Dementia is a broad category of brain diseases that leads to a long-term and often gradual decline in thinking and remembering ability to affect one's daily functioning. Other common symptoms include emotional problems, difficulty with language, and decreased motivation. A person's consciousness is usually unaffected. The diagnosis of dementia requires a change from a person's normal mental function and a greater than expected decline due to aging. These diseases also have a significant influence on one's caregiver.
The most common type of dementia is Alzheimer's disease, which accounts for 50% to 70% of cases. Other common types include vascular dementia (25%), Lewy body dementia (15%), and frontotemporal dementia. Less common causes include normal pressure hydrocephalus, Parkinson's disease of dementia, syphilis, and Creutzfeldt-Jakob disease among others. More than one type of dementia may exist in the same person. A small number of cases occur in families. In DSM-5, dementia is reclassified as a neurocognitive disorder, with varying degrees of severity. The diagnosis is usually based on a history of disease and cognitive tests with medical imaging and blood tests used to rule out other possible causes. A mini mental state examination is one of the commonly used cognitive tests. Efforts to prevent dementia include trying to lower risk factors such as high blood pressure, smoking, diabetes, and obesity. Screening of the general population for this disorder is not recommended.
There is no known cure for dementia. Cholinesterase inhibitors such as donepezil are often used and may be useful in mild to moderate disturbances. However, the overall benefits may be small. There are many steps that can improve the quality of life of people with their dementia and caregivers. Cognitive and behavioral interventions may be appropriate. Educating and providing emotional support to caregivers is important. The exercise program may be useful in relation to daily life activities and potentially improve results. Treatment of behavioral problems with antipsychotics is common but is usually not recommended because of few benefits and side effects, including an increased risk of death.
Globally, dementia affects about 46 million people by 2015. About 10% of people develop the disorder at some point in their lives. It becomes more common with age. About 3% of people aged between 65-74 have dementia, 19% between 75 and 84 and nearly half of those over 85 years old. By 2013 dementia resulted in about 1.7 million deaths rising from 0.8 million in 1990. As more and more people live longer, dementia becomes more common in the population as a whole. However, for people of a certain age, it may become less frequent, at least in developed countries, due to a decrease in risk factors. This is one of the most common causes of disability among the old. It is believed to generate an economic cost of 604 billion USD per year. People with dementia are often physically or chemically controlled to a greater extent than necessary, raising human rights issues. Social stigma against those affected is common.
Video Dementia
Signs and symptoms
Symptoms of dementia vary in different types and stages of diagnosis. The most affected areas include memory, visual-spatial, language, attention, and problem solving. Most types of dementia are slow and progressive. By the time the person shows signs of disturbance, the process in the brain has occurred for a long time. It is possible for the patient to have two types of dementia at the same time. Approximately 10% of people with dementia have what is known as mixed dementia, which is usually a combination of Alzheimer's disease and other types of dementia such as frontotemporal dementia or vascular dementia.
Possible neuropsychiatric symptoms are referred to as Psychological symptoms and dementia behaviors (BPSD) and these may include:
- Customize problems
- Tremor
- Difficulty speaking and language
- Difficulty eating or swallowing
- Memory distortion (believes that memory has occurred when not yet, assumes old memory is new memory, combines two memories, or confuses people in memory)
- Wandering or agitated
- Perceptions and visual issues
- Symptoms of behavioral and psychological dementia almost always occur in all types of dementia and may manifest as:
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- Agitation
- Depression
- Anxiety
- Abnormal motor behavior
- Happy mood
- Irritability
- Apati
- Disinhibition and impulsivity
- Delusions (often believe people steal from them) or hallucinations
- Changes in sleep or appetite.
When people with dementia are in a state beyond their ability, there may be sudden changes to cry or anger (a "disaster response").
Psychosis (often delusional persecution) and agitation/aggression also often accompany dementia.
Mild cognitive impairment
In the first stage of dementia, signs and symptoms of the disorder may be subtle. Often, early signs of dementia only become apparent when looking into the past. The early stage of dementia is called mild cognitive impairment (MCI). 70% of those diagnosed with MCI progress to dementia at some point. In MCI, a person's brain changes have occurred for a long time, but the symptoms of the disorder are just beginning to show up. These problems, however, are not severe enough to affect a person's daily functioning. If they do, it is considered dementia. Someone with an MCI score between 27 and 30 on the Mini-Mental State Examination (MMSE), which is a normal score. They may have memory problems and difficulty finding words, but they solve everyday problems and handle their own life affairs well.
Initial stage
In the early stages of dementia, the person begins to show symptoms seen by those around them. In addition, symptoms begin to interfere with daily activities. People usually score between 20 and 25 on MMSE. The symptoms depend on the type of dementia that a person has. The person may begin to have difficulty with more complex tasks and tasks around the house or at work. The person can usually take care of himself but may forget things like taking pills or washing clothes and may need to be told or reminded.
Early dementia symptoms typically include memory difficulties, but may also include some word search issues (anomia) and problems with organizational planning and skills (executive function). One excellent way to assess someone's damage is to ask if they are still capable of handling their finances independently. This is often one of the first things that becomes problematic. Other signs may get lost in new places, repeat things, personality changes, social withdrawal and difficulties at work.
When evaluating a person for dementia, it is important to consider how that person could function five or ten years earlier. It is also important to consider a person's level of education when assessing loss of function. For example, an accountant who can no longer balance a checkbook will be more apprehensive than a person who has not graduated from high school or has never taken care of his own finances.
