There is often misperception and confusion with the terms dementia and Alzheimer’s disease, but there is a distinctive difference. Dementia is a symptom that can be caused by many disorders and Alzheimer’s disease is the type and cause of dementia. When someone is told they have dementia, it means that they have significant memory problems as well as other cognitive difficulties, and that these problems are severe enough to get in the way of daily living.
Dementia may be caused by any of the followings: high fever, AIDS, dehydration, systemic lupus erythematosus, hydrocephalus, Lyme disease, vitamin deficiencies, long-term drug or alcohol abuse, poor nutrition, hypercalcemia, hypothyroidism, brain tumor and multiple sclerosis. Dementia can also result from a reaction to medication or a head injury that causes bleeding in the brain. Dementia includes deterioration in memory, and intellectual incapability such as inability to generate comprehensible speech and understand written or spoken language; inability to recognize objects; inability to think conceptually, plan, make sound judgments and carry out complex tasks. The deterioration in intellectual abilities must be severe enough to restrict with daily life. Different types of dementia are related with different symptom, patterns and microscopic brain abnormalities.
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Alzheimer’s disease causes drastic changes in the brain. As healthy brain substance degenerate people suffering from Alzheimer’s disease experience a decline in memory and the capability to use their brain to do tasks. Alzheimer’s disease is a progressive brain disorder. It destroys brain cells, causing problems with behavior, memory and thinking severe enough to affect work, or social life. Alzheimer’s disease is fatal and gets worse over time. Alzheimer’s disease is predominantly common in elder people. Because it is the most common cause of dementia, Alzheimer’s disease is frequently associated with the general term dementia. Though, there are many other causes of dementia. To be clear, Alzheimer’s is a type of dementia and that is the key difference between Alzheimer’s and dementia.
Even though Alzheimer’s disease is responsible for 60-70 percent cases of dementia, other conditions that cause dementia include: Parkinson’s disease, Vascular dementia, Frontotemporal dementia and dementia with Lewy Bodies. In the early phases of a disease, there may be some differences between the diseases. For instance, in dementia with Lewy Bodies early symptoms may not be forgetfulness, but recurrent visual hallucinations, lowered attention span and variability between phases of lucidity followed by phases of confusion. Nevertheless, as the specific disease progresses, more portions of the brain become affected, and the differences between one cause of dementia to another becomes vague and delicate.
Physicians at times prefer the word “dementia”, perchance because Alzheimer’s has become a heavy and complicated word. “Dementia” someway sounds less terrifying to many people, and now even the specialists have started using this word. Differentiating between other types of dementia and Alzheimer’s disease is not easy and direct as defining these terms. In reality, people and their disordered behaviors are more complicated than the simple definitions of the disorders. Remember, the chief difference among dementia and Alzheimer’s is that Alzheimer’s is a definite disease and dementia is an indication of Alzheimer’s.
Link to websites
http://www.alzheimersreadingroom.com/2009/09/dementia-and-eight-types-of-dementia.html
http://www.dementiaguide.com/community/dementia-articles/Difference_Alzheimer’s_and_Dementia
http://www.mayoclinic.com/health/alzheimers-disease-and-dementia/AZ00053
What Causes Dementia?
In a healthy brain, bulk and speed may deteriorate in adulthood, but the brain continues to form vital functions throughout the life. However, when the brain connections are lost due to inflammation, injury or disease, brain cells ultimately die and dementia may possibly result. Understanding cause of the dementia is the first step. In the preceding twenty years, scientists have explained the origins of dementia. Genetics might increase the risks, but scientists believe that a combination of hereditary, lifestyle and environmental factors are the most likely causes. Dementia has several different causes, some of which are hard to tell apart. Causes of dementia may be divided into reversible and irreversible dementias. Some of the conditions that cause dementia may be reversible, even though unluckily most types of dementia do not recover with medical treatment. So, it is very important to assess dementia symptoms carefully, so as not to miss possibly treatable conditions.
In order to be diagnosed with dementia, one must suffer a decline in mental ability severe enough to interfere with daily life. While symptoms of dementia can vary greatly, the most common indicators are memory issues, communication and language impairment, and the loss of ability to focus and pay attention. Symptoms of dementia often tend to start out slowly and then gradually progress over time. Most of the types of dementia continue to worsen and are usually irreversible. Observable dementia signs may include: asking the same questions repeatedly, becoming lost in familiar locations, being unable to follow simple directions, getting disorientated about time, people and places, and a loss in attentiveness for personal hygiene. There is no distinct test that can show whether a person has dementia.
Irreversible causes
The main irreversible causes of dementia are given below. Treatment emphases on slowing progress of the underlying disorder and relieving symptoms.
Alzheimer disease: This is the most commonly occurring cause of dementia. Alzheimer tends to run in families. In this disease, atypical protein deposits in the brain and destroy brain cells in the areas that control memory and intellectual functions. Alzheimer disease is irreversible, and no known treatment exists. Though, certain medicines can slow its progress.
Vascular dementia: This is another most common cause of dementia. This dementia is caused by hardening of the arteries, in the brain. Deposits of fats, dead cells, and other debris inside the wall of arteries, partially or completely block the blood flow. This blockage causes disruptions of blood flow, to the brain. Vascular dementia is related high cholesterol, to high blood pressure, diabetes, heart disease, and related conditions. Treating those conditions can slow the development of vascular dementia.
