aetiology & clinical features of alzheimers disease

8/18/2019 Aetiology & Clinical Features of Alzheimers disease

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CLINICAL FEATURES

OF ALZHIEMER’SDISEASE

Chairperson: Dr. Anpa!a

"resen#er: Dr. $i%ona


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Introduction: Dementia

• A disease process marked byprogressive cognitive impairment inclear consciousness

• Development of multiple cognitivedecits manifested by both memoryimpairment and impairment in at least

one other cognitive domain includinglanguage, praxis, gnosis, andexecutive functioning


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• Decline from a previous level offunctioning

• Involves multiple cognitive domains

• Signicant impairment in social oroccupational functioning


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• Divided into various types based onaetiology:

Alzhiemers

!e"y body

#ascular

$rontotemporal

%ther medical and neurologicalconditions


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Introduction: Alzhiemers

• &ntil recently, the most common form ofdementia

• %nset and progression follo"s a

characteristic pattern• 'robable diagnosis can be made on the

basis of clinical history

•

Associated "ith specic neuropathologicalchanges seen in the brain on histology

• Denitive diagnosis can be made only atautopsy


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Introduction: Alzhiemers

• Alzheimer(s disease is a gro"ing problema)ecting the lives of not only the su)erers, butalso their families

•

*uge costs to society, to the families of thosea)ected, and to the individuals themselves

• Direct + indirect nancial costs

• motional impact resulting in distress andpsychiatric morbidity

• -etter health care services. substantial rise inelderly population of developing countries


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His#or& • /ovember 01th, 2342

• 125year5old "oman

•

Auguste Deter• 'resented "ith

progressive impairmentof

- memory,

- aphasia,

- disorientation,

- psychosocialincompetence

- hallucinations

• 'resenile dementia


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His#or& • Dr7 Alois Alzhiemer

• 8orked in $rankfurt

"ith $ranz /issl• xamined Auguste

Deter

•

8orking under 9raeplinin unich a time of herdeath

•

;e


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Denition

• DS5I#5=;

• Dementia of the Alzheimer(s type

•

=he gradual onset and continuingcognitive decline involving:

- emory impairment and one or moreof

- Aphasia,

- Apraxia,

-

Agnosia, and


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Denition

- Signicant impairment in social oroccupational functioning

- ;epresent a signicant decline from aprevious level of functioning

- ust not be due to:

other central nervous system conditionsor

systemic conditions or

the result of substances


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Denition

- ust not occur exclusively during thecourse of a delirium

- ust not be accounted for by anotherAxis I disorder

- $urther divided into t"o types:

arly onset >before the age of 61 yrs?

!ate onset >61 and above?


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Denition

• I@D5 24

• A? 'resence of dementia7

•

-? Insidious in onset "ith slo"deterioration7

• @? Absence of clinical evidence orndings from special investigations,tosuggest that the mental state maybedue to other systemic or braindisease,"hich can induce dementia7


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Denition

• I@D5 24

• D? Absence of a sudden,apoplecticonset ,or of neurological signs of focaldamage,such as hemiparesis,sensoryloss,visual eld defects + inco5ordination occurring early in the

illness


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pidemiology

• Incidence increases "ith age

–471 percent per year at age 61 to63,

–2 percent per year from age 4 toB,

– 0 percent per year from age 1 to3,

– C percent per year from age 4 toB,

– and ercent er ear after a e


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pidemiology

• A)ects "omen three times as often asmen

• ore common in black than in "hiteAmerican "omen

• %ther risk factors:

- 'resence of a positive family history

- Do"ns syndrome

- *istory of head trauma

-

!o" level of education


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/europathology

• 'ostmortem: brain in AD

- !ighter

-

ore prominent sulci- !arger ventricular volume

•

icroscopic examination:- xtracellular amyloid pla


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/europathology: Amyloid'la


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/europathology: Amyloid'la


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/europathology

• 'la


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/europathology: /eurobrillarytangle

• Intracellular inclusion bodies

• @ontain paired helical laments

•

@omposed of aggregates ofhyperphosphorylated A'=

• $ound in the entorhinal cortex,hippocampus, lateral temporal lobe,neocortex

• /ot pathognomonic for Alzheimer(sdisease


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/europathology: %ther ndings

