Chronic, progressive neurodegenerative disorder characterized by a global, nonreversible impairment in cerebral functioning.
Characterized by memory loss, loss of social and occupational functioning, diminished executive function, speech and motor deficits, personality change, plus behavioral 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 behavioral and psychological symptoms.
Psychosocial interventions and caregiver support are key to managing disease course. Caregiver support groups are beneficial to caregivers and should be considered, where available.
- memory loss
- nominal dysphasia
- misplacing items/getting lost
- decline in activities of daily living (ADLs) and instrumental activities of daily living (IADLs)
- personality change
- unremarkable initial physical exam
- mood changes
- poor abstract thinking
- constructional dyspraxia
1st Tests To Order
- bedside cognitive testing
- metabolic panel
- serum TSH
- serum vitamin B12
- urine drug screen
Other Tests to Consider
- CSF analysis
- serum VDRL
- serum HIV
- formal neuropsychological testing
- genetic testing
- fluorodeoxyglucose (FDG)-PET
- single-photon emission computed tomography (SPECT)
- supportive treatment
- environmental control measures
- cholinesterase inhibitors
- management of insomnia
- management of behavioral and psychological symptoms
- severe disease or cholinesterase inhibitors not tolerated or ineffective
- switch to or add memantine