Dementia: Difference between revisions
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'''Dementia''' (taken from [[Latin]], originally meaning "madness", from ''de-'' "without" + ''ment'', the root of ''mens'' "mind") is a serious loss of global [[cognition|cognitive]] ability in a previously unimpaired person, beyond what might be expected from normal [[aging]]. It may be static, the result of a unique global [[brain injury]], or progressive, resulting in long-term decline due to damage or [[disease]] in the body. Although dementia is far more common in the [[Geriatrics|geriatric]] population (about 5% of those over 65 are said to be involved),<ref name=Sadock2008/> it can occur before the age of 65, in which case it is termed "early onset dementia".<ref>{{cite journal |author=Fadil, H., Borazanci, A., Haddou, E. A. B.,Yahyaoui, M., Korniychuk, E., Jaffe, S. L., Minagar, A. |title=Early Onset Dementia |journal=International Review of Neurobiology |volume=84 |pages=245–262 |year=2009 |doi=10.1016/S0074-7742(09)00413-9 |series=International Review of Neurobiology |isbn=978-0-12-374833-1 |pmid=19501722}}</ref> |
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Dementchiam is not a single disease, but a non-specific [[syndrome]] (i.e., set of [[Medical sign|signs]] and [[symptom]]s). Affected cognitive areas can be [[memory]], [[attention]], [[language]], and [[problem solving]]. Normally, symptoms must be present for at least six months to support a diagnosis.<ref name=Def>{{cite web |title=Dementia definition |url=http://www.mdguidelines.com/dementia/definition |work=MDGuidelines |publisher=Reed Group |accessdate=2009-06-04}}</ref> Cognitive dysfunction of shorter duration is called ''[[delirium]]''. |
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Especially in later stages of the condition, subjects may be [[disorientation|disoriented]] in time (not knowing the day, week, or even year), in place (not knowing where they are), and in person (not knowing who they and/or others around them are).{{citation needed|date=October 2013}} |
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Dementia can be classified as either reversible or irreversible, depending upon the [[etiology]] of the disease. Fewer than 10% of cases of dementia are due to causes that may be reversed with treatment. |
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Some of the most common forms of dementia are: [[Alzheimer's disease]], [[Multi-infarct dementia|vascular dementia]], [[frontotemporal dementia]], [[semantic dementia]] and [[dementia with Lewy bodies]]. |
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==Signs and symptoms== |
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Dementia is not merely a problem of memory. It reduces the ability to learn, reason, retain or recall past experience and there is also loss of patterns of thoughts, feelings and activities. Additional mental and behavioral problems often affect people who have dementia, and may influence quality of life, caregivers, and the need for institutionalization. As dementia worsens individuals may neglect themselves and may become disinhibited and may become incontinent. (Gelder ''et al.'' 2005). Behaviour may be disorganized, restless or inappropriate. Some people become restless or wander about by day and sometimes at night. When people with dementia are put in circumstances beyond their abilities, there may be a sudden change to tears or anger (a ''"catastrophic reaction"'').<ref>{{cite book |author=Geddes, John; Gelder, Michael G.; Mayou, Richard |title=Psychiatry |publisher=Oxford University Press |location=Oxford [Oxfordshire] |year=2005 |page=141 |isbn=0-19-852863-9 |oclc=56348037 }}</ref> A common symptom of dementia for dementia sufferers to deny that relatives, even relatives in their immediate family, are their own relatives. |
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Depression affects 20–30% of people who have dementia, and about 20% have anxiety.<ref>{{cite journal |author=Calleo J, Stanley M |title=Anxiety Disorders in Later Life Differentiated Diagnosis and Treatment Strategies |journal=Psychiatric Times |volume=25 |issue=8 |year=2008 |url=http://www.psychiatrictimes.com/display/article/10168/1166976}}</ref> Psychosis (often delusions of persecution) and agitation/aggression also often accompany dementia. Each of these must be assessed and treated independently of the underlying dementia.<ref>{{Cite journal |last=Shub |first=Denis |last2=Kunik |first2=Mark E|title=Psychiatric Comorbidity in Persons With Dementia: Assessment and Treatment Strategies |journal= Psychiatric Times |volume=26 |issue=4 |date=April 16, 2009 |url=http://www.psychiatrictimes.com/alzheimer-dementia/article/10168/1403050}}</ref> |
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It is possible for a patient to exhibit two or more dementing processes at the same time, as none of the known types of dementia protects against the others. Indeed, about 10% of people with dementia have what is known as ''mixed dementia'', which may be a combination of Alzheimer's disease and [[multi-infarct dementia]].<ref>[http://www.alzheimers.org.uk/site/scripts/documents_info.php?categoryID=200171&documentID=161&gclid=CNfxysiaxK4CFeYhtAodDlEIXQ What is vascular dementia?] Alzheimer's Society.</ref><ref>{{cite journal |author=Lee AY |title=Vascular dementia |journal=Chonnam Med J |volume=47 |issue=2 |pages=66–71 |year=2011|pmid=22111063 |pmc=3214877 |doi=10.4068/cmj.2011.47.2.66 |url=}}</ref> |
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==Causes== |
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===Fixed cognitive impairment=== |
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Various types of brain injury may cause irreversible but fixed cognitive impairment. [[Traumatic brain injury]] may cause generalized damage to the white matter of the brain ([[diffuse axonal injury]]), or more localized damage (as also may [[neurosurgery]]). A temporary reduction in the brain's supply of blood or oxygen may lead to [[cerebral hypoxia|hypoxic-ischemic injury]]. [[Stroke]]s (ischemic stroke, or intracerebral, subarachnoid, subdural or extradural hemorrhage) or infections ([[meningitis]] and/or [[encephalitis]]) affecting the brain, prolonged epileptic [[seizure]]s and acute [[hydrocephalus]] may also have long-term effects on cognition. Excessive alcohol use may cause [[alcohol dementia]], [[Wernicke's encephalopathy]] and/or [[Korsakoff's psychosis]]. |
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===Slowly progressive dementia=== |
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Dementia that begins gradually and worsens progressively over several years is usually caused by [[neurodegenerative disease]]—that is, by conditions that affect only or primarily the neurons of the brain and cause gradual but irreversible loss of function of these cells. Less commonly, a non-degenerative condition may have secondary effects on brain cells, which may or may not be reversible if the condition is treated. |
