Dementia is a group of symptoms affecting intellectual and social abilities, severely enough to interfere with daily functioning. It is caused by conditions or changes in the brain. Dementia is the loss of mental functions such as thinking, memory, and reasoning that interferes with a person’s daily life and activities, Different types of dementia exist, depending on the cause. Alzheimer’s disease is the most common type. Dementia is a loss of the mind, it could be static which results from global brain injury or it could be progressive which results in long term decline in cognitive function (Hopkins). Dementia indicates problems with at least two brain functions, such as memory loss along with impaired judgment or language. Dementia has never been known to be a disease but a group of symptoms that causes diseases and conditions, some symptoms are changes in personality, mood, and behavior. Dementia can make someone confused and unable to remember the names and important people in their lives like the name of children, husband, sisters and brothers. Some cases of dementia can be treated or cured because the cause is treatable, like dementia caused by substance abuse e.g. street drugs, alcohol, controlled substances, dementia caused by severe depression. This is known as pseudo-dementia (false dementia) and is treatable. In most cases, a true dementia cannot be cured, because of some causes that are curable and partially treated; doctors must be thorough in making the decisions so as not to miss potentially treatable conditions. The frequency of treatable causes of dementia is believed to be about 10 % (WebMD 2010). Dementia is classified as cortical or sub cortical depending on the area that is affected. Cortical dementia affects the cerebral cortex or the outer layer of the brain; the cortex is a sheet of neural tissue that is outermost to the cerebrum of the mammalian brain. It plays a key role in memory, attention, thinking, awareness, consciousness and language.it could lead to problems with memory, thinking, and language, difficulty comprehending written or spoken material. Subcortical dementia results from dysfunction in the other brain areas below the cortex; it is the portion of the brain immediately below the cerebral cortex, this is a categorized dementia which can also bring about memory loss, degradation in thinking ability as well as changes in movement and emotions (Hopkins 2010).

There are some related Dementia; Mild cognitive impairment is a transition stage between the cognitive decline of normal aging and the more serious problems caused by Alzheimer’s disease. This disorder can affect the language, writing and reading and could probably cause memory loss. Vascular dementia is the form of dementia that the condition is more than one; it is a group of syndromes relating to different vascular mechanisms. It is preventable and the early detection and an accurate diagnosis are important. Mixed dementia is a condition in which Alzheimer’s disease and vascular dementia occur at the same time, Dementia with Lewy body is a progressive declined disease or syndrome of the brain with several diseases, especially with two common diseases of older adults, Alzheimer’s and Parkinson’s. Parkinson disease is a degenerative disorder of the central nervous system that often impairs the sufferer’s motor skills, speech, and other functions, Huntington disease, it is a genetically programmed degeneration of nerve cells in certain areas of the brain. This degeneration causes uncontrolled movements, loss of intellectual faculties, and emotional disturbance. Creutzfeldt-jacob disease Creutzfeldt-Jakob disease is a rare, degenerative, neurological disorder that is invariably fatal and incurable. Normal pressure hydrocephalus is a condition in which there is too much cerebrospinal fluid in the ventricles. This occurs when the natural system for draining and absorbing extra cerebrospinal fluid does not work right. Wernicke-korsakoff syndrome is a neurological disorder that could be acute or chronic which is caused by the deficiency in the B vitamin thiamine, Frontotemporal dementia is a degenerative condition of the part of the brain it is a clinical syndrome caused by degeneration of the frontal lobe of the brain and may extend back to the temporal lobe, It is one of three syndromes caused by frontotemporal lobar degeneration. Dementia has lots of symptoms and all varies depending on the cause, the common ones are memory loss, difficulty in performing activities of daily living, inappropriate behavior, aggitation, personality changes, difficulty with coordination and motor function. Dementia can be diagnoses in different ways; the doctor determines the kind of test, it is important for the doctors to rule out the curable dementia, like depression, normal pressure hydrocephalus, or vitamin B12 deficiency which can cause the same symptoms. Early diagnosis and treatment is important for the patient. The different ways of diagnosing is autopsy to confirm or refine the clinical diagnosis of Alzheimer disease, the patient history so as to help the doctor rule out some conditions, physical examination to help the doctor rule out the treatable and curable cause of dementia and identify some other illness in the body which and coincide with dementia, neurological examination to assess the sensory neuron and motor neuron, especially reflexes to determine if the nervous system is functioning and to determine a movement disorder or stroke that may affect the patient’s diagnosis, lab test to rule out some symptoms like kidney failure that could contribute to the cause of dementia, the test includes complete blood count, urinalysis, blood glucose test, cerebrospinal fluid analysis etc. Brain scan to detect abnormalities of the brain the size of 5 mm and larger, it can also be used by doctors to identify stroke, tumor or other problems that causes dementia, there are different kinds of brain scan which are, computed tomography (CT) which combines special x-ray equipment with complicated computers to produce multiple images or pictures of the inside of the brain. These images of the area being studied can then be examined on a computer monitor, printed or transferred to a CD and magnetic resonance imaging (MRI) used in radiology to visualize detailed internal structure and limited function of the body. Psychiatric evaluation used to determine there is depression including sad, hopeless or worthless, or another form of psychiatric disorder which may be contributing to the symptoms of dementia, and presymptomatic testing is used when no treatment available stands in contrast to genetic testing done for the diagnosis of the dementia (White).

