3/2/2023 0 Comments Late bird basis![]() ![]() The Mini-Mental State Examination (MMSE) is 1 bedside test that can help to evaluate changes in a patient’s cognitive abilities. 13 Another commonly used criteria, the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association (NINCDS-ADRDA) Work Group requires the presence of dementia that is documented by clinical examination, deficits in at least 2 cognitive domains, absence of other systemic disorders, progressive worsening of memory for the diagnosis of “probable AD.” 14 The Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition ) criteria for diagnosing dementia requires the loss of 2 or more of the following: memory, language, calculation, orientation, or judgment. 11, 12Ĭurrently, the diagnosis of AD is based on clinical history, neurological examination, and neuropsychological tests. 4 Treatment of AD with cholinesterase inhibitors and memantine may result in slowing of cognitive decline in patients with mild-to-moderate dementia, but current treatments do not modify the course of illness. ![]() Death commonly occurs from general inanition, malnutrition, and pneumonia. Neurological symptoms that may occur later in the course of illness include seizures, hypertonia, myoclonus, incontinence, and mutism. Delusions and hallucinations are not typically presenting signs but can present any time during the course of illness. Changes in mood and affect often accompany the decline in memory. With disease progression, impairment in other areas of cognition (eg, language, abstract reasoning, and executive function or decision making) occurs to varying degrees and typically is associated with difficulty at work or in social situations or household activities. An inability to retain recently acquired information is typically the initial presentation, whereas memory for remote events is relatively spared until later. 4, 7 – 10 Although the first-degree relatives of patients with late-onset disease have approximately twice the expected lifetime risk of the disease, the pattern of transmission is rarely consistent with Mendelian inheritance.īoth EOAD and LOAD present clinically as dementia that begins with a gradual decline of memory and then slowly increases in severity until the symptoms eventually become incapacitating. 4 With the exception of a few autosomal dominant families that are single-gene disorders (see below), most AD cases appear to be a complex disorder that is likely to involve multiple susceptibility genes and environmental factors. 5, 6 Early-onset disease can also occur in families with late-onset disease. Approximately 60% of EOAD cases have multiple cases of AD within their families, and of these familial EOAD cases, 13% are inherited in an autosomal dominant manner with at least 3 generations affected. Both EOAD and LOAD may occur in people with a positive family history of AD. However, LOAD, which is the most common form of AD, is defined as AD with an age at onset later than 60 or 65 years. Early-onset AD accounts for approximately 1% to 6% of all cases and ranges roughly from 30 years to 60 or 65 years. ![]() The disease is divided into 2 subtypes based on the age of onset: early-onset AD (EOAD) and late-onset AD (LOAD). 4 The duration of disease is typically 8 to 10 years, with a range from 2 to 25 years after diagnosis. An estimated 25% to 45% of persons older than 85 years have dementia. 3 Approximately 10% of persons older than 70 years have significant memory loss, and more than half of these individuals have probable AD. person years for people who are older than 90 years. person years for people between 65 and 69 years to 56. ![]() Indeed, AD prevalence increases significantly with age, and AD incidence increases from 2. The prevalence and incidence of AD strongly suggest that age is the most influential known risk factor. Moreover, over 5 million new cases of AD are reported each year, and the incidence increases from 1% between the ages of 60 and 70 to 6% to 8% at the age of 85 years or older 1 and is likely to increase as a greater proportion of the population ages. Alzheimer disease accounts for over 50% of all dementia cases, and it presently affects more than 24 million people worldwide. It is characterized by a gradual loss of memory and cognitive skills. Alzheimer disease ( OMIM #104300) is the most common irreversible, progressive cause of dementia. ![]()
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