Escolar Documentos
Profissional Documentos
Cultura Documentos
CAROL DAVILA
BUCURESTI
CURS
DE
NEUROLOGIE
Ataxia non-Friedreich
- aseamănă ca simptome, dar ROT → normale/vii, nu apare
cifoscolioza si cardiomiopatia
- nu se cunosc mutaţii genetice
1 Alzheimer Europe calculated the numbers of people living with dementia by using the EURODEM prevalence rates [Hofman A. et al, The prevalence of dementia in Europe:
a collaborative study of 1980-1990 findings. International Journal of Epidemiology 1991; 20; 3: 736-748] and combining them with the population statistics provided by Eurostat
(the official statistics office of the European Union). 2. Ann Inter Med, 148, 379—379, 2008.
3 Warner J, Butler R. Alzheimer’s disease. Clinical Evidence 2000; 3: 419-425
4 Ferri CP, et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005; 336: 2112-17
dependenţi de anturaj
Cea mai mare parte dintre bolnavi sunt ingrijiti acasa (70%), restul –
în instituţii specializate -> impact asupra îngrijitorilor în creştere
1 Richards SS, Hendrie HC. Diagnosis, Management and Treatment of Alzheimer’s Disease. Arch Intern Med 1999; 159: 789-798
2 Johnson N, Davis T, et al. The Epidemic of Alzheimer’s Disease. Pharmacoeconomics 2000; 18: 215-223
3 Bosanquet N, Huttin C, Kurz A, et al. Alzheimer’s disease: an international perspective on care delivery. Health Policy Review. No. 11. London: Imperial College of Science,Technology and Medicine, University of London, 1997
4 Lovestone and Gauthier. Management of Dementia. Martin Dunitz Ltd, 2001
Metabolism
Neuroregenerare şi neuroreparaţie
- afectarea plasticităţii neuronale şi sinaptice
90% - sporadice:
10% - familială:
debut precoce – mutaţii genetice la nivelul
genelor pentru presenilina-1, presenilina-2, PPA
debut tardiv – mutaţii la nivelul genei pentru
apolipoproteina E
Disfunctie
mitocondriala
Stress oxidativ
Excitotoxicitate
Inflamatie
Deficit colinergic
Pierdere sinaptica
Degenerare
APOPTOTIC -like
Ameliorarea simptomatologiei
Anticolinesterazice: Donepezil, Rivastigmina, Galantamina
Antagonisti de receptori NMDA: Memantina
Psihotrope
Terapia tulburarilor comportamentale
Psihoterapie
DIAGNOSTIC POZITIV
max = 30
<25 => deteriorare cognitiva
Conf. Dr. Ioan Buraga - Curs Neurol
ogie
Conf. Dr. Ioan Buraga - Curs Neurol
ogie
Test DSM –IV
TRATAMENT
INHIBITORII DE COLINESTERAZA
Donepezil = Aricept ;
Rivastigmina = Exelon ;
Galantamina (e si agonist de R nicotinic)
Nu avem tratament curativ -> doar se prelungeşte evoluţia
! Factori de risc major – aceeaşi de la ateroscleroză si AVC
> ½ colesterol e in creier asigura plasticitarea neuronala