*iranos bodies

• Intracellular aggregates of actin andactin5associated proteins

• ;od5shaped, crystal5like, andeosinophilic

• Seen in hippocampal pyramidal cells

• $ound in patients of AD

• /ot pathognomonic


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• Degeneration of nerve cells

• Amyloid deposition in leptomeningealblood vessels: amyloidangiopathy

• /europil threads are short neuronalprocesses found in the cortical regionsassociated "ith tangle pathology

• Shrinkage of neurons + loss of dendriticspines

• Atrophy is most apparent in the

associational cortex areas


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• Granulovacuolar degeneration

• Signicant degenerative changes inneurons are seen in the hippocampus,locus ceruleus, and nucleus basalis ofynert

• !oss of cholinergic neurons in the

nucleus basalis

• !oss of brainstem noradrenergic andserotonergic neurons

• Abnormal aggregation of H5synuclein


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• !oss of large neurons:

- !ayer II of entorhinal cortex

-

'yramidal neurons in layers III and # ofneocortex

- @holinergic neurons in the basal forebrain

-

Select subcortical nuclei- ;elative sparing of occipital and

cerebellar area

•

Shrinkage of golgi apparatus


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Aetiology

• ulti5factorial

• Genetic + environmental factors

•

ultiple path"ays + agents involved• #arious hypotheses put for"ard

• Dynamic interaction bet"een the

di)erent protective as "ell as riskfactors


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Aetiology: Genetic factors

• utations or copy number variations"ithin several genes that result in thecleavage of A'' into AE: early5onset

Alzheimer(s disease• !ate5onset Alzheimer(s disease is a

complex disorder, in "hich risk is

inuenced by multiple genes, byenvironmental factors, and by theirinteractions


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Genetics: arly onset AD

• utations at three genetic loci: autosomaldominant inheritance

• Amyloid precursor protein >A''? gene

located on chromosome 02- %ver 04 di)erent mutations in fe"er than

244 families "orld"ide

- ;ecently, families "ith duplications of A''found

- Similar to the increased risk of AD

associated "ith trisomy 02


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• 'resenilin52 >'S 2? on chromosome 2B – ore than 264 mutations reported

– %nset of symptoms before age 14

– Autosomal dominant traits "ith nearlycomplete penetrance

•

'resenilin5 0 >'S 0? on chromosome 2 – ;are

– AD but not fully penetrant

–

%nset before 61yrs


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• 'S 2: 04J• 'S 0: 2J

• A'': 1J

• ;emainder: SingleK multigenic causation


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Genetics: !ate onset AD

•%ne gene "ith a clearly establishedrelationship to late5onset AD is apolipoprotein gene

• APOE gene on chromosome 23

• =hree common alleles, coding for threeprotein isoforms that di)er by the substitutionof an amino acid at Lust t"o positions

•It has been demonstrated that the MB alleleconfers risk, "hilst the M0 may be protective


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•Increased risk of AD in individuals carrying theMB allele >A'%B? in both familial and sporadiccases

• Increased risk and the mean age of onset of

AD is earlier: number of A'%B alleles from 4to 0

•Single copy of allele: 05B fold increased risk

• ="o A'%B alleles: increase the risk by B5fold


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Genetics: !ate onset AD• Accounts for 14 per cent of the genetic

variance• @arrying one or even t"o A'%B alleles is

neither necessary nor suNcient for thedevelopment of AD7

• $or those "ho are disease5free at age 61, atmost 14 percent of A'%B homozygotes "illdevelop Alzheimer(s disease "ithin their

lifetimes• =hus limiting the use of the A'%B genotype

as a predictive test

• 8hen A'%B testing is added to theevaluation of individuals clinicall dia nosed


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• Genes contributing to the remaining O14J ofrisk for late5onset AD are unkno"n

• any regions throughout the genome

implicated as possibly harboring risk genes,though no genes have been denitivelyidentied

• A combination of linkage and associationstudies using large populations "ill identifythe other genes that inuence AD, either

alone or in interactions "ith other genes or


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• Genes contributing to the remaining O14J ofrisk for late5onset AD are unkno"n

