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Dementia

Definition

Dementia isn't a specific disease. Instead, dementia describes a group of symptoms affecting thinking and social abilities severely enough to interfere with daily functioning.

Many causes of dementia symptoms exist. Alzheimer's disease is the most common cause of a progressive dementia.

Memory loss generally occurs in dementia. However, memory loss alone doesn't mean you have dementia. Dementia indicates problems with at least two brain functions, such as memory loss and impaired judgment or language, and the inability to perform some daily activities such as paying bills or becoming lost driving.

Dementia can make you confused and unable to remember people and names. You also may experience changes in personality and social behavior. However, some causes of dementia are treatable and even reversible.

Symptoms

Dementia symptoms vary depending on the cause, but common signs and symptoms include;

  • Memory loss
  • Difficulty communicating
  • Difficulty with complex tasks
  • Difficulty with planning and organizing
  • Difficulty with coordination and motor functions
  • Problems with disorientation, such as getting lost
  • Personality changes
  • Inability to reason
  • Inappropriate behavior
  • Paranoia
  • Agitation
  • Hallucinations

When to see a doctor
See a doctor if you or a loved one experiences memory problems or other dementia symptoms. Some treatable medical conditions can cause dementia symptoms, so it's important that a doctor determine the underlying cause.

Alzheimer's disease and several other types of dementia worsen over time. Early diagnosis gives you time to plan for the future while you can participate in making decisions.

Causes

Dementia involves damage of nerve cells in the brain, which may occur in several areas of the brain. Dementia may affect people differently, depending on the area of the brain affected.

Dementias can be classified in a variety of ways and are often grouped by what they have in common, such as what part of the brain is affected, or whether they worsen over time (progressive dementias).

Some dementias, such as those caused by a reaction to medications or an infection, are reversible with treatment.

Progressive dementias
Types of dementias that worsen over time include:

Alzheimer's disease. In people age 65 and older, Alzheimer's disease is the most common cause of dementia. People generally may develop symptoms after age 60, but some people may have early-onset forms of the disease, often as the result of a defective gene.

Although in most cases the exact cause of Alzheimer's disease isn't known, plaques and tangles are often found in the brains of people with Alzheimer's. Plaques are clumps of a protein called beta-amyloid, and tangles are fibrous tangles made up of tau protein.

Certain genetic factors also may make it more likely that people will develop Alzheimer's.

Alzheimer's disease usually progresses slowly over seven to 10 years. Your cognitive abilities slowly decline. Eventually, the affected areas of your brain don't work properly, including parts of your brain that control memory, language, judgment and spatial abilities.

Lewy body dementia. Lewy body dementia affects approximately 10 to 22 percent of people with dementia, making it one of the most common types of dementia. Lewy body dementia becomes more common with age.

Lewy bodies are abnormal clumps of protein that have been found in the brains of people with Lewy body dementia, Alzheimer's disease and Parkinson's disease.

People with Lewy body dementia often have a condition called rapid eye movement (REM) sleep behavior disorder that involves acting out dreams.

Vascular dementia. Vascular dementia, the second most common type of dementia, occurs as a result of brain damage due to reduced or blocked blood flow in blood vessels leading to your brain.

Blood vessel problems may be caused by stroke, infection of a heart valve (endocarditis) or other blood vessel (vascular) conditions.

Symptoms usually start suddenly and often occur in people with high blood pressure or people who have had strokes or heart attacks in the past.

Several different types of vascular dementia exist, and the types have different causes and symptoms. Alzheimer's disease and other dementias also may be present at the same time as this dementia.

Frontotemporal dementia. This less common cause of dementia tends to occur at a younger age than does Alzheimer's disease, generally between the ages of 40 and 65.

This is a group of diseases characterized by the breakdown (degeneration) of nerve cells in the frontal and temporal lobes of the brain, the areas generally associated with personality, behavior and language.

Signs and symptoms of frontotemporal dementia can include inappropriate behaviors, language problems, difficulty with thinking and concentration, and movement problems.

As with other dementias, the cause isn't known, although in some cases this dementia is related to certain genetic mutations.

Other disorders linked to dementia

Huntington's disease. This inherited disease causes certain nerve cells in your brain and spinal cord to waste away.

Signs and symptoms usually appear during your 30s or 40s. People may experience personality changes, such as irritability or anxiety. The condition causes a severe decline in thinking (cognitive) skills over time. Huntington's disease also causes weakness and difficulty with walking and movement.

Traumatic brain injury. This condition is caused by repetitive head trauma, such as experienced by boxers, football players or soldiers.

Depending on the part of the brain injured, this condition can cause dementia signs and symptoms such as uncoordinated movement and impaired speech, as well as slow movement, tremors and rigidity (parkinsonism). Symptoms may not appear until many years after the actual trauma.

A person who has experienced a single traumatic head injury could develop a similar condition called post-traumatic dementia, which may cause symptoms such as long-term memory problems.

HIV-associated dementia. Infection with the human immunodeficiency virus (HIV), which causes AIDS, destroys brain matter and may cause memory problems, withdrawal from social situations, concentration problems or movement problems.
Creutzfeldt-Jakob disease. This rare brain disorder usually occurs in people without risk factors. This condition may be due to an abnormal form of a protein. Creutzfeldt-Jakob disease sometimes may be inherited or caused by exposure to diseased brain or nervous system tissue.

Signs and symptoms of this fatal condition usually appear around age 60 and initially include problems with coordination, memory, thinking and vision. Symptoms worsen over time and may include the inability to move or talk, blindness, or infections.

