Ternopil State Medical University named I.Horbachevsky

1. Ternopil State Medical University named I.Horbachevsky Chair of neurology, psychiatry, narcology and medical psychology Prep. by Roksolana Hnatyuk M.D., Ph.D.

2. Head Trauma… Alzheimer's Disease, Pick’s Disease

3. Traumatic psychoses

4. Healthy and affected brain cell

6. Amnesia - is lost of explicit memory. The central symtom of amnestic disordersis development of memory disorder characterized by impairment in the ability to learn new information (anterograde amnesia) and the inability to recall previously remembered knowledge (retrograde amnesia).

8. Anterograde amnesia - the inability explicitly to recall events that occurred after whatever trauma caused memory loss. Retrograde amnesia - the inability explicitly to recall events that occurred before whatever trauma caused memory loss.

9. Syndroms of psychic disorders in different period of trauma

14. Intelligence - the ability to understand, recall, mobilize and constructively integrate previous learning in meeting new situations.

15. Mental retardation:

16. Mental retardation:

20. What Are Some Dementia Types? • The effects of the different dementia types are similar, but not identical, as each one tends to affect different parts of the brain. Here are the • AIDS related dementia • Alcohol related dementia • Alzheimer's disease, has two forms : • Familial Alzheimer's Disease (FAD), also known as Early Onset Alzheimer's or Younger Onset Alzheimer's.

21. Alzheimer's disease • AD is by far the most common cause of dementia in the elderly, accounting for 60%80% of cases. It is estimated that four million adults in the United States suffer from AD. The disease strikes women more often than men, but researchers don't know yet whether the sex ratio simply reflects the fact that women in developed countries tend to live longer than men, or whether female sex is itself a risk factor for AD. One well-known long-term study of Alzheimer's in women is the Nun Study, begun in 1986 and presently conducted at the University of Kentucky.

22. The criteria for diagnosing Alzheimer's include: • - Memory Loss. Alzheimer's patients will begin to lose short-term memory. As the illness progresses, patients begin to lose memory of familiar friends, family members, objects, and places. - Loss of mobility, or impaired ability to perform everyday tasks.

23. Disorientation and wandering. Alzheimer's patients may become disoriented in familiar places. Alzheimer's patients may also roam and wander away from their home. - Impaired language ability. Many Alzheimer's patients lose the ability to converse with ease. They may grasp for words, or find themselves incapable of telling a coherent story. - Aggression, paranoia - Chronic insomnia and depression

24. Diagnosis • In some cases, a patient's primary physician may be able to diagnose the dementia; in many instances, however, the patient will be referred to a neurologist or a gerontologist (specialist in medical care of the elderly). Distinguishing one disorder from other similar disorders is a process called differential diagnosis. The differential diagnosis of dementia is complicated because of the number of possible causes; because more than one cause may be present at the same time; and because dementia can coexist with such other conditions as depression and delirium. Delirium is a temporary disturbance of consciousness marked by confusion, restlessness, inability to focus one's attention, hallucinations, or delusions. In elderly people, delirium is frequently a side effect of surgery, medications, infectious illnesses, or dehydratation. Delirium can be distinguished from dementia by the fact that delirium usually comes on fairly suddenly (in a few hours or days) and may vary in severity it is often worse at night. Dementia develops much more slowly, over a period of months or years, and the patient's symptoms are relatively stable. It is possible for a person to have delirium and dementia at the same time.

25. Mental status examination • A mental statuse examination (MSE) evaluates the patient's ability to communicate, follow instructions, recall information, perform simple tasks involving movement and coordination, as well as his or her emotional state and general sense of space and time. The MSE includes the doctor's informal evaluation of the patient's appearance, vocal tone, facial expressions, posture, and gait as well as formal questions or instructions. A common form that has been used since 1975 is the so-called Folstein Mini-Mental Status Examination, or MMSE. Questions that are relevant to diagnosing dementia include asking the patient to count backward from 100 by 7s, to make change, to name the current President of the United States, to repeat a short phrase after the examiner (such as, "no ifs, ands, or buts"); to draw a clock face or geometric figure, and to follow a set of instructions involving movement (such as, "Show me how to throw a ball" or "Fold this piece of paper and place it under the lamp on the bookshelf.") The examiner may test the patient's abstract reasoning ability by asking him or her to explain a familiar proverb ("People who live in glass houses shouldn't throw stones," for example) or test the patient's judgment by asking about a problem with a common-sense solution, such as what one does when a prescription runs out.

26. Neurological examination • A neurological examination includes an evaluation of the patient's cranial nerves and reflexes. The cranial nerves govern the ability to speak as well as sight, hearing, taste, and smell. The patient will be asked to stick out the tongue, follow the examiner's finger with the eyes, raise the eyebrows, etc. The patient is also asked to perform certain actions (such as touching the nose with the eyes closed) that test coordination and spatial orientation. The doctor will usually touch or tap certain areas of the body, such as the knee or the sole of the foot, to test the patient's reflexes. Failure to respond to the touch or tap may indicate damage to certain parts of the brain.

27. Diagnostic imaging • The patient may be given a computed tomography (CT) scan or magnetic resonanse imagining(MRI) to detect evidence of strokes, disintegration of the brain tissue in certain areas, blood clots or tumors, a buildup of spinal fluid, or bleeding into the brain tissue. Positron-emission tomography (PET) or single-emission computed tomography (SPECT) imaging is not used routinely to diagnose dementia, but may be used to rule out Alzheimer's disease or frontal lobe degeneration if a patient's CT scan or MRI is unrevealing.

