Alzhaimer and treatment

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Dementia

• Progressive deterioration of intellect,
  behavior and personality as a consequence of
  diffuse disease of the brain hemispheres,
  maximally affecting the cerebral cortex and
  hippocampus.
• Dementia is a symptom of disease rather
  than a single disease entity!!!

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Dementia
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• Memory must be impaired to make the diagnosis of
  dementia.
• Loss of memory for recent events is the earlist
  feature of dementia.
• Subsequent symptoms include abnormal behavior,
  loss of intellect, mood changes, and difficulty
  coping with ordinary routes.
• Insight may be retained initially, but is then
  usually lost.
• Ultimately, there is loss of self-care,
  wandering, incontinence, and often paranoia.

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• Dementia may occur at any age but is more common
  in the elderly, accounting for 40 of long-term
  psychiatric in-patients over the age of 65 years.
• The prevalence in persons aged between 50 and 70
  years is about 1 and in those approaching 90
  years reaches 50.
• An annual incidence rate is 190/100 000 persons.

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• Clinical course
• The rate of progression depends upon the
  underlying cause.
• The duration of history helps establish the cause
  of dementia Alzheimers disease is slowly
  progressive over years, whereas encephalitis may
  be rapid over weeks. Dementia due to
  cerebrovascular disease appears to occur stroke
  by stroke.

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Dementias classificationBased on cause

• Alzheimers disease (60 of all dementias)
• Cerebrovascular (multiinfarct state, subcortical
  small vessel, amyloid angiopathy,) (20)
• Neurodegenerative (DLB, Picks disease,
  Huntingtons chorea, Parkinsons disease)
• Infectious (Creutzfeld-Jakob disease, HIV
  infection, progressive multifocal
  leucoencephalopathy)
• Normal pressure hydrocephalus
  TREATABLE!
• Nutritional (thiamine deficiency in alcoholics!,
  B12 deficiency, folate deficiency)
• Metabolic (hepatic disease, thyroid d.,
  parathyroid d., Cushings syndrome)
• Chronic inflammatory (MS, )
• Trauma (head injury, Punch drunk syndrome)
• Tumour (e.g. subfrontal meningioma)

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Alzhaimer and Treatment
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Alzheimer's disease

• The commonest cause of dementia.
• The disorder rarely occurs under the age of 45
  years.
• The incidence increases with age.
• The cause of AD is not known (neurodegenerative
  d.).
• Up to 30 of cases are familial (the loci were
  found on chromosome 21 and 19).
• Pathology the presence of senile plaques and
  neurofibrillary tangles in the brain.
• Diagnosis of AD may be established during life by
  early memory failure, slow progression and
  exclusion of other causes.

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• Age is the most powerful risk factor for the
  development of AD, 65-85 years doubling in every
  5 year age group (age 85 in the range of of
  30-40).

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Risk factors

• Gender (womengtmen)
• Lower education
• Family history
• Coronary artery disease.
• Hypertension
• Hyperhemocysteine
• Head trauma
• Elevated fat in the diet

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Reduce the risk of AD

• The use of nonsteroidal anti- inflammatory drugs
  (NSAIDs)
• Anti oxidants
• Cholesterol lowering drugs

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Alzheimer's disease

• CT scanning aids diagnosis by excluding multiple
  infarction or a mass lesion.
• MRI shows bilateral temporal lobe atrophy.
• SPECT usually shows temporoparietal
  hypoperfusion.

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Treatment

• The primary pharmacological treatment AchE
  Inhibitors (AchEI)
• Exelon (rivastigmine)
• Reminyl (galantamine)
• Aricept (donepezil)

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• Improvement in cognitive function.
  Neurobehavioral symptoms.
• Apathy visual hallucinations.

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• Side effects
• GI effects

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• Dose of medication is increased progressively
  until either beneficial effects are noted or side
  effects interfere.

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• Memantine (N-methyl-D-aspartate antagonist)
• Awaiting a decision by the FDA (food drug
  Administration)
• Blocking potential excitotoxic stimulation of CNS
  neurons.

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Other medications

• Vit E antioxidant 1000 IU (BD)
• Estrogen or other hormone replacement
• Neither low-Dose prednisolone or NSAIDs

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Medications for Behavioral and neuropsychiatric
symptoms

• Efficient lighting
• Urinary tract infections
• Depression (SSRIs) and anxiety and irritability
• Agiotation (neuroleptic) risperidone-olonzapine
• - (SSRI) citaloperam
• Sleep (trazodone).