Alzheimers Disease

Dementia is an acquired syndrome in which intellectual ability decreases to the point that it interferes with daily function. There are two major causes of dementia in older persons: Alzheimer's disease and vascular dementia. Approximately 60 percent of dementing illnesses are caused by Alzheimer's disease, 15 percent are caused by vascular dementia and many of the remainder involve concurrent Alzheimer's disease and vascular dementia ("mixed dementia"). I. Pathophysiology

A. Alzheimer's disease is associated with diffuse neuron injury and death, with senile plaques and neurofibrillary tangles. The average duration of the disease is 10 years, during which afflicted persons progress from mild memory loss to the need for 24-hour supervision to total dependency and death. Risk factors for Alzheimer's disease are age, a family history of the disease, and Down syndrome.

B. Vascular dementia is generally one of two types: multi-infarct dementia or subcortical vascular dementia. In multi-infarct dementia, the neurologic examination reveals focal, asymmetric abnormalities, and multiple strokes are evident on computed tomography (CT) or magnetic resonance imaging (MRI) of the brain. Subcortical vascular dementia (Binswanger's disease) is characterized by vascular disease that predominantly affects the midbrain.

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