There is no specific treatment for dementia; the treatment is to treat the cause. Patient with dementia needs to be under the supervision of medical care to focus on the quality care, medication and treatments such as therapy, and family members to help in activities of daily living, and to help the patient cope with many challenges. The goal of treatment is to control the symptoms of the disease; some patient might be hospitalized for a short period of time. The available drugs that the Food and Drug Administration (FDA) approved to determine the treatment of behavioral disorder in patient with dementia is antipsychotic medication which includes, Risperdal, Seroquel, Zyprexa and Abilify, they are used to reduce the psychotic symptoms of dementia and allow the patient to function effective and appropriately (FDA 2005). Drugs for treatment of dementia should be avoided unless they are really necessary, before any of these drugs are prescribed doctors make sure the patient is physically healthy, comfortable and well taken care of. Some symptoms that also be treated is when patient is pain, have problems with sight and have difficulty hearing, all this can make patient more confused and increase their vulnerability. It is essential for patients to take the drugs exactly as prescribed to make it effective, but if the symptoms are not controlled the doctor may refer the patient to a specialist for further advice. There are some possible side effects of these drugs that may worsen the symptoms which are muscle stiffness, tremor, anemia, depression, heart failure, infection, nutritional disorder, hypoxia and abnormal movements, which must be listed on the drug guide. The doctor usually starts the medication with low dose and gradually increase the dose until the desired outcome is achieved. It is important to inform the doctor about any other drug that the patient is taking to avoid contraindications and once treatment is established it is important to review it regularly. In most cases these drugs should not be prescribed for more than three months and patient should not assume that if the has been proved to be effective does not mean it is going to be effective on them. There are some more drugs that can be prescribed which are mood stabilizer (citalopram, fluoxetine, and imipramine), stimulant (methylphenidate) and serotonin affecting drugs (trazodone, buspirone), information on how to take this drugs must be provided by the doctor or pharmacist.

What is Alzheimer?

Alzheimer’s disease is a brain disorder named after German physician Alois Alzheimer, who first described it in 1906 Alzheimer’s, it is irreversible, slowly progressive disease of the brain that is characterized by impairment of memory and eventually by disturbances in reasoning, planning, language, perception memory and thinking skills, and even the ability to carry out the simplest tasks. It is cited as number one mental health among people age 60 and the risk goes up as you get older. The risk is also higher if a family member has had the disease. Alzheimer is a progressive disorder that starts in the brain in the area that involves thought, memory and language. It is characterized by the stage of increasing impairment and dependency (alz.org2010). People with Alzheimer disease may have trouble remembering things that happened recently or names of people. The earliest sign of Alzheimer disease is behavior such as suspiciousness and a thought process heavily influenced by anxiety or fear, often to the point of irrationality and delusion, angry, outburst, withdrawal. Over the time the symptoms of Alzheimer gets worse, they tends to forget how to speak, write, read, brush their teeth, comb their hair and even forget family members this might make them aggressive, wander around, and get stressed. The cause of Alzheimer disease is unknown but lots of factors have been explored. There is no single test that can detect Alzheimer but the disease is diagnosed by some symptoms, some findings on neurological examination and some result from diagnostic test. The tests show the possible sign and symptoms. The pathological hallmark associated with Alzheimer’s disease is amyloid plaque and neurofibrillary tangles, amyloid is found between nerve cells in the brain. Amyloids are insoluble fibrous protein aggregates sharing specific structural traits that the body produces normally, in an healthy brain the amyloid are broken and diminishes but in an Alzheimer’s disease the amyloid form hard and insoluble plaques. Neurofibrillary tangles are also found in the brain of Alzheimer disease patients, this is the accumulation of twisted protein filaments within neurons of the cerebral cortex; a characteristic pathological feature found in the brains of Alzheimer’s disease patients. In Alzheimer’s disease, there is an overall shrinkage of brain tissue and theories have proved that there is no cure for it. The part of the brain called sulci are widened while the part called gyri shrunk. The ventricle that contains the cerebrospinal fluid is enlarged. The disease Alzheimer is affecting over 5.3 millions of Americans; it cost over $148 billion annually to take care of an Alzheimer’s patient (Alazraki).

