DEMENTIA AND ALZHEIMER’S DISEASE

• Define and classify Dementia. Describe the clinical manifestations of

Alzheimer’s disease. (4+6)
• S/N – Dementia.
• Dementia is an acquired progressive dysfunction of brain that leads to gradual
decline in Cognitive abilities ( mainly memory ) and hampers Activities of daily life
( ADL ).
• MC cause of dementia is Alzheimer’s disease.
CLASSIFICATION

• Vascular – Multi infarct dementia.

• DEGENERATIVE – 1. Alzheimer’s disease.
2. Fronto-temporal dementia.
3. Huntington’s disease.
4. Parkinson’s disease
5. Pick’s disease.
6. Progressive supranuclear palsy.
7. Dementia with Lewy bodies.
• Head injury.
• Chronic infection – Prion disease, HIV, TB
CONT.

• Drugs and Alcohol.

• Vitamin B1 and B12 deficiency.
• Hypothyroidism.
• Liver failure.
• Normal pressure hydrocephalus.
• Brain tumors.
ALZHEIMER’S DISEASE

• Onset – age 65 – 85 years has 30-40% incidence.

• Risk factors – Age
Female
Genetic and family history – ApoE4
Low socio economic group
Heart disease
High fat diet
• Early onset recent memory loss is the earliest feature.
CLINICAL FEATURES

• MEMORY LOSS –
Short term recent memory.
Long term memory is usually preserved.
• LANGUAGE –
Loss of verbal fluency and difficult word finding.
Aphasia
• Disorder of perception and visual orientation.
• Anosognosia – unawareness of cognitive deficit.
• Apraxia – inability to perform skilled task.
 NEUROPSYCHIATRIC SYMPTOMS
MOOD DISTURBANCES – Depression
Agitation
BEHAVIOURAL CHANGES – Verbal and physical aggression
Wandering aimlessly
Uncooperating
Urinary incontinence
THINKING DISORDER – Hallucination
Delusion
PERSONALITY CHANGES – Apathy and detachment from surrounding
Social disengagement
PATHOLOGY

• Deposition of Amyloid plaques.

• Neurofibrillary tangles – twisted
neurofilaments in the cytoplasm of
TAU protein.
• Reduction of Acetylcholine in various
cortical areas.
• Loss of neurons.
• Reduced in size of Hippocampus.
• Reduced size of Amygdala.
• Increased size of Ventricles.
IMAGING

• Cortical atrophy in the Temporal and

Parietal lobe.
• Hippocampal atrophy.
• CT scan also rules out structural
lesions like hemorrhage and tumors.
MEDICAL TREATMENT

• TACRINE – Cholinesterase inhibitor that increases the concentration of

Acetylcholine and decrease the rate of cognitive decline.
• DONEPEZIL – same as Tacrine. Has better absorption and long acting.
• RIVASTIGMINE – better acting.
• MEMANTINE – binds to Magnesium receptors and inhibits the influx of Calcium
and thus reduces neuronal excitability.