Patho

• - progressive deterioration of cognitive (ie thought) function
• - most notably memory, but also attention language, and problem solving
• - neuropsychiatric symptoms- apathy, agitation, depression
• Women have the higher prevalence and this increases over 78

the cost 5 billion a yr but there are hiddeb costs

• - difficulty learning o retaining new information
• - information retrival deficits
• - ersonal episodice memory impairement (misplacing items
• -declarative memory (what) affected more than procedural memory (how)

• - list generation deficits
• -word finding difficulties (naming problems)
• - less complex sentence structure (but comprehension reasonable intact

-problems in planning, predicting, correlating, abstracting

- problems in integrating and processing of information in order to make a decision (often the first sign in highly intelligent people)

• - these changes are very common and are often the main treatment focus as they trigger institutionalisation
• - apathetic, socially withdrawn, depressed
• - disinhibition (inappropriate sexual behaviour orlanguage)
• - self centered behaviours (childishness, selfishness)
• -agitation, wandering, agresion
• - sleep disturbances
• - delusions, perceptual disturbances

• - results from impaired functioning of cortical andsub-cortical brain systems, particularly those associated with memory and other cognitive functions
• - generally caused by structural damage that is progressive and relatively irreversible

Alzheimer's disease even under 65 (35%) and this increases to 54% over 65

• - shrinkage of the brain is easily detected by eye. Evident from opening up of sulci and apparent enlargement of ventricles

• - amyloid plaques (aka seni,e plaques, neuritic plaques) extracellular deposists of an abnormal, insoluble protein call amyloid
• - neurofibrillary tangles- intracellular collections a protein called tau, from disrupted neuronal microtubules
• - widespread loss of neurons
• these changes typically first appear in the temporal lobe (entorhinal cortex and hippocampus), but then spread to prefrontal cortex and beyond

• Starts in the prefrontal cortex then develops to the temoral cortex and bottom of midbrain and occitpial lobe then severe AD results in majority of the brain

• - deep into the temporal lobe

• retrograde amnesia- loss of memory before the incident
• anterograde amnesia- loss of memory ofter incident

• - learning is the acquition of new knowledge or info
• - memory- the retention of learned info
• - declarative memory- memory for facts and events - easy to form and easy to forget, can be recalled for conscious recollection
• - procedural memory- memory for skills and behaviour - hard to learns, requires repitition, hard to forget, can be recalled without conscious recollection

• - immediate memory (fractionsof seconds)
• - limited capacity
• - requires continuous rehearsal
• - use and lose
• Working memory (sec-min) - a more elaborate form of short term memory- perhaps a reflection of multiple short term memory systems
• Long term memory (days to years)- unlimited capacity, doesnt require continuous rehearsal, use or lose

• - hippocampus is critical to forming declarative memories
• - the memories are stored ealsewhere- in association cortex

So in an alzheimers pt they have wasting of the hippocampus

• - prefontal lobe wasting- loss of speech/ language, function, behavious and emotional state
• - wasting of hippocampus- wasting of memory