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Dementia-Symptoms, Causes and Management

Dementia

Consider James, a 68-year-old university professor  who was observed  by relatives to be forgetting important dates. He often forgot dates of significant family events and struggled to follow simple conversations in the home. On several occasions, he wandered away from home only to get lost in familiar areas. One evening, he went out to buy groceries across the road, but got lost and had to spend the entire night outside! His colleagues later realized he could only describe his job by title only. He could not also remember the name of his university or the subject he taught. Eventually, he required assistance in shaving, bathing and dressing.  After another incident of wandering away from home, James was taken to a neurologist who made a diagnosis of Alzheimer’s dementia.
What is dementia?
Generally, it is defined as a progressive loss of intellectual functions in an individual that is awake and alert. This is seen as difficulty with memory, attention, thinking, and comprehension. Other mental functions can often be affected, including mood, personality, judgment, and interactions with other.
How common is this disease?
The prestigious journal of the Alzheimer’s association reported that about 40 million persons had dementia as at 2010. More than 2 million persons with dementia are cared for in nursing homes.
The prevalence of the disorder is expected to double by 2030. According to World health Organization, up to 7.7 million new cases are expected yearly. So, a new case of dementia occurs every four seconds! This shows that it is an increasingly important problem with huge socioeconomic burden.
What are the causes of Dementia?
Alzheimer’s disease is the commonest cause of dementia. It was first described in 1907, by Alois Alzheimer, who reported the case of Auguste D, a woman with early onset dementia whose brain had unusual pathological features. It was Alzheimer’s colleague, Emil Kraepelin, who named the disease after the discoverer. The other common causes of dementia are Stroke, fronto-temporal dementia, Parkinson’s disease, dementia pugilistica commonly seen in boxers and in those with repeated head injury . In a few cases, infection or vitamin deficiencies may be the cause.
What are the signs and symptoms?
• The first evidence of the condition is often minor forgetfulness which progresses gradually over 1–2 years. There is increasing memory disturbance resulting in difficulties in managing day to day activities at home and workplace.
• Difficulty in remembering places results in wandering and getting lost in familiar environment.
• Poor sense of time gives rise to poorly kept appointments.
• Sudden outbursts known as ‘Catastrophic reaction’ may occur. This may occur when the individual is overwhelmed.
• Behavioral changes also occur, manifesting as restlessness and aggression (both verbal and physical).
• Sleeping and eating patterns may become unpredictable. If unchecked, they may become poorly nourished.
• Interest in sexual activities usually wanes. However, in some cases the individual become dis-inhibited and may become more active sexually.
• Self-care and social behavior decline.
• Depressive symptoms such as loss of interest, reduced energy and low mood occur occasionally.
• Delusions and hearing voices of unseen people may also occur.
Who are those at risk of Alzheimer’s dementia?
A number of risk factors have been identified. According to the National Institute on Aging some common factors associated with dementia include:
• Advancing age. Generally persons that are 60 years old and above are at risk.
• Heavy Alcohol use and smoking. While moderate drinking may be protective, prolonged and heavy drinkers are at risk. Smoking may limit blood flow to the brain and may increase the risk.
• Family history. Some types of dementia run in families.
• Some health conditions such as Down syndrome, Diabetes, Hypertension, Atherosclerosis, Stroke, Depression and Head injury have all been linked with dementia.
How is it managed and treated?
At present, there is no cure for Alzheimer’s dementia. Nevertheless, clinicians may prescribe medications that improve cognitive functions or slow down rate of deterioration.
Medications may also be needed to manage aggression or agitation.
The care of patients with Alzheimer’s dementia is multidisciplinary, usually undertaken by a team comprising a geriatrician (in most cases a psychiatrist), neurologist, psychologist, nurses, occupational therapist and other support staffs.
Carers of persons with dementia bear a huge burden. It is important to obtain adequate information and receive training. Support groups like Alzheimer’s association have a lot of resources and are readily available to help carers.

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