In Alzheimer's dementia the most prominent early symptom is memory difficulty. Others include word search issues and getting lost. In other types of dementia, such as dementia with Lewy bodies and fronto-temporal dementia, personality changes and difficulties with organization and planning may be the first signs.
Middle stage
As dementia progresses, symptoms that are first experienced in the early stages of dementia generally worsen. The rate of decline is different for each person. A person with a moderate dementia score between 6-17 in MMSE. For example, people with moderate Alzheimer's dementia lose almost all new information very quickly. People with dementia can be severely disrupted in solving problems, and their social judgments are usually also disrupted. They usually can not function outside their own homes, and generally should not be left alone. They may be able to do simple tasks around the house but not much else, and start needing help for personal care and hygiene aside from simple reminders.
End stage
People with late-stage dementia usually turn more inward and need help with most or all of their personal care. People with late-stage dementia usually require 24-hour surveillance to ensure personal safety, as well as to ensure that basic needs are met. If left unattended, a person with late-stage dementia may wander or fall, may not recognize the general danger around them like a hot stove, may not realize they need to use the bathroom or become unable to control their bladder or intestines (wetting). ).
Changes in eating often occur. Caregivers of people with end-stage dementia often provide a drained diet, viscous fluid, and food aid, prolong their life, cause them to gain weight, reduce choking risks, and make people more likely to feed. A person's appetite may drop to the point that the person will not eat at all. They may not want to get out of bed, or may need complete help to do so. Generally, the person no longer recognizes the person he knows. They may have significant changes in sleeping habits or difficulty sleeping at all.
Maps Dementia
Cause
Causes that can be reversed
There are four main causes of easily reversible dementia: hypothyroidism, vitamin B12 deficiency, Lyme disease, and neurosyphillis. All people with memory difficulties should be examined for hypothyroidism and B12 deficiency. For Lyme disease and neurosyphilis, testing should be done if there is a risk factor for the disease in that person. Because risk factors are often difficult to determine, testing for neurosyphillis and Lyme disease as well as other factors mentioned can be done as common in cases where dementia is suspected.
Alzheimer's Disease
Alzheimer's disease accounts for 50% to 70% of cases of dementia. The most common symptoms of Alzheimer's disease are short-term memory loss and trouble finding words. People with Alzheimer's disease also have problems with visual-spatial areas (for example, they may begin to get lost often), reasoning, judgment, and insight. Insight refers to whether or not the person is aware he or she has memory problems.
Common early symptoms of Alzheimer's include repetition, getting lost, trouble keeping track of bills, problems with cooking especially new or complicated food, forgetting to take medication, and word search issues.
The part of the brain most affected by Alzheimer's is the hippocampus. Other parts of the brain that exhibit shrinkage (atrophy) include the temporal and parietal lobes. Although this pattern shows Alzheimer's, brain shrinkage in Alzheimer's disease varies greatly, and brain scans can not really make a diagnosis. The relationship between undergoing anesthesia and AD is not clear.
vascular dementia
Vascular dementia is responsible for at least 20% of cases of dementia, making it the second most common cause of dementia. It is caused by an illness or injury that affects the blood supply to the brain, usually involving a series of minor strokes. The symptoms of dementia depend on where in the brain a stroke has occurred and whether the vessels are large or small. Some injuries can lead to progressive dementia over time, while a single injury located in an area critical to cognition (ie the hippocampus, thalamus) may cause sudden cognitive decline.
In brain scans, a person with vascular dementia may show evidence of multiple strokes of different sizes at different locations. People with vascular dementia tend to have risk factors for vascular disease, such as tobacco use, high blood pressure, atrial fibrillation, high cholesterol or diabetes, or other signs of vascular disease such as heart attacks or previous angina.
Dementia with Lewy body
Dementia with Lewy body (DLB) is dementia that has the main symptoms of visual hallucinations and "Parkinsonism". Parkinsonism is a symptom of Parkinson's disease, which includes tremors, stiff muscles, and a face without emotion. Visual hallucinations in DLB in general are a very obvious hallucination of people or animals and they often occur when a person will fall asleep or just wake up. Other prominent symptoms include problems with attention, organization, problem solving and planning (executive functioning), and difficulties with visual-spatial function.
Again, imaging studies can not always make DLB diagnoses, but some signs are very common. A person with DLB often exhibits occipital hypoperfusion in SPECT scans or occipital hypometabolism on PET scans. Generally, DLB diagnosis is very easy and unless complicated, brain scanning is not always necessary.
Frontotemporal dementia
Frontotemporal dementia (FTD) is characterized by drastic personality changes and language difficulties. In all FTDs, the person has a relatively early social withdrawal and lack of early insight into the disturbance. Memory issues are not the main feature of this interruption.
There are three main types of FTD. The first has major symptoms in the areas of personality and behavior. This is called the variant of FTD behavior (bv-FTD) and is the most common. In bv-FTD, the person shows a change in personal hygiene, becomes rigid in their thinking, and rarely realizes that there is a problem, they are socially withdrawn, and often experience a drastic increase in appetite. They may also be socially inappropriate. For example, they may make inappropriate sexual comments, or may start using pornography openly when they have never done it before. One of the most common signs is apathy, or does not care about anything. However, apathy is a common symptom in various dementias.
Two other types of FTD feature language problems as the main symptoms. The second type is called semantic dementia or temporary dementia (TV-FTD). The main feature of this is the loss of meaning of words. It might start with the difficulty of naming something. The person can eventually also lose the meaning of the object as well. For example, pictures of birds, dogs, and airplanes on someone with an FTD may all appear almost identical. In a classic test for this, a patient is shown a picture of a pyramid and beneath it is a picture of a palm tree and a pine tree. The person is asked to say which one is the best with the pyramid. On TV-FTD that person will not be able to answer that question.
