Alzheimer Disease Dementia: an acquired, generalized, and often progressive impairment of cognitive function that affects the content, but not the level of consciousness.

Alzheimer Disease--- Etiology and pathogenesis Neurochemical: ChAT, ACh memory,cognitive functions ( hippocampus, neocortex) Genetic: Amyloid precursor protein(APP) gene presenilin 1(PS1), presenilin 2(PS2) apolipoprotein E(APOE4) FAD---autosomal dominant inherience

Alzheimer Disease--- Pathology Pathology  Senile plaques: APP deposited in its center Senile plaques  Neurofibrillary tangles (NFTs)(F1/F2)F1F2  mainly the loss of cholinergic neuron in superficial cortex  granulovacuolar degeneration  cerebral amyloid angiopathy

Alzheimer Disease--- Clinical findings  Early manifestations:  recent memory impairment(typically the first sign) disoriented(time,place)  leave work(aphasia, acalculia and anomia)  lost easily(apraxias and visuospatial disorientation)  depression  primitive reflexes

Alzheimer Disease--- Clinical findings  Late manifestations: lost the previously preserved social graces  psychiatric symptoms may be prominent  extrapyramidal rigidity and bradykinesia  Mutism, incontinence and bedridden state are terminal manifestations.

Alzheimer Disease--- Investigative studies & Differential diagnosis  CT or MRI scan often show cortical atrophy and enlarged ventricles(Non- special) & PET(F1/F2)F1F2  Early dementia: depression, senile forget and amnesia.

Alzheimer Disease--- Investigative studies & Differential diagnosis  More advanced dementia:multi-infarct dementia(step-wise progression), Creutzfeldt-Jakob disease(shorter course, characteristic EEG, prominent myoclonus).

Alzheimer Disease---Treatment & Prognosis  Symptomatic treatment:  cerebral vasodilators, neural protective drugs  acetylcholine precursors(choline and lecithin)

Alzheimer Disease---Treatment & Prognosis  AChE inhibitor, antipsychotic drugs rehabilitative management  Death typically occurs from 5~10ys after the onset of symptoms.