Parkinson disease: Patients with this disease characteristically have limb stiffness, speech problems, and tremor (shaking at rest). Dementia might develop late in this disease, but not everybody with Parkinson disease has dementia. Speech, reasoning, memory, and decision making are most likely to be affected.
Lewy body dementia: This dementia is caused by abnormal deposits of protein, called Lewy bodies, which destroy brain cells. The deposits can cause symptoms like tremor and muscle rigidity. Lewy body dementia affects concentration thinking and attention more than language and memory. Lewy body dementia has no known cure.
Huntington disease: This is an inherited disease and causes degenerative of certain types of brain cells that control movement and thinking. Dementia occurs in the late stages of the disease. Personality changes are characteristic feature. Reasoning, judgment memory and speech may also be affected.
Creutzfeldt-Jakob disease: This disease occurs most often in young and middle-aged people. Infectious agents which are called prions kill brain cells, causing memory loss and behavior changes. The disease progresses quickly and is fatal.
frontotemporal dementia: This is a rare disorder that harms cells in the front area of the brain. It causes memory loss, language problems and personality changes.
Treatable/reversible Causes
The dementia in these disorders may be reversible or partially reversible.
Head injury: This mentions to brain damage from accidents, for example from road traffic accidents; gunshot wounds; or from activities such as boxing. The resultant damage of brain cells can cause dementia.
Infections: Infections such as meningitis and encephalitis are main causes of dementia. Other infections, such as HIV and syphilis, can also affect the brain in advanced stages. In all such cases, inflammation in the brain harms the cells.
Hydrocephalus: The brain fluid is called cerebrospinal fluid. If too much fluid accumulates outside the brain substance, it causes hydrocephalus. This condition raises the pressure on the brain and compresses it. It might cause severe damage and death. Hydrocephalus may cause dementia symptoms or coma. Patients have trouble walking and they can’t control urination. At the same time they start to lose memory.
Brain tumors: A tumor can press on brain structures which control hormone secretion. They can also press the brain cells, causing damage. Treating the tumor can reverse the symptoms.
Toxic exposure: People who work around heavy metal dust and fumes especially lead without protective equipment may develop dementia because these substances can damage brain cells.
Metabolic disorders: Diseases of pancreas, liver or kidneys can lead to dementia by disturbing the amount of salts and other chemicals in the blood. These alterations occur rapidly and affect the patients’ level of consciousness. Treatment of the underlying disease may fully reverse the disorder. If the underlying disease continues, brain cells may die, and the patient will have dementia.
Hormone disorders: Diseases of organs such as thyroid gland, parathyroid glands, pituitary gland, or adrenal glands can cause hormone imbalances, which results in dementia if not treated.
Poor oxygenation: People who do not have enough oxygen in their blood may develop dementia because the blood brings oxygen to the brain cells, and brains cells need oxygen to live. The most common causes of hypoxia are lung diseases such as emphysema or pneumonia. Cigarette smoking is a frequent cause of emphysema. Heart disease leading to congestive heart failure may also lower the amount of oxygen in the blood. Sudden, severe hypoxia may also cause brain damage and symptoms of dementia. Sudden hypoxia may occur if someone is comatose or has to be resuscitated.
Drug reactions or drug abuse: Certain drugs can cause temporary problems with memory as side effects in aged people. Misuse of drugs, whether deliberate or unintentional, can cause dementia. The common culprits are tranquilizers and sleeping pills. Illegal drugs, especially cocaine and heroin may also cause dementia, particularly in high doses and if taken for long periods.
Nutritional deficiencies: Lack of certain nutrients, particularly B vitamins, can cause dementia if not improved.
Chronic alcoholism: Prolong use of alcohol can causes dementia due to complications of alcohol misuse such as liver disease and nutritional deficiencies.
Link to websites
http://www.emedicinehealth.com/dementia_overview/page3_em.htm#dementia_treatable_causes
http://www.webmd.com/alzheimers/guide/alzheimers-dementia
http://www.helpguide.org/elder/alzheimers_dementias_types.htm
http://my.clevelandclinic.org/disorders/dementia/hic_types_of_dementia.aspx
What are the types of dementia?
Dementia develops when the areas of the brain that are involved with memory, learning, language and decision-making are affected by infections or diseases. When life’s encounters include dementia or memory loss, perceptions, priorities and relationships inevitably change. But the good news is that some types of dementia can be reversed or treated if caught in time. With dementia, there will be noticeable decline in learning, communication, problem solving and remembering. These changes may happen quickly or very slowly over time. The development and outcome of dementia differ, but are mostly determined by which area of the brain is affected and the type of dementia and.
It is appropriate to categorize most dementias as Alzheimer type and non-Alzheimer type. The Alzheimer type are characterized primarily by memory loss, supplemented by impairment in other intellectual functions such as language function, skilled motor functions or perception, visual or other. Non-Alzheimer dementias include the frontotemporal lobar degenerations, which generally are of two main types. One primarily affects speech and the other is characterized mainly by changes in behavior, and personality change. In both of these types, memory loss is comparatively mild, if present. Other types of dementia, comprising vascular disorders, normal pressure hydrocephalus, Parkinson’s dementia and dementia with Lewy bodies would be categorized under the non-Alzheimer disorders.
Dementias can be categorized in a variety of ways and are frequently grouped by common similarities, such as the brain is affected, or deterioration over time which is termed as progressive dementias. According to most professionals, there are two main types of dementia, depending upon the area of brain affected, that are called cortical and subcortical dementias. Brain disorders causing dementia are situated either in the cortical area or within subcortical regions of brain.