The last type of FTD is called progressive non-progressive aphasia (PNFA). This is mainly the problem of generating speech. They find it difficult to find the right words, but most of them have trouble coordinating the muscles they need to talk. Finally, someone with a PNFA uses only one word or may become completely mute.
Progressive supranuclear paralysis
Progressive supranuclear palsy (PSP) is a form of dementia characterized by problems with eye movements. Generally the problem begins with difficulty moving the eyes up or down (vertical gaze palsy). Because the difficulty of moving the eyes up can sometimes occur in normal aging, problems with downward eye movements are key in the PSP. Other major PSP symptoms include backward falling, balance problems, slow motion, stiff muscles, irritability, apathy, social withdrawal, and depression. The person may also have certain "frontal lobe signs" such as persistence, holding reflexes and usage behavior (the need to use objects once you see them). People with PSP often have progressive difficulties eating and swallowing, and finally by talking as well. Due to the slow stiffness and movement, the PSP is sometimes misdiagnosed as Parkinson's disease.
In brain scans, the midbrain of the person with the PSP generally shrinks (stops developing), but no other common brain disorder is seen in a person's brain image.
Corticobasal degeneration
Corticobasal degeneration is a rare form of dementia characterized by various types of neurological problems worsening over time. This is because the disorder affects the brain in many different places, but at different levels. One common sign is the difficulty of using only one limb. One very rare phenomenon under any condition other than corticobasal degeneration is the "alien leg." The corpse of the alien is a member of the body of a man who seems to have his own mind, moving without control of one's brain. Other common symptoms include the motion of one or more limbs (myoclonus), different symptoms in different (asymmetric) limbs, speech impairment that is unable to move the oral muscles in a coordinated way, numbness and tingling of the limbs and ignoring one one's sight or senses. By ignoring, one ignores the opposite side of the body from the one who has the problem. For example, a person may not feel pain on one side, or maybe just draw half a picture when asked. In addition, affected limbs may be stiff or have muscle contractions that cause strange repetitive motion (dystonia).
The areas of the brain most commonly affected by corticobasal degeneration are the posterior frontal lobes and the parietal lobes. However, many other parts of the brain can be affected.
Extremely progressive
Creutzfeldt-Jakob disease usually causes dementia that worsens from week to month, and is caused by prions. Common causes of slow progressive dementia also occasionally present with rapid development: Alzheimer's, dementia with Lewy bodies, frontotemporal lobe degeneration (including corticobasal degeneration and progressive supranuclear paralysis).
On the other hand, encephalopathy or delirium may develop relatively slowly and resemble dementia. Possible causes include cerebral infections (viral encephalitis, subacute sclerosis panencephalitis, Whipple disease) or inflammation (limbic encephalitis, Hashimoto encephalopathy, cerebral vasculitis); tumors such as lymphoma or glioma; drug toxicity (eg, anticonvulsant drugs); metabolic causes such as liver failure or renal failure; and chronic subdural hematoma.
Immunologically-mediated
Chronic inflammatory conditions that may affect the brain and cognition include BehÃÆ'§et disease, multiple sclerosis, sarcoidosis, SjÃÆ'¶gren syndrome, systemic lupus erythematosus, celiac disease, and non-sheath gluten sensitivity. These types of dementia can develop rapidly, but usually have a good response to early treatment. It consists of immunomodulators or steroid administration, or in some cases, the elimination of the causative agent.
Other conditions
There are many other medical and neurological conditions in which dementia occurs only at the end of the disease. For example, the proportion of patients with Parkinson's disease develops dementia, although very varied numbers are cited for this proportion. When dementia occurs in Parkinson's disease, the underlying cause may be dementia with Lewy bodies or Alzheimer's disease, or both. Cognitive impairment also occurs in Parkinson-plus syndromes of progressive supranuclear paralysis and corticobasal (and the same underlying pathology may lead to clinical syndrome of frontotemporal lobe degeneration). Although acute porphyry may cause disorders of chaos and psychiatric disorders, dementia is a rare feature of this rare disease.
Apart from those mentioned above, inherited conditions that may cause dementia (along with other symptoms) include:
Light cognitive impairment
Mild cognitive impairment means that the person shows memory or difficulty thinking, but the difficulty is not severe enough to meet the diagnostic criteria for dementia. They should score between 25-30 on MMSE. About 70% of people with MCI continue to develop some form of dementia. MCI is generally divided into two categories. The first one is mainly memory loss (amnestic MCI). The second category is anything that is not primarily a memory problem (non-amnestic MCI). People with memory problems especially generally continue to develop Alzheimer's disease. People with other types of MCI may continue to develop other types of dementia.
Diagnosis of MCI is often difficult, because cognitive tests may be normal. Often, deeper neuropsychological testing is needed to make the diagnosis. the most commonly used criteria are called Peterson's criteria and include:
- Memory or other cognitive complaints (mind processing) by people or people who know the patient well.
- The person should have other memory or cognitive problems compared to people of the same age and level of education.
- The problem should not be severe enough to affect a person's daily function.
- The man must not have dementia.
