1. Dementia Zheng dongming

2. 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% 85 40% But dementia is not aging.

3. Diseases that can cause dementia < Degenerative disease:Alzheimer’disease < Nondegenerative disease:vascular dementia

4. Alzhemier’disease(AD) b The most frequent cause of dementia b described by Alzhemier in 1907 b more female than male b familial AD :autosomal dominant inheritance

5. Etiology and pathogenesis b The cause of Alzheimer's Disease is not fully understood. It is believed there may be genetic (hereditary) factors involved.(APP,PS1,PS2,ApoE) b 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). b Environmental factors may also have an influence on the progress of the disease, but the extent of this is not fully known.

6. Pathology b Senile plaques:characteristic change b neurofibrilary tangles,NFTs b granulovacuolar degeneration b loss of neuron b crebral amyloid angiopathy

8. Clinical findings ÀMemory impairment: b impairment of recent memory is typically the first sign of Alzheimer’s disease----often noticed only by family members. b progress gradually.

9. Clinivcal findings ÁCognitive impairment: [aphasia \ disorientation to time, place,visuospatial,lost easy. \ acaculia \ apraxia [ unable to learn,work,social activity

10. Clinical findings ÂPsychiatric symptoms: ` depression,apathy ` delirium,euphoria ` paranoia ` hallucinations,delusion ` insomnia

11. Cliniacal findings b Restless, agitated b lost of social grace b no pyramidal signs b seizure b extraspyramidal signs:Parkinson syndroms

12. Investigative studies b CT,M RI show cortical atrophy,enlarged ventricles. b Mini-mental state examination MMSE b WAIS-RC b CDR,BBS,HIS

13. Diagnosis of NINCDS-ADRDA b Probable:age,exclusion others b possible b definitive Diferrential diagnosis: 1.MCI 2.depression 3.dementia of other causes

14. National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) and the Alzlieimer's Disease and Related Diseases Association (ADRDA) proposed : National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) and the Alzlieimer's Disease and Related Diseases Association (ADRDA) proposed : b (l) Dementia defined by clinical examination, the Mini-Mental Scale, the Blessed Dementia Scale, or similar mental status examination. b (2) Age of patient (over 40 years). b (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). b (4) Absence of disturbed consciousness. b (5) Exclusion of other brain diseases.

15. treatment b No effective method. b AChE inhibitor:Tacrine,donepezil b symptomatic therapy b rehabilitation

16. Prognosis b Death from inanition or infection generally occur 5~10 years after the first symptom.