《神经病学》（英文）课件5.Alzheimer Disease

1、 Alzheimer DiseaseDementia: an acquired, generalized, and often progressive impairment of cognitive function that affects the content, but not the level of consciousness.Alzheimer Disease- Etiology and pathogenesisNeurochemical: ChAT , ACh memory,cognitive functions (hippocampus, neocortex)Genetic:

2、Amyloid precursor protein(APP) gene presenilin 1(PS1), presenilin 2(PS2) apolipoprotein E(APOE4) FAD-autosomal dominant inherienceAlzheimer Disease- PathologySenile plaques: APP deposited in its centerNeurofibrillary tangles(NFTs)(F1/F2)mainly the loss of cholinergic neuron in superficial cortexgran

3、ulovacuolar degenerationcerebral amyloid angiopathyAlzheimer Disease- Clinical findingsEarly manifestations: recent memory impairment(typically the first sign) disoriented(time,place)leave work(aphasia, acalculia and anomia)lost easily(apraxias and visuospatial disorientation)depressionprimitive ref

4、lexesAlzheimer Disease- Clinical findingsLate manifestations:lost the previously preserved social graces psychiatric symptoms may be prominentextrapyramidal rigidity and bradykinesiaMutism, incontinence and bedridden state are terminal manifestations.Alzheimer Disease- Investigative studies & Differ

5、ential diagnosisCT or MRI scan often show cortical atrophy and enlarged ventricles(Non-special) & PET(F1/F2)Early dementia: depression, senile forget and amnesia. Alzheimer Disease-Investigative studies & Differential diagnosisMore advanced dementia:multi-infarct dementia(step-wise progression), Cre

6、utzfeldt-Jakob disease(shorter course, characteristic EEG, prominent myoclonus).Alzheimer Disease-Treatment & PrognosisSymptomatic treatment: cerebral vasodilators, neural protective drugs acetylcholine precursors(choline and lecithin)Alzheimer Disease-Treatment & PrognosisAChE inhibitor, antipsychotic