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ALZHEIMERS DEMENTIA
A. Laksmidewi
Department Of Neurology Faculty Of Medicine, Udayanauniversity
Sanglah Hospital Denpasar
THE NEUROBEHAVIOR
DEMENTIA
Diagnose? Management?
COMMON SYMPTOM OF DEMENTIA
Slide 9
Inside the Human
BrainMain Players
The Three
Slide 10
Inside the Human
BrainMain Players
The Three
Slide 11
Inside the Human
Brain
Other Crucial Parts
Slide 12
VASCULAR DEMENTIA(VaD)
VaD is probably the second most common form of
dementia
Dementias presenting with prominent motor features
VaD is a heterogenous syndrome
Pathophysiological classification of VaD are due to:
-Vessel size, Haemodynamic factors,
Venous occlusion,Hemorrhagic factors
-Mixed type dementia
NT. deficit occurred in VaD especially in the
cholinergic system
Clinical sign ,relevant with location, volume &
pathophysiologies.
The DSM-IV definition for VaD
III Evidence that I and II are temporally linked , e.g one of the following
*No evidence for cognitive decline prior to stroke episode
*Abrupt onset of dementia with focal neurologic features
*Step wise decline in cognition
VaD, Criteria NINDS-AIREN
I.Probable VaD:
a. Deficits in multiple domains of cognitive functions, confirmed
clinically and neuropsychologically
and interfering with every day life.
b. CVD: Focal neuro signs & evidence of VD on CT or MRI.
c. Temporal relationship between I a & I b.
Features consistent include: early gait disturbance, unsteadiness .
Urinary symptoms,pseudobulbar palsy, personality and mood
changes.
Features that make diagnosis unlikely include: early memory
deficit/progressive without focal lesions on neuroimaging ,
absence of focal neuro signs, absence of vascular lesions on CT
or MRI.
CONTINUE.
II.Possible VaD:
a. Features of section I a with focal neuro signs but
CT/MRI has not been performed to confirm vascular
lesion
b. Absence of a temporal relationship between I a & I
b.
1. Multi-infarct dementia.
2. Strategic single infarct dementia.
3. Small vessel disease with dementia.
4. Ischemic-hypoxic dementia.
5. Hemorrhagic dementia.
RISK FACTORS FOR VAD:
1. Hypertension.
2. Alcohol use.
3. Smoking.
4. Dietary factors.
5. D.M.
6. Hematologic factors.
Assessment
Cognition
Dementia
Function Behavior
Ass.
Slide 20
AD and the
Brain
Mild to Moderate AD
AD spreads through the brain.
The cerebral cortex begins to
shrink as more and more neurons
stop working and die.
Mild AD signs can include
memory loss, confusion, trouble
handling money, poor judgment,
mood changes, and increased
anxiety.
Moderate AD signs can include
increased memory loss and
confusion, problems recognizing
people, difficulty with language
and thoughts, restlessness,
agitation, wandering, and
repetitive statements. Slide 21
AD and the
Brain
Severe AD
In severe AD, extreme shrinkage
occurs in the brain. Patients are
completely dependent on others
for care.
Symptoms can include weight
loss, seizures, skin infections,
groaning, moaning, or grunting,
increased sleeping, loss of
bladder and bowel control.
Death usually occurs from
aspiration pneumonia or other
infections. Caregivers can turn to
a hospice for help and palliative
care.
Slide 22
Alzheimer's Disease: Genetics and Biochemistry
Gross Pathology:
Diffuse cerebral atrophy
Dilatation of ventricles
Microscopic :
Neurofibrillary tangles (NFT)
Senile plaques (SP)
Targets in particular :
-cortex,hippocampus,amygdala
-cholinergic basal forebrain
Massive loss of synapses that correlates with
cognitive decline.
AD and the
Brain
Neurofibrillary
Tangles
PHARMACOLOGICAL THERAPY
-Cholinesterase Inhibitors
SKOR ISKEMIK HACHINSKI
NO AKTIVITAS 1 2 3
1 MAKAN
2 MENGENAKAN&MELEPASKAN PAKAIAN
3 MENYISIR RAMBUT & BERCUKUR
4 BERJALAN
5 TURUN & NAIK KE TEMPAT TIDUR
6 MANDI
7 KE KAMAR MANDI(TOILETING)
8 BUTUH BANTUAN UNT BELANJA,MANDI DLL
9 INKONTINENSIA(TIDAK; 1-2X/mgg ; 3 mgg )
IADL
NO AKTIVITAS 1 2 3
1. MENGGUNAKAN TELEPON
2. BEPERGIAN DGN KENDARAAN/ BIS/ TAKSI
3. BELANJA BAHAN MAKANAN & PAKAIAN
4. MENYEDIAKAN MAKANAN/TATA MEJA
5. MELAKUKAN PEKERJAAN RUMAH
6. MINUM OBAT SENDIRI
7. MENGATUR KEUANGAN SENDIRI
SKOR ISKEMIK HACHINSKI