Obesity in Children and Adolescents

Childhood Obesity Facts

Obesity means an excess amount of body fat. No general agreement exists on the lowest definition of obesity in children and adolescents, unlike standards for adults. Nevertheless, most professionals accept published guidelines based on the body mass index (BMI) -- modified for age, pubertal stage, and gender -- to measure obesity in children and adolescents. Others define pediatric obesity as body weight at least 20% higher than the healthy weight range for a child or adolescent of that height, or as a body fat percentage above 25% in boys or above 32% in girls.

Although rare in the past, obesity is now among the most widespread medical problems affecting children and adolescents living in the United States and other developed countries. About 15% of adolescents (12-19 years of age) and children (6-11 years of age) are obese in the United States according to the American Obesity Association. These numbers have continued to increase since at least the early 1990s. Pediatric obesity represents one of our greatest health challenges.

Obesity has a profound effect on a patient's life. Obesity increases the patient's risk of numerous health problems, and it also can create emotional and social problems. Obese children are also more likely to be obese as adults, thereby increasing their lifelong risk of serious health problems such as heart disease and stroke.

If your child or teenager is overweight, further weight gain can be prevented. Parents can help their children keep their weight in the healthy range.

• In infancy, breastfeeding and delaying introduction of solid foods may help prevent obesity.
• In early childhood, children should be given healthy, low-fat snacks and take part in moderate-vigorous physical activity every day. Their television viewing should be limited to no more than seven hours per week (this includes sedentary entertainment like video games and internet surfing).
• Older children can be taught to select healthy, nutritious foods and to develop good exercise habits. Their time spent watching television and playing with computer or video games should be limited to no more than seven hours each week. Avoid snacking or eating meals while watching TV, movies, and videos. Avoid consumption of sugary products, especially those high in corn syrup or fructose derivatives, such as regular soda, pop, or cola (which some regions call "phosphate" drinks).

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Running

Baby, we were born to run." Those immortal words by Bruce Springsteen may be more than just rock and roll lyrics, they may explain our evolutionary past. In this article, I'll describe the biological and social history of running, the health and fitness benefits (and risks) of running, how to get started, how to run properly, and some training techniques.

History of Running

The conventional thinking among most scholars is that early man (hunter-gatherers) ran in short sprints as a matter of survival -- to catch prey and escape danger -- but that running, and particularly endurance running, was merely a byproduct of the ability to walk and not a natural part of our evolution. The argument goes that (1) running is less efficient than walking (you burn more calories doing it), and (2) humans are poor sprinters compared to four-legged animals (who run much faster), and so it is concluded that we were never designed, or "born" to run. In evolutionary terms, scientists would say that we were not adapted for running.

But University of Utah biologist Dennis Bramble and Harvard University anthropologist Daniel Lieberman suggest otherwise. In their research, published in the prestigious journal Nature, they claim that the "roots of running may be as ancient as the origin of the human genus, and its demands a major contributing factor to the human body form." In other words, the act of running helped shaped the way we look.

The evidence for this claim is based on their work, in which they examined 26 traits of the human body that contribute to running skill, and in particular, long-distance running. Among the 26 traits are

1. a ligament that connects the back of the skull to the vertebrae in the spine that acts like a shock absorber,
2. our shoulders, which are separated from the head and neck (unlike apes), that allows our body to rotate while our head and eyes remain forward,
3. a taller body than apes, with a narrow trunk and waist, that allows for a more efficient running gait,
4. independent body movement between the hips, legs, and torso that counteract the twisting forces between the upper and lower body while running,
5. tendons and ligaments in the feet and legs that act like springs, and
6. a strong prominent buttocks that propel and stabilize the body during running.

Based on the evidence, they claim, "Running has substantially shaped human evolution. Running made us human -- at least in an anatomical sense. We think running is one of the most transforming events in human history. We are arguing the emergence of humans is tied to the evolution of running." If Bramble and Lieberman are right, then indeed the lyrics are true -- "Baby, we were born to run!"

Moving forward through the millennia to the ancient Olympic Games (776 B.C.) in Olympia, Greece, you find what could be the first documented competitive running event. It is reported that Koroibos, a cook from the city of Elis, won a 600-foot-long road race in those Olympics. But it was the ancient Greek messenger Pheidippides who set the stage for running in the modern era. In 490 B.C., Pheidippides ran 26 miles from the town of Marathon to Athens to announce the Greek victory over Persia in the Battle of Marathon. It was this event that inspired the running of the marathon (26.2 miles) in the first modern Olympic Games in Athens, Greece, in 1896, but organized running in the modern era had its roots earlier than that. The first collegiate races were sponsored by the Intercollegiate Association of Amateur Athletes of America in 1873, and in 1888, the Amateur Athletic Union held its first championships.

It was in the 20th century that the scope of organized and recreational running widened. The first NCAA national championships were held for men in 1921, and women's track and field became a part of the Olympic Games in 1928. Today, the International Association of Athletics Federations (IAAF) governs the sport internationally and includes more than 200 member nations. In the United States and Canada, track and field is one of the most popular high school sports with more than 950,000 high school students participating in events in each year. Recreationally, it is estimated that over 15 million Americans jog or run for fitness and health. In 2007, more than 20,000 runners completed the 111th Boston Marathon (the world's oldest marathon), and more than 39,000 participated in the New York City Marathon (the world's largest marathon -- and more than 90,000 applied to participate!). What do 15 million Americans know and love about running that you don't? Let's have a look.

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Exercise

Exercise Overview

Exercise isn't a new idea. Records of people exercising go back to 1100 B.C., when the Greeks competed in the javelin throw, distance running, archery, and boxing. Hippocrates (460 B.C.-377 B.C.), the father of medicine, wrote that "eating alone will not keep a man well; he must also take exercise." Milo of Croton, in 6 B.C., discovered the Principle of Progressive Overload, in which he carried a calf every day on his shoulders and as it grew into a bull and got heavier, he got stronger (just like adding heavier dumbbells).

Skip ahead a thousand years to 1844, when the YMCA was founded and people started to do more formal exercise. Then, in 1896, the first modern Olympic games began, and by the early 1900s, gymnastics was mandatory for all American school children. In the late 1950s, things really picked up; Jack LaLanne had an exercise show on TV and the President's Council on Physical Fitness was created; the 1960s and '70s produced Jackie Sorensen and Jane Fonda exercise videos, Nautilus gyms, Ken Cooper coining the word "aerobics," and the running phenomenon started by George Sheehan, Jim Fixx, and others; and now today we have limitless types of exercise classes, technology built into every cardio machine, and all sorts of contraptions for building muscles. In this article, we'll take a more in-depth look at what exercise is all about.

