Pathophysiology

• Loss of Ach
  • 50-90% reduction in function of choline acetyltransferase due to degeneration of the basal forebrain
• Start at MTL and parietal lobe
• often co-exist with LBD - Lewy Body Dementia and Vascular dementia

Presentation

• Initial presentation: amnestic MCI (Loop of Pepez) and Spatial disorientation (Parietal lobe)

  

Order of appearance:

1. Short term memory loss
   • Good long term
2. Geographic dis-orientation
3. Dis-oriented to date (e.g. way off in left field → 40 decades ago)

Prognosis

10 - 15 years until death

Biomarkers (emerging)

Medical-Legal

• Driving ability reporting → MTO
• SDM

Treatment