Alzheimer’s disease

03/12/2013 by admin | Psychiatry

Definition

Alzheimer’s disease is a primary degenerative cerebral disease of unknown aetiology, affecting higher mental functions.

It is the most common type of dementia accounts for 50-60% of dementia cases.

 

Physical Features

Global brain atrophy, with deposition of Beta-amyloid protein plaques in the brain.

 

Clinical features

  • Gradual progressive cognitive decline (can be as short as 2-3 years)
  • Onset usually late in life >65years but may occur earlier.
  • Apathy (lack of interest, enthusiasm) of mood
  • Personality deterioration
  • Paranoia
  • Parkinsonian features

 

Diagnosis

  • Made by excluding other causes of dementia:
    • Hypothyroidism, hypercalaemia, vitamin B12 deficiency, niacin deficiency, neurosyphilis, normal pressure hydrocephalus, or subdural haematoma).

 

Differencial diagnosis

Depressive disorder, schizophrenia

Delirium

Other primary dementias- Pick’s, Creutzfeldt-Jakob, or Huntington’s disease

Drug induced cognitive impairment- e.g. benzodiazepines

Parkinson’s

Acute confusional state, amnesia

 

Treatment

Acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine)

These increase concentrations of Ach neurotransmitter, although is only effective in a select proportion of cases.

 

Prognosis

Alzheimer’s is a progressive condition for which there is no cure currently.

Symptoms in early and middle stages of the disease may be relieved by medication.

The course of the illness varies form person to person from 5 years to 20 years.

The most common cause of death is infection.

 

Early onset Alzheimer’s (<65 years) can occur in people with Down’s syndrome and in those who inherit the amyloid precursor or presenilin proteins.

 

Complications

Patients can have affective and psychotic psychiatric symptoms.

Inability to feed independently leads to weight loss, malnutrition, and dehydration.

Immobility, mutism, pressure ulcers, and infections are all complications of dementia.

The difficulties with care can cause a great deal of difficulty for families and carers, who therefore need a great deal of support.

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