Medical college lectures: neurology 5th year.

1. DEMENTIA& ALZHEIMER’S ! Dr. Mohamad Shaikhani.

4. CAUSES OF DEMENTIA Variant CJD Kuru Gerstmann-Sträussler-Scheinker disease Sporadic Creutzfeldt-Jakob disease (CJD) Prion diseases Post-encephalitic Whipple's disease Subacute sclerosing panencephalitis Syphilis HIV Infective Anoxia/carbon monoxide poisoning Heavy metal poisoning Thiamin deficiency B 12 deficiency Alcohol Toxic/nutritional Communicating/non-communicating 'Normal pressure' hydrocephalus Hydrocephalus Punch-drunk syndrome Chronic subdural haematoma Post-head injury Traumatic Sarcoidosis Multiple sclerosis Inflammatory Paraneoplastic syndrome (limbic encephalitis) Primary cerebral tumour Secondary deposits Neoplastic Mitochondrial encephalopathies Leucodystrophies Huntington's disease Wilson's disease Pick's disease Dystrophia myotonica Cortical Lewy body disease Progressive supranuclear palsy Others (e.g. cortico-basal degeneration) Alzheimer's disease Degenerative/inherited Cerebral vasculitis Amyloid angiopathy Multiple emboli Diffuse small-vessel disease Vascular Rare Unusual Common Type

27. clinical diagnosis of Alzheimer’s Disease A)Definite Alzheimer’s Disease B) Probable Alzheimer’s Disease C) Possible Alzheimer’s Disease

33. MILD COGNITIVE IMPAIRMENT progression: 25 GDS 3 71 NYU 12 Isolated memory loss 74 Seattle 6 CDR 0.5 72 MGH 15 Questionable dementia 66 Columbia 14 Memory Impairment 74 Toronto 12 MCI 81 Mayo Annual conversion rate to AD % Criteria Mean Age Study

38. “ Distinguishing Features of Cortical & Subcortical Dementia” Psychomotor retardation Forgetfulness Cognitive dilapidation Impaired insight Poor strategy formulation Aphasia- Amnesia Visuospatial disorder Poor abstraction Aculculia Apraxia Agnosia- loss of the power to recognize the import of sensory stimulus. Intellectual Functions Subcortical Cortical

39. “ Distinguishing Features of Cortical & Subcortical Dementia” Depression (rarely, mania) Indifference Personality/Emotions Subcortical Cortical

40. “ Distinguishing Features of Cortical & Subcortical Dementia” Dysarthria Normal (until late) Speech Subcortical Cortical

41. “ Distinguishing Features of Cortical & Subcortical Dementia” Abnormal (parkinsonian, chorea, dystonia, etc.) Normal (until late) Motor Subcortical Cortical

42. “ Distinguishing Features of Cortical & Subcortical Dementia” Thalamus basal ganglia rostral brainstem Neocortical association areas&hippocampus Anatomy Subcortical Cortical

43. Mixed dementias cortical & subcortical structures are involved

45. Factors involved in Multi-infarct Dementia(vascular dementia)

47. Factors involved in Slow virus Dementia

49. Three important facts about Dementia syndrome or pseudodementia:

51. 3 important effects of depression

53. Differentiate primary depression & primary dementia by History !

55. Differentiate Depression & Dementia by clinical testing

57. 2 facts of Normal Pressure hydrocephalus

59. High risk for Subdural Hematoma

61. Symptoms of Subdural H

70. AD: Treatment No cure for AD Limited therapy to help symptoms or to slow progression Therapies to improve symptoms: Enhancement of cholinergic system Increase dietary choline: little effect on cognition AChE inhibitors: small cognitive enhancing effect

71. Anticholinesterases, such as donepezil, rivastigmine & galantamine, or NMDA (N-methyl-D-aspartate receptor antagonists (memantine) appear to improve cognitive function to some extent in Alzheimer's disease