Alzheimer’s Disease

….And other dementias….

AD

• Can be divided into Early Onset (< 60) and Late Onset (>60).

• Perhaps two different etiologies

• After age 65, the number of cases doubles every 5 years.

• 3% of people 65-74 have the disease

• Approx. 50% of people over 85 have the disease.

GRADING SYSTEM

Grade 1 (top row of 4 images) corresponds to mild cerebral atrophy and ventricular dilatation. Note this degree of change may be assessed as compatible with normal

aging. Thus, grade 1 accomodates scoring of brains from nondemented control subjects with minimal or no gross neuropathology.

Grade 2 (middle row of 4 images) corresponds to moderately severe cerebral atrophy and ventricular dilatation. Note widening of sulci, rounding of frontal horns, and

expansion of the area of the body and 3rd ventricle. Grade 3 (bottom row of 4 images) corresponds to severe cerebral atrophy and

ventricular dilatation. Dramatic shrinkage of gyri, gaping of some sulci, and extreme ventricular dilatation is obvious. Note also the white matter area is markedly

diminished from the amount noted in grade 1 brains.

Plaques

• Extracellular• Contain A-beta (sequence cleaved from

APP)• Metals (aluminum, zinc)• Immunoglobulin G• Amyloid P• apoE• ETC….over 30 other proteins

Tangles

• Intracellular

• Bundles of long unbranched elements that form a fibrous twisted pair of filaments

• Consist of tau protein (a protein that ordinarily stabilizes cellular microtubules)

• Are somewhat correlated with degree of dementia – post-mortem.

1- Memory 2- Orientation3- Judgment4- Community Affairs5- Home & Hobbies6- Personal Care

Axis of Diagnosis

Impairment Level and CDR Score (0,  0.5,   1,  2,  3)

  None0

Questionable0.5

Mild 1

Moderate2

Severe3

Memory

No memory loss or slight inconsistent forgetfulness

Consistent slight forgetfulness; partial recollection of events; "benign" forgetfulness

Moderate memory loss; more marked for recent events; defect interferes with everyday activities

Severe memory loss; only highly learned material retained; new material rapidly lost

Severe memory loss; only fragments remain

Orientation

Fully oriented

Fully oriented except for slight difficulty with time relationships

Moderate difficulty with time relationships; oriented for place at examination; may have geographic disorientation elsewhere

Severe difficulty with time relationships; usually disoriented to time, often to place

Oriented to person only

Judgment

& Problem

Solving

Solves everyday problems & handles business & financial affairs well; judgment good in relation to past performance

Slight impairment in solving problems, similarities, and differences

Moderate difficulty in handling problems, similarities, and differences; social judgment usually maintained

Severely impaired in handling problems, similarities, and differences; social judgment usually impaired

Unable to make judgments or solve problems

Communit

y Affair

s

Independent function at usual level in job, shopping, volunteer and social groups

Slight impairment in these activities

Unable to function independently at these activities although may still be engaged in some; appears normal to casual inspection

No pretense of independent function outside homeAppears well enough to  taken to functions outside a family home

No pretense of independent function outside home Appears too ill to be be taken to functions outside a family home

Home and

Hobbies

Life at home, hobbies, and intellectual interests well maintained

Life at home, hobbies, and intellectual interests slightly impaired

Mild but definite impairment of function at home; more difficult chores abandoned; more complicated hobbies and interests abandoned

Only simple chores preserved; very restricted interests, poorly maintained

No significant function in home

Personal

Care

Fully capable of self-care Needs prompting

Requires assistance in dressing, hygiene, keeping of personal effects

Requires much help with personal care; frequent incontinence