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Alzheimer's disease
·Alzheimer's disease (AD) is a progressive neurodegenerative disease with an insidious onset. ·Clinically, it is characterized by comprehensive dementia manifestations such as memory impairment, aphasia, apraxia, agnosia, impairment of visuospatial skills, executive dysfunction, and personality and behavioral changes. The cause is still unknown. ·Those who develop the disease before the age of 65 are called Alzheimer's disease; those who develop the disease after the age of 65 are called Alzheimer's dementia. ·Drawing is not easy, I hope you will be happy, thank you❤️
Bearbeitet um 2023-11-17 09:43:04
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Alzheimer's disease
- bacteria
This is a mind map about bacteria, and its main contents include: overview, morphology, types, structure, reproduction, distribution, application, and expansion. The summary is comprehensive and meticulous, suitable as review materials.
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Alzheimer's disease (Alzheimer's disease)
Overview
●Degenerative diseases of the central nervous system that occur in early and old age. ●The cause of the disease is still unclear, but it is mainly related to genetic and environmental factors. ●Progressive cognitive dysfunction and behavioral impairment ● There is no cure. Comprehensive treatment can alleviate the condition and delay its progression.
What is Alzheimer's disease?
Alzheimer’s disease (AD) occurs in old age and pre-elderly years. Degenerative disease of the central nervous system characterized by progressive cognitive dysfunction and behavioral impairment.
Clinical manifestations include memory impairment, aphasia, apraxia, agnosia, visuospatial Ability impairment, abstract thinking and calculation impairment, personality and behavior changes, etc.
What is the prevalence of Alzheimer's disease in the population?
Alzheimer's disease is the most common type of dementia in the elderly and is also the most common type of dementia in the elderly. One of the most common chronic diseases, accounting for approximately 50% to 70% of Alzheimer's disease.
A 2016 survey showed that approximately 40 million people worldwide are suffering from Alzheimer’s disease. And this number is expected to double every 20 years. The proportion of elderly people in developing countries is lower than Although developed countries in Europe and the United States have a higher rate of Alzheimer's disease than Western Europe and the United States.
Epidemiological surveys also show that Alzheimer’s disease occurs more frequently in people over 65 years old. The prevalence rate in the population is approximately 4% to 8% in developed countries. Chinese scholar Jia Jianping The research report of the professor's team is about 3%~7%, and the prevalence rate in women is higher than that in men. There are currently approximately 6 million to 8 million Alzheimer's disease patients in our country.
As age increases, the prevalence of Alzheimer's disease gradually increases, with an average age increase of 6.1 years. Its prevalence rate doubles, and after the age of 85, the prevalence rate of AD can be as high as 20% to 30%.
What are the types of Alzheimer's disease?
Depending on the severity of cognitive impairment, Alzheimer's disease Divided into three categories: mild, moderate and severe (see symptoms section for details).
According to the form of onset, the disease can be divided into Sporadic Alzheimer's disease and familial Alzheimer's disease:
·Sporadic Alzheimer's disease: accounts for more than 90% of Alzheimer's disease patients. Carriers of the APOE ɛ4 allele are the most clearly at-risk group for this disease.
·Familial Alzheimer's disease: It is inherited in an autosomal dominant manner, and most cases begin before the age of 65. It is mainly caused by mutations in the amyloid precursor protein gene, presenilin-1 gene and presenilin-2 gene.
Cause
Alzheimer's disease is caused by genes, lifestyle and environmental factors The combined effects are caused in part by specific genetic changes.
The exact cause of Alzheimer's disease has not yet been elucidated.
Although the following risk factors do not directly induce Alzheimer's disease, they increase the risk of the disease:
risk factors
age
Increasing age is the greatest known risk factor for Alzheimer's disease.
Alzheimer’s disease is not a sign of normal aging; However, as age increases, the probability of developing Alzheimer's disease increases year by year.
positive family history
If a first-degree relative (parent or sibling) Having Alzheimer's disease increases your risk of developing the disease.
down syndrome
Many people with Down syndrome also develop Alzheimer's disease.