• any regions throughout the genome

implicated as possibly harboring risk genes,though no genes have been denitivelyidentied

• A combination of linkage and associationstudies using large populations "ill identifythe other genes that inuence AD, either

alone or in interactions "ith other genes or


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Genetics: %ther genes involved

Susceptible loci on chromosome 24

#;00 gene, ID gene7

Susceptible loci on chromosome 20

Alpha50 macroglobulin gene, !D! receptor Prelated protein gene,Glyceraldehyde5C5phosphate dehydrogenase gene7

icrotubule5 associated protein tau

@hromosome 2


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Genetics: %ther genes involved

/eprilysin

@hromosome C


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Aetiology: Amyloid E protein

• In 23B, the protein deposited in blood

vessels >congophilic angiopathy? in AD "assho"n to be a B5kDa peptide E5amyloid

• =his peptide, "hich is identical to the amyloidin pla


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• $ormation of b5amyloid is reported as theinitiating, or at least early event

• !eadS to all the other changes observedincluding

- tau aggregation and phosphorylation- neuronal loss

- cholinergic decits

-

clinical symptoms


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• A'' is a ubi


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• @leavage by E5secretase then R5secretasegenerates AE, "hile cleavage by H5secretaseyields a nontoxic peptide7


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• =he E5amyloid products vary in length

• 'redominant species having a length of B4 orB0 amino acids

• !onger peptides are some"hat more prone to

forming brils in vitro• xtracellular aggregation of AE5B0 forms the

nidus for additional amyloid deposition +pla


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Aetiology: Amyloid E protein• vidence indicates that self5aggregation of AE into

soluble lo"5n oligomers is a primary source ofsynaptotoxicity7

– 'ost mortem studies in animals transgenic formutant human A'' sho"s that decits in synaptic

structure and function precede deposition ofinsoluble AE into pla


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Aetiology: Amyloid E protein• AE may lead to synapse loss and neuronal death via

other do"nstream e)ectors7 – AE contributes to the hyperphosphorylation of

microtubule5associate protein =au >A'=?, "hichenhances its aggregation7

– %verproduction and aggregation of A'= causesynapse loss independent of the effects of AE7

– Soluble AE oligomers exist in e


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Aetiology: Amyloid E protein• Aggregation of H5synuclein also occurs in some

individuals "ith AD, and can contribute independentlyto cognitive impairments

• Also, the presenilins participate in /%=@* signallinga complex signal5transduction cascade

• @ritical in determining neuronal cell fate• utations in the presenilin genes may result in an

interference "ith the normal functioning of theprotein or may induce a gain in a novel pathogenic

function


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• echanisms of AE clearance:

- etallopeptidases such as Insulin degradingenzyme >ID? have AE degrading activity

- Qinc metalloproteinases may have AE

degrading activity- Abnormal endosomal function may impair

clearance of AE

- Any abnormality in degradation or clearancemay contribute to the pathogenesis


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• Amyloid cascade hypothesis:

Amyloid production and accumulation play acentral role in initiatng a cascade of eventsthat leads to cellular dysfunction, neuron loss

and eventually disease manifestations


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• Amyloid cascade hypothesis:

Amyloid production and accumulation play acentral role in initiatng a cascade of eventsthat leads to cellular dysfunction, neuron loss

and eventually disease manifestations


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Aetiology: /eurochemistry

• ost consistent changes involve loss ofcholinergic, serotonergic and glutamatergicmarkers

• vidences for failed cholinergic transmission

causing clinical symptoms:- Decreased presynaptic cholinergic markers in

neocortex and hippocampus in AD. corelates"ith disease severity

- Degeneration of basal forebrain neurons

- -asal forebrain lesionsK pharmacologicalblockade of mAch receptors impairs learning,

memory, attention


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• =he activity of choline acetyltransferase,the enzyme responsible for the nal step ofA@h synthesis, is substantially reduced inpatients "ith AD

•

@onrmed on autopsy of patients "ith atleast a moderate stage but not in patients"ith mild illness