The Benefits of Regular Exercise

• Reduce the risk of premature death
• Reduce the risk of developing and/or dying from heart disease
• Reduce high blood pressure or the risk of developing high blood pressure
• Reduce high cholesterol or the risk of developing high cholesterol
• Reduce the risk of developing colon cancer and breast cancer
• Reduce the risk of developing type 2 diabetes
• Reduce or maintain body weight or body fat
• Build and maintain healthy muscles, bones, and joints
• Reduce depression and anxiety
• Improve psychological well-being
• Enhanced work, recreation, and sport performance
• Increased blood supply to muscles and ability to use oxygen
• Lower resting systolic and diastolic blood pressure in people with high blood pressure
• Increased HDL cholesterol (the good cholesterol)
• Decreased blood triglycerides
• Improved glucose tolerance and reduced insulin resistance
• Increased muscular strength
• Increased strength of tendons and ligaments
• Potentially improves flexibility (range of motion of joints)
• Improved strength, balance, and functional ability in older adults

Physical Fitness

Physical fitness is a measure of the condition of the body to perform during activities of daily living (light, moderate, and strenuous), formal exercise (like when you work out), and emergencies (as when you must escape from danger like a fire). The physical fitness of our nation is declining, proved by the rising rates of obesity, diabetes, some types of cardiovascular disease, and other medical conditions. To improve physical fitness, one must "practice," or work out. Emphasis should be on improving aerobic conditioning (stamina or endurance), muscular strength and endurance, and flexibility. The types of exercise necessary to do this are described next.

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Definition of Evolution

Definition of Evolution

Evolution: The continuing process of change.

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Breastfeeding

Introduction to Breastfeeding

Breastfeeding or bottle feeding your newborn baby is a personal decision. If you choose to breastfeed, it will be helpful if you are in a supportive environment and have resources to assist you with questions you may have or breastfeeding problems that may develop. The following breastfeeding tips may also be helpful:

• Consider attending a series of La Leche League meetings or reading La Leche League's book on breastfeeding (The Womanly Art of Breastfeeding) before the birth of your baby.
• Ask other breastfeeding mothers for advice.
• Join a supportive network including other like-minded mothers helps with the commitments of this style of feeding.
• If you are undecided at birth time, consider a one-month trial. It is easy to go from breastfeeding to bottle-feeding.
• The first month of breastfeeding is the most difficult, so if you get through that period, the rest will be easier.

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Definition of La Leche League

La Leche League: An organization that helps and supports breastfeeding mothers with advice, ideas, and both legal and medical advocacy. Abbreviated LLL.

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Stroke

Stroke Overview

Stroke is a brain attack. It ismuch like a heart attack, only it occurs in the brain.Like a heart attack, stroke is a medical emergency. Do not wait or hesitate to call for emergency medical help. Fast treatment makes a big difference in outcome for someone having a stroke.

CALL 911 for STROKE

When the blood supply to a part of the brain is cut off or greatly decreased, a stroke occurs. If the blood supply is cut off for several hours or more, the brain cells, without enough blood supply,die.

Depending upon the amount of blood involved and location of the stroke area in the brain, a person having a stroke can show many signs and symptoms. These can range from barely noticeable difficulties moving or speaking to paralysis or death.

Until recently, doctors were unable to do much while a person was having a stroke or immediately afterward. Now however, treatments for the acute event, while it is happening, are available, which makes recognizing strokes and getting immediate care critically important.

• About 750,000 new strokes occur in the United States each year. Stroke is the third most common cause of death (after heart disease and cancer). Strokes occur more frequently in older people but can occur in persons ofall ages, including children. African Americans are at a higher risk of stroke than whites. Hispanics have an intermediate risk.
  
• A transient ischemic attack (known as a TIA or ministroke) is similar to a stroke except that, with a TIA, the symptoms go away completely within 24 hours. People who have a TIA are very likely to have a stroke in the near future.

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Obesity

Obesity Overview

The foods we eat every day contribute to our well-being. Foods provide us with the nutrients we need for healthy bodies and the calories we need for energy. If we take in more calories than we burn, the extra food turns to fat and is stored in our bodies. If we overeat regularly, we gain weight, and if we continue to gain weight, we may become obese.

Obesity results from the accumulation of excess fat on the body. Obesity is considered a chronic (long-term) disease, like high blood pressure or diabetes. It has many serious long-term consequences for your health, and it is a leading cause of preventable deaths in the United States (with tobacco use and high blood pressure). Obesity is defined as having a body mass index (BMI) of greater than 30. The BMI is a measure of your weight relative to your height. See the Body Mass Index Calculator.

Obesity is an epidemic in the United States and in other developed countries. More than two-thirds of Americans are overweight, including at least one in five children. Nearly one-third are obese. Obesity is on the rise in our society because food is abundant and most of us are employed in positions that require little to no physical activity. On the bright side, recent data suggest that childhood obesity, while still high, may no longer be on the rise.

Each year, Americans spend billions of dollars on dieting, diet foods, diet books, diet pills, and the like. Another $75 billion is spent on treating the diseases associated with obesity. Furthermore, businesses suffer an estimated $20 billion loss in productivity each year from absence due to illness caused by obesity.

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Body Mass Index

Body-mass index, or BMI, is used as one measure of obesity or state of being overweight. BMI is used as a baseline and, then subsequently, to measure the effectiveness of a weight loss and/or health regimen implemented in cooperation with an individual's physician and other health care providers.

The National Institutes of Health recommends four BMI Categories:

• Underweight = <18.5
• Normal weight = 18.5-24.9
• Overweight = 25-29.9
• Obesity = BMI of 30 or greater

References:

"Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults," National Heart, Lung, and Blood Institute, in cooperation with the National Institutes of Health.

"Calculate Your Body Mass Index," National Heart, Lung, and Blood Institute, in cooperation with the National Institutes of Health.

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Chronic Kidney Disease

Chronic Kidney Disease

Chronic Kidney Disease Overview

Normal kidneys and kidney function

The kidneys are a pair of bean-shaped organs that lie on either side of the spine in the lower middle of the back. Each kidney weighs about ¼ pound and contains approximately one million filtering units called nephrons. Each nephron is made of a glomerulus and a tubule. The glomerulus is a miniature filtering or sieving device while the tubule is a tiny tube like structure attached to the glomerulus.

The kidneys are connected to the urinary bladder by tubes called ureters. Urine is stored in the urinary bladder until the bladder is emptied by urinating. The bladder is connected to the outside of the body by another tube like structure called the urethra.

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Diabetes Mellitus

Diabetes Overview

Diabetes mellitus (DM) is a set of related diseases in which the body cannot regulate the amount of sugar (specifically, glucose) in the blood.

The blood delivers glucose to provide the body with energy to perform all of a person's daily activities.

• The liver converts the food a person eats into glucose. The glucose is then released into the bloodstream.
• In a healthy person, the blood glucose level is regulated by several hormones, primarliy insulin. Insulin is produced by the pancreas, a small organ between the stomach and liver. The pancreas also makes other important enzymes released directly into the gut that helps digest food.
• Insulin allows glucose to move out of the blood into cells throughout the body where it is used for fuel.
• People with diabetes either do not produce enough insulin (type 1 diabetes) or cannot use insulin properly (type 2 diabetes), or both (which occurs with several forms of diabetes).
• In diabetes, glucose in the blood cannot move efficiently into cells, so blood glucose levels remain high. This not only starves all the cells that need the glucose for fuel, but also harms certain organs and tissues exposed to the high glucose levels.

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Eclampsia Definition and Overview

Eclampsia, a life-threatening complication of pregnancy, is a condition that causes a pregnant woman, usually previously diagnosed with preeclampsia (high blood pressure and protein in the urine), to develop seizures or coma. In some cases, seizures or coma may be the first recognizable sign that a pregnant woman has had preeclampsia. Key warning signs of developing eclampsia in a woman diagnosed with preeclampsia may be severe headaches, blurred or double vision, or seeing spots. Toxemia of pregnancy is a common name formerly used to describe preeclampsia and eclampsia.

