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DEMENTIA The word dementia comes from the Latinde meaning "apart" and mens from the genitive

mentis meaning "mind". Dementia is the progressive deterioration in cognitive function - the ability to process thought (intelligence). Dementia is not a specific disease. It's an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities.It is often incorrectly referred to as "senility" or "senile dementia," which reflects the formerly widespread but incorrect belief that serious mental decline is a normal part of aging. Symptoms of Dementia Memory loss - the patient may forget his way back home from the shops. He may forget names and places. He may find it hard to remember what happened earlier on during the day. Moodiness - the patient may become more and more moody as parts of the brain that control emotion become damaged. Moods may also be affected by fear and anxiety - the patient is frightened about what is happening to him. Communicative difficulties - the affected person finds it harder to talk read and/or write. Types of Dementia Alzheimers Disease Alzheimers Disease is the most common type of dementia; accounts for 60 to 80 percent of cases. Difficulty remembering names and recent events is often an early clinical symptom; later symptoms include impaired judgment, disorientation, confusion, behavior changes and trouble speaking, swallowing and walking. Hallmark abnormalities are deposits of the protein fragment beta-amyloid (plaques) and twisted strands of the protein tau (tangles). Frontotemporal Dementia Involves damage to brain cells, especially in the front and side regions of the brain. Typical symptoms include changes in personality and behavior and difficulty with language. No distinguishing microscopic abnormality is linked to all cases. Picks disease, characterized by Picks bodies, is one type of frontotemporal dementia. Vascular Dementia Vascular Dementia is considered to be the second-most-common type of dementia. Impairment is caused by decreased blood flow to parts of the brain, often due to a series of small strokes that block arteries. Symptoms often overlap with those of Alzheimers, although memory may not be as seriously affected. Dementia with Lewy Bodies

Pattern of decline may be similar to Alzheimers, including problems with memory, judgment and behavior changes. Alertness and severity of cognitive symptoms may fluctuate daily. Visual hallucinations, muscle rigidity and tremors are common. Hallmarks include Lewy bodies (abnormal deposits of the protein alphasynuclein) that form inside nerve cells in the brain. Normal Pressure Hydrocephalus Normal pressure hydrocephalus (NPH) is caused by the buildup of fluid in the brain. Symptoms include difficulty walking, memory loss and inability to control urine. NPH can sometimes be corrected with surgical installation of a shunt in the brain to drain excess fluid. Mild cognitive impairment (MCI) is a condition in which a person has problems with memory, language or another essential cognitive function that are severe enough to be noticeable to others and show up on tests, but not severe enough to interfere with daily life. Some people with mild cognitive impairment go on to develop dementia. For others, the symptoms of mild cognitive impairment do not progress to dementia, and some people who have mild cognitive impairment at one point in time later revert to normal cognitive status. Mixed dementia Mixed dementia is characterized by the presence of the hallmark abnormalities of Alzheimers and another type of dementia, most commonly vascular dementia, but also other types, such as dementia with Lewy bodies, frontotemporal dementia and normal pressure hydrocephalus. Parkinsons disease Many people who have Parkinsons disease develop dementia in the later stages of the disease. The hallmark abnormality is Lewy bodies (abnormal deposits of the protein alpha-synuclein) that form inside nerve cells in the brain. Creutzfeldt-Jakob disease Rapidly fatal disorder that impairs memory and coordination and causes behavior changes. Variant Creutzfeldt-Jakob disease is believed to be caused by consumption of products from cattle affected by mad cow disease. Caused by the misfolding of prion protein throughout the brain.

There are two main categories of dementia According to most experts, there are two main categories of dementia - cortical and subcortical dementias. Cortical Dementia - The cerebral cortex is affected. This is the outer layer of the brain. The cerebral cortex is vital for cognitive processes, such as language and memory. Alzheimer's disease is a form of cortical dementia, as is CJD (Creutzfeldt-Jakob disease).

Subcortical Dementia - A part of the brain beneath the cortex (deeper inside) becomes affected or damaged. Language and memory are not usually affected. A patient with subcortical dementia will usually experience changes in his personality, his thinking may slow down, and his attention span may be shortened. Dementias which sometimes result from Parkinson's disease are subcortical dementias, as are those caused by AIDS and Huntington's disease. Diagnosis of dementia Dementia is diagnosed by using many methods such as patient's medical and family history, physical exam, neurological evaluations, cognitive and neuropsychological testing, CT's, MRI's and other brain scans, mental status exams, electroencephalograms, blood tests, psychiatric evaluations, and even some pre-symptomatic tests are available for some patients that may have a genetic link to dementia. The following tests are commonly used:

AMTS (Abbreviated Mental Test Score) A score lower than six out of ten suggests a need for further evaluation. MMSE (Mini Mental State Examination) A score lower than twenty-four out of thirty suggests a need for further evaluation) 3MS (Modified Mini-Mental State Examination) CASI (Cognitive Abilities Screening Instrument)

Treatments and drugs Most types of dementia can't be cured. However, doctors will help you manage your symptoms. Treatment of dementia symptoms may help slow or minimize the development of symptoms.

Cholinesterase inhibitors. These medications including donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) work by boosting levels of a chemical messenger involved in memory and judgment. Side effects can include nausea, vomiting and diarrhea. Although primarily used to treat Alzheimer's disease, these medications may also treat vascular dementia, Parkinson's disease dementia and Lewy body dementia.

Memantine. Memantine (Namenda) works by regulating the activity of glutamate. Glutamate is another chemical messenger involved in brain functions, such as learning and memory. A common side effect of memantine is dizziness. Some research has shown that combining memantine with a cholinesterase inhibitor may have beneficial results.

Other medications. Your doctor may prescribe other medications to treat other symptoms or conditions, such as a sleep disorder. Occupational therapy. Your doctor may suggest occupational therapy to help you adjust to living with dementia. Therapists may teach you coping behaviors and ways to adapt movements and daily living activities as your condition changes.

Therapies Several dementia symptoms and behavior problems may be treated initially using nondrug approaches, such as:

Modifying the environment. Reducing clutter and distracting noise can make it easier for someone with dementia to focus and function. It also may reduce confusion and frustration. Modifying your responses. A caregiver's response to a behavior can make the behavior, such as agitation, worse. It's best to avoid correcting and quizzing a person with dementia. Reassuring the person and validating his or her concerns can defuse most situations.

Modifying tasks. Break tasks into easier steps and focus on success, not failure. Structure and routine during the day also help reduce confusion in people with dementia.

Precious Anne T. Madreo SN DOMC