• 'articularly evident in the nucleus basalis of

eynert and several neocortical regions• $orms the rationale for treatment "ith

choline5esterase inhibitors

•

Simplication of aetiology


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• Serotonin plays a key role in mood andanxiety disorders "hich are commonly foundto coexist "ith AD

• =here is a loss of the noradrenergic neurons in

the locus coerulus in AD• =his has been found to be associated "ith

exacerbated amyloid pathology, behaviouraldecits and neuron loss

• ay contribute to the developmentKprogression of AD


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• Glutamate excitotoxicity may play a role in

neurodegeneration

• ;eductions in glutamate receptors,predominantly located at postsynaptic sites

on dendritic spines• AE appears to destabilize dendritic spines,

resulting in retraction and synapse loss, viamodulation of the function of both H5amino5C5

hydroxy515methyl5B5isoazole5proprionic acid>A'A? and /5methyl5D5aspartate >/DA?classes of postsynaptic glutamate receptors


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Aetiology: Age

• Greatest risk factor

• C percent of people older than 61 years of age

• 04 to C4 percent of people older than 1years7

• Is it a correlated observation or "hether thereare specic age5related processes thatenhance pathological processes in AD is notkno"n7


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Aetiology: ducation

• pidemiological studies people "ith less

education are at increased risk of developingAD

• $unctional neuroimaging people "ith higher

educational attainment or higher premorbidintellectual functioning but similar levels ofdementia severity have more severe ndings7

• Suggests a protective e)ect of education

• ;elationship bet"een cognitive decline andneocortical synaptic density in AD7

• =here is also some evidence that education

can increase synaptic density


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Aetiology: strogen• strogen replacement after menopause may reduce

the risk of AD• strogen increases density of synaptic population +

excitatory synapses onto dendritic spines, in bothhippocampus and cortex7

• It also may interact "ith A'' processing, to increasebrain AE concentrations7

• strogen inhibits oxidation of lipids, lipoproteins, andnucleic acids in vitro and is protective of cells in

culture against a number of insults, including AE7• 'rospective studies of estrogen treatment: little

evidence of cognitive enhancement or reducedcognitive decline

•

8omens health initiative study: no prevention of


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Aetiology: =raumatic brain inLury

• @an increase the rate of cognitive decline in

the elderly

• Increase the risk for subse


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Aetiology: Inammation• 'opulation studies sho" that /SAID or corticosteroid

use decreases the risk of developing AD7• Studies support the hypothesis that some /SAIDs

lo"er AEB0 by directly modulating the activity of R5secretase

• /europathological studies demonstrate that thebrains of AD patients have increased concentrationsof acute5phase reactants, cytokines, and complementprotein, "hen compared to age5matched controls7

•

@linical trials of /SAIDs in Alzheimer(s diseasegenerally do not support an e)ect on slo"ing diseaseprogression

• Strongest association of /SAIDs has been "ith drugexposure 05C yrs before onset of disease. protective roleonly in preclinical stages


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Aetiology: /icotine

• @ase5control studies reduced likelihood of

AD in smokers7

• @ohort studies have found the oppositerelationship7

•

Indirect stimulation of nicotinic receptors viause of acetylcholinesterase inhibitors hasbenet in the treatment of AD7

• =here is also in vitro evidence that nicotine

may protect against AE toxicity7

• Increased incidence in smokers may be due todeletrious e)ect of smoking on cardiovascular

health

Aetiology: %xidative inLury +


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Aetiology: %xidative inLury +mitochondrial dysfunction

•

%xidative inLury is caused by reaction of freeradicals "ith cellular components

• -rain highly susceptible to oxidative inLury

• vidences for oxidative damage in AD:

- *igher levels of oxidized lipids, proteins, D/Ain brains of AD patients

- *ighest oxidative damage in most a)ected

areas and lo"est in most spared areas- 'athological lesions sho" signs of oxidative

inLury

- %xidative damage promotes protein

Aetiology: %xidative inLury +


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Aetiology: %xidative inLury +mitochondrial dysfunction

•

pidemiological studies and randomizedcontrolled trials using antioxidants as a modeof treatment have had mixed results