There has never been any evidence suggesting an orderly progression of disease beginning with mild preeclampsia progressing to severe preeclampsia and then on to eclampsia. The disease process can begin mild and stay mild, or can be initially diagnosed as eclampsia without prior warning.

• Approximately 5% to 7% of all pregnancies are complicated by preeclampsia.
• Preeclampsia usually occurs in a woman's first pregnancy but may occur for the first time in a subsequent pregnancy.
• Less than one in 100 women with preeclampsia will develop eclampsia or (convulsions or seizures) or coma.
• Up to 20% of all pregnancies are complicated by high blood pressure. Complications resulting from high blood pressure, preeclampsia, and eclampsia may account for up to 20% of all deaths that occur in pregnant women.

Eclampsia Causes

• No one knows what exactly causes preeclampsia or eclampsia, although abnormalities in the endothelial system (the lining cells of blood vessels) have been described as a potential cause.
• Since the exact cause of preeclampsia or eclampsia is poorly understood, it is not possible to effectively predict when preeclampsia or eclampsia will occur, or to administer any treatments to prevent preeclampsia or eclampsia from occurring (or recurring).
• Preeclampsia usually occurs with first pregnancies. However, preeclampsia also occurs more frequently with multiple gestations, in women older than 35 years, in women with high blood pressure before pregnancy, in women with diabetes, and in women with other medical problems (such as connective tissue disease and kidney disease).
• Obese women also have a higher risk of preeclampsia and eclampsia than women of normal weight.
• For unknown reasons, African American women are more likely to develop eclampsia and preeclampsia than white women.
• Preeclampsia may run in families, although the reason for this is unknown.
• Preeclampsia is also associated with problems with the placenta, such as too much placenta, too little placenta, or how the placenta attaches to the wall of the uterus. Preeclampsia is also associated with hydatidiform mole pregnancies, in which no normal placenta and no normal baby are present.
• There is nothing that any woman can do to prevent preeclampsia or eclampsia from occurring. Therefore, it is both unhealthy and not helpful to assign blame and to review and rehash events that occurred either just prior to pregnancy or during early pregnancy that may have contributed to the development of preeclampsia.
• Other risk factors that have been described for eclampsia include lower socioeconomic status, teen pregnancy, and poor outcomes in previous pregnancies (including fetal death or intrauterine growth retardation)

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Pregnancy

 

 

Early Pregnancy Symptoms

 

Stages of Pregnancy Pictures

 

Pregnancy Overview

Pregnancy occurs when an egg is fertilized by a sperm, grows inside a woman's uterus (womb), and develops into a baby. In humans, this process takes about 264 days, but the obstetrician will date from the last menstrual period or 280 days (40 weeks).

• The doctor will use certain terms in discussing a woman's pregnancy. Some of the following definitions are useful:
  
  • Intra-uterine pregnancy: A normal pregnancy occurs when a fertilized egg is implanted in the uterus (womb) and an embryo grows.
    
  • Embryo: The term used for the developing fertilized egg during the first 12 weeks of pregnancy.
    
  • Fetus: The term used for the developing embryo after 12 weeks of gestation.
    
  • Beta human chorionic gonadotropin (also called beta-hCG): This hormone is secreted by the placenta and can be measured to determine the presence and progression of the pregnancy. Urine or blood can be tested for its presence, and it is the hormone measured by a home pregnancy test. A positive result means a woman is pregnant; however, this test result can stay positive for several weeks after delivering a baby or after a miscarriage.
    
  • Trimester: The length of time of a pregnancy is divided into three sections called trimesters (about three months each). Each trimester has particular events and developmental markers. For instance, the first trimester builds the foundation of the different organ systems.
    
  • Estimated date of delivery (EDD): The delivery date is estimated by counting forward 280 days from the first day of the woman's last period. It is also called the estimated date of confinement (EDC).
  
   
• The woman who is pregnant and her doctor will monitor the pregnancy either to prevent certain conditions from developing or to treat those conditions early. These conditions include the following:
  
  • High-risk pregnancy: If a woman is considered to be likely to have complications during pregnancy, the pregnancy may be termed high risk. Examples include pregnancies in women with diabetes and those with high blood pressure. Age-related complications can occur in women such as teenagers, women who are over the age of 35, or women who have been treated for infertility or with pregnancies from the use of assisted reproductive technologies.
    
  • Ectopic pregnancy: This is a pregnancy in which the egg implants somewhere other than the uterus. This can be life threatening. Ectopic pregnancy must be diagnosed early to avoid damage tothe Fallopian tubes and to prevent serious illness or death. It is also called tubal pregnancy (if the egg implants in the Fallopian tubes) or extra-uterine pregnancy.
    
  • Cervical Incompetence or Preterm Labor: This is a condition in which the cervix begins to dilate (widen) and efface (thin) before the pregnancy has reached term. Cervical incompetence can be a cause of miscarriage and preterm birth in the second and third trimesters.
    
  • Preeclampsia/eclampsia: Preeclampsia is a systemic disease that can affect various organ systems. Vascular effects cause the blood pressure to rise in the woman who is pregnant, changes in kidney function, swelling throughout the body, and alterations in blood chemistry and nerve reflexes. If left untreated, preeclampsia can lead to eclampsia, a serious illness that causes seizures, coma, and even death.
    
  • Multiple Gestation (for example twins, triplets): Preterm birth is twice as likely in twin pregnancies as in singleton pregnancies. The percentage of preterm birth is even greater for triplet pregnancies and quadruplet pregnancies. Preeclampsia also occurs three to five times more frequently with multiple gestation.

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What is HCG (Novarel, Ovidrel, Pregnyl)?

What is HCG (Novarel, Ovidrel, Pregnyl)?

Human chorionic gonadotropin (HCG) is a hormone that supports the normal development of an egg in a woman's ovary, and stimulates the release of the egg during ovulation.

HCG is used to cause ovulation and to treat infertility in women, and to increase sperm count in men. HCG is also used in young boys when their testicles have not dropped down into the scrotum normally. This can be caused by a pituitary gland disorder.

HCG may also be used for other purposes not listed in this medication guide.

What are the possible side effects of HCG (Novarel, Ovidrel, Pregnyl)?

Stop using HCG and get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these signs of a blood clot: pain, warmth, redness, numbness, or tingling in your arm or leg; confusion, extreme dizziness, or severe headache.

Some women using this medicine have developed a condition called ovarian hyperstimulation syndrome (OHSS), especially after the first treatment cycle. OHSS can be a life-threatening condition. Call your doctor right away if you have any of the following symptoms of OHSS:

• severe pelvic pain;
• swelling of the hands or legs;
• stomach pain and swelling;
• shortness of breath;
• weight gain;
• diarrhea;
• nausea or vomiting; or
• urinating less than normal.

This medication can cause early puberty in young boys. Call your doctor if a boy using this medicine shows early signs of puberty, such as a deepened voice, pubic hair growth, and increased acne or sweating.

Less serious side effects may include:

• headache;
• feeling restless or irritable;
• mild swelling or water weight gain;
• depression;
• breast tenderness or swelling; or
• pain, swelling, or irritation where the injection is given.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is the most important information I should know about HCG (Novarel, Ovidrel, Pregnyl)?

Human chorionic gonadotropin (HCG) is given as an injection under the skin or into a muscle. If you use this medicine at home, your doctor, nurse, or pharmacist will give you specific instructions on how and where to inject this medicine. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles and syringes.