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Causes of dementia depend on the age at which symptoms begin. In the elderly population (usually defined in this context as over 65 years of age), a large majority of dementia cases are caused by [[Alzheimer's disease]], [[vascular dementia]], or both. [[Dementia with Lewy bodies]] is another commonly exhibited form, which again may occur alongside either or both of the other causes.<ref name=pmid11213093>{{cite journal |title=Pathological correlates of late-onset dementia in a multicentre, community-based population in England and Wales. Neuropathology Group of the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS) |journal=Lancet |volume=357 |issue=9251 |pages=169–75 |year=2001 |pmid= 11213093 |doi=10.1016/S0140-6736(00)03589-3 |author=Neuropathology Group. Medical Research Council Cognitive Function and Aging Study}}</ref><ref name=pmid12904992>{{cite journal |title=Age-associated prevalence and risk factors of Lewy body pathology in a general population: the Hisayama study |journal=Acta Neuropathol |volume=106 |issue=4 |pages=374–82 |year=2003 |pmid=12904992 |author=Wakisaka Y et al. |doi=10.1007/s00401-003-0750-x}}</ref><ref name=pmid12480729>{{cite journal |title=Cerebrovascular pathology and dementia in autopsied Honolulu-Asia Aging Study participants |journal=Ann N Y Acad Sci |volume=977 |issue=9 |pages=9–23 |year=2002 |pmid=12480729 |author=White L et al. |doi= 10.1111/j.1749-6632.2002.tb04794.x}}</ref> [[Hypothyroidism]] sometimes causes slowly progressive cognitive impairment as the main symptom, and this may be fully reversible with treatment. [[Normal pressure hydrocephalus]], though relatively rare, is important to recognize since treatment may prevent progression and improve other symptoms of the condition. However, significant cognitive improvement is unusual. |
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Dementia is much less common under 65 years of age. Alzheimer's disease is still the most frequent cause, but inherited forms of the disease account for a higher proportion of cases in this age group. [[Frontotemporal lobar degeneration]] and [[Huntington's disease]] account for most of the remaining cases.<ref name=pmid12058088>{{cite journal |title=The prevalence of frontotemporal dementia |journal=Neurology |volume=58 |issue=11 |pages=1615–21 |year=2002 |pmid=12058088 |author=Ratnavalli E et al. |doi=10.1212/WNL.58.11.1615}}</ref> [[Vascular dementia]] also occurs, but this in turn may be due to underlying conditions (including [[antiphospholipid syndrome]], [[CADASIL]], [[MELAS]], [[homocystinuria]], [[moyamoya]] and [[Binswanger's disease]]). People who receive frequent head trauma, such as boxers or football players, are at risk of [[chronic traumatic encephalopathy]]<ref>{{cite journal |title=Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy following Repetitive Head Injury |journal=J Neuropathol Exp Neurol |volume=68 |issue=7 |pages=709–735 |year=2009 |pmid=19535999 |author=McKee A et al. |doi=10.1097/NEN.0b013e3181a9d503 |pmc=2945234}}</ref> (also called [[dementia pugilistica]] in boxers). |
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In young adults (up to 40 years of age) who were previously of normal intelligence, it is very rare to develop dementia without other features of neurological disease, or without features of disease elsewhere in the body. Most cases of progressive cognitive disturbance in this age group are caused by psychiatric illness, alcohol or other drugs, or metabolic disturbance. However, certain genetic disorders can cause true neurodegenerative dementia at this age. These include [[Early-onset Alzheimer's disease|familial Alzheimer's disease]], [[Spinocerebellar ataxia|SCA17]] ([[dominance (genetics)|dominant]] inheritance); [[adrenoleukodystrophy]] ([[Sex linkage|X-linked]]); [[Gaucher's disease]] type 3, [[metachromatic leukodystrophy]], [[Niemann-Pick disease type C]], [[pantothenate kinase-associated neurodegeneration]], [[Tay-Sachs disease]] and [[Wilson's disease]] (all [[dominance (genetics)|recessive]]). Wilson's disease is particularly important since cognition can improve with treatment. |
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At all ages, a substantial proportion of patients who complain of memory difficulty or other cognitive symptoms have [[major depressive disorder|depression]] rather than a neurodegenerative disease. Vitamin deficiencies and chronic infections may also occur at any age; they usually cause other symptoms before dementia occurs, but occasionally mimic degenerative dementia. These include deficiencies of [[vitamin B12 deficiency|vitamin B<sub>12</sub>]], [[folate deficiency|folate]] or [[pellagra|niacin]], and infective causes including [[cryptococcal meningitis]], [[AIDS dementia complex|HIV]], [[Lyme disease]], [[progressive multifocal leukoencephalopathy]], [[subacute sclerosing panencephalitis]], [[syphilis]] and [[Whipple's disease]]. |
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===Rapidly progressive dementia=== |
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[[Creutzfeldt-Jakob disease]] typically causes a dementia that worsens over weeks to months, being caused by [[prion]]s. The common causes of slowly progressive dementia also sometimes present with rapid progression: [[Alzheimer's disease]], [[dementia with Lewy bodies]], [[frontotemporal lobar degeneration]] (including [[corticobasal degeneration]] and [[progressive supranuclear palsy]]). |
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On the other hand, [[encephalopathy]] or [[delirium]] may develop relatively slowly and resemble dementia. Possible causes include brain infection ([[viral encephalitis]], [[subacute sclerosing panencephalitis]], [[Whipple's disease]]) or inflammation ([[limbic encephalitis]], [[Hashimoto's encephalopathy]], [[cerebral vasculitis]]); tumors such as [[Primary central nervous system lymphoma|lymphoma]] or [[glioma]]; drug toxicity (e.g. [[anticonvulsant]] drugs); metabolic causes such as [[Hepatic encephalopathy|liver failure]] or [[kidney failure]]; and chronic [[subdural hematoma]]. |
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===As a feature of other conditions=== |
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There are many other medical and neurological conditions in which dementia only occurs late in the illness. For example, a proportion of patients with [[Parkinson's disease]] develop dementia, though widely varying figures are quoted for this proportion.{{Citation needed|date=October 2009}} When dementia occurs in Parkinson's disease, the underlying cause may be [[dementia with Lewy bodies]] or [[Alzheimer's disease]], or both.<ref name=pmid17101891>{{cite journal |title=Clinical phenotype of Parkinson disease dementia |journal=Neurology |volume=67 |issue=9 |pages=1605–11 |year=2006 |pmid=17101891 |author=Galvin JE et al. |doi=10.1212/01.wnl.0000242630.52203.8f}}</ref> Cognitive impairment also occurs in the Parkinson-plus syndromes of [[progressive supranuclear palsy]] and [[corticobasal degeneration]] (and the same underlying pathology may cause the clinical syndromes of [[frontotemporal lobar degeneration]]). Chronic inflammatory conditions of the brain may affect cognition in the long term, including [[Behçet's disease]], [[multiple sclerosis]], [[sarcoidosis]], [[Sjögren's syndrome]] and [[systemic lupus erythematosus]]. Although the acute [[porphyria]]s may cause episodes of confusion and psychiatric disturbance, dementia is a rare feature of these rare diseases. |
