Chronic, progressive neurodegenerative disorder characterised by a global, non-reversible impairment in cerebral functioning.
Characterised by memory loss, loss of social and occupational functioning, diminished executive function, speech and motor deficits, personality change, plus behavioural and psychological disturbance.
Deteriorating course over up to 8-10 years.
Brain lesions are marked by neurofibrillary tangles, senile plaques, neuronal loss and brain atrophy, with defects in acetylcholine synthesis at the cellular level.
Treatment requires a multidisciplinary approach with increasing emphasis on behavioural and psychological symptoms.
Psychosocial interventions and carer support are key to managing disease course. Carer support groups are beneficial to carers and should be considered, where available.
Alzheimer's disease (AD) is a chronic neurodegenerative disease with an insidious onset and progressive but slow decline. AD is the most common type of dementia. It often co-exists with other forms of dementia such as vascular dementia (mixed-type dementia). The histopathology of AD is characterised by senile plaques, neurofibrillary tangles, and neuronal loss. The hallmark symptoms are memory loss, impairment of daily activities, and neurobehavioural abnormalities. Definition of severity varies according to country, but a commonly accepted categorisation is mild, moderate, and severe. The Mini-Mental State Examination can be used as a guide to cognitive impairment, but education and language must be taken into consideration when interpreting scores.
History and exam
- advanced age
- family history
- Down's syndrome
- low IQ
- traumatic brain injury
- female sex
- elevated plasma homocysteine level
- cerebrovascular disease
- lifestyle (smoking, obesity, diet high in saturated fats, and alcohol consumption)
- less than secondary school education
- artificially sweetened soft drink consumption
- cerebrospinal fluid (CSF) analysis
- serum rapid plasma reagin/Venereal Disease Research Laboratory (VDRL)
- serum HIV
- formal neuropsychological testing
- genetic testing
- fluorodeoxyglucose-PET (FDG-PET)
- single-photon emission CT (SPECT)
Assistant Professor of Psychiatry
Mount Sinai School of Medicine
JN declares that she has no competing interests.
Dr Judith Neugroschl would like to gratefully acknowledge Dr Brandy R. Matthews, Dr Asif S. Bhutto, and Dr Julie K. Gammack, the previous contributors to this topic.
Kings Harbor Multicare Center
RJG declares that he has no competing interests.
Professor of Neurology
Department of Neurology/Alzheimer Center
VU University Medical Center
PS declares that he has no competing interests.
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