Fixed cognitive breakdown
Different types of brain injury can cause irreversible cognitive disorders that remain stable over time. Traumatic brain injury can cause general damage to the white matter of the brain (diffuse axonal injury), or more localized damage (as well as possible neurosurgery). A temporary reduction of blood or oxygen supply in the brain can lead to hypoxic-ischemic injury. Stroke (ischemic stroke, or intracerebral hemorrhage, subarachnoid, subdural or extradural) or infection (meningitis or encephalitis) affecting the brain, prolonged epilepsy seizures, and acute hydrocephalus may also have long-term effects on cognition. Excessive use of alcohol may cause alcohol dementia, Wernicke's encephalopathy, or Korsakoff psychosis.
Slowly progressive
Dementia that begins gradually and progressively worsens over several years is usually caused by neurodegenerative disease - that is, by conditions that affect only or especially the brain neurons and cause the loss of function of these cells gradually but can not be changed again. Less commonly, non-degenerative conditions may have secondary effects on brain cells, which may or may not be reversible if the condition is treated.
The cause of dementia depends on the age at which the symptoms begin. In the elderly population (usually defined in this context as over 65 years), most cases of dementia are caused by Alzheimer's disease, vascular dementia, or both. Dementia with Lewy bodies is another commonly exhibited form, which again can occur in addition to one or both of the other causes. Hypothyroidism sometimes causes slow progressive cognitive impairment as a major symptom, and this may be completely reversible with treatment. Normal pressure hydrocephalus, although relatively rare, is important to recognize as treatment can prevent progression and improve other symptoms of the condition. However, significant cognitive enhancement is unusual.
Dementia is much less common under the age of 65 years. Alzheimer's disease is still the most frequent cause, but a form that is inherited from an interruption account for a higher proportion of cases in this age group. Degeneration of the frontotemporal lobe and Huntington's disease are the cause of most of the remaining cases. Vascular dementia also occurs, but this may in turn be due to underlying conditions (including antiphospholipid syndrome, CADASIL, MELAS, homocystinuria, moyamoya, and Binswanger disease). People who often experience head trauma, such as boxers or soccer players, are at risk of having chronic traumatic encephalopathy (also called dementia pugilistica in boxers).
In young adults (up to age 40) who previously had normal intelligence, very rare dementia without features of other neurological diseases, or without disease features elsewhere in the body. Most cases of progressive cognitive impairment in this age group are caused by psychiatric illness, alcohol or other drugs, or metabolic disorders. However, certain genetic disorders may cause true neurodegenerative dementia at this age. These include family Alzheimer's disease, SCA17 (dominant inheritance); adrenoleukodystrophy (X-linked); Gaucher disease type 3, metachromatic leukodystrophy, Niemann-Pick type C disease, neurodegeneration associated kinase pantothenate, Tay-Sachs disease, and Wilson disease (all recessive). Wilson's disease is very important because cognition can increase with treatment.
At all ages, most patients who complain of memory difficulties or other cognitive symptoms are depressed rather than neurodegenerative diseases. Vitamin deficiency and chronic infection can also occur at any age; they usually cause other symptoms before dementia occurs, but sometimes mimic degenerative dementia. These include vitamin B 12 , folate, or niacin deficiencies, and infective causes include cryptococcal meningitis, AIDS, Lyme disease, progressive multifocal leukoencephalopathy, sclerosis subacute sclerosis, syphilis, and Whipple disease.
Diagnosis
As seen above, there are many types and causes of dementia, often showing slightly different symptoms. However, the symptoms are very similar and it is usually difficult to diagnose the type of dementia with only symptoms. Diagnosis may be aided by brain scan techniques. In many cases, the diagnosis can not be completely certain except with a brain biopsy, but this is rarely recommended (although it can be done on autopsy). In those who get older, general screening for cognitive impairment using cognitive tests or early diagnosis of dementia has not been shown to improve outcomes. However, it has been proven that screening exams are beneficial for those over the age of 65 with memory complaints.
Usually, symptoms should be present for at least six months to support the diagnosis. Cognitive dysfunction with a shorter duration is called delirium . Delirium can be easily confused with dementia because of similar symptoms. Delirium is characterized by sudden onset, fluctuations, short duration (often lasting from hour to week), and is particularly associated with somatic (or medical) disorders. For comparison, dementia usually has a long, slow onset (except in cases of stroke or trauma), slow mental function decline, and longer duration (month after year).
Some mental illnesses, including depression and psychosis, can produce symptoms that must be distinguished from both delirium and dementia. Therefore, any evaluation of dementia should include depression screening such as a Neuropsychiatric Inventory or a Geriatric Depression Scale. Doctors used to think that anyone who comes with memory complaints is depressed and not dementia (because they think that those with dementia are generally unaware of their memory problems). This is called pseudodementia. However, in recent years researchers have noticed that many older people with memory complaints actually have MCI, the early stage of dementia. Depression should always remain high on the list of possibilities, however, for parents with memory problems.
Changes in thinking, hearing and vision are associated with normal aging and can cause problems when diagnosing dementia because of similarity.
Cognitive test
There are several short tests (5-15 minutes) that have reasonable reliability to screen for dementia. While many tests have been studied, current mini mental status checks (MMSE) are the most studied and most used. MMSE is a useful tool to help diagnose dementia if the results are interpreted along with a person's personality assessment, their ability to perform their daily activities, activities and behaviors. Other cognitive tests include abbreviated mental test scores (AMTS), Mental Modification of Mini Examination (3MS), Cognitive Abilities Screening Instrument (CASI), Trace-making tests, and tests drawing clock. The MOCA (Montreal Cognitive Assessment) is a very reliable screening test and is available online for free in 35 different languages. MOCA has also been shown to be better at detecting mild cognitive impairment than MMSE.
