癡呆dememtia-神經(jīng)病學雙語課件

1、DementiaZheng dongmingDementiaZheng dongmingWhat 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. What is denmentia ?Dementia r

2、eDiseases that can cause dementiaDegenerative disease:AlzheimerdiseaseNondegenerative disease:vascular dementiaDiseases that can cause dementAlzhemierdisease(AD)The most frequent cause of dementiadescribed by Alzhemier in 1907more female than malefamilial AD :autosomal dominant inheritanceAlzhemierd

3、isease(AD)The most Etiology and pathogenesisThe cause of Alzheimers Disease is not fully understood. It is believed there may 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) Acetylchol

4、ine is required for the normal functioning of the brain cells and, as levels of the chemical decrease, plaques form creating 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.Etiology

5、 and pathogenesisThe cPathology Senile plaques:characteristic changeneurofibrilary tangles,NFTsgranulovacuolar degenerationloss of neuroncrebral amyloid angiopathyPathology Senile plaques:chara癡呆dememtia神經(jīng)病學雙語課件Clinical findingsMemory impairment:impairment of recent memory is typically the first sig

6、n of Alzheimers disease-often noticed only by family gress gradually.Clinical findingsMemory impairClinivcal findingsCognitive impairment:aphasiadisorientation to time , place,visuospatial,lost easy.acaculiaapraxiaunable to learn,work,social activityClinivcal findingsCognitive imClinical

7、findingsPsychiatric symptoms:depression,apathydelirium,euphoriaparanoiahallucinations,delusioninsomniaClinical findingsPsychiatric sCliniacal findingsRestless, agitatedlost of social graceno pyramidal signs seizureextraspyramidal signs:Parkinson syndromsCliniacal findingsRestless, agInvestigative st

8、udiesCT,M RI show cortical atrophy,enlarged ventricles.Mini-mental state examination MMSEWAIS-RCCDR,BBS,HISInvestigative studiesCT,M RI sDiagnosis of NINCDS-ADRDAProbable:age,exclusion otherspossibledefinitiveDiferrential diagnosis:1.MCI2.depression3.dementia of other causesDiagnosis of NINCDS-ADRDA

9、Proba National Institute of Neurological and Communicative Disorders and Stroke (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 examinatio

10、n.(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. National InstittreatmentNo effective method.AChE inhibitor:Tacrine,donepezilsymptomatic therapyrehab