dementia 痴呆 jie ming shen, m.d., ph.d. department of neurology ruijin hospital, ssmu
TRANSCRIPT
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Dementia
痴呆Jie Ming Shen, M.D., Ph.D.
Department of Neurology
Ruijin Hospital, SSMU
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Defenition• A syndrome of acquired cognitive
and behavioral impairment to markedly interfere with social and occupational functioning.
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Manifestation
• Memory• Language
• Visuospatial skills• Cognition
• Behavior & psychiatric syndrome• Eexecutive functionsxecutive functions
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Types
Degeneration:• Alzheimer disease• Frontotemporal dementia & Pick’s diseas
e• Dementia with Lewy body
Non-Degeneration:• Vascular dementia
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Alzheimer Disease
阿尔茨海默病
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定义• A progressive degeneration with unknown pathogenesis
• memory, cognitive and behavioral impairment
• cortic atrophy• lose of neurons
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pathogenesis
• Cause: unknown• hereditary• environment• metabolic abnormality• β- amyloid deposition in the brain • decrease in acetylcholine • other
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Pathogenesis
• neurotoxic properties • formation of NFTs and SPs
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Pathogenesis
Gene mutation• amyloid precursor protein (APP, on chromosome 21),
• presenilin I (on chromosome 14)• presenilin II (on chromosome 1)• lipoprotein E-epsilon 4 genotype
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Pathology
cerebrocortical atrophy• temporal lobe• front lobe• parietal lobe
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Pathology
•senile plaques (SPs)•neurofibrillary tangles•lose of neurons•granulovacular degeneration•cerebral amyloid angiopathy
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Pathology
•neurofibrillary tanglesmicrotubule-associated protein tau-hyperphosphorylated.
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Pathology
•lose of neurons• granulovacular degeneration•cerebral amyloid angiopathy
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Clinic
•M=F•>65 y-o 5%•>85 y-o 20%•sporadic 90%
•familial history 5%
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Clinic
Abnornalities in• ability of daily living• behaviour• cognition• mismanagement of funds or serious lapses in their family, social, and occupational responsibilities
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Clinic
Early stage• slowly progressive memory loss of insidious onset in a fully consciousness, trouble remembering recent events or activities
• orientation disturbance• language disorders with communication
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Clinic
Early stage• inability to solve simple arithmetic problems
• impairment in their visuospatial skills
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Clinic
Early stage• problems with activities of daily living
• frontal gait• walk away from home and get lost • difficulty recognizing familiar people or things
• Greater risk of falls and accidents• cognition
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Clinic
Late• more serious symptoms• psychiatric syndromes• Loss of mobility• behaviour
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Clinic
Late• epilepsy• extrapyramid sign• clonus• pyramid sign• fecal incontinence
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WORK-UP
Imaging Studies• CT & MRI:cerebrocortic atrophy Lab Studies:• CSF tau protein Aβ • cognic scales •gene detection:
APP, PS-1, ApoE4
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Psychology assessment scale • MMSE• WAISRC• CDR• BBS• HIS
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Diagnosis• Age: 40-90 y-o• clinic manifestation of dementia + psychology assessment scale
• progressive memory & mental disturbance
• cognition disturbance • no consciousness problem• excluding encephalopathy
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Differential diagnosis
• Mild cognitive impairment • Depression• Vascular dementia• Frontotemporal dementia• Dementia with Lewy body
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Vascular dementiathe second most common cause of dementia• Cause: atherosclerosis, lacular infarctions in subcortic, basal ganglia and thalamus
• related to high blood pressure, high cholesterol, heart disease, diabetes, and related conditions. Treating those conditions can slow the progress of vascular dementia
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Treatment• cholinesterase inhibitors (ChEIs) & the avoidance of centrally acting anticholinergic medications
• psychotropic medications & behavioral interventions Risperidone
• neuroprotect agents• N-methyl-D-aspartate (NMDA) antagonists• anti-inflammatory agents• clioquinoline, an antibiotic
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TreatmentCentrally cholinesterase inhibitors (ChEIs)• tacrine• Aricept5 mg PO qn for 3-4 wk, the 10 mg PO qd
• Exelon1.5 mg PO bid for 1 mo, 3 mg PO bid for 1 mo, 4.5 mg PO for 1 mo, then 6 mg PO bid
• Galantamine4-12 mg PO bid bid
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ChEIs adverse effects• nausea• vomiting• diarrhea• dizziness.
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Neuroprotective agents
• Free-radical scavengers:Vitamin E 1000 IU PO bid
• MAO-BI: selegillin• gingko biloba•duxil
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Patient education
•patient education• Both physical and mental activities are recommended
• cognitive retraining