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Aside from those mentioned above, inherited conditions that can cause dementia (alongside other symptoms) include:<ref>{{cite journal |title= Cognitive Decline in a Young Adult with Pre-Existent Developmental Delay – What the Adult Neurologist Needs to Know |url=http://pn.bmj.com/cgi/content/abstract/4/2/70 |journal=Practical Neurology |volume=4 |pages=70–87 |year=2004 |author=Lamont P |doi= 10.1111/j.1474-7766.2004.02-206.x |issue=2}}</ref> |
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{{Columns-start|num=2}} |
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* [[Alexander disease]] |
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* [[Canavan disease]] |
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* [[Cerebrotendinous xanthomatosis]] |
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* [[Dentatorubral-pallidoluysian atrophy]] |
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* [[Fatal familial insomnia]] |
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* [[Fragile X-associated tremor/ataxia syndrome]] |
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* [[Glutaric aciduria type 1]] |
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* [[Krabbe's disease]] |
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* [[Maple syrup urine disease]] |
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{{Column}} |
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* [[Niemann Pick disease]] type C |
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* [[Neuronal ceroid lipofuscinosis]] |
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* [[Neuroacanthocytosis]] |
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* [[Organic acidemias]] |
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* [[Pelizaeus-Merzbacher disease]] |
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* [[Urea cycle disorders]] |
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* [[Sanfilippo syndrome]] type B |
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* [[Spinocerebellar ataxia]] type 2 |
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{{Columns-end}} |
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==Diagnosis== |
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There are many specific types and causes of dementia, often showing slightly different symptoms. However, the symptom overlap is such that usually it is impossible to diagnose the type of dementia by symptomatology alone. Diagnosis may be aided by [[Neuroimaging|brain scanning]] techniques. In some cases certainty cannot be attained except with brain [[biopsy]] during life, or at [[autopsy]] in death. Proper differential diagnosis between the types of dementia ([[cerebral cortex|cortical]] and [[cerebral cortex#Laminar pattern|subcortical]]) requires referral to a specialist.{{Citation needed|date=January 2009}} |
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Normally, symptoms must be present for at least six months to support a diagnosis.<ref name="Def" /> Cognitive dysfunction of shorter duration is called ''[[delirium]]''. Delirium can be easily confused with dementia due to similar symptoms. Delirium is characterized by a sudden onset, fluctuating course, a short duration (often lasting from hours to weeks), and is primarily related to a somatic (or medical) disturbance. In comparison, dementia has typically an insidious onset (except in the cases of a stroke or trauma), slow decline of mental functioning, as well as a longer duration (from months to years).<ref>{{cite journal|author=Caplan, J.P., & Rabinowitz, T. |pmid=20951272|year=2010|title=An approach to the patient with cognitive impairment: Delirium and dementia|volume=94|issue=6|pages=1103–16, ix|doi=10.1016/j.mcna.2010.08.004|journal=The Medical clinics of North America}}</ref> |
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Some [[Mental disorder|mental illness]]es, including [[depression (mood)|depression]] and [[psychosis]], may produce symptoms that must be differentiated from both delirium and dementia.<ref name=Glea>{{cite journal |author=Gleason OC |title=Delirium |journal=American Family Physician |volume=67 |issue=5 |pages=1027–34 |year=2003 |pmid=12643363 |url=http://www.aafp.org/afp/20030301/1027.html }}</ref> |
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===Cognitive testing=== |
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{| align="right" border="2"| class="wikitable" style="text-align:center;margin-left:15px" |
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|+[[sensitivity (tests)|Sensitivity]] and [[specificity (tests)|specificity]] of common tests for dementia |
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|- |
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| '''Test''' |
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| '''Sensitivity''' |
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| '''Specificity''' |
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| '''Reference''' |
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|- |
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| ''MMSE'' |
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| 71%–92% |
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| 56%–96% |
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|<ref name=pmid12779304>{{cite journal |title=Screening for dementia in primary care: a summary of the evidence for the U.S. Preventive Services Task Force |journal=Ann Intern Med |volume=138 |issue=11 |pages=927–37 |date=3 June 2003 |pmid=12779304 |url=http://www.annals.org/cgi/content/full/138/11/927 |author1=Boustani, M |author2=Peterson, B |author3=Hanson, L |author4=Harris, R |author5=& Lohr, K |author6=U.S. Preventive Services Task Force |doi=10.7326/0003-4819-138-11-200306030-00015}}</ref> |
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|- |
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| ''3MS'' |
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| 83%–93.5% |
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| 85%–90% |
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|<ref name=pmid17178826>{{cite journal |author=Cullen B, O'Neill B, Evans JJ, Coen RF, Lawlor BA |title=A review of screening tests for cognitive impairment |journal=Journal of Neurology, Neurosurgery, and Psychiatry |volume=78 |issue=8 |pages=790–9 |year=2007|pmid=17178826 |pmc=2117747 |doi=10.1136/jnnp.2006.095414 }}</ref> |
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|- |
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| ''AMTS'' |
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| 73%–100% |
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| 71%–100% |
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|<ref name=pmid17178826/> |
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|} |
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There exist some brief tests (5–15 minutes) that have reasonable reliability to screen cognitive status. |
