Dementia

 

 

 

 

 

Dementia

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Institution

 

Dementia

There are multiple scientific definitions used about Dementia. The term ‘dementia’ is applied to a collection of signs and symptoms such as loss of control of physical functionality, changes in behavior and mood, challenges in planning and organizing one’s daily activities, challenges in communication and memory lapses. These indicators, taken together, indicate possible physical brain damage, owing to an acute progressive deterioration of nerve cells. This progressive brain damage can come because of a combination of various ailments: whereas Alzheimer’s is the best-known and most common cause of Dementia, there are other, similarly known causes, for instance, prion ailments, alcohol-associated dementia frontal, temporal dementia, as well as vascular dementia. For this research, the term ‘dementia’ will refer to a combination of all these factors that result in brain damage.

Incidence of Dementia

Estimations of the rate of incidence of Dementia vary widely across the different averaged age sets. The rate of occurrence among individuals aged over 85 years, for instance, has a higher rate of occurrence that estimations of individuals aged from 65 years and above. Laures-Gore (2012) notes that one in every five individuals aged over 80 years has some form of dementia (Ishi et al., 2016). Furthermore, data relating to the rate of prevalence is frequently classified more narrowly or more widely than ‘dementia.’ The CDCP (Center for Disease Control and Prevention), for instance, cites data for prevalence rates for certain specific causative factors for dementia, usually Alzheimer’s disease, whereas the NIH (National Institute of Health) incorporates dementia within the serious mental disease category.

Information relating to the spread of Alzheimer’s shows an increasing rate of occurrence. Beginning at the age of 65 years, chances of contracting the disease increases twofold every five years (Laures-Gore, 2012). At the time one is hitting 85 years, between 25% and nearly 50% of the individuals will have started exhibiting symptoms of Alzheimer’s illness. The CDC estimates that nearly 5.3 million US citizens have Alzheimer’s and other related ailments. Estimations further indicate that by the year 2050, that number is anticipated to be twice as much, owing to aging of the baby boomers generation. Scholars have singled Alzheimer’s disease as the sixth largest cause of death in the US (Beckett, 2015). The disease has further been singled out by Heron et al. (2009) as the leading cause of death among senior citizens aged 65 years and above.

It is important to note that, in spite its strong link with old age, the disease is not specifically a reserve of the old persons. It is estimated that 900,000 individuals under the age of 65 years living in North America have dementia. Similarly, in the UK, it is estimated that 18,050 people below 65 years have dementia. These numbers represent slightly fewer than 2.5% of both the United States and the UK populations of individuals living with dementia. Individuals living with Down syndrome (Prasher, 2014) are at a higher risk of suffering from dementia at an early age, with a projected incidence rate of approximately 9% of the individuals aged between 40 and 49 years, as well as 36% of individuals aged between 50 years and 59 years (Heron et al., 2009).

Risk Factors

Medical research analysts have discovered various significant risk factors that are closely associated with dementia. These comprise genetics and age, but also lifestyle choices and medical conditions. An individual’s risk of developing dementia is dependent on a blend of all these risk elements. Some risk factors, for instance, genetics, which is passed on from one generation to the other and age are beyond our control (Beckett, 2015). The other risk factors include controllable elements, for instance, certain life’s choices such as smoking, which increases the risk of developing dementia.

Different dementia risk elements additionally appear to be significant at various stages in a human being’s life. For instance, multiple studies indicate that remaining in education past the age of 17 years appears to lessen risk factors in old age. A majority of the most common and avoidable risk factors for the disease, which include type 2 diabetes and high blood pressure, seem to initially appear between the ages of 40 years and 65 years (mid-life). Researchers have claimed that changes in the chemical composition of the brain, which begins in mid ages may be directly associated with the high rates of occurrence. The following are some notable risk factors for dementia.

