Alzheimer's disease (Alzheimer s disease, AD) is a degenerative disease of the central nervous system that occurs in the elderly and the eld
Alzheimer's disease (Alzheimer s disease, AD) is a degenerative disease of the central nervous system that occurs in the elderly and the elderly, and is the most common type of dementia in the elderly. Clinical insidious onset, early manifestations of memory loss, with the progress of the disease, the emergence of a comprehensive cognitive decline, the ability to decline in daily life, can be accompanied by a variety of psychiatric symptoms and behavioral disorders. Its etiology and pathogenesis are still unclear. Characterized pathologically by neuritic plaques and neurofibrillary tangles and neuronal loss and amyloid angiopathy.
[clinical manifestations] AD often between 40 years old to the age of onset, especially in the elderly (after the age of 65 years), part of the onset in the early stage of the elderly (early-onset AD) (). Clinical insidious onset, the continued progress in the episodic memory impairment for early outstanding performance, with the progress of the disease, comprehensive cognitive decline, interfere with daily activities, often appear mental symptoms in a certain stage of the disease. In the later stages of the disease, abnormal gait and convulsions may occur. Final bed rest.
1 cognitive impairment cognitive dysfunction is the core symptom of AD.
(1) memory disorder in patients with early AD characterized by episodic memory impairment, patients can't recall recent events, often forget things placed, or even forget the last meal to eat meals, typically repeatedly tell the same thing, repeatedly asked the same question, because some patients can not find anything stolen delusion.
(2) early onset of disorientation can occur in patients with temporal disorientation, who do not know the current year, season, do not know a few days a few days and weeks. Mild to moderate stage, patients with disorientation, easy to get lost. To severe, patients in the room is lost, can not know their loved ones, and even do not know their own.
(3) executive dysfunction AD patients in the early implementation of executive function abnormalities, patients with decreased motivation, rigid thinking, rigid, can not adapt to the new environment, the ability to solve problems.
(4) in the early stage of aphasia patients with AD, the language barrier, the language cavity, and the obvious writing disorder can occur. With the progress of the disease, reading and writing ability to further decline, lack of substance, lack of logic. Severe patients with stereotyped language, terminally ill patients with silence.
2 the ability to reduce the daily activities of cognitive impairment caused by the decline in the ability of patients with daily life. Complex daily ability damage in patients with AD, such as work, shopping, travel, independent independent cooking can be difficult; to moderate, basic daily capacity patients also decline, can not completely take care of themselves, bathe and dress need guidance and help others; patients with severe daily severedisabilities, eat, two will also need help. Terminally ill patients can not eat, fully care of others.
3 behavioral and psychological symptoms of behavioral and psychological symptoms are common in patients with AD, including apathy, agitation, depression, sleep disorders are the most common. Usually in the early stages of the disease changes in mood and emotional apathy. To the middle and late stages of the disease, other symptoms such as sleep disorders, hallucinations, delusions and other symptoms of hyperactivity, walking, attack and other common symptoms.
4 neurological signs in patients with AD early no neurological signs, such as the presence of focal signs, should be suspected of AD diagnosis. Nervous system disease signs often emerge late for the balance disorders, abnormal gait, muscle tension, myoclonus, etc.. The patient finally lost the ability to stand, walk, and stay in bed for a long time.
1 routine blood, urine, biochemical examination AD routine blood, urine, biochemical examination. The blood, urine and biochemical examination of patients with 2 Effects: the exclusion of other causes of dementia, such as liver and kidney dysfunction, such as the lack of VB12; to determine whether patients had complications and treatment, such as anemia, electrolyte disorders, infection etc..
2 cerebrospinal fluid examination AD patients with normal cerebrospinal fluid examination. The detection of specific biochemical indicators can be found that A 42 decreased, total tau protein and abnormal phosphorylation of tau protein increased, with an auxiliary diagnostic value.
