Ternopil State Medical University named I.Horbachevsky

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Ternopil State Medical University named
I.Horbachevsky

• Chair of neurology, psychiatry, narcology and
  medical psychology
• Prep. by Roksolana Hnatyuk
• M.D., Ph.D.

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• Head Trauma Alzheimer's Disease, Picks Disease

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Traumatic psychoses
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Healthy and affected brain cell
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Amnesia -

• is lost of explicit memory.
• The central symtom of amnestic disordersis
  development of memory disorder characterized by
  impairment in the ability to learn new
  information (anterograde amnesia) and the
  inability to recall previously remembered
  knowledge (retrograde amnesia).

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Anterograde amnesia -

• the inability explicitly to recall events that
  occurred after whatever trauma caused memory
  loss.
• Retrograde amnesia - the inability explicitly to
  recall events that occurred before whatever
  trauma caused memory loss.

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Syndroms of psychic disorders in different period
of trauma
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Intelligence -

• the ability to understand, recall, mobilize and
  constructively integrate previous learning in
  meeting new situations.

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Mental retardation
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Mental retardation
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What Are Some Dementia Types?

• The effects of the different dementia types are
  similar, but not identical, as each one tends to
  affect different parts of the brain.
• Here are the
• AIDS related dementia
• Alcohol related dementia
• Alzheimer's disease, has two forms
• Familial Alzheimer's Disease (FAD), also known as
  Early Onset Alzheimer's or Younger Onset
  Alzheimer's.

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Alzheimer's disease

• AD is by far the most common cause of dementia in
  the elderly, accounting for 6080 of cases. It
  is estimated that four million adults in the
  United States suffer from AD. The disease strikes
  women more often than men, but researchers don't
  know yet whether the sex ratio simply reflects
  the fact that women in developed countries tend
  to live longer than men, or whether female sex is
  itself a risk factor for AD. One well-known
  long-term study of Alzheimer's in women is the
  Nun Study, begun in 1986 and presently conducted
  at the University of Kentucky.

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The criteria for diagnosing Alzheimer's include

• - Memory Loss. Alzheimer's patients will begin
  to lose short-term memory. As the illness
  progresses, patients begin to lose memory of
  familiar friends, family members, objects, and
  places. - Loss of mobility, or impaired ability
  to perform everyday tasks.

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• Disorientation and wandering. Alzheimer's
  patients may become disoriented in familiar
  places. Alzheimer's patients may also roam and
  wander away from their home. - Impaired
  language ability. Many Alzheimer's patients lose
  the ability to converse with ease. They may grasp
  for words, or find themselves incapable of
  telling a coherent story. - Aggression,
  paranoia - Chronic insomnia and depression

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Diagnosis

• In some cases, a patient's primary physician may
  be able to diagnose the dementia in many
  instances, however, the patient will be referred
  to a neurologist or a gerontologist (specialist
  in medical care of the elderly). Distinguishing
  one disorder from other similar disorders is a
  process called differential diagnosis. The
  differential diagnosis of dementia is complicated
  because of the number of possible causes because
  more than one cause may be present at the same
  time and because dementia can coexist with such
  other conditions as depression and delirium.
  Delirium is a temporary disturbance of
  consciousness marked by confusion, restlessness,
  inability to focus one's attention,
  hallucinations, or delusions. In elderly people,
  delirium is frequently a side effect of surgery,
  medications, infectious illnesses, or
  dehydratation. Delirium can be distinguished from
  dementia by the fact that delirium usually comes
  on fairly suddenly (in a few hours or days) and
  may vary in severity it is often worse at night.
  Dementia develops much more slowly, over a period
  of months or years, and the patient's symptoms
  are relatively stable. It is possible for a
  person to have delirium and dementia at the same
  time.