Alzheimer's Disease Signs and Symptoms in People with Down Syndrome It often appears on the body 10 to 20 years earlier than the general population.
gender
The difference in risk between men and women is not significant, but overall, women suffer more It may be related to the fact that women generally live longer than men and changes in hormone levels after menopause.
mild cognitive impairment
Mild cognitive impairment refers to a person's memory or other thinking abilities that are impaired The degree of decline is greater than expected for their age, and patients can still socialize or work normally.
People with mild cognitive impairment have a significantly increased risk of progression to dementia.
When the primary impaired cognitive ability of a person with mild cognitive impairment is When memory is lost, progression to Alzheimer's disease is more likely.
Previous head trauma
People who have suffered severe head trauma are at greater risk of developing Alzheimer's disease.
chronic
Chronic diseases such as high blood pressure, high cholesterol, type 2 diabetes, and obesity may increase the risk.
bad lifestyle
Lack of exercise, smoking or exposure to secondhand smoke, lack of sleep, high-fat diet, Bad lifestyle habits such as sitting for long periods of time can increase the risk of Alzheimer's disease.
Low educational level and less social interaction
Low education level (less than a high school education) may also be a risk factor for Alzheimer's disease.
Being socially active may reduce your risk of Alzheimer's disease.
symptom
·Alzheimer's disease has an insidious onset, progressive worsening of symptoms, and existing cognitive function decrease, and may also have other neuropsychiatric symptoms. Memory loss is a core symptom. As the disease progresses, memory impairment gradually worsens and other symptoms gradually appear.
What are the typical symptoms of Alzheimer's disease?
Alzheimer's disease usually has an insidious onset and continues to progress. The main manifestations are cognitive decline and non-cognitive neuropsychiatric symptoms.
Medically, it is divided into pre-dementia stage and dementia stage. The main difference is whether the patient's ability to live has been reduced.
predementia stage
·Mild impairment of memory;
·Reduced ability to learn and retain new knowledge;
·Other cognitive abilities, such as attention, executive function, Language and visuospatial abilities may be mildly impaired;
·Does not affect basic daily living abilities and does not reach the level of dementia.
dementia stage
This stage is Alzheimer’s disease in the traditional sense. At this stage, the patient's cognitive function impairment has led to a decline in daily living ability. According to the degree of cognitive impairment, it can be divided into three stages: mild, moderate and severe.
mild dementia
·The first thing that appears is memory loss of recent events. Often forgetting things you do every day and some commonly used items.
·As the disease progresses, long-term memory loss may occur. That is, the forgetfulness of things and people that have happened long ago.
·Some patients suffer from visuospatial impairment, cannot find their way home after going out, and cannot accurately copy three-dimensional images.
·Fatigue, anxiety and negative emotions are prone to occur when facing unfamiliar and complex things.
·Exhibit personality disorders, Such as being unkempt, unkempt, irritable, irritable, selfish and suspicious.
moderate dementia
·Memory impairment continues to worsen;
·Reduced ability to work, learn new knowledge and social contacts, In particular, there is a significant decline in the knowledge and skills previously mastered;
· Decreased logical thinking and comprehensive analysis abilities, repetitive speech, Decreased calculation ability, obvious visual-spatial impairment, such as being unable to find one's room at home;
·Aphasia, apraxia, agnosia, etc. may occur;
·Some patients may also develop epilepsy and ankylosing-oligokinesia syndrome;
·Patients often have obvious behavioral and mental abnormalities and are introverted patients Become irritable, euphoric, and talk more, whereas the original outgoing personality Patients may become taciturn and uninterested in anything;
·Obvious personality changes occur, and some even engage in behaviors that cause loss of shame (such as urinating and defecating in public).
severe dementia
·The above symptoms gradually worsen;
·Apathy, erratic crying and laughing, loss of speech ability, Unable to complete simple daily tasks such as dressing and eating;
·Being speechless and lying in bed all day long, gradually losing the ability to contact the outside world (including relatives and friends);
·Tension or flexion paralysis of the limbs and sphincter dysfunction;
·It is often complicated by symptoms of systemic diseases, such as lung and urinary tract infections, Pressure ulcers and symptoms of systemic failure, and eventually death due to complications.