Cortical Dementia – In cortical dementia, the cerebral cortex of the brain is affected. This is the outer region of the brain. The cerebral cortex is important for intellectual processes, such as memory and language. The distinctive convolutions of the cortex play an important role in processing information. Patients with cortical dementia are unable to recall words and understand language. Creutzfeldt-Jakob disease, Pick’s disease, Binswanger’s disease and Alzheimer’s disease are included in cortical dementia.
Subcortical Dementia – In subcortical dementia, the region of the brain below the cortex becomes impaired or damaged. Memory and language are not typically affected. A person with subcortical dementia will experience changes in his behavior, his thinking might slow down, and his concentration span may be shortened. Dementias which result from Parkinson’s disease, AIDS and Huntington’s disease are subcortical dementias.
In multi-infarct dementia, both the cortical and subcortical areas of the brain are affected or damaged. Multi-infarct dementia is caused by a sequence of small strokes. A stroke is a disruption in or obstruction of the blood supply to any portion of the brain. When the strokes affect a small area, there may be no signs of a stroke. Over time, when more areas of the brain are involved, the symptoms of multi-infarct dementia begin to appear.
Link to websites
http://my.clevelandclinic.org/disorders/dementia/hic_types_of_dementia.aspx
http://www.medicalnewstoday.com/articles/142214.php
What are sign & symptoms of dementia?
Symptoms of dementia differ considerably by the patients, the primary cause of the dementia and the part of brain that is affected. Most patients affected by dementia have some of these symptoms. The symptoms may be evident, or they may possibly be very subtle and remain unrecognized for some time. The first indication of dementia is generally loss of short-term memory. Other symptoms and signs are as follows:
Early dementia
Memory loss; this is typically the earliest and most obvious symptom.
Trouble in identifying people and places
Word-finding trouble – May be able to compensate by using synonyms or defining the word
Fail to recall names, recent events, or losing things
Trouble in performing familiar activities – household tasks, driving, cooking a meal
Personality changes – such as a sociable person becomes quiet or a quiet person is silly
Unusual behavior
Poor decision making
Mood swings, often with momentary periods of anger
Behavior disorders – Distrust and suspiciousness
Deterioration in level of functioning but able to follow conventional routines at home
Confusion, disorientation in strange surroundings
Depression is common, and anxiety or violence may occur.
Intermediate dementia
Deterioration of symptoms that are seen in early dementia
Incapable to carry out daily activities e.g. bathing, grooming, dressing, feeding etc
Disturbed sleep
Increasing confusion and disorientation even in familiar environments
Incapable to learn new information
Hallucinations
Risk of accidents and falls due to confusion and poor judgment
Behavior disorders – aggressiveness, misunderstandings, suspicious, nervousness and inappropriate sexual behavior
Believing the person has completed or experienced things that never occurred
Distraction, poor concentration
Lack of interest in the world
Abnormal moods; depression, anxiety
Severe dementia
Worsening of symptoms that are seen in early and intermediate dementia
Complete dependency on others for daily activities
Unable to walk or move from one place to other place independently
Weakening of other movements such as swallowing
Increases risk of malnutrition, choking, and inhaling foods and drinks into lungs
Complete loss of both short- and long-term memory – unable to recognize even friends and close relatives
Complications – malnutrition, dehydration, infections, problems with bladder control, aspiration, pressure sores, seizures, injuries from falls or accidents
The person may not be aware of these problems, especially the behavior problems. This is especially true in the later stages of dementia.
Depression in aged people may cause dementia like symptoms. Approximately 40% of patients with dementia are also depressed. Common symptoms of depression are depressed mood, sleep disturbances, weight gain or loss, loss of interest in activities once enjoyed, withdrawal from others, suicidal thoughts, loss of ability to think clearly or concentrate and feelings of worthlessness.
People with untreated dementia present a gradual decline in intellectual functions and movements. Complete dependence and death are the last stages.
Some types of dementia cause certain symptoms: Patients who have dementia with Lewy bodies have visual hallucinations. And they might fall frequently. In frontotemporal dementia the first symptom may be unusual behavior or personality changes. Patients with this disease may not express any concern for others, or they may say impolite things, make sexually explicit remarksor expose themselves.In vascular dementia there is abrupt onset of symptoms.
It is important to know that memory loss can be caused by conditions other than dementia, such as depression, and that those conditions can be treated. Also, occasional trouble with memory (such as briefly forgetting someone’s name) can be a normal part of aging. But if you are worried about memory loss or if a loved one has memory loss that is getting worse, see your doctor.
Link to websites
http://www.emedicinehealth.com/dementia_overview/page4_em.htm#dementia_symptoms
http://www.webmd.com/alzheimers/tc/dementia-symptoms
Care for patients with dementia
When an individual with dementia finds that their intellectual abilities are deteriorating, they often feel helpless and in need of encouragement, support and assurance. The persons closest to them, including their family members and friends, must do everything to help the individuals to retain their feelings of self-worth and sense of identity. A person with dementia may follow these steps to improve quality of life.
Quiet, peaceful and steady surroundings
A quiet, peaceful and even surrounding reduces problems such as anxiety, nervousness and confusion. Unfamiliar situations or people, disturbed routines, feeling rushed, loud noises, or being asked to finish multistep tasks can cause frustration. When a patient has dementia, becoming distressed reduces the capability to think clearly even more.
