Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

102 Alzheimer’s Disease

■Parietal lobe dysfunction (pictorial construction, calculations, right

left discrimination, performance of complex motor tasks)

■Frontal lobe dysfunction (judgment, social skills, grasp reflexes)

tests

Lab Tests

■Diagnosis made clinically

■Serum & CSF studies normal

■Apoliprotein E e4 allele is a risk factor

■Brain imaging may show atrophy

differential diagnosis

■Degenerative disorders: Pick’s disease, Creutzfeldt-Jacob disease,

normal-pressure hydrocephalus, dementia w/ Lewy bodies, cor-

ticobasal ganglionic degeration, progressive supranuclear palsy

excluded clinically

Systemic Disorders

■Cancer: primary or metastatic excluded by neuroimaging & CSF

cytology

■Infection: serology studies differentiate AIDS dementia & neu-

rosyphilis

■Metabolic disorders: blood studies differentiate hypothyroidism,

vitamin B12 deficiency, hepatic & renal failure

■Vascular disorders: brain imaging excludes chronic subdural

hematoma & multi-infarct dementia

■Head trauma: severe open or closed head injury

■Behavioral disorders: history & neuropsychological testing exclude

pseudodementia

management

■Reduce or stop meds that may exacerbate cognitive problems

■Follow Mini-Mental Status Examination

specific therapy

■Indication: cognitive loss

■Cholinesterase inhibitors: mild improvement in cognitive function

in early Alzheimer’s

➣Donepezil

➣Galantamine

➣Rivastigmine

Memantine