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While many tests have been studied,<ref name=pmid17163083>{{cite journal |author=Sager MA, Hermann BP, La Rue A, Woodard JL |title=Screening for dementia in community-based memory clinics |journal=Wisconsin medical journal|volume=105 |issue=7 |pages=25–9 |year=2006|pmid=17163083 |url= http://www.wisconsinmedicalsociety.org/_WMS/publications/wmj/issues/wmj_v105n7/sager.pdf |format=PDF }}</ref><ref name=pmid17287448>{{cite journal |title= Clinical predictors of progression to Alzheimer disease in amnestic mild cognitive impairment |journal=Neurology |volume=68 |issue=19 |year=2007 |pmid=17287448 |doi= 10.1212/01.wnl.0000258542.58725.4c |author1=Fleisher, A |author2=Sowell, B |author3=Taylor, C |author4=Gamst, A |author5=Petersen, R |author6=Thal, L |author7= Alzheimer's Disease Cooperative Study |pages= 1588–95}}</ref><ref name=pmid12614094>{{cite journal |author=Karlawish, J & Clark, C |title=Diagnostic evaluation of elderly patients with mild memory problems |journal=Ann Intern Med |volume=138 |issue=5 |pages=411–9 |year=2003 |pmid=12614094 |url=http://www.annals.org/cgi/content/full/138/5/411 |doi=10.7326/0003-4819-138-5-200303040-00011}}</ref> presently the [[mini mental state examination]] (MMSE) is the best studied and most commonly used, albeit some may emerge as better alternatives. Other examples include the [[abbreviated mental test score]] (AMTS), the, ''Modified Mini-Mental State Examination'' (3MS),<ref name=pmid3611032>{{cite journal |author=Teng EL, Chui HC |title=The Modified Mini-Mental State (3MS) examination |journal=The Journal of Clinical Psychiatry |volume=48 |issue=8 |pages=314–8 |year=1987|pmid=3611032 }}</ref> the ''Cognitive Abilities Screening Instrument'' (CASI),<ref name= pmid8054493>{{cite journal |author=Teng EL, Hasegawa K, Homma A, et al. |title=The Cognitive Abilities Screening Instrument (CASI): a practical test for cross-cultural epidemiological studies of dementia |journal=International Psychogeriatrics / IPA |volume=6 |issue=1 |pages=45–58; discussion 62 |year=1994 |pmid=8054493 |doi= 10.1017/S1041610294001602 }}</ref> the [[Trail-making test]],<ref>{{cite journal |title=Trail Making test A and B: Normative Data Stratified by Age and Education |journal= Archives of Clinical Neuropsychology|year=2004 |first=T.N.T.N |last= Tombaugh |volume=19 |issue=2 |pages=203–214 |pmid=15010086|doi=10.1016/S0887-6177(03)00039-8}}</ref> and the clock drawing test.<ref name=pmid9598672>{{cite journal |title=CLOX: an executive clock drawing task |journal=J Neurol Neurosurg Psychiatry |volume=64 |issue=5 |pages=588–94 |year=1998 |pmid=9598672 |doi=10.1136/jnnp.64.5.588 |author1=Royall, D |author2=Cordes, J. |author3=Polk, M. |pmc=2170069}}</ref> |
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Another approach to screening for dementia is to ask an informant (relative or other supporter) to fill out a questionnaire about the person's everyday cognitive functioning. Informant questionnaires provide complementary information to brief cognitive tests. Probably the best known questionnaire of this sort is the ''[[Informant Questionnaire on Cognitive Decline in the Elderly]] (IQCODE)''.<ref>{{cite journal |author=Jorm AF |title=The Informant Questionnaire on cognitive decline in the elderly (IQCODE): a review |journal=International Psychogeriatrics / IPA |volume=16 |issue=3 |pages=275–93 |year=2004 |pmid=15559753 |doi=10.1017/S1041610204000390 }}</ref> On the other hand the ''[[General Practitioner Assessment Of Cognition]]'' combines both, a patient assessment and an informant interview. It was specifically designed for the use in the primary care setting. |
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Clinical neuropsychologists provide diagnostic consultation following administration of a full battery of cognitive testing, often lasting several hours, to determine functional patterns of decline associated with varying types of dementia. Tests of memory, executive function, processing speed, attention, and language skills are relevant, as well as tests of emotional and psychological adjustment. These tests assist with ruling out other etiologies and determining relative cognitive decline over time or from estimates of prior cognitive abilities. |
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===Laboratory tests=== |
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Routine [[blood test]]s are also usually performed to rule out treatable causes. These tests include [[vitamin B12|vitamin B<sub>12</sub>]], [[folic acid]], [[thyroid-stimulating hormone]] (TSH), [[C-reactive protein]], [[full blood count]], [[electrolyte]]s, [[calcium in biology|calcium]], [[renal function]], and [[liver enzyme]]s. Abnormalities may suggest [[vitamin deficiency]], [[infection]] or other problems that commonly cause confusion or disorientation in the elderly. The problem is complicated by the fact that these cause confusion more often in persons who have early dementia, so that "reversal" of such problems may ultimately only be temporary.{{Citation needed|date=November 2009}} |
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Testing for alcohol and other known dementia-inducing drugs may be indicated. |
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===Imaging=== |
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A [[computed axial tomography|CT scan]] or [[magnetic resonance imaging]] (MRI scan) is commonly performed, although these modalities do not have optimal sensitivity for the diffuse metabolic changes associated with dementia in a patient that shows no gross neurological problems (such as paralysis or weakness) on neurological exam. CT or MRI may suggest [[normal pressure hydrocephalus]], a potentially reversible cause of dementia, and can yield information relevant to other types of dementia, such as infarction ([[stroke]]) that would point at a vascular type of dementia. |
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The [[functional neuroimaging]] modalities of [[SPECT]] and [[Positron emission tomography|PET]] are more useful in assessing long-standing cognitive dysfunction, since they have shown similar ability to diagnose dementia as a clinical exam and cognitive testing.<ref>{{cite journal |last=Bonte |first=FJ |coauthors=Harris TS, Hynan LS, Bigio EH, White CL 3rd |year=2006|title=Tc-99m HMPAO SPECT in the differential diagnosis of the dementias with histopathologic confirmation |journal=Clinical Nuclear Medicine |volume=31 |issue=7 |pages=376–8 |pmid=16785801 |doi=10.1097/01.rlu.0000222736.81365.63}}</ref> The ability of SPECT to differentiate the vascular cause (i.e., [[multi-infarct dementia]]) from Alzheimer's disease dementias, appears superior to differentiation by clinical exam.<ref>{{cite journal |last=Dougall |first=NJ |coauthors=Bruggink S, Ebmeier KP |year=2004|title=Systematic review of the diagnostic accuracy of 99mTc-HMPAO-SPECT in dementia |journal=The American Journal of Geriatric Psychiatry |volume=12 |issue=6 |pages=554–70 |pmid=15545324 |doi=10.1176/appi.ajgp.12.6.554}}</ref> |
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Recent research has established the value of PET imaging using carbon-11 Pittsburgh Compound B as a radiotracer (PIB-PET) in predictive diagnosis of various kinds of dementia, in particular [[Alzheimer's disease]]. Studies from Australia have found PIB-PET 86% accurate in predicting which patients with mild cognitive impairment would develop Alzheimer's disease within two years. In another study, carried out using 66 patients seen at the University of Michigan, PET studies using either PIB or another radiotracer, carbon-11 dihydrotetrabenazine (DTBZ), led to more accurate diagnosis for more than one-fourth of patients with mild cognitive impairment or mild dementia.<ref>{{cite journal |author=Abella HA |title=Report from SNM: PET imaging of brain chemistry bolsters characterization of dementias |journal=Diagnostic Imaging |date=June 16, 2009 |url=http://www.diagnosticimaging.com/imaging-trends-advances/cardiovascular-imaging/article/113619/1423022}}</ref> |
