阿尔茨海默病课件

阿尔茨海默病TheFederalgovernment’sleadagencyforAlzheimer’sdiseaseresearchistheNationalInstituteonAging,partoftheNationalInstitutesofHealth.NIHispartoftheU.S.DepartmentofHealthandHumanServices.TheImpactofADOnceconsideredararedisorder,Alzheimer’sdiseaseisnowseenasamajorpublichealthproblemthatisseriouslyaffectingmillionsofolderAmericansandtheirfamilies.Slide2WhatisAD?(slides4–6)InsidetheHumanBrain(slides8–14)ADandtheBrain(slides16–22)ADResearch:FindingNewAnswersandAskingBetterQuestions(slides24–35)ImprovingSupportforFamiliesandOtherCaregivers(slides37–39)WheretoGetHelp(slides40-41)Alzheimer’sDisease:UnravelingtheMysterySlide3ADStatistics….ADisthemostcommoncauseofdementiaamongpeopleage65andolder.Scientistsestimatethataround4.5millionpeoplenowhaveAD.Forevery5-yearagegroupbeyond65,thepercentageofpeoplewithADdoubles.WhatisAD?By2050,13.2millionolderAmericansareexpectedtohaveADifthecurrentnumbersholdandnopreventivetreatmentsbecomeavailable.Slide5WhatisAD?WherearepeoplewithADcaredfor?homeassistedlivingfacilities(thoseintheearlystages)nursinghomes(specialcareunits)ThenationalcostofcaringforpeoplewithADisabout$100billioneveryyear.Slide6TheBrain’sVitalStatistics(slide8)TheThreeMainPlayers(slides9–11)OtherCrucialParts(slide12)TheBraininAction(slide13)Neurons(slide14)InsidetheHumanBrainSlide7TounderstandAlzheimer’sdisease,it’simportanttoknowabitaboutthebrain…TheBrain’sVitalStatisticsAdultweight:about3poundsAdultsize:amediumcauliflowerNumberofneurons:100,000,000,000(100billion)Numberofsynapses(thegapbetweenneurons):100,000,000,000,000(100trillion)InsidetheHumanBrainSlide82. Cerebellum–inchargeofbalanceandcoordination:takesupabout10%ofbrainconsistsoftwohemispheresreceivesinformationfromeyes,ears,andmusclesandjointsaboutbody’smovementsandpositionTheThreeMainPlayersInsidetheHumanBrainSlide10Hippocampus:whereshort-termmemoriesareconvertedtolong-termmemoriesThalamus:receivessensoryandlimbicinformationandsendstocerebralcortexHypothalamus:monitorscertainactivitiesandcontrolsbody’sinternalclockLimbicsystem:controlsemotionsandinstinctivebehavior(includesthehippocampusandpartsofthecortex)InsidetheHumanBrainOtherCrucialPartsSlide12NeuronsThebrainhasbillionsofneurons,eachwithanaxonandmanydendrites.Tostayhealthy,neuronsmustcommunicatewitheachother,carryoutmetabolism,andrepairthemselves.ADdisruptsallthreeoftheseessentialjobs.InsidetheHumanBrainSlide14PlaquesandTangles(slides16–18)TheChangingBraininAD(slides19–22)ADandtheBrainSlide15PlaquesandTangles:TheHallmarksofADThebrainsofpeoplewithADhaveanabundanceoftwoabnormalstructures:AnactualADplaqueAnactualADtanglebeta-amyloidplaques,whicharedensedepositsofproteinandcellularmaterialthataccumulateoutsideandaroundnervecellsneurofibrillarytangles,whicharetwistedfibersthatbuildupinsidethenervecellADandtheBrainSlide16Beta-amyloidPlaquesAmyloidprecursorprotein(APP)istheprecursortoamyloidplaque.1.

APPsticksthroughtheneuron membrane.2.

EnzymescuttheAPPintofragments ofprotein,includingbeta-amyloid.3.

Beta-amyloidfragmentscometogether inclumpstoformplaques.1.2.3.ADandtheBrainInAD,manyoftheseclumpsform,disruptingtheworkofneurons.Thisaffectsthehippocampusandotherareasofthecerebralcortex.Slide17NeurofibrillaryTanglesNeuronshaveaninternalsupportstructurepartlymadeupofmicrotubules.Aproteincalledtauhelpsstabilizemicrotubules.InAD,tauchanges,causingmicrotubulestocollapse,andtauproteinsclumptogethertoformneurofibrillarytangles.ADandtheBrainSlide18PreclinicalADSignsofADarefirstnoticedintheentorhinalcortex,thenproceedtothehippocampus.Affectedregionsbegintoshrinkasnervecellsdie.Changescanbegin10-20yearsbeforesymptomsappear.MemorylossisthefirstsignofAD.ADandtheBrainSlide20MildtoModerateADADspreadsthroughthebrain.Thecerebralcortexbeginstoshrinkasmoreandmoreneuronsstopworkinganddie.MildADsignscanincludememoryloss,confusion,troublehandlingmoney,poorjudgment,moodchanges,andincreasedanxiety.ModerateADsignscanincludeincreasedmemorylossandconfusion,problemsrecognizingpeople,difficultywithlanguageandthoughts,restlessness,agitation,wandering,andrepetitivestatements.ADandtheBrainSlide21TheSearchforCauses(slides24–28)DiagnosingAD(slides29–30)ClinicalTrials(slide31)TheSearchforTreatments(slides32-33)NewNIAStudy(slide34)ManagingtheSymptomsofAD(slide35)ADResearch:FindingNewAnswersandAskingBetterQuestionsSlide23ADResearch:theSearchforCausesADdevelopsADdevelopswhengenetic,lifestyle,andenvironmentalfactorsworktogethertocausethediseaseprocesstostart.Inrecentyears,scientistshavediscoveredgeneticlinkstoAD.TheyarealsoinvestigatingotherfactorsthatmayplayaroleincausingAD.NIA-fundedAlzheimer’sDiseaseCenters(ADCs)acrossthecountryareleadingtheresearcheffortslookingintocauses,diagnosis,andtreatmentofAD.Slide24PartnershipbetweentheNIAandtheAlzheimer’sAssociationNeedtorecruitatotalof1,000familiestofindtheremaininglate-onsetriskfactorgenes2ormorelivingsiblingswithADOneotherlivingfamilymemberwithorwithoutADContact:e-mail:orWebsite:Late-onsetADGeneticsStudyADResearch:theSearchforCausesSlide26StudiesattheCellularandMolecularLevelHomocysteine,anaminoacid,isariskfactorforheartdisease.AstudyshowsthatanelevatedlevelofhomocysteineisassociatedwithincreasedriskofAD.ScientistsarealsolookingatinflammationincertainregionsofthebrainandstrokesasriskfactorsforAD.ADResearch:theSearchforCausesOxidativedamagefromfreeradicalmoleculescaninjureneurons.

