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Demens ved Alzheimers sykdom

Sist revidert:
Sist revidert av:
Definisjon:
Kliniske kriterier oppfylt for både demenssyndromet og Alzheimers demens. Histopatologi karakterisert ved amyloide (senile) plakk, nervefibriller (tau-protein) og nevrontap
Forekomst:
Den hyppigste formen for demens i Norge. Prevalens ca. 60 000 personer. De fleste er eldre enn 65 år 
Symptomer:
Typiske demenssymptomer er betydelig redusert hukommelse i ≥ 6 måneder ved normal bevissthet, reduserte evner til orientering, logisk tenkning, planlegging, språk og kommunikasjon. Dessuten generell handlingssvikt, atferdsendringer og funksjonstap. Nedsatt bevissthet forekommer ved alvorlig demens 
Funn:
Det påvises kognitiv svikt ved standardiserte kognitive tester, svikt av emosjonell kontroll og sviktende funksjonsevne i forhold til dagliglivets funksjoner
Diagnostikk:
Klinisk diagnose. Viktig med komparentopplysninger. Cerebral bildediagnostikk og laboratorieundersøkelser brukes for å utelukke reversible årsaker til kognitiv svikt. Dessuten benyttes funksjonell bildediagnostikk og biomarkører til forskning på Alzheimers sykdom 
Behandling:
Organisering av støttetiltak er hovedbehandlingen. Selv om effekten er begrenset, bør alle pasienter vurderes for medikamentell behandling mot (vanlige) symptomer ved Alzheimers demens, med enten kolinesterasehemmer eller memantin. Bortsett fra alvorlige tilfeller anbefales det hovedsakelig ikke-medikamentell behandling mot atferdsforstyrrelser eller psykiatriske symptomer ved demens (APSD) 
  • Helsedirektoratet. Demens . Nasjonal faglig retningslinje. Først publisert 16.08.2017. Sist faglig oppdatert 03.01.2020. 
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  • Peter D. Jost, spesialist i allmennmedisin, redaktør NEL

Tidligere fagmedarbeidere

  • Dag Årsland, overlege geriatrisk seksjon, Helse Stavanger HF, professor Stavanger Universitetssykehus
  • Ivar B. Mediås, spesialist i allmennmedisin, leder for NSAM referansegruppe i geriatri, Sørum legesenter, Sørumsand
  • Bjørnar Grenne, PhD, konst. overlege, Klinikk for hjertemedisin, St. Olavs Hospital, Trondheim