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==Prevention== |
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{{Main|Prevention of dementia}} |
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Many prevention measures have been proposed, including both lifestyle changes and medication although none has been reliably shown to be effective. |
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==Management== |
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Except for the treatable types listed above, there is no cure. [[Acetylcholinesterase inhibitor|Cholinesterase inhibitor]]s are often used early in the disease course. Cognitive and behavioral interventions may also be appropriate. Educating and providing emotional support to the [[caregiver]] (or carer) is of importance as well [[elderly care]]. |
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===Medications=== |
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Currently, no medications have been shown to prevent or cure dementia.<ref>{{cite journal |author= Rafii, M. S. & Aisen, P. S. |title= Recent developments in Alzheimer's disease therapeutics |journal=BMC medicine |volume= 7 |pages= 1–4 |year=2009 |doi=10.1186/1741-7015-7-7}}</ref> Medications are used to treat the behavioural and cognitive symptoms and have no effect on the underlying pathophysiology.<ref name=Lleo>{{cite journal |author=Lleó A, Greenberg SM, Growdon JH |title=Current pharmacotherapy for Alzheimer's disease |journal=Annu. Rev. Med. |volume=57 |pages=513–33 |year=2006 |pmid=16409164 |doi=10.1146/annurev.med.57.121304.131442}}</ref> |
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[[Acetylcholinesterase inhibitor]]s, such as [[donepezil]], may be useful for Alzheimer disease and other similar diseases causing dementia such as Parkinsons or vascular dementia.<ref name=Lleo/> The quality of the evidence however is poor.<ref>{{cite journal|last=Rodda|first=J|coauthors=Morgan, S; Walker, Z|title=Are cholinesterase inhibitors effective in the management of the behavioral and psychological symptoms of dementia in Alzheimer's disease? A systematic review of randomized, placebo-controlled trials of donepezil, rivastigmine and galantamine.|journal=International psychogeriatrics / IPA|date=2009 Oct|volume=21|issue=5|pages=813–24|pmid=19538824|doi=10.1017/S1041610209990354}}</ref> No difference has been shown between the agents in this family.<ref>{{cite journal|last=Birks|first=J|title=Cholinesterase inhibitors for Alzheimer's disease.|journal=Cochrane database of systematic reviews (Online)|date=2006 Jan 25|issue=1|pages=CD005593|pmid=16437532|doi=10.1002/14651858.CD005593}}</ref> In a minority of people side effects including [[bradycardia]] and [[syncope (medicine)|syncope]].<ref>{{cite journal |author=Gill S. S., Anderson, G. M., Fischer, H.D., Li, P., Normand, S. T. & Rochon, P. A. |title=Syncope and its consequences in patients with dementia receiving cholinesterase inhibitors: A population-based cohort study |journal=Archives of Internal Medicine |volume=169 |issue=9 |pages=867–873 |year=2009 |doi=10.1001/archinternmed.2009.43 |pmid=19433698}}</ref> |
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[[NMDA receptor|N-methyl-D-aspartate (NMDA) receptor]] blockers such as [[memantine]] may be of benefit but the evidence is less conclusive than for AChEIs.<ref>{{cite journal|last=Bond|first=M|coauthors=Rogers, G; Peters, J; Anderson, R; Hoyle, M; Miners, A; Moxham, T; Davis, S; Thokala, P; Wailoo, A; Jeffreys, M; Hyde, C|title=The effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (review of Technology Appraisal No. 111): a systematic review and economic model.|journal=Health technology assessment (Winchester, England)|year=2012|volume=16|issue=21|pages=1–470|pmid=22541366|doi=10.3310/hta16210}}</ref> Due to their differing mechanisms of action memantine and acetylcholinesterase inhibitors can be used in combination however the benefit is slight.<ref name=Rain>{{cite journal |author=Raina P, Santaguida P, Ismaila A, et al. |title=Effectiveness of cholinesterase inhibitors and memantine for treating dementia: evidence review for a clinical practice guideline |journal=Annals of Internal Medicine |volume=148 |issue=5 |pages=379–97 |year=2008 |pmid=18316756 |url=http://www.annals.org/cgi/content/full/148/5/379 |doi=10.7326/0003-4819-148-5-200803040-00009 }}</ref><ref name=Atri>{{cite journal |author=Atri A, Shaughnessy LW, Locascio JJ, Growdon JH |title=Long-term Course and Effectiveness of Combination Therapy in Alzheimer's Disease |journal=Alzheimer Disease and Associated Disorders |volume=22 |issue=3 |pages=209–21 |year=2008 |pmid=18580597 |doi=10.1097/WAD.0b013e31816653bc |pmc=2718545}}</ref> |
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[[Antidepressant]] drugs: [[Clinical depression|Depression]] is frequently associated with dementia and generally worsens the degree of [[cognitive]] and [[behavioral]] impairment. [[Antidepressant]]s effectively treat the cognitive and behavioral symptoms of depression in patients with Alzheimer's disease,<ref>{{cite journal |author=Thompson S, Herrmann N, Rapoport MJ, Lanctôt KL |title=Efficacy and safety of antidepressants for treatment of depression in Alzheimer's disease: a metaanalysis |journal=Canadian Journal of Psychiatry |volume=52 |issue=4 |pages=248–55 |year=2007 |pmid=17500306 |url=http://publications.cpa-apc.org/media.php?mid=586&xwm=true |format=PDF }}</ref> but evidence for their use in other forms of dementia is weak.<ref>{{cite journal |author=Bains J, Birks JS, Dening TR |title=The efficacy of antidepressants in the treatment of depression in dementia |journal=Cochrane Database of Systematic Reviews |issue=4|pages=CD003944 |year=2002 |pmid=12519625 |doi=10.1002/14651858.CD003944 |editor1-last=Dening |editor1-first=Tom }}</ref> |
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It is recommended that [[benzodiazepines]] such as [[diazepam]] be avoided in dementia due to the risks of increased cognitive impairment and falls.<ref name=Beers2012/> There is little evidence for the effectiveness in this population.<ref>{{cite journal |author=Lolk A, Gulmann NC |title=[Psychopharmacological treatment of behavioral and psychological symptoms in dementia] |language=Danish |journal=Ugeskr Laeg |volume=168 |issue=40|pages=3429–32 |year=2006 |pmid=17032610}}</ref> [[Antipsychotic drugs]], both [[typical antipsychotics]] and [[atypical antipsychotics]], increase the risk of death in dementia.<ref>{{cite web|url=http://www.fda.gov/medwatch/safety/2008/safety08.htm#Antipsychotics |title=FDA MedWatch – 2008 Safety Alerts for Human Medical Products |work=FDA}}</ref> The use for dementia-associated behavior problems thus should only be considered after other treatment modalities have failed and if the person in question is at either risk to themselves or others.<ref name=Beers2012>{{cite journal|last=American Geriatrics Society 2012 Beers Criteria Update Expert|first=Panel|title=American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults.|journal=Journal of the American Geriatrics Society|date=2012 Apr|volume=60|issue=4|pages=616–31|pmid=22376048|doi=10.1111/j.1532-5415.2012.03923.x}}</ref> Generally stopping antipsychotics does not cause problems, even in those who have been on them a long time.<ref>{{cite journal|last=Declercq|first=T|coauthors=Petrovic, M; Azermai, M; Vander Stichele, R; De Sutter, AI; van Driel, ML; Christiaens, T|title=Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia.|journal=The Cochrane database of systematic reviews|date=2013 Mar 28|volume=3|pages=CD007726|pmid=23543555|doi=10.1002/14651858.CD007726.pub2}}</ref> There is no solid evidence that [[folate]] or [[vitamin B12]] improves outcomes in those with cognitive problems.<ref>{{cite journal|last=Malouf|first=R|coauthors=Grimley Evans, J|title=Folic acid with or without vitamin B12 for the prevention and treatment of healthy elderly and demented people|journal=Cochrane database of systematic reviews (Online)|date=2008 Oct 8|issue=4|pages=CD004514|pmid=18843658|doi=10.1002/14651858.CD004514.pub2}}</ref> |