Slide27Scientistsexaminecharacteristics,lifestyles,anddiseaseratesofgroupsofpeopletogathercluesaboutpossiblecausesofAD.TheNIAiscurrentlyfundingepidemiologicstudiesinavarietyofdifferentgroups.Twoofthestudiesfocusonreligiouscommunities.Researchersconductyearlyexamsofphysicalandmentalstatus,andstudiesofdonatedbrainsatautopsy.Someearlyresultsindicate:Mentallystimulatingactivityprotectsthebraininsomeways.Inearlylife,higherskillsingrammaranddensityofideasareassociatedwithprotectionagainstADinlatelife.EpidemiologicStudiesADResearch:theSearchforCausesSlide28PhysicianstodayuseanumberoftoolstodiagnoseAD:adetailedpatienthistoryinformationfromfamilyandfriendsphysicalandneurologicalexamsandlabtestsneuropsychologicaltestsimagingtoolssuchasCTscan,ormagneticresonanceimaging(MRI).PETscansareusedprimarilyforresearchpurposesADResearch:DiagnosingADSlide30Clinicaltrialsaretheprimarywaythatresearchersfindoutifapromisingtreatmentissafeandeffective.Trialsexamineapproveddrugstoseeiftheycanbeusedforotherpurposes,orlookatexperimentaldrugs.Participatinginatrialmeansregularcontactwiththestudyteam,whocanprovidestate-of-the-artADcare.ADResearch:ClinicalTrialsSlide31DrugsusedtotreatmildtomoderateADsymptomsinclude:AriceptExelonReminylAnadditionaldrug,Namenda,hasbeenapprovedtotreatsymptomsofmoderatetosevereAD.Thesedrugscanhelpimprovesomepatients’abilitiestocarryoutactivitiesuptoayearorso,buttheydonotstoporreverseAD.ScientistsarealsostudyingagentsthatsomedaymaybeusefulinpreventingAD.Forexample,theyhaveexperimentedwithavaccineagainstAD.Althoughthefirstclinicaltrialwasstoppedduetosideeffectsinsomeparticipants,valuableinformationwasgathered.ADResearch:theSearchforTreatmentsSlide32Researchersalsoarelookingatothertreatments,including:cholesterol-loweringdrugscalledstatinsanti-oxidants(vitamins)andfolicacidanti-inflammatorydrugssubstancesthatpreventformationofbeta-amyloidplaquesnervegrowthfactortokeepneuronshealthyADResearch:theSearchforNewTreatmentsSlide33TheNIAislaunchinganewresearchpartnership,calledtheNeuroimagingandBiomarkersofADInitiative,tostudyhowthebrainchangesinMildCognitiveImpairment(MCI)andAD.ADResearch:NewNIAStudyUsingMRIsandPETscansconductedatregularintervals,researchershopetolearnpreciselywhenandwhereinthebrainproblemsoccur.Researcherswillalsoexaminebloodsamplestocheckforhigherlevelsofabnormalsubstancesthatcouldbeconsidered“biomarkers”ofAD.Slide34Between70to90%ofpeoplewithADeventuallydevelopbehavioralsymptoms,includingsleeplessness,wanderingandpacing,aggression,agitation,anger,depression,andhallucinationsanddelusions.Expertssuggestthesegeneralcopingstrategiesformanagingdifficultbehaviors:ADResearch:ManagingSymptomsSlide35Staycalmandbeunderstanding.Bepatientandflexible.Don’targueortrytoconvince.Acknowledgerequestsandrespondtothem.Trynottotakebehaviorspersonally.Remember:it’sthediseasetalking,notyourlovedone.Expertsencouragecaregiverstotrynon-medicalcopingstrategiesfirst.However,medicaltreatmentisoftenavailableifthebehaviorhasbecometoodifficulttohandle.Researcherscontinuetolookatbothnon-medicalandmedicalwaystohelpcaregivers.WhoaretheADCaregivers?(slide37)DemandsofCaregiving(slide38)TechnologyandCaregiving(slide39)NationalSupportforCaregivers(slide40)HowtoContacttheADEARCenter(slide41)ImprovingSupportforFamiliesandOtherCaregiversSlide36WhoaretheADCaregivers?Spouses–thelargestgroup.Mostareolderwiththeirownhealthproblems.Daughters–thesecondlargestgroup.Calledthe“sandwichgeneration,”manyaremarriedandraisingchildrenoftheirown.Childrenmayneedextrasupportifaparent’sattentionisfocusedoncaregiving.Gr