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What is Dementia?
Dementia is the loss of intellectual functions (such as thinking,
remembering and reasoning) of sufficient severity to interfere
with a person's daily functioning. It is not a disease in
itself, but rather a group of symptoms which may accompany
certain diseases or physical conditions. The cause and rate
of progression of dementia's vary. Some of the more well-known
diseases that produce dementia include Alzheimer's disease,
Vascular dementia, Parkinson's and Pick's disease. Other conditions
which may cause or mimic dementia include depression, brain
tumors, nutritional deficiencies, head injuries, hydrocephalus,
infections (AIDS, menengitis, syphilis), drug reactions and
thyroid problems.
It is imperative that all persons experiencing memory deficits
or confusion undergo a thorough diagnostic work up. This requires
examination by a physician experienced in the diagnosis of
dementing disorders and detailed laboratory testing. The examination
should include a re-evaluation of all medications. This process
will help the patient obtain treatment for reversible conditions,
aid the patient and family in planning future care, and provide
important medical information for future generations.
Alzheimer's Disease
Alzheimer's disease is the most common of the dementing
disorders currently affecting as many as 4 million Americans.
Alzheimer's disease is a progressive, degenerative disease
that attacks the brain and results in impaired memory,
thinking and behavior. Symptoms of Alzheimer's disease
include a gradual memory loss, decline in ability to
perform routine tasks, disorientation in time and space,
impairment of judgement, personality change, difficulty
in learning, and loss of language and communication
skills. As with all dementias, the rate of progression
in Alzheimer's patients varies from case to case. From
the onset of symptoms, the life span of an Alzheimer
sufferer can range anywhere from 3 to 20 or more years.
The disease eventually leaves its victims unable to
care for themselves. While a definitive diagnosis of
Alzheimer's disease is possible only through the examination
of brain tissue, which is usually done at autopsy, it
is important for a person suffering from any symptoms
of dementia to undergo a thorough clinical examination.
In fact, after such an evaluation, approximately 20%
of suspected Alzheimer's cases prove to be a medical
condition other than Alzheimer's, sometimes treatable.
Ten Warning Signs of Alzheimer's
Disease
1. Recent memory loss that affects job performance.
Everyone forgets things then recalls them later. Alzheimer´s
patients forget often, never recall and repeatedly ask the
same question, forgetting the earlier answer.
2. Difficulty performing familiar tasks. "People
with Alzheimer's disease could prepare a meal, forget
to serve it and even forget they made it."
3. Problems with language. A person with
Alzheimer's may forget simple words or use inappropriate
words, making speech difficult or impossible to comprehend.
4. Disorientation of time and place.
People with Alzheimer's may get lost on their own street
and forget how they got there or how to get home.
5. Poor or weaker judgement. Even a normal
person might get distracted and fail to watch a child.
A person with Alzheimer's disease could entirely forget
the child under their care and leave the house.
6. Problems with abstract thinking. Anybody
can have trouble balancing a checkbook; a person with
Alzheimer's could forget completely what the numbers
are and what needs to be done with them.
7. Misplacing things. A person with Alzheimer's
disease may put things in inappropriate places - an
iron in the freezer or a wristwatch in the sugar bowl
- and not be able to retrieve them.
8. Changes in mood or behavior. Everyone
has occassional moods, but people with Alzheimer's can
have rapid mood swings - from calm to tears to anger
- within a few minutes.
9. Personality changes. A person with
Alzheimer's may change drastically and inappropriately,
becoming irritable, suspicious or fearful.
10. Loss of initiative. People with
Alzheimer's may become passive and reluctant to get
involved in activities. Vascular Dementia
Vascular dementia is a deterioration of mental capabilities
caused by multiple strokes (infarcts) in the brain.
The onset of Vascular dementia may be relatively sudden
as many strokes can occur before symptoms appear. These
strokes may damage areas of the brain responsible for
a specific function as well as produce generalized symptoms
of dementia. As a result Vascular dementia may appear
similar to Alzheimer's disease. Vascular dementia is
not reversible or curable, but recognition of an underlying
condition (high blood pressure) often leads to a specific
treatment that may modify the progression of the disorder.
Vascular dementia is usually diagnosed through neurological
examination and brain scanning techniques, such as computerized
axial tomography (CAT scan) or magnetic resonance imaging
(MRI), in order to identify strokes in the brain.
Parkinson's Disease
Parkinson's disease (PD) is a progressive
disorder of the central nervous system which affects
more than one million Americans. Individuals with PD
lack the substance dopamine, which is important for
the central nervous system's control of muscle activity.
Parkinson's disease is often characterized by tremors,
stiffness in limbs and joints, speech impediments and
difficulty in initiating physical movement. In the course
of the disease, some patients develop dementia. Medications
such as levodopa which converts itself into dopamine
once inside the brain and deprenyl, which prevents degeneration
of dopamine-containing neurons, are used to improve
diminished or reduced motor symptoms in PD patients
but do not correct the mental changes that occur.
Pick's Disease
Pick's disease is a rare brain disorder which, like
Alzheimer's disease, is usually difficult to diagnose.
Disturbances in personality, behavior and orientation
may precede and initially be more severe than memory
defects. Like Alzheimer's disease, a definitive diagnosis
is usually obtained only at autopsy.
Normal Pressure Hydrocephalus
Normal pressure hydrocephalus is an unusual disorder
which involves an obstruction in the normal flow of
cerebrospinal fluid. This blockage causes a buildup
of cerebrospinal fluid on the brain. Symptoms of normal
pressure hydrocephalus include dementia, urinary incontinence
and difficulty in walking. Presently, the most useful
diagnostic tools are the neuroimaging techniques (ie.,
MRI). Normal pressure hydrocephalus may be caused by
any of several factors including menengitis, encephalitis
and head injuries. In addition to treatment of the underlying
cause, the condition may be corrected by a surgical
procedure (insertion of a shunt) to divert the fluid
away from the brain.
Depression
Depression is a psychiatric disorder marked by sadness,
inactivity, difficulty in thinking and concentration,
feelings of hopelessness, and sometimes suicidal tendencies.
Many severely depressed patients will have some mental
deficits including poor concentration and attention.
When dementia and depression are present together, cognitive
deterioration may be exaggerated. Depression, whether
present alone or in combination with dementia, can be
reversed with proper treatment. |
