痴呆dememtia——神经病学双语ppt课件.ppt

Dementia,Zheng dongming,What is denmentia?,Dementia refers to an acquired,genneralized,persisting and often progressive impairment of intelligence that affects the content,but not the level,of conciousness.Age:60 1%85 40%But dementia is not aging.,Diseases that can cause dementia,Degenerative disease:AlzheimerdiseaseNondegenerative disease:vascular dementia,Alzhemierdisease(AD),The most frequent cause of dementiadescribed by Alzhemier in 1907more female than malefamilial AD:autosomal dominant inheritance,Etiology and pathogenesis,The cause of Alzheimers Disease is not fully understood.It is believed there may be genetic(hereditary)factors involved.(APP,PS1,PS2,ApoE)With the disease,there is a striking deficiency of a substance called acetylcholine in the brain.(ChAT)Acetylcholine is required for the normal functioning of the brain cells and,as levels of the chemical decrease,plaques form creating bundles of fibers(neurofibrillary tangles).Environmental factors may also have an influence on the progress of the disease,but the extent of this is not fully known.,Pathology,Senile plaques:characteristic changeneurofibrilary tangles,NFTsgranulovacuolar degenerationloss of neuroncrebral amyloid angiopathy,Clinical findings,Memory impairment:impairment of recent memory is typically the first sign of Alzheimers disease-often noticed only by family members.progress gradually.,Clinivcal findings,Cognitive impairment:aphasiadisorientation to time,place,visuospatial,lost easy.acaculiaapraxiaunable to learn,work,social activity,Clinical findings,Psychiatric symptoms:depression,apathydelirium,euphoriaparanoiahallucinations,delusioninsomnia,Cliniacal findings,Restless,agitatedlost of social graceno pyramidal signs seizureextraspyramidal signs:Parkinson syndroms,Investigative studies,CT,M RI show cortical atrophy,enlarged ventricles.Mini-mental state examination MMSEWAIS-RCCDR,BBS,HIS,Diagnosis of NINCDS-ADRDA,Probable:age,exclusion otherspossibledefinitive,Diferrential diagnosis:1.MCI2.depression3.dementia of other causes,National Institute of Neurological and Communicative Disorders and Stroke(NINCDS)and the Alzlieimers Disease and Related Diseases Association(ADRDA)proposed:(l)Dementia defined by clinical examination,the Mini-Mental Scale,the Blessed Dementia Scale,or similar mental status examination.(2)Age of patient(over 40 years).(3)Deficits in two or more areas of cognition and progressive worsening of memory and other cognitive functions-such as language,perception,and motor skills(praxis).(4)Absence of disturbed consciousness.(5)Exclusion of other brain diseases.,treatment,No effective method.AChE inhibitor:Tacrine,donepezilsymptomatic therapyrehabilitation,Prognosis,Death from inanition or infection generally occur 510 years after the first symptom.,