Aetiology: ;isk $actors


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Aetiology: ;isk $actorsCa#e'or& Fa(#or In)en(e on AD ris*

!ife events Aging Increases risk

arly life linguistic ability Decreases risk =raumatic brain inLury Increases risk

Genetics A'%MB Increases risk

Do"ns syndrome Greatly increases risk

Sex $emale vs male Increases risk

strogen replacement ay lo"er risk

DietKmedication

#itaminK nutrientsupplementation

#itamins @ + may beprotective

/SAID use Decreases risk

Statin use Decreases risk

@ardiovascular risk factors

*ypercholesterolemia Increases risk

*ypertension Increases risk

levated plasma homocysteine Increases risk

Diabetes mellitus Increases risk


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@linical features

• =he hallmark feature of dementia iscognitive impairment

• 'atients must demonstrate

impairment in memory and at leastone other cognitive domain

• =he early course is usually diNcult to

ascertain as the patient is a poorinformant

• Also early signs may be subtle and

may be missed by the caregivers


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@linical features: @ognitive

• @ognitive decline is manifested as

- Amnesia,

- Aphasia,

- Agnosia, and

- Apraxia


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@linical features: Amnesia

• emory loss in AD is early andinevitable7

• ;ecent memories are lost before

remote memories• =here is individual variation, "ith

some patients able to recall specic

and detailed events of childhood andothers apparently having fe" distantmemories accessible7

•

8ith disease progression, even


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• 'rimary problem is of ac


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• Short5term memory is impairedbefore long5term memory

• 'atients are unable to learn ne"

information or ne" skills• ay become disoriented and

confused in ne" environments

•!ater in the illness progression, long5term memory "ill become impaired


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• 'atients "ill no longer recall theirpersonal past history

• 8ill forget previously highly learned

material• 'rocedural memory for previously

learned skills may be retained longer


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@linical features: Aphasia

• !anguage decits in AD are not veryprominent

• ay only be apparent on detailed

examination• 8ord5nding diNculties >nominal

dysphasia?: earliest phenomena

observed• Accompanied by circumlocutions,

"ord substitutions, or

mispronouncing "ords


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• As the disorder progresses, syntax isa)ected and speech becomesincreasingly paraphasic

•

'atients have diNculty maintainingconversations

• =hen they stop initiating

conversation7• =hey may appear more "ithdra"n

and disengaged as their ability to

engage "ith others through


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• ;eceptive aphasia, or comprehensionof speech, is almost certainlya)ected7

•

In the nal stages, speech is grosslydeteriorated "ith decreased uency,preservation, echolalia, and abnormal

non5speech utterances• ventually, speech may become

incomprehensible and unintelligible


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@linical features: Agnosia

• $ailure to recognize or identifyobLects despite intact sensoryfunction

•

reected in the inability to recognizefamiliar obLects, familiar faces, or, inlater stages, one(s o"n reection in

the mirror• It also manifests as lack of insight

into one(s o"n impairment andunrealistic assessment of one(s



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• irror sign 'atients "ill interpret the

face in the mirror as some otherindividual and respond by talking to it orby apparent fearfulness7

• @an present as an apparent hallucinatoryexperience, until it is realized that theThallucination( is xed in both content and

space, occurring only "hen self5reectioncan be seen

• Implications for care needs and safety if

the unrecognized obLects are important

@linical features: Apra+ia


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• DiNculties "ith complex tasks >not due to

motor impairment? become apparent inthe moderate stages7

• DiNculties "ith dressing or tasks in thekitchen are noticed rst, but these areinevitably preceded by loss of ability for

more diNcult tasks7



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• Strategies to avoid such tasks are often

ac


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cognitive functions•

Impairment in executive functioning- planning,

- organizing,

-

se


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$unctional impairment•

*as the most impact on the person themselvesand necessitates most of the care needs ofpatients

• Abilities to function in ordinary life >ADLs? arelost, starting "ith the most subtle and easilyavoided and progressing to the most basic andessential

• $unctional abilities decline alongside cognitiveabilities but the precise correlation bet"een

these functions is not perfect, suggesting that

@linical features:


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Instrumental AD!s, those related to the use ofobLects or the outside "orld, are lost rst andcan be subtle7

• Self5care AD!s include dressing and personalhygiene and are also lost gradually.