Another approach to screening for dementia is to ask informants (relative or other supporters) to fill out a questionnaire about the person's daily cognitive function. The informant questionnaire provides complementary information for short cognitive tests. Perhaps the most recognizable questionnaire of this type is the Questionnaire of Inquisitors on Cognitive Impairment in the Elderly (IQCODE) . There is not enough evidence to determine how accurate IQCODE is to diagnose or predict dementia. The Alzheimer's Disease Caregiver Questionnaire is another tool. It is about 90% accurate for Alzheimer's and can be completed online or in the office by caregivers. On the other hand, the General Practitioner Assessment Of Cognition combines the two, patient assessment and informant interview. It's specifically designed for use in primary care settings.
Clinical neuropsychologists provide diagnostic consultation after full battery administration of cognitive testing, often lasting several hours, to determine the functional degradation pattern associated with different types of dementia. Memory tests, executive functions, processing speed, attention, and relevant language skills, as well as emotional and psychological adjustment tests. These tests help to rule out other etiologies and determine relative cognitive decline over time or from previous cognitive ability estimates.
Laboratory test
Regular blood tests are also usually performed to rule out treatable causes. These tests include vitamin B 12 , folic acid, thyroid-stimulating hormone (TSH), C-reactive protein, complete blood count, electrolytes, calcium, kidney function, and liver enzymes. Abnormalities may indicate vitamin deficiency, infection, or other problems that usually cause confusion or disorientation in the elderly.
Imaging
CT scan or magnetic resonance imaging (MRI scan) is generally performed, although this test does not take diffuse metabolic changes associated with dementia in someone who does not show gross neurological problems (such as paralysis or weakness) on neurologic examination. CT or MRI may suggest normal pressure hydrocephalus, potentially reversible cause of dementia, and may produce information relevant to other types of dementia, such as an infarction (stroke) that will lead to a type of vascular dementia.
SPECT and PET functional neuroimaging modalities are more useful in assessing older cognitive dysfunction, as they have demonstrated similar ability to diagnose dementia as clinical and cognitive tests. SPECT's ability to differentiate vascular causes (ie, multi-infarct dementia) from Alzheimer's disease dementia, appears superior to clinical examination.
Recent studies have determined the value of PET imaging using Pittsburgh-11 Pittsburgh Compound B as a radiotracer (PIB-PET) in the predictive diagnosis of various types of dementia, specifically Alzheimer's disease. Studies from Australia have found an accurate 86% PIB-PET in predicting patients with mild cognitive impairment who will develop Alzheimer's disease within two years. In another study, conducted using 66 patients seen at the University of Michigan, PET research using PIB or another radiotracer, carbon-11 dihydrotetrabenazine (DTBZ), led to a more accurate diagnosis for more than a quarter of patients with mild cognitive impairment. or mild dementia.
Prevention
A number of factors can reduce the risk of dementia. A group of efforts is believed to prevent one-third of cases and include early education, treat high blood pressure, prevent obesity, prevent hearing loss, treat depression, become active, prevent diabetes, not smoking, and prevent social isolation. However, the 2018 review concluded that there is no cure that has good evidence of the preventive effect including blood pressure medication.
Among healthier parents, computerized cognitive training can improve memory. But it is not known whether it prevents dementia. Short-term training has limited evidence. In those with evidence of normal mental function for drugs is poor. The same goes for supplements.
Management
Except for the handled type listed above, there is no cure. Cholinesterase inhibitors are often used early in the course of the disorder; however, the benefits are generally small. Cognitive and behavioral interventions may be appropriate. There is some evidence that educating and providing support for people with dementia, as well as caregivers and family members, improves outcomes. The exercise program is useful in relation to daily life activities and potentially increase dementia.
Psychological therapy
Psychological therapy for dementia includes temporary evidence for memory therapy, some benefits for cognitive reframing for nurses, unclear evidence for validation therapy, and temporary evidence for mental exercise, such as cognitive stimulation programs for people with mild to moderate dementia.
Adult daycare centers and special care units in nursing homes often provide special care for dementia patients. Adult daycare centers offer limited supervision, recreation, eating, and health care to the participants, as well as giving concessions to caregivers. In addition, home care can provide one-on-one support and home care that allows for the more individual attention required as the disorder develops. Psychiatric nurses can make a special contribution to the mental health of people.
Because dementia undermines normal communication because of receptive and expressive language changes, as well as the ability to plan and resolve problems, restless behavior is often a form of communication for people with dementia. Actively searching for potential causes, such as pain, physical illness, or excessive stimulation can help reduce agitation. In addition, using "ABC behavioral analysis" can be a useful tool for understanding behavior in people with dementia. This involves looking at antecedents (A), behavior (B), and consequences (C) associated with an event to help determine the problem and prevent any further incidents that might arise if one's needs are misunderstood. Little is understood, whether regular music therapy is helpful because of the lack of high quality data.
Drugs
There are no drugs proven to prevent or cure dementia. Drugs can be used to treat behavioral and cognitive symptoms but have no effect on the underlying disease process.
Acetylcholinesterase inhibitors, such as donepezil, may be useful for Alzheimer's disease and dementia in Parkinson, DLB, or vascular dementia. But the quality of the evidence is poor and the benefits are small. There is no difference shown between agents in this family. In a minority of people, side effects include a slow heartbeat and fainting.
