Cystic Fibrosis Disease – The Healing Space Clinic

Dementia Disease

BASICS

DESCRIPTION

A pathologic process defined as a persistent impairment of a prior level of intellectual functioning

Dementia of the Alzheimer's type (DAT) is the most common form and characterized by a relentless deterioration of higher cortical functioning. The rate of deterioration is variable.
Ischemic vascular dementia (IVD) formerly multi-infarct dementia, occurs as a result of clinical or subclinical cerebral infarcts secondary to atherosclerosis. Deterioration is stepwise with periods of clinical plateaus.
Frontotemporal dementia (FTD) - insidious change in personality with cognitive dysfunction. Onset usually prior to age 65.
Secondary dementias - also referred to as "reversible dementias" because the cognitive impairment may reverse with treatment of the primary disorder
Dementia with Lewy bodies (DLB) - early onset dementia with associated psychosis, depression
System(s) affected: Nervous
Genetics:
- At least 15% of patients with DAT will report a positive family history
- Persons with Trisomy 21 (Down syndrome) who survive into their 20's and 30's will inevitably develop a progressive dementia
Incidence/Prevalence in USA:
- 0.5% between ages 60 and 64; 3.2% between ages 80-90
- 1480/100,000
- 1.2 million people in the U.S. have severe dementia and another 2.5 million have moderate illness; 10% of all persons over the age of 65 have clinically important dementia
Predominant age: Increasing incidence with increasing age. Can occur in younger persons secondary to trisomy 21 or AIDS.
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

Impaired short- and long-term memory
Impaired abstract thinking
Impaired judgment
Aphasia
Apraxia
Agnosia
Anomia
Personality change, emotional outbursts, wandering, restlessness, hyperactivity, especially with FTD
Sleep disturbances
Mood disturbances
Urinary incontinence (usually late in DAT or normal pressure hydrocephalus)
Fecal incontinence (late)
Rigidity
Tremor (especially with DLB)
Hallucinations (especially with DLB)
Delusions
Overt paranoid behavior
Weight loss
Seizures

CAUSES

DAT - genetic predisposition in > 15%
IVD - due to cerebral atherosclerosis or emboli with clinical or subclinical infarcts
Secondary dementias - causes include hypothyroidism, vitamin B deficiency, normal pressure hydrocephalus, AIDS, syphilis, and various medications. The dementia will be accompanied by the other signs and symptoms characteristic of the primary disorder.

RISK FACTORS

Increasing age
Prevalence of atherosclerotic disease (IVD)
Trisomy 21 (Down syndrome)
History of head trauma
History of CNS infection

DIAGNOSIS

LABORATORY

Done primarily to rule out potentially reversible causes

Thyroid function tests
Syphilis serology
Serum B12 and folate
Complete blood count and screening metabolic profile

Drugs that may alter lab results: Thyroid hormone replacement and iodine preparations may affect thyroid function tests
Disorders that may alter lab results: False positive syphilis serology with acute infections, leprosy, subacute bacterial endocarditis, and autoimmune disorders

PATHOLOGICAL FINDINGS

DAT - granulovesicular degeneration, neurofibrillary tangles, senile neuritic plaques, microvascular amyloid
Old infarcts, atherosclerotic disease

SPECIAL TESTS

Mental status testing
Neuropsychologic testing
Electroencephalogram for patients with altered consciousness or associated seizures

IMAGING

Head computed tomography if history suggestive of a mass, or focal neurologic signs or in patient with dementia of brief duration
Magnetic resonance imaging (MRI) is more sensitive than computed tomography for detection of soft tissue lesions (small infarcts, mass lesions, atrophy of the brainstem, and other subcortical structures). MRI may also clarify ambiguous computed tomography findings.
Magnetic resonance imaging (MRI) is more sensitive than computed tomography for detection of soft tissue lesions (small infarcts, mass lesions, atrophy of the brainstem, and other subcortical structures). MRI may also clarify ambiguous computed tomography findings.
Positive emission tomography (PET) shows cortical hypometabolism

DIAGNOSTIC PROCEDURES

N/A

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient except when complications warrant hospitalization
Nursing home - if disease progresses to the point that long-term care becomes necessary

GENERAL MEASURES

Daily schedules and written directions
Support and education of caregivers
Emphasis on nutrition, personal hygiene, personal safety (accident-proofing the home) and supervision
Discussions with the family concerning advanced directives
Socialization (adult day care)
Sensory stimulation (prominent displays of clocks and calendars)
Improvement in sleep hygiene
Pharmacotherapy should be reserved for specific behavioral symptoms after nonpharmacologic therapy has failed

SURGICAL MEASURES

N/A

ACTIVITY

Fully active with direction and supervision

DIET

No special diet

PATIENT EDUCATION

The 36-Hour Day by Mace and Rabins
Printed material available from the Alzheimer's Association, (800)621-0379

FOLLOW UP

PREVENTION/AVOIDANCE

N/A

POSSIBLE COMPLICATIONS

Antipsychotic-induced extrapyramidal effects
Falls
Pressure sores
Malnutrition
Constipation
Various infections

EXPECTED COURSE AND PROGNOSIS

DAT - a progressive disease with variable rates of progression, but inevitably leading to profound cognitive impairment
IVD - less likely to be progressive but cognitive improvement is unlikely
Secondary dementias - treatment of the underlying condition may lead to improvement

MISCELLANEOUS

ASSOCIATED CONDITIONS

Depression
Insomnia

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric:

In the elderly, begin drugs with small doses and increase slowly
Drugs with a long half-life (fluoxetine, lorazepam, etc.) require closer monitoring in the elderly; it may be better to choose a drug with a shorter half-life (sertraline, paroxetine, temazepam)

Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

DAT = dementia of Alzheimer's type
IVD = ischemic vascular dementia
FTD = frontotemporal dementia
DLB = dementia with Lewy bodies

Clinical Investigations

ROLE OF HOMOEOPATHY

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