Call your doctor at once if you have any of these signs of a blood clot: pain, warmth, redness, numbness, or tingling in your arm or leg; confusion, extreme dizziness, or severe headache.

Some women using this medicine have developed a condition called ovarian hyperstimulation syndrome (OHSS), especially after the first treatment cycle. OHSS can be a life-threatening condition. Call your doctor right away if you have any symptoms of OHSS: severe pelvic pain, swelling of the hands or legs, stomach pain and swelling, shortness of breath, weight gain, diarrhea, nausea or vomiting, and urinating less than normal.

HCG can cause early puberty in young boys. Call your doctor if a boy using this medicine shows early signs of puberty, such as a deepened voice, pubic hair growth, and increased acne or sweating.

Using this medicine can increase your chances of having a multiple pregnancy (twins, triplets, quadruplets, etc). A multiple pregnancy is a high-risk pregnancy for the mother and for the babies. Follow your doctor's instructions about any special care you may need during your pregnancy.

Although HCG can help you become pregnant, this medication is in the FDA pregnancy category X. This means that using the medication once you are pregnant can cause birth defects in the baby. Do not use this medication if you are pregnant. Tell your doctor right away if you become pregnant during treatment.

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Definition of Fetus

Stages of Pregnancy Pictures

Early Pregnancy Symptoms

 

 

Fetus: An unborn offspring, from the embryo stage (the end of the eighth week after conception, when the major structures have formed) until birth.

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Definition of Embryo

Embryo: An organism in the early stages of growth and differentiation, from fertilization to the beginning of the third month of pregnancy (in humans). After that point in time, an embryo is called a fetus.

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Alzheimer's Disease Pictures

Could It Be Alzheimer's?

It's normal for our loved ones to become a bit forgetful as they age. So how can we separate a harmless "senior moment" from a more serious problem like Alzheimer's disease? One in eight people 65 and older have this devastating form of dementia. In its first stages, Alzheimer's may not be obvious to friends and family. But there are some early warning signs to watch for.

 

Warning Signs: Memory and Speech

In early Alzheimer's, long-term memories usually remain intact while short-term memories become sketchy.

 Your loved one may forget conversations you had. He or she may repeat questions that were already answered.

 The disease also disrupts speech, so patients may struggle to remember common words.

 

Warning Signs: Behavior

In addition to memory loss, Alzheimer's can cause confusion and behavior changes.

 Your loved one may get lost in familiar places.

Mood swings and poor judgment are also common, as is poor hygiene.

People who once dressed with style may resort to wearing stained clothes and unwashed hair.

 

 

Don't Ignore the Signs

 

While it's difficult to face the possibility that a loved one could have Alzheimer's, it's better to consult a doctor sooner rather than later.

First, the diagnosis might not be Alzheimer's after all.

The symptoms could be caused by a highly treatable problem, such as a thyroid imbalance.

 And if it is Alzheimer's, today's treatments work best when they are used early in the course of the disease.

 

 

Diagnosing Alzheimer's

 

There is no simple test for Alzheimer's, so the doctor will rely on you to describe the changes in your loved one.

A mental status test, sometimes called a "mini-cog," or other screening tests can help evaluate the patient's mental function and short-term memory.

In addition, neurological exams and brain scans may be used to rule out other problems, such as a stroke or tumor -- and they can help provide other information about the brain.

 

Alzheimer's Progression: What to Expect

Alzheimer's disease takes a different path in every patient.

 In some people the symptoms worsen quickly, leading to severe memory loss and confusion within a few years.

In others, the changes may be more gradual with the disease taking 20 years to run its course.

 The average length of survival after a diagnosis of Alzheimer's is three to nine years.

 

How Alzheimer's Affects Daily Life

Because Alzheimer's affects concentration, patients may lose the ability to manage ordinary tasks like cooking or paying the bills.

A study suggests difficulty balancing a checkbook is often one of the first effects of Alzheimer's.

 As the symptoms worsen, your loved one may not recognize familiar people or places.

 He or she may get lost easily, or use utensils improperly, such as combing hair with a fork. Incontinence, balance problems, and loss of language are common in the advanced stages.

 

Alzheimer's and Driving

Poor coordination, memory loss, and confusion make for a dangerous combination behind the wheel. If you feel your loved one should not be driving, explain why. If he or she won't listen, ask the doctor to step in.

If the patient still insists on driving, contact the Department of Motor Vehicles for an assessment. Then make an alternate plan for your loved one's transportation needs.

 

Alzheimer's and Exercise

Exercise can help people with Alzheimer's maintain some muscle strength and coordination. It also improves mood and may reduce anxiety.

 Check with your loved one's doctor to learn which types of exercise are appropriate.

Repetitive activities, such as walking, weeding, or even folding laundry may be the most effective at promoting a sense of calm.

 

Alzheimer's Medications

There is no cure for Alzheimer's disease, and no known way to slow the nerve damage within the brain. But there are a variety of medications that appear to help maintain mental function and slow the disease progression.

 If these treatments are given during the early stages of Alzheimer's, your loved one may be able to remain independent and carry out daily tasks for a longer period of time.

 

The Caregiver's Role

As the caregiver of someone with Alzheimer's, you will probably wear many hats -- cook, chauffeur, accountant. While you may have to handle the meal planning and finances, encourage the patient to do some activities independently.

 It may help to label cabinets with their contents and put up sticky notes with reminders of daily tasks.

Be sure to buy a weekly pill box for medications.

 

Challenges in Caregiving

In the early stages of Alzheimer's, patients often understand what is happening and may be ashamed or anxious. Watch for signs of depression because this can often be managed with medication.

 In the more advanced stages, your loved one may become paranoid or violent and could even turn on you. Remember that the disease is responsible for this change.

 Alert the doctor about violent behavior promptly.

 

Sundown Syndrome

Some people with Alzheimer's become distressed when the sun goes down. This agitation tends to last through the evening and sometimes all through the night.

 The cause is not known, but there are some strategies to ease the tension.

Keep the house well lit and close the drapes before sunset.

Try distracting your loved one with a favorite activity or TV show.

And restrict caffeine after breakfast.

 

When Your Loved One Doesn't Know You

Many people with Alzheimer's have trouble remembering names -- even those of close family members. A temporary fix is to put up pictures of friends and relatives with names printed underneath. Eventually, the patient may no longer recognize faces and may react to loved ones as if they are strangers.

 This can be a distressing time for family members, especially the primary caregiver.

 

Warning Signs of Caregiver Stress

Caring for someone with Alzheimer's can be physically and mentally taxing. Signs of caregiver stress include:

• Anger, sadness, and mood swings
• Headaches or back pain
• Difficulty concentrating
• Difficulty sleeping

 

Taking Care of the Caregiver

To avoid caregiver burnout, make sure you take at least a few minutes to do something you enjoy every day. Stay in touch with friends and keep up with hobbies whenever possible.

 Find a friend or relative to be your support person.

 You can also join an online or local caregiver support group through the Alzheimer's Association.

 

 

Essential Documents

While your loved one is still able to make important decisions, contact an attorney about drafting advance directives. These are legal documents that spell out the patient's preferences for medical treatments and end-of-life care.

 The patient should designate someone to make health care decisions and manage finances on his or her behalf.

This can avoid confusion when your loved one is no longer able to state his or her wishes.

