神經(jīng)內(nèi)科英文教學(xué)課件癡呆

1、Dementia癡呆What is denmentia ?Dementia refers to an acquired,genneralized,persisting and often progressive impairment of intelligence that affects the content,but not the level,of conciousness.Age: 60 1% 85 40% But dementia is not aging. Diseases that can cause dementiaDegenerative disease:Alzheimerd

2、iseaseNondegenerative disease:vascular dementiaAlzhemierdisease(AD)The most frequent cause of dementiadescribed by Alzhemier in 1907more female than malefamilial AD :autosomal dominant inheritanceEtiology and pathogenesisThe cause of Alzheimers Disease is not fully understood. It is believed there m

3、ay be genetic (hereditary) factors involved.(APP,PS1,PS2,ApoE)With the disease, there is a striking deficiency of a substance called acetylcholine in the brain.(ChAT) Acetylcholine is required for the normal functioning of the brain cells and, as levels of the chemical decrease, plaques form creatin

4、g bundles of fibers (neurofibrillary tangles).Environmental factors may also have an influence on the progress of the disease, but the extent of this is not fully known.Pathology Senile plaques:characteristic changeneurofibrilary tangles,NFTsgranulovacuolar degenerationloss of neuroncrebral amyloid

5、angiopathyClinical findingsMemory impairment:impairment of recent memory is typically the first sign of Alzheimers disease-often noticed only by family gress gradually.Clinivcal findingsCognitive impairment:aphasiadisorientation to time , place,visuospatial,lost easy.acaculiaapraxiaunable

6、 to learn,work,social activityClinical findingsPsychiatric symptoms:depression,apathydelirium,euphoriaparanoiahallucinations,delusioninsomniaCliniacal findingsRestless, agitatedlost of social graceno pyramidal signs seizureextraspyramidal signs:Parkinson syndromsInvestigative studiesCT,M RI show cor

7、tical atrophy,enlarged ventricles.Mini-mental state examination MMSEWAIS-RCCDR,BBS,HISDiagnosis of NINCDS-ADRDAProbable:age,exclusion otherspossibledefinitiveDiferrential diagnosis:1.MCI2.depression3.dementia of other causes National Institute of Neurological and Communicative Disorders and Stroke (

8、NINCDS) and the Alzlieimers Disease and Related Diseases Association (ADRDA) proposed :(l) Dementia defined by clinical examination, the Mini-Mental Scale, the Blessed Dementia Scale, or similar mental status examination.(2) Age of patient (over 40 years).(3) Deficits in two or more areas of cognition and progressive worsening of memory and other cognitive functions-such as language, perception, and motor skills (praxis).(4) Absence of disturbed consciousness.(5) Exclusion of other brain diseases.treatmentNo effective method.AChE inhibitor:Tacri