1、Alzheimers disease(AD)點擊添加文本點擊添加文本點擊添加文本點擊添加文本basic knowledgeepidemiologycause basic knowledge of Alzheimers Alzheimers disease most common cause of dementia chronic neurodegenerative disease people over 65 years difficulty in remembering recent events to managing self care One of the most financial

2、ly costly diseasesepidemiology30 million people6 million in China6% of people over 65 years1.6% in the 6574 age group 19% in the 7584 group 42% in the greater than 84 groupquadruple by 2050Younger incidence causeseveral competing hypothesesgeneticsamyloid precursor protein (APP) and presenilins 1 an

3、d 2apolipoprotein E (APOE)TREM2cholinergicamyloidamyloid precursor protein (APP)N-APP/DR6 pathwayair pollution?etcsymptomsdementiabrain diseaseslong term &gradual decreasecommon symptomsemotional problemslanguage problems motivation problemsnot affect consciousnessmain characteristica change from us

4、ual mental functioning& a greater decline than due to aging Alzheimer disease( AD )chronic neurodegenerative diseasestarts slowly gets worse over timedivided into four stagespre-dementiaearlymoderateadvancedpre-dementiamild cognitive impairment(MCI）“amnestic MCI” -short-term memory lossADexecutive f

5、unctions impairmentattentiveness/planning /flexibilitysemantic memory impairmentmemory of meanings & concept relationshipsemotion impairmentapathyearly memory problems new facts of memories other memories languages problems fine motor tasks may present difficulties (commonly unnoticed)shrinking voca

6、bularydecreased word fluencya general impoverishment of oral & written languagemoderateparaphasias frequent incorrect word substitutions skills be progressively lostreading/ writing/complex movementmemory problems worsenlong-term memory become impairedmentally unstablewandering/irritability/labilemo

7、derateanosognosia people lose insight of their disease process and limitations urinary incontinencesundown syndrome psychological phenomenon associated with increased confusion and restlessness in patientsoccur in the evening or while the sun is settingadvancedcompletely dependent upon caregiverslan

8、guages reduced simple phrase/single wordunderstand and return emotional signalaggressiveness /extreme apathy & exhaustionfail to do simplest movementdie not because of AD itself!diagnosis201201029 趙艾琳點擊添加文本點擊添加文本點擊添加文本點擊添加文本criteriatechniques diagnosis Neuropsychological examinationHematological exa

9、minationNeuroimaging examinationElectroencephalogram (EEG)Cerebrospinal fluid (CSF) examinationGene testingCore x 1 Supporting x 4 點擊添加文本點擊添加文本點擊添加文本點擊添加文本techniques mini-mental state examination (MMSE) damage of intelligence relative to educationneuropsychological examination activity of daily livi

10、ng (ADL) examination early damage of cognitive functionbehavioral and psychological symptoms of dementia(BPSD) examination frequency of symptoms burden of caregivers treatment effects點擊添加文本點擊添加文本點擊添加文本點擊添加文本techniques hematological examinationroutine blood test renal function test liver function tes

11、tblood folate levelcomplications & potential risksother causes leading to dementia點擊添加文本點擊添加文本點擊添加文本點擊添加文本structural imaging other causes leading to dementia eg. CT, MRI: hippocampus, medial temporal lobetechniques neuroimaging examinationfunctional imaging reliability eg. PET, SPECT: superior and p

12、osterior temporal lobe, cingulate gyrus, precuneus點擊添加文本點擊添加文本點擊添加文本點擊添加文本techniques increase: wavedecrease: wave, average frequencyelectroencephalogram (EEG)cerebrospinal fluid (CSF) examinationCSF cell countprotein electrophoresisgene testingmutant genes: APP, PS1, PS2, APOE4點擊添加文本點擊添加文本點擊添加文本點擊添加

13、文本criteria coresupporting 1supporting 2supporting 3supporting 4點擊添加文本點擊添加文本點擊添加文本點擊添加文本core criterion early and obvious episodic memory obstaclepatients: slow and progressive hypomnesiatests: severe memory losschange of other cognitive functions點擊添加文本點擊添加文本點擊添加文本點擊添加文本supportive criteriaatrophy of m

14、iddle temporal gyrus abnormal CSF biomarker A42, Tau specific PET functional neuroimaging temporal and occipital lobe glucose metabolic rate dominant autosome mutation relative to AD in direct relatives treatmentprognosis201201051 黃思思點擊添加文本點擊添加文本點擊添加文本點擊添加文本treatmentpresent treatment alleviating sym

15、ptoms increasing acetylcholine nerve protection improving cerebral circulation and cerebral metabolismincurable disease no treatment can stop the progression of the diseasetreatmentfeature: reduction in the activity of the cholinergic neurons treat the cognitive problems of ADcommonly used: acetylch

16、olinesterase inhibitors tacrine rivastigmine, galantamine, huperzine A donepezilM receptor agonist increasing acetylcholinetreatment by Antioxidantion and scavenging free radicalsvitamin E and selcgiliheginaton (Ginkgo biloba extract)nerve protectingtreatment clarantin (Naftidrofuryl) : directly pro

17、mote tricarboxylic acid cycle dilated blood vesselpiracetam : promote absorption of amino acids & phospholipids, protein synthesis and glucose utilizationimproving cerebral circulation and cerebral metabolismtreatmentother medication: calcium antagonistNimodipineEstrogen replacement therapy A vaccinePsychosocial intervention