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Dementia other than Alzheimers Disease

Dementia other than Alzheimers Disease Discuss the distinction between normal aging and dementia based on pathology Define common causes of dementia besides AD Discuss the pathology of common causes of non- AD dementia Discuss the role of non-AD pathology in EOD.

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Dementia other than Alzheimers Disease

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  1. Dementia other than Alzheimers Disease • Discuss the distinction between normal aging and dementia based on pathology • Define common causes of dementia besides AD • Discuss the pathology of common causes of non- AD dementia • Discuss the role of non-AD pathology in EOD

  2. Data from Religious Order for Intact Subjects n=296 • 75%+ Some brain amyloid • 22% Macro-infarctions • 24% Micro-infarctions • 13% Some Lewy bodies Ann. Neurology 2012 (72) 599-609

  3. Methods to clinically characterize dementias • Clinically e.g. Alcohol Related • Imaging e.g. PET ligands • Pathological features e.g. SDAT • Molecular diagnostics e.g. DLBD • Genetic diagnostics e.g. HD

  4. Dementia Other Than Alzheimers Disease Mixed dementia is probably most common Mixed dementia has the lowest diagnostic accuracy of all dementias No specific consensus criteria for clinical or pathological diagnoses

  5. Common vs Uncommon Causes of Dementia

  6. Vascular Dementia in Older Persons 1. No consensus criteria on the definition of VaD 2. Few strategic lesions that cause the disorder 3. White matter ischemia is impossible to quantitate. 4. Common finding in AD

  7. Diffuse Lewy Body Disease: A Disorder of Synuclein

  8. Neuropathology for PD 62% Ideopathic PD ( Lewy bodies) 9.5% No Specific Pathology 8.8% Vascular PD 8.0% AD pathology only 4.2% PSP Brain Pathology 23(2013) 29 - 33

  9. Early Onset Dementia • Typical age – 50 to 60 yrs • 500,000 Americans • Psychosocial catastrophe to family

  10. Risk Factors for EOD HR Condition 4.82 Alcohol Intoxication 2.96 Any Stroke 2.75 Treatment with Antipsychotic Meds 1.89 Depression JAMA Internal Med 2013 173(17) 1612 -18

  11. Alcohol Related Dementia • Actual incidence difficult to define • Associated with frontal lobe damage • Frequently seen with Wernicke’s encephalopathy • Often includes neurological findings

  12. Table 2.Differential Diagnosis of EOD Based on Percent of Study Population MS=multiple sclerosis TBI=traumatic brain injury PD=Parkinson’s disease n=population size ETOH=alcohol-related dementia NOS=not otherwise specified VaD=vascular dementia

  13. Pathology in Non-degenerative Non-vascular dementia • 7.7% Autopsy series • 30% All EOD cases vs 5% of Late Onset • Common diseases include cancer 13/43, Alcohol-related 7/43 and SMI 11/43 • None had NPH or B12 deficiency Arch Neurology 2006 63 218-221

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