Classification and Pathophysiology of Alzheimer's Disease

Classification

• Alzheimer's with dementia.

Until now there are differing opinions about the relationship between Alzheimer's and vascular dementia.

Some scientists believe that vascular dementia is on track aterogenis dyslipidemia, especially with a short chain and unsaturated LDL, carotid atherosclerosis, high systolic blood pressure and an increase in the ratio of IR-UII (English: plasma levels of immunoreactive), while Alzheimer's is on another track, namely hiposomatomedinemia and hypogonadism.

Another scientist found as pathogens of vascular dementia that accompanies Alzheimer's on track inflammation of atherosclerosis, or even suggested that atherosclerosis is an inflammatory trigger hypoperfusion of the brain and result in Alzheimer's.

• Alzheimer accompanied by ataxia.

• or a combination of both.

Pathophysiology

Simtoma Alzheimer's is characterized by changes that are degenerative in some neurotransmitter systems, including changes in the function of neural systems that release monoaminergik glutamic acid, noradrenaline, serotonin and a series of systems that are controlled by neurotransmitters. Degenerative changes also occurred in several areas of the brain such as the temporal lobe and parietal lobe, and parts of the frontal cortex and cingulate gyrus, followed by the loss of nerve cells and synapses.

Sekretase- and presenilin-1 is an enzyme that functions to slice the C-terminus domain in AAP and release molecules from the kinesin enzyme cluster. Apoptosis occurs in nerve cells covered the amyloid plaques that still contained the C-terminus of the molecule, and does not occur if the molecule has been cut. This is inferred by the team of Howard Hughes Medical Institute, led by Lawrence S. B. Goldstein, the terminus-C carrying the signal to the neuron apoptosis. Signal apoptosis was also expressed by proNGF is not cut, when bound to p75NTR neurotrofin perceiving, and sortilin hormone stimulated.

Suspected due to the buildup of plaque induced apolipoprotein-E, which acts as kaperon protein, vitamin B1 defiensi controlling cerebral glucose metabolism such as O-GlkNAsilasi, and the lack of an enzyme that is made up of complex compounds such as thiamine-alpha ketoglutarate dehydrogenase complex, pyruvate dehydrogenase, transketolase, O- GlcNAc transferase, protein phosphatase 2A, and beta-N-asetilglukosaminidase. This resulted in an increase in cerebrospinal zalir pressure, decreasing the ratio of the hormone CRH, and igniting simtoma hypoglycemia in the brain, although the body has hyperglycemia.

In addition to presenilin-1 enzyme dysfunction that triggers simtoma ataxia, there are enzymes that cause Cdk5 and GSK3beta hiperfosforilasi tau protein, to form a pile PHF. Hiperfosforilasi also be a barrier formed between protein ligation S100beta and tau, and cause neurita dystrophy, although the zinc metabolic disorders may also prevent ligation.

Simtoma induces hyperinsulinemia and hyperglycemia also hiperfosforilasi protein tau and amyloid-beta oligomerasi which resulted in the accumulation of amyloid plaques. But despite oligomerasi induces insulin amyloid-beta, insulin also inhibits the enzyme activity of the enzyme and kaspase kaspase-9-3 that also carry signals apoptosis, and stimulates the secretion of Hsp70 by LAN5 cell to cell activating defense programs.

There is a minor controversy with allegations that hiperfosforilasi was caused by a latent infection by measles virus, or Borrelia. Seven of the 10 cases examined by the Alzheimer's McLean Hospital Brain Bank of Harvard University, suggests this kind of infection.

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Definition of Alzheimer's Disease

Alzheimer's disease is not contagious, but rather a kind of syndrome with apoptosis of brain cells at the same time, so that the brain seems to shrivel and shrink.

Alzheimer's disease is also said to be synonymous with parents. The risk for Alzheimer's increases with age. Starting at age 65, a person has a five percent risk of this disease and will be doubling every five years, a doctor said. According to him, even if the disease is associated with a parent, but history proves that free pesakit menghidap certainly the first known disease is women in their early 50's.

Alzheimer's disease most commonly found in older people aged around 65 years and over. In developed countries like the United States is found to be more than 4 million elderly people with Alzheimer's disease. This figure is expected to rise to nearly 4 times in 2050. This is related to the higher life expectancy in the developed countries, so that the elderly population increases.

In the early stages of Alzheimer's, decreased vascular risk factors may complicate the diagnosis of this syndrome, but reduces the speed of the development of dementia.

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Symptoms of AIDS

The symptoms of AIDS are primarily the result of conditions not normally develop in individuals with healthy immune systems. Most of these conditions are infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of the immune system that HIV damages.

