HPI A 73-year-old woman is brought to your practice by her husband who is concerned for his wife’s well-being. He explains that for the past few months.

Slides:



Advertisements
Similar presentations
Cognition enhancing or neuroprotective compounds for the treatment of cognitive disorders: why? when? which? Lockhart BP, Lestage PJ. January 2003.
Advertisements

Etiopathogenesis of Alzheimer's disease
Management of Early Dementia Dr Eleanor Mullan Consultant Psychiatrist Mental Health Services for Older People South Lee, Cork Feb 2011.
Demyelinating Diseases. Demyelination is a common degenerative change in the nervous system secondary to neuronal or axonal injury, But in the group of.
Martha Stearn, MD Institute for Cognitive Health St John’s Medical Center Jackson, Wyoming.
Alzheimer’s Disease By Juan Escobar Per: 4. Alzheimer’s Disease  A common form of dementia of unknown cause, usually beginning in late middle age, characterized.
Richard P. Halgin Susan Krauss Whitbourne University of Massachusetts at Amherst slides by Travis Langley Henderson State University Abnormal Psychology.
MCB 135K: Discussion March 2, General Info Mid-Term I: –Avg 87 –Std. Deviation 10 –Re-grades by next Wednesday Include a cover sheet that addresses.
Alzheimer’s Disease Dr. Murtaza (dictator ibby) Dr. Smith Dr. Probus Dr. Blandford.
Dementia with Lewy Bodies
DEMENTIA JOE BEDFORD IBRAHIM ELSAFY ESCALIN PEIRIS.
DEMENTIA By: Angela Pabon. What is Dementia? Dementia does not always mean that one has Alzheimer's disease, there are over 80 forms of dementia The definition.
Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine Palmerston North Hospital.
Alzheimer’s Disease By: Ryan Triplett. Alzheimer’s The deterioration of intellectual capabilities, memory, judgment, and personality to the extent that.
The Brain. Problems with the Brain… Dementia – group of symptoms affecting intellectual and social abilities severely enough to interfere with daily.
Middle and Old Age. Maximum Recorded Life Spans Human Indian Elephant Gorilla Common Toad Domestic Cat Domestic Dog Vampire Bat House Mouse
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 22 Alzheimer’s Disease.
Understanding the Person with Dementia Oxford Brookes University What is dementia? How do we diagnose it? What can we do? Sharon Christie OPTIMA, University.
Chapter 15 - Cognitive Disorders I.Delirium Acute, temporary impairment in perception & cognition Fluctuating course.
ALZHEIMER’S DISEASE BY OLUFOLAKUNMI KEHINDE PRE-MD 1.
Alzheimer’s Disease Angela Singh, PharmD Associate Professor of Pharmacy Practice Florida A&M University College of Pharmacy & Pharmaceutical Sciences.
Dementia syndrome.
Burcu Ormeci, MD Department of Neurology.  In the United States;  As many as 7 million people have dementia  Almost half of all people age 85 and older.
Methodological Issues 4 Age effects - the consequence of being a given chronological age 4 Cohort effects - the consequences of having been born in a given.
Biological Myths of Aging Memory declines drastically with age for all people. IQ declines drastically with age in all people. Learning becomes more difficult.
Clear organic causes, where primary symptom is a significant deficit in cognitive ability changes in the person’s personality and behavior (due to the.
Dementia in Clinical Practice Mary Ann Forciea MD Clinical Prof of Medicine Division of Geriatric Medicine UPHS Photo: Nat Geographic.
DEMENTIA AND ALZHEIMER'S DISEASE. IMPAIRMENT OF BRAIN FUNCTION ( DECLINE IN INTELLECTUAL FUNCTIONING) THAT INTERFERES WITH ROUTINE DAILY ACTIVITIES. MENTAL.
Alzheimer’s Disease Causes, Effects, and Treatments.
1 TOPIC 13 COGNITIVE DISORDER.  Dissociative disorder involve changes or disturbances in identity, memory or consciousness that affect the ability to.
Cristopher Ramirez Psychology Period 6. A common form of dementia, usually beginning in late middle age, characterize by memory lapses, confusion, emotional.
