Pick disease dementia
Introduction
Introduction to Pico's disease dementia Because Pick first reported the disease in 1892, it was called Pick's disease. Pathological changes are mainly atrophy of the cerebral cortex, or localized changes of the frontal lobe and temporal lobe, or subcortical dementia. The main manifestation of Pico disease dementia is progressive intellectual disability, which is a chronic disease course. The pathological change is the amount of leaf atrophy dominated by temporal lobe. However, neurofibrillary tangles and senile plaques in the brain do not exceed normal aging. basic knowledge The proportion of illness: 0.001% Susceptible people: can start at any stage of adulthood, but more than 50 to 60 years old, women are more common than men Mode of infection: non-infectious Complications: Acne Multiple lung infections
Cause
The cause of Pick disease dementia
(1) Causes of the disease
The etiology of this disease is unknown, and some families have obvious genetic predisposition. They may be autosomal dominant, but most of them are sporadic. Some mental trauma is often regarded as the cause of the disease. Brain trauma can also be the predisposing factor of this disease.
(two) pathogenesis
At present, the exact pathogenesis of this disease has not been determined. The pathological changes are mainly limited by the frontal or frontal and temporal atrophy of the brain, and the degree of atrophy on both sides is asymmetrical. %, the most common atrophy of frontal lobe is atrophy, 50% of the left atrophy is more serious, limited asymmetry of the frontal lobe or frontal and temporal lobe atrophy with ventricular enlargement, especially the lateral ventricle angle is obvious, other parts of the cortex atrophy, There is a characteristic brown "blade" atrophy in the cerebral gyrus, and the outer neurons of the atrophic cortex are severely lost. The characteristic changes of the microscopic examination are gliosis and swelling of neurons (pick cells) and cytoplasmic argyrophils. Inclusion body (Pick body), according to which pathological diagnosis can be made, but this kind of cells may be rare, must be carefully searched, the brain coronal section can be seen that the cerebral cortex is significantly thinner, firmer than normal, visible cortical II under the microscope There is significant neuronal reduction in the /III layer, but the IV, V, and VI layers are not significantly reduced, but the order of cells is disordered, the degeneration becomes severe, the Nissl body disappears, there is nuclear offset and concentration, and the cells shrink, but No age spots Neurofibrillary tangles, there is also no cytoplasm ARGYROPHIL bodies.
Prevention
Pico disease dementia prevention
As the etiology and pathogenesis of this disease have not yet been elucidated, the prevention of the cause remains to be studied. Various methods can be applied to prevent this disease, including drugs, nursing, psychology, physical therapy, etc., while preventing Alzheimer's disease through diet, exercise and lifestyle. At the same time, actively prevent various infectious diseases and trauma, treat various chronic physical diseases, and continuously improve the health level. Here, only the diet for preventing Alzheimer's disease is introduced. In addition to the low calorie diet, the following points are worth noting:
1. Vitamin E Although no research has clearly shown that vitamin E can increase memory, vitamin E is an antioxidant that can prevent nerve cells from being destroyed by free radicals. At the same time, studies have indicated that patients with Alzheimer's disease have been taking vitamin E for 2 consecutive years. Delaying 8 months of degeneration, experts recommend that 400 units of vitamin E can be added daily to help prevent Alzheimer's disease.
2. Female hormones have recently shown that women who add female hormones after menopause can reduce their chances of developing Alzheimer's disease by 30% to 40%.
3. Eat more fish Dutch large-scale research shows that if you eat more fish, the cholesterol in the diet is lower, the probability of getting Alzheimer's disease is only 40% of the average person. This study is for 5,000 people over 55 years old.
4. Multi-use brain In the past, studies have shown that brain-like and interesting things are often used to keep the mind sensitive and to exercise brain cells to respond quickly.
5. More exercise Many people know that exercise can reduce the risk of stroke. In fact, exercise can also promote the production of nerve growth hormone and prevent brain degradation.
6. Maintain interpersonal relationships to maintain interpersonal relationships, avoid long-term depression and depression, because depression is also a risk factor for Alzheimer's disease.
In short, the elderly should use more brains, read more books, learn new things, even talk to friends, play mahjong, play chess, etc., to stimulate brain power, stimulate nerve cell vitality, to delay the aging process of the whole body, thereby reducing the occurrence of dementia. ,development of.
Complication
Pico-disease dementia complications Complications multiple lung infections of acne
1. If the patient is in bed for a long time and maintains a certain fixed position or posture for a long time, the body is under pressure, the back and back of the back skin and soft tissue blood circulation is blocked, malnutrition, poor resistance, easy to cause local skin redness , ulceration, erosion, ulcers, sputum formation of acne. In severe cases, the ulcer enlarges and deepens, and secondary systemic infection can cause sepsis and endanger life.
2. If the patient has incontinence. If not treated in time, it is easy to cause urinary tract infection. Therefore, care must be taken to change the cloth frequently and keep it clean. If you have perianal or red skin, use warm water to clean, dry, and apply zinc oxide paste to protect the skin. If you have constipation, you should be laxative in time, you can use the open dew or use soapy water to enema. Increasing the intake of cellulose in the diet can prevent the stool from drying out to some extent. The traditional Chinese medicine Senna leaf soaked in water on behalf of the tea has a good laxative function.
3. The patient lacks exercise, has poor resistance, and is prone to pulmonary infection. Therefore, special care should be taken to avoid cold and prevent colds. Otherwise, the sputum is not easy to cough up after infection of the upper respiratory tract, and it is easy to spread to the lower respiratory tract to cause lung infection.