Sleeping pattern
Dementia behaviors may become worse at night when the patient is more tired, stressed by the demands of the day or maybe confused because of darkness. Try to establish calming sleeping routine. It can be helpful to avoid the noise of television or family members. Leaving lights on helps prevent confusion. Exercising during the day, avoiding daytime napping and limiting caffeine during the day may help prevent nighttime agitation.
Reminder
A patient can use a reminder for upcoming events and tasks that needed to be completed on daily basis. The patient may check off those tasks when done.
Make a plan
A patient should make a comprehensive plan that identifies objectives for care. Various support agencies, legal advisers, primary and specialty doctors, care centers, and family members can help achieve these objectives. The families should consider about the followings:
The plan for treatment
Primary caregiver
Caretaking at a family home or a nursing home
Support in daily routine such as meal preparation, taking medications and daily hygiene
Put labels on everything to help them with the forgetfulness
Treat them with affection and respect
Plan activities that are stress free such as music therapy and walks to the garden or park
Legal issues such as power of attorney for health care issues and a living will
The disease will progress over time, and the care needs to be adjusted with symptoms. Patients with dementia should be encouraged to carry on their daily activities as long as the activities don’t cause confusion or frustration. Mental, physical and social activities help maintain a individual’s health and well-being.
Lifestyle modification
Leading a healthy lifestyle is vital to lowering your risk of dementia and other diseases. Recent research proposes that good mental stimulation and health habits may delay the onset of dementia. Plans to improve mental clearness are:
Regular exercise: Exercising regularly will make the heart and circulatory system more effective. It will also help lower the cholesterol and blood pressure, decreasing the risk of developing dementia.
Challenge your mind
Eat a healthy diet: A low-fat, high-fiber diet is recommended, comprising fresh fruit and vegetables and whole grains. Limit the amount of salt in the diet. Too much salt will increase the blood pressure, which increases the risk of developing dementia. Avoid eating foods that are rich in the cholesterol, which also increases the risk of developing dementia.
Minimize stress
Get regular and peaceful sleep
Avoid smoking and reduce drinking: Smoking and excessive alcohol consumption increases blood pressure and blood cholesterol level. Both are major risk factor for developing cardiovascular diseases and dementia.
Maintain a healthy weight: Overweight may increase the blood pressure, which increases the risk of dementia.
Keep the blood pressure at a healthy level.
Link to websites
http://www.mayoclinic.com/health/dementia/DS01131/DSECTION=lifestyle-and-home-remedies
http://www.nhs.uk/Conditions/Dementia/Pages/Prevention.aspx
How is dementia treated?
Because dementia can be caused by any number of disorders, obtaining a precise diagnosis is important for the management and treatment. However dealing with dementia is a challenge, the doctor can assess the personal risk factors, evaluate symptoms, offer tips on healthy lifestyle, and help to obtain suitable care. For most of the dementias, treatments to reverse or stop disease development are not available. However, treatment with available medications and other measures, such as cognitive training can benefit the patients to some extent.
Drugs to specifically treat Alzheimer’s disease and other progressive dementias are available and are prescribed for several patients. Though these drugs do not stop the disease or reverse the brain damage, they can improve sign and symptoms and slow the advancement of the disease. This may possibly improve the person’s quality of life, ease the liability on caregivers, and delay the admission to a nursing home. The researchers are also evaluating whether these drugs are useful for treating other types of dementia.
Many individuals with dementia, mostly those in the early stages of the disease, may possibly benefit from practicing tasks intended to improve performance in particular aspects of intellectual functioning. For instance, individuals can sometimes be educated to use memory supports, such as reminders, note taking or computerized recall devices.
Behavior amendment – rewarding suitable or positive behavior and disregarding inappropriate behavior may help control intolerable or dangerous behaviors.
Treatment of dementia possibly will help slow or reduce the development of symptoms.
Cholinesterase inhibitors: These medicines work by increasing levels of chemical messengers involved in judgment and memory. Side effects can comprise diarrhea, nausea or vomiting. Though mostly used in Alzheimer’s disease, they’re also used to treat Parkinson’s, Lewy body and vascular dementias.
Memantine: This drug is widely used for the treatment of dementia. It works by regulating the action of glutamate, which is a chemical messenger involved in almost all brain functions, such as memory and learning. Its common side effect is lightheadedness or dizziness. Some studies have shown that combining cholinesterase inhibitor with a memantine may have even improved results. However, it is primarily used to cure Alzheimer’s disease, but it may also be helpful in improving signs and symptoms in other dementias.
Additional medications: However, no standard treatment for dementia is available, but some symptoms can be treated. Other treatments aim to decrease the risk factors for advanced brain damage and impairment.
Management of the underlying causes of dementia may also slow or at times stop its progression. For example, to prevent a stroke, the clinician may prescribe medicines to control raised cholesterol levels, high blood pressure, diabetes mellitus and heart disease. Clinicians may also prescribe medicine to treat disorders such as blood clots, sleeplessness and anxiety for individuals with vascular dementia.
In addition, some particular symptoms and behavioral issues can be managed with antidepressants, sedatives and other medications, but certain drugs may possibly worsen other symptoms.
There is no treatment available for Creutzfeldt-Jakob disease. Care should be focused on making sure that the person is contented and relaxed.