Ageing

Of all known risk factors for dementia, age is the strongest risk factor. Whereas there is a possibility of developing the disease at an early age, the probability of developing dementia increases largely as people grow older. After reaching 65 years, an individual’s likelihood of contracting the disease becomes twice as high every five years (Beckett, 2015). Such a high prevalence rate is attributed to factors such as immune system changes; the natural flagging of the body’s natural healing and repair systems; loss of sex-related hormones after experiencing changes in mid-life; changes to cell structure, DNA, and nerve cells; increased risk of cardiovascular conditions, for instance, stroke and heart disease; and high blood pressure.

Gender

Research indicates that women are more likely to develop Alzheimer’s as opposed to men. The rates for women victims are significantly higher, despite their age at death being significantly higher than that of men. It is not yet clear why women have higher incidence rates. Scholars have many times suggested that Alzheimer’s disease among women is associated with lack of estrogen – the female sex hormone especially after reaching menopause. There are, however, no medical tests to support this argument. For a majority of dementias that is not specifically associated with Alzheimer’s, women and men have similar levels of risk (Mayo et al., 2013). In cases involving vascular dementia, the prevalence rates for men are higher than for women. It is the reason why cases of heart disease and stroke in men are higher than in women.

Ethnicity

Some evidence shows that individuals from various ethnic communities have a higher likelihood. For instance, people living in South Asia – countries such as Pakistan, India, and Bangladesh have higher rates of developing vascular dementia than natives from western countries. South Asians are known to have extremely high occurrence rates of diabetes, coronary ailments and stroke, which scholars argue explains the higher rates of dementia. Equally, individuals of African origin have higher rates of occurrence of dementia. Africans are more susceptible to stroke and diabetes (Beckett, 2015). These effects can be traced down to a blend of variances in genes, exercise, smoking, and diet.

Genetics

Medical researchers have known for a long time that genes handed over from one generation to the other can affect people’s levels of susceptibility to certain ailments. There is insufficient evidence highlighting the importance of genes lineages about the illness. Nonetheless, significant strides have been made in the world of science in the recent past. Researchers have discovered about 21 genes that enhance the risk factors associated with dementia (Prasher, 2014). For instance, APOE (Apolipoprotein) increases individuals’ chances of developing Alzheimer’s disease. Therefore, there are high chances of developing the disease if one or multiple immediate family members have the disease.

Diseases and Medical Conditions

Cardiovascular Factors. There are strong indications that ailments or conditions that affect blood circulation, arteries, and the heart have an effect on an individual’s probability of developing the condition. The primary cardiovascular risk factors for dementia include obesity – in mid-life, high blood cholesterol levels, high BP (Blood Pressure) and type 2 diabetes. These risk factors are avoidable for cardiovascular ailments (heart disease and stroke, for instance, abnormal heart movements) and dementia.

Depression. Individuals that have suffered from depression whether early or in later years additionally have higher rates of developing dementia. There is no medical evidence linking depression to dementia directly. There is some evidence, nonetheless, which indicates that dementia developed between ages 45 and 60 results in higher risks of dementia in old age (Beckett, 2015). Contrastingly, instances, where individuals suffer depression later in life, may be early signs and symptoms of possibilities of developing dementia as opposed to being a risk factor.

Lifestyle Factors

Medical researchers have established that lifestyle choices have an effect on risks of developing dementia, particularly concerning risks touching on cardiovascular wellbeing. Large group studies indicate that risk of developing dementia is moderate in individuals who have reasonable healthy behaviors between ages of 40 and 60. These behaviors, scholars argue, include maintaining a healthy and balanced diet, moderate alcohol consumption, not smoking, and practicing a regular body toning or physical exercise regime. Practicing the above-listed routines reduces dementia-related risks.

Symptoms of Dementia

Dementia symptoms can vary based on the stage of the disease and diagnosis. Even though late-stage symptoms and signs may be the same across etiologies, distinguishing early signs and symptoms can differ significantly. For instance, people with Huntington’s disease and Frontotemporal dementia experience depression and behavior changes. On the other hand, individuals with primary progressive aphasia endure a continued loss of dialectal functionality; and people suffering from Binswanger’s disease, which is a different vascular dementia experience dysphagia and dysarthria – two conditions linked to neurological challenges (Pendlebury et al., 2010). Beliefs, opinions regarding the aging process and cultural values about the decline of cognitive abilities may affect an individual’s or family’s decision regarding salutary services. In addition, it may sometimes delay or inhibit individuals from seeking assistance until signs are evidently above the mild or early stages.