 

Home Health Care

Many patients express a desire to stay in their own homes as long as possible. Unfortunately, they may have trouble getting dressed or using the bathroom on their own as the disease advances.

 A home health aide can assist with personal hygiene and other daily tasks.

 You can also look into local services that deliver meals or provide transportation to the elderly. Most communities have an Area Agency on Aging that provides such services.

 

Assisted Living Facilities

There may come a day when your loved one can no longer be cared for at home.

 If he or she does not need 24-hour nursing care, an assisted-living facility may be an appropriate choice.

ALFs provide housing, meals, and activities, but are much less expensive than nursing homes.

 Look for a facility with an Alzheimer's special care unit, which delivers 24-hour supervision and personal care to meet the needs of people with dementia.

 

 

 

End-Stage Alzheimer's

People with advanced Alzheimer's may lose the ability to walk, talk, or respond to others.

 Eventually, the disease can hinder vital functions, such as the ability to swallow.

 Patients in this stage may benefit from hospice care, which provides pain relief and comfort for the terminally ill.

 

 

 

 

Helping Children Cope

Children may feel confused, afraid, or even resentful when a family member is affected by Alzheimer's. Let the child know these feelings are normal and answer his or her questions about the illness honestly.

 Help the child celebrate happy memories of the patient -- for example, by creating a scrapbook.

 

 

Reducing Your Risk of Alzheimer's

If you're caring for a relative with Alzheimer's, you might be wondering if there's anything you can do to reduce your own risk. Research in this area is ongoing, but diet and exercise appear key.

 Studies indicate a lower risk among people who eat a Mediterranean diet rich in vegetables, fish, and nuts. Research also suggests those who are the most physically active are the least likely to get Alzheimer's.

 

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Brain Disorders Image Collection

 

1. Picture of Vascular (Multi-Infarct) Dementia 1

Vascular dementia is the second most common cause of dementia, after Alzheimer's disease. It accounts for up to 20 % of all dementias and is caused by brain damage from cerebrovascular or cardiovascular problems - usually strokes. It also may result from genetic diseases, endocarditis (infection of a heart valve), or amyloid angiopathy (a process in which amyloid protein builds up in the brain's blood vessels, sometimes causing hemorrhagic or "bleeding" strokes). In many cases, it may coexist with Alzheimer's disease. Unlike people with Alzheimer's disease, people with vascular dementia often maintain their personality and normal levels of emotional responsiveness until the later stages of the disease. People with vascular dementia frequently wander at night and often have other problems commonly found in people who have had a stroke, including depression and incontinence.

 

 

2. Picture of Vascular (Multi-Infarct) Dementia 2 

There are several types of vascular dementia, which vary slightly in their causes and symptoms. One type, called multi-infarct dementia (MID), is caused by numerous small strokes in the brain. Multi-infarct dementia typically includes multiple damaged areas, called infarcts, along with extensive lesions in the white matter, or nerve fibers, of the brain. Although not all strokes cause dementia, in some cases a single stroke can damage the brain enough to cause dementia. This condition is called single-infarct dementia. Dementia is more common when the stroke takes place on the left side (hemisphere) of the brain and/or when it involves the hippocampus, a brain structure important for memory.

Other types of vascular dementia include Binswanger's disease and CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarct and leukoencephalopathy).

 

 

 

3. Picture of Lewy Body Dementia



Lewy body dementia (LBD) is one of the most common types of progressive dementia. Lewy body dementia usually occurs sporadically, in people with no known family history of the disease. However, rare familial cases have occasionally been reported. In Lewy body dementia, cells die in the brain's cortex (outer layer), and in a part of the mid-brain called the substantia nigra. Many of the remaining nerve cells in the substantia nigra contain abnormal structures called Lewy bodies that are the hallmark of the disease.

The symptoms of Lewy body dementia overlap with Alzheimer's disease in many ways, and may include memory impairment, poor judgment, and confusion. However, Lewy body dementia typically also includes visual hallucinations, parkinsonian symptoms such as a shuffling gait (walk) and flexed posture, and day-to-day fluctuations in the severity of symptoms. Patients with Lewy body dementia live an average of 7 years after symptoms begin. There is no cure for Lewy body dementia, and treatments are aimed at controlling the parkinsonian and psychiatric symptoms of the disorder.

 

 

 

 4. Picture of Frontotemporal Dementia (FTD)

Frontotemporal dementia, sometimes called frontal lobe dementia, describes a group of diseases characterized by degeneration of nerve cells - especially those in the frontal and temporal lobes of the brain. Unlike Alzheimer's disease, frontotemporal dementia usually does not include formation of amyloid plaques. In many people with frontotemporal dementia, there is an abnormal form of tau protein in the brain, which accumulates into neurofibrillary tangles. This disrupts normal cell activities and may cause the cells to die.

 

 

 

5. Picture of HIV-associated Dementia (HAD)

A 40-year-old woman diagnosed with HIV presented with confusion and decline in memory. The MRI shows atrophy and white matter hyperintensity on T2 not involving U-fibers.

 

 

 

6. Picture of Huntington's Disease

Huntington's disease is a hereditary disorder caused by a faulty gene for a protein called huntingtin. The children of people with the disorder have a 50% chance of inheriting it. The disease causes degeneration in many regions of the brain and spinal cord. Symptoms of Huntington's disease usually begin when patients are in their thirties or forties, and the average life expectancy after diagnosis is about 15 years. Cognitive symptoms of Huntington's disease typically begin with mild personality changes, such as irritability, anxiety, and depression, and progress to severe dementia. Many patients also show psychotic behavior. Huntington's disease causes chorea - involuntary jerky, arrhythmic movements of the body - as well as muscle weakness, clumsiness, and gait disturbances.

 

 

 

7. Picture of Corticobasal Degeneration (CBD)

(A,B) T2-weighted image showing diffuse asymmetric (L > R) bilateral frontoparietal atrophy (arrows) in a 54-year-old woman with progressive nonfluent aphasia and mild parkinsonism due to pathology-proven corticobasal degeneration.

 

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Dementia Pictures

 

 

Dementia Overview

A woman in her early 50s was admitted to a hospital because of increasingly odd behavior.

 Her family reported that she had been showing memory problems and strong feelings of jealousy. She also had become disoriented at home and was hiding objects.

During a doctor's examination, the woman was unable to remember her husband's name, the year, or how long she had been at the hospital. She could read but did not seem to understand what she read, and she stressed the words in an unusual way.

 She sometimes became agitated and seemed to have hallucinations and irrational fears.

Auguste Deter was the first person reported (in 1901) to have the form of dementia now known as Alzheimer's disease. The disease is named after Alois Alzheimer, the German doctor who first described it.

Alzheimer's disease is a major cause of dementia. After Auguste Deter died in 1906, doctors examined her brain and found that it appeared shrunken and contained several unusual features; including strange clumps of protein called plaques and tangled fibers inside the nerve cells.

 

What is Dementia?

Dementia is not a specific disease. It is a descriptive term for a collection of symptoms that can be caused by a number of disorders that affect the brain. People with dementia have significantly impaired intellectual functioning that interferes with normal activities and relationships.

They also lose their ability to solve problems and maintain emotional control, and they may experience personality changes and behavioral problems such as agitation, delusions, and hallucinations.

 While memory loss is a common symptom of dementia, memory loss by itself does not mean that a person has dementia. Doctors diagnose dementia only if two or more brain functions - such as memory, language skills, perception, or cognitive skills including reasoning and judgment - are significantly impaired without loss of consciousness.

