Friday, March 4, 2011

Dementia treatment

How is dementia treated?
Dementia is not curable but more and more drugs are coming on the market that can delay cognitive impairment.Two types of drugs are commonly prescribed.Cholinesterase inhibitors (Aricept, Exelon and Razadyne) prevent the breakdown of acetylcholine, a
neurotransmitter that is essential to memory and thought processes. These drugs are used to treat mild and moderate Alzheimer’s and can delay the progression of the disease up to a year. Only about half the people who have tried the drug have benefited. The other drug, memantine (Namenda), regulates glutamate, a different neurotransmitter. It is prescribed for patients with moderate to severe Alzheimer’s. It also delays the disease’s progression in some patients. Other symptoms such as restlessness, combativeness, hallucinations and delusions can be treated with behavior modification as well as medication. Caregivers need to be alert to things that trigger behavioral problems, such as a change in environment. The patient may be responding to an awareness of their diminishing abilities, or attempting to communicate some need. Patients should be checked for injuries, illness, drug interactions or side effects. Dementia also can change sleep patterns, which can affect mood.
A variety of anti-depressant, anti-anxiety and anti-psychotic drugs are available.

Are alternative treatments available?
A number of nutritional supplements are sometimes used to reduce dementia symptoms. Research on their effectiveness is limited and claims are mostly anecdotal. Some may have side effects or interfere with prescription medications. The manufacturing of these products is not regulated and so their quality and purity can vary widely. Before trying any of these products, research the product and manufacturers. You should also consult a Physician as some vitamins/herbal medication may interfere with prescribed drugs.
Vitamin E is sometimes prescribed because it is an antioxidant. It may help delay mental decline. However, in high doses, Vitamin E can interfere with medications including blood-clotting drugs.
Another antioxidant, Coenzyme Q10, or ubiquinone, sometimes is used to treat dementia. It occurs naturally in the body, but little is known about effective dosages or side effects.
Turmeric, the bright yellow seasoning in curries, also has shown to have antioxidant properties. Studies in rats have found that turmeric stimulates an enzyme called hemeoxygenase to act as a defense mechanism against free radicals, which are believed to be a factor in dementia.
The herb ginkgo biloba has been used for centuries by the Chinese to treat memory problems. It has antioxidant and anti-inflammatory properties.
Research has found that it can help with cognition and behavior, but it also can reduce the blood’s ability to clot. There is a lot of evidence that suggests ginkgo can help to reverse some of the memory difficