Dementia

Dementia, the symptom complex of progressive global impairment of intellectual function, is a major medical, social, and economic problem that is worsening as the number of elderly people in the general population increases. It is discussed in Geriatric Medicine, and the only point to be reiterated here is the importance of recognizing early any treatable or reversible causes of dementia, such as normal-pressure hydrocephalus, intracranial mass lesions, vascular disease, hypothyroidism, thiamin or vitamin B12 deficiency, Wilson's disease, hepatic or renal failure, neurosyphilis, and the chronic meningitides.

Dementia (from Latin de - "apart, away" + mens ( genitive mentis ) "mind") is the progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging . Instead, dementia refers to a group of illnesses that involve memory, behavior, learning, and communicating problems. After a while, this makes it hard for the person to take care of himself or herself. The condition is rare in people under the age of 60 - there are about 18,000 people affected in the UK - but affects one person in 20 over the age of 65 and one in five over 80. Patients who have had a stroke are at increased risk for vascular dementia. Recently, vascular lesions have been thought to play a role in AD. The most common form of dementia, Alzheimer's disease, accounts for 50-75% of all cases of dementia. Another 20-30% is due to blood vessel disease ("multi-infarct dementia" or "mini-strokes"). Symptoms of dementia can be classified as either reversible or irreversible depending upon the etiology of the disease. At first, memory loss and trouble thinking clearly may bother the person who has dementia. Dementia can be progressive, as with Alzheimer's, or transient, perhaps as the result of a head injury. These abnormalities tend to settle in brain areas that control the ability to learn a new fact and remember it 30 minutes, or a day later, a skill we refer to as "memory". Years of studying dementias have shown that Alzheimer's disease is not the only type of brain degeneration. Less than 10% of all dementias are reversible. Dementia is a non-specific term that encompasses many disease processes, just as fever is attributable to many etiologies.

The term "dementia" is used to describe the gradual deterioration of "intellectual" abilities and behavior that eventually interferes with customary daily living activities. "Customary Particularly affected areas may be memory , attention , language and problem solving , although particularly in the later stages of the condition, affected persons may be disoriented in time (not knowing what day (of the week, or possibly of the month), what month or what year it is), place (not knowing where they are) and person (not knowing who they are). Several recent studies also suggest that the risk of developing AD is increased when a patient is exposed to vascular risk factors such as hypertension, diabetes mellitus, peripheral arterial disease, and smoking, which usually are associated with cerebrovascular disease and vascular dementia Alzheimer's disease is a form of brain degeneration in which abnormal particles called neurofibrillary tangles and neuritic plaques form in the brain and destroy healthy neurons (brain cells). . Although people with dementia typically remain fully conscious, the loss of short- and long-term memory are universal. Dementia may also change a person's mood and personality. Most people who reach advanced years do not develop dementia, and the expectation that senility is an inevitable part of the aging process is incorrect.

Causes of Dementia

Common causes of Dementia :

• When the underlying process does not permanently damage the cortical tissue, the dementia may sometimes be stopped or reversed.
• The causes of dementia include various diseases and infections, strokes, head injuries, drugs, and nutritional deficiencies. 
• Conditions, such as atherosclerosis, that harm the blood vessels supplying the brain.
• Amyotrophic lateral sclerosis (ALS)
• Injury to the brain caused by tumors, head injury, or strokes .
• Dementia with Lewy bodies , which causes protein deposits (Lewy bodies) in brain cells.
• Secondary dementias are those caused by, or closely related to, some other recognizable disease - whether AIDS, a chronic subdural hematoma , multiple sclerosis, or one of numerous other identifiable mental conditions.
• Reversible conditions can be caused by a high fever, dehydration, vitamin deficiency and poor nutrition, bad reactions to medicines, problems with the thyroid gland, or a minor head injury.

Symptoms of Dementia

Some common symptoms of Dementia :

• Everyone has trouble finding the right word sometimes, but a person with Alzheimer's disease may forget simple words or substitute inappropriate words, making his or her sentence incomprehensible.
• Word-finding difficulty - May be able to compensate by using synonyms or defining the word
• Decline in level of functioning but able to follow established routines at home
• Hallucinations and delusions
• Impaired recognition through the senses
• Emotional problems - changes in mood, loss of emotional control, and a withdrawal from previous interests, activities and social interactions.
• apraxia (impaired ability to carry out motor activities despite intact motor function)
• Decrease in problem-solving skills and judgment capability
• they may forget simple words, may use the wrong words without noticing, or their conversation may become simplified, repetitive or irrelevant.

Treatment of Dementia

• Neuroprotective drugs such as nimodipine, propentofylline, and posatirelin are currently under study and may be useful for vascular dementia.
• Drug treatment is primarily used to prevent further worsening of vascular dementia by treating the underlying disease such as hypertension and diabetes mellitus
• those related to head injury, hydrocephalus or tumour, which may be treatable with surgery,
• The most important advances in the cure of breast cancer have come through the use of drug therapy.
• Fluoxetine, imipramine, or Celexa to help stabilize mood
• Dementia caused by intoxication, hyperthyroidism, pernicious anemia , subdural hematoma, benign brain tumors , hydrocephalus , or insulin shock can be reversed or improved by treating the condition.
• Stimulant drugs (such as methylphenidate) to increase activity
• those related to infections, where treating the infection will normally cure the dementia

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