impairment to markedly interfere with social and occupational functioning.
Manifestation
• Memory• Language
• Visuospatial skills• Cognition
• Behavior & psychiatric syndrome• Eexecutive functionsxecutive functions
Types
Degeneration:• Alzheimer disease• Frontotemporal dementia & Pick’s diseas
e• Dementia with Lewy body
Non-Degeneration:• Vascular dementia
Alzheimer Disease
阿尔茨海默病
定义• A progressive degeneration with unknown pathogenesis
• memory, cognitive and behavioral impairment
• cortic atrophy• lose of neurons
pathogenesis
• Cause: unknown• hereditary• environment• metabolic abnormality• β- amyloid deposition in the brain • decrease in acetylcholine • other
Pathogenesis
• neurotoxic properties • formation of NFTs and SPs
Pathogenesis
Gene mutation• amyloid precursor protein (APP, on chromosome 21),
• presenilin I (on chromosome 14)• presenilin II (on chromosome 1)• lipoprotein E-epsilon 4 genotype
Pathology
cerebrocortical atrophy• temporal lobe• front lobe• parietal lobe
Pathology
•senile plaques (SPs)•neurofibrillary tangles•lose of neurons•granulovacular degeneration•cerebral amyloid angiopathy
Pathology
•neurofibrillary tanglesmicrotubule-associated protein tau-hyperphosphorylated.
Pathology
•lose of neurons• granulovacular degeneration•cerebral amyloid angiopathy
Clinic
•M=F•>65 y-o 5%•>85 y-o 20%•sporadic 90%
•familial history 5%
Clinic
Abnornalities in• ability of daily living• behaviour• cognition• mismanagement of funds or serious lapses in their family, social, and occupational responsibilities
Clinic
Early stage• slowly progressive memory loss of insidious onset in a fully consciousness, trouble remembering recent events or activities
• orientation disturbance• language disorders with communication
Clinic
Early stage• inability to solve simple arithmetic problems
• impairment in their visuospatial skills
Clinic
Early stage• problems with activities of daily living
• frontal gait• walk away from home and get lost • difficulty recognizing familiar people or things
• Greater risk of falls and accidents• cognition
Clinic
Late• more serious symptoms• psychiatric syndromes• Loss of mobility• behaviour
Clinic
Late• epilepsy• extrapyramid sign• clonus• pyramid sign• fecal incontinence
WORK-UP
Imaging Studies• CT & MRI:cerebrocortic atrophy Lab Studies:• CSF tau protein Aβ • cognic scales •gene detection:
APP, PS-1, ApoE4
Psychology assessment scale • MMSE• WAISRC• CDR• BBS• HIS
Diagnosis• Age: 40-90 y-o• clinic manifestation of dementia + psychology assessment scale
• progressive memory & mental disturbance
• cognition disturbance • no consciousness problem• excluding encephalopathy
Differential diagnosis
• Mild cognitive impairment • Depression• Vascular dementia• Frontotemporal dementia• Dementia with Lewy body
Vascular dementiathe second most common cause of dementia• Cause: atherosclerosis, lacular infarctions in subcortic, basal ganglia and thalamus
• related to high blood pressure, high cholesterol, heart disease, diabetes, and related conditions. Treating those conditions can slow the progress of vascular dementia
Treatment• cholinesterase inhibitors (ChEIs) & the avoidance of centrally acting anticholinergic medications
• psychotropic medications & behavioral interventions Risperidone
• neuroprotect agents• N-methyl-D-aspartate (NMDA) antagonists• anti-inflammatory agents• clioquinoline, an antibiotic
TreatmentCentrally cholinesterase inhibitors (ChEIs)• tacrine• Aricept5 mg PO qn for 3-4 wk, the 10 mg PO qd
• Exelon1.5 mg PO bid for 1 mo, 3 mg PO bid for 1 mo, 4.5 mg PO for 1 mo, then 6 mg PO bid
• Galantamine4-12 mg PO bid bid
ChEIs adverse effects• nausea• vomiting• diarrhea• dizziness.
Neuroprotective agents
• Free-radical scavengers:Vitamin E 1000 IU PO bid
• MAO-BI: selegillin• gingko biloba•duxil
Patient education
•patient education• Both physical and mental activities are recommended
• cognitive retraining
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