As an assessment for the underlying cause of behavior is necessary before prescribing antipsychotic drugs for symptoms of dementia. Antipsychotic drugs should be used to treat dementia only if non-drug therapy is unsuccessful, and that person's actions threaten himself or others. Changes in aggressive behavior are sometimes the result of other solvable problems, which may make antipsychotic treatment unnecessary. Because people with dementia can become aggressive, resistant to their treatment, and otherwise disrupt, sometimes antipsychotic drugs are treated as a response therapy. These drugs have risky side effects, including increasing the likelihood of stroke and death. Generally, stopping antipsychotics for people with dementia does not pose a problem, even to those who have long experienced it.
N-methyl-D-aspartate (NMDA) receptor blockers such as memantine may be beneficial but evidence is less conclusive than for AChEIs. Because their mechanisms are different from the action of memantine and acetylcholinesterase inhibitors can be used in combination but have little benefit.
While depression is often associated with dementia, selective serotonin reuptake inhibitors (SSRIs) do not appear to affect the outcome. Sertraline and citalopram SSRIs have been shown to reduce symptoms of agitation, compared with placebo.
The use of drugs to reduce sleep disorders that people with dementia often have not been well studied, even for medications that are commonly prescribed. In 2012, the American Geriatrics Society recommends that benzodiazepines such as diazepam, and non-benzodiazepine hypnotics, be avoided for people with dementia because of the increased risk of cognitive impairment and decline. In addition, there is little evidence for the effectiveness of benzodiazepines in this population. There is no clear evidence that melatonin or ramelteon improves sleep for people with dementia because of Alzheimer's disease. There is limited evidence that low doses of trazodone may improve sleep, but more research is needed.
There is no strong evidence that folate or vitamin B12 improve results in those with cognitive problems. Statins also have no benefit in dementia. Medications for other health conditions may need to be managed differently for people who also have a diagnosis of dementia. The MATCH-D criteria can help identify ways that the diagnosis of dementia alters drug management for other health conditions. It is unclear whether there is a link between blood pressure medication and dementia. It is possible that people may experience an increased incidence of cardiovascular events if these drugs are withdrawn.
Pain
As they get older, they experience more health problems, and most health problems associated with aging carry a huge burden of pain; therefore, between 25% and 50% of older adults experience persistent pain. Age with dementia experiences a prevalence of the same conditions that cause pain as an elderly without dementia. Pain is often overlooked in older adults and, when screened, is often judged poorly, especially among those with dementia because they are unable to inform others that they are in pain. Beyond the issue of humane care, the never-ending pain has functional implications. Persistent pain can lead to decreased ambulation, depressed mood, sleep disturbance, appetite impairment, and exacerbation of cognitive impairment, and pain-related disorders with activity are factors that contribute to falls in the elderly.
Although persistent pain in people with dementia is difficult to communicate, diagnose and treat, failure to address persistent pain has functional, psychosocial, and life-quality implications for this vulnerable population. Health professionals often lack skills and usually lack the time needed to accurately recognize, assess, and monitor pain in people with dementia. Family members and friends can make a valuable contribution to the care of a person with dementia by learning to recognize and assess their pain. Educational resources (such as Understanding Pain and Dementia tutorials) and observation assessment tools are available.
Difficulty eating
People with dementia may have difficulty eating. Where available as an option, the recommended response to the problem of eating is to ask the nurse to help feed the person. A secondary option for people who can not swallow effectively is to consider placement of a gastrostomy filler tube as a way to nourish. However, in bringing people comfort and maintaining functional status while lowering the risk of aspiration and death pneumonia, assistance with oral feeding is at least as good as tube feeding. Feeding the tubes is associated with agitation, increased use of physical and chemical restraint, and worsening ulcer pressure. Giving a tube can also cause excess fluid, diarrhea, abdominal pain, local complications, poor human interaction, and may increase aspiration risk.
The benefits of this procedure in those with advanced dementia have not been proven. The risks of using tube feeding include agitation, people pulling out the tubes or physically or chemically immobilized to prevent them from doing this, or getting pressure ulcers. There is an approximately 1% mortality rate directly related to the procedure with a major 3% complication rate. The percentage of people at the end of their lives with dementia using food tubes in the US has dropped from 12% in 2000 to 6% by 2014.
Alternative medicine
Aromatherapy and massage have no clear evidence. There is research on the efficacy and safety of cannabinoids in reducing the symptoms of behavioral and psychological dementia.
Omega-3 fatty acid supplements from plants or fish sources do not seem to be beneficial or harm people with mild to moderate Alzheimer's disease. It is unclear whether taking omega-3 fatty acid supplements can improve other types of dementia.
Palliative care
Given the progressive nature of dementia and terminals, palliative care can help patients and their caregivers by helping both people with disorders and their caregivers understand what to expect, deal with the loss of physical and mental abilities, plan the patient's wants and goals including substitute decision making, and discuss desire for or against CPR and life support. Because the decline can be rapid, and since most people prefer to allow people with dementia to make their own decisions, palliative care involvement before the final stages of dementia is recommended. Further research is needed to determine appropriate palliative care interventions and how well they help people with advanced dementia.
People-centered care helps maintain the dignity of people with dementia.
Epidemiology
The number of cases of dementia worldwide in 2010 is estimated at 35.6 million. The price increases significantly with age, with dementia affecting 5% of the population older than 65 and 20-40% of those older than 85. About two-thirds of individuals with dementia live in low- and middle-income countries, where the increase sharpest in predictable numbers. Prices are slightly higher in women than men at age 65 and older.
In 2013 dementia resulted in about 1.7 million deaths, up from 0.8 million in 1990.
