1. dozapine dosage
2. shcu as revastagmin,
3. AD
4. Trigger Text
4.1. 1
4.1.1. Mrs Um Mohammed, age 80, has been brought to your by her daughter who informs you that her mother has become increasingly forgetful over the last approximately 12 months: at times unaware of the day and date, and she often forgets prayer times and there is a gradual and progressive decline in her memory. She is becoming concerned with her mother’s ability to cope at home, particularly given the declining health of her father. Mrs Um Mohammed acknowledges that she occasionally has problems remembering people’s names, but feels that she has a good memory for her age. Her daughter agrees that her memory is at times very good, and better than her own for remembering items from their shared past
4.2. 2
4.2.1. Two years later, you receive a call from Mrs Um Mohammed neighbour of five years, who has found Mrs. Mohammed wandering the street, uncertain of where she is. The neighbour tells you that initially Mrs Mohammed ran away, claiming that the she was trying to kill her. She also tells you that Mrs Mohammed is usually independent and friendly, but over the last few days has seemed increasingly confused, and has been calling out during the night. While sharing lunch the day before, Mrs Mohammed had been drowsy, and had coughed a number of times. The neighbour has taken her back into the house, and has found your number by the telephone
5. Step1: Identify cues
5.1. Difficult words
5.1.1. no words
5.2. Cues
5.2.1. 1- 80 years old female
5.2.2. 2- brought by her daughter
5.2.3. 3- forgetfulness over the last year
5.2.3.1. At time not aware of day and date
5.2.3.2. long term memory is intact
5.2.3.3. the loss of the memory is gradual and progressive
5.2.4. 4- her husband health is deteriorating
6. Sep2: problem Formulation
6.1. An 80 years old female brought by her daughter complaining of increasing forgetfulness and memory deterioration. However, her long term memory is intact.
7. Step3: Hypothesis Generation
7.1. 1- learning and memory
7.1.1. memory it is located in the temporal and pre-frontal area
7.1.2. when there is a lesion, patient will develop the aggressive reaction
7.1.3. bapis circuit of the memory
7.1.4. mamilary body
7.1.5. amegdula
7.1.6. hypocampus
7.2. 2-the medical term for forgetfulness is amnesia
7.2.1. the definition of the memory
7.2.1.1. memory is defined as the encoding of the information within the brain
7.2.1.2. the second componant in the storing of the information
7.2.1.3. the third is the retreaval the information
7.2.2. memory is defined as the encoding of the information within the brain
7.2.3. memory is defined as the encoding of the information within the brain
7.3. 3- one of the causes is the accumulation of protein within the brain cytoplasm
7.3.1. so it would interfere with the transportation and leading to the memory loss
7.4. 4-infection by herpis simplex in the temporal lobe
7.5. 5- as aging process occur, their will be a neuropalstisity
7.6. 6- new memory build up
7.6.1. an increase between the wiring and connection of the neurons
7.6.1.1. the AMDA and NAMD receptors are involved in this process
7.7. 7- the problem might be specifically within the storage part of memory process.
7.7.1. the reason of that could be trumatic, HIV , krestfild- jacop disease and enciphalitis
7.8. 8- vascular injury to the brain such as multi infarct dementia
7.9. 9- Huntington disease would develop dementia later in the disease
7.10. 10- iatrogenic caused by using drug,like the benzodiazpin, B-blocker, atropin derivatives and IV drud abuse
7.11. 11- alcohol consumption leading to worcis korsicoof syndrome
7.12. 12- frontotemporal dementia
7.13. 13- depression might lead to psudodementia
7.14. 14- mass occupying lesion (Tumor) near to the temporal lobe. However it is unlikely
7.15. 15- Multiple sclerosis
7.16. 16- hypothyroidism associated dementia
7.17. vitamin B 12
8. Step4: Hypothesis Organization
8.1. alzahimar disease
8.2. dementai with lowy body
9. Step5: Learning Objectives
9.1. 1- to know the definition of demintia pathophysiology and sign and symptoms
9.2. 2-To describe the normal anatomy and physiology of memory
9.3. 3- to know the definition of alzahimar pathophysiology and sign and symptoms
10. Step6: Review of learning obejectives
10.1. anatomy and physiology
10.1.1. declirative memory stored in the medial temporal lobe
10.1.2. nondeclirative is stored in the neocortex,etc.