In the early stages of Alzheimer’s disease, the short-term memory begins to fade, when the cells in the brain begins to diminishes, the ability to perform routine tasks declines. As Alzheimer’s disease spreads through the cerebral cortex judgment declines, emotional outbursts may occur and language is impaired. As the disease progresses, more nerve cells die, leading to changes in behavior, such as wandering and agitation. In the final stages of the disease, people may lose the ability to recognize faces and communicate; they normally cannot control bodily functions and require constant care.

Physicians discuss with the patient and family which tests are most appropriate to establish the correct diagnosis but there is no test that diagnose Alzheimer disease, but the disease is diagnosed by the symptoms, firstly patients have to complete a physical examination to rule out some symptoms, the patient the patient mental status and neuropsychological will be assessed to determine which thinking and memory function may be affected. The patient may have a psychiatric assessment to rule out some mental illness and depression. The patient may be asked to do a brain scan (MRI, CT scan, and PET scan) to help detect signs and symptoms of stroke that can bring changes to the structure of brain associated with thinking. Blood test may be ordered to check for infection, kidney and liver function, electrolyte level, thyroid disorder and other factors that can cause memory loss. Other tests that sometimes provide important diagnostic information include electroencephalogram (EEG), urine tests, and tests on cerebrospinal fluid (CSF) obtained by a lumbar puncture. The possible drugs approved by the Food and Drug Administration (FDA) are tacrine which should be taken on an empty stomach, one hour before, or two hours after meals. If stomach upset occurs, it may be taken with meals; however, food can decrease tacrine blood levels significantly. The possible side effect of this drug is diarrhea, nausea, vomiting, muscle ache and loss of appetite. Donepezil is expected to delay the onset of Alzheimer disease for about one year in people suffering from mild cognitive impairment; it belongs to a class of drugs called cholinesterase inhibitors, it inhibits acetylcholinesterase, an enzyme responsible for the destruction of one neurotransmitter, acetylcholine. The possible side effects associated with this drug include headache, generalized pain, fatigue, nausea, vomiting, loss of appetite, weight loss, dizziness, muscle cramping, joint pain, diarrhea, insomnia, and increased frequency of urination. Namenda was actually prescribed for moderate to severe stage Alzheimer disease but now is being prescribed even in earlier stages of the disease, Namenda is an orally active receptor antagonist that regulates the activity of glumate in the brain. Cholinesterase inhibitors are used to treat cognitive functions and behavioral symptoms in Lewy body disease. Clonazepam is a benzodiazepine derivative with anticonvulsant and muscle relaxant, it is generally considered to be among the long-acting benzodiazepines and Opiate drugs used to relieve pain. Antipsychotic drugs not approved by FDA are sometimes used to treat agitation include, Risperidone Benzodiazepines and drugs such as Olanzapine , Quetiapine , Ziprasadone .The drugs increase the risk of death in elderly patients and the side effects include sedation, confusion and increased muscle tone.

CITATION

Charles L. White, “Autopsy for dementia” 2010

Croft, Harry.” Psychiatric medication” medication for mental illness http://www.healthplace.com/otherinfo/psychiatric-disorder-definations/medication. 5 may 2010

Alazraki, Melly. “Nothing you can do will help” daily finance 5/01/10. 11.00am http://www.dailyfinance.com/story/nih-on-alzheimer-much/19460466/mellyalazraki

Hopkins, John. Special Report. 7thth ed. New York: new York Times, 2009. Print. Kesner, Julian. “Three new dementia fighters.” Prevention Jan. 2009: 104. Professional Collection. Web. 04 May, 2010

Webmd.com 2010