History
Until the end of the 19th century, dementia was a much broader clinical concept. These include mental illness and all kinds of psychosocial disabilities, including reversible conditions. Dementia currently refers only to anyone who loses the ability to reason, and is applied similarly to psychosis of mental illness, "organic" diseases such as brain-destroying syphilis, and age-related dementia, associated with "hardening of the arteries".
Dementia has been mentioned in medical texts since antiquity. One of the earliest known allusies about dementia is associated with the 7th-century Greek philosopher Pythagoras, which divides the human age range into six distinct phases: 0-6 (infancy), 7-21 (adolescents), 22-49 (young adults), 50-62 (middle age), 63-79 (old age), and 80-death (elderly). The last two he describes as "artum", the period of mental and physical decay, and from the last phase is where "the place of mortal existence closes after a very long time very fortunately, some of the human species arrives at, where the mind is reduced to immunity from the first time of infancy ". In 550 BC, the Athenian statesman and the Greek poet Solon argued that the requirements of a man's will may not apply if he exhibits a loss of consideration due to old age. Chinese medical texts also refer to that condition, and the characters for "dementia" translate literally to "stupid parents".
Aristotle and Plato of Ancient Greece talked about the mental deterioration of old age, but seemed to see it only as an inevitable process affecting all parents, and that can not be prevented. Plato states that parents are not suited for any position of responsibility because, "There is not much mind intelligence that ever took them in their youth, these traits will be called judgment, imagination, reasoning power, and memory. gradually collected by the damage and can barely fulfill their functions. "
By contrast, Roman statesman Cicero views far more in line with modern medical wisdom that the loss of mental function is inevitable in the elderly and "only affects weak-willed elderly people". He talks about how those who remain mentally active and eager to learn new things can prevent dementia. However, Cicero's view of aging, though progressive, is largely ignored in a world that would be dominated by Aristotle's medical writings for centuries. Subsequent doctors during the time of the Roman Empire such as Galen and Celsus merely repeated Aristotle's beliefs while adding some new contributions to medical knowledge.
Byzantine physicians sometimes write about dementia, and it is recorded that at least seven emperors whose life spans exceed the age of 70 show signs of cognitive decline. In Constantinople, there is a special hospital to accommodate those diagnosed with dementia or madness, but this is naturally not applicable to emperors who are above the law and whose health conditions can not be generally recognized.
Otherwise, little is noted about dementia in western medicine for nearly 1700 years. One of several references to it is the 13th-century friars Roger Bacon, who views old age as a divine punishment for original sin. Although he repeats Aristotle's existing conviction that dementia is inevitable after a considerable period of time, he makes a very progressive statement that the brain is the center of memory and the mind rather than the heart.
Poets, playwrights, and other writers, however, often allude to the loss of mental function in old age. Shakespeare especially mentions it in some of his plays including Hamlet and King Lear .
Dementia in the elderly is called senility or senility , and is seen as a normal and inevitable aspect of being old, not because it is caused by a particular disease. At the same time, in 1907, an early-onset, specific organic dementia process, called Alzheimer's disease, has been described. It is associated with certain microscopic changes in the brain, but is seen as a rare disease in middle age because the first patient diagnosed was a 50-year-old woman.
During the 19th century, doctors generally believed that dementia in the elderly was the result of cerebral atherosclerosis, although opinions fluctuated between the idea that it was due to a major arterial blockage supplying the brain or small strokes within the cerebral vessels. cortex. This viewpoint remained a conventional medical wisdom during the first half of the 20th century, but in the 1960s increasingly challenged as a link between neurodegenerative disease and cognitive decline associated with established ages. In the 1970s, the medical community declared that vascular dementia was less frequent than previously thought and Alzheimer's disease caused most of the mental disorders in old age. But lately, it is believed that dementia is often a mixture of both conditions.
Just like other diseases related to aging, dementia is relatively rare before the 20th century, due to the fact that this is the most common in people over 80, and such life spans are rare in pre-industrial times. In contrast, syphilis dementia is widespread in developed countries until it is largely eradicated by the use of penicillin after World War II. With a significant increase in life expectancy after World War II, the number of people in developed countries over 65 began to climb quickly. While parents represent an average of 3-5% of the population before 1945, in 2010 it is common in many countries to have 10-14% people over 65 and in Germany and Japan, this figure exceeds 20%. Public awareness of Alzheimer Disease greatly increased in 1994 when former US president Ronald Reagan announced that he had been diagnosed with the condition.
In the period 1913-20, schizophrenia was well defined in the same way as today, and also the term dementia praecox has been used to show the development of senile dementia at a younger age.. Finally, the two terms together, so that until 1952 doctors use the term dementia praecox (early adult) and schizophrenia alternately. The term premature dementia for mental illness suggests that other types of mental illnesses such as schizophrenia (including paranoia and decreased cognitive capacity) can be expected to arrive normally in all people of greater age (see paraphrenia). After about 1920, early use of dementia for what is now understood as schizophrenia and senile dementia helps to limit the meaning of the word to "permanent, irreversible mental deterioration". This initiates a change in the use of more familiar terms today.
In 1976, neurologist Robert Katzmann suggested a link between dementia and Alzheimer's. Katzmann suggests that much of the senility that occurs (by definition) after age 65, is pathologically identical to Alzheimer's disease that occurs before age 65 and therefore should not be treated differently. He notes that "senile senile" is not considered a disease, but rather a part of aging, is keeping millions of aged patients experiencing what is otherwise synonymous with Alzheimer's disease from being diagnosed as having a disease process, rather than just being considered a normal aging. Katzmann thus states that Alzheimer's disease, if taken occurs over the age of 65, is actually common, not infrequently, and is the fourth or fifth leading cause of death, although it is rarely reported in death certificates in 1976.
