Bệnh nhân Alzheimer có mặt với chứng mất trí vỏ não chính với suy giảm trí nhớ là một tính năng chiếm ưu thế. Parkinson tính năng không phải là hiếm trong Active Directory, nhưng thường sẽ hiển thị trong bệnh tiên tiến khi suy giảm nhận thức là nghiêm trọng. | CLINICAL CASES 183 Alzheimer patients present with a primary cortical dementia with memory impairment as a predominant feature. Parkinsonian features are not uncommon in AD but often will show in advanced disease when cognitive impairment is severe. In addition AD patient can inadvertently be treated with antipsychotics for associated behavioral disturbances and develop drug-induced parkinsonism. With Parkinson disease patients can also have a dementia but it is predominantly subcortical slowed thought processes retrieval attention and concentration and is usually not a predominant clinical feature of the disease. CNS infections such as HIV encephalitis or chronic fungal meningitis can present with slowly progressive dementia and motor dysfunction. Often the dementia and motor dysfunction are more global and include multiple cortical and subcortical deficits extrapyramidal and pyramidal dysfunction and a more rapid clinical course. Normal pressure hydrocephalus and cerebrovascular disease particularly ischemic disease of the deep white matter typically presents as what is called lower body parkinsonism with early gait and balance problems lower body akinesia bradykinesia little or no tremor. Urinary abnormalities and the executive frontal lobe dysfunction are common. For both these disorders neuroimaging often shows characteristic abnormalities. APPROACH TO DIFFUSE LEWY BODY DEMENTIA Definitions Constructional apraxia Difficulty in performing tasks involved with construction for example drawing a five-pointed star. Executive function Mental capacity to control and plan mental skills the ability to sustain or flexibly direct attention the inhibition of inappropriate behavioral or emotional responses the planning of strategies for future behavior the initiation and execution of these strategies and the ability to flexibly switch among problem-solving strategies. It is mediated by the prefrontal lobes of the cerebral cortex. Ideomotor apraxia Disturbance of voluntary