VIII. NEURODEGENERATIVE DISEASES. - Are disorders characterized by the cellular degeneration of subsets of neurons that typically are related by function,
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 33 Delirium and Dementia.
WHAT DO YOU REMEMBER ABOUT ALZHEIMER’S DEMENTIA?.
 Alzheimer's disease (AD), also known as Senile Dementia of the Alzheimer Type (SDAT) or simply Alzheimer’s is the most common form of dementia. This.
Alzheimer’s Disease By: Chelcy Branon. Facts  In 2006, there were 26.6 million sufferers worldwide  Costs 100 billion dollars per year.
NEUROCOGNITIVE DISORDERS
10 signs to early detection 1. Memory loss that affects daily life 2. Challenges in planning or solving problems 3. Difficulty completing projects at.
Dementia. What is Dementia? Dementia is a gradual decline of mental ability that affects your intellectual and social skills to the point where daily.
Dementia 痴呆 Jie Ming Shen, M.D., Ph.D. Department of Neurology Ruijin Hospital, SSMU.
DEMENTIA ABDULMAJEED ALOLAYAH What is DEMENTIA ? It is a chronic global impairment of cognitive functions without disturbed consciousness.
Amyotrophic lateral sclerosis
Dementia Care Wendy Burnett CNS for Older People.
Cognitive Disorders Chapter 13 Nature of Cognitive Disorders: An Overview Perspectives on Cognitive Disorders Cognitive processes such as learning, memory,
Dementia Nicholas Cascone, PA-C.
Neurobiology of Dementia Majid Barekatain, M.D., Associate Professor of Psychiatry Neuropsychiatrist Isfahan University of Medical Sciences Ordibehesht.
BY: AMAN SINGH AND ALLY MATTINGLY Alzheimer's Disease.
It is a chronic neurodegenerating disease that usually starts slowly and gets worse over time.
Pathogenesis and pathology of parkinsonism
Alzheimer's By Emily Toro Period 1.
Alzheimer’s Disease Stephanie Aparicio May 4, 2011 Period 5.
Orientation to Early Memory Loss. Let’s look for some answers… What is happening? What should I do? Where should I go?
Revealing the Various Types of Dementia. As one advances in age, the brain becomes vulnerable to various diseases and symptoms. Most of these changes.
Memory and Aging Educational Presentation Presented by Tessa Lundquist, M.S. University of Massachusetts Amherst.
Chapter 14 Neurocognitive Disorders
This is an umbrella term, not a disease in its own right. It is a term used for a large group of symptoms that adversely affect the brain and can be caused.
Chapter 10: Nursing Management of Dementia
DEGENERATIVE DISEASES is a disease in which the function or structure of the affected tissues or organs will progressively deteriorate over time, whether.
By Graham Maione ALZHEIMER’S DISEASE:ALZHEIMER’S DISEASE: A Comprehensive LookA Comprehensive Look.
Alzheimer Disease (Senile Dementia) Characterized by progressive memory loss, is increasingly common in developed countries as populations include more.
Alzheimer Disease Dementia: an acquired, generalized, and often progressive impairment of cognitive function that affects the content, but not the level.
DEMENTIA 1/6/16 DR TONY O’BRIEN MD FRCP. Dementia Common – 700,000 sufferers in the UK Common – 700,000 sufferers in the UK Prevalence increases with.
Title: Alzheimer’s disease and the social
Alzheimer Disease Dementia: an acquired, generalized, and often progressive impairment of cognitive function that affects the content, but not the level.
Alzheimer Disease Dementia: an acquired, generalized, and often progressive impairment of cognitive function that affects the content, but not the level.
“The effects of chronic changes to the functioning of the nervous system due to interference to neurotransmitter function, illustrated by the role of Dopamine.
Dementia Supischa Theerasasawat Eric Pfeiffer, M.D J. Wesson Ashford
Chapter 30 Delirium and Dementia
Drugs for Degenerative Diseases of the Nervous System
Alzheimer's.
Presentation transcript:

