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Alzheimer's disease, Hippocampus, Orbito-frontal cortex / septal areas…
Alzheimer's disease
Anatomy of the limbic system
cortical structures
Orbito-frontal cortex
limbic lobe
cingulate gyrus
sub-callosal area
Isthmus of limbic lobe
parahippocampal gyrus
uncus
Septal area
Hippocampal formation
Hippocampus proper
subiculum
Dentate gyrus
Entorhinal cortex (uncus)
Connecting pathways
mammillo-thalamic tract
Anterior thalamic nucleus
Stria terminalis
septal areas / hypothalamic nucleus
fornix
Mammillary body
cingulum
Hippocampus
Longitudinal stria (indosium griseum)
Dentate gyrus - hippocampus
medial forebrain bundle
Hypothalamus and midbrain reticular formation
Anterior commissure
Olfactory cortical areas and tracts of the other side
Hippocampal commissure / commissure of fornix
Hippocampus of the opposite side
Sub-cortical structures
Anterior nucleus of thalamus
Hypothalamus
Amygdaloid nucleus
Papez circuit
Hypothalamus
Mamillo-thalamic tract
Anterior thalamic nuclei
Thalamic radiation
cingulate gyrus
cingulum fibers
Hippocampus
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Neocortex
structures determines what functions takes place
MMSE
Mini-Mental State Examination
standardized screening examination of cognitive function
with further investigations
Pathophysiology of Alzheimer's disease
Amyloid Precursor protein (APP)
helps in neuronal repair
Transmembrane protein found in cell membrane of neurons.
it is cleaved by
α-secretase and γ-secretase
soluble peptides (non-pathogenic pathway)
β-secretase and γ-secretase
non-soluble beta-amyloid peptides (pathogenic pathway)
aggregation
formation of plaques
The plaques and tangles trigger inflammation
neuronal injury
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Tau protein
Intracellular protein found inside neurons.
microtubule associated protein (supports cytoskeleton of neurons)
In Alzheimer’s disease, its phosphorylated by kinase
Loss of ability to bind to microtubule
aggregation
formation of neurofibrillary tangles.
Gross appearance
the brain undergo atrophy
wide sulci
compensatory ventricular enlargement
narrow gyri
showing signs and symptoms and stages
dementia types
Alzheimer's disease
Vascular dementia
Lewy body dementia
Frontotemporal dementia
Mixed dementia
most common type is
Huntington's disease
Creutzfeldt-Jakob disease
Parkinson's disease
Wernicke-Korsakoff Syndrome
vitamin B1 (thiamine) deficiency
Investigations for Alzheimer's disease
to diagnose and give the proper treatment
imaging
CT
PET
MRI
history taking
neurological physical examinations
genetic testing
to rule out other diagnosis
urinalysis
liver function test
ESR
full blood count
culture
signs and symptoms of Alzheimer's disease in different stages
thus the need to test the cognitive function
stages
Mild cognitive impairment
Mild Alzheimer's
Moderate Alzheimer's
Severe Alzheimer's
Signs and symptoms
Aphasia
Anomia
Amnesia
Apraxia
Agnosia
Physiology of memory
types of memory
Intermediate-long term memory
long-term memory
Short-term memory
Sensory memory
abnormalities might lead to
negative memory
habituation
ignore information
closing of Ca2+ channels in presynaptic neurons
decrease Ca2+ influx
decrease neurotransmitter release
reduced behavioral response
positive memory
sensitization
associated with emotions
pain and pleasure
storing memory
Serotonin release at Facilitating interneurons
increase cAMP
blockage of K+ channels in presynaptic neurons
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Risk factors of Alzheimer's disease
Non-modifiable
gender
more prevalent in females
genetics
PSEN1
PSEN2
APP
MAPT
APOe4
aging
modifiable
Type 2 diabetes
Traumatic brain injury
cerebrovascular disease
epilepsy
Depression
lack of physical activity
sleep disturbance
saturated fatty acids
smoking
alcohol
Air pollution
lack of education
which lead to certain pathological events
Managements of Alzheimer's disease
to prevent further complications
Pharmacological
Cholinesterase inhibitors
Non selective
Tacrine
withdrawn from use
due to its hepatic toxicity
selective
Donepezil
Galantamine
Rivastigmine
NMDA antagonists
Memantine
Non-pharmacological
reduction in environmental triggers
Education
optimal managements of comorbid diseases
environmental changes to create serene environment
Immunotherapy
Aducanumab
Solanezumab
not used because it failed to improve cognition
Complications of Alzheimer's disease
also by spreading awareness
Malnutrition and dehydration
Bladder and bowel problems
Depression
Falls
Infection
pneumonia
Prolonged immobilization
pulmonary embolism
Prevention of Alzheimer's disease
to decrease the prevalence of the disease
reducing the risks by leading a healthy lifestyle
keeping your brain active
learning
eating a healthy diet
sleeping well
physical activity
avoid smoking
avoid alcohol
Epidemiology of Alzheimer's disease
to preserve the structures and functions for a longer time and enhance the quality of life
Alzheimer's disease is rare in the UAE mainly because the country has relatively young population
UAE is the second country to sign up for Aducanumab
Affects more among females
AD is the leading cause of dementia
Hippocampus
Orbito-frontal cortex / septal areas
Mammillary body
Amygdaloid nucleus
Anterior thalamic nucleus
septal areas
Hippocampus
olfactory cortical areas and tracts from one side