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===Pain===<!--This section is linked from [[Pain#In_nonverbal_patients]]--> |
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{{See also|Pain#In nonverbal patients|l1=Assessment in nonverbal patients}} |
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As people age, they experience more health problems, and most health problems associated with aging carry a substantial burden of pain; so, between 25% and 50% of older adults experience persistent pain. Seniors with dementia experience the same prevalence of conditions likely to cause pain as seniors without dementia.<ref name="Hadjistavropoulos 2007">{{cite journal |last1= Hadjistavropoulos |first1=T |last2=Herr |first2=K |last3=Turk |first3=DC |last4=Fine |first4=PG |last5=Dworkin |first5=RH |last6= Helme |first6=R|last7=Jackson |first7=K |last8=et al. |title=An interdisciplinary expert consensus statement on assessment of pain in older persons |journal=Clinical Journal of Pain |year= 2007 |volume= 23 |issue=1 suppl |pages=S1–43 |pmid=17179836|doi=10.1097/AJP.0b013e31802be869 }}</ref> Pain is often overlooked in older adults and, when screened for, often poorly assessed, especially among those with dementia since they become incapable of informing others that they're in pain.<ref name="Hadjistavropoulos 2007"/><ref name=Shega>{{cite journal |last1=Shega |first1=J |last2=Emanuel |first2=L |last3=Vargish |first3=L |last4=Levine |first4=S.K. |last5=Bursch |first5=H|last6=Herr |first6=K |last7=Karp |first7=J.F. |last8=Weiner |first8=D.K. |year=2007 |title=Pain in persons with dementia: complex, common, and challenging |journal=Journal of Pain |volume=8 |issue=5 |pages=373–8 |pmid=17485039 |doi=10.1016/j.jpain.2007.03.003}}</ref> Beyond the issue of humane care, unrelieved pain has functional implications. Persistent pain can lead to decreased ambulation, depressed mood, sleep disturbances, impaired appetite and exacerbation of cognitive impairment,<ref name= Shega/> and pain-related interference with activity is a factor contributing to falls in the elderly.<ref name="Hadjistavropoulos 2007"/><ref name=Blyth>{{cite journal |last1=Blyth |first1=F |last2= Cumming |first2=M.R. |last3=Mitchell |first3=P |last4=Wang|first4=J.J. |year=2007 |title=Pain and falls in older people |journal=European Journal of Pain |volume=11 |issue=5|pages= 564–71 |pmid=17015026|url=http://www.ncbi.nlm.nih.gov/pubmed/17015026?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=8 |doi= 10.1016/j.ejpain.2006.08.001}}</ref> |
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Although persistent pain in the person with dementia is difficult to communicate, diagnose and treat, failure to address persistent pain has profound functional, [[psychosocial]] and [[quality of life]] implications for this vulnerable population. Health professionals often lack the skills and usually lack the time needed to recognize, accurately assess and adequately monitor pain in people with dementia.<ref name="Hadjistavropoulos 2007"/><ref name=Brown>{{cite journal |last1=Brown |first1=C. |year=2009 |title=Pain, aging and dementia: The crisis is looming, but are we ready? |journal=British Journal of Occupational Therapy |volume=72 |issue=8 |pages=371–75|url=http://www.ingentaconnect.com/content/cot/bjot/2009/00000072/00000008/art00007}}</ref> Family members and friends can make a valuable contribution to the care of a person with dementia by learning to recognize and assess their pain. Educational resources (such as the {{Plain link|url=http://www.painanddementia.ualberta.ca |name=Understand Pain and Dementia}} tutorial) and observational assessment tools are available.<ref name= "Hadjistavropoulos 2007"/><ref name=Herr>{{cite journal |last1=Herr |first1=K |last2=Bjoro |first2=K |last3=Decker |first3=S |last4=Wang |year=2006 |title=Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review |journal=Journal of pain and symptom management|volume=31 |issue=2 |pages=170–92 |pmid=16488350 |url= http://www.ncbi.nlm.nih.gov/pubmed/16488350 |doi=10.1016/j.jpainsymman.2005.07.001}}</ref><ref name=Stolee2005>{{cite journal |last1=Stolee |first1=P |last2=Hillier |first2=LM |last3=Esbaugh |first3=et al. |year=2005 |title=Instruments for the assessment of pain in older persons with cognitive impairment |journal=Journal of the American geriatrics society |volume=53 |issue=2 |pages=319–26|pmid=15673359 |doi=10.1111/j.1532-5415.2005.53121.x |last4=Bol |first4=N |last5=McKellar |first5=L |last6=Gauthier |first6=N}}</ref> |
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===Feeding tubes=== |
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In advanced dementia, people may lose the ability to swallow effectively, leading to the consideration of [[Percutaneous endoscopic gastrostomy|gastrostomy]] [[feeding tube]] placement as a way to give nutrition. Benefits of this procedure in those with advanced dementia has not been shown.<ref>{{cite journal|last=Sampson|first=EL|coauthors=Candy, B; Jones, L|title=Enteral tube feeding for older people with advanced dementia.|journal=Cochrane database of systematic reviews (Online)|date=2009 Apr 15|issue=2|pages=CD007209|pmid=19370678|doi=10.1002/14651858.CD007209.pub2}}</ref> The risks include agitation, the person pulling out the tube, and tubes becoming dislodged, clogged, or malpositioned among others. There is about a 1% fatality rate directly related to the procedure<ref>{{cite journal |author=Lockett MA, Templeton ML, Byrne TK, Norcross ED |title=Percutaneous endoscopic gastrostomy complications in a tertiary-care center |journal=Am Surg |volume=68 |issue=2 |pages=117–20|year=2002|pmid=11842953}}</ref> with a 3% major complication rate.<ref>{{cite journal |author=Finocchiaro C, Galletti R, Rovera G, ''et al.'' |title=Percutaneous endoscopic gastrostomy: a long-term follow-up |journal=Nutrition |volume=13|issue=6 |pages=520–3 |year=1997 |pmid=9263232 |doi=10.1016/S0899-9007(97)00030-0}}</ref> |
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===Services=== |
