Alzheimer’s Disease ….And other dementias….

AD Can be divided into Early Onset ( 60). Perhaps two different etiologies After age 65, the number of cases doubles every 5 years. 3% of people have the disease Approx. 50% of people over 85 have the disease.

GRADING SYSTEM Grade 1 (top row of 4 images) corresponds to mild cerebral atrophy and ventricular dilatation. Note this degree of change may be assessed as compatible with normal aging. Thus, grade 1 accomodates scoring of brains from nondemented control subjects with minimal or no gross neuropathology. Grade 2 (middle row of 4 images) corresponds to moderately severe cerebral atrophy and ventricular dilatation. Note widening of sulci, rounding of frontal horns, and expansion of the area of the body and 3rd ventricle. Grade 3 (bottom row of 4 images) corresponds to severe cerebral atrophy and ventricular dilatation. Dramatic shrinkage of gyri, gaping of some sulci, and extreme ventricular dilatation is obvious. Note also the white matter area is markedly diminished from the amount noted in grade 1 brains.

Plaques Extracellular Contain A-beta (sequence cleaved from APP) Metals (aluminum, zinc) Immunoglobulin G Amyloid P apoE ETC….over 30 other proteins

Tangles Intracellular Bundles of long unbranched elements that form a fibrous twisted pair of filaments Consist of tau protein (a protein that ordinarily stabilizes cellular microtubules) Are somewhat correlated with degree of dementia – post-mortem.

1- Memory 2- Orientation 3- Judgment 4- Community Affairs 5- Home & Hobbies 6- Personal Care Axis of Diagnosis

Impairment Level and CDR Score (0, 0.5, 1, 2, 3) None 0 Question able 0.5 Mild 1 Moderat e 2 Severe 3 Memo ry No memory loss or slight inconsistent forgetfulnes s Consistent slight forgetfulnes s; partial recollection of events; "benign" forgetfulnes s Moderate memory loss; more marked for recent events; defect interferes with everyday activities Severe memory loss; only highly learned material retained; new material rapidly lost Severe memory loss; only fragments remain Orient ation Fully oriented Fully oriented except for slight difficulty with time relationship s Moderate difficulty with time relationship s; oriented for place at examinatio n; may have geographic disorientati on elsewhere Severe difficulty with time relationship s; usually disoriented to time, often to place Oriented to person only

Judg ment & Probl em Solvin g Solves everyday problems & handles business & financial affairs well; judgment good in relation to past performanc e Slight impairment in solving problems, similarities, and differences Moderate difficulty in handling problems, similarities, and differences; social judgment usually maintained Severely impaired in handling problems, similarities, and differences; social judgment usually impaired Unable to make judgments or solve problems Com munit y Affair s Independen t function at usual level in job, shopping, volunteer and social groups Slight impairment in these activities Unable to function independen tly at these activities although may still be engaged in some; appears normal to casual inspection No pretense of independen t function outside home Appears well enough to taken to functions outside a family home No pretense of independen t function outside home Appears too ill to be be taken to functions outside a family home

Home and Hobbi es Life at home, hobbies, and intellectual interests well maintained Life at home, hobbies, and intellectual interests slightly impaired Mild but definite impairment of function at home; more difficult chores abandoned; more complicate d hobbies and interests abandoned Only simple chores preserved; very restricted interests, poorly maintained No significant function in home Perso nal Care Fully capable of self-careNeeds prompting Requires assistance in dressing, hygiene, keeping of personal effects Requires much help with personal care; frequent incontinenc e