Seek medical advice
Alzheimer's disease is divided into pre-dementia and dementia stages, This disease can be better studied, prevented and treated. When patients develop symptoms related to the pre-dementia stage, they should seek medical attention as soon as possible.
When patients have difficulty concentrating, memory or thinking ability decline, When subjective symptoms such as hallucinations and delusions reach a level that affects normal work and life, Patients should first seek medical treatment immediately for comprehensive assessment and judgment. Family members also need to protect and take care of the patient to prevent danger.
Before seeking medical treatment, you should prepare your personal medical history (including personal history and family history), Medications you usually use (including prescription drugs, over-the-counter drugs, traditional Chinese medicine, vitamins or other dietary supplements, etc.), symptom records (especially regarding memory, Cognitive, emotional, mental and other aspects of performance), etc., so that doctors can make a comprehensive diagnosis.
Which department should I go to for treatment for Alzheimer’s disease?
Hospitals with conditions can provide treatment at the "Memory Clinic"; Hospitals that do not have memory clinics should seek treatment at the neurology department; It is best to see a cognitive impairment specialist for diagnosis and treatment.
What are the related tests for Alzheimer's disease?
Physical and neurological examination
Including reaction ability, muscle strength and muscle tone, Examination of vision and hearing, coordination, balance, etc.
laboratory tests
Routine blood and urine tests, and blood biochemistry tests were all normal. Cerebrospinal fluid examination can reveal reduced levels of amyloid-42 (Aβ42), Total tau protein and phosphorylated tau protein were increased.
EEG
The early EEG changes of Alzheimer's disease are mainly decreased amplitude and slowed alpha rhythm.
A few patients have early EEG alpha waves that are significantly reduced or even disappear completely. As the disease progresses, more extensive theta activity may gradually appear, especially in the frontal and parietal lobes. In the late stage, diffuse slow waves appear.
Film degree exam
CT examination showed brain atrophy and ventricular enlargement; brain MRI examination showed bilateral temporal lobes, Hippocampus shrinks. SPECT perfusion imaging and fluorodeoxyglucose PET imaging reveal the parietal lobe, Blood flow and metabolism in the hippocampus of the temporal and frontal lobes, especially the bilateral temporal lobes, are reduced.
PET imaging techniques using various ligands (such as PIB-PET, AV45-PET) shows beta-amyloid (Aβ) deposition in the brain.
neuropsychological examination
Assessing cognitive needs includes memory function, speech function, orientation, application ability, Seven areas including attention, perception (vision, hearing, perception) and executive functions are conducted.
Commonly used tools include:
Classification
name
overall rating scale
Mini-Mental Status Examination (MMSE)
Montreal Cognitive Test (MoCA)
Alzheimer's disease cognitive function assessment scale (ADAS-cog)
Cognitive Ability Screening Inventory (CASI)
grading scale
Clinical Dementia Rating Scale (CDR)
Global Decline Scale (GDS)
Psychiatric Behavior Rating Scale
Hamilton Depression Rating Scale (HAMD)
Neuropsychiatric Inventory (NPI)
scale for identification
Hachinski ischemia scale
genetic test
If there is a clear family history, Genes such as APP, PSEN1, PSEN2 and APOEε4 can be detected. The discovery of mutations can help with diagnosis and early prevention of disease.
Biomarkers
Alzheimer's disease can be diagnosed with biomarkers during the asymptomatic phase, Such as Aβ42, total tau protein and phosphorylated tau protein in cerebrospinal fluid and APP, PSEN1, and PSEN2 gene mutations.
What diseases should be distinguished from Alzheimer's disease?
vascular dementia
Vascular dementia (VaD) has symptoms similar to Alzheimer's disease. However, the etiology, pathology, treatment and prognosis are different.
Specifically as shown on the right:
Classification
AD
VAD
gender
More common in women
More common in men
Course of disease
Progressive, continuous progressive development
Volatility Progress
subjective symptoms
few
Common, headache, Dizziness, numbness of limbs, etc.