People with AIDS also have an increased risk of developing various cancers such as Kaposi's sarcoma and cervical cancer is cancer of the immune system known as lymphomas. Additionally, people with AIDS have systemic symptoms of infection like fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss. The specific opportunistic infections that AIDS patients develop depends in part on the prevalence of these infections in the geographic area where the patient lives.

Lung Infection

Pneumocystis pneumonia (originally known as Pneumocystis carinii pneumonia, and still abbreviated as PCP which now stands for P neumo ystis p neumonia c) is relatively rare in healthy, immunocompetent people, but common among HIV-infected persons. It is caused by Pneumocystis jirovecii.

Prior to the diagnosis, treatment and routine prophylaxis in Western countries, it is common direct cause of death. In developing countries, it is still one of the first indications of AIDS in untested individuals, although it does not generally occur unless the CD4 count less than 200 cells per uL of blood.

Tuberculosis (TB) is unique among infections associated with HIV because it is transmissible to immunocompetent people via the respiratory route, easily treatable once identified, can occur in the early stages of HIV disease, and is preventable with drug therapy. However, multidrug resistance is a serious problem.

Even though its incidence has declined because of the use of directly observed therapy and other improved practices in Western countries, this is not the case in developing countries where HIV is most prevalent. In the early stages of HIV infection (CD4 count> 300 cells per uL), TB typically presents as a pulmonary disease. In advanced HIV infection, TB often appears atypically with extrapulmonary (systemic) disease a common feature. Symptoms are usually constitutional and are not localized to one particular site, often affecting bone marrow, bone, urinary and gastrointestinal, liver, regional lymph nodes, and central nervous system.

Gastrointestinal Infections

Esophagitis is an inflammation of the lining of the lower end of the esophagus (gullet or swallowing tube leading to the stomach). In HIV-infected individuals, this is usually due to a fungal infection (candidiasis) or viral (herpes simplex-1 or cytomegalovirus). In rare cases, it could be due to mycobacteria.

Unexplained chronic diarrhea in HIV infection is due to many possible causes, including common bacterial (Salmonella'''','' Shigella'','''' or'''' Listeria Campylobacter) and parasitic infections, and no opportunistic infections common such as cryptosporidiosis, microsporidiosis, Mycobacterium avium complex'''' (MAC) and viruses, astrovirus, adenovirus, rotavirus and cytomegalovirus, (the latter as a course of colitis).

In some cases, diarrhea may be a side effect of some medications used to treat HIV, or it may simply accompany HIV infection, particularly during primary HIV infection. It may also be a side effect of antibiotics used to treat bacterial causes of diarrhea (common for Clostridium difficile''''). In the later stages of HIV infection, diarrhea is considered as a reflection of changes in the way the intestinal tract absorbs nutrients, and may be an important component of HIV-related wasting.

Neurological and psychiatric involvement

HIV infection can lead to a variety of neuropsychiatric sequelae, either by infection of the now susceptible nervous system of organisms, or as a direct result of the disease itself.

Toxoplasmosis is a disease caused by a single-celled parasite called Toxoplasma gondii''''; usually infects the brain, causing toxoplasma encephalitis, but it can also infect and cause disease in the eyes and lungs. Cryptococcal meningitis is an infection of the membranes (membranes covering the brain and spinal cord) by the fungus Cryptococcus neoformans''''. It can cause fever, headache, fatigue, nausea, and vomiting. Patients may also develop seizures and confusion; untreated, can be deadly.

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease, in which the gradual destruction of the myelin sheath covering the axons of nerve cells damage the transmission of nerve impulses. It is caused by a virus called JC virus which occurs in 70% of the population in latent form, causing disease only when the immune system is very weak, as is the case for AIDS patients. It is rapid, usually causing death within months of diagnosis.

AIDS dementia complex (ADC) is a metabolic encephalopathy induced by HIV infection and fueled by immune activation of HIV infected brain macrophages and microglia. These cells are productively infected by HIV and secrete neurotoxins of both host and viral origin. Specific neurological disorder manifested by cognitive, behavioral, and motor abnormalities that occur after years of HIV infection and is associated with low CD4 + T cells and viral load levels are high.

The prevalence of 10-20% in Western countries but only 1-2% of HIV infections in India. This difference may be due to the HIV subtype in India. AIDS related mania is sometimes seen in patients with advanced HIV disease, but it presents with more irritability and cognitive impairment and less euphoria than a manic episode associated with true bipolar disorder. Unlike the latter condition, it may have a more chronic course. This syndrome is less often seen with the advent of multi-drug therapy.

