Dementia: cognitive impairment chronic > Health and Wellness.

What is dementia?

Dementia is a chronic deterioration of at least three higher functions (at the start, finally usually alter the intellectual functions), purchased (main difference with mental retardation, since this usually arise from childhood), and with a level of awareness and attention normal (unlike the delirium, in which there is a decreased level of consciousness). The diagnosis usually occurs when the patient takes three months presenting a set of signs and symptoms that respond to these changes.
Dementias undertake intellectual faculties of those affected such as language, memory, and visuospatial skills, as well as their emotional ability and personality.
Dementia affects 2% of persons aged 65-70, and 20% of those older than 80 years. It is the leading cause of long-term disability in the elderly, which is an important public health problem, taking into account the increase in the life expectancy in the developed societies.

Types of dementia

There are varied types of dementia. These are the most common:

• Alzheimer's disease
• Fronto-temporal dementia (or Pick's disease)
• Vascular dementia
• Multi-infarct dementia
• Binswanger disease
• Lewy body dementia

Alzheimer's disease

It is the most common cause of dementia in the West. The onset of symptoms usually occurs beginning at age 65, but in some patients it may occur before age 40 (in which case is usually associated with hereditary forms of the disease, which can occur in 25% of cases).
At the beginning the clinic is limited to occasional lapses of memory, but then sets an alteration of recent memory (capacity to store new information and retrieve it after a period of time) and learning ability, and with the passage of time remote memory will also be lost (to recall distant events).
To learn more, see the section dedicated to Alzheimer's disease.
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Fronto-temporal dementia (Pick's disease)

It is a degenerative alteration, characterized by the presence of abnormal substances, which are referred to as bodies and Pick cells, in the interior of some neurons located in the frontal and temporal lobes.
It typically affects patients in the ages of life; so, it is more frequent in patients dementia aged between 45 and 65 years old.
It is usually a dementia progressing slowly, and the main clinical alteration is in the sphere of personality; the most striking symptoms are:

• Difficulties in social relations, which leads to isolation.
• Compulsive and inappropriate behavior in different environments.
• Alterations in the control of emotions.
• Loss of executive capabilities.
• Involvement of the language from the early stages of the disease, which may be the first noticeable symptom.
• Deterioration of the ability to read and write, as well as decrease in vocabulary.
• Abrupt changes in mood.
• Muscle stiffness.
• Advancing disease, apathy is the symptom that dominates in the clinic.
• Alterations in recent memory and learning ability are usual.

The diagnosis is based on the symptoms presented by the patient, since the compulsive behavior and emotional alterations are evident from the beginning of the disease. Tests that may be performed include: magnetic resonance imaging of the brain, electroencephalography (EEG), examination of the cerebrospinal fluid, computed tomography of the head, etc.
Cure for this disease, which comes to completely incapacitate the patient is no known. Treatment they used antidepressants and antipsychotic drugs to control the emotional ups and downs of the sick, as well as those drugs that help relieve other associated disorders like nutrition and thyroid problems, depression, infections, anemia, etc.
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Vascular dementia

Vascular dementia are due to a stroke that causes the blood circulation to stop water a part of the brain, which causes the death of the affected neurons.
This is one of the few dementia that can be prevented, avoiding or controlling the risk factors such as high blood pressure, hypercholesterolemia, which can cause atherosclerosis or diabetes, to reduce the chances of suffering from it in the future.
Indeed, there are studies showing that proper treatment of hypertension reduces the presence of impairment congnitivo and the risk of dementia.
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Multi-infarct dementia

As its name suggests, this dementia is multi-infarct or cerebral embolism, which can be asymptomatic, and that leave residual infartadas areas.
His home is usually abrupt, especially if it occurs after one of these strokes, and are usually neurological symptomatology companion as a sequela of ischemic accident.
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Binswanger disease

Subtype of vascular dementia, which is due to high blood pressure and atherosclerosis, so it is also known as atherosclerosis subcortical encephalopathy.
This insanity is due to degeneration of the white matter of the brain cause of occlusion of cerebral blood vessels, which limits the amount of blood reaching the brain in general, and white matter in particular. Brain cells deprived of oxygen, they deteriorate and die, which causes dementia.
Risk factors that increase the chances of occurrence of this disorder are:

• High blood pressure.
• Atherosclerosis (hardening of the blood vessels).
• Cardiovascular diseases.
• Diabetes.