3 in the early stage of structural imaging, the hippocampus and medial temporal lobe were the main brain atrophy, and the latter was extensive atrophy. CT is economical, but MRI is more sensitive.
4 genetic testing for autosomal dominant AD families should be carried out genetic testing to determine the mutation gene. Screening for mutations in members of the family who are not members of the disease may help predict whether or not the disease will occur in the future.
Diagnosis and differential diagnosis
The elderly insidious onset, early episodic memory disorder prominent progressed, the overall decline in intelligence, the disease appeared in the late early mental symptoms, neurological signs, imaging in hippocampus and temporal lobe atrophy, exclude other diseases caused by cognitive decline, can be diagnosed as clinically probable AD. Pathological diagnosis.
Identification of AD and dementia should lead to other causes, associated with hallucinations, depression and behavioral and psychological symptoms of AD and delirium, depression and schizophrenia identification. Mild AD should be differentiated from benign amnesia.
1 mild AD and benign amnesia should be identified as early as possible to distinguish between benign amnesia and early AD, lifting the burden of the elderly.
Table 1 mild AD and benign amnesia
Seriously, prompting no help
It's likely to think about it later
Memory tests were significantly lower than those in normal subjects or in the past
Memory check Chang Zhengchang
Memory disorders have a positive impact on life
Generally does not affect life
Other cognitive functions
Other cognitive impairments, such as orientation, visual spatial function, etc.
Other cognitive functions
Worse than ever
A normal independent life
Can change significantly
No obvious change
Continued progress over the years
2 AD and other causes of dementia is a type of dementia, a variety of reasons can lead to dementia, different types of dementia treatment and prognosis, should be identified.
(1) vascular dementia is often relatively sudden onset (day to week), showing a fluctuating process, often accompanied by limb hemiplegia and other signs of stroke, head CT or MRI often have a clear stroke lesions. However, it should be noted that the onset of subcortical vascular dementia is relatively hidden, the development process is slow, and sometimes difficult to distinguish AD.
(2) frontotemporallobardegeneration frontotemporallobardegeneration is a relatively rare degenerative brain changes, often occurring in the aged, changes in personality or behavior (FTD) language disorder (progressive non fluent aphasia and semantic dementia) for early outstanding performance, memory, orientation and visual spatial function of early relative retention imaging, in the frontal and anterior temporal lobe atrophy.
(3) Louis's dementia, dementia, dementia, and dementia are the 3 core symptoms of the patients with cognitive impairment, such as the wave of cognitive impairment, the syndrome of Parkinson, and the visual hallucination of the patients with severe dementia. In addition, patients with antipsychotic drugs are over sensitive. The cognitive impairment of AD patients is persistent, hallucinations and Parkinson symptoms appear in the late stage of the disease, can be identified.
AD should be with other subcortical dementia (such as Parkinson's disease, Huntington's disease, hepatolenticular degeneration and progressive supranuclear palsy etc.) identification, also need to pay attention to eliminate prion disease and other infectious encephalopathy dementia, normal intracranial pressure hydrocephalus, metabolic and toxic dementia etc..
Currently, there are no specific drugs to prevent or reverse the course of disease. The purpose of AD treatment is to delay the progress of the disease, improve the quality of life of patients and reduce the burden of family members. The treatment principle is: the early prevention and treatment of early identification of AD for treatment in the early stages of the disease; the long-term treatment of AD is a chronic progressive disease requiring long-term regular medication; curative effect and side effect of the regular follow-up evaluation of drugs, evaluate the progress of the disease, the adjustment of drugs and treatment programs; strengthening nursing many patients died of complications, therefore, to strengthen the daily care, has important significance for prevention and treatment of complications. Treatment of AD includes the following aspects.
1 improve cognitive and life skills, including drugs and non drugs in two areas.
(1) research on non pharmacological measures suggests that mental and cognitive exercise may improve cognitive function, or slow down cognitive function. Patients should try to make certain activities, such as reading books, newspapers, etc. should be as far as possible to maintain the puzzle, ability in patients, caregivers don't do everything.