Symptom
Symptoms of Pick's disease dementia Common symptoms Dementia, dementia, progressive dementia, depression, irritability, irritability, personality change
It can start at any stage of adulthood, but more than 50 to 60 years old, women are more common than men. The most significant clinical manifestation is early signs of frontal lobe lesions, and obvious personality and behavioral changes appear more than memory disorders. Early and more common, childish, no self-control, lying, alcohol, laziness, impoliteness, mischief; emotional impulses, irritability, roaming, poor judgment, can be "stealing", sexual behavior de-suppression ( Detained, such as sexual harassment, some patients may have social withdrawals, lack of initiative or depression.
The clinical symptoms can be divided into three stages. The first stage of the prominent symptoms is behavioral disorder, which is mainly characterized by less movement, laziness, loss of self-knowledge, multiple impulsive behaviors, frequent outings, no housework, and even moral sorrow such as theft. Lying or insulting young girls can also be characterized as irritability, distraction, cognitive impairment, loss of high intentional intention in the second period, lack of initiative and initiative, repeated speech, and feeling or motor aphasia. Disappearing, loss of recognition, there may be extra-pyramidal signs such as gear-like muscle rigidity and sluggish face. The third stage is severe dementia, personality decline, loss of speech ability, limb contracture, incontinence, loss of self-recognition, and may occur. Stereotypes and sucking, strong grip and other original reflections, the disease has few hallucinations and delusions, seizures are rare, and dementia develops more rapidly.
Examine
Examination of Pick's disease dementia
Psychological examination is an important method to diagnose the severity of dementia and dementia. In recent years, many internationally simple and rapid screening tools have been introduced and revised in China. The diagnostic validity, sensitivity and specificity are high. :
1. Mini Mental State Exami-nation (MMSE) was compiled by Folstein in 1975 to assess the scoring criteria. If the answer or operation is correct, record "1", the error is "5", refuse to answer or say no. Record "9" or "7", the main statistics of the "1" project sum (MMSE total score), the range is 0 ~ 300 international standard 24 is divided into critical values, 18 ~ 24 for mild dementia, 16 ~ 17 for moderate Dementia, 15 is divided into severe dementia. China has found that the critical value is different due to different educational levels; illiterate is 17 points, primary school (educational years 6 years) is 20 points, and middle school and above is 24 points.
2. Hasegawa Dementia Scale (HDS) Developed by Hasegawa Kazuo in 1974, a total of 11 projects, including orientation (2 items), memory (4 items), common sense (2 items), calculations ( 1 item), remember the naming memories (2 items).
The scale uses the positive score method, the full score is 32.5 points, the original author's critical value is: dementia 10.5 points, suspicious dementia 10.5 ~ 21.5 points, edge state 22.O ~ 30.5 points, normal 31.0 points, can also The normal value is divided according to the degree of education: illiterate 16 points, primary school < 20 points, secondary school < 24 points.
3. Activity of Daily Living Scale (ADL) Developed by Lawton and Brody in 1969, it is mainly used to assess the daily living ability of subjects.
The ADL is divided into 14 items and the score is 4:
1 You can do it yourself.
2 Some difficulties.
3 need help.
4 can not do, 64 points full score, total score 16 points is completely normal, > 16 points have different degrees of functional decline, single item 1 is divided into normal, 2 to 4 points function is reduced, there are 2 or more than 3 Or the total score 22 is the critical value, suggesting that the function has significantly reduced, the conventional total score in China is 18.5 ± 5.5.
CT and MRI: can show frontal atrophy, typical cases of forehead enlargement, forehead, temporal lobe atrophy, lateral ventricle and apex, occipital lobe less affected, a few cases of frontal atrophy may not be obvious, single photon emission tomography (SPECT Or positron emission tomography (PET) helps identify with AD, but sometimes it can only be diagnosed by autopsy.
Diagnosis
Diagnosis and diagnosis of Pick disease dementia
diagnosis
1. The age of onset is between 50 and 60 years old.
2. There is evidence of organic changes, there is progressive mental decline; memory impairment as a prominent performance, often forgetful orientation errors.
3. Insidious onset, early appearance of personality, behavior and personality changes, decreased self-care ability in daily life.
4. Advanced cerebral cortical dysfunction, such as thinking, understanding, judgment, analysis of comprehensive ability and computational power loss; emotional retardation or euphoria; social behavior is rude, poor self-control ability.
5. Progressive dementia.
6. Clear consciousness.
7. Indifferent performance, euphoria, language barriers, will decline, occasional pyramidal tract sign.
8. Head CT often shows localized atrophy of frontal or temporal lobe.
9. In the early stage of EEG examination, the disappearance of wave and the diffuse high wave amplitude slow wave can be found.
Differential diagnosis
1. Cerebral arteriosclerotic psychosis: These patients have multiple urgency, disease course and symptom fluctuations, often multiple remissions and exacerbations, and the personality remains intact. Clinical evidence of arteriosclerosis, such as retinal arteriosclerosis and serum cholesterol increase Higher, and often accompanied by a history of stroke.
2. Brain tumors These patients have clinical manifestations of increased intracranial pressure and localized nervous system compression signs caused by tumor occupying. Cranial space-occupying changes can be seen in the head CT.
3. The age of onset of paralytic dementia is early. There has been a history of sphincter disease. The cerebrospinal fluid examination showed an increase in cells and protein. The gold gel curve was paralyzed, and the blood and cerebrospinal fluid were positive for syphilis.
4. It is very difficult to identify the two diseases in Alzheimer's disease clinically. Most cases can be diagnosed after pathological anatomy.
