Dementia In Senior

Signs symptoms and possible causes of dementia in seniors, and how it may be treated.

Most of us have had times when we forgot the name of someone close to us or misplaced our car keys or even our car. So how do we know when we or someone we love is developing dementia?

First, we need to know what dementia is. Dementia is a condition of declining mental abilities, especially memory. The person will have problems doing things he or she used to be able to do, like keep the check book, drive a car safely, or plan a meal. He or she will often have problems finding the right words and may become confused when given too many things to do at once. The person with dementia may also change in personality, becoming aggressive, paranoid, or depressed.

Dementia is not just old age. As we get older, it takes us longer to remember things or to find the right word to say. But this is NOT dementia. Dementia keeps us from doing the things we used to do because of the mental changes. Although dementia is more common in old age, it is not "normal" and should be evaluated. Aging alone does not interfere with our abilities to function.

The medical community describes dementia as "impaired intellectual capacity". Dementia patients may also be labeled as having "presenile" or "senile" dementia, "chronic" or "organic brain syndrome," "arterio-sclerosis," or "cerebral atrophy. Dementing conditions are caused by abnormal disease processes, and can affect younger as well as older persons.

The U.S. Congress, Office of Technology Assessment estimates that 1.8 million Americans have severe dementia and another 1 to 5 million Americans have mild to moderate dementia. According to the Alzheim-er's Association, approximately 4 million of these people are afflicted with Alzheimer's disease. By the year 2040, the number of persons with Alzheimer's disease may exceed 6 million.

Signs of dementia include short-term memory loss, inability to think problems through or complete complex tasks without step-by-step instructions, confusion, difficulty concentrating and paranoid, inappropriate or bizarre behavior.

Deteriorating intellectual capacity may be caused by a variety of diseases and disorders. The National Institute on Aging states that some 100 conditions which mimic serious disorders are actually reversible. These are sometimes called "pseudodementias," and are often treatable. Examples of conditions causing reversible symptoms of dementia are:

Reactions to Medications--Older persons taking prescription drugs may suffer adverse reactions including confusion. Sedatives, hypnotics, neuroleptics, antihypertensives and antiarthritic medications are among the most common. All medications including over-the-counter remedies should be monitored by a physician to reduce the possibility of side effects.

Emotional Distress--Depression or major life changes such as retirement, divorce or loss of a loved one can affect one's physical and mental health. A physician should be informed about major stressful events. Severe delusional states should also be diagnosed by a psychiatrist.

Metabolic Disturbances--Problems including renal failure, liver failure, electrolyte imbalances, hypoglycemia, hypercalcemia, hepatic diseases or pancreatic disorders can provoke a confusional state, changes in sleep, appetite or emotions.

Vision and Hearing--Undetected problems of vision or hearing may result in inappropriate responses. This could be misinterpreted as dementia because an individual is unable to perceive surroundings or understand conversations. Hearing and eye examinations should be performed.

Nutritional Deficiencies--Deficiencies of folate, niacin, riboflavin and thiamine can produce cognitive impairment. Special attention should be given to patients who have difficulty in chewing, swallowing, or digesting food. Loss of taste and smell, loss of appetite, poorly fitting dentures or even difficulty shopping or preparing food may lead to nutritional deficiencies.

Endocrine Abnormalities--Hypothyroidism, hyperthyroidism, parathyroid disturbances or adrenal abnormalities can cause confusion which mimics dementia.

Infections--Older persons can develop infections which produce a sudden onset of a confusional state. This should be brought to the attention of a physician. Confusion caused by an infection is often treatable.

Subdural Hematoma (blood clot on the surface of the brain)--Clots can form which create collections of fluid that exert pressure on the brain. These clots can be treated by draining the fluid before it has caused permanent damage.

Normal Pressure Hydrocephalus--The flow and absorption of spinal fluid, which is manufactured inside the brain, is interrupted. When the fluid is not absorbed properly, it builds up inside the brain and creates pressure. Surgery can be performed to drain the spinal fluid into the bloodstream to relieve the pressure.

Brain Tumors--Tumors in the brain can cause mental deterioration. Benign tumors can be surgically removed. For other tumors, a combination of surgery and radiation/chemotherapy can help the patient.

Atherosclerosis (hardening of the arteries)--Intellectual impairment can result when a series of small strokes occurs (multi-infarct dementia). Built-up atherosclerotic plaques can be surgically removed or medically treated in order to prevent future strokes from occurring. If action is taken early enough, the patient can be helped.

Certain conditions cause cognitive impairment which is not reversible. These include:

Head Trauma--Traumatic brain injury can occur at any age. Trauma from a fall or an accident can precipitate personality, cognitive or behavior changes. If brain injury is mild, previous functioning may be restored over time. In cases of moderate to severe head trauma, brain impairment may be lasting. Careful attention should be paid to any blows to the head. Head injuries should be examined by a neurologist or rehabilitation specialist.

Cerebral Degenerative Diseases--If dementia is caused by a degenerative disease, progressive cognitive deterioration cannot be reversed. The most common irreversible dementia is Alzheimer's disease. Other degenerative diseases which can also cause dementia include Parkinson's disease, Huntington's chorea and Pick's disease. Other causes of dementia include cerebrovascular accidents (stroke), anoxia (loss of oxygen to the brain), Creutzfeld-Jakob's disease, Binswanger disease, AIDS and Multiple Sclerosis.

To diagnose dementia, a complete medical and neuro- psychological evaluation is recommended and a complete patient history is very important. Brain scans such as CT ("CAT" scans) or MRI (Magnetic Resonance Imaging) are an important part of the process. PET (Positron Emission Tomography) and SPECT (Single Photon Emission Computed Tomography) are newer, less available techniques which cannot be done at all hospitals. Much of the diagnostic procedure is a process of elimination to rule out any treatable causes of dementia

Chronic or irreversible dementia requires special care.

Special arrangements and support must be offered to families who care for a dementia patient at home. Behavior management techniques (such as controlling wandering, disorientation, sleeplessness or incontinence), safety precautions for home care (such as attending to electrical appliances, car keys, supervision and doors that lock) and legal considerations (for arranging finances, or durable power of attorney) should be attended to by family caregivers. Most care is provided at home but some patients may require placement in some type of residential facility in later stages.

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