Introduction 1

Introduction 1 1 Introduction SENILE DEMENTIA: OVERVIEW Senile dementia is a disease caused by degeneration of the brain cells. It is different from normal senility in the elderly in that the patient’s brain function will gradually deteriorate resulting in progressive loss of memory and mental abilities, and noticeable personality changes. Causes and Development Dementia is always caused by an underlying disease or condition. Brain tissue is damaged, and functioning is diminished. The most common cause of dementia is Alzheimer’s disease, a progressive brain disorder causing deterioration in memory and thought processes. Causes include: • Alzheimer’s disease • Vascular dementia, the second most common cause of dementia, accounting for up to 20% of all dementias • Huntington disease, a progressive degenerative disease that causes dance-like movements and mental deterioration • Atherosclerosis, or hardening of the arteries • Multiple sclerosis, a disorder of the sheath that lines the brain and spinal cord • HIV, the immunodeficiency disorder that leads to AIDS 2 Diagnosis and Treatment of Senile Dementia • Parkinson’s disease, a degenerative disorder of part of the nervous system • Creutzfeldt-Jakob disease, a rapidly progressing degenerative disorder of the nervous system causing problems with walking, talking, and the senses • Pick’s disease, a disorder of the brain that causes slowly progressing dementia • Viral or bacterial encephalitis, an inflammation of the brain • Lewy body disease, a degenerative disease of the nervous system • Normal pressure hydrocephalus, or increased cerebrospinal fluid in the brain • Chronic subdural hematoma, or bleeding between the brain lining and brain tissue • Brain tumor • Wilson disease, a rare disease causing an accumulation of copper in the liver, brain, kidneys, and corneas • Neurosyphilis, an infection of the nervous system by the syphilis bacteria, which causes weakness and mental deterioration • Progressive supranuclear palsy, also known as Steele- Richardson-Olszewski syndrome, a rare disorder of late middle age that causes widespread neurological problems. Certain abnormalities of a person’s metabolism or hormones may also be responsible for the development of dementia, including the following: • Hypothyroidism, which means the thyroid gland is underactive • Hyperthyroidism, which means the thyroid gland is overactive • High-dose steroid abuse • Deficiency, or low body levels, of vitamin B12 • Thiamine deficiency • Deficiency of niacin, or vitamin B3 • Chronic alcohol abuse Introduction 3 • Chronic exposure to metals, such as lead or mercury, and to dyes, such as aniline • Medication side-effects or drug interactions. In some of these cases, dementia can be reversed by removing the toxic agent or bringing vitamin levels back to normal. Signs and Symptoms Symptoms at the early stage include the following: • Forgetting recent events (distant memories also fade as the disease progresses) • Experiencing difficulty in reasoning, calculation, and accepting new things • Becoming confused over time, place and direction • Impaired judgment • Changes in personality • Becoming passive and losing initiative. Symptoms at the middle stage include the following: • Losing cognitive ability, such as the ability to learn, judge, and reason • Becoming emotionally unstable, and easily losing temper or becoming agitated • Needing help to simply live from day to day • Confusing night and day; disturbing others’ normal sleeping time. Symptoms at the later stage include the following: • Losing all cognitive ability • Becoming entirely incapable of self-care, including eating, bathing, and so on • Neglecting personal hygiene • Incontinence • Losing weight gradually • Walking unsteadily and becoming confined to bed. Treatment and Prevention Senile dementia that is caused by depression, poor nutrition, thyroid dysfunction, drug poisoning, alcoholism, and so on, can 4 Diagnosis and Treatment of Senile Dementia often be corrected by treating the underlying problem. Alzheimer’s disease and multi-infarct dementia are degenerative diseases, and up to now there is no effective treatment. It is best to recognize the symptoms early and be diagnosed and assessed by a doctor. There are currently some medications available to slow the progress of Alzheimer’s disease. If you recognize the symptoms of senile dementia in a family member, these steps should be taken: • Consult your doctor to confirm the diagnosis. • Join a family support group for senile dementia patients. This will help to ease the pressure of looking after the patient through sharing of experience. • Take advantage of social services such as day care centers for the elderly. • Explain your loved one’s illness to your relatives and neighbors to gain their understanding