The symptoms usually occur gradually, worsening progressively although, occasionally, they stabilize and even improve. The main manifestations of this disease are:

• Alteration of the March (more slow and unstable).
• Loss of memory.
• Progressive deterioration of cognitive, motor and intellectual faculties.
• Difficulties to express themselves.
• Depression.
• Incontinence.
• Loss of coordination, tremors...
• Apathy.
• Disorientation.
• Paralysis on one side of the body.

The diagnosis is determined through tests such as magnetic resonance imaging and computed tomography of the brain. You can also be a photo simple emission computed tomography (SPECT according to its acronym in English), which aims to identify the function of the cerebral white matter degeneration.
No known cure for this disease, and drugs that are administered to the patient aim to control the pathologies associated with hypertension, hypercholesterolemia and depression, as well as decrease the risk of stroke.
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Lewy body dementia

It is the third leading cause of dementia in the elderly, after ad and vascular dementia and, as its name suggests, the typical characteristic is the presence of so-called Lewy bodies, which are abnormal protein deposits scattered throughout the brain, affecting on the functions of certain neurotransmitters, altering perception, thinking and behavior of those affected.
Symptoms:

• Slowly progressive cognitive impairment. Cognitive fluctuations are typical data of this disease, and are mainly based on the State's attention and alert.
• Visual hallucinations are also features, as well as alterations of sleep (in the phase of muscle relaxation these patients tend to have lots of activity).
• The patient may also have auditory, olfactory, tactile and gustatory hallucinations.
• Changes in mood and behavior (sadness, depression, anger, lack of initiative...).
• Trembling, and other symptoms like weakness and muscle stiffness may be and unsteady gait, make difficult times the differential diagnosis of Parkinson's disease.

The diagnosis includes physical and neurological examinations assessing capacity functional and expressive of the patient, his memory, and other skills, as well as perform tests such as CT or MRI. However, the only definitive diagnosis is obtained after the death of the patient, to perform an autopsy.
No known cure for this insanity and the treatment should be customized because the disease causes sensitivity to certain drugs.

Causes of dementia

Dementias can be degenerative, when there is a progressive and irreversible death of the neurons (such as in the case of Alzheimer's disease), and no degenerative when loss of neurons can be stopped, such as in the case of dementia caused by alcohol abuse, where the loss of neurons ends when the patient stops consuming alcohol (although not recover the neurons that have already been destroyed). Also be considered primary when dementia is, in itself, the main disorder presenting patient; and secondary, when the deterioration of intellectual function occurs as a result of other factors such as head trauma, intoxication by alcohol, drugs or drugs, a deficit of vitamins, or dementia is associated with other pathology (as AIDS, Creutzfeld-Jakob disease, parkinson...).
The most frequent reasons for dementia are:

• Alzheimer's disease (50-90%).
• Multiple cerebral infarctions (5-10%).
• Alcoholism (5-10%).
• Endocrino-metabolicos disorders, such as hypothyroidism and deficiency of vitamin B12.
• Brain disorders, such as neoplasms, bruises...
• Other degenerative diseases, such as the Pick, parkinson, Huntington.
• Infections of the CNS.

Most dementias are irreversible and have no cure, though the accompanying symptoms can be treated. It is very important to find out if the cause of dementia is treatable, since about 10% of dementias are reversible if treated in time, in another 10% you can stop the progression of the disease, and another 10% is due to psychiatric causes (pseudodemencias).

Treatable causes

• Vascular dementias, due to an insufficient cerebral blood flow.
• Post-traumatic dementia.
• Dementia as a result of alcohol abuse.
• Metabolico-carenciales diseases: thyroid disorders, deficiency of vitamin B12, folate, and vitamin B1, alterations in the regulation of calcium...
• Inflammatory and infectious, diseases such as meningitis, syphilis, vasculitis...
• Intracranial process.
• Depression.

Not treatable and irreversible causes

• Degenerative diseases.
• Infectious diseases, such as AIDS.