 

What Are the Different Kinds of Dementia?

Dementing disorders can be classified many different ways.

 These classification schemes attempt to group disorders that have particular features in common, such as whether they are progressive or what parts of the brain are affected. Some frequently used classifications are shown in this chart.

Some types of dementia fit into more than one of these classifications.

 For example, Alzheimer's disease is considered both a progressive and a cortical dementia. There are many disorders that can cause dementia which are described on the following slides.

 

 

Alzheimer's Disease

Alzheimer's disease is the most common cause of dementia in people aged 65 and older.

 Experts believe that up to 4 million people in the United States are currently living with the disease: one in ten people over the age of 65 and nearly half of those over 85 have Alzheimer's disease

. At least 360,000 Americans are diagnosed with Alzheimer's disease each year and about 50,000 are reported to die from it. In most people, symptoms of Alzheimer's disease appear after age 60. However, there are some early-onset forms of the disease, usually linked to a specific gene defect, which may appear as early as age 30.

 Alzheimer's disease usually causes a gradual decline in thinking abilities, usually during a span of 7 to 10 years. Nearly all brain functions, including memory, movement, language, judgment, behavior, and abstract thinking, are eventually affected.

 

Alzheimer's Disease (continued)

Alzheimer's disease is characterized by two abnormalities in the brain: amyloid plaques and neurofibrillary tangles. Amyloid plaques, which are found in the tissue between the nerve cells, are unusual clumps of a protein called beta amyloid along with degenerating bits of neurons and other cells. Neurofibrillary tangles are bundles of twisted filaments found within neurons.

These tangles are largely made up of a protein called tau. In healthy neurons, the tau protein helps the functioning of microtubules, which are part of the cell's structural support and deliver substances throughout the nerve cell. However, in Alzheimer's disease, tau is changed in a way that causes it to twist into pairs of helical filaments that collect into tangles.

When this happens, the microtubules cannot function correctly and they disintegrate.

 This collapse of the neuron's transport system may impair communication between nerve cells and cause them to die. Researchers do not know if amyloid plaques and neurofibrillary tangles are harmful or if they are merely side effects of the disease process that damages neurons and leads to the symptoms of Alzheimer's disease.

 They do know that plaques and tangles usually increase in the brain as Alzheimer's disease progresses.

 

Alzheimer's Disease (continued)

In the early stages of Alzheimer's disease, patients may experience memory impairment, lapses of judgment, and subtle changes in personality.

 As the disorder progresses, memory and language problems worsen and patients begin to have difficulty performing activities of daily living, such as balancing a checkbook or remembering to take medications.

They may become disoriented about places and times, may suffer delusions (such as the idea that someone is stealing from them or that their spouse is being unfaithful), and may become short-tempered and hostile.

 During the late stages of the disease, patients begin to lose the ability to control motor functions such as swallowing, or lose bowel and bladder control.

They eventually lose the ability to recognize family members and to speak. As the disease progresses it begins to affect the person's emotions and behavior and they develop symptoms such as aggression, agitation, depression, sleeplessness, or delusions.

On average, patients with Alzheimer's disease live for 8 to 10 years after they are diagnosed. However, some people live as long as 20 years.

 Patients with Alzheimer's disease often die of aspiration pneumonia because they lose the ability to swallow late in the course of the disease.

 

Vascular (Multi-Infarct) Dementia

Vascular dementia is the second most common cause of dementia, after Alzheimer's disease. It accounts for up to 20 % of all dementias and is caused by brain damage from cerebrovascular or cardiovascular problems - usually strokes. It also may result from genetic diseases, endocarditis (infection of a heart valve), or amyloid angiopathy (a process in which amyloid protein builds up in the brain's blood vessels, sometimes causing hemorrhagic or "bleeding" strokes).

In many cases, it may coexist with Alzheimer's disease. Unlike people with Alzheimer's disease, people with vascular dementia often maintain their personality and normal levels of emotional responsiveness until the later stages of the disease.

People with vascular dementia frequently wander at night and often have other problems commonly found in people who have had a stroke, including depression and incontinence.

 

 

 

 

 

Vascular Dementia (continued)

There are several types of vascular dementia, which vary slightly in their causes and symptoms. One type, called multi-infarct dementia (MID), is caused by numerous small strokes in the brain. Multi-infarct dementia typically includes multiple damaged areas, called infarcts, along with extensive lesions in the white matter, or nerve fibers, of the brain. Although not all strokes cause dementia, in some cases a single stroke can damage the brain enough to cause dementia. This condition is called single-infarct dementia. Dementia is more common when the stroke takes place on the left side (hemisphere) of the brain and/or when it involves the hippocampus, a brain structure important for memory.

Other types of vascular dementia include Binswanger's disease and CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarct and leukoencephalopathy).

 

 

 

Lewy Body Dementia (LBD)

Lewy body dementia (LBD) is one of the most common types of progressive dementia. Lewy body dementia usually occurs sporadically, in people with no known family history of the disease.

 

 However, rare familial cases have occasionally been reported. In Lewy body dementia, cells die in the brain's cortex (outer layer), and in a part of the mid-brain called the substantia nigra

. Many of the remaining nerve cells in the substantia nigra contain abnormal structures called Lewy bodies that are the hallmark of the disease.

The symptoms of Lewy body dementia overlap with Alzheimer's disease in many ways, and may include memory impairment, poor judgment, and confusion.

 However, Lewy body dementia typically also includes visual hallucinations, parkinsonian symptoms such as a shuffling gait (walk) and flexed posture, and day-to-day fluctuations in the severity of symptoms. Patients with Lewy body dementia live an average of 7 years after symptoms begin. There is no cure for Lewy body dementia, and treatments are aimed at controlling the parkinsonian and psychiatric symptoms of the disorder.

 

Frontotemporal Dementia (FTD)

Frontotemporal dementia, sometimes called frontal lobe dementia, describes a group of diseases characterized by degeneration of nerve cells - especially those in the frontal and temporal lobes of the brain. Unlike Alzheimer's disease, frontotemporal dementia usually does not include formation of amyloid plaques. In many people with frontotemporal dementia, there is an abnormal form of tau protein in the brain, which accumulates into neurofibrillary tangles.

 

 This disrupts normal cell activities and may cause the cells to die.

Experts believe frontotemporal dementia accounts for 2% to 10% of all cases of dementia.

Symptoms of frontotemporal dementia usually appear between the ages of 40 and 65. In many cases, people with frontotemporal dementia have a family history of dementia, suggesting that there is a strong genetic factor in the disease.

The duration of frontotemporal dementia varies, with some patients declining rapidly over 2 to 3 years and others showing only minimal changes for many years.

 People with frontotemporal dementia live with the disease for an average of 5 to 10 years after diagnosis.

Because structures found in the frontal and temporal lobes of the brain control judgment and social behavior, people with frontotemporal dementia often have problems maintaining normal interactions and following social conventions.

They may steal or exhibit impolite and socially inappropriate behavior, and they may neglect their normal responsibilities.

 Other common symptoms include loss of speech and language, compulsive or repetitive behavior, increased appetite, and motor problems such as stiffness and balance problems

. Memory loss also may occur, although it typically appears late in the disease.