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Mental status examination

• A mental statuse examination (MSE) evaluates the
  patient's ability to communicate, follow
  instructions, recall information, perform simple
  tasks involving movement and coordination, as
  well as his or her emotional state and general
  sense of space and time. The MSE includes the
  doctor's informal evaluation of the patient's
  appearance, vocal tone, facial expressions,
  posture, and gait as well as formal questions or
  instructions. A common form that has been used
  since 1975 is the so-called Folstein Mini-Mental
  Status Examination, or MMSE. Questions that are
  relevant to diagnosing dementia include asking
  the patient to count backward from 100 by 7s, to
  make change, to name the current President of the
  United States, to repeat a short phrase after the
  examiner (such as, "no ifs, ands, or buts") to
  draw a clock face or geometric figure, and to
  follow a set of instructions involving movement
  (such as, "Show me how to throw a ball" or "Fold
  this piece of paper and place it under the lamp
  on the bookshelf.") The examiner may test the
  patient's abstract reasoning ability by asking
  him or her to explain a familiar proverb ("People
  who live in glass houses shouldn't throw stones,"
  for example) or test the patient's judgment by
  asking about a problem with a common-sense
  solution, such as what one does when a
  prescription runs out.

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Neurological examination

• A neurological examination includes an evaluation
  of the patient's cranial nerves and reflexes. The
  cranial nerves govern the ability to speak as
  well as sight, hearing, taste, and smell. The
  patient will be asked to stick out the tongue,
  follow the examiner's finger with the eyes, raise
  the eyebrows, etc. The patient is also asked to
  perform certain actions (such as touching the
  nose with the eyes closed) that test coordination
  and spatial orientation. The doctor will usually
  touch or tap certain areas of the body, such as
  the knee or the sole of the foot, to test the
  patient's reflexes. Failure to respond to the
  touch or tap may indicate damage to certain parts
  of the brain.

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Diagnostic imaging

• The patient may be given a computed tomography
  (CT) scan or magnetic resonanse imagining(MRI) to
  detect evidence of strokes, disintegration of the
  brain tissue in certain areas, blood clots or
  tumors, a buildup of spinal fluid, or bleeding
  into the brain tissue. Positron-emission
  tomography (PET) or single-emission computed
  tomography (SPECT) imaging is not used routinely
  to diagnose dementia, but may be used to rule out
  Alzheimer's disease or frontal lobe degeneration
  if a patient's CT scan or MRI is unrevealing.

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• BOOKS
• American Psychiatric Association. Diagnostic and
  Statistical Manual of Mental Disorders.4th
  edition, text revised. Washington, DC American
  Psychiatric Association, 2000.
• "Dementia." The Merck Manual of Diagnosis and
  Therapy, edited by Mark H. Beers, M.D., and
  Robert Berkow, M.D. Whitehouse Station, NJ Merck
  Research Laboratories, 1999.
• Lyon, Jeff, and Peter Gorner. Altered Fates Gene
  Therapy and the Retooling of Human Life.New York
  and London W. W. Norton Co., Inc., 1996.
• Marcantonio, Edward, M.D. "Dementia." Chapter 40
  in The Merck Manual of Geriatrics,edited by Mark
  H. Beers, M.D., and Robert Berkow, M.D.
  Whitehouse Station, NJ Merck Research
  Laboratories, 2000.
• Morris, Virginia. How to Care for Aging
  Parents.New York Workman Publishing, 1996. A
  good source of information about caring for
  someone with dementia as well as information
  about dementia itself.

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• Many tests are also used to diagnose Alzheimer's
  disease. Blood and urine tests are used to rule
  out other problems. Imaging tests are also used,
  including magnetic resonance imaging (MRI),
  computerized tomography (CT), and positron
  emission tomography (PET) scans. These scans may
  reveal if brain tissue has measurably shrunk, if
  protein deposits have appeared, and if cavities
  in the brain have enlarged. These tests can give
  physicians a good sense of whether a patient is
  suffering from Alzheimer's. However, the only
  definitive tests involve the autopsy and
  examination of the patient's brain cells.

