Alzheimers_Disease

Alzheimers Disease (AD) is clinically pure dementia syndrome without clinical evidence of another underlying disease, relevant to the observed cognitive impairment. Regards to epidemiology, AD is the most common cause of AD in the elderly and its prevalence increases with age. Causes can be unknown, Risk factors – age, Depression, Family history of dementia in 1st degree relatives, Same risk factors of Cardio vascular disease, Genetics – apolipoprotein E epsolin 4 allele, Trisomy 21 In Neuropathology there is increased no. of neuritic plaques in the cereral cortex, reactive astrocytes and microglia may appear on may appear at periphery of these plaques. Neurofibrillary tangles, amyloid angiopathy and granolovacuolar degeneration. Cognitive and behavioural manifestations: Memory Loss – is the most presenting feature of Ad Memory of recent events and ability to learn new information are affected and deteriorate over time. - language impairment (anomia and sensory like aphasia) - Depression, delusion, loss of interest in personal habits and community affairs Diagnosis - there is no biologic or neurophysiologic marker for AD - defn diagnosis can only be made from a combo of clinical and histopath findings. Course has 3 stages: 1) Probable AD – dementia, impairment in memory, progressive worsening of memory and 1 other cognitive fn, no disturbance in conciousness, onset btw 40-90 years. As well as loss of motos skills, diminishes ADL’s. 2) Possible AD – fulfillment of the above criteria with variation in onset or clinical course, or a single but gradually progressive cognitive impairment without identifiable cause. 3) Definitive AD – fulfillment of above and histo evidence of AD based on autopsy/brain tissue biopsy. Stages of symptoms Stage 1 (MILD) – lasts 2-3 years, patient shows ST memory impairment, anxiety, depression Stage 2 (MOD) – neuropsychiatric manifestations, visual hallucinations, false beliefs Stage 3 (SEV) – motor sign decline, cognitive decline Neuroimaging techniques - CT of brain - MRI - CBF - PET Management - AD is not curable - Physician must treat medical problems, maintain patients nutrition and monitor drug use. - M includes simplification, definition and familiarization of the pt’s environment, whilst avoiding isolation and understimulation. - Orientation therapy - Exercise to reduce restlessness - Occupational and music therapy - Group therapy and family counseling services - Multidisciplinary approach - Presence of depression and paranoia may require psychoactive meds - Cholinergic augmentation therapy – with cholinesterase inhibitors eg tacrine, galantamine (4m x 2d), Rivastigmine (1.5mg 2xd), Donepezil (5mgx1d) - N-methyl D aspartate antagonist - Memantine block the toxic effects associated with excess glutamate - Slowing progession of AD, but not approved – Alpha Tocopherol