Dementia – Significantly impaired intellectual functioning

Dementiais a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior.

Dementia

People with Dementia have significantly impaired intellectual functioning that interferes with normal activities and relationships. They also lose their ability to solve problems and maintain emotional control, and they may experience personality changes and behavioral problems such as agitation, delusions, and hallucinations. While Memory Loss is a common symptom of Dementia, memory loss by itself does not mean that a person has Dementia.

Types of Dementia

  • Cortical Dementia: Dementia where the brain damage primarily affects the brain’s cortex, or outer layer. Cortical Dementias tend to cause problems with memory, language, thinking, and social behavior.
  • Subcortical Dementia: Dementia that affects parts of the brain below the cortex. Subcortical Dementia tends to cause changes in emotions and movement in addition to problems with memory.
  • Progressive Dementia: Dementia that gets worse over time, gradually interfering with more and more cognitive abilities.
  • Primary Dementia: Dementia such as AD that does not result from any other disease.
  • Secondary dementia: Dementia that occurs as a result of a physical disease or injury.

Causes of Dementia

  • Medical conditions that progressively attack brain cells and connections, most commonly seen in Alzheimer’s disease, Parkinson’s disease, or Huntington’s disease.
  • Medical conditions such as strokes that disrupt oxygen flow and rob the brain of vital nutrients. Additional strokes may be prevented by reducing high blood pressure, treating heart disease, and quitting smoking.
  • Poor nutrition, dehydration, and certain substances, including drugs and alcohol. Treating conditions such as insulin resistance, metabolic disorders, and vitamin deficiencies may reduce or eliminate symptoms of dementia.
  • Single trauma or repeated injuries to the brain. Depending on the location of the brain injury, cognitive skills and memory may be impaired.
  • Infection or illness that affects the central nervous system, including Creutzfeldt-Jakob disease and HIV. Some conditions are treatable, including liver or kidney disease, depression-induced pseudodementia, and operable brain tumors.

Symptoms of Dementia

Dementia is a collection of symptoms including memory loss, personality change, and impaired intellectual functions resulting from disease or trauma to the brain. These changes are not part of normal aging and are severe enough to impact daily living, independence, and relationships. With dementia, there will likely be noticeable decline in communication, learning, remembering, and problem solving. These changes may occur quickly or very slowly over time. Common Symptoms are:-

  • Memory loss
  • Impaired judgment
  • Difficulties with abstract thinking
  • Faulty reasoning
  • Inappropriate behavior
  • Loss of communication skills
  • Disorientation to time and place
  • Gait, motor, and balance problems
  • Neglect of personal care and safety
  • Hallucinations, paranoia, agitation

Causes of Dementia

There are several diseases and conditions that result in dementia. These include:

  • Alzheimer’s disease. The most common cause of dementia. During the course of the disease the chemistry and structure of the brain change, leading to the death of brain cells. Problems of short-term memory are usually the first noticeable sign.
  • Vascular Dementia.  If the oxygen supply to the brain fails due to vascular disease, brain cells are likely to die and this can cause the symptoms of vascular dementia. These symptoms can occur either suddenly, following a stroke, or over time through a series of small strokes.
  • Dementia with Lewy Bodies. This form of dementia gets its name from tiny abnormal structures that develop inside nerve cells. Their presence in the brain leads to the degeneration of brain tissue. Symptoms can include disorientation and hallucinations, as well as problems with planning, reasoning and problem solving. Memory may be affected to a lesser degree. This form of dementia shares some characteristics with Parkinson’s disease.
  • Fronto-Temporal Dementia (Including Pick’s Disease). In fronto-temporal dementia, damage is usually focused in the front part of the brain. At first, personality and behaviour changes are the most obvious signs.

Diagnosis of Dementia

In some people, the signs and symptoms of dementia are easily recognized; in others, they can be very subtle. A careful and thorough evaluation is needed to identify their true cause.

  • The individual’s health care provider will conduct a detailed medical interview to develop a picture of the symptoms. The interview will address the symptoms and when they began, the person’s medical problems now and in the past, family medical problems, medications, work and travel history, and habits and lifestyle.
  • Family members, especially those who live with the affected person, will also be asked about his or her symptoms.
  • The review of medications is very important, especially for seniors, who are more likely to take several medications and to experience side effects.
  • A thorough physical examination will look for evidence of illness and dysfunction that might shed light on what is causing the symptoms.
  • This evaluation is designed to identify reversible, treatable causes of dementia symptoms.
  • At any point in the evaluation or treatment, the person with dementia may be referred to specialists in conditions of older people (geriatricians), in brain disorders (neurologists), or in mental disorders (psychiatrists).

Treatment of Dementia

Medical care depends on the underlying condition, but it most often consists of medications and non-drug treatments such as behavioral therapy.

  1. 1.      Self Care at Home for Dementia

Many individuals with dementia in the early and intermediate stages are able to live independently.

  • With regular checks by a local relative or friend, they are able to live without constant supervision.
  • Those who have difficulty with activities of daily living require at least part-time help from a family caregiver or home health aide.
  • Visiting nurses can make sure that these individuals take their medications as directed.
  • Housekeeping help is available for those who cannot keep up with household chores.

Other affected individuals require closer supervision or more constant assistance.

  • Round-the-clock help in the home is available, but it is too expensive for many.
  • Individuals who require this level of assistance may need to move from their home to the home of a family caregiver or to an assisted-living facility.
  • Many families prefer these options because they give the individual the greatest possible independence and quality of life.
  1. 2.      Medication for Dementia

The drugs listed here are some of the most frequently prescribed from each class.

  • Cholinesterase inhibitors – Tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), galantamine/galanthamine (Reminyl)
  • Antidepressants/anxiolytics – Fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa)
  • Antipsychotics – Haloperidol (Haldol), risperidone (Risperdal), quetiapine (Seroquel), olanzapine (zyprexa), ziprasidone (Geodon)
  • Anticonvulsants – Valproic acid (Depakote), carbamazepine (Tegretol) gabapentin (Neurontin), lamotrigine (Lamictal)

All drugs cause side effects. In prescribing a drug, doctors weigh whether the benefits of the drug outweigh the side effects. Seniors are especially likely to experience drug side effects. People with dementia who are taking any of these drugs must be checked often to make sure that the side effects are tolerable.

 

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2 thoughts on “Dementia – Significantly impaired intellectual functioning

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