SUMMARY HOT TOPICS IN NEUROLOGY
AND PSYCHIATRY (HTNP)
1
,NEURODEGENERATION INTRODUCTION
Why is research important for clinical practice?
Proposal of a solution: What is the problem and why not solved yet?
Concrete RQ: your solution for the problem
Propose a plan: set up for success or waste of time?
What is needed to study the questions?
What will be the outcomes of the research?
Dementia
Outline:
• Definition and prevalence of dementia
• Most common causes:
- AD
- Lewy body dementia
- Frontotemporal dementia
- Vascular dementia
• Experimental AD treatments
Learning objectives:
• Knowledge on clinical presentation, underlying pathology, diagnosis and treatment of dementia.
Dementia: definition – DSM-V: major cognitive disorder
• Evidence of significant cognitive decline from a previous level performance in one or more
cognitive domains: complex attention, executive function, learning, language, visuoconstruction,
or social cognition.
• Decline objectified by tests or clinical assessment
• Cognitive deficits interfere with independence in everyday activities
• Does not occur excessively in the context of a delirium
• Cannot be explained by other mental disorders, such as depression
Dementia is more than a memory problem:
- Number 1 cause of mortality in the Netherlands
- Most expensive disease after mental retardation
• Annual costs 6.6 billion euro
Epidemiology
Prevalence:
• 260.000 patients
2
, • 1 out of 3 in people aged 80 years
• 1 out of 2 in people aged 90 years
Incidence:
• Life-time risk 20%
Is dementia Alzheimer’s disease?
• Dementia: syndrome of multiple cognitive impairments (including memory)
• AD: one of the causes of dementia (really the disease)
Most common causes of dementia
From pathology to clinical manifestation
Alzheimer’s disease
• First case described by Alois Alzheimer in 1906
• 182.000 patients in the Netherlands
Genetics:
• Heritability around 60%
• 2-5% autosomal dominant mutations in amyloid related genes
• Risk genes:
- Inflammation-related (e.g TREM2)
- Lipid metabolism-related (e.g APOE)
- Amyloid related (e.g ADAM10)
3
, AD: Typical patient
• Age > 75 years
• Short term memory
• Loss of planning, organization
• Insecure, depressive and anxious
• Denial, shame for stigma
AD: Atypical patient
• Age < 65 years
• Visual problems (posterior cortical atrophy)
• Behavioral problems (frontal variant)
• Language problems (logopenic aphasia)
AD brain under the microscope
- Amyloid plaques ** yellow plaques around the cells
- Tau Tangles **within the plaques
→ together they destroy the brain cells
Brain atrophy in AD (in MRI)
4
AND PSYCHIATRY (HTNP)
1
,NEURODEGENERATION INTRODUCTION
Why is research important for clinical practice?
Proposal of a solution: What is the problem and why not solved yet?
Concrete RQ: your solution for the problem
Propose a plan: set up for success or waste of time?
What is needed to study the questions?
What will be the outcomes of the research?
Dementia
Outline:
• Definition and prevalence of dementia
• Most common causes:
- AD
- Lewy body dementia
- Frontotemporal dementia
- Vascular dementia
• Experimental AD treatments
Learning objectives:
• Knowledge on clinical presentation, underlying pathology, diagnosis and treatment of dementia.
Dementia: definition – DSM-V: major cognitive disorder
• Evidence of significant cognitive decline from a previous level performance in one or more
cognitive domains: complex attention, executive function, learning, language, visuoconstruction,
or social cognition.
• Decline objectified by tests or clinical assessment
• Cognitive deficits interfere with independence in everyday activities
• Does not occur excessively in the context of a delirium
• Cannot be explained by other mental disorders, such as depression
Dementia is more than a memory problem:
- Number 1 cause of mortality in the Netherlands
- Most expensive disease after mental retardation
• Annual costs 6.6 billion euro
Epidemiology
Prevalence:
• 260.000 patients
2
, • 1 out of 3 in people aged 80 years
• 1 out of 2 in people aged 90 years
Incidence:
• Life-time risk 20%
Is dementia Alzheimer’s disease?
• Dementia: syndrome of multiple cognitive impairments (including memory)
• AD: one of the causes of dementia (really the disease)
Most common causes of dementia
From pathology to clinical manifestation
Alzheimer’s disease
• First case described by Alois Alzheimer in 1906
• 182.000 patients in the Netherlands
Genetics:
• Heritability around 60%
• 2-5% autosomal dominant mutations in amyloid related genes
• Risk genes:
- Inflammation-related (e.g TREM2)
- Lipid metabolism-related (e.g APOE)
- Amyloid related (e.g ADAM10)
3
, AD: Typical patient
• Age > 75 years
• Short term memory
• Loss of planning, organization
• Insecure, depressive and anxious
• Denial, shame for stigma
AD: Atypical patient
• Age < 65 years
• Visual problems (posterior cortical atrophy)
• Behavioral problems (frontal variant)
• Language problems (logopenic aphasia)
AD brain under the microscope
- Amyloid plaques ** yellow plaques around the cells
- Tau Tangles **within the plaques
→ together they destroy the brain cells
Brain atrophy in AD (in MRI)
4