People with dementia report a continued loss of memory. As the illnesses aggravate, early signs intensify, and in the end, affects the individual’s capacity to function independently and communicate effectively. The following are the common symptoms and signs of dementia.

Attention

People with dementia are attention deficient. Common characteristics include among other things being distracted easily; challenges in giving attention, save for simplifications and restrictions; process information at a reduced speed – processing takes longer than expected.

Memory and Learning

Common memory and learning insufficiencies include challenges in remembering and acquiring new data (information), for instance, new routines, events, or appointments (Blackburn, 2014); working/short-term memory loss – Acute forgetfulness of information recently acquired or seen; and periodic memory lapses, including challenges in recollecting specific experiences, situations or autobiographical events.

Executive Functioning and Reasoning

Executive functioning and common reasoning deficits comprise mental capacity deficits; lack of inhibition (Ronnald et al., 2015). Others include challenges in correcting personal errors, self-monitoring, and reacting to feedback; challenges in handling intricate tasks and multi-tasking; impaired reasoning and poor judgment; challenges in making sound decisions concerning safety; challenges in planning, and setting objectives, including dependence on other individuals to make decisions or plan activities.

Social Behavior and Cognition

Common cognition and social behavior deficits include delusions and paranoia of persecution (Ronnald et al., 2015). Others include loss of motivation/initiative; strange or erratic behavior; obsessive or compulsive conduct; negative response to questioning; depression; restlessness; fluctuation of mood, including crying and agitation; loss of empathy; and reduced capacity of reading facial expressions.

Types of Dementia

Currently, there are more than 100 dementia categories the most prevalent being Alzheimer’s disease. The CDC reports indicate that Alzheimer’s has the most number of victims of all cases of reported dementia, averaged at 62%. Others categories include Parkinson’s disease (2%), frontotemporal dementia (2%), Lewy bodies dementia (4%), and vascular dementia (16.9%) (Yamin et al., 2016). There are other less prevalent causes of dementia, which include; syphilis, prion illnesses, alcohol-based dementias, and the Huntington’s disease.

Alzheimer’s Disease

For the duration of the disease, abnormally folded, as well as excessive bodily proteins, which accumulate in the human brain, bring about the growth and formation of elements commonly referred to as protein ‘plaques’ around “tangles” and neurons, which leads to the suffocation of the brain cells, and in particular in the area mandated for keeping memory. The level of chemical messengers (neurotransmitters) are additionally affected, a situation which results in the disruption of brain communication (Yamin et al., 2016). A blend of these factors, including diet, environmental factors, genetic inheritance, and age compound the challenges further, enhancing the disease progression.

Vascular Dementia

Vascular dementia is a series of many strokes that results in the damaging of the blood vessels network – also commonly referred to as the human body vascular network, which is responsible for transporting blood within the human brain network. The resultant interruptions in oxygen supply – which is usually transported in the form of hemoglobin often results in the death of the human brain cells. Dead cells in the brain subsequently lead to vascular dementia, characterized by death of brain cells. Vascular dementia risk factors include diabetes, high level of cholesterol, heart challenges, and high blood pressure. Vascular dementia is also caused by Binswanger’s disease, also commonly known as ‘sub-cortical VD (Vascular Dementia).’

PDD (Parkinson’s Disease Dementia) and (DLB) Lewy Bodies Dementia

Lewy bodies are round protein elements that accumulate in brain cells, interrupt the chemical composition of the brain, and unsettle the regular operational processes of the brain cells. The same protein deposits are found in victims of the Parkinson’s. Research indicates that many victims of Parkinson’s develop dementia later on in life. The correlation between PDD and DLB is intricate at the very least. Researchers argue that while the two disorders constitute part of the same band, they result in varied symptoms and signs owing to the differences in the manner in which the Lewy bodies are distributed in the brain.

