Dementia

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= Definition: = A state of mental deterioration characterized by impaired memory and intellect and by altered personality and behavior. Gen Psych Ch 6,pp.190

= Examples: =

Causes, incidence, and risk factors
Most types of dementia are nonreversible (degenerative). Nonreversible means the changes in the brain that are causing the dementia cannot be stopped or turned back. Alzheimer's disease is the most common type of dementia. Lewy body disease is a leading cause of dementia in elderly adults. People with this condition have abnormal protein structures in certain areas of the brain. Dementia also can be due to many small strokes. This is called vascular dementia. The following medical conditions also can lead to dementia: Some causes of dementia may be stopped or reversed if they are found soon enough, including: Dementia usually occurs in older age. It is rare in people under age 60. The risk for dementia increases as a person gets older.
 * Huntington's disease
 * Multiple sclerosis
 * Infections that can affect the brain, such as HIV /AIDS and Lyme disease
 * Parkinson's disease
 * Pick's disease
 * Progressive supranuclear palsy
 * Brain injury
 * Brain tumors
 * Chronic alcohol abuse
 * Changes in blood sugar, sodium, and calcium levels (see: Dementia due to metabolic causes)
 * Low vitamin B12 levels
 * Normal pressure hydrocephalus
 * Use of certain medications, including cimetadine and some cholesterol-lowering medications

Symptoms
Dementia symptoms include difficulty with many areas of mental function, including: Dementia usually first appears as forgetfulness. Mild cognitive impairment is the stage between normal forgetfulness due to aging and the development of dementia. People with MCI have mild problems with thinking and memory that do not interfere with everyday activities. They are often aware of the forgetfulness. Not everyone with MCI develops dementia. Symptoms of MCI include: The early symptoms of dementia can include: As the dementia becomes worse, symptoms are more obvious and interfere with the ability to take care of yourself. The symptoms may include: People with severe dementia can no longer: Other symptoms that may occur with dementia:
 * Language
 * Memory
 * Perception
 * Emotional behavior or personality
 * Cognitive skills (such as calculation, abstract thinking, or judgment)
 * Difficulty performing more than one task at a time
 * Difficulty solving problems or making decisions
 * Forgetting recent events or conversations
 * Taking longer to perform more difficult mental activities
 * Difficulty performing tasks that take some thought, but that used to come easily, such as balancing a checkbook, playing games (such as bridge), and learning new information or routines
 * Getting lost on familiar routes
 * Language problems, such as trouble finding the name of familiar objects
 * Losing interest in things you previously enjoyed, flat mood
 * Misplacing items
 * Personality changes and loss of social skills, which can lead to inappropriate behaviors
 * Change in sleep patterns, often waking up at night
 * Difficulty doing basic tasks, such as preparing meals, choosing proper clothing, or driving
 * Forgetting details about current events
 * Forgetting events in your own life history, losing awareness of who you are
 * Having hallucinations, arguments, striking out, and violent behavior
 * Having delusions, depression, agitation
 * More difficulty reading or writing
 * Poor judgment and loss of ability to recognize danger
 * Using the wrong word, not pronouncing words correctly, speaking in confusing sentences
 * Withdrawing from social contact
 * Perform basic activities of daily living, such as eating, dressing, and bathing
 * Recognize family members
 * Understand language
 * Incontinence
 * Swallowing problems

Signs and tests
In a healthy brain, mass and speed may decline in adulthood, but this miraculous machine continues to form vital connections throughout life. However, when connections are lost through inflammation, disease, or injury, neurons eventually die and dementia may result. The prospect of literally losing one's self can be traumatic, but early intervention can dramatically alter the outcome. Understanding causes is the first step. In the past twenty years, scientists have greatly demystified the origins of dementia. Genetics may increase your risks, but scientists believe a combination of hereditary, environmental, and lifestyle factors are most likely at work.

Types of Dementia
It is convenient to classify most dementias as either of Alzheimer type or non-Alzheimer type. The former are characterized predominantly by memory loss, accompanied by impairment in other cognitive functions or "domain," such as language function (aphasia), skilled motor functions (apraxia), or perception, visual or other (agnosias). Non-Alzheimer dementias include the frontotemporal lobar degenerations, which generally are of two main types. One primarily affects speech, as in the primary progressive aphasia syndromes. The other is characterized primarily by changes in behavior, including apathy, disinhibition, personality change and what is called executive function (e.g., planning ahead and organizational ability). In both of these types, memory loss is relatively mild, if present, until later in the course of the disease. Other forms of dementia, including vascular disorders (multiple strokes), dementia with Lewy bodies, Parkinson’s dementia, and normal pressure hydrocephalus would be grouped among the non-Alzheimer disorders.

Dementia Age Related
Dementia will affect roughly 10% of Americans over the age of 65 and roughly 50% by the age of 85. Not surprisingly, [|dementia] is most often associated as a disorder of later life, but this does not mean it exclusively affects older people.

Available Medication
Memory-enhancing drugs, including the cholinesterase inhibitors (e.g., donepezil, rivastigmine, and galantamine) along with memantine, a medication that acts on another neurotransmitter system have all been shown to have some benefit in improving memory function in some patients. None of these drugs appear to influence the course of dementias, however. There are medications, such as antidepressants, anxiolytic agents, and mood stabilizers, that can be helpful in alleviating some of the accompanying symptoms in demented patients, and others that can sometimes be of benefit in controlling behavioral problems (such as hallucination and agitation). However, potentially negative side effects may limit the usefulness of many of these drugs. Many newer therapeutic approaches are currently being tested.

How common is Dementia?
Although dementia has always been common, it has become even more common among the elderly in recent history. It is not clear if this increased frequency of dementia reflects a greater awareness of the symptoms or if people simply are living longer and thus are more likely to develop dementia in their older age. Dementia caused by neurological degenerative disease, especially Alzheimer's disease, is increasing in frequency more than most other types of dementia. Some researchers suspect that as many as half of all people over 85 years old develop Alzheimer's disease. Dementia associated with AIDS, which appeared to be increasing in frequency in the 1990s is now much less commonly seen, since the development of highly effect anti-retroviral therapy.

=Analogies:= Having dementia is like st art ing in the fourth grade and going backwards. My math, spelling, vocabulary, and history began to chip away. My thoughts of what use to be, became the past.

**Mnemonic:**
Make sure they don't have problems with: D-rug and alcohol

E-yes and ears

M-etabolic and endocrine disorders

E-motional disorders

N-eurologic disorders

T-umors and trauma

I-nfection

A-rteriovascular disease

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