Transcript Особливості перебігу та виходу астенічн

Ternopil State Medical
University
named I.Horbachevsky
Chair of neurology, psychiatry,
narcology and medical psychology
Prep. by Roksolana Hnatyuk
M.D., Ph.D.
Head Trauma…
Alzheimer's Disease,
Pick’s Disease
Traumatic psychoses
Healthy
and
affected
brain cell
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).
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.
Syndroms of psychic disorders in different
period of trauma
Intelligence the ability to understand, recall,
mobilize and constructively integrate
previous learning in meeting new
situations.
Mental retardation:
Mental retardation:
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.
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.
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.
 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
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.
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.
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.
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.
 BOOKS
 American Psychiatric Association. Diagnostic and
Statistical Manual 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
The Merck 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.
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.
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.

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.
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.
 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.
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.
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
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
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)
Neurological/physical problems
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Increased muscle rigidity or stiffness
Difficulty moving about
Lack of coordination
General weakness
Memory loss
Urinary incontinence
 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.
 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.
Thank you for your attention!