A Family Doctor's Tale -DEMENTIA

DOC I HAVE DEMENTIA

Dementia is  a disease in which brain tissue degenerates to the extent of loss of memory and other intellectual abilities serious enough to interfere with daily life.

In Dementia there is a severe and progressive decline in mental function.

It affects a person's ability to:
1.think,remember and reason

2.learn new information and skills

3.solve problems and make judgement

The causes of Dementia are :
There are several different factors which may contribute to its development.

They can be divided into:
1.Irreversible conditions
a.Aging is one important risk factor.
Alzeimer's Disease

b.Stroke

c.Parkinson's disease

2.Reversible conditions
a.Hypothyroidism

b.Vitamin B12 deficiency

c.Alcohol dependence diseases


Irreversible Dementia cannot be cured but it may be possible to slow down the progression of the disease.

It may be possible treat the cognitive symptoms.

Potentially reversible dementia may be curable.

The Symptoms of Dementia are:
1.Memory loss or Forgetfulness is often one of the earliest symptoms (Patients may forget dates, names of common objects and familiar people)

2.Confusion(Disorientation in time and place) ,

3.Trouble with organizing

4.Misplacing things,

5.Difficulty in expressing thoughts,

6.Difficulty performing familiar tasks

7.Difficulty understanding others

8.Poor or decreased judgment

9.Wandering and getting lost in familiar places

10.Changes in mood and behaviour (They may become easily agitated or depressed)

a.Changes in personality

b.paranoia

c.hallucinations

d.agitation

e.anxiety

f.sleep problems

Dementia should be assessed and investigated.

Diagnosis can be based on :
1.History of depression, anxiety, hallucination, paranoia, agitation or sleep problems

2.Various tests may be done to exclude other conditions that may be causing the same problems:
a.blood sugar, thyroid hormone, vitamin B12 level

b.CT Scan or MRI of the brain to exclude tumors or stroke

The family doctor can refer the patient to a psychiatrist for further assessment if dementia is suspected.

The Management of Dementia is by:
Dementia is quite common in old people.

Referral to a psychiatrist may then be necessary for assessement and advice on management.

Management of dementia usually involve :

1.Treatment of reversible causes and risk factors:
a.treatment of any reversible causes such as hypothyroidism(thyroxine tabs), Vitamin B12 deficiency(injections of Vitamin B12 or B12 oral tablets)

b.reduction of risk facors for stroke such as diabetes, hypertension, high cholesterol

c.Use of blood thinning medicines such aspirin, plavix, ticlid, warfarin to prevent stroke

2.At the present moment there is no cure for non reversible Dementia but there are many ways to reduce the behavioural and psychological symptoms.

These including having
a.a fixed routine daily,

b.making the home and surroundings safe and familiar

c.using memory aids like diaries and calendars.

d.social interactions and contacts with other patients

e.activity programs

3.There are now drugs available to help delay or prevent symptoms from becoming worse:
a.One group of drugs helps improve the ability to think, understand, and remember.(Donepezil, Rivastigmine, Galantamine, Memantine) .

There may be improvement of the symptoms but ultimately they do not prevent the disease from getting worse.

b.Another group of drugs is also to help with behavioural problems associated with Dementia, such as aggressiveness, agitation, depression, and anxiety.(Prozac, Seroxat, Zoloft)

4.Caring for a patient with dementia can be frustrating and stressful.

It gets worse as the disease progresses.

There are now support groups and organisations which can help caregivers providing:.
a.education on dementia and caretaker skills
b.individual and family couseling
c.caretaker support groups
d.dementia day care service