Currently, there's a lotof interest in obstetrical complications and/or a catastrophe during the second trimester of gestation as the added insult that makes the hereditary trait manifest itself: Br.
There is gliosis of theposterior columns, dorsal corticospinal tract, and spinocerebellar tracts; the cerebellar cortex and other motor areas may also be involved.
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Despite the sincere belief by her well-intentioned familyand caregivers that she was aware andrespondingthoughtfully, she had no Purkinje cells in the cerebellum and no big motor cells in her cortex.
It is so well-knownthat I'm not worried about borrowers.
DEMENTIA: Sustained permanent decrease in several dimensions of intellectual function, so as to interfere in normal social or economic activity.
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They range fron simple Mendelian disorders (for example, Huntington'sand many others) through disorders that areprobably polygenic and variably expressed (for example, Alzheimer's andschizophrenia) to "disorders in whichheredity plays no part" (for example, common parkinsonism).
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When there is cognitive decline in old age, the brain will typicallyshow neurofibrillary tangles and/or micro-infarcts and/or Lewy bodiesin the cortex.
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"Valsalva headache" following straining at stool / exertion / coughing probablyhas an interesting correlate (something somewhere in the dura must be gettingstretched), but so far it has eluded us.
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When the decline is rapid / catastrophic, a classicdementing disease pathology will be found (Neurology 75: 1070, 2010 --the Roman Catholic Religious Orders study, which followed older nuns, priests,and brothers over years and performed brain autopsies.)AMENTIA: Mental retardation (misnomer)OBTUNDED: Less responsive than normal, especially to painDELIRIUM: Reversible impairment of mental functioning, typically with some degree of disorientation, usually without permanent abnormalities, usually with some agitation.
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74:57, 1999; Neurology 60: 1181, 2003)
Psychiatric / functional disease
Overlooked medical disease