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[[Adult daycare]] centers as well as special care units in nursing homes often provide specialized care for dementia patients. Adult daycare centers offer supervision, recreation, meals, and limited health care to participants, as well as providing respite for caregivers. In addition, [[home care]] can provide one-on-one support and care in the home allowing for more individualized attention that is needed as the disease progresses. Psychiatric nurses can make a distinctive contribution to people's mental health.<ref>{{cite book |author=Barker, Philip |title=Psychiatric and mental health nursing: the craft of caring |publisher=Arnold |location=London |year=2003 |isbn=0-340-81026-2 |oclc=53373798}}</ref> |
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Since dementia impairs normal communication due to changes in receptive and expressive language, as well as the ability to plan and problem solve, agitated behaviour is often a form of communication for the person with dementia and actively searching for a potential cause, such as pain, physical illness, or overstimulation can be helpful in reducing agitation.<ref name="Weitzel 2011">{{cite journal |author=Weitzel T, Robinson S, Barnes MR, ''et al.'' |title=The special needs of the hospitalized patient with dementia |journal=Medsurg Nurs |volume=20 |issue=1 |pages=13–8; quiz 19 |year=2011 |pmid=21446290 |doi= |url=}}</ref> Additionally, using an "ABC analysis of behaviour" can be a useful tool for understanding behavior in people with dementia. It involves looking at the antecedents (A), behavior (B), and consequences (C) associated with an event to help define the problem and prevent further incidents that may arise if the person's needs are misunderstood.<ref>{{cite journal|pmid=16913375|year=2006|last1=Cunningham|first1=C|title=Understanding challenging behaviour in patients with dementia|volume=20|issue=47|pages=42–5|journal=Nursing standard|doi=10.7748/ns2006.08.20.47.42.c4477}}</ref> |
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==Society and culture== |
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Many countries consider the care of people living with dementia to be a national priority, and invest in resources and education to better inform health and social service workers, unpaid carers, relatives and members of the wider community. Several countries have national plans or strategies.<ref>{{cite news |url= http://www.alz.co.uk/sites/default/files/national-alzheimer-and-dementia-plans.pdf |title=National Alzheimer and Dementia Plans Planned Policies and Activities (PDF) |date=April 2012 |publisher=Alzheimer's Disease International |location=[[London, England|London]]}}</ref> In these national plans, there is recognition that people can live well with dementia for a number of years, as long as there is the right support and timely access to a diagnosis. [[David Cameron]] has described dementia as being a "national crisis", affecting 800,000 people in the [[United Kingdom]].<ref>{{cite news |url= http://www.guardian.co.uk/society/2012/mar/26/dementia-research-funding-to-double |title=Dementia research funding to more than double to £66m by 2015|first=Sarah |last=Boseley |work=[[The Guardian]] |date=26 March 2012 |location=[[London, England|London]] |issn=0261-3077 |oclc=60623878 |accessdate=27 April 2012}}</ref> |
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In the [[United States]], Florida's [[Baker Act]] allows law-enforcement authorities and the judiciary to force [[mental evaluation]] for those suspected of having developed dementia or other mental [[incapacity|incapacities]].{{Citation needed|date=March 2008}} In the [[United Kingdom]], as with all mental disorders, where a person with dementia could potentially be a danger to themselves or others, they can be detained under the [[Mental Health Act 1983]] for the purposes of assessment, care and treatment. This is a last resort, and usually avoided if the patient has family or friends who can ensure care. |
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[[Driving]] with dementia could lead to severe injury or even death to self and others. Doctors should advise appropriate testing on when to quit driving.<ref>{{cite web |title=Drivers with dementia a growing problem, MDs warn |date=September 19, 2007 |publisher=CBC News, Canada |url=http://www.cbc.ca/health/story/2007/09/19/drivers-dementia.html?ref=rss}}</ref> The [[United Kingdom]] [[DVLA]] (Driving & Vehicle Licensing Agency) states that people with dementia who specifically have poor short term memory, disorientation, lack of insight or judgment are almost certainly not fit to drive, and in these instances the DVLA must be informed so that the driving licence can be revoked. They do, however, acknowledge low-severity cases and those with an early diagnosis, and those drivers may be permitted to drive pending medical reports. |
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There are many support networks available to those who have a diagnosis of dementia, and their families and carers. There are also charitable organisations which aim to raise awareness and campaign for the rights of people living with dementia. |
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==Epidemiology== |
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[[Image:Alzheimer and other dementias world map - DALY - WHO2004.svg|thumb|[[Disability-adjusted life year]] for Alzheimer and other dementias per 100,000 inhabitants in 2002. |
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The number of cases of dementia worldwide in 2010 was estimated at 35.6 million.<ref>{{cite journal|last=Alzheimer's Disease International|title=World Alzheimer Report 2009|year=2009|pages=38|url=http://www.alz.co.uk/research/world-report|accessdate=11 March 2012|editor1-first=Prince, M. & Jackson, J.}}</ref> Rates increase significantly with age, with dementia affecting 5% of the population older than 65 and 20–40% of those older than 85.<ref name=Sadock2008>{{cite book|last=Sadock|first=Benjamin James Sadock, Virginia Alcott|title=Kaplan & Sadock's concise textbook of clinical psychiatry|year=2008|publisher=Wolters Kluwer/Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-8746-8|page=52|url=http://books.google.com/books?id=ubG51n2NgfwC&pg=PA52|edition=3rd}}</ref> Around two thirds of individuals with dementia live in low and middle income countries, where the sharpest increases in numbers are predicted.<ref>{{cite journal|last=Alzheimer's Disease International|title=World Alzheimer Report 2009|year=2009|pages=36|url=http://www.alz.co.uk/research/world-report|accessdate=11 March 2012|editor1-first=Prince, M. & Jackson, J.}}</ref> Rates are slightly higher in women than men at ages 65 and greater.<ref name=Sadock2008/> |
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==History== |
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{{See also|Dementia praecox|Alzheimer's disease}} |
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Until the end of the 19th century, dementia was a much broader clinical concept. It included mental illness and any type of psychosocial incapacity, including conditions that could be reversed.<ref name=Berr>{{cite journal |author=Berrios GE |title=Dementia during the seventeenth and eighteenth centuries: a conceptual history |journal=Psychological Medicine |volume=17 |issue=4 |pages=829–37 |year=1987|pmid=3324141 |doi=10.1017/S0033291700000623}}</ref> Dementia at this time simply referred to anyone who had lost the ability to reason, and was applied equally to psychosis of mental illness, "organic" diseases like [[syphilis]] that destroy the brain, and to the dementia associated with old age, which was attributed to "hardening of the arteries." |
