Dementia is a disease that can cause a long term gradual decline which affects memory, thinking, social interactions, and overall daily functioning. A person’s consciousness is not affected Patients with irreversible dementia are eventually unable to care for themselves and may require full time care.
According to the Alzheimers Association, “an estimated 5.2 million Americans of all ages have Alzheimer’s disease in 2013. This includes an estimated 5 million people age 65 and older and approximately 200,000 individuals under age 65 who have younger onset Alzheimer’s. One in nine people age 65 and older (11 percent) has Alzheimer’s. About one-third of people age 85 and older (32 percent) have Alzheimer’s disease. Of those with Alzheimer’s disease, an estimated 4 percent are under age 65, 13 percent are 65 to 74, 44 percent are 75 to 84, and 38 percent are 85 or older.” More women have Alzheimers disease than men. This may be due to their longer life span. Furthermore, data indicates a prevalence for Alzheimers in the older African-American and Hispanic populations.
According to the World Health Organization (WHO),”The number of people living with dementia worldwide is currently estimated at 47.5 million and is projected to increase to 75.6 million by 2030. The number of cases of dementia are estimated to more than triple by 2050.” The cost could rise to $1.1 trillion dollars.
There are many causes of dementia. The following will list some of the more common causes. Alzheimer’s disease is the most common cause of a progressive dementia. It is the 6th leading cause of death in the United States. Alzheimer’s is not a normal part of aging process. In fact, Alzheimer’s is not just a disease which affects the elderly. Up to 5 percent of people with the disease have early onset Alzheimer’s, which often appears when someone is in their 40s or 50s. There are abnormal findings in the brain called plaques and tangles which are suspected in damaging and killing nerve cells. This eventually leads to memory failure, personality changes, and problems carrying out daily activities. Beta-amyloid plaques which are protein build up in the spaces between nerves cells. Tangles are made up of another protein called tau which builds up inside cells.
Vascular dementia is the second most common type of dementia. It occurs after a stroke. It is also called multi-infarct dementia. Risk factors for vascular dementia include age, high blood pressure, smoking, high cholesterol, diabetes, cardiovascular disease, and cerebrovascular disease. The prognosis for vascular dementia is usually not very promising
Dementia with the presence of Lewy bodies. People with dementia with Lewy bodies often have memory loss and thinking problems like Alzheimer patients; however, they are more likely to have symptoms such as sleep disturbances, visual hallucinations, and muscle rigidity which is also characteristic of Parkinson’s disease. Lewy bodies are abnormal clumps of the protein called alpha-synuclein. When they develop in a part of the brain called the cortex, dementia can result. Alpha-synuclein is also present in the brains of people with Parkinson’s disease, but the aggregates or clumps may appear in a pattern that is different from dementia with Lewy bodies.
In mixed dementia, the abnormalities are linked to more than one type of dementia. They occur simultaneously in the brain. Recent studies suggest that mixed dementia is more common than previously thought. Mixed dementia is characterized by the hallmark abnormalities of more than one type of dementia. It can be comprised of Alzheimer’s and vascular dementia, or other types, such as dementia with Lewy bodies.
Parkinson’s Disease is characterized as a movement disorder. If dementia develops, symptoms are often similar to dementia with Lewy bodies. The deposition of alpha-synuclein aggregates are likely to be found in an area deep in the brain called the substantia nigra. These clumps are thought to cause damage to the nerve cells that produce dopamine.
Most types of dementia cannot be cured. Management of dementia symptoms may help to slow or lessen the severity of the disease. Some of the medications currently used to manage the symptoms are called cholinesterase inhibitors. These medications include donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne). Another medication Namenda(memantine), works by regulating the activity of glutamate, a neurotransmitter.
Your doctor may also prescribe occupational therapy to help you adjust to living with dementia. These health professionals can teach you coping mechanisms and ways to adapt your movements as well as your ADL’s or activities of daily living.
Diagnosis of dementia can be very challenging. In order to diagnose your condition, your doctor will review your medical history, symptoms, and perform a physical examination. Doctors may order a battery of tests including a neurological examination which will evaluate your muscle tone and strength, reflexes, coordination, balance, and your senses. In addition, the doctor may perform cognitive and neuropsychological tests. These tests measure your thinking skills, your memory, language, alertness, ability to reason, and orientation. Doctors may order brain scans, such as a CT or MRI, to check for evidence of stroke, bleeding, vascular malformation, and to rule out the possible presence of a tumor. Furthermore, the doctor may order routine blood work to rule out vitamin B12 deficiency or thyroid disorders.
The doctor may order other tests. For example, electroencephalography (EEG). It can be used to demonstrate cognitive dysfunction. Studies have shown differences in normal aging subjects versus those experiencing dementia or cognitive decline. Another test is the carotid ultrasound which will demonstrate any narrowing or blockage of the arteries which supply the brain with blood. In addition, a carotid Doppler shows movement of blood through your arteries.
Early diagnosis is very important. At the first sign of persistent memory loss or behavioral changes, you should consult your primary care physician or a neurologist. There is help out there if you are experiencing problems associated with dementia.
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