Today s Topics
Memory Impairment & Dementia Age Associated Memory Impairment Dementia
Definition of dementia Depression Schizophrenia Mental retardation Delirium : Not final diagnosis term, but symptomatologic term Cognitive Functions Memory Reasoning Language Judgement Praxis Attention Insight Calculation Visuospatial perception
Memory Impairment & Dementia Normal Minimal cognitive impairment MCI Language Calculation Execution Judgment Attention Visuospatial function Dementia Memory
: Creutzfeldt-Jacob.. AIDS. Behcet.. Cryptococcal. :... : Wernicke-Korsakoff. B12. Pellagra. Marchiafava-Bignami :...... :. Dementia pugilistica(punch-drunken ) :....
Binswanger s disease Lacunar state (Multi-infarct dementia) (Strategic infarct dementia) (Subcortical vascular dementia) (Post-stroke dementia)
(Alzheimer s disease) (Frontotemporal dementia) (Lewy body dementia) (Parkinson s disease) (Progressive supranuclear palsy) (Cortical-basal ganglionic degeneration)
(Alzheimer s disease) (Vascular dementia) (Mixed dementia) (Frontotemporal dementia) (Lewy body dementia)
Instruments used to assess cognitive function Cognitive functions Memory Language Praxis Attention Insight Reasoning Judgement Calculation Visuospatial perception Mini-Mental State Examination MMSE-K or K-MMSE Hasegawa Dementia Scale 7 Minute Screen
1.,. 2.. 3.. 4.. 5.. 6.,. 7.. 8.. 9.. 10.. 11.. 12.. 13.. 14.. 15..
Mini-Mental Status Examination, Korea (MMSE-K)
Visuospatial perception
Specific functions impaired by damage Inferior occipital and posterior temporal visual association cortices : required to retrieve the unique knowledge about an object when it is presented visually Ventromedial frontal cortex : required to make social judgment Left anterior temporal pole : required to retrieve the names of unique entities but not common nouns or other non-unique entities
Epidemiology of dementia
History Alzheimer s disease 1907 ; Alois Alzheimer senile plaques neurofibrillary tangle cortical atrophy due to cell loss Alzheimer s disease
History Alzheimer s disease
Clinical diagnosis of probable Alzheimer s disease Clinical criteria to diagnose AD during life NINCDS-ADRDA (McKhann 1984) DSM-IV (American Psychiatric Association 1994) CERAD (Mirra 1991) WHO (Wetterling 1995)
Clinical diagnosis of Alzheimer s disease
Risk factors of AD Alzheimer s disease Aging Genetic risks associated with AD Family history of AD Family history of Down syndrome History of depression Estrogen deficiency Lack of education Head Trauma
Neuropathology of AD Alzheimer s disease Neuritic plaques tau protein Neurofibrillary tangles beta amyloid
Clinical Features of AD Alzheimer s disease Delayed free recall recall of a list of items after a few minutes delay, without cues or hints Recognition short term memory recall items from the same list but with the aid of cues or multiple choices Naming highly specific things Visual perception, getting lost, drawing Socially appropriate behavior Professional judgments of complex situations Insight or awareness that one has a memory problem Mathematical skills
Clinical Features of AD Alzheimer s disease
Clinical Features of AD Alzheimer s disease
Imaging of AD Alzheimer s disease MRI : Diffuse cortical atrophy Hippocampal atrophy AD Normal
. - APP. PS1. PS2. ApoE e4 - beta amyloid. Tau protein. - beta amyloid. Tau protein. Neuronal thread protein - skin amyloid. Tropicamide. Olfactory biopsy
Clinical Features Alzheimer s disease Cognitive decline Loss of functional autonomy Loss of motor function Mood changes Behavioral symptoms
Dementia with psychiatric symptoms Validated dementia Cognitive impairment, not dementia Minimal cognitive impairment Normal with risk factor of dementia
Dementia of Alzheimer s type : DAT others Alzheimer s disease others Subcortical Vascular dementia Frontotemporal dementia Dementia with Lewy body PSP & CBGD