Dementias Are Broken Down Into Two Differentiating Types

Dementia

Dementia is a term to define a progressive decline in cognitive functioning due to a type of damage or disease. Cognitive (mental) functioning affects memory, language, attention, problem solving. Dementia is not a disease itself, but rather a group of symptoms that might accompany certain diseases or conditions. Symptoms also might include changes in personality, mood, and behavior. Dementia is irreversible when caused by disease or injury, but might be reversible when caused by drugs, alcohol, hormone or vitamin imbalances, or depression.

Dementia develops when the parts of the brain that are involved with learning, memory, decision-making, and language are affected by any of various infections or diseases. The most common cause of dementia is Alzheimer’s disease, but there are as many as 50 other known causes.

Dementia is considered a late-life disease because it tends to develop mostly in elderly people. About 5 percent to 8 percent of all people over the age of 65 have some form of dementia, and this number doubles every five years above that age. It is estimated that as many as half of people 85 or older suffer from dementia.

Dementias are broken down into two differentiating types.

1. Cortical Dementias (more commonly known – protein build ups): Affect the cerebral Cortex which plays a role in processing information and connecting functions such as language and memory. Alzheimer's and Creutzfeldt-Jakob (mad cow – lots of hallucinations) disease are two forms of cortical dementia. Cortical dementia patients typically show severe memory impairment and aphasia, the inability to recall words and understand common language.

Other types of Cortical Dementias: (in general can have gait imbalances – falls)

·  Vascular Dementia (SVOD – small vessel occluded disease – stenosis in cerebral arteries-decreased blood flow to neurons)

·  Lewy Body (Alpha Synuclein proteins) – can have daytime drowsiness

·  Alcohol Dementia (Korsakoff’s/ Wernicke’s – can’t say what you want to say)

-  Proteins get into nerve cells – create Tao bundles (where protein build ups occur)

-  Loss of cognition is a big component

-  Personality change (confabulation), changes in mood (irritability), frustrated that their cognition is changing

-  Onset – behavioral and mood changes

-  Alzheimer’s – Beta Amyloid proteins (gooey proteins that stick to nerve fibers)

2. Subcortical Dementias: Result from dysfunction in the parts of the brain that are beneath the cortex. Usually, the memory loss and language difficulties that are characteristic of cortical dementias are not present. Rather, people with subcortical dementias, such as Huntington's disease, Parkinson's disease, and AIDS dementia complex, tend to show changes in their personality and attention span, and their thinking slows down. (may have secondary morbidity that causes their dementia. Dementia is directly related to disease.) People with Osteoporosis. High MCV – macrocytosis (macrocytic anemia) – can slow progression by giving vit. B or folate.

Other types of Subcortical Dementias:

·  Vitamin B Deficiency

·  Hypercalciemia

·  Renal Failure

·  Heart Failure.

3. Diagnosis

Is made by multiple subjective and objective testing: Rule out reversible mental causes.

·  MMSE (mini mental status exam-to test cognitive function)

·  Clock Drawing Test (for dementia vs delirium) If delirium they can do it, Dementia would be off

·  Family cognitive questionnaire for longitudinal evaluation

·  Lab Tests:

o  CBC (look for leukocytosis, anemia (low hct and Hem), increased MCV

o  Vitamin B levels

o  folic acid

o  TSH

o  RPR (rapid plasma reagan – syphilis)

o  Urinalysis (can have mental status change from UTI)

o  Comprehensive metabolic panel.

·  CT Scan for reversible causes (only good for structural damage e.g. stoke, tumor etc)

4. Treatment

ACE inhibitors – bind to proteins. It slows it down, only tx of sx

Need to stop drinking

Treatable causes of dementia are reversible disorders that can be cured completely, or at least partially, by treating the underlying disorder. Because some types of dementia are treatable or partially treatable, it is important not to assume that a person who is showing any symptoms of dementia is suffering from Alzheimer's disease or another incurable disease. For example, dementias caused by any of the following are often at least partially treatable:

·  Chronic drug abuse

·  Tumors that can be removed

·  Subdural hematoma, an accumulation of blood beneath the outer covering of the brain that results from a broken blood vessel, usually as a result of a head injury (which can be minor and even unrecognized)

·  Normal pressure hydrocephalus

·  Metabolic disorders, such as a vitamin B12 deficiency

·  Hypothyroidism, a condition that results from low levels of thyroid secretion

·  Hypoglycemia, a condition that results from low blood sugar

Non-treatable causes of dementia include:

·  Alzheimer’s disease

·  Multi-infarct dementia

·  Dementias associated with Parkinson’s disease and similar disorders

·  AIDS dementia complex

Cholinesterase inhibitors are often used early in the disease course (Cognex, Aricept, and Exelon) with modest effectiveness. Medications are mostly used to treat the symptoms.

Give low dose of neuroleptics for sundowners.

Need to have a routine and have family aware of routine. Any comorbidities that can exacerbate decline need to take meds.

When you have diagnosed dementia:

1.  Assess the physical, mental, behavioral and social course of the patient

2.  Identify patients strengths and weakness

3.  Identify with family/caregiver and patient consider to be the main problems

4.  Identify any treatable complications of coexisting pathology in the patient

5.  Identify what the caregiver’s unmet needs are, and recommend the appropriate services

6.  Frequently review needs of patient and caregiver

7.  Establish strong liaisons with other professionals involved with the patient

8.  Arrange to see the career regularly once the patient dies or is placed in long term care.

GOULD assessment – to assess ability to care for themselves. From state or county that go in and do a thorough assessment of how they are taking care of their home.

PP505 – In Maine, where you voice concerns about peoples’ ability to care for themselves.