Link to websites
http://www.mayoclinic.com/health/dementia/DS01131/DSECTION=treatments-and-drugs
http://www.medicinenet.com/dementia/page16.htm#is_there_any_treatment_for_dementia
http://www.helpguide.org/elder/alzheimers_dementias_types.htm
TESTS USED IN DIAGNOSING DEMENTIA
Memory impairment and other dementia symptoms have numerous causes, so diagnosis may be challenging and it involves a number of tests.
Medical history
The doctor will ask about the onset of symptoms and any other health problems that might help in diagnose, for example diabetes mellitus, hypertension or a family history of dementia. The doctor may also request information from the family member.
Physical examination
A physical examination helps to rule out causes of dementia and other disorders that may cause similar symptoms. This examination can also help recognize signs of other diseases, such as vitamin deficiency, heart disease, hormonal diseases, infection and any side effects of medication, which can overlap with dementia. These other causes are easily treated.
Cognitive tests
Intellectual functions should be evaluated to diagnose dementia. A number of tests measure general intellectual skills, coordination, academic skills, spatial skills, language skills, attention, memory, judgment and reasoning. The objective is to determine presence of dementia is present, its severity and affected part of the brain. Some of the commonly applied cognitive tests comprise:
Mini-Mental Status Examination
This test is conducted by a doctor and takes around 5 minutes to complete. The Mini-Mental Status Examination is the most common test for detecting dementia. It evaluates skills such as writing, reading, coordination and short-term memory.
Alzheimer’s Disease Assessment Scale-Cognitive
This test can be used for individuals with mild symptoms. It is the best brief examination for language and memory. It takes approximately 30 minutes and is conducted by a specialist or a psychologist.
Neuropsychological evaluation
This involves very sensitive tests conducted by a neuropsychologist. The usual testing session will take at least 2 hours and may be conducted over more than one visit. A number of tests will be used and may comprise tests of memory, reasoning, comprehension and writing.
Radiological tests
X-rays may be taken and those who are chronic smoker will commonly need a chest X-ray to rule out lung tumor, which may cause a secondary brain tumor.
Brain imaging techniques
Brain imaging techniques are necessary to identify tumors, strokes or other conditions that can cause dementia. Alzheimer’s disease alters brain structure and can be seen with a brain scan. Several kinds of scans are in use.
CT and MRI scans. The best imaging techniques for detecting dementia are magnetic resonance imaging (MRI) and computerized tomography (CT). Magnetic resonance imaging is a technique that uses a radio waves and magnetic field to create thorough images of the tissues and organs. Computerized tomography is an X-ray technique that creates images of body and shows internal structures in cross section. These scans help to identify strokes, brain-size changes and other problems such as hydrocephalus.
Electroencephalogram (EEG). This device can detect and record outlines of electrical activity and abnormalities. These abnormalities can indicate intellectual dysfunction, which is common in individuals with moderate and severe Alzheimer’s disease. An EEG can also identify Creutzfeldt-Jakob disease, seizures and other conditions associated with dementia.
Positron Emission Tomography and Single-Photon Emission Computerized Tomography
In these tests, a radioactive material is injected into the patient and emissions from the brain are detected through the detectors in the scanner. Positron Emission Tomography provides visual images of activity in the brain. Single-Photon Emission Computerized Tomography is used to see the blood flow to different regions of the brain.
Laboratory tests
Different types of lab tests can help rule out dementia and other conditions, such as kidney failure, that can cause similar symptoms. Treatable medical diseases are often associated with dementia. Tests that can help in detecting treatable medical diseases include:
Complete blood count to rule out anemia and infection
Blood glucose test to rule out diabetes
Blood or urine test to detect drugs or alcohol
Renal function test
Serum electrolytes
Liver function test
Tests for Vitamin B12 deficiency
Thyroid hormone levels to rule out hypothyroidism
Cerebrospinal fluid examination to rule out brain infections
Psychiatric evaluation
This test may be performed to rule out depression or other psychiatric disorder.
Link to websites
http://www.fightdementia.org.au/understanding-dementia/tests-used-in-diagnosing-dementia.aspxhttp://www.mayoclinic.com/health/dementia/DS01131/DSECTION=tests-and-diagnosis
Understanding the Various Dementia Stages
Dementia is a disorder that is characterized by a group of signs and symptoms that results in weakening of the function of brain. There are distinct dementia stages and each has its characteristic symptoms. Several symptoms may possibly be experienced by nearly all patients affected with this condition but it must be noted that sign and symptoms of dementia stages may also differ from person to person. It will be appropriate to look at various stages of dementia along with the proper dementia care that is required.
Main Stages of Dementia
There are three main stages of dementia which categorizes the disorder into general signs and symptoms.
Mild: In this stage, affected persons still have the ability to live independently and they can still perform day-to-day hygiene activities such as taking a bath. They can also make sensible judgment but their ability to socialize and work is impaired.
Moderate: In this stage, working somewhere is not possible any longer. In this stage, the independent living begins to diminish. Therefore, supervision may be beneficial.
Severe: In this, affected persons needs total observation since their independent functions and everyday activities are severely damaged.
Dementia can also be classified into different stages by concentrating on the intellectual function of the patients experiencing dementia. This classification consists of seven stages and comprises a wide-ranging list of signs and symptoms.
The Seven Stages of Dementia
Stage 1/No Cognitive Decline
In this stage there are no clinical and personal complaints of memory loss.
Stage 2/Very Mild Cognitive Decline
This stage is characterized by memory weakening related to aging for example individuals forget where they placed things and even names.
Stage 3/Mild Cognitive Decline:
In this stage clear cut impairments occur. Patient may perform poorly at work and may be lost when going to familiar places. They may also forget names and items as well as forget valuable things.