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Treatment of Alzheimer's

• Unfortunately, there is currently no cure for
  Alzheimer's disease. If diagnosed early, the
  patient can be prescribed certain medications
  that may delay the onset of symptoms. These
  medications include aricept, exelon, and reminyl.
  Medications can also be used to treat symptoms of
  Alzheimer's, such as the insomnia, anxiety,
  depression, and aggression that can accompany the
  disease. Many Alzheimer's patients suffer from
  other health problems that may exacerbate the
  symptoms of Alzheimer's. Anemia, nutritional
  deficiencies, and thyroid disease are often co
  morbid with Alzheimer's. These may also be
  treated with medications to put the patient at
  ease.

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The Three Stages of Alzheimer's disease

• Alzheimer's disease manifests itself in three
  distinct stages.
• In the first stage, the patient begins to
  demonstrate signs of memory loss. They may forget
  where objects are located, and may forget common
  words throughout the course of normal
  conversation.
• The second stage, the patient begins to
  demonstrate significant impairment in cognitive
  ability. They may be incapable of carrying on a
  coherent conversation, and may begin to forget
  familiar faces.
• In the third and final stage, the patient becomes
  incapable of taking care of him or herself. They
  may become physically impaired, increasingly
  irritable, and forget their closest
  acquaintances.

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What is Pick's disease, or fronto-temporal
dementia?

• Arnold Pick, who first described the disease in
  1892, Pick's Disease causes an irreversible
  decline in a person's functioning over a period
  of years. Although it is commonly confused with
  the much more prevalent Alzheimer's disease,
  Pick's Disease is a rare disorder that causes the
  frontal and temporal lobes of the brain, which
  control speech and personality, to slowly
  atrophy. It is therefore classified as a
  "fronto-temporal dementia", or FTD.

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• According to the National Institute of
  Neurological Disorders and Stroke, the following
  conditions are currently grouped together as
  frontotemporal dementias
• Pick's Disease,
• primary progressive aphasia,
• semantic dementia. 

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What are the signs and symptoms of Pick's
Disease?

• Because the frontal lobes affect behavior and
  emotional response, people with Pick's Disease
  will usually show signs of changes in personality
  before they manifest evidence of dementia. This
  may begin as impulsiveness or a lack of
  inhibition. While the progression of symptoms in
  Pick's Disease is fortunately slow, symptoms do
  worsen over time.

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Behavioral changes

• Impulsivity
• Obsessive/compulsiveness (for example, overeating
  or only eating one type of food)
• Drinking alcohol to excess (when this was not
  previously a problem)
• Rudeness or impatience, leading to aggression
• Poor judgment
• Withdrawal or seclusion
• Inability to function or interact in social
  situations
• Inability to hold a job
• Lack of attention to personal hygiene
• Sexual exhibitionism or promiscuity

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Emotional changes

• Abrupt mood changes
• Lack of warmth, concern, or empathy
• Indifference to events or to one's environment
• Easily distracted difficulty maintaining a line
  of thought
• Unaware of the changes in behavior
• Decreased interest in activities of daily living

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Language changes

• Reduced quality of speech shrinking vocabulary,
  difficulty finding a word
• Difficulty speaking or understanding speech
  (aphasia)
• Repeating words others say (echolalia)
• Weak, uncoordinated speech sounds
• Decreased ability to read or write
• Complete loss of speech (mute)

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Neurological/physical problems

• Increased muscle rigidity or stiffness
• Difficulty moving about
• Lack of coordination
• General weakness
• Memory loss
• Urinary incontinence

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• If at least three of the following five
  distinguishing characteristics are present in the
  early stages, the diagnosis is likely to be
  Pick's rather than Alzheimer's
• onset before age 65
• initial personality changes
• loss of normal controls, e.g., gluttony,
  hypersexuality
• lack of inhibition
• roaming behavior.

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• Also, as compared with Alzheimer's disease,
  obvious mental impairment and memory loss occur
  later in Pick's Disease patients than in
  Alzheimer's patients.

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Thank you for your attention!