28. BOOKS • American Psychiatric Association. Diagnostic and StatisticalManual of Mental Disorders.4th edition, text revised. Washington, DC: American Psychiatric Association, 2000. • "Dementia." The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, M.D., and Robert Berkow, M.D. Whitehouse Station, NJ: Merck Research Laboratories, 1999. • Lyon, Jeff, and Peter Gorner. Altered Fates: Gene Therapy and the Retooling of Human Life.New York and London: W. W. Norton & Co., Inc., 1996. • Marcantonio, Edward, M.D. "Dementia." Chapter 40 in TheMerck Manual of Geriatrics,edited by Mark H. Beers, M.D., and Robert Berkow, M.D. Whitehouse Station, NJ: Merck Research Laboratories, 2000. • Morris, Virginia. How to Care for Aging Parents.New York: Workman Publishing, 1996. A good source of information about caring for someone with dementia as well as information about dementia itself.

29. Many tests are also used to diagnose Alzheimer's disease. Blood and urine tests are used to rule out other problems. Imaging tests are also used, including magnetic resonance imaging (MRI), computerized tomography (CT), and positron emission tomography (PET) scans. These scans may reveal if brain tissue has measurably shrunk, if protein deposits have appeared, and if cavities in the brain have enlarged. These tests can give physicians a good sense of whether a patient is suffering from Alzheimer's. However, the only definitive tests involve the autopsy and examination of the patient's brain cells.

30. Treatment of Alzheimer's • Unfortunately, there is currently no cure for Alzheimer's disease. If diagnosed early, the patient can be prescribed certain medications that may delay the onset of symptoms. These medications include aricept, exelon, and reminyl. Medications can also be used to treat symptoms of Alzheimer's, such as the insomnia, anxiety, depression, and aggression that can accompany the disease. Many Alzheimer's patients suffer from other health problems that may exacerbate the symptoms of Alzheimer's. Anemia, nutritional deficiencies, and thyroid disease are often co morbid with Alzheimer's. These may also be treated with medications to put the patient at ease.

31. The Three Stages of Alzheimer's disease • Alzheimer's disease manifests itself in three distinct stages. • In the first stage, the patient begins to demonstrate signs of memory loss. They may forget where objects are located, and may forget common words throughout the course of normal conversation. • The second stage, the patient begins to demonstrate significant impairment in cognitive ability. They may be incapable of carrying on a coherent conversation, and may begin to forget familiar faces. • In the third and final stage, the patient becomes incapable of taking care of him or herself. They may become physically impaired, increasingly irritable, and forget their closest acquaintances.

32. What is Pick's disease, or fronto-temporal dementia? • Arnold Pick, who first described the disease in 1892, Pick's Disease causes an irreversible decline in a person's functioning over a period of years. Although it is commonly confused with the much more prevalent Alzheimer's disease, Pick's Disease is a rare disorder that causes the frontal and temporal lobes of the brain, which control speech and personality, to slowly atrophy. It is therefore classified as a "fronto-temporal dementia", or FTD.

33. According to the National Institute of Neurological Disorders and Stroke, the following conditions are currently grouped together as frontotemporal dementias: • Pick's Disease, • primary progressive aphasia, • semantic dementia. 

34. What are the signs and symptoms of Pick's Disease? Because the frontal lobes affect behavior and emotional response, people with Pick's Disease will usually show signs of changes in personality before they manifest evidence of dementia. This may begin as impulsiveness or a lack of inhibition. While the progression of symptoms in Pick's Disease is fortunately slow, symptoms do worsen over time.

35. Behavioral changes • Impulsivity • Obsessive/compulsiveness (for example, overeating or only eating one type of food) • Drinking alcohol to excess (when this was not previously a problem) • Rudeness or impatience, leading to aggression • Poor judgment • Withdrawal or seclusion • Inability to function or interact in social situations • Inability to hold a job • Lack of attention to personal hygiene • Sexual exhibitionism or promiscuity

36. Emotional changes • Abrupt mood changes • Lack of warmth, concern, or empathy • Indifference to events or to one's environment • Easily distracted; difficulty maintaining a line of thought • Unaware of the changes in behavior • Decreased interest in activities of daily living

37. Language changes • Reduced quality of speech: shrinking vocabulary, difficulty finding a word • Difficulty speaking or understanding speech (aphasia) • Repeating words others say (echolalia) • Weak, uncoordinated speech sounds • Decreased ability to read or write • Complete loss of speech (mute)

38. Neurological/physical problems • Increased muscle rigidity or stiffness • Difficulty moving about • Lack of coordination • General weakness • Memory loss • Urinary incontinence

39. If at least three of the following five distinguishing characteristics are present in the early stages, the diagnosis is likely to be Pick's rather than Alzheimer's: • onset before age 65; • initial personality changes; • loss of normal controls, e.g., gluttony, hypersexuality; • lack of inhibition; • roaming behavior.

40. Also, as compared with Alzheimer's disease, obvious mental impairment and memory loss occur later in Pick's Disease patients than in Alzheimer's patients.

41. Thank you for your attention!