and support. • Make alterations in your home environment to prevent accidents. • Establish a daily routine for the patient to reduce his or her feelings of confusion. • Have the patient wear a wrist bracelet labeled with his name and telephone number. Always have a recent photo of the patient at home so that it will help to find him if he or she gets lost. There is up till now no effective way to prevent Alzheimer’s disease. However, multi-infarct dementia is caused by damaged blood vessels, and can be prevented through healthy living habits. MEMORY LOSS AND OTHER SYMPTOMS OF DEMENTIA While symptoms of dementia can vary greatly, at least two of the following core mental functions must be significantly impaired to be considered dementia: • Memory • Communication and language • Ability to focus and pay attention Introduction 5 • Reasoning and judgment • Visual perception People with dementia may have problems with short-term memory, keeping track of a purse or wallet, paying bills, planning and preparing meals, remembering appointments or traveling out of the neighborhood. Many dementias are progressive, meaning symptoms start out slowly and gradually get worse. If you or a loved one is experiencing memory difficulties or other changes in thinking skills, don’t ignore them. Professional evaluation may detect a treatable condition. And even if symptoms suggest dementia, early diagnosis allows a person to get the maximum benefit from available treatments and provides an opportunity to volunteer for clinical trials or studies. It also provides time to plan for the future. Causes Dementia is caused by damage to brain cells. This damage interferes with the ability of brain cells to communicate with each other. When brain cells cannot communicate normally, thinking, behavior and feelings can be affected. The brain has many distinct regions, each of which is responsible for different functions (for example, memory, judgment and movement). When cells in a particular region are damaged, that region cannot carry out its functions normally. Different types of dementia are associated with particular types of brain cell damage in particular regions of the brain. For example, in Alzheimer’s disease, high levels of certain proteins inside and outside brain cells make it hard for brain cells to stay healthy and to communicate with each other. The brain region called the hippocampus is the center of learning and memory in the brain, and the brain cells in this region are often the first to be damaged. That’s why memory loss is often one of the earliest symptoms of Alzheimer’s. While most changes in the brain that cause dementia are permanent and worsen over time, thinking and memory problems caused by the following conditions may improve when the condition is treated or addressed: 6 Diagnosis and Treatment of Senile Dementia • Depression • Medication side effects • Excess use of alcohol • Thyroid problems • Vitamin deficiencies. Diagnosis of dementia There is no one test to determine if someone has dementia. Doctors diagnose Alzheimer’s and other types of dementia based on a careful medical history, a physical examination, laboratory tests, and the characteristic changes in thinking, day-to-day function and behavior associated with each type. Doctors can determine that a person has dementia with a high level of certainty. But it’s harder to determine the exact type of dementia because the symptoms and brain changes of different dementias can overlap. In some cases, a doctor may diagnose “dementia” and not specify a type. If this occurs it may be necessary to see a specialist such as a neurologist or gero-psychologist. Dementia treatment and care Treatment of dementia depends on its cause. In the case of most progressive dementias, including Alzheimer’s disease, there is no cure and no treatment that slows or stops its progression. But there are drug treatments that may temporarily improve symptoms. The same medications used to treat Alzheimer’s are among the drugs sometimes prescribed to help with symptoms of other types of dementias. Non-drug therapies can also alleviate some symptoms of dementia. Ultimately, the path to effective new treatments for dementia is through increased research funding and increased participation in clinical studies. Right now, volunteers are urgently needed to participate in more than 180+ actively enrolling clinical studies and trials about Alzheimer’s and related dementias. Dementia risk and prevention Some risk factors for dementia, such as age and genetics, cannot be changed. But researchers continue to explore the impact of other risk factors on brain health and prevention of dementia. Introduction 7 Some of the most active areas of research in risk reduction and prevention

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