Alzheimer's disease
Introduction
Introduction to Alzheimer's disease This is a group of primary brain degenerative diseases whose causes are unknown. They often start in old age or early age, and they are slow to develop and progress gradually. Dementia is the main manifestation. Pathological changes are mainly caused by diffuse atrophy of the brain and neuronal degeneration. In the past, according to the age of onset, it was divided into Alzheimer's disease and Alzheimer's disease. Modern research tends to treat both as a unit of disease. Known as Alzheimer's disease, the onset of pre-aged people, mostly family history of the same disease, the disease develops rapidly, in the elderly population of developed countries, the prevalence of dementia is 4% to 6%. As we age, the proportion continues to rise. It is generally believed that for every 5 years of age, the prevalence will double. More than half of them are Alzheimers' disease, and women are more common than men. The survey data in some areas of China are similar. basic knowledge The proportion of illness: 0.001% Susceptible population: often onset in old age or early age Mode of infection: non-infectious Complications: dementia, hemorrhoids, fracture, pneumonia
Cause
The cause of Alzheimer's disease
Genetic factors (51%):
In recent years, there has been an important breakthrough in the etiology of this disease. Using molecular genetics and linkage analysis, it is found that this disease is a familial genetic disease, and the risk of the same disease among family members of some patients. Higher than the general population, in addition, the risk of congenital (Down syndrome) is also increased, there is a potential familial connection, the brain of both diseases shows the same neuropathological changes, the main components of senile plaques The deposition of -amyloid protein is linked to the long arm amyloid precursor protein gene located on chromosome 21, which has been confirmed in early-stage patients, and is also found in late-onset cases with apolipoprotein 19 E-4 (APOE4) genetics are associated, and certain genes on chromosome 14 are also thought to be involved in the current process of production, indicating a positive genetic link.
Other factors (20%):
Accelerated normal aging process, accumulation of neurotoxins such as aluminum or silicon in the brain; progressive failure of the immune system; weakened detoxification of the body and chronic viral infections, may be related to the occurrence of this disease, old age, widowed, low education, living alone Economic distress and life-threatening people have more chances of getting sick, and psychosocial factors may be the cause of the disease in this group.
Prevention
Alzheimer's disease prevention
At present, many elderly people and their families are afraid that Alzheimer's disease will come to themselves or their families. Therefore, the cause of senile dementia is not very clear, so prevention is also difficult, but we should not be active. Treat this issue with attitude.
First, as I said before, it is not the elderly who will necessarily get Alzheimer's disease;
Second, some physical diseases and senile dementia are closely related, such as coronary heart disease, trauma, etc., we need to actively treat;
Third, for the elderly themselves, in addition to cheerful and optimistic personality, moderate physical exercise and sports, especially with a wide range of interests, and more fresh stimulation, is conducive to brain activity, because of the potential of the human brain Very large, although some nerve cells can not be used for work due to aging, then adjacent nerve cells can be mobilized to make up for their deficiencies, so that the function is compensated, so the elderly can not be kept at home to be isolated, Appropriate participation in social activities, to maintain a certain relationship with the outside world, even if suffering from AD, whether the patient has social activities, his degree of disease will be different, so talk to friends; learn some art, such as painting, calligraphy Chess, East, etc. These are all effective ways to promote the development of brain nerves.
Complication
Alzheimer's disease complications Complications Dementia Acne Fracture Pneumonia
Progressive progression of the disease, on average about 5 to 10 years, rarely self-healing, and finally to severe dementia, often due to hemorrhoids, fractures, pneumonia and other secondary physical illness or failure and death.
Symptom
Symptoms of Alzheimer's disease Common symptoms Memory impairment Cognitive dysfunction Dizziness Personality Change Forgetful aphasia
More insidious onset, a small number of patients in the case of physical illness, fracture or mental stimulation, symptoms appear quickly, memory disorders are often the first symptoms of the disease, such as often lost items, forgetting promised things, words and words Repeatedly, and then, the smart recession is getting worse. I dont know how to eat when I go out. I cant find my own family after I go out. I cant name my family. I cant even answer my name, age, marriage, etc., sometimes due to memory loss. Misconstruction and fiction; or suspected of being stolen by others because they cannot find the items they placed; or suspected that their spouses are not guilty because of strong guilt, the delusions of such fragments may gradually fade with the increase of dementia, patients The visual orientation ability is often damaged at an early stage. It is impossible to copy a simple three-dimensional figure. It can be detected from the neuropsychological test. Some patients cannot use the vocabulary correctly. They cannot recognize their own image in the mirror. There is still aphasia. Agnosia, apraxia and loss of autologous site and strong grip, sucking and other primitive reflexes.