Stage 4/Moderate Cognitive Decline:
This stage is manifested by reduced knowledge of recent happenings, familiar persons, personal history and even reduced concentration.
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Stage 5/Moderate Dementia:
Individuals are totally dependent on others. They can’t remember names such as their family member names and phone numbers.
Stage 6/Moderately Severe Dementia:
The patients may retain some awareness of their past but may at times forget name of family members and latest experiences. They might also slow delusional behavior along with preoccupied and anxiety symptoms.
Stage 7/Very Severe Cognitive Decline:
In this stage, verbal skills, urine control and motor skills such as walking are totally lost.
Link to websites
http://www.dementiacarecentral.com/node/540
http://www.dementiastages.net/
What is the definition of dementia?
Dementia is a broad-spectrum term that defines a group of symptoms-like loss of memory, language, judgment, and intellectual function. The word dementia comes from the Latin word meaning “apart from mind”. Dementia is a group of disorders that cause a permanent deterioration of individual’s ability to reason, think and manage his own life. Dementia is triggered by biological processes inside the brain that cause the permanent destruction or death of the brain’s cells.
The number of patients with dementia is progressively increasing. Dementia is considerably more common among aged people. Though, dementia can affect people of any age but it is comparatively infrequent in people under the age of 65. In the world there are approximately 36 million people with dementia. Almost 28 million individuals living with dementia do not have a diagnosis. It is predicted that numbers of patients living with dementia worldwide double every 20 years.
Dementia causes an individual to have weakened memory, absent-mindedness, an inability to remember new information, to lose the capability to speak and the capability to understand spoken or written language. The patient also loses the aptitude to plan, make good decisions and perform multi-step jobs. This means that the patient cannot manage his daily routine. With this diagnosis, the consequences for the patient and his family can be shocking.
Dementia is the continuous decline in intellectual functions that is the ability to process thought or intelligence. Continuous decline means the symptoms will progressively become worse. The worsening is more than might be predictable from normal aging and is due to the disease or damage. Dementia isn’t a particular disease. Instead, dementia refers to a set of symptoms affecting intellectual and social capabilities severely enough to effect daily functioning. Generally, memory loss occurs in dementia; however only memory loss doesn’t mean you have dementia. Dementia specifies problems with at least two brain functions, for example memory loss and impaired language or judgment. Dementia can make the patient confused and incapable to remember individuals and names. Patient may experience alterations in personality and social conduct. Though, some causes of dementia are curable.
Many reasons of dementia symptoms are present. Diseases like Alzheimer’s disease, Vacular dementia or Lewy body disease that are categorized as dementias have some factors in common. Alzheimer’s disease represents about 60 percent of all dementias and in individuals over the age of 65, it is the common cause of dementia. The other common causes of dementia are Lewy bodies and vascular dementia. Vascular dementia is caused by blockage of blood supply. Other forms include alcohol dementia which is caused by continuous use of alcohol; trauma dementia which is caused by head injury; and an infrequent form of dementia that is fronto-temporal dementia.
Dementia, contrasting Alzheimer’s, is not an ailment in itself. In dementia, the higher intellectual functions of the patient are involved in the beginning. In the later stages, the patient might not know what day of the week it is, and might not be able to recognize the people around him. The clinical signs, symptoms and the course of dementia differ, depending on the type of illness causing it, and the site and number of impaired brain cells. Some types progress gradually over years, whereas others may result in abrupt loss of intellectual function. All types of dementia are characterized by different structural or pathologic alterations in the brain, such as collection of atypical plaques and tangles in patients with Alzheimer’s disease, and accumulation of abnormal tau protein in patients with fronto-temporal dementia.
When a patient is diagnosed with dementia, the patient or the family members have no information regarding the type of dementia. Each type disease related to dementia has a different sequence of illness, different signs and different encounters. The managements and mediations may be different as well.
Dementia is a group of symptoms affecting intellectual and social abilities, severely enough to interfere with daily functioning. It is caused by conditions or changes in the brain. Dementia is the loss of mental functions such as thinking, memory, and reasoning that interferes with a person’s daily life and activities, Different types of dementia exist, depending on the cause. Alzheimer’s disease is the most common type. Dementia is a loss of the mind, it could be static which results from global brain injury or it could be progressive which results in long term decline in cognitive function (Hopkins). Dementia indicates problems with at least two brain functions, such as memory loss along with impaired judgment or language. Dementia has never been known to be a disease but a group of symptoms that causes diseases and conditions, some symptoms are changes in personality, mood, and behavior. Dementia can make someone confused and unable to remember the names and important people in their lives like the name of children, husband, sisters and brothers. Some cases of dementia can be treated or cured because the cause is treatable, like dementia caused by substance abuse e.g. street drugs, alcohol, controlled substances, dementia caused by severe depression. This is known as pseudo-dementia (false dementia) and is treatable. In most cases, a true dementia cannot be cured, because of some causes that are curable and partially treated; doctors must be thorough in making the decisions so as not to miss potentially treatable conditions. The frequency of treatable causes of dementia is believed to be about 10 % (WebMD 2010). Dementia is classified as cortical or sub cortical depending on the area that is affected. Cortical dementia affects the cerebral cortex or the outer layer of the brain; the cortex is a sheet of neural tissue that is outermost to the cerebrum of the mammalian brain. It plays a key role in memory, attention, thinking, awareness, consciousness and language.it could lead to problems with memory, thinking, and language, difficulty comprehending written or spoken material. Subcortical dementia results from dysfunction in the other brain areas below the cortex; it is the portion of the brain immediately below the cerebral cortex, this is a categorized dementia which can also bring about memory loss, degradation in thinking ability as well as changes in movement and emotions (Hopkins 2010).