(2) the drug treatment, drug treatment of AD has 2 categories: cholinesterase inhibitors (donepezil, Kabbala Ting, domestic drug for Karst of huperzine A) and excitatory amino acid receptor antagonists (memantine hydrochloride). The selection principle is: the mild AD patients preferred a cholinesterase inhibitor, such as an invalid for another, such as invalid, can be replaced by or with the excitatory amino acid receptor antagonist; moderate patients can be any type of preferred two drugs, such as a cholinesterase inhibitor can be replaced by other invalid cholinesterase inhibitors combined with excitatory amino acid receptor antagonist; severe patients preferred excitatory amino acid receptor antagonists, such as invalid, can be replaced by or with the use of cholinesterase inhibitors. At the same time to pay attention to the contraindications of the two classes of drugs can be the first choice of another drug is contraindicated or relative contraindications to a medication. In addition, memantine hydrochloride on patients with AD agitation can improve, for the elderly and infirm, behavioral and psychological symptoms in patients with obvious may be preferred.
Other drugs include: the nootropic drugs pyrrolidinones drugs such as piracetam, aniracetam (also known as Arnie Si Staw) and the ergot drug oxiracetam; two hydergin, nicergoline; egb. These drugs may be effective and can be used clinically, but the results are inconsistent.
2 control mental and behavioral symptoms, including drugs and non drug 2 means
Neuropsychiatric symptoms common in patients with dementia, increased mortality, increased the burden on caregivers, timely and effective control of behavioral and psychological symptoms can improve the quality of life of patients and their families. At present, there are two ways to improve the treatment of mental behavior, including non drug and drug treatment.
(1) non drug therapy, including psychological intervention for patients and caregivers, is the preferred method of treatment to improve mental behavior. Caregivers should respect patients, language kind, while keeping the environment safe and quiet, to avoid the mental symptoms induced by patients. In the non drug treatment before, the need for behavioral and emotional changes were analyzed, the cause or trigger point therapy, targeted to the right. After treatment, the treatment effect should be checked and the symptoms should be evaluated to guide the next treatment.
(2) drug treatment
At present, 5 depression selective serotonin reuptake inhibitors used in the elderly, such drugs include fluoxetine (Prozac), Pa Rossi Dean (PHT), citalopram, sertraline, etc..
Anxiety of two benzodiazepines in improving anxiety efficacy (such as diazepam, Laura etc.), but because of the long-term use of drugs and drug resistance on clinical application of such drugs in the treatment of anxiety should choose short acting preparations, and the longest course is not more than 4 weeks or intermittent application, also can use at the same time selectivity of 5 selective serotonin reuptake inhibitors citalopram, such as Pa Rossi Dean, the latter 2 weeks after discontinuation of diazepam preparation work. Selective serotonin reuptake inhibitors may be used for fear of panic disorder or panic attacks.
Hallucinations, delusions, agitation, aggression and other psychotic symptoms
Memantine hydrochloride on improvement of agitation, attack, restlessness and other symptoms have certain effect, can be added. Selective 5-HT receptor reuptake inhibitors play a role in improving mood. When these drugs are ineffective, can choose new atypical antipsychotic drugs such as quetiapine, olanzapine, risperidone, but should be to the side effects of drugs that family. Use should pay attention to the following principles (1) low dose initiation; (2) slow increment; (3) the increment interval for a long time; (4) try to use the minimum effective dose; (5) can alleviate the condition, but not for complete control; (6) pay attention to drug interactions; (7) treatment individualized therapy.
3 in the treatment of complications of AD advanced patients can not feed themselves, instability of gait, finally in this stage, often malnourished, falls, fractures, pulmonary or urinary tract infection, bedsore and nursing care should be strengthened to prevent these complications, such as complications, should adopt corresponding treatment measures.