Alzheimer - Progressive form of senile dementia, leading to complete loss of cognitive abilities, developing mainly after 60-65 years. Clinically manifested emerging gradually and constantly progressive disorder of cognitive abilities: attention, memory, language, praxis, gnosis, psychomotor coordination, orientation and thinking. Diagnosing Alzheimer's allows a thorough history, brain PET, the exclusion of other types of dementia using EEG, CT or MRI. Treatment is palliative, includes medication (cholinesterase inhibitors, memantine) and psychosocial (art therapy, psychotherapy, sensory integration, presence simulation) therapy.
dementia. Globally, according to 2006 the number of patients with Alzheimer's disease, was 26.5 million. Man. There is a clear trend of increasing incidence, which makes diagnosing the problem and treat this disease one of the most important problems of modern psychiatry and neurology.
Characterized by a significant correlation between the incidence of dementia, Alzheimer's type and age. Thus, in the age group of 65 years there has been about 3 cases per 1000 person of the disease, and among people aged 95 years already 69 cases by 1000. The indicator of this disease prevalence in developed countries is much higher, because their population has a greater life expectancy. Among women, Alzheimer's disease is more common than among men, which is partially attributed to the higher, compared with men, their life expectancy.
Down's syndrome. At the same time in all patients with Down syndrome who have reached 40 years of age, there is Alzheimer-like pathology.
Contributing factors synthesis of pathological beta amyloid called failure of mitochondrial oxidation processes, intercellular more acidic reaction medium, large amounts of free radicals. It marked pathological amyloid deposits in the brain parenchyma and in the walls of cerebral blood vessels. It should be noted that these deposits are characterized not only Alzheimer's disease, they are observed in congenital cerebral hematomas genesis, Down's syndrome and normal aging processes take place.
According to the third hypothesis of Alzheimer's disease is associated with loss of neurons as a result of the accumulation in them of hyperphosphorylated tau protein, the threads of which are glued together and form tangles. According to the tau protein accumulation hypothesis is associated with a defect in its structure; plexus formation causes disintegration intraneuronal transport, which in turn leads to the disruption of the signal transmission between neurons, and then to their destruction. On the other hand, the formation of neurofibrillary tangles observed in other cerebral degenerations (eg, in progressive supranuclear palsy and frontotemporal atrophy). Therefore, many researchers deny the independent pathogenetic significance of tau protein, considering it a consequence of the accumulation of mass destruction of neurons.
Among the possible causes triggering Alzheimer's disease, pathological called synthesis of apolipoprotein E. The latter has affinity for amyloid protein and is involved in the transportation of tau protein, which may underlie diseases typical morphological changes, described above.
Many researchers believe Alzheimer's disease is genetically determined. Identified 5 major genetic areas, which associated with the development of the disease. They are located at 11214 19 and 21 chromosomes. Mutations in these loci lead to violations of protein metabolism of cerebral tissue, entailing the accumulation of amyloid or tau.
speech disorders. The latter are characterized by the decrease of the rate of speech, vocabulary impoverishment, weakening the ability of writing and verbally express their thoughts. However, at this stage, while communicating the patient adequately operates uncomplicated concepts.
Because disorders of praxis and planning movements when performing tasks with the use of fine motor skills (drawing, sewing, writing, dressing), the patient has an awkward appearance. Under raney dementia patient is still able to independently perform many simple tasks. But in situations requiring complex cognitive effort, it needs help.
Progressive cognitive inhibition leads to a significant reduction in the ability to perform independent actions. Obvious are agnosia and speech disorders. There paraphrase - the loss of the grammatical structure of language and its meaning, because instead of forgotten words, patients are increasingly using the wrong word. This is accompanied by the loss of writing skills (dysgraphia) and reading (dyslexia). The growing disorder praxis deprives the patient's ability to cope even with simple daily tasks such as dressing, undressing, eating and self-pr.
Under moderate dementia observed changes in long-term memory, previously untouched by the disease. Memory disorders progresses to such an extent that patients do not remember even their closest relatives. Characterized by neuropsychiatric symptoms: emotional lability, sudden aggressiveness, tearfulness, resistance care; possible vagrancy. Approximately 1/3 of patients with Alzheimer's disease revealed misidentification syndrome, and others. Manifestations of delirium. Perhaps incontinence.
These patients is reduced to the use of certain phrases or single words. In the future, language skills are lost completely. In this case a long time preserved the ability to perceive and maintain emotional contact with others. Alzheimer's disease in the stage of severe dementia, characterized by complete apathy, although sometimes aggressive manifestations may occur. Patients exhausted both mentally and physically. They are unable to independently perform even the simplest action, barely moved, and eventually cease to climb out of bed. There is a loss of muscle mass. Due to complications of immobility such as a developing congestive pneumonia, bedsores and other. It complications ultimately cause death.
encephalitis, intracranial tumor, brain abscess, epilepsy, chronic ischemia, stroke and transferred al.), and traumatic brain injury.
Diagnosing Alzheimer's disease in predementsii stage quite difficult. During this period, only the extended neuropsychological testing can reveal certain disorders of higher nervous functions. In the study, patients are encouraged to memorize words, copy the figures, to perform complex arithmetic, to read and retell old.
In order to exclude other diseases that can lead to the development of dementia, neurological examination neurologist conducts appoint additional examinations: EEG, REG, Echo-EH, CT scan or MRI of the brain. Some importance in confirming the diagnosis is the identification of beta-amyloid deposits during brain PET introduction Pittsburgh composition B. The latter is proved that another marker of disease may be the detection of tau protein and beta-amyloid in the cerebrospinal fluid taken for analysis by lumbar puncture.
Differential diagnosis of Alzheimer's type dementia performed with vascular dementia, parkinsonism, dementia with Lewy bodies, dementia, epilepsy, and others. Neurological disorders.
dizziness, confusion, headache, hallucinations.
Cholinesterase inhibitors (rivastigmine, donepezil, galantamine) demonstrated moderate effectiveness when trying to treat Alzheimer's disease in the early stage or moderate dementia. Donepezil can be used in severe dementia. The use of cholinesterase inhibitors in predementsii stage failed to prevent or slow the development of symptoms. Side effects of these drugs include: bradycardia, weight loss, anorexia, muscle spasms, gastritis with high acidity.
In cases where Alzheimer's disease is accompanied by anti-social behavior, for the relief of aggression possible appointment of antipsychotics. However, they can cause cerebrovascular complications additional reduction of cognitive functions, and motor disturbances with prolonged use increases mortality of patients.
Along with pharmacological applied psychosocial treatments of patients having Alzheimer's disease. So, supportive psychotherapy seeks help patients with early dementia to adapt to the disease. In more severe stages of dementia using art therapy, sensory room, memories of therapy, presence simulation, sensor integration, Validation therapy. These techniques do not result in a clinically significant improvement, however, in the opinion of many authors, they reduce anxiety and aggressiveness of patients, improve their mood and thinking, soften some problems (such as incontinence).
smoking, diabetes, high cholesterol, hypertension) cause more severe dementia of the Alzheimer type and may increase the risk of its occurrence.
In connection with the above, to prevent Alzheimer's disease and slow down its flow, it is recommended to lead a healthy lifestyle at any age to stimulate thinking and do physical exercises.