Symptoms of dementia

The first symptoms of dementia are mild and rare times are associated with a possible disease. The patient has a slight deterioration of memory, mistaken for fatigue on many occasions, but he may not be aware of these oversights. They tend to be coworkers or family, those who see a loss of efficiency, a greater number of errors, and a greater reliance on agendas and annotations to remember tasks (mild dementia).
Later the patient with dementia have difficulty maintaining their social relations, forget names, quotes or conversations, it repeats several times the same question because it does not hold the answers... The patient is ever more disoriented, fails simple commitments, and may result in loss to make regular tours (moderate dementia).
Every day he forgets more events and shows more indifferent toward the environment and society in general, begins to need help to carry out the basic activities of daily living, and has serious problems with language; It also presents sudden changes in mood and emotional disorders. Finally, they lose all the mental faculties do not recognize family members and are totally dependent (severe dementia).
The main symptoms that manifest the majority of people with severe dementia are:

• They lose the notion of their own identity and time.
• They have hallucinations and delusions, and sometimes your behavior is violent.
• They cannot be themselves simple and routine tasks.
• Your sleep patterns are altered, and wake up frequently during the night.
• They often suffer incontinence.
• They may have trouble swallowing.
• It is difficult to communicate with them because they don't understand the language, and talk in a confusing manner, or do not use the words correctly.

Patients often die from pneumonia or another infection because, after 5-10 years of evolution of the disease, its defenses are diminished.

Diagnosis of dementia

Diagnosis is mainly clinical: physician develop a complete medical history, and inquire about possible family history.
Most dementias are due to degenerative processes, but the loss of brain mass (cerebral atrophy) is not synonymous with dementia.
Many test have been developed to assess cognitive impairment, and most used is currently the minimental test that quickly allows you to assess memory, temporo-spatial orientation, language, writing, reading, calculation, and visuospatial and ideomotoras actions. It is scored from 0 to 30 points, whereas normal 27 to 30 points, and dementia under 24 points.
Memory loss is the most common sign early, but is usually attributed to the age or they underestimated its importance, so that from the onset of symptoms until the patient is diagnosed sometimes arrive to spend up to two years. Family members tend to be the first to detect that a problem exists, it is therefore advisable to consult with a specialist if you look at any suspicious behavior on your loved ones.

Treatment of dementia

Some dementias can be cured (see types). In that case, the treatment will be focused to cure disease or eliminate the problem that has caused the dementia, as it is the case with alcohol abuse, a brain tumor, a metabolic disorder... However, in those cases in which is a degenerative and irreversible process, the goal of treatment is to relieve the symptoms of the disease, and should be customized depending on the type of dementia and symptoms that the patient manifests.
The treatment of other conditions, associated or not to dementia, such as anemia, depression, nutritional deficiencies, thyroid disorders or infections, can also improve or reduce the symptoms of the disease.
In general, tend to use medications to control behavior problems arising from the loss of cognitive abilities of the subject, which aim to reduce the confusion, impulsiveness, anxiety, and even the aggressiveness of patients, such as:

• Antipsychotics (haloperidol).
• Antidepressants (fluoxetine, citalopram, paroxetine).
• Sedative or Neuroleptics (risperidone, olanzapine).
• Drugs that Act on serotonin (trazodone).
• Anxiolytic (alprazolam, diazepam).
• Benzodiazepines, to alleviate disorders of sleep (lorazepam, triazolam).
• Inhibitors of acetylcholinesterase (donepezil, galantamine).

Psychotherapy is not effective for these patients, since it can generate anxiety and greater confusion.
It is important to note that patients with mild cognitive impairment do not have why to develop dementia. However, the prognosis for patients with dementia is not good, since they tend to get worse and suffer a physical impairment that significantly reduces its quality and life expectancy. In paragraph recommendations offer a number of tips which facilitate the task of the caretaker and contribute to improving the safety of patients.

Recommendations for the caregiver

If you care to care for a family member or person who suffer dementia, here are some tips that will be of help in your work:

• It is important to adapt housing and the environment of the patient, in accordance with the evolution of the disease.
• Establish habits and schedules for the sick not trash it.
• Have the House tidy and avoid carpet or furniture which can trip.
• Place to view calendars and clocks.
• The clothes and shoes should be comfortable and also easy to apply and remove.
• Preserve to maximize their independence and privacy, but overseeing their activities to prevent accidents.
• Stored in inaccessible places for the sick objects or substances which can be dangerous for him.
• Placed in the bathtub or shower grab bars and non-slip mat.
• Not lead to noisy and crowded places because it could alter.
• Do not yell or push him. Talk slowly and clearly and concisely as possible.
• It is important for the caregiver to come in contact with others in the same situation, associations or groups of support, which can provide psychological support, and inform you of your right to receive certain benefits as the home help.
• Refer to the possibility of the patient to attend a day centre, which will deal with it for a few hours, and the patient can follow therapies that help delay the progression of the disease.

Published for educational purposes