diease

Dementia


OVERVIEW OF Dementia :

     It is a neurological in which the brain cells become inactive and results in dementia and impaired cognitive functions. The main cause for the Dementia is Dementia’s disease.


EPIDEMIOLOGY :

It accounts for the 60-70 % of the dementia cases and it is uncommon under the age of 45 yrs.


CAUSES :

Age:it usually starts after 65 yrs

Gender:women get the disease commonly when compared to men

Familial/Genetic:Previous familial history of the disease with parents or siblings may leads to dementia;the gene known as apolipoprotein E(APOE) increases the risk of the disease.

Down’s syndrome:people with this syndrome tens to have dementia in their 30-40s.

Alzheimer's disease

Head Injury : some studies suggest that previous history of head injury may be linked with dementias disease.

Poor sleep habits

Heart diseases and stroke

Structure of brain:

The brain is divides into frontal lobe,parietal lobe, occipital lobe and temporal lobe.


PATHOPHYSIOLOGY :

It is caused by the abnormal build up of proteins in the brain.The buildup of protein called amyloid protein and tau protein leads to the death of the brain cells.Amyloid proteins build up in the surface of the brain forming larger masses of cells called plaques.Twisted protein of another protein which is termed as tau results in tangled structure of protein.These plaque and tangled blocks the synaptic communication between the nerve cells and results is loss of brain function and prevents the brain from carrying out its action.This leads to the programmed cell death in the indivduals with deposition of amyloid fibrils in their brain.The slow and ongoing death of the cells starting in one area of the brain eventually sprading to other areas usually starts in the area which controls the memory and leading to the cause of the Dementia’s disease.

Mild stage:

greater memory loss and impaired cognitive functions.Wandering and getting lost,repeating the questions,difficulty in paying bills and collecting money,feeling difficult to do day to day activities,personality and behavioural changes.patients are often diagnosed in this stage

Moderate stage:

In this stage the damage occurs to the brain cell that controls the language,reasoning,sensory processing and consciousness.Memory loss and confusion grows and the patients loss the ability to recognize the family and friends.The person find difficulty in dressing and to cope up with the new situations,inability to do multistep task.The patient might experience hallucinations,delusions and paranoia.

Severe stage:

The amyloid and tau tangles covers the brain and leads to shrinkage of the brain.Loss of communication and the patient is completely depend on the other for their survival.the patient is mostly bed ridden at this stage and he/she is nearer to death.


COMMON CLINICAL SIGNS AND SYMPTOMS :

Inability to recall the past events

Difficulty to recognize the family members

Difficult in finding the words and reading

Spatial or vision issues

Impaired reasoning /judgement skills

Movement difficulties and problems linked to smell perception is also seen in some cases

 


DIAGNOSTIC :

It is usually diagnosed with the history of the patient and behavioural changes and impaired cognitive functions.

Magnetic resonance imaging-MRI

Computed tomography-CT

Single photon emission computed tomography

Electroencephalogram(EEG): the doctors might suggest EEG to detect any abnormalities in the brain.

Imaging tests: CT scan, MRI scan SPECTs and  PET scans help doctors locate the tumor and determine if it is cancerous or benign.

Neurological exam: During a neurological exam, your doctor will look for changes in your balance, coordination, mental status, hearing, vision and reflexes. These changes can point to the part of your brain that may be affected by a tumor.

Spinal tap:A doctor uses a small needle to remove fluid from around the spine. A laboratory examines this fluid to look for cancer cells. It is also known as lumbar puncture.

Single photon emission computed tomography

Positron emission tomography :it is used in early diagnosis of Dementia disease.

Biomarker tests. A biomarker is a biological factor that can be measured to indicate the presence or absence of disease or the risk of developing a disease. The biomarker for Dementia disease is the beta amyloid,tau proteins and phsopho tau which are detected in the CSF 

Neuropsychological test mainly to observe cognitive functions is done with MINI MENTAL STATE EXAMINATION


TREATMENT AND PROGNOSIS :

The treatment purely depends upon the mediactions.

Psychotherapy: providing support to the patients verbally.

Medications used to treat the cognitive problems of Dementia's disease include: four  acetylcholinesterase inhibitors (tacrinerivastigminegalantamine, and donepezil) and memantine, an NMDA receptor antagonist.

Memantine is believed to work by regulating glutamate, an important brain chemical. When produced in excessive amounts, glutamate may lead to brain cell death. Because NMDA antagonists work differently from cholinesterase inhibitors, the two types of drugs can be prescribed in combination.

The FDA has also approved donepezil, the rivastigmine patch, and a combination medication of memantine and donepezil for the treatment of moderate to severe Dementia’s.

Donepezil:

Acetylcholinesterase inhibitor. It is prescribed as it prevents the breakdown of the acetylcholine in brain.

Rivastigmine:

It prevents the breakdown of butyrl cholinesterases.

Common behavioral symptoms of Dementia’s include sleeplessness,wandering,agitation anxiety, aggression, restlessness, and depression. Scientists are learning why these symptoms occur and are studying new treatments — drug and nondrug — to manage them. Research has shown that treating behavioral symptoms can make people with Dementia’s more comfortable and makes things easier for caregivers.


PROGNOSIS :

A patient  with dementia disease tends to survive five to eight years after the diagnosis and this time period might increase depending upon the several factors.Patient with alzheiner tends to behave aggressive,paranoia and anxiety.


PREVENTION :

Create positive environment

Stay mentally active: play crossword,puzzle and other brain active games.

Get physically active:it increases the blood flow to the brain and keeps the brain active.

Create stress free environment.


Medicines used in the Treatment :

donepizil

rivostigmine


REFERENCE :

http://medicinenet.com

http://cdcgov.in

http://who.in

Davidson principle and practice of general medicine-22nd edition

http://ncbi.gov.in

http://sciencedirect.in