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Alzheimer's Disease and Other Dementias by Dra Merioles 07.20.16
Alzheimer's Disease and Other Dementias by Dra Merioles 07.20.16
A N D O TH ER D EM EN TIA S
Aileen Costa-Merioles, MD, FPCP
Internal Medicine Specialist
the elderly
Insidious loss of episodic memory
followed by a slowly progressive
dementia that evolves over years
Typical duration 8-10 years
plaques containing
amyloid beta (A),
neurofibrillary tangles
(NFTs) composed of
hyperphosphorylated
tau filaments, and A
accumulation of in
blood vessel walls in
cortex and
leptomeninges
apolipoprotein 4 (Apo 4)
EPID EM IO LO GY
most important risk factors for AD
STAG ES O F AD
Early stage typical amnestic AD
cognitive problems begin to interfere
STAG ES O F AD
middle stages -- the patient is unable
STAG ES O F AD
late stages wandering aimlessly
Loss of judgment and reasoning
Delusions
Capgras syndrome (10% of AD
cases)
shuffling gait with generalized
muscle rigidity associated with
slowness and awkwardness of
movement
STAG ES O F AD
end stages -- AD patients become
pathology
treatm ent
Inhibition of the cholinesterases,
treatm ent
act by blocking overexcited N-
methyl-d-aspartate (NMDA)
glutamate receptors
memantine (target dose, 10 mg
twice daily)
treatm ent
Ginkgo biloba
Modest improvement in cognitive
Vascular D em entia
cerebrovascular disease
two general categories:
multi-infarct dementia
diffuse white matter disease
leukoaraiosis, subcortical arteriosclerotic
leukoencephalopathy, or Binswangers
disease
M AN IFESTATIO N
chronic cognitive deficits, commonly
M AN IFESTATIO N
PE --focal neurologic
deficits such as
hemiparesis, a
unilateral Babinski
sign, a visual field
defect, or
pseudobulbar palsy
Neuroimaging --
multiple areas of
infarction
TREATM EN T
preventing new ischemic injury by
core clinicalsyndrom es
behavioralvariant (bvFTD )
most common FTD syndrome
social and emotional systems
nonfl
uent/agram m atic variant
primary progressive aphasia (PPA),
develop profound inability to produce
D IAG N O STICS
gross pathologic hallmark of FTLD is
PARKIN SO N S D ISEASE
D EM EN TIA AN D D EM EN TIA
W ITH LEW Y
BO D IES
PD D AN D D LB
DLB clinical syndrome:
visual hallucinations, parkinsonism,
PD D AN D D LB
Both PDD and DLB
Involves brainstem pathology below
PD D AN D D LB
first manifestation of illness:
Delirium
precipitated by an infection, new
D LB
key neuropathologic feature is the
TREATM EN T
DLB
dopaminergic medications
cholinesterase inhibitors
reducing hallucinosis, stabilizing
delusional symptoms
Exercise programs
Antidepressants
Atypical antipsychotics
(CTE)