There are some related Dementia; Mild cognitive impairment is a transition stage between the cognitive decline of normal aging and the more serious problems caused by Alzheimer’s disease. This disorder can affect the language, writing and reading and could probably cause memory loss. Vascular dementia is the form of dementia that the condition is more than one; it is a group of syndromes relating to different vascular mechanisms. It is preventable and the early detection and an accurate diagnosis are important. Mixed dementia is a condition in which Alzheimer’s disease and vascular dementia occur at the same time, Dementia with Lewy body is a progressive declined disease or syndrome of the brain with several diseases, especially with two common diseases of older adults, Alzheimer’s and Parkinson’s. Parkinson disease is a degenerative disorder of the central nervous system that often impairs the sufferer’s motor skills, speech, and other functions, Huntington disease, it is a genetically programmed degeneration of nerve cells in certain areas of the brain. This degeneration causes uncontrolled movements, loss of intellectual faculties, and emotional disturbance. Creutzfeldt-jacob disease Creutzfeldt-Jakob disease is a rare, degenerative, neurological disorder that is invariably fatal and incurable. Normal pressure hydrocephalus is a condition in which there is too much cerebrospinal fluid in the ventricles. This occurs when the natural system for draining and absorbing extra cerebrospinal fluid does not work right. Wernicke-korsakoff syndrome is a neurological disorder that could be acute or chronic which is caused by the deficiency in the B vitamin thiamine, Frontotemporal dementia is a degenerative condition of the part of the brain it is a clinical syndrome caused by degeneration of the frontal lobe of the brain and may extend back to the temporal lobe, It is one of three syndromes caused by frontotemporal lobar degeneration. Dementia has lots of symptoms and all varies depending on the cause, the common ones are memory loss, difficulty in performing activities of daily living, inappropriate behavior, aggitation, personality changes, difficulty with coordination and motor function. Dementia can be diagnoses in different ways; the doctor determines the kind of test, it is important for the doctors to rule out the curable dementia, like depression, normal pressure hydrocephalus, or vitamin B12 deficiency which can cause the same symptoms. Early diagnosis and treatment is important for the patient. The different ways of diagnosing is autopsy to confirm or refine the clinical diagnosis of Alzheimer disease, the patient history so as to help the doctor rule out some conditions, physical examination to help the doctor rule out the treatable and curable cause of dementia and identify some other illness in the body which and coincide with dementia, neurological examination to assess the sensory neuron and motor neuron, especially reflexes to determine if the nervous system is functioning and to determine a movement disorder or stroke that may affect the patient’s diagnosis, lab test to rule out some symptoms like kidney failure that could contribute to the cause of dementia, the test includes complete blood count, urinalysis, blood glucose test, cerebrospinal fluid analysis etc. Brain scan to detect abnormalities of the brain the size of 5 mm and larger, it can also be used by doctors to identify stroke, tumor or other problems that causes dementia, there are different kinds of brain scan which are, computed tomography (CT) which combines special x-ray equipment with complicated computers to produce multiple images or pictures of the inside of the brain. These images of the area being studied can then be examined on a computer monitor, printed or transferred to a CD and magnetic resonance imaging (MRI) used in radiology to visualize detailed internal structure and limited function of the body. Psychiatric evaluation used to determine there is depression including sad, hopeless or worthless, or another form of psychiatric disorder which may be contributing to the symptoms of dementia, and presymptomatic testing is used when no treatment available stands in contrast to genetic testing done for the diagnosis of the dementia (White).
There is no specific treatment for dementia; the treatment is to treat the cause. Patient with dementia needs to be under the supervision of medical care to focus on the quality care, medication and treatments such as therapy, and family members to help in activities of daily living, and to help the patient cope with many challenges. The goal of treatment is to control the symptoms of the disease; some patient might be hospitalized for a short period of time. The available drugs that the Food and Drug Administration (FDA) approved to determine the treatment of behavioral disorder in patient with dementia is antipsychotic medication which includes, Risperdal, Seroquel, Zyprexa and Abilify, they are used to reduce the psychotic symptoms of dementia and allow the patient to function effective and appropriately (FDA 2005). Drugs for treatment of dementia should be avoided unless they are really necessary, before any of these drugs are prescribed doctors make sure the patient is physically healthy, comfortable and well taken care of. Some symptoms that also be treated is when patient is pain, have problems with sight and have difficulty hearing, all this can make patient more confused and increase their vulnerability. It is essential for patients to take the drugs exactly as prescribed to make it effective, but if the symptoms are not controlled the doctor may refer the patient to a specialist for further advice. There are some possible side effects of these drugs that may worsen the symptoms which are muscle stiffness, tremor, anemia, depression, heart failure, infection, nutritional disorder, hypoxia and abnormal movements, which must be listed on the drug guide. The doctor usually starts the medication with low dose and gradually increase the dose until the desired outcome is achieved. It is important to inform the doctor about any other drug that the patient is taking to avoid contraindications and once treatment is established it is important to review it regularly. In most cases these drugs should not be prescribed for more than three months and patient should not assume that if the has been proved to be effective does not mean it is going to be effective on them. There are some more drugs that can be prescribed which are mood stabilizer (citalopram, fluoxetine, and imipramine), stimulant (methylphenidate) and serotonin affecting drugs (trazodone, buspirone), information on how to take this drugs must be provided by the doctor or pharmacist.
