痴呆dememtia-神经病学双语课件

DementiaZhengdongmingDementiaZhengdongming1Whatisdenmentia?Dementiareferstoanacquired,genneralized,persistingandoftenprogressiveimpairmentofintelligencethataffectsthecontent,butnotthelevel,ofconciousness.Age:601%8540%Butdementiaisnotaging.

Whatisdenmentia?Dementiare2DiseasesthatcancausedementiaDegenerativedisease:Alzheimer’diseaseNondegenerativedisease:vasculardementiaDiseasesthatcancausedement3Alzhemier’disease(AD)ThemostfrequentcauseofdementiadescribedbyAlzhemierin1907morefemalethanmalefamilialAD:autosomaldominantinheritanceAlzhemier’disease(AD)Themost4EtiologyandpathogenesisThecauseofAlzheimer'sDiseaseisnotfullyunderstood.Itisbelievedtheremaybegenetic(hereditary)factorsinvolved.(APP,PS1,PS2,ApoE)Withthedisease,thereisastrikingdeficiencyofasubstancecalledacetylcholineinthebrain.(ChAT)Acetylcholineisrequiredforthenormalfunctioningofthebraincellsand,aslevelsofthechemicaldecrease,plaquesformcreatingbundlesoffibers(neurofibrillarytangles).Environmentalfactorsmayalsohaveaninfluenceontheprogressofthedisease,buttheextentofthisisnotfullyknown.EtiologyandpathogenesisThec5PathologySenileplaques:characteristicchangeneurofibrilarytangles,NFTsgranulovacuolardegenerationlossofneuroncrebralamyloidangiopathyPathologySenileplaques:chara6痴呆dememtia——神经病学双语课件7ClinicalfindingsMemoryimpairment:impairmentofrecentmemoryistypicallythefirstsignofAlzheimer’sdisease----oftennoticedonlybyfamilymembers.progressgradually.ClinicalfindingsMemoryimpair8ClinivcalfindingsCognitiveimpairment:aphasiadisorientationtotime,place,visuospatial,losteasy.acaculiaapraxiaunabletolearn,work,socialactivityClinivcalfindingsCognitiveim9ClinicalfindingsPsychiatricsymptoms:depression,apathydelirium,euphoriaparanoiahallucinations,delusioninsomniaClinicalfindingsPsychiatrics10CliniacalfindingsRestless,agitatedlostofsocialgracenopyramidalsignsseizureextraspyramidalsigns:ParkinsonsyndromsCliniacalfindingsRestless,ag11InvestigativestudiesCT,MRIshowcorticalatrophy,enlargedventricles.Mini-mentalstateexaminationMMSEWAIS-RCCDR,BBS,HISInvestigativestudiesCT,MRIs12DiagnosisofNINCDS-ADRDAProbable:age,exclusionotherspossibledefinitiveDiferrentialdiagnosis:1.MCI2.depression3.dementiaofothercausesDiagnosisofNINCDS-ADRDAProba13NationalInstituteofNeurologicalandCommunicativeDisordersandStroke(NINCDS)andtheAlzlieimer'sDiseaseandRelatedDiseasesAssociation(ADRDA)proposed:(l)Dementiadefinedbyclinicalexamination,theMini-MentalScale,theBlessedDementiaScale,orsimilarmentalstatusexamination.(2)Ageofpatient(over40years).(3)Deficitsintwoormoreareasofcognitionandprogressiveworseningofmemoryandothercognitivefunctions--suchaslanguage,perception,andmotorskills(praxis).(4)Absenceofdisturbedconsciousness.(5)Exclusionofotherbraindiseases.NationalInstit14treatmentNoeffectivemethod.AChEinhibitor:Tacrine,donepezilsymptomatictherapyre