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Understanding Dementia -Dr. Ruwani Gunawardane

Author: 18 June 2017 No Comment

Overview on Understanding Dementia:

At the Center for Brain and Neuro Care (CNBC), we diagnosis and treat memory disorders. This includes programs that focus on Alzheimer’s disease, frontotemporal dementia, and normal pressure hydrocephalus, as well as stroke and related vascular dementia. We take a multidisciplinary approach to reducing the progression of the disease, both to improve a patient’s quality of life and reduce their caregiver’s burden. Here at the CBNC, patients can expect to have a comprehensive personalized assessment and treatment plan.

Alzheimer’s disease is the commonest type of dementia that commonly affects those between ages 60-85. Patients can have problems with memory, thinking, language and behavior. It progresses slowly, increasing a caregiver’s burden over time. However, the disease is medically manageable. If you are experiencing memory loss, you need to seek your doctor’s attention right away for early intervention. This is the best way to slow the progression of the disease.

What is Dementia?:

Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior. The risk increases as a person gets older. Most types of dementia are nonreversible (degenerative), which means the changes in the brain are progressive and cannot be reversed.

ALZHEIMER’S DISEASE IS THE MOST COMMON TYPE OF DEMENTIA. OTHER TYPES OF DEMENTIA ARE:
+ Frontal-Temporal Dementias (behavioral problems, poor impulse control, word finding difficulties, rapid mood changes)
+ Vascular dementia (caused by many small strokes)
+ Lewis body dementia (hallucinations, vivid dreams, movement impairments)
SOME CAUSES OF DEMENTIA MAY BE STOPPED OR REVERSED IF THEY ARE FOUND SOON ENOUGH, INCLUDING:
+ Brain injury
+ Brain tumors
+ Chronic alcohol abuse
+ Changes in blood sugar, sodium, and calcium levels (dementia due to metabolic causes)
+ Low vitamin B12 level
+ Normal pressure hydrocephalus
+ Use of certain medicines, including cimetidine and some cholesterol drugs

Symptoms:

Dementia usually first appears as forgetfulness. Mild cognitive impairment (MCI) is the stage between normal forgetfulness due to aging and the development of dementia. People with MCI have mild problems with thinking and memory.

THEY MAY ALSO HAVE MILD PROBLEMS WITH:
+ Emotional behavior or personality
+ Thinking and judgment (cognitive skills)
+ Language
+ Perception
SYMPTOMS OF MCI CAN INCLUDE:
+ Difficulty doing more than one task at a time
+ Difficulty solving problems or making decisions
+ Forgetting recent events or conversations
+ Taking longer to do more difficult mental activities
EARLY SYMPTOMS OF DEMENTIA CAN INCLUDE:
+ Difficulty with 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 with the names of familiar objects
+ Losing interest in things previously enjoyed, having a flat mood
+ Misplacing items
+ Personality changes and loss of social skills, which can lead to inappropriate behaviors
AS DEMENTIA BECOMES WORSE, SYMPTOMS ARE MORE OBVIOUS AND INTERFERE WITH THE ABILITY TO TAKE CARE OF ONESELF. THESE WORSENING SYMPTOMS MAY INCLUDE:
+ Change in sleep patterns, often waking up at night
+ Difficulty with basic tasks, such as preparing meals, choosing proper clothing, or driving
+ Forgetting details about current events
+ Forgetting events in one’s own life history, losing self-awareness
+ Having hallucinations, arguments, striking out, and violent behavior
+ Having delusions
+ Becoming depressed or agitated
+ 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
PEOPLE WITH SEVERE DEMENTIA CAN NO LONGER:
+ Perform basic activities of daily living, such as eating, dressing, and bathing
+ Recognize family members
+ Understand language

Other symptoms may include problems controlling bowel movements or urine and difficulty swallowing.

Diagnosis:

A skilled health care provider can often diagnose dementia by:
+ Doing a complete physical exam, including nervous system exam
+ Asking about the person’s medical history and symptoms
+ Doing mental function tests (mental status examination)
OTHER TESTS MAY BE ORDERED TO FIND OUT IF OTHER PROBLEMS MAY BE MAKING THE DEMENTIA WORSE, SUCH AS:
+ Anemia
+ Brain tumor
+ Chronic infection
+ Intoxication from medications
+ Severe depression
+ Thyroid disease
+ Vitamin deficiency
+ The following tests and procedures may be done:
+ B12 level
+ Bloodammonia levels
+ Blood chemistry (chem-20)
+ Blood gas analysis
+ Cerebrospinal fluid (CSF) analysis
+ Drug or alcohol levels (toxicology screen)
+ Electroencephalograph(EEG)
+ Head CT
+ Mental status test
+ MRI of head
+ Thyroid function tests, including thyroid stimulating hormone
+ Thyroid stimulating hormonelevel
+ Urinalysis

Treatments:

Treatment depends on the condition causing the dementia. Some people may need to stay in the hospital for a short time. Sometimes dementia medicine can make a patient’s confusion worse. Stopping or changing these medicines is part of the treatment. Certain mental exercises can help with dementia. Patients are often prescribed medications to help improve neural activity, treat underlying depression, and control psychiatric manifestations (hallucinations, paranoia, fixed beliefs, among others). It should be noted that currently there is no cure, vaccine, or way to halt progression of the disease. However, promising research trials are emerging and ongoing.

TREATING CONDITIONS THAT SOMETIMES LEAD TO CONFUSION OFTEN GREATLY IMPROVES MENTAL FUNCTION. SUCH CONDITIONS INCLUDE:
+ Anemia
+ Congestive heart failure
+ Decreased blood oxygen (hypoxia)
+ Depression
+ Heart failure
+ Infections
+ Nutritional disorders
+ Thyroid disorders

Prevention:

As mentioned, there is no vaccine for dementia. However, a multidisciplinary approach can help to slow and reduce the progression of the disease in combination with medication management.
– early detection is key, keeping a comprehensive family history sometimes helps as genetics do play a role
– eating a well-balanced and healthy diet
– exercising daily for 30 minutes
– neurocognitive stimulating exercises, such as crossword puzzles or Lumocity
– partaking in new hobbies and activities, such as dancing, singing and music, can help to enhance brain pathways and create new ones
– controlling BP, weight and sugar

Center for Brain & Neuro Care   301-490-3700  www.centerforbrainmd.com