•

'ersonal hygiene becomes poor as dentures arenot cleaned and baths taken less often, beforenally assistance is re


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;epresents a decline from a previouslevel of functioning

• If patients are still "orking, there must be

diNculties "ith Lob performance• =here must also be diNculties in social

functioning

/europsychiatric


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/europsychiatricfeatures

•

-ehavioral disturbances:- @ommon in many types of dementia

- 'revalence increases "ith advancing

dementia7- Include disinhibition, agitation, aggressive

behavior, uncooperative behavior, and

"andering- Agitation, particularly "orsening in the

evening hours, is common

-

ating disturbances may be seen

/europsychiatric


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•

-ehavioral disturbances:- 8andering a"ay from home can pose a

great threat to safety

-

xcessive or inappropriate vocalizations>grunting and screaming? occur in thelate stages

-

Incontinence may pose hygiene issues- Account for substantial caregiving burden

- %ften the trigger for moves to higher

levels of care7

/europsychiatric


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ood changes:• =he relationship bet"een AD and depression is

complex7

– Depression is a risk factor for AD,

– depression can be confused "ith dementia>pseudodementia?,

– depression occurs as part of dementia,

– cognitive impairments are found in depression7

• Assessing the mood of a person "ith dementia isdiNcult7

• 'sychomotor retardation, apathy, crying, poor

appetite, disturbed sleep, and expressions of

/europsychiatric


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ood changes:• aLor depressive episode is found in524J,

• inor depressive episode in 01J,

• Some features of depression in 14J

• Assessment of depression in a carer in up to 1J

• Depression is more common in the early than inthe later stages of AD but this may reect thediNculties of assessing depression in the moreseverely a)ected and least communicative

/europsychiatric


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ood changes:• Severely a)ected patients in nursing homes

may be particularly prone to depression7

• lation, disinhibition, and hypomania5

infre


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Anxiety:• $airly common throughout the course of

dementia

•

stimated to occur in about 64 percent ofpatients7

• %ften manifest as fear of being alone,

and patients "ill search for theircaregivers so as not to be alone

/europsychiatric


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'ersonality @hanges• @hanges in personality are an almost

inevitable

–

profound cognitive impairmentresulting in the loss of recognition ofloved ones,

–

!oss of understanding of and ability toreact "ith the outside "orld,

• 'ersonality change is most fre


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'ersonality @hanges• Individuals may become more anxious or

fearful, there is a attening of a)ect, and

a "ithdra"al from challenging situations• 're5existing personality traits may

become stronger or exaggerated duringthe course of a dementing illness

• !ess commonly, disinhibition "ithinappropriate sexual behaviours orinappropriate a)ect + aggressiveness

/europsychiatric


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'sychosis• Generally occur in the middle stages of

illness

•

@o5occur "ith behavioral disturbance• 24 5 14 J su)er from delusions and 24 5

01 J experience hallucinations

•

'aranoia: belief that belongings havebeen stolen

/europsychiatric


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'sychosis• Inability to nd a lost or misplaced obLect

is interpreted in a paranoid "ay "ith the

conviction that the obLect must havebeen stolen

• @an become more pervasive as theillness progresses

• In later stages, patients may havehallucinations in any modality, but mostcommonly visual hallucinations

/europsychiatric


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'sychosis• ay see deceased relatives

• isidentication syndromes5 @apgras(

syndrome may occur• *allucinations are often congruent "ith

delusions of the same theme

•

'sychotic symptoms can sometimes leadto behavioral disturbance as patients actout on them

/europsychiatric


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Sleep Disturbance• Altered sleep5"ake cycles can result in

disrupted and fragmented sleep

•

Seen in about half of patients• 'atients may have phase5shifted sleep,

going to bed late and sleeping late in the

morning7• ay also take fre


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•

@atastrophic reaction:- =he emotional and behavioral reaction

- =o a situation that either over"helms or

creates stress on the individualexperiencing dementia

- -ecause the situation >or stimulus? is

beyond the person(s ability tocomprehend

- Short5lived

-

'atient is confronted, and cannot avoid,

/europsychiatric


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•

Sundo"ning phenomenon:- &ni


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$amily history 'resent 7 @ommon insiblings

