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Thread: Alzheimer's Disease case pictures - NEURORADIOLOGY ATLAS

  1. #1

    Default Alzheimer's Disease case pictures - NEURORADIOLOGY ATLAS

    Alzheimer's Disease
    A 73 year old woman was brought to neurological evaluation by her brother because of a 3 year history of memory impairment. She had completed high school and worked in a clerical position until her retirement in 1985. She had lived alone and maintained her own home and financial affairs since the death of her husband in 1980. The brother had begun to notice gradually worsening memory impairment and difficulty finding words, but the patient became angry at the suggestion that she may have a progressive impairment. Others had noted decline in housekeeping and financial affairs, but she had no complaints.

    Elevated arterial blood pressure was documented on several occasions, but she never took medication. She had no children and had a hysterectomy.

    She was a well-groomed woman who was alert and friendly. General and elemental neurological exams were normal.

    Her speech was highly anomic and paraphasic, with a tendency to use vague referents such as "things" and "stuff". She was able to provide her name, but when asked about her current age, she said: "I don't know . . ., about 8 I think." She incorrectly stated her birth month, but then became aware of this. Given three choices, she was able to give the correct month. She was unable to give the year of her birth, the current year, or the name of the current U.S. President. On formal testing, she scored well below average in all cognitive domains. These tests included the Wechsler Memory scale, the Wechsler Adult Intelligence Scale, digit span and similarities subtests, the Boston Naming Test, the CERAD Word List Memory Test, the CERAD Visuo-spatial Construction, the Cross Circle Tests, the California Proverb Test, and the Graphomotor Alternation Test. She tended to perseverate both verbal and motor responses. The conclusion of the evaluation was that she met research criteria for "probable" Alzheimer's disease, that she required complete supervision around the clock to insure her safety, and that she would probably benefit from social stimulation provided by a group living situation.

    Dementia is currently the main cause of dependency in older people and a major public health concern affecting about 36 million people worldwide.1 Because of population growth and demographic ageing, this number is expected to double every 20 years and to reach 115 million in 2050,1 resulting in tragic human consequences and social costs.2 3 4 As there are no effective treatments, the search for putative modifying factors remains a priority. Several studies have shown that benzodiazepine use could be one of these.5 6 7 8 9 This class of drugs is mainly used to treat anxiety or insomnia.10 Prevalence of use among elderly patients is consistently high in developed countries and ranges from 7% to 43%.11 12 13 14 International guidelines10 recommend short term use, mainly because of withdrawal symptoms that make discontinuation problematic. Although the long term effectiveness of benzodiazepines remains unproved for insomnia15 16 17 18 and questionable for anxiety,15 their use is predominantly chronic in older people.19 20
    Alzheimer's Disease case pictures NEURORADIOLOGY attachment.php?s=4ccd2227ecbf38b499c54efd034d6e47&attachmentid=1526&d=1440346523

    While the acute deleterious effects of benzodiazepines on memory and cognition are well documented,21 22 23 24 the possibility of an increased risk of dementia is still a matter of debate. The frequency of symptoms highly correlated with prescription of benzodiazepines (anxiety, insomnia, and depressive disorders) increases in the years before a diagnosis of dementia.25 26 27 28 Hence, benzodiazepines might not cause the disease but rather be prescribed to treat its prodromes. Adjustment for such a reverse causality bias is not easy in observational studies as prodromes are often not recorded as such. It might consist in the demonstration of a delayed risk9 or in the censoring of information on exposures started during the suspected prodromal phase. Moreover, few studies published on the topic have had sufficient power to investigate a cumulative dose relation, which is a compelling argument in the assessment of a potentially drug induced outcome.

    We evaluated the association between past benzodiazepine use and the risk of Alzheimers disease using an administrative claims database with a long follow-up period and investigated the potential dose-effect relation.

    Study design and setting
    We carried out a case-control study among older people (age >66) living in the community in the province of Quebec (Canada) and who were members of the public drug plan from 1 January 2000 to 31 December 2009. In Quebec, nearly all older people (about 98%) are covered by the drug plan. Data sources for the study consisted of the prescription and medical services recorded in an administrative claims database (RAMQ). The source population included random samples of 38 741 people with a diagnosis or treatment (such as cholinesterase inhibitors or memantine) related to dementia for cases and 86 259 people without these conditions for controls.

    Selection of cases and controls
    People were eligible for inclusion as cases for the study if they met the following criteria: a first diagnosis (index date) of Alzheimers disease (ICD-9 (international classification of disease, ninth revision) 331.0) recorded during the study period without any record of another type of dementia at the index date or before; absence of any anti-dementia treatment before index date; and at least six years of follow-up before the index date. Each person with dementia (case) was matched on sex, age group (70-74, 75-79, 80-84, or ≥85), and duration of follow-up (6, 7, 8, 9, or 10 years) at the index date with four controls by using an incidence density sampling strategy.

    Exposure assessment
    Benzodiazepine use was assessed with dispensation claims recorded in the RAMQ database. We considered all benzodiazepines included in the RAMQ list of reimbursed drugs during the study period (table 1⇓). Treatments initiated less than five years before the index date were not considered as this could convey a reverse causality bias. Therefore, exposure was ascertained in a time window ranging from five to 10 years (maximum duration of follow-up) before the index date.

    This case-control study based on 8980 individuals representative of elderly people living in the community in Quebec showed that the risk of Alzheimers disease was increased by 43-51% among those who had used benzodiazepines in the past. Risk increased with density of exposure and when long acting benzodiazepines were used. Further adjustment on symptoms thought to be potential prodromes for dementiasuch as depression, anxiety, or sleep disordersdid not meaningfully alter the results.

    Benzodiazepine use and risk of Alzheimer’s disease: case-control study | The BMJ
    Alzheimer's Disease

    Last edited by Medical Photos; 08-23-2015 at 04:15 PM.

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  3. #2
    Junior Member
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    Jun 2011



    Default Alzheimers Disease case pictures NEURORADIOLOGY ATLAS

    Hello doctor,

    My father had an MRI and a CT scan which combined showed that

    1 Minimal Dilatation of the Ventricles and Subarachnoid Spaces 2 Retention Cyst VS Polyp Formation Identified involving the right Frontal Sinus
    3 Right Maxillary and Bilateral Ethmoid Sinusitis.

    The results also indictated that there is no increased or decreased density identified within the brain parenchyma; no evidence of parenchymal hemorrhage; no extra axial fluid collections; bilateral mastoid regions are intact;

    Also says that Cocha Bullosa formation is identified involving the left middle nasal turbinate.

    the MRI also indicated a Partially Empty Sella.

    Is there any suggestion as to what disease this could be?
    He said he had experienced loss of sense of direction and has blacked out. Is this something that can lead to a stroke because it has to do with CSF fluid being blocked? Please help
    , , .

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