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Alzheimer's (Different Forms of Dementia (Multi-infarct dementia =…
Alzheimer's
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Diagnosis
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CT scan of head to rule out hydrocphalus or tumour, and to confirm cerebral atrophy and distribution
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History = rate of decline, impaired social function, general disorders (stroke or head injury), nutritional status, drug and family history
Pathophysiology
Progressive deterioration of intellect, behaviour, and personality as a consequence of a disease of the cerebral hemispheres (cerebral cortex and hippocampus especially)
Formation of neuritic plaques, neurofibrillary tangles, neuronal loss, granulovacuolar degeneration, cerebral atrophy, and loss of subcortical projections (cholinergic especially)
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Cause not known, but associated with chromosome 21, and gene encoding amyloid precursor protein APP (early-onset familial forms of AD)
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No linkage between single genetic mutation and sporadic late-onset AD, but association with ε4 allele of APOE gene (chromosome 19) which encodes for apolipoprotein E.
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Treatment and Management
Multi-infarct dementia = good diabetic control, bp control, cholesterol control, aspirin
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Anti-glutamatergic = since AD is associated with slow, atypical form of excitotoxicity (with slowly increasing glutamate)
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Symptoms
Deterioration of intellect, behaviour, and personality
Not the same as delirium (acute and reversible associated with infective, toxic, or metabolic disturbances)
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Rumination of past and confusion of time, place, and failure to identify people
Mood changes, anxiety, short-temper, obsessional behaviour, depression
End stage = mute, incontinent, and passes away
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Prognosis
Decline, average durage 8-10 years
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