10.1.3. the hippocampus structures
10.1.3.1. it is started by the entorine gyrus then the dentate gureus followed by the sending some axons to the CA1 a prat of the hippocumpus then to the CA1 and eventually to the sabiculum
10.1.4. physiology
10.1.4.1. the conseladation is the process by which we can store the information the long term memory
10.2. dementai
10.2.1. defined as progressive deteroratioon of cognetive function
10.2.1.1. it has a lot of sign and symptoms which gathered in the word MEALS
10.2.2. reversaible
10.2.2.1. depprestion
10.2.2.2. alcholoism
10.2.2.3. vit B1
10.2.2.4. hydrocephalus
10.2.2.5. vit B12
10.2.3. the causes of dementai
10.2.3.1. irreversible
10.2.3.1.1. AD 60-70%
10.2.3.1.2. vascular
10.2.3.1.3. frontotemporal
10.2.3.1.4. dementai with lowy body
10.2.4. the dementai is not a nortmal aging process of losing the memory it has a behavioral and mood problem
10.3. AD
10.3.1. rick factors
10.3.1.1. Age
10.3.1.2. female
10.3.1.3. family history
10.3.2. protective factor
10.3.2.1. smoking
10.3.2.2. and high level of education
10.3.3. defined as progressive loss on the memory independent of the attention state
10.3.4. sign and symptoms
10.3.4.1. loss of memory followed by the disability and imobility
10.3.5. patholophysiology
10.3.5.1. mainly the deposition of the AB in the cytoplasm of the nerve cell through the nonamyiolginc pathway which invole the B and G secretase
11. step7 : inquiry plan
11.1. history
11.1.1. HPI
11.1.1.1. SOCRATES
11.1.1.1.1. she feels her old memory is better than her daughter
11.1.1.1.2. she has some dificality in the rememabring the name of less familior people
11.1.1.1.3. there is some gradual progression in the memory loss
11.1.1.1.4. there is an interference with Daily actives
11.1.2. Family history
11.1.2.1. um moammed parents die at a young ages
11.1.3. social history
11.1.3.1. um mohammed is a retired house wife
11.1.3.2. she has life in the same house with her husband for 45
11.1.3.3. her husband has a prostate cancer
11.1.4. past medical history
11.1.4.1. nothing important
11.2. vital signs of the second visit
11.2.1. remarkable decrease in the standing BP
11.2.2. there is a inquiry about if she has a pnemonia
11.2.3. the remaining physical examination can not be performed because of the low level of cooperation
11.3. physical examination
11.3.1. vital signs
11.3.1.1. appeared well
11.3.1.2. T37
11.3.1.3. PR 90
11.3.1.4. BP 130/70 laying
11.3.1.5. BP 115/65 standing
11.3.2. Neuro examination
11.3.2.1. cognetive state
11.3.2.1.1. not oriented in place and time
11.3.2.1.2. she coulg copying a bentagon
11.3.2.1.3. less than 22
11.3.2.2. the rest is normal
11.3.3. other physical examination is normal
11.4. investigation
11.4.1. CBC
11.4.2. electolites
11.4.3. imaging
11.4.4. thyroid function test
11.4.5. vitamins
12. step 8 : diagnosis
13. Step 9 : Review
14. Step 10 : Management
14.1. goal of management
14.1.1. there is no cureble treatment of AD
14.1.2. so only symptomatic treatmet
14.2. mamintine if the oatient has modrate to sever symptoms.
14.2.1. is a NMDA inhibitor
14.3. some patient wiould develop depression
14.3.1. so we will givw them a anti-depressive treatment
14.4. estrogen replacement therapy
14.4.1. is might increase the incedance of AD
14.4.2. it mignt increase the chance of developing cancer
14.5. non pharmacological management
14.5.1. observaing the patient
14.5.2. the environment especially in the kitchen and other part of the home
14.5.3. familly support
14.5.4. nursing house
14.5.5. rotien physical activities
14.5.5.1. cardiopulmonary fittness
14.5.6. give them a rotien ,so they could be focus in their lifestyle
14.5.7. eveloation of their sycological staus
14.5.8. well educated person will have less incedance to have this disease
14.5.8.1. so solving the pazzl will help to decrease the progression
14.5.9. patient education
14.5.10. discussion of the problem that those patient they can not judge things approprittly
14.6. in general the ACH is an important nerotransmittors in the brain,so the main treatment of AD is anticholanstraize inhebitor
14.6.1. when you start take one of theim and start solw and go slow
14.6.2. tacrine , revastagmine, dozpine, glantamine
14.6.3. it is effective in the decrease the progression of the disease , but without any curable effect
14.6.4. it might leed to fractures ,so they need a close monitor
14.7. for the behavior changes we give valoraic acid
14.8. the compination of both is better in the treatment of the modrate to sever form of the AD
14.9. diatery measure
14.9.1. medatrainan diet
14.10. preventive measure
14.10.1. such as alcohol and smoking