Frontotemporal Dementia (FTD)

FTD (Frontotemporal dementia) is one of the most intermittent types of dementia. The term – Frontotemporal – covers an extensive range of conditions including dementia related to motor neuron ailment, front lobe degeneration, and Pick’s disease. FTD is caused by extensive damage to the temporal lobe or frontal lobe of the brain (Revesz et al., 2011). Nearly 50% of all the diagnosed cases report a family history of the disease in the familial lineage. Even though symptoms differ between different people, damage typically is seen in the front part of the brain, at first affecting behavior and mood more than the individual’s memory.

Treatment Options

Presently, the currently available treatment options for dementia are not able to reverse the causal degeneration of a human’s brain cells, even though they might provisionally delay or improve cognitive functionality (Paranji et al., 2016).

Drugs

For dementia treatment, Cholinesterase inhibitors can be applied to people showing moderate signs and experts should administer the treatment for such people. An individual’s past cognitive capacities – whether low or high – should be considered when evaluating their ailment as moderate. Memantine should only be administered to individuals with moderately acute Alzheimer’s (Harrison Dening et al., 2016).

Cholinesterase Inhibitors for Alzheimer’s Disease. A majority of individuals would put into consideration rivastigmine, galantamine, and donepezil, which form part of cholinergic medication for the ailment. These three drugs have varied pharmacological properties, although they operate through the inhibition of the breaking down of acetylcholine, a significant neurotransmission agent linked with memory through obstructing acetylcholinesterase (Harrison Dening et al., 2016).

Memory Training Programs

Memory training programs concentrate on retraining or improving memory skills through methods such as didactic approaches, vanishing cues, procedural memory stimulation, errorless learning, and spaced retrieval (Peavy et al., 2000).

Reality Orientation

RO (reality orientation) comprises a method for improving quality and reducing confusion of life of persons diagnosed with dementia through the provision of orientation information (person, place or time) to further enhance the awareness and understanding of the environment (Lewis et al., 2015). All throughout the day, information is repeated at unvarying intervals.

Nutrition

Nutrition involves changes to one’s diet. Dietary changes comprise changing the taste, temperature, texture, and viscosity of liquid or food to facilitate ease of swallowing and safety. Characteristic changes may incorporate pureeing solid foods, chopping, softening, or thickening liquids, for instance, juice, coffee, or water. Temperature or taste of food may be changed to give extra additional sensory matter for eating, and preferences of the person are put into consideration to the farthest extent (Kwok, 2007). The medical safety of the treatments and nutritional needs are additionally put into consideration before changing the diet.

 

 

 

 

 

 

 

 

 

 

 

References

Beckett, M. W., Ardern, C. I., & Rotondi, M. A. (2015). A meta-analysis of prospective studies on the role of physical activity and the prevention of Alzheimer’s disease in older adults. BMC Geriatrics159. doi:10.1186/s12877-015-0007-2

Blackburn, D. J., Wakefield, S., Shanks, M. F., Harkness, K., Reuber, M., & Venneri, A. (2014). Memory difficulties are not always a sign of incipient dementia: a review of the possible causes of loss of memory efficiency. British Medical Bulletin, 112(1), 71-81. doi:10.1093/bmb/ldu029

Hadžović-Džuvo, A., Lepara, O., Valjevac, A., Panić, J., Hujdur, M., Ćorić, A., &. Ščetić, L.    (2016). Serum total antioxidative capacity level is positively associated with cognitive functions in patients with probable Alzheimer’s disease and vascular dementia. Medical Journal, 22(2), 77-82.

Harrison Dening, K., King, M., Jones, L., Vickestaff, V., & Sampson, E. L. (2016). Advance care planning in Dementia: Do family carers know the treatment preferences of people with early Dementia. PLoS ONE, 11(7), 1-15.