Secondary dementias. People with movement disorders and other conditions may develop dementia. For example, many people with Parkinson's disease eventually develop dementia symptoms (Parkinson's disease dementia).
The relationship between these disorders and dementia isn't completely understood.

Dementia causes that can be reversed
Some causes of dementia or dementia-like symptoms can be reversed. Your doctor may identify and treat these causes:

Infections and immune disorders. Dementia can result from fever or other side effects of your body's attempt to fight off an infection. People may develop dementia or thinking difficulties if they have brain infections like meningitis and encephalitis, untreated syphilis, Lyme disease, or conditions that cause a completely compromised immune system, such as leukemia.

Conditions such as multiple sclerosis that arise from the body's immune system attacking nerve cells also can cause dementia.

Metabolic problems and endocrine abnormalities. People with thyroid problems, too little sugar in the bloodstream (hypoglycemia), too low or too high amounts of sodium or calcium, or an impaired ability to absorb vitamin B-12 may develop dementia or other personality changes.
Nutritional deficiencies. Dementia symptoms can occur as a result of not drinking enough liquids (dehydration); not having enough thiamine (vitamin B-1), a condition common in people with chronic alcoholism; and not having enough vitamins B-6 and B-12 in your diet.
Reactions to medications. Dementia may occur as a reaction to a single medication or because of an interaction of several medications.
Subdural hematomas. Subdural hematomas are caused by bleeding between the surface of the brain and the covering over the brain. They can cause symptoms similar to dementia.
Poisoning. Dementia symptoms can occur as a result of exposure to heavy metals, such as lead, and other poisons, such as pesticides.

Dementia symptoms also may occur in some people who have abused alcohol or recreational drugs. Symptoms may disappear after treatment, but in some cases symptoms may still be present after treatment.

Brain tumors. Dementia rarely can result from damage caused by a brain tumor.
Anoxia. This condition, also called hypoxia, occurs when organ tissues aren't getting enough oxygen. Anoxia may occur due to severe asthma, heart attack, carbon monoxide poisoning or other causes.

If you've experienced a severe lack of oxygen, recovery may take longer. Symptoms, such as memory problems or confusion, may occur during recovery.

Heart and lung problems. Your brain can't survive without oxygen. Dementia symptoms may occur in people with chronic lung problems or a heart condition that deprives the brain of the oxygen it needs.
Normal-pressure hydrocephalus. Sometimes people have normal-pressure hydrocephalus, a condition caused by enlarged ventricles in the brain. This condition can cause walking problems, urinary difficulty and memory loss. Shunt surgery, which delivers cerebrospinal fluid from the head to the abdomen or heart, may help these symptoms.
Treatment & Drugs

Most types of dementia can't be cured. However, doctors will help you manage your symptoms. Treatment of dementia symptoms may help slow or minimize the development of symptoms.

Cholinesterase inhibitors. These medications — including donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) — work by boosting levels of a chemical messenger involved in memory and judgment.

Side effects can include nausea, vomiting and diarrhea. Although primarily used to treat Alzheimer's disease, these medications may also treat vascular dementia, Parkinson's disease dementia and Lewy body dementia.

Memantine. Memantine (Namenda) works by regulating the activity of glutamate. Glutamate is another chemical messenger involved in brain functions, such as learning and memory. A common side effect of memantine is dizziness.

Some research has shown that combining memantine with a cholinesterase inhibitor may have beneficial results.

Other medications. Your doctor may prescribe other medications to treat other symptoms or conditions, such as a sleep disorder.
Occupational therapy. Your doctor may suggest occupational therapy to help you adjust to living with dementia. Therapists may teach you coping behaviors and ways to adapt movements and daily living activities as your condition changes.
Therapies
Several dementia symptoms and behavior problems may be treated initially using nondrug approaches, such as:

Modifying the environment. Reducing clutter and distracting noise can make it easier for someone with dementia to focus and function. It also may reduce confusion and frustration.
Modifying your responses. A caregiver's response to a behavior can make the behavior, such as agitation, worse. It's best to avoid correcting and quizzing a person with dementia. Reassuring the person and validating his or her concerns can defuse most situations.
Modifying tasks. Break tasks into easier steps and focus on success, not failure. Structure and routine during the day also help reduce confusion in people with dementia.
Lifestyle & Home Remedies

People with dementia will experience progression of their symptoms and behavior problems over time. Caregivers may need to adapt the following suggestions to individual situations:

Enhance communication. When talking with your loved one, maintain eye contact. Speak slowly in simple sentences, and don't rush the response. Present only one idea or instruction at a time. Use gestures and cues, such as pointing to objects.
Encourage exercise. Exercise benefits everyone, including people with dementia. The main benefits of exercise include improved strength and cardiovascular health. Some research also shows physical activity may slow the progression of impaired thinking (cognitive) function in people with dementia.
Exercise can also lessen symptoms of depression, help retain motor skills and create a calming effect.

Encourage participation in games and thinking activities.Participating in games, crossword puzzles and other activities in which people are using thinking (cognitive) skills may help slow mental decline in people with dementia.
Establish a nighttime ritual. Behavior is often worse at night. Try to establish going-to-bed rituals that are calming and away from the noise of television, meal cleanup and active family members. Leave night lights on to prevent disorientation.

Limiting caffeine during the day, discouraging daytime napping and offering opportunities for exercise during the day may help prevent nighttime restlessness.

Encourage keeping a calendar. Keeping a reminder calendar may help your loved one remember upcoming events, daily activities and medication schedules. Consider sharing a calendar with your loved one.
Plan for the future. Develop a plan with your loved one that identifies goals for care in the future. Several support groups, legal advisers, family members and others can help you. You'll need to consider financial and legal issues, safety and daily living concerns, and long-term care options.


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