痴呆dememtia——神经病学双语课件.ppt

Dementia Zheng dongming What is denmentia ? Dementia refers to an acquired,genneralized,persisting and often progressive impairment of intelligence that affects the content,but not the level,of conciousness. Age: 60 1% 85 40% But dementia is not aging. Diseases that can cause dementia Degenerative disease:Alzheimer’disease Nondegenerative disease:vascular dementia Alzhemier’disease(AD) The most frequent cause of dementia described by Alzhemier in 1907 more female than male familial AD :autosomal dominant inheritance Etiology and pathogenesis The cause of Alzheimers Disease is not fully understood. It is believed there may be genetic (hereditary) factors involved.(APP,PS1,PS2,ApoE) With the disease, there is a striking deficiency of a substance called acetylcholine in the brain.(ChAT) Acetylcholine is required for the normal functioning of the brain cells and, as levels of the chemical decrease, plaques form creating bundles of fibers (neurofibrillary tangles). Environmental factors may also have an influence on the progress of the disease, but the extent of this is not fully known. Pathology Senile plaques:characteristic change neurofibrilary tangles,NFTs granulovacuolar degeneration loss of neuron crebral amyloid angiopathy Clinical findings Memory impairment: impairment of recent memory is typically the first sign of Alzheimer’s disease----often noticed only by family members. progress gradually. Clinivcal findings Cognitive impairment: aphasia disorientation to time , place,visuospatial,lost easy. acaculia apraxia unable to learn,work,social activity Clinical findings Psychiatric symptoms: depression,apathy delirium,euphoria paranoia hallucinations,delusion insomnia Cliniacal findings Restless, agitated lost of social grace no pyramidal signs seizure extraspyramidal signs:Parkinson syndroms Investigative studies CT,M RI show cortical a