Cognitive function
global dementia, Personality damage
patchy damage, Relatively reserved personality
accompanying symptoms
Abnormal mental behavior
focal nerve Systemic symptoms and signs
neuropsychological examination
outstanding early episodic memory impairment
Impairment of episodic memory is often not obvious. Impaired executive functions are common
CT/MRI
Brain atrophy
Cerebral infarction or hemorrhage
PET/SPECT
Symmetry of temporal and parietal lobes low sexual blood flow
limitations, asymmetry low sexual blood flow
frontotemporal dementia
Frontotemporal dementia (FTD) is a group of diseases characterized by progressive frontal and/or temporal lobe atrophy. However, it is often difficult to detect the disease in its early stages. As the disease progresses, examination can reveal typical localized brain atrophy and low metabolism.
specific:
Classification
AD
FTD
loss of self-control
common, Late onset of disease
common, Appear early
changes in eating
anorexia, Weight loss is more common
Strong appetite, Love carbohydrates
Stereotypic behavior
rare
common
decreased speech
Late onset of disease
common
loss of inhibition
may have, but to a lesser extent
common
Euphoria
rare
common
Emotional indifference
common, Nothing serious
common, serious
self neglect (Poor self-care skills)
less, Late onset of disease
common
memory impairment
Appear early, serious
Appears late in the disease
executive dysfunction
Most patients present at a late stage
Appear early, progressive aggravation
visuospatial ability
early involvement
relatively reserved
Calculate ability
early involvement
relatively reserved
Dementia with Lewy bodies
Dementia with Lewy bodies (DLB) compared with Alzheimer's disease Recall and recognition functions are relatively preserved, while speech fluency, The impairment in visual perception and completion of operational tasks is more serious.
At similar cognitive levels, patients with DLB have more severe functional impairment than patients with Alzheimer's disease. Motor and neuropsychiatric disorders are more severe. At the same time, patients with this type of dementia have worse ability to take care of themselves.
Parkinson's disease dementia
Parkinson's disease dementia (PDD) refers to cognitive impairment in patients with Parkinson's disease reaching the level of dementia.
Compared with impairments in other cognitive areas, patients with PDD have particularly severe impairments in executive functions. PDD patients have reduced short-term memory and long-term memory abilities, but the severity is less severe than Alzheimer's disease. Deficits in visuospatial function are also common and are more severe than those in Alzheimer's disease.
treat
There is no specific drug that can cure Alzheimer's disease or effectively reverse the disease process. A combination of medications, non-drug treatments, and careful care can reduce symptoms and slow progression of the disease.
What medications are available for Alzheimer's disease?
Due to large individual differences, there is no absolute best, fastest or most effective medication. In addition to commonly used over-the-counter drugs, the most appropriate drug should be selected based on the individual situation under the guidance of a doctor.
Improve cognitive function
Acetylcholinesterase inhibitors (AChEI): Including donepezil, rivastigmine, huperzine A, etc., Mainly increases the level of acetylcholine in the brain and strengthens synaptic transmission;
N-methyl-D-aspartate (NMDA) receptor antagonists: Memantine can antagonize NMDA receptors and regulate glutamate activity. Now used to treat patients with moderate to severe Alzheimer’s disease;
Brain metabolism activators such as oxiracetam are sometimes used clinically.
Control mental symptoms
Many patients develop psychiatric symptoms at some stage of the disease; Such as hallucinations, delusions, depression, anxiety, agitation, sleep disorders, etc. Antidepressants and antipsychotics may be given, Selective 5-HT reuptake inhibitors are commonly used in the former, Such as fluoxetine, paroxetine, citalopram, sertraline, etc. Atypical antipsychotics are commonly used in the latter, Such as risperidone, olanzapine, quetiapine.
The principles of use of these drugs are:
· Low dose initiation;
·Slow increment;
·The increment interval is slightly longer;
·Try to use the smallest effective dose;
·Individualization of treatment;
·Be aware of drug-drug interactions.
What surgical treatments are available for Alzheimer's disease?
The disease generally does not require surgical treatment.
How is Alzheimer’s disease treated with Chinese medicine?