 

HIV-associated Dementia (HAD)

HIV-associated dementia (HAD) results from infection with the human immunodeficiency virus (HIV) that causes AIDS. HIV-associated dementia can cause widespread destruction of the brain's white matter. This leads to a type of dementia that generally includes impaired memory, apathy, social withdrawal, and difficulty concentrating.

 People with HIV-associated dementia often develop movement problems as well.

 There is no specific treatment for HIV-associated dementia, but AIDS drugs can delay onset of the disease and may help to reduce symptoms.

 

 

Huntington's Disease

Huntington's disease is a hereditary disorder caused by a faulty gene for a protein called huntingtin. The children of people with the disorder have a 50% chance of inheriting it.

The disease causes degeneration in many regions of the brain and spinal cord. Symptoms of Huntington's disease usually begin when patients are in their thirties or forties, and the average life expectancy after diagnosis is about 15 years.

Cognitive symptoms of Huntington's disease typically begin with mild personality changes, such as irritability, anxiety, and depression, and progress to severe dementia.

 Many patients also show psychotic behavior.

 Huntington's disease causes chorea - involuntary jerky, arrhythmic movements of the body - as well as muscle weakness, clumsiness, and gait disturbances.

 

Dementia Pugilistica

Dementia pugilistica, also called chronic traumatic encephalopathy or Boxer's syndrome, is caused by head trauma, such as that experienced by people who have been punched many times in the head during boxing. The most common symptoms of the condition are dementia and parkinsonism, which can appear many years after the trauma ends. Affected individuals may also develop poor coordination and slurred speech. A single traumatic brain injury may also lead to a disorder called posttraumatic dementia (PTD).

 Posttraumatic dementia is much like dementia pugilistica but usually also includes long-term memory problems. Other symptoms vary depending on which part of the brain was damaged by the injury.

 

Corticobasal degeneration (CBD)

Corticobasal degeneration (CBD) is a progressive disorder characterized by nerve cell loss and atrophy of multiple areas of the brain. Brain cells from people with corticobasal degeneration often have abnormal accumulations of the protein tau.

 Corticobasal degeneration usually progresses gradually over the course of 6 to 8 years. Initial symptoms, which typically begin at or around age 60, may first appear on one side of the body but eventually will affect both sides.

 Some of the symptoms, such as poor coordination and rigidity, are similar to those found in Parkinson's disease.

Other symptoms may include memory loss, dementia, visual-spatial problems, apraxia (loss of the ability to make familiar, purposeful movements), hesitant and halting speech, myoclonus (involuntary muscular jerks), and dysphagia (difficulty swallowing).

Death is often caused by pneumonia or other secondary problems such as sepsis (severe bacterial infection of the blood) or pulmonary embolism (a blood clot in the lungs).

 

 

Creutzfeldt-Jakob Disease (CJD)

Creutzfeldt-Jakob disease (CJD) is a rare, degenerative, fatal brain disorder that affects about one in every million people per year worldwide. Creutzfeldt-Jakob disease belongs to a family of human and animal diseases known as the transmissible spongiform encephalopathies (TSEs).

 This includes bovine spongiform encephalopathy (BSE), which is found in cows and often referred to as "mad cow" disease. Symptoms usually begin after age 60 and most patients die within 1 year.

 

 Many researchers believe Creutzfeldt-Jakob disease results from an abnormal form of a protein called a prion. Most cases of Creutzfeldt-Jakob disease occur sporadically - that is, in people who have no known risk factors for the disease.

However, about 5% to 10% of cases of Creutzfeldt-Jakob disease in the United States are hereditary, caused by a mutation in the gene for the prion protein.

 Patients with Creutzfeldt-Jakob disease may initially experience problems with muscular coordination; personality changes, including impaired memory, judgment, and thinking; and impaired vision.

Other symptoms may include insomnia and depression. As the illness progresses, mental impairment becomes severe.

 Patients often develop myoclonus and they may go blind.

They eventually lose the ability to move and speak, and go into a coma. Pneumonia and other infections often occur in these patients and can lead to death.

 

 

Dementias in Children

While it is usually found in adults, dementia can also occur in children.

For example, infections and poisoning can lead to dementia in people of any age.

In addition, some disorders unique to children can cause dementia.

These include Niemann-Pick disease, Batten disease and Lafora body disease.

 

What Other Conditions Can Cause Dementia?

Doctors have identified many other conditions that can cause dementia or dementia-like symptoms. Examples of these include:

• reactions or side effects to medications;
• metabolic problems and endocrine abnormalities such as thyroid disease, hypoglycemia, too little (hyponatremia) or too much sodium or calcium (hypercalcemia), or the inability to absorb vitamin B12 (pernicious anemia);
• nutritional deficiencies such as thiamine (vitamin B1), B6, or B12 and severe dehydration;
• infections such as meningitis, encephalitis, untreated syphilis, and Lyme disease;
• subdural hematomas where there is bleeding between the brain's surface and its outer covering (the dura);
• poisoning such as exposure to lead, other heavy metals, alcohol, recreational drugs or other poisonous substances;
• brain tumors;
• anoxia/hypoxia in which there is a diminished supply of oxygen to an organ's tissues, for example heart attack, severe asthma, heart surgery, smoke or carbon monoxide inhalation, or an overdose of anesthesia; and
• heart and chronic lung problems disease that prevents the brain from receiving adequate oxygen, which can starve brain cells.

 

What Conditions Are Not Dementia?

• Age-related cognitive decline. As people age, they usually experience slower information processing and mild memory impairment. In addition, their brains frequently decrease in volume and some nerve cells, or neurons, are lost.
• Mild cognitive impairment. Some people develop cognitive and memory problems that are not severe enough to be diagnosed as dementia but are more pronounced than the cognitive changes associated with normal aging. Although many patients with this condition later develop dementia, some do not.
• Depression. People with depression are frequently passive or unresponsive, and they may appear slow, confused, or forgetful.
• Delirium. Delirium is characterized by confusion and rapidly altering mental states. The person may also be disoriented, drowsy, or incoherent, and may exhibit personality changes. Delirium is usually caused by a treatable physical or psychiatric illness, such as poisoning or infections. Patients with delirium often, though not always, make a full recovery after their underlying illness is treated.

 

What Are the Risk Factors for Dementia?

Researchers have identified several risk factors that affect the likelihood of developing one or more kinds of dementia. Some of these factors are modifiable, while others are not.

 

How Is Dementia Diagnosed?

Doctors employ a number of strategies to diagnose dementia.

 It is important that they rule out any treatable conditions, such as depression, normal pressure hydrocephalus, or vitamin B12 deficiency, which can cause similar symptoms. "

Early, accurate diagnosis of dementia is important for patients and their families because it allows early treatment of symptoms. For people with Alzheimer's disease or other progressive dementias, early diagnosis may allow them to plan for the future while they can still help to make decisions. These people also may benefit from drug treatment.

Doctors have devised a number of techniques to help identify dementia with reasonable accuracy such as asking questions about the patient's history, physical examination, neurological evaluations (balance, sensory function, reflexes, etc.), cognitive and neuropsychological tests (memory, language skills, math skills, problems solving, etc.), brain scans (computed tomographic (CT) scans and magnetic resonance imaging (MRI), etc.), laboratory tests (blood tests, urinalysis, toxicology screen, thyroid tests, etc.), psychiatric evaluation, and presymptomatic testing (genetic tests).

 

Is There Any Treatment for Dementia?

