 Most common and important degenerative disease of the brain  Shrinkage in size and weight of the brain  Severe degree of diffuse cerebral atrophy that evolve over the years are associated with dementia presenting with this disease

 Insidious in onset  Gradual development of forgetfulness  major symptom  Failure in cerebral function manifested disturbances in vocabulary and writing  Amnesia, aphasia, agnosia, and apraxia  Changes in locomotion  Lengthy pre-clinical period  7 years or more  Symptomatic course  5 years or more

 Early stages of Alzheimer disease are usually dominated by a disproportionate failure of retentive memory, with integrity of other cognitive abilities  Short and long term memory fails  e.g. impairment of retentive memory to the point that a patient can recall nothing of what he has learned a minute or 2 previously

 Forgetting of words esp. proper names  Progresses to a point where fluency is seriously impaired

 Derangement of parieto-occipital functions  “posterior cortical dementia”  Prosopagnosia, losing one’s way in familiar surrounding, difficulty, inability to interpret a road map, to distinguish right from left, or to park or garage a car, and difficulty in setting the table or dressing are all manifestations of a special ailure to orient the schema of one’s body with that of surrounding space.  Neglect of stimuli in one visual field  Gerstmann syndrome

 Most prominent event  May appear before the more obvious memory or language defects announce themselves

 2 nd most common form of dementia after Alzheimer's disease  degenerative cerebrovascular disease that leads to a progressive decline in memory and cognitive functioning  occurs when the blood supply carrying oxygen and nutrients to the brain is interrupted by a blocked or diseased vascular system  higher in men than in women  incidence increases with age  2 nd most common form of dementia after Alzheimer's disease  degenerative cerebrovascular disease that leads to a progressive decline in memory and cognitive functioning  occurs when the blood supply carrying oxygen and nutrients to the brain is interrupted by a blocked or diseased vascular system  higher in men than in women  incidence increases with age

 Stroke-related dementia ◦ Single-infarct dementia ◦ Multi-infarct dementia  Small vessel disease-related dementia ◦ known as sub-cortical vascular dementia ◦ Binswanger's disease (severe form)  Vascular dementia and Alzheimer's disease (mixed dementia)  Stroke-related dementia ◦ Single-infarct dementia ◦ Multi-infarct dementia  Small vessel disease-related dementia ◦ known as sub-cortical vascular dementia ◦ Binswanger's disease (severe form)  Vascular dementia and Alzheimer's disease (mixed dementia)

Physical signs/symptoms  Memory problems; forgetfulness  Dizziness  Leg or arm weakness  Lack of concentration  Moving with rapid, shuffling steps  Loss of bladder or bowel control Physical signs/symptoms  Memory problems; forgetfulness  Dizziness  Leg or arm weakness  Lack of concentration  Moving with rapid, shuffling steps  Loss of bladder or bowel control Behavioral signs/symptoms  Slurred speech  Language problems  Abnormal behavior  Wandering or getting lost in familiar surroundings  Laughing or crying inappropriately  Difficulty following instructions  Problems handling money Behavioral signs/symptoms  Slurred speech  Language problems  Abnormal behavior  Wandering or getting lost in familiar surroundings  Laughing or crying inappropriately  Difficulty following instructions  Problems handling money

 high blood pressure  diabetes  high cholesterol  family history of heart problems  disease in arteries elsewhere in the body  heart rhythm abnormalities  lifestyle factors (overweight/smoking)  high blood pressure  diabetes  high cholesterol  family history of heart problems  disease in arteries elsewhere in the body  heart rhythm abnormalities  lifestyle factors (overweight/smoking)

 taking medication to treat any underlying conditions ◦ control high blood pressure and heart disease  commitment to a healthier lifestyle ◦ stopping smoking, taking regular exercise, healthy diet and drinking alcohol in moderation  receiving rehabilitative support ◦ physiotherapy, occupational therapy and speech therapy  taking medication to treat any underlying conditions ◦ control high blood pressure and heart disease  commitment to a healthier lifestyle ◦ stopping smoking, taking regular exercise, healthy diet and drinking alcohol in moderation  receiving rehabilitative support ◦ physiotherapy, occupational therapy and speech therapy

 Characterized by visual hallucinations, parkinsonism, fluctuating alertness, falls and often REM sleep behavior disorders  Dementia can precede or follow the appearance of parkinsonism  Highly susceptible to metabolic perturbation; some may manifest first with delirium precipitated by infection or other systemic disturbance

 Better memory than AD but more severe visuospatial deficits  Key pathologic feature: LEWY BODIES in the cortex, amygdala, cingulate cortex, and substantia nigra.