Kang, H. S., Kwon, J. H., Kim, S., Na, D. L., Kim, S. Y., Lee, J., & … Kim, D. K. (2016). Comparison of neuropsychological profiles in patients with Alzheimer’s disease and mixed dementia. Journal of the Neurological Sciences369, 134-138. doi:10.1016/j.jns.2016.08.022.

Khan, A., Kalaria, R. N., Corbett, A., & Ballard, C. (2016). Update on Vascular Dementia.  Journal of Geriatric Psychiatry & Neurology, 29(5), 281-301.

Kwok, T., Twinn, S., & Yan, E. (2007). The attitudes of Chinese family caregivers of older people with dementia towards life sustaining treatments. Journal of Advanced Nursing, 58(3), 256-262.

Laures-Gore, J. S. (2012). Aphasia severity and salivary cortisol over time. Journal of Clinical And Experimental Neuropsychology34(5), 489-496. doi:10.1080/13803395.2012.658356

Lewis, M., Rand, E., Mullaly, E., Mellor, D., & Macfarlane, S. (2015). Uptake of a newly implemented advance care-planning program in a dementia diagnostic service. Age and Ageing44(6), 1045-1049. doi:10.1093/ageing/afv138.

Lugtenburg, A., Zuidersma, M., Oude Voshaar, R. C., & Schoevers, R. A. (2016). Symptom dimensions of depression and 3-year incidence of dementia: results from the Amsterdam study of the elderly. Journal of Geriatric Psychiatry and Neurology29(2), 99-107. doi:10.1177/0891988715606235.

Mayo, A. M., Wallhagen, M., Cooper, B. A., Mehta, K., Ross, L., & Miller, B. (2013). The relationship between functional status and judgment/problem solving among individuals with dementia. International Journal of Geriatric Psychiatry28(5), 514-521. doi:10.1002/gps.3854

Paranji, S., Paranji, N., Wright, S., & Chandra, S. (2016). A nationwide study of the impact      of dysphagia on hospital outcomes among patients with dementia. American Journal         of Alzheimer’s Disease and Other Dementias, 1533317516673464.

Peavy, G. M., Salmon, D. P., Rice, V. A., Galasko, D., Samuel, W., Taylor, K. I., & Thal, L. (2000). Neuropsychological assessment of severely demeted elderly: the severe cognitive impairment profile. Archives of Neurology53(4), 367-372.

Pendlebury, S. T., Cuthbertson, F. C., Welch, S. V., Mehta, Z., & Rothwell, P. M. (2010). Underestimation of cognitive impairment by Mini-Mental State Examination versus the Montreal Cognitive Assessment in patients with transient ischemic attack and stroke: a population-based study. Stroke; A Journal Of Cerebral Circulation, 41(6), 1290-1293. doi:10.1161/STROKEAHA.110.579888

Prasher, V. P. (2014). Practical Dementia Care for Adults with Down Syndrome or with Intellectual Disabilities. New York: Nova Science Publishers, Inc.

Revesz, T. (2011). Globular glial tauopathies (GGT) presenting with motor neuron disease or frontotemporal dementia: an emerging group of 4-repeat tauopathies. Acta Neuropathologica122(4), 415-428. doi:10.1007/s00401-011-0857-4

Rönnlund, M., Sundström, A., Adolfsson, R., & Nilsson, L. (2015). Self-reported memory failures: Associations with future Dementia in a population-based study with long-term follow-up. Journal of the American Geriatrics Society, 63(9), 1766-1773

Su, B., Liu, H., Wang, X., Chen, S. G., Siedlak, S. L., Kondo, E., & … Lee, H. (2009). Ectopic localization of FOXO3a protein in Lewy bodies in Lewy body dementia and Parkinson’s disease. Molecular Neurodegeneration432. doi:10.1186/1750-1326-4-32.

Yamin, S., Stinchcombe, A., & Gagnon, S. (2016). Comparing cognitive profiles of licensed drivers with mild Alzheimer’s disease and mild dementia with Lewy Bodies. International Journal of Alzheimer’s Disease, 6542962, 1-11.    

 

 

 

 

 

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