What is Alzheimer?
Alzheimer’s disease is a brain disorder named after German physician Alois Alzheimer, who first described it in 1906 Alzheimer’s, it is irreversible, slowly progressive disease of the brain that is characterized by impairment of memory and eventually by disturbances in reasoning, planning, language, perception memory and thinking skills, and even the ability to carry out the simplest tasks. It is cited as number one mental health among people age 60 and the risk goes up as you get older. The risk is also higher if a family member has had the disease. Alzheimer is a progressive disorder that starts in the brain in the area that involves thought, memory and language. It is characterized by the stage of increasing impairment and dependency (alz.org2010). People with Alzheimer disease may have trouble remembering things that happened recently or names of people. The earliest sign of Alzheimer disease is behavior such as suspiciousness and a thought process heavily influenced by anxiety or fear, often to the point of irrationality and delusion, angry, outburst, withdrawal. Over the time the symptoms of Alzheimer gets worse, they tends to forget how to speak, write, read, brush their teeth, comb their hair and even forget family members this might make them aggressive, wander around, and get stressed. The cause of Alzheimer disease is unknown but lots of factors have been explored. There is no single test that can detect Alzheimer but the disease is diagnosed by some symptoms, some findings on neurological examination and some result from diagnostic test. The tests show the possible sign and symptoms. The pathological hallmark associated with Alzheimer’s disease is amyloid plaque and neurofibrillary tangles, amyloid is found between nerve cells in the brain. Amyloids are insoluble fibrous protein aggregates sharing specific structural traits that the body produces normally, in an healthy brain the amyloid are broken and diminishes but in an Alzheimer’s disease the amyloid form hard and insoluble plaques. Neurofibrillary tangles are also found in the brain of Alzheimer disease patients, this is the accumulation of twisted protein filaments within neurons of the cerebral cortex; a characteristic pathological feature found in the brains of Alzheimer’s disease patients. In Alzheimer’s disease, there is an overall shrinkage of brain tissue and theories have proved that there is no cure for it. The part of the brain called sulci are widened while the part called gyri shrunk. The ventricle that contains the cerebrospinal fluid is enlarged. The disease Alzheimer is affecting over 5.3 millions of Americans; it cost over $148 billion annually to take care of an Alzheimer’s patient (Alazraki).
In the early stages of Alzheimer’s disease, the short-term memory begins to fade, when the cells in the brain begins to diminishes, the ability to perform routine tasks declines. As Alzheimer’s disease spreads through the cerebral cortex judgment declines, emotional outbursts may occur and language is impaired. As the disease progresses, more nerve cells die, leading to changes in behavior, such as wandering and agitation. In the final stages of the disease, people may lose the ability to recognize faces and communicate; they normally cannot control bodily functions and require constant care.
Physicians discuss with the patient and family which tests are most appropriate to establish the correct diagnosis but there is no test that diagnose Alzheimer disease, but the disease is diagnosed by the symptoms, firstly patients have to complete a physical examination to rule out some symptoms, the patient the patient mental status and neuropsychological will be assessed to determine which thinking and memory function may be affected. The patient may have a psychiatric assessment to rule out some mental illness and depression. The patient may be asked to do a brain scan (MRI, CT scan, and PET scan) to help detect signs and symptoms of stroke that can bring changes to the structure of brain associated with thinking. Blood test may be ordered to check for infection, kidney and liver function, electrolyte level, thyroid disorder and other factors that can cause memory loss. Other tests that sometimes provide important diagnostic information include electroencephalogram (EEG), urine tests, and tests on cerebrospinal fluid (CSF) obtained by a lumbar puncture. The possible drugs approved by the Food and Drug Administration (FDA) are tacrine which should be taken on an empty stomach, one hour before, or two hours after meals. If stomach upset occurs, it may be taken with meals; however, food can decrease tacrine blood levels significantly. The possible side effect of this drug is diarrhea, nausea, vomiting, muscle ache and loss of appetite. Donepezil is expected to delay the onset of Alzheimer disease for about one year in people suffering from mild cognitive impairment; it belongs to a class of drugs called cholinesterase inhibitors, it inhibits acetylcholinesterase, an enzyme responsible for the destruction of one neurotransmitter, acetylcholine. The possible side effects associated with this drug include headache, generalized pain, fatigue, nausea, vomiting, loss of appetite, weight loss, dizziness, muscle cramping, joint pain, diarrhea, insomnia, and increased frequency of urination. Namenda was actually prescribed for moderate to severe stage Alzheimer disease but now is being prescribed even in earlier stages of the disease, Namenda is an orally active receptor antagonist that regulates the activity of glumate in the brain. Cholinesterase inhibitors are used to treat cognitive functions and behavioral symptoms in Lewy body disease. Clonazepam is a benzodiazepine derivative with anticonvulsant and muscle relaxant, it is generally considered to be among the long-acting benzodiazepines and Opiate drugs used to relieve pain. Antipsychotic drugs not approved by FDA are sometimes used to treat agitation include, Risperidone Benzodiazepines and drugs such as Olanzapine , Quetiapine , Ziprasadone .The drugs increase the risk of death in elderly patients and the side effects include sedation, confusion and increased muscle tone.
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