1. Neuropathology Examination
Definitive diagnosis can not be enforced in the absence of neuropathology confirmation. Generally found that bilateral atrophy, symmetrical, often times the brain weight was 1000 g (850 -1250 grams).
Some studies reveal; atrophy is more prominent in the temporoparietal lobes, anterior frontal, occipital cortex whereas, the primary motor cortex, somatosensory system remains intact (Jerins 1937).
Abnormalities in the neuropathology of Alzheimer's disease consists of:
Neurofibrillary tangles (NFT)
Neuronal cytoplasm is made of abnormal filaments containing neurofilament protein, ubiquine, epitoque. NFT is also found in the neocortex, hippocampus, amygdala, substantia alba, locus ceruleus, dorsal raphe nucleus of the brain stem. NFT in addition found in Alzheimer's disease, are also found in the brains of elderly people, down syndrome, Parkinson's, SSPE, extrapyramidal syndrome, supranuclear palsy. NFT density correlated with the severity of dementia.
Senile Plaques (SP)
Is a complex structure caused by the degeneration of nerve endings containing abnormal filaments, extracellular amyloid fibers, astrocytes, microglia. Amloid precursor protein contained in the SP strongly related to chromosome 21. Senile plaques are mainly found in the neocortex, amygdala, hippocampus, cortex piriformis, and little was found in the primary motor cortex, somatosensory cortex, visual cortex, and auditory. Senile plaque is also present in peripheral tissues. Perry (1987) said Senile plaque density associated with decreased cholinergic. Both histopathological picture (NFT and senile plaques) are characteristic features of Alzheimer's disease patients.
Neuron Degeneration
On microscopic examination of the changes and the death of neurons in Alzheimer's disease is very selective. The death of neurons in neocortical pyramidal neurons primarily found in the temporal and frontal lobes. Also found in the hippocampus, amygdala, brain stem nuclei including the locus serulues, raphe nucleus and substanasia nigra. Cholinergic neuronal cell death mainly in the basal nucleus of meynert, and noradrenergic cells in the locus ceruleus and especially serotogenik cells in the dorsal raphe nucleus, the nucleus of the dorsal tegmentum.
It has been found nerve growth factor on cholinergic neurons that degenerate in lesions of experimental animals, and this is the hope in the treatment of Alzheimer's disease.
Vacuole Changes
It is an oval-shaped neuronal cytoplasm and nucleus can shift. Number vacuole is significantly associated with the number of NFT and SP, these changes are often found in temporomedial cortex, amygdala and insula. Never found in the frontal cortex, parietal, occipital, hippocampus, cerebellum and brain stem.
Lewy Body
Intraneuronal cytoplasmic part that is widely available on enterhinal, cingulate gyrus, insula cortex, and amygdala. A small amount of the cortex of the frontal, temporal, parietal, occipital. Cortical Lewy body is the same as the immuno-reactivity that occurs in the brain stem Lewy body Parkinson's disease on histopathologic picture.
Hansen et al stated Lewy body variant of Alzheimer's disease is.
2. Neuropsychology Examination
Alzheimer's Disease is always cause symptoms of dementia. Function neuropsychology examination to determine the presence or absence of general cognitive impairment and determine in detail the pattern of deficits. Psychological test also aims to assess the function displayed by some parts of the brain that is different such as memory impairment, loss of expression, calculation, attention and language understanding. A systematic evaluation of neuropsychological function have important diagnostic as:
- The presence of cognitive deficits associated with early dementia who may know if there are changes that occur due to minor normal aging.
- Comprehensive neuropsychological examination allows to distinguish cognitive abnormalities in global dementia with selective deficits caused by focal dysfunction, metabolic factors, and psychiatric disorders.
- Identify overview of neuropsychological disorders caused by dementia due to various causes. The Consortium to establish a Registry for Alzheimer's Disease (CERALD) presents a neuropsychological assessment procedure by using the tools batrey manifest cognitive impairment, where the examination consists of:
1. Verbal Fluency animal category.
2. Modified boston naming test.
3. Mini mental state.
4. Word list memory.
5. Constructional praxis.
6. Word list recall.
7. Word recognition list.
This test takes 30-40 minutes, and less than 20-30 minutes at the controls.
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