Alzheimer Disease the most common of Dementia

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Introduction
Dementia describes progressive decline of cognitive function, usually affecting the cortex as a whole, though sometimes patchily. Memory is especially affected, intellect gradually fails. There is loss of emotional control, deterioration of social behavior and loss of motivation. There are many causes of this syndrome. Dementia is a substantial cause of morbidity in any ageing population, with profound social and economic effects. Dementia affects some 10% of any population over 65, and 20% over 80. The commonest causes are Alzheimers disease.(1)

What is Dementia?
Dementia isn't a specific disease. Instead, dementia describes a group of symptoms affecting intellectual and social abilities severely enough to interfere with daily functioning.

Etiology
Many cause of dementia, such us: degenerative disease, vascular, metabolic, vitamin deficiency, toxic, endocrine, infection, trauma. And many more But the most common of dementia is Alzheimer disease that include the generative disease about 60%

Symptoms
The symptoms of dementia is divide into ABC A : activity of daily living B : behaviour/ behaviour psychological syndrome of dementia (BPSD) C : cognition or cognitive defisicits

B/ Behaviour Psychological syndrome of dementia (BPSD)

Paranoid: the people have taken his/her money, house in not oness home Hallucination: Depression: Anxiety: Social dysinhibition: Wandering Agitation

C/Cognitive deficits
Memory: shortterm and longterm Orientation: time,person, place Language : Aphasia, anomian thingking, calculation, learning capacity Personality Judgement : ability to perform tasks in sequence Reduce activity daily living

Risk factor
Risk factors that can not be changed Age. The risk of Alzheimer's disease, vascular dementia and several other dementias increases significantly with age. However, dementia isn't a normal part of aging. Family history. People with a family history of dementia are at greater risk of developing it. However, many people with a family history never develop symptoms, and many people without a family history do. Down syndrome. By the time they reach middle age, most people with Down syndrome develop the plaques and tangles characteristic of Alzheimer's disease, according to studies. Many, but not all, also develop dementia.(6)

 Alcohol use. Consuming large amounts of alcohol appears to increase the risk of dementia. Atherosclerosis. This buildup of fats and other substances in and on your artery walls (plaques) is a significant risk factor for vascular dementia because it interferes with blood flow to your brain. Blood pressure. Blood pressure that's too high, and also possibly too low, can put you at risk of developing Alzheimer's disease and vascular dementia. Cholesterol. High levels of low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, can significantly increase your risk of developing vascular dementia. Depression. Although not yet well understood, late-life depression, may be an indication for the development of Alzheimer's-related dementia. Diabetes. If you have type 2 diabetes, you're at increased risk of developing both Alzheimer's disease and vascular dementia. High estrogen levels. High levels of total estrogen in women have been associated with greater risk of developing dementia. This can be determined through a blood test. Smoking. Smoking likely increases the risk of developing dementia because it puts you at a higher risk of atherosclerosis and other types of vascular disease.(6)

Can be change

DSM-IV criteria for the diagnosis of Dementia of the Alzheimer's Type

(4)

A. The development of multiple cognitive deficits manifested by both: 1.Memory impairment (impaired ability to learn new information or to recall previously learned information) 2.One or more of the following cognitive disturbances: (a) aphasia (language disturbance) (b) apraxia (impaired ability to carry out motor activities depite intact motor function) (c) agnosia (failure to recognize or identify objects despite intact sensory function) (d) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting) B. The cognitive deficits in criteria A1 and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning. C. The course is characterized by gradual onset and continuing cognitive decline.

D. The cognitive deficits in Criteria A1 and A2 are not due to any of the following: (1) other central nervous system conditions that cause progressive deficits in memory and cognition (e.g., cerebrovascular disease, Parkinson's disease, Huntington's disease, subdural hematoma, normal-pressure hydrocephalus, brain tumor) (2) systemic conditions that are known to cause dementia (e.g., hypothyroidism, vitamin B or folic acid deficiency, niacin deficiency, hypocalcaemia, neurosyphilis, HIV infection) (3) substance-induced conditions E. The deficits do not occur exclusively during the course of a delirium. F. the disturbance is do not better accounted for by another axis I disorder (e.g., major depressive disorder, schizophrenia) (2)(4)

Test in Dementia
Blood test: full blood count, ESR, C-reactive protein, urea, electrolytes, blood glucose, liver biochemistry, serum calcium, vitamin B12, folate, T3 T4, HIV serology. Imaging : Chest X-rays, CT scan, MRI brain Other: genetic studies, EEG, CSF, brain biopsy. Psychiatric evaluation/neuropsychiatri: MMSE(mini mental states examination) CDT (clock drawing test) IADL

What is Alzheimer Disease?

Alzheimers disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills. This is the commonest dementia, a degenerative disease of the cortex, accounting for over 65% of dementia in any age group.(3)

Etiology
AD develops when genetic, lifestyle, and environmental factors work together to cause the disease process to start. In recent years, scientists have discovered genetic links to AD. They are also investigating other factors that may play a role in causing AD

Genetic
The two main types of AD are early-onset and late-onset: Early-onset AD is rare, usually affecting people aged 30 to 60 and usually running in families. Researchers have identified mutations in three genes that cause earlyonset AD. Late-onset AD is more common. It usually affects people over age 65. Researchers have identified a gene that produces a protein called apolipoprotein E (ApoE). Scientists believe this protein is involved in the formation of betaamyloid plaques.

To understand Alzheimers disease, its important to know about the brain

Cerebellum in charge of balance and coordination Brain Stem connects the spinal cord with the brain relays and receives messages to and from muscles, skin, and other organs controls automatic functions such as heart rate, blood pressure, and breathing. Hippocampus: where short-term memories are converted to long-term memories

Thalamus: receives sensory and limbic information and sends to cerebral cortex Hypothalamus: monitors certain activities and controls bodys internal clock Limbic system: controls emotions and instinctive behavior (includes the hippocampus and parts of the cortex)

Neuropathology
Amyloid plaque : which are dense deposits of protein and cellular material that accumulate outside and around nerve cells Neurofibrillary tangles : which are twisted fibers that build up inside the nerve cell

AD and the Brain

Beta-amyloid Plaques
1.

Amyloid precursor protein (APP) is the precursor to amyloid plaque.

1. APP sticks through the neuron membrane.

2.

2. Enzymes cut the APP into fragments of protein, including beta-amyloid.

3. Beta-amyloid fragments come together in clumps to form plaques.

In AD, many of these clumps form, disrupting the work of neurons. This affects the hippocampus and other areas of the cerebral cortex.
Slide 17

3.

AD and the Brain

Neurofibrillary Tangles

Neurons have an internal support structure partly made up of microtubules. A protein called tau helps stabilize microtubules. In AD, tau changes, causing microtubules to collapse, and tau proteins clump together to form neurofibrillary tangles. Slide 18

 Amyloid accumulation and Neurofibrillary tangles nerve cell death neurochemical deficiency cognitive and behaviour changes

Conclusion
Alzheimer's disease is the most common cause of dementia in people age 65 and older. Symptoms usually appear after age 60, but early-onset forms of the disease can occur, usually as the result of a defective gene. Alzheimer's disease usually progresses slowly, over seven to ten years, causing a gradual decline in cognitive abilities. Caring for a person with Alzheimers disease can have high physical, emotional, and financial costs. The demands of day-to-day care, changing family roles, and difficult decisions about placement in a care facility can be hard to handle. (8)