Some patients with early emotional disorders, manifested as manic or depressive symptoms, may be misdiagnosed as a functional psychosis, as the disease gradually worsens, dementia symptoms become more and more obvious to be diagnosed, patients may still have personality changes, lack Shame and morality, not paying attention to personal hygiene, can not eat their own life, often collecting waste paper debris as a treasure, and in the later period, bedridden all day long, incontinence, ambiguous, disorganized speech.
In some patients, the mental symptoms deteriorate sharply, and the consciousness is blurred or paralyzed, accompanied by illusions and hallucinations. It is often caused by acute trauma, changing environment or various physical diseases, such as asymptomatic pneumonia, urine. Road infection, fracture and trauma, but still left varying degrees of personality changes and intelligent defects.
In terms of the body, the appearance is old, the skin is dry and wrinkled, the pigmentation is pale, the hair is pale, the teeth are shed, the muscles are atrophied, the pain reaction disappears, and other nervous system examinations often have no obvious positive signs, and tremors, convulsions, hemiplegia and muscle rigidity can occur in the late stage. In the early stage of EEG examination, only the rhythm slowed down, and the late stage was diffuse slow wave. CT examination showed cortical atrophy and third ventricle enlargement.
Examine
Alzheimer's disease check
Pathological examination showed cerebral cortical atrophy, cerebral gyrus flattened, sulcal widening, ventricle enlargement, weight loss, atrophy in sputum, top forehead and hippocampus area, and more obvious in early onset, histological examination, cortex Deep large nerve cells disappear or degenerate extensively, chromatin dissolves, nucleoli shrinks, dendrites decrease, stellate glial cells proliferate, and characteristic senile plaques and neurofibrillary tangles change The senile plaque is a plaque of argyrophilic tissue, which is round or irregular. The center is caused by amyloid deposition. The surrounding area is denatured glial cells. The number of cortical senile plaques is related to clinical symptoms. Many studies have found that There are abnormal axonal and dendritic processes in senile plaques. The neurofibrillary tangles are composed of paired helical filaments (PHF) or neurotubules, which are all amyloid degeneration of nerve tissue. In the deep nerve cells of the cortex, the presence of senile plaques and neurofibrillary tangles does not occur, and some elderly patients can see more Years of plaque and only a small amount of neurofibrillary tangles, biochemical examination of most neuropeptides such as: cholecystokinin, thyrotropin releasing factor and substance P are in the normal range, acetylcholine, serotonin and norepinephrine Both decreased, the decline of acetylcholine was most obvious in the hippocampus, and the growth hormone level increased.
Diagnosis
Diagnosis and diagnosis of Alzheimer's disease
The onset is slow, and the progressively worsened dementia is the main clinical symptom. Although the disease development can be temporarily paused, it is irreversible. According to the medical history, physical examination and laboratory examination to exclude other possible causes of dementia, it is necessary to distinguish it from the following diseases.
1. The symptoms of depression in the old age of other psychiatric diseases are not uncommon. The patient's memory is diminished, the thinking is difficult, the answer is slow, the response is slow, the movement is reduced, and the illusion of "dementia" is easy to be given, but the depressive symptoms are more urgent. There are clear boundaries, pre-existing intelligence and well-being, and clinical symptoms are mainly emotional depression. If you check carefully, you can find that the response content is relevant, self-knowledge can still be maintained, and the anti-depression drug has good curative effect, and there is no legacy personality. Or intelligent defects, toxic, symptomatic, reactive psychosis and schizophrenia in the elderly can be identified according to detailed medical history, careful physical examination and mental examination.
2. Other diseases manifested as dementia There are many diseases that can cause signs of dementia, such as pernicious anemia, neuromedin, frontal lobe tumor, normal pressure hydrocephalus, and other dementia caused by primary degenerative brain diseases, such as Pick disease, Huntington disease, Parkinson's disease, etc., most of which can be recovered if they are diagnosed and treated early, and clinically combined with medical history, physical examination and laboratory tests to identify. For the identification of cerebral arteriosclerotic psychosis, see the following multiple infarct dementia.
