Dementia Disease

Dementia Disorder Information on Symptoms/Signs, Treatment, Care, Cause, Medication, Stage, Test, Type

Chronic brain syndrome

Definition of Dementia

Dementia is an acquired global impairment of intellect, memory and personality, but without impairment of consciousness. There is often an associated deterioration in emotional control, social behaviour and motivation. Dementia is used both to refer to the primary dementing illness, such as Alzheimer's disease, as well as the process itself, which may be secondary to some other disease (e.g. hypothyroidism). Presenile dementia is the term used for patients under 65 years of age and senile dementia for older patients. However, there is no clinical difference.

Dementia, which is characterized by confusion, memory loss, and disorientation, is not an inevitable part of growing old. In fact, only 15 percent of older Americans suffer from this condition. Of that number, an estimated 60 percent suffer from Alzheimer's disease, a progressive mental deterioration for which no cause or cure has been found.

Causes and incidence of Dementia

An estimated 2 million people in the United States suffer from severe dementia and another 1 to 5 million people experience mild to moderate dementia. Five to eight percent of people over the age of 65 have some form of dementia and the number doubles every 5 years over age 65. The other 40 percent of all dementias can be caused by:

• Complications of chronic high blood pressure, blood vessel disease or a previous stroke. Deterioration is in steps rather than in a steady progression.
• Parkinson's disease, which generally begins with involuntary and small tremors or problems with voluntary movements. Dementia may occur when the disease is severe or very advanced.
• Huntington's disease, a genetic disorder that begins in middle age and has symptoms of changed personality, mental decline, psychosis and movement disturbance.
• Creutzfeldt-Jakob disease, thought to be caused by a viral infection leading to rapid and progressive dementia.

Symptoms of Dementia - Hallucinations

People with dementia often have hallucinations. It's not clear if this is an indication that the dementia is getting worse. But most dementia does worsen over time. Hallucinations can also be a symptom of specific types of dementia, such as Lewy body disease.

Diagnostic Criteria of Dementia

• Impairment in short- and long-term memory
• At least 1 of the following:
  • Impairment in abstract thinking
  • Impaired judgment
  • Other disturbances of higher cortical function
  • Personality change
• Memory impairment and intellectual impairment caused significant social and occupational impairments
• Absence of occurrence exclusively during the course of Delirium
• Either of the following:
  • Evidence of an organic factor causing this impaired memory and intellect
  • Impaired memory and intellect cannot be accounted for by any nonorganic mental disorder.

Differential Diagnosis

• Normal process of aging
• Delirium
• Schizophrenia
• Major Depressive Episode
• Factitious Disorder with Psychological Symptoms.

Signs and tests of Dementia Disease

A neurologic examination may reveal abnormalities. Early signs of dementia include mild problems with memory or attention. Over time, the following cognitive difficulties may appear:

• Language problems
• Disorientation
• Personality changes
• Visual or spatial problems
• Slow thinking
• Impaired skilled motor function (apraxia)
• Impaired recognition (agnosia)
• Difficulty with planning and organizing
• Weakness
• Incontinence
• Falling

Treatment and care of Dementia disorder

The goal of treatment is to control the symptoms of dementia. Treatment varies with the specific disorder. Hospitalization may be needed for a short time. The underlying causes should be identified and treated, this includes treating reversible organic lesions such as tumors.
Depending on the cause of the dementia, there are different treatments available. For example if the cause of dementia were severe hypothyroidism, the treatment would be thyroid hormone replacement.

Until the past few years there was little that could be done to alter the course of Alzheimer's disease. Currently there are a few medications that have been shown to afford (at most) a modest transient benefit. The cholinesterase inhibitors (Aricept® (donepezil) and Cognex® (tacrine) help some individuals.

Caring for an individual with Alzheimer's disease or a related dementia can be challenging and, at times, overwhelming. Frustration is a normal and valid emotional response to many of the difficulties of being a caregiver. In order to respond without extreme frustration, you will need to:

• learn to recognize the warnings signs of frustration;
• intervene to calm yourself down physically;
• modify your thoughts in a way that reduces your stress;
• learn to communicate assertively;
• learn to ask for help.

Types of Dementia

• Cortical dementias
  • Alzheimer's disease
  • Vascular dementia (also known as multi-infarct dementia), including Binswanger's disease
  • Dementia with Lewy bodies (DLB)
  • Alcohol-Induced Persisting Dementia
    • Korsakoff's syndrome
    • Wernicke's encephalopathy
  • Frontotemporal lobar degenerations (FTLD), including Pick's disease
    • Frontotemporal dementia (or frontal variant FTLD)
    • Semantic dementia (or temporal variant FTLD)
    • Progressive non-fluent aphasia
  • Creutzfeldt-Jakob disease
  • Dementia pugilistica
  • Moyamoya disease
• Subcortical dementias
  • Huntington's disease
  • Parkinson's disease
  • Syphilis
  • Subdural hematoma
  • Pseudodementia (associated with clinical depression and bipolar disorder)
  • Substance-induced persisting dementia (related to psychoactive use and formerly Absinthism)
  • Mixed Dementia - Dementia due to multiple etiologies
  • Dementia due to other general medical conditions (i.e. end stage renal failure, cardiovascular disease etc.)
  • Dementia not otherwise specified (used in cases where no specific criteria is met)

  Dementia and early onset dementia have been associated with neurovisceral porphyrias. Porphyria is listed in textbooks in the differential diagnosis of dementia.

Depression May Up Risk of Dementia in Men

The risk of dementia, especially AD, was significantly increased with premorbid depressive symptoms only in men. The risk was approximately two times greater in those with a history of depression than for those without a history of depression, and was independent of the presence of vascular disease.

"The prevalence and clinical manifestations of both AD and depression differ in men and women," Dal Forno noted in an interview with Reuters Health.

"We know that male and female brains have anatomical and functional differences and are exposed differently to sex hormones throughout life, hormones known to have effects on both depression and AD," she noted. "As a consequence, male and female brains might react to conditions causing or enhancing a disease quite differently, which seems to be precisely what we found in this investigation."

Given the prevalence of depression and increasing longevity worldwide, "clearly the public health and economic implications are significant," the researcher added.

Furthermore, "Prevention of depressive disorders and aggressive as well as long-term treatment of depression may impact on the epidemiology of dementia," she added. "This is particularly relevant in men since they generally are less likely to admit to symptoms of depression and to seek treatment."

Dementia Related Articles

Dementia Overview
Multi infarct Dementia
Fronto Temporal dementia
Lewy Body dementia
Frontal Lobe dementia
Parkinsons-Dementia
Pick's disease
Niemann-Pick Disease

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