“Dr Irena’s” Health Tips – No. 20
Dementia (Part 2)
Irena Hulson is continuing with her series of health tips, which have been very well received by our readers, especially those who can relate to certain of the topics covered and we hope to receive and publish more in the future for your information. If there is a particular topic you would like to see published please let us know and we will ask Irena to see what she can find on the subject.
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By Irena Hulson
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 behaviour and ignoring inappropriate behaviour – also may help control unacceptable or dangerous behaviours.
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 non-steroidal 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.
People with dementia often develop behaviour problems because of frustration with specific situations. Understanding and modifying or preventing the situations that trigger these behaviours 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 orientate 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. 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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