This suggestion opens the view that dementia is never normal, and should always be the result of a particular disease process, and not part of the normal healthy aging process, per se . The ensuing debate caused time for the diagnosis of the proposed disease of "senile dementia type Alzheimer" (SDAT) in people over age 65, with "Alzheimer's disease" diagnosed in people younger than 65 who had the same pathology. Finally, however, it is agreed that age limits are artificial, and that Alzheimer's disease is the appropriate term for people with specific brain pathologies seen in this disorder, regardless of the person's age with the diagnosis. A useful finding is that although the incidence of Alzheimer's disease increases with age (from 5-10% of children aged 75 to 40-50% of 90 years), there is no age at which everyone develops it, so it is not an inevitable consequence of aging, no matter how old a person is. This evidence is shown by many documented supercentenarians (people living to 110 or more) who have not suffered serious cognitive impairment. There is some evidence that dementia is likely to develop between the ages of 80 and 84 and individuals who pass through that point unaffected have a lower chance of developing it. Women play a larger role in the percentage of cases of dementia than men, although this can be attributed to their longer life span and a greater chance of reaching an age where this condition may occur.
Also, after 1952, mental illnesses such as schizophrenia were excluded from the organic brain syndrome category and thus (by definition) removed from the possible causes of "madness" (dementia). At the same time, however, the traditional cause of dementia - "hardening of the arteries" - now returns as a set of vascular causes of dementia (small stroke). This is now called multi-infarction dementia or vascular dementia .
In the 21st century, a number of other types of dementia have been distinguished from Alzheimer's disease and vascular dementia (both of which are the most common types). This differentiation is based on pathological examination of brain tissue, by symptomatology, and by different patterns of brain metabolic activity in nuclear medical imaging tests such as SPECT and PETscan brain. Different forms of dementia have different prognoses (expected outcomes of the disease), and also different sets of epidemiological risk factors. The causal etiology of many of them, including Alzheimer's disease, remains unclear, although many theories exist such as the accumulation of protein plaque as part of normal aging, inflammation (either from pathogenic bacteria or exposure to toxic chemicals), inadequate blood sugar, and traumatic. brain damage.
Society and culture
The cost of community dementia is high, especially for family caregivers.
Many countries consider the care of people living with dementia as a national priority and invest in resources and education to better inform health and health service workers, unpaid nurses, relatives, and wider community members. Some countries have national plans or strategies. In this national plan, there is recognition that people can live healthy with dementia for several years, as long as there is appropriate support and appropriate access to diagnosis. Former British Prime Minister David Cameron describes dementia as a "national crisis", affecting 800,000 people in Britain.
In the UK, as with all mental disorders, where people with dementia are potentially a danger to themselves or others, they can be detained under the Mental Health Act of 1983 for the purpose of assessment, care and treatment. This is a last resort, and is usually avoided if the person has family or friends who can confirm the treatment.
Driving with dementia can cause severe injury or even death to yourself and others. Doctors should suggest proper testing at the time of stopping driving. The United Kingdom DVLA (Driver & Vehicle Licensing Agency) states that people with dementia who specifically have poor short-term memory, disorientation, or lack of insight or assessment are not eligible for riding, and in this case the DVLA must be notified so that the license can revoked. They, however, recognize cases of low severity and those with early diagnosis, and drivers may be allowed to encourage delayed medical reports.
Many support networks are available for people with dementia and their families and caregivers. Some charitable organizations aim to raise awareness and campaign for the rights of people living with dementia. There is also support and guidance to assess the capacity of the tester in people with dementia.
By 2015, Atlantic Philanthropies announced a $ 177 million prize aimed at understanding and reducing dementia. The recipient is the Global Brain Health Institute, a program led by the University of California, San Francisco, and Trinity College Dublin. This donation is the largest non-capital grant ever made in the Atlantic, and the largest philanthropic donation in Irish history.
Dental health
There is limited evidence linking poor oral hygiene with cognitive impairment. However, failure to perform tooth brushing and gingival inflammation can be used as a predictor of the risk of dementia.
Bacterial mouth
The relationship between Alzheimer's and gum disease is oral bacteria. In the oral cavity, a large number of bacterial species can be found including P. gingivalis , F. nucleatum , P. intermedia , and T. forsythia . Six oral trepomena spottetetes have also been examined in the brains of Alzheimer's patients. Spirochetes are neurotrophic, meaning they act to destroy nerve tissue and create inflammation. Inflammatory pathogens are an indicator of Alzheimer's disease and the bacteria associated with gum disease have been found in individual brains of Alzheimer's disease. Bacteria invade nerve tissue in the brain, increase blood-brain barrier permeability and promote the onset of Alzheimer's among the elderly population. It has also been found that individuals with large amounts of dental plaque have a risk of cognitive decline. Poor oral hygiene can also have adverse effects on speech and nutrients that cause general and cognitive health decline.
Oral virus
Herpes simplex virus (HSV) has been found in more than 70% of the 50 and the older population. HSV persists in the peripheral nervous system and can be triggered by stress, illness or fatigue. High proportion of viral proteins in amyloid-containing plaques or neurofibrillary tangles (NFTs) strongly confirm the involvement of HSV-1 in the pathology of Alzheimer's disease. NFT is known as a major marker of Alzheimer's disease. HSV-1 produces the main component of NFT.
References
External links
Media related to Dementia in Wikimedia Commons
- Dementia in Curlie (based on DMOZ)
Source of the article : Wikipedia
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