1. Dementia syndrome

2. Definitions
The disturbance and symptoms significantly interfere with work or usual social activities or relationships with others
The syndrome associated with a progressive loss of memory and other intellectual functions that is serious enough to interfere with performing the tasks of daily life
The decline in intellectual function, including difficulties with language, simple calculations, planning and judgment, and motor (muscular movement) skills as well as loss of memory

3. Signs and symptoms loss of cognitive ability memory attention language
problem solving
disorientation in time, in place, in persons
behavioural problems
emotional changes
depression, anxiety, paranoia

4. Causes neurodegenerative diseases Alzheimer´s disease
Parkinson´s disease
stroke
trauma
chronic alcohol abuse
Korsakoff´s syndrome
genetic diseases
Huntington disease
metabolic diseases
Tay-Sachs disease
Gaucher disease
infections
Creutzfedt-Jakob disease
viral encephalitis

5. The most frequent:
Alzheimer´s disease %
Vascular dementia
Dementia with Lewy bodies
Frontotemporal dementia
80%
90%

6. Alzheimer´s disease

7. History
German psychiatrist Alois Alzheimer identified the first case of what became known as Alzheimer's disease in a 50-year-old woman he called Auguste D (A. Deter).
Alzheimer followed her until she died in 1906, when he first reported the case publicly.
Alois Alzheimer
Auguste D

8. Characteristics 4 stages Pre-dementia mild cognitive difficulties
memory loss - remembering recently learned facts and inability to acquire new information
subtle problems with attentiveness, planning, flexibility, abstract thinking
Early dementia
the increasing impairment of learning and memory
difficulties with language - shrinking vocabulary and decreased word fluency
executive functions, perception (agnosia), or execution of movements (apraxia)

9. Moderate dementia
inability to perform most common activities of daily living
speech difficulties become evident due to an inability to recall vocabulary, which leads to frequent incorrect word substitutions
reading and writing skills are also progressively lost
complex motor sequences become less coordinated - risk of falling increases
memory problems worsen – problems to recognise close relatives
behavioural changes – irritability, lability, aggression
urinary incontinence
Advanced dementia
completely dependent upon caregivers
language is reduced to simple phrases or even single words, or complete loss of speech
extreme apathy and exhaustion
not be able to perform even the most simple tasks without assistance
immobility, they lose the ability to feed themselves
death (infection, pneumonia)

10. Risk factors Higher risk od AD age 65 – 75 y 3% 75 – 85 y 19%
Lower risk of AD ??
antioxidants (ginkgo biloba) ?
estrogens ??
ibuprofen ??
smoking ?????
Higher risk od AD
age
65 – 75 y %
75 – 85 y 19%
> 85 y  50%
positive family history
low degree of education
depression
women > men
trauma of head

11. Macroscopic changes
brain atrophy – temporal lobe, parietal lobe, frontal cortex, cingulate gyrus
enlargement of ventricles

13. Microscopic changes
loss of neurons and synapses in the cerebral cortex
amyloid plaques
neurofibrillary tangles

14. Amyloid plaques (senile plaques)
dense, mostly insoluble deposits of beta-amyloid peptide outside and around neurons
beta-amyloid - small peptide (39–43 amino acids) 
a fragment from the amyloid precursor protein (APP) – a transmembrane protein of neurons
APP is critical to neuron growth, survival and post-injury repair
in Alzheimer's disease, an unknown process (mutation of APP gene?) causes APP to be divided into smaller fragments by enzymes (proteolysis)
accumulation of aggregated amyloid fibrils – toxic - disrupting the cell's calcium ion homeostasis, induces apoptosis (hypothesis)

16. Neurofibrillary tangles
aggregates of fibres
hyperfosforylated protein tau - accumulate inside the cells
normal function of tau protein - stabilizes the microtubules (important for transport in neurons) – microtubule-associated protein
in AD - tau is hyperphosphorylated – composes pairs with other threads, creating neurofibrillary tangles and disintegrate the neuron's transport system

18. Other factors Presenilins 1 and 2 – transmembrane proteins
mutations in Alzheimer disease
Allele e4 of apolipoprotein E
3 alleles – e2, e3, ee4
e4 – higher risk of atherosclerosis and Alheimer disease

19. The mini-mental state examination (MMSE) or Folstein test - brief 30-point
questionnaire test - used to screen for cognitive impairment.
Category
Possible points
Description
Orientation to time 5
From broadest to most narrow. Orientation to time has been correlated with future decline.
Orientation to place
From broadest to most narrow. This is sometimes narrowed down to streets,[and sometimes to floor.[
Registration 3
Repeating named prompts
Attention and calculation
Serial sevens, or spelling "world" backwards. It has been suggested that serial sevens may be more appropriate in a population where English is not the first language.
Recall
Registration recall
Language 2
Name a pencil and a watch
Repetition 1
Speaking back a phrase
Complex commands 6
Varies. Can involve drawing figure shown.