While treatments to reverse or halt disease progression are not available for most of the dementias, patients can benefit to some extent from treatment with available medications and other measures, such as cognitive training.

Drugs to specifically treat Alzheimer's disease and some other progressive dementias are now available and are prescribed for many patients. Although these drugs do not halt the disease or reverse existing brain damage, they can improve symptoms and slow the progression of the disease. This may improve the patient's quality of life, ease the burden on caregivers, and/or delay admission to a nursing home. Many researchers are also examining whether these drugs may be useful for treating other types of dementia.

Many people with dementia, particularly those in the early stages, may benefit from practicing tasks designed to improve performance in specific aspects of cognitive functioning. For example, people can sometimes be taught to use memory aids, such as mnemonics, computerized recall devices, or note taking.

Behavior modification - rewarding appropriate or positive behavior and ignoring inappropriate behavior - also may help control unacceptable or dangerous behaviors.

 

Medications for Alzheimer's Disease

Most of the drugs currently approved by the U. S. Food and Drug Administration (FDA) for Alzheimer's disease fall into a category called cholinesterase inhibitors. There are currently four cholinesterase inhibitors approved for use in the United States; however, only: donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne – previously called Reminyl) are used by most physicians because the fourth, tacrine (Cognex) has more undesirable side effects than the other three.

These drugs temporarily improve or stabilize memory and thinking skills in some individuals. Doctors may also prescribe other drugs, such as anticonvulsants, sedatives; and antidepressants, to treat seizures, depression, agitation, sleep disorders, and, other specific problems that can be associated with dementia.

 

Medications for Vascular Dementia

There is no standard drug treatment for vascular dementia, although some of the symptoms, such as depression, can be treated.

Most other treatments aim to reduce the risk factors for further brain damage. However, some studies have found that cholinesterase inhibitors, such as galantamine (Razadyne) and other Alzheimer's disease drugs, can improve cognitive function and behavioral symptoms in patients with early vascular dementia.

The progression of vascular dementia can often be slowed significantly or halted if the underlying vascular risk factors for the disease are treated.

 Doctors may prescribe medicines to control high blood pressure, high cholesterol, heart disease, and diabetes. Medications to relieve restlessness or depression, or to help patients sleep better may also be prescribed.

 

Medications for Vascular Dementia

There is no standard drug treatment for vascular dementia, although some of the symptoms, such as depression, can be treated.

 Most other treatments aim to reduce the risk factors for further brain damage. However, some studies have found that cholinesterase inhibitors, such as galantamine (Razadyne) and other Alzheimer's disease drugs, can improve cognitive function and behavioral symptoms in patients with early vascular dementia.

The progression of vascular dementia can often be slowed significantly or halted if the underlying vascular risk factors for the disease are treated.

Doctors may prescribe medicines to control high blood pressure, high cholesterol, heart disease, and diabetes. Medications to relieve restlessness or depression, or to help patients sleep better may also be prescribed.

.

Medications for Other Dementias

Some studies have suggested that cholinesterase inhibitors, such as donepezil (Aricept), can reduce behavioral symptoms in some patients with Parkinson's dementia.

At present, no medications are approved specifically to treat or prevent frontotemporal dementia and most other types of progressive dementia.

However, sedatives, antidepressants, and other medications may be useful in treating specific symptoms and behavioral problems associated with these diseases.

Scientists continue to search for specific treatments to help people with Lewy body dementia. Current treatment is symptomatic, often involving the use of medication to control the parkinsonian and psychiatric symptoms.

There is no known treatment that can cure or control Creutzfeldt-Jakob disease. Current treatment is aimed at alleviating symptoms and making the patient as comfortable as possible.

Opiate drugs can help relieve pain and the drugs clonazepam (Klonopin) and sodium valproate (Depacon) may help relieve myoclonus

 

 

Can Dementia be Prevented?

Research has revealed a number of factors that may be able to prevent or delay the onset of dementia in some people. For example, studies have shown that people who maintain tight control over their glucose levels tend to score better on tests of cognitive function than those with poorly controlled diabetes. Several studies also have suggested that people who engage in intellectually stimulating activities, such as social interactions, chess, crossword puzzles, and playing a musical instrument, significantly lower their risk of developing Alzheimer's disease and other forms of dementia. Other preventive actions include lowering homocysteine (amino acids), lowering cholesterol levels, lowering blood pressure, exercise, education, controlling inflammation, and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and similar drugs.

 

Caring for People with Dementia

People with moderate and advanced dementia typically need round-the-clock care and supervision to prevent them from harming themselves or others. They also may need assistance with daily activities such as eating, bathing, and dressing. Meeting these needs takes patience, understanding, and careful thought by the person's caregivers.

A typical home environment can present many dangers and obstacles to a person with dementia such as sharp knives, dangerous chemicals, tools, and other hazards which should be removed or locked away. Safety measures include installing bed and bathroom safety rails, removing locks from bedroom and bathroom doors, and lowering the hot water temperature to 120° F (48. 9° C) or less to reduce the risk of accidental scalding.

 

Caring for People with Dementia (continued)

People with dementia often develop behavior problems because of frustration with specific situations. Understanding and modifying or preventing the situations that trigger these behaviors may help to make life more pleasant for the person with dementia as well as his or her caregivers. For instance, the person may be confused or frustrated by the level of activity or noise in the surrounding environment. Reducing unnecessary activity and noise (such as limiting the number of visitors and turning off the television when it's not in use) may make it easier for the person to understand requests and perform simple tasks.

Confusion also may be reduced by simplifying home decorations, removing clutter, keeping familiar objects nearby, and following a predictable routine throughout the day.

Calendars and clocks also may help patients orient themselves. Normal leisure activities as long as they are safe and do not cause frustration such as crafts, games, music and exercise, and other intellectually stimulating activities may slow the decline of cognitive function in some people.

 

Driving and Dementia

Many studies have found that driving is unsafe for people with dementia. They often get lost and they may have problems remembering or following rules of the road. They also may have difficulty processing information quickly and dealing with unexpected circumstances. Even a second of confusion while driving can lead to an accident.

Driving with impaired cognitive functions can also endanger others. Some experts have suggested that regular screening for changes in cognition might help to reduce the number of driving accidents among elderly people, and some states now require that doctors report people with Alzheimer's disease to their state motor vehicle department. However, in many cases, it is up to the person's family and friends to ensure that the person does not drive.

 

 

 

 

 

 

What Research Is Being Done on Dementia?

Research on the causes of Alzheimer's disease and other dementias includes studies of genetic factors, neurotransmitters, inflammation, factors that influence programmed cell death in the brain, and the roles of tau, beta amyloid, and the associated neurofibrillary tangles and plaques in Alzheimer's disease.

Since many dementias and other neurodegenerative diseases have been linked to abnormal clumps of proteins in cells, researchers are trying to learn how these clumps develop, how they affect cells, and how the clumping can be prevented.

Researchers are searching for additional genes that may contribute to Alzheimer's disease, and they have identified a number of gene regions that may be involved. They are also continually working to develop new drugs for Alzheimer's disease and other types of dementia.

Many researchers believe a vaccine that reduces the number of amyloid plaques in the brain might ultimately prove to be the most effective treatment for Alzheimer's disease. Current research focuses on many different aspects of dementia. This research promises to improve the lives of people affected by the dementias and may eventually lead to ways of preventing or curing these disorders.

 

 

 

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