Tumors and malignancies

Patients with HIV infection have substantially increased incidence of several cancers. This is primarily due to co-infection with an oncogenic DNA virus, especially Epstein-Barr virus (EBV), Kaposi's sarcoma associated herpesvirus (KSHV) (also known as human herpesvirus-8 and human papillomavirus (HPV).

Kaposi's sarcoma (KS) is the most common tumor in HIV-infected patients. The appearance of this tumor in young homosexual men in 1981 was one of the first signals of the AIDS epidemic. Caused by a virus called Kaposi's sarcoma gammaherpes associated herpes virus (KSHV), often appears as purplish nodules on the skin, but can affect other organs, especially the mouth, gastrointestinal tract, and lungs. High-grade B cell lymphomas such as Burkitt's lymphoma, Burkitt's-like lymphoma, diffuse large B-cell lymphoma (DLBCL), and primary central nervous system lymphoma appear more frequently in HIV-infected patients. Particular cancers often foreshadow a poor prognosis. Epstein-Barr Virus (EBV) or KSHV cause many of these lymphomas. In HIV-infected patients, lymphoma often arises in extranodal sites such as the gastrointestinal tract. When they occur in HIV-infected patients, KS and aggressive B-cell lymphoma that gives a diagnosis of AIDS.

Invasive cervical cancer in HIV-infected women is also considered AIDS-defining. This is caused by the human papillomavirus (HPV).

In addition to AIDS-defining tumors listed above, HIV-infected patients increases the risk of certain other tumors, especially cancer Hodgkin's disease, anal and rectal carcinomas, hepatocellular carcinoma, head and neck, and lung cancer. Some of these are causes by viruses, such as Hodgkin's disease (EBV), anal cancer / rectum (HPV), head and neck cancers (HPV), and hepatocellular carcinoma (hepatitis B or C). Other factors include exposure to carcinogens (cigarette smoke for lung cancer), or living for years with subtle immune defects.

Interestingly, the incidence of common tumors, such as breast cancer or colon cancer, does not increase in HIV-infected patients. In areas where HAART is widely used to treat AIDS, the incidence of many AIDS-related malignancies has decreased, but at the same time malignant cancers overall have become the most common cause of death of HIV-infected patients. In recent years, increasing the proportion of these deaths have been from non-AIDS-defining cancers.

Other infections

AIDS patients often develop opportunistic infections that present with non-specific symptoms, especially low-grade fevers and weight loss. These include opportunistic infections with Mycobacterium avium-intracellulare'''' and cytomegalovirus (CMV). CMV can cause colitis, as described above, and CMV retinitis can cause blindness.

Penicilliosis because'''' Penicillium marneffei now the third most common opportunistic infection (after extrapulmonary tuberculosis and cryptococcosis) in HIV-positive individuals in endemic areas of Southeast Asia.

Infection that often goes unrecognized in AIDS patients parvovirus B19. Its main consequence is anemia, which is difficult to distinguish from the effects of antiretroviral drugs used to treat AIDS itself.

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Definition of AIDS Diseases

Acquired Immunodeficiency Syndrome or Acquired Immune Deficiency Syndrome (AIDS abbreviated) is a collection of symptoms and infections (or: syndrome) is caused by damage to the human immune system caused by HIV infection, or infection of other viruses that attack similar to other species (SIV, FIV, etc.).

Self virus called Human Immunodeficiency Virus (HIV for short) is the virus that weakens the immunity of the human body. People who are exposed to the virus will become vulnerable to opportunistic infections or tumors susceptible. Although there has been handling can slow the spread of the virus, but the disease is not completely curable.

HIV and the virus-like viruses are generally transmitted by direct contact between the skin layers (mucous membrane) or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluids, preseminal fluid, and breast milk. Transmission can occur through sexual intercourse (vaginal, anal, or oral), blood transfusion, contaminated hypodermic needles, between mother and baby during pregnancy, childbirth, or breastfeeding, or other forms of contact with the body fluids.

Scientists have generally found that HIV originated in sub-Saharan Africa. Today AIDS has become a disease. AIDS estimated 38.6 million people worldwide. In January 2006, UNAIDS in collaboration with the WHO estimate that AIDS has killed more than 25 million people since it was first recognized on June 5, 1981. Thus, this disease is one of the deadliest plague in history. AIDS claimed to have caused the death of as many as 2.4 to 3.3 million in 2005 alone, and more than 570,000 of them are children. Antiretroviral treatment can actually reduce the death rate and severity of HIV infection, but access to treatment is not available in all countries.

Social penalty for people with HIV / AIDS, are generally more severe when compared with other deadly disease. Sometimes the social punishment were also tertimpakan to health workers or volunteers, who are involved in caring for people living with HIV / AIDS (PLWHA).

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