Transcript of "Learning Issue: Name: Dementia Definition Dementia describes a ..."
Learning Issue: <br />Name: Dementia<br />DefinitionDementia describes a group of symptoms that are caused by changes in brain function.Causes Most types of dementia are nonreversible (degenerative). Nonreversible means the changes in the brain that are causing the dementia cannot be stopped or turned back. Alzheimer's disease is the most common type of dementia.Lewy body disease is a leading cause of dementia in elderly adults. People with this condition have abnormal protein structures in certain areas of the brain.Dementia also can be due to strokes. This is called vascular dementia.The following medical conditions also can lead to dementia:Parkinson's diseaseMultiple sclerosisHuntington's diseasePick's diseaseProgressive supranuclear palsyInfections that can affect the brain, such as HIV/AIDS and Lyme diseaseSome causes of dementia may be stopped or reversed if they are found soon enough, including:Brain tumorsChanges in blood sugar, sodium, and calcium levels (see: Dementia due to metabolic causes)Low vitamin B12 levelsNormal pressure hydrocephalusUse of certain medications, including cimetadine and some cholesterol-lowering medicationsChronic alcohol abuseDementia usually occurs in older age. It is rare in people under age 60. The risk for dementia increases as a person gets olderRisk FactorsAn example of risk factors for dementia that cannot change involves getting older (the risk of dementia tends to increase with age). Other dementia risk factors you cannot control include having: A family history of dementia Down syndrome Mild cognitive impairment History of a stroke. Dementia risk factors that can be controlled include: High blood pressure (hypertension) High cholesterol (hypercholesterolemia) Diabetes Atherosclerosis Smoking Heavy alcohol use. Homocysteine levels in the blood. PathophysiologyTypically, extracellular β-amyloid deposits, intracellular neurofibrillary tangles (paired helical filaments), and senile plaques develop, and neurons are lost. Cerebrocortical atrophy is common, and use of cerebral glucose is reduced, as is perfusion in the parietal lobe, temporal cortices, and prefrontal cortex.Other common abnormalities include increased brain and CSF concentrations of the tau protein (a component of neurofibrillary tangles and β-amyloid) and reduced levels of choline acetyltransferase and various neurotransmitters (eg, somatostatin).Signs and SymptomsDementia symptoms include difficulty with many areas of mental function, including:Language, Memory, Perception, Emotional behavior or personality, Cognitive skills (such as calculation, abstract thinking, or judgment).Dementia usually first appears as forgetfulness.Other symptoms that may occur with dementia: Incontinence, Swallowing problemsDiagnostic TestingDementia can often be diagnosed with a history and physical exam. A health care provider will take a history, do a physical exam (including a neurological exam), and perform some tests of mental function called a mental status examination.The health care provider may order tests to help determine whether other problems could be causing dementia or making it worse. These conditions include:Thyroid diseaseVitamin deficiencyBrain tumorIntoxication from medicationsChronic infectionAnemiaSevere depressionThe following tests and procedures may be done:B12 levelBlood ammonia levelsBlood chemistry (chem-20)Blood gas analysisCerebrospinal fluid (CSF) analysisDrug or alcohol levels (toxicology screen)Tests for exposure to metals such as lead or arsenicElectroencephalograph (EEG)Glucose testHead CTLiver function testsMental status testMRI of headSerum calciumSerum electrolytesThyroid function testsThyroid stimulating hormone levelUrinalysisMedications/ Treatment planMeasures to ensure safetyProvision of appropriate stimulation, activities, and cues for orientationElimination of drugs with sedating or anticholinergic effectsPossibly cholinesterase inhibitorsAssistance for caregiversArrangements for end-of-life carThe goal of treatment is to control the symptoms of dementia. Treatment depends on the condition causing the dementia. Some people may need to stay in the hospital for a short time.Stopping or changing medications that make confusion worse may improve brain function.There is growing evidence that some kinds of mental exercises can help dementia.Treating conditions that can lead to confusion often greatly improve mental functioning. Such conditions include:AnemiaDecreased oxygen (hypoxia)DepressionHeart failureInfectionsNutritional disordersThyroid disordersMedications may be needed to control behavior problems caused by a loss of judgement, increased impulsivity, and confusion. Possible medications include:Antipsychotics (haloperidol, risperdal, olanzapine)Mood stabilizers (fluoxetine, imipramine, citalopram)Serotonin-affecting drugs (trazodone, buspirone)Stimulants (methylphenidate)Certain drugs may be used to slow the rate at which symptoms worsen. The benefit from these drugs is often small, and patients and their families may not always notice much of a change.Donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne, formerly called Reminyl)Memantine (Namenda)A person's eyes and ears should be checked regularly. Hearing aids, glasses, or cataract surgery may be needed.Psychotherapy or group therapy usually does not help because it may cause more confusionQuestions for PatientHow it relates to patientSamuel is forgetful and his behavior has changed from usual<br />3 main points for this learning issue:<br />Sources:<br />http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-1-4160-6231-8..10052-2&isbn=978-1-4160-6231-8&sid=1048767266&type=bookPage§ionEid=4-u1.0-B978-1-4160-6231-8..10052-2&uniqId=217512642-17#4-u1.0-B978-1-4160-6231-8..10052-2<br />http://www.merck.com/mmpe/sec16/ch213/ch213c.html#sec16-ch213-ch213c-128<br />