Absent7 @ommon ino)spring

Genetic causes A'', 'S52 +0 A'% epsilonB

&ni


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parietal + motor signs7ore dyspraxic + visuo5spatial decits7

!anguage decits5prominent>"ordcomprehension +naming?

disturbances common

G changes ore severeabnormalities

!esser abnormalities

'rogression ;apid Insiduous

/eurochemical assive neuronal loss inlocus ceruleus + nucleusbasalis of eynert7

Diminuition in cholineacetyltransferaseactivity in frontal cortex7Involves GA-A,+Somatostatin also7

-asal ganglia neuronalloss + cholinergicchanges7

Chara(#eris#i( Ear%& onse# La#e onse#

Imaging Severe @ortical + !ess marked cortical


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subcorticalinvolvement7markeddecrease in

hippocampalvolume7greaterventricular enlargement

involvement

yoclonus @ommon ;are

@S$ /othing signicant !o"er A-eta25B0*igher p =au

Incidence of Do"nssyndrome andmyeloproliferative

disorders

@ommon &ncommon

Age adLusted mortality *igher !o"er

/e"er advances


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/e"er advances

• A s#,& !easrin' #he ra#e o- -a%%sa!on' see!in'%& (o'ni#ie%& hea%#h&o%,er a,%#s /i#h an, /i#ho#pre(%ini(a% A%0hei!er1s an, a 2rain"ET s(an %oo*in' -or ,eposi#s o-a!&%oi,: Those peop%e /i#h a!&%oi,,eposi#s ha, #/i(e #he ris* o- -a%%s.

•

These s#,& res%#s s''es# #ha#3 inso!e peop%e3 (han'es in 'ai# an,2a%an(e !a& appear as ear%&in,i(a#ors o- A%0hei!er1s3 een 2e-ore

!e!or& (han'es.

/e"er advances


97/100

/e"er advances

• I# has 2een -on, #ha# #he !os#si'ni4(an# -a(#ors re%a#e, #o!ain#ainin' hea%#h& (o'ni#ionin(%,e, %o/ s(ores on !easres o-s#ress3 an+ie#&3 ,epression an,#ra!a 5 ,espi#e par#i(ipan#s1e+perien(in' %i-e6#hrea#enin'

i%%nesses3 io%en(e3 or %iin' /i#ha,,i(#e, paren#s an, sposes.

• Hen(e i# /as h&po#hesi0e, #ha#resi%ien(e in #he -a(e o- ,is#ressin'

%i-e een#s is %i*e%& re%a#e, #o posi#ie

/e"er advances


98/100

/e"er advances

• The ear%ies# A%0hei!er1s re%a#e, 2rain(han'es are sa%%& seen in #hehippo(a!ps3 #he 7(on#ro% (en#er7 o-!e!or&6re%a#e, a(#ii#& in #he 2rain 5/hi(h o-#en is one o- #he 4rs# 2rainareas a8e(#e, 2& A%0hei!er1s.

• Resear(h is no/ 2ein' (on,(#e, on a

pro#o(o% -or MRI62ase, ea%a#ion o-A%0hei!er1s ,isease6re%a#e,hippo(a!pa% shrin*a'e.

/e"er advances


99/100

/e"er advances

• So!e in,ii,a%s /i#h MCI hae anin(rease, ris* o- ,ee%opin'A%0hei!er1s.

•

A '%o2a% perspe(#ie on MCI in(%,in',a#a -ro! si+ (on#ries -on, #ha# an!2er o- (o!!on -a(#ors e!er'e asin,i(a#ors o- #he pro'ression -ro!

MCI #o A%0hei!er1s3 in(%,in':,epression3 apa#h&3 an+ie#&3 a'e3 %osso- a2i%i#& in a(#ii#ies o- ,ai%& %iin'3(ar,ioas(%ar -a(#ors 9in(%,in'

s#ro*e an, ,ia2e#es3 an, %o/ %ee%s


100/100

aetiology & clinical features of alzheimers disease

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