HPI A 73-year-old woman is brought to your practice by her husband who is concerned for his wife’s well-being. He explains that for the past few months he has noticed a severe decline in his wife’s short term memory. At first he attributed this to “normal aging”, but has recently noticed that has become less involved in her bridge club and rarely leaves the house. Of most concern, however, is a recent episode in which his wife had been preparing a meal for their son’s visit and had left the gas stove on for several hours unattended. What other questions would you like to ask?

HPI Medical Hx: Tonsilectomy (1948), Hysterectomy (1989) Family Hx: Mother suffered from dementia and HTN, Father had HTN and CAD Social Hx: Married 55 years, 2 children, works as a substitute teacher What is your differential diagnosis?

Differential Diagnosis MCI Dementia – Alzheimer’s disease – Vascular dementia – Mixed dementia – Dementia with Lewy bodies (DLB) – Frontotemporal dementia (FTD) Depression (“Pseudodementia”) Hypothyroidism Normal pressure hydrocephalus (NPH) Infection – Neurosyphilis Head trauma – Chronic subdural hematoma Side effect of medication Vitamin deficiency – B12 What is your next step in assessing the patient?

Physical Exam Vitals: – BP 115/48 – T 37.3 – RR 22 Gen: The patient is calm and cooperative CV, Resp, abdominal exams: all wnl Psych: negative depression screen Neuro: – alert and oriented to person and place, unable to name the day of the week. – Registration 3/3, recall 0/3 at 5 minutes – Unable to recall what the patient ate for breakfast this AM – MMSE: 21/30 – Speech is fluent and appropriate in content – CN II-XII grossly intact – Motor: Strength 5/5 proximal and distal bilateral upper and lower extremeties – Sensory: intact to light touch, pinprick, and vibration throughout – MSRs 2+ and equal in upper and lower extremeties – Downgoing plantar response bilaterally – No resting or intention tremor – Tone normal (no rigidity) – Gait is smooth; not wide-based

Laboratory tests CBC: normal WBC: 6,000 TSH: 2.7 uU/mL (normal) Free T4: normal B12: 816 pg/mL (normal) VDRL/RPR: negative What would you like to do next?

MRI MRI can detect patterns of cerebral atrophy suggestive of various neurodegenerative diseases. In AD, cortical atrophy is seen as accentuation of the sulci and is localized most commonly to the frontal, temporal, and parietal lobes. Commonly, hippocampal atrophy is seen. What does this pattern of atrophy suggest? What further testing can we perform?

Neuropsychological Tests Tests were preformed in order to identify lapses in cognitive function and abilities. Patient was found to be profoundly affected by short-term memory loss, testing in the 3 rd percentile. The patient was asked to draw a clock face displaying a time of 2:45. The patient scored a four based on the following scale:

Alzheimer’s Disease AD is the most common cause of dementia (~50%) Alzheimer disease (AD) is a neurodegenerative disorder of uncertain cause and pathogenesis that primarily affects older adults. The main clinical manifestations of AD are selective memory impairment and dementia. AD symptoms are likely a result of the accumulation of neuritic (senile) plaques as well as neurofibrillary tangles. How would you like to proceed with this patient?

Histological interpretations Light micrograph of human brain tissue in Alzheimer's disease, showing a senile plaque (pale area in center), a characteristic histological feature of the disease. Alzheimer's disease is a form of progressive dementia; the brain is smaller than normal, with degenerative changes affecting the frontal and temporal lobes. Senile plaques are extracellular tangled masses of filaments & granules, often centered around an area of amyloid beta. Amyloid beta is derived from the larger protein amyloid precursor protein (APP) located on chromosome 21. Other genes associated with AD are presenilin 1 and 2. The main other feature of Alzheimer's disease is the formation of neurofibrillary tangles, masses of thickened filaments in the cytoplasm of neurons (nerve cells).

Histological features cont’d Neurofibrillary tangles are bundles of filaments in the cytoplasm of the neurons that displace the nucleus. They are composed of abnormal tau protein (tauopathy), which normally acts as a microtubule stabilizing protein. In pyramidal neurons, they often have an elongated flame shape, as demonstrated in this slide.

Treatment While treatments are available that can modulate the course of the disease and/or ameliorate some symptoms, there is no cure, and the disease inevitably progresses in all patients. Most treatments are designed to augment the neurotransmitter acetylcholine. Acetylcholinesterase inhibitors (Aricept) are the only drugs that are known to slow the progress of AD-related memory loss. NMDA glutamate receptor antagonists (memantine/Namenda) are also commonly used to slow the progression of AD. Antidepressants and antipsychotics are frequently employed to treat behavioral disturbances.

Summary The patient and her husband were given information on the disease and some symptoms that might manifest as its progression continues. Language deficits, loss of mathematical skills and eventual loss of learned motor skills are commonly found in late-stage AD. In final stages, patients may become incontinent, mute, or unable to walk.

Neuropsychological Testing Role in Diagnosis Helpful in the evaluation of individuals with cognitive impairment and dementia. Cognitive testing under standardized conditions using demographically appropriate norms is more sensitive to the presence of impairments, especially impairments of executive function. Can establish a baseline in order to follow the patient over time. Neuropsychological assessment can also help differentiate between dementia and depression. Can assess competencies and guide recommendations pertaining to driving, financial decisions, and need for increasing supervision