Dementia

General Illness Information

Common Name: Dementia

Medical Term: None Specified

Description:

Dementia is a brain disorder characterized by a gradual and progressive mental deterioration  Memory loss is most common, but other mental faculties may be affected including attention, judgment, comprehension, orientation, learning, calculation, problem solving, mood and behavior.  Agitation or withdrawal, hallucinations, delusions, insomnia and loss of inhibitions are common. There are many different causes of dementia but it is essential to exclude treatable causes.

Alzheimer’s disease is the commonest cause of dementia.  It affects 3 to 4 million people in the U.S.

Dementia is not a normal part of aging  As people age , changes in the brain cause some memory loss, especially short term memory loss and also some decline in learning ability .However, these normal changes do not affect ability to function.  Dementia is a much more serious decline in mental ability and is also progressive.  Second most common cause of dementia is successive minor strokes. These small strokes gradually destroy brain tissue and lead to dementia.

Dementia is a major cause of disability in the elderly.

Causes: Dementia is due to degeneration and loss of gray matter in the brain. The most common cause of dementia is Alzheimer’s disease. The exact cause of Alzheimer’s Disease is not certain. Genetic factors may play a role- the disease seems to run in some families and is associated with some specific gene abnormalities.  Research into the genetic factors has implicated chromosome 21 as the gene responsible for the development of familial Alzheimer’s disease.  Abnormality of  Chromosome 21 (trisomy 21) is also responsible for Down’s syndrome. In fact patients with Down syndrome have a higher risk for developing Alzheimer’s disease by age 50.

The second most common cause of dementia is successive minor strokes, which gradually destroy brain tissue and lead to dementia. This condition occurs most commonly in patients with diabetes and high blood pressure and is due to cerebral atherosclerosis (hardening of the arteries in the brain). Dementia can also occur as a result of a brain injury or after an episode of cardiac arrest. People who suffer repeated head injuries e.g. boxers, often develop dementia. Secondary dementias- also referred to as “reversible dementias” because the cognitive impairment may reverse with treatment of the primary disorder, are listed below: Infections such as syphilis, HIV  and Creutzfeldt-Jakob disease; Alcoholism; Chronic poisoning e.g. mercury; hypothyroidism; vitamin B12 deficiency; normal pressure hydrocephalus and certain medications.; Inherited disorders  such as Huntington’s Disease and Parkinson’s disease; Brain tumor.

 

Prevention: Seeking early medical treatment for underlying diseases such as syphilis, hypertension, alcoholism, and diabetes may prevent dementia. Vitamin B12 deficiency, and hypothyroidism if untreated can lead to Dementia. Protecting oneself from head injury may also prevent dementia. Wear seat belts in vehicles. Wear protective headgear for riding bicycles, motorcycles and participating in contact sports. Don’t drink or use mind-altering drugs. Do not drive while under the influence of alcohol or drugs. Recently, some herbal supplements such as Ginkgo Biloba have elicited interest in the prevention of dementia.

Signs & Symptoms

Forgetfulness, especially of recent events. The ability to keep track of time and the ability to recognize people, places and objects diminish. People with dementia have difficulty finding and using the right words and have difficulty with abstract thinking (e.g. working with numbers) Poor judgment Confusion. Speech pattern changes- they use simpler words or use words incorrectly or may have difficulty finding the correct words. Loss of interest in normal activities. Avoid complex activities such as balancing a checkbook, reading and working. Some people with dementias are very good at hiding their deficiencies by avoiding complex tasks. Disorientation, especially at night. Personality changes such as increased anxiety, depression and also unpredictable, sometimes violent, behavior. Unpredictable, sometimes violent, behavior.

Risk Factors

  • Adults over 60.
  • Excess alcohol consumption.
  • Use of mood-altering drugs- such as cocaine, LSD or mescaline, or glue stiffing.
  • Family history of Alzheimer’s disease.
  • Chemical or environmental exposure to heavy metals.
  • Diabetes, high blood pressure and atherosclerosis.

Diagnosis & Treatment

Diagnosis is a matter of clinical judgment. Forgetfulness is usually the first apparent sign that is noted by the family members or the doctor. Mental status testing usually performed in the doctors office and more sophisticated neuro-psychological testing may help in making the diagnosis and help determine the degree of impairment. Dementia may sometimes be due to a treatable cause, such as thyroid disease, abnormal blood levels of electrolytes, infections, vitamin deficiencies, medication toxicity and H IV.  Therefore, blood work and other laboratory investigations such as CT scan, MRI, EEG and a lumbar puncture must be done. At present there are no reliable tests available to make a definite diagnosis of Alzheimers disease. Therefore it can only be proved by examining the brain at autopsy.

General Measures:

  • Notice early behavior changes and seek prompt medical care.
  • A thorough examination will detect curable conditions.
  • Provide simple reminders, such as a clock, daily calendar or nametag.
  • Minimize changes in daily routine and environment.
  • Treat the person with respect and kindness.
  • Provide a protected, non-judgmental environment when the patient cannot provide self-care.
  • When home care is no longer possible, find a good extended-care facility.
  • As the persons condition deteriorates, a nursing home provides the best care.
  • Visit the patient often even if he or she doesn’t seem to recognize you.
  • Psychotherapy or counseling for family members.

Medications:

Medication appropriate to treat the underlying condition.

Ant psychotic drugs are sometimes used to treat agitation  and other behavioral problems. However, these  anti-psychotic drugs are not very effective in controlling the behavior problems and have potential of causing serious side effects. Ant psychotic drugs are very effective in treatment of paranoia and hallucinations.

Activity:

Encourage as much activity as possible with supervision and direction.

Diet:

  • Provide a well-balanced diet.
  • Choline and lecithin supplements are under study. Studies appear to indicate that certain dietary supplements may help to improve memory and mental function.  These include Ginkgo biloba, ginseng, and gotu kola.  Phosphatidylserine has been used in conjunction with these supplements to facilitate entry  through the blood brain barrier.
  • Feeding assistance will eventually become necessary.

Possible Complications:

  • Infections, falls and injuries, and poor nutrition. These occur because the ill person cannot care for himself or herself.
  • Misdiagnosis. Some curable conditions, such as pernicious anemia, hypothyroidism, chronic drug toxicity and subdural  hematoma, have symptoms that mimic dementia.

 

Prognosis

This condition is currently considered incurable. Medications may prevent the condition from worsening, but it cannot restore lost brain function ,except for the secondary dementias in which the treatment of the underlying condition may cause improvement of the condition.

Other

Nothing Specified.

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