There is currently no evidence-based medical evidence to support the TCM treatment of this disease. However, some traditional Chinese medicine treatments or medicines can relieve symptoms. It is recommended to go to a regular medical institution and receive treatment under the guidance of a physician.
supportive care
Patients with severe Alzheimer's disease often suffer from malnutrition, Complications such as lung and urinary tract infections and pressure ulcers should be treated with supportive and symptomatic treatments.
What other treatments are available for Alzheimer's disease?
Vocational training, cognitive rehabilitation therapy, music therapy, etc.
Patients in the predementia stage of Alzheimer's disease should adjust their diet (Mediterranean diet), Physical exercise and cognitive training combine to slow cognitive decline.
prognosis
The course of Alzheimer's disease is about 5 to 10 years, and a few patients can survive for more than 10 years. Deaths often occur due to complications such as lung infections, urinary tract infections, and pressure ulcers.
daily
Due to the cognitive decline of patients with Alzheimer's disease, which affects normal work and life, Adapting the living environment to the patient's needs is an important part of any treatment plan.
For people with Alzheimer's disease, establishing and strengthening daily habits, Minimizing tasks that require memory can effectively improve the quality of life.
How to care for Alzheimer’s disease at home?
Create a safe and comfortable environment
Keep keys, wallets, phones and other valuables in the same place at home, Daily appointments should be held at the same time as much as possible to facilitate patient memory.
Keep medications in a safe place and use a daily checklist to record doses.
Use a calendar or whiteboard at home to record daily Schedule and make a habit of checking off completed projects.
Make sure the patient carries identification or wears a medical alert bracelet, Carry a mobile phone with location function and enter it into the phone Important phone numbers to locate missing patients.
Make sure the patient's shoes are comfortable and install sturdy handrails on stairs and bathrooms, Remove excess furniture, clutter and carpets to prevent falls or bumps.
Reduce the number of mirrors for Alzheimer’s patients May find images in the mirror confusing or frightening.
A calm and stable home environment promotes calmness A stable home environment can help reduce behavioral problems.
New surroundings, noise, large groups of people, being rushed Or being asked to do complex tasks can cause anxiety.
People with Alzheimer's disease experience a variety of emotions—confusion, frustration, Anger, fear, uncertainty, sadness and depression. Family members should listen patiently; Provide emotional support, reassure patients, and try to help patients maintain their dignity.
Focus on caregivers
People with Alzheimer's disease often express anger, guilt, stress, Negative emotions such as depression, worry, sadness and social isolation, Long-term care of a patient may affect the caregiver's mental health, Therefore, caregivers should also maintain a healthy lifestyle, pay attention to rest, Maintain a peaceful mind, avoid anxiety, and seek help from a psychologist if necessary.
What should patients with Alzheimer’s disease pay attention to in daily life management?
Lifestyle and Family Therapy
A healthy lifestyle promotes overall health, and may play a role in maintaining cognitive health.
Exercise: Regular exercise is an important part of the treatment plan. Activities such as daily walks can help improve your mood and keep your joints, Muscle and heart health. Exercise can also promote sleep, Prevent constipation. People with Alzheimer's disease who have difficulty walking You can use a stationary bike or participate in some chair-related exercises.
Nutrition: People with Alzheimer's disease may forget to eat and drink. Leading to malnutrition, dehydration and constipation. Family members should remind and help patients eat on time.
Social activities: Regular social activities can help patients retain certain abilities. Do something meaningful and enjoyable for people with Alzheimer’s disease Overall health is important, such as listening to music, dancing, reading or listening to books, Garden, do arts and crafts, or participate in social activities at an aged care center.
Management and treatment of other chronic conditions
Control chronic diseases such as hypertension, hyperlipidemia, and diabetes.
Alzheimer's disease condition What indicators need to be monitored daily?
If you find that the disease is progressing faster or complications occur, you should seek medical treatment promptly and follow the doctor's instructions for regular examinations.
How to prevent Alzheimer's disease?
Alzheimer's disease is preventable. Generally speaking, most risk factors for cerebrovascular disease are Risk factors for Alzheimer's disease and controlling them Can reduce the incidence and prevalence of Alzheimer's disease.
Get enough sleep, eat properly, exercise, Good mood, mental activities and interactions with relatives and friends, All help prevent the onset of Alzheimer's disease.