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Dementia in the elderly was called ''senile dementia'' or ''senility,'' and viewed as a normal and somewhat inevitable aspect of growing old, rather than as being caused by any specific diseases. At the same time, in 1907, a specific organic dementing process of early onset, called [[Alzheimer's disease]], had been described. This was associated with particular microscopic changes in the brain, but was seen as a rare disease of middle age. |
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Much like other diseases associated with aging, dementia was rare before the 20th century, although by no means unknown, due to the fact that it is most prevalent in people over 80, and such lifespans were uncommon in preindustrial times. Conversely, syphilitic dementia was widespread in the developed world until largely being eradicated by the use of penicillin after WWII. |
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By the period of 1913–20, [[schizophrenia]] had been well-defined in a way similar to today, and also the term [[dementia praecox]] had been used to suggest the development of senile-type dementia at a younger age. Eventually the two terms fused, so that until 1952 physicians used the terms ''[[dementia praecox]]'' (precocious dementia) and ''[[schizophrenia]]'' interchangeably. The term ''precocious dementia'' for a mental illness suggested that a type of mental illness like schizophrenia (including paranoia and decreased cognitive capacity) could be expected to arrive normally in all persons with greater age (see [[paraphrenia]]). After about 1920, the beginning use of ''dementia'' for what we now understand as schizophrenia and senile dementia helped limit the word's meaning to "permanent, irreversible mental deterioration." This began the change to the more recognizable use of the term today. |
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In 1976, neurologist Robert Katzmann suggested a link between senile dementia and Alzheimer's disease.<ref>{{cite news |first=Gina |last=Kolata |authorlink=Gina Kolata |title=Drug Trials Test Bold Plan to Slow Alzheimer's|url=http://www.nytimes.com/2010/07/17/health/research/17drug.html |newspaper=The New York Times |date=June 17, 2010 |accessdate=June 17, 2010}}</ref> Katzmann suggested that much of the senile dementia occurring (by definition) after the age of 65, was pathologically identical with Alzheimer's disease occurring before age 65 and therefore should not be treated differently. He noted that the fact that "senile dementia" was not considered a disease, but rather part of aging, was keeping millions of aged patients experiencing what otherwise was identical with Alzheimer's disease from being diagnosed as having a disease process, rather than simply considered as aging normally.<ref name="Katzman1976">{{cite journal|last1=Katzman|first1=R.|title=The Prevalence and Malignancy of Alzheimer Disease: A Major Killer|journal=Archives of Neurology| volume=33|issue=4|year=1976|pages=217–218|doi=10.1001/archneur.1976.00500040001001|pmid=1259639}}</ref> Katzmann thus suggested that Alzheimer's disease, if taken to occur over age 65, is actually common, not rare, and was the 4th or 5th leading cause of death, even though rarely reported on death certificates in 1976. |
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This suggestion opened the view that dementia is never normal, and must always be the result of a particular disease process, and is not part of the normal healthy aging process, ''per se''. The ensuing debate led for a time to the proposed disease diagnosis of "senile dementia of the Alzheimer's type" (SDAT) in persons over the age of 65, with "Alzheimer's disease" diagnosed in persons younger than 65 who had the same pathology. Eventually, however, it was agreed that the age limit was artificial, and that Alzheimer's disease was the appropriate term for persons with the particular brain pathology seen in this disease, regardless of the age of the person with the diagnosis. A helpful finding was that although the incidence of Alzheimer's disease increased with age (from 5–10% of 75-year-olds to as many as 40–50% of 90-year-olds), there was no age at which all persons developed it, so it was not an inevitable consequence of aging, no matter how great an age a person attained. Evidence of this is shown by numerous documented supercentenarians (people living to 110+) that experienced no serious cognitive impairment. |
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Also, after 1952, mental illnesses like schizophrenia were removed from the category of ''[[organic brain syndrome]]s,'' and thus (by definition) removed from possible causes of "dementing illnesses" (dementias). At the same, however, the traditional cause of senile dementia– "hardening of the arteries" – now returned as a set of dementias of vascular cause (small strokes). These were now termed ''multi-infarct dementias'' or ''[[vascular dementia]]s''. |
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In the 21st century, a number of other types of dementia have been differentiated from Alzheimer's disease and vascular dementias (these two being the most common types). This differentiation is on the basis of pathological examination of brain tissues, symptomatology, and by different patterns of brain metabolic activity in nuclear medical imaging tests such as [[SPECT]] and [[Positron emission tomography|PET]]scans of the brain. The various forms of dementia have differing prognoses (expected outcome of illness), and also differing sets of epidemologic risk factors. The causal etiology of many of them, including Alzheimer's disease, remains unknown, although many theories exist such as accumulation of protein plaques as part of normal aging, inflammation, inadequate blood sugar, and traumatic brain injury. |
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== References == |
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{{Reflist|colwidth=30em}} |
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==External links== |
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* {{dmoz|Health/Conditions_and_Diseases/Neurological_Disorders/Dementia/}} |
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{{Diseases of the nervous system}} |
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{{Mental and behavioural disorders|selected = neurological}} |
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{{Speech and voice symptoms and signs}} |
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[[Category:Cognitive disorders]] |
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[[Category:Organic, including symptomatic, mental disorders]] |
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[[Category:Dementia| ]] |
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[[Category:Psychiatric diagnosis]] |
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[[Category:Learning disabilities]] |
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[[Category:Aging-associated diseases]] |
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Revision as of 02:34, 18 October 2013
{{Infobox chiam disease
| Name = Dementchiam | ICD10 = F00-F07 | ICD9 = 290-294 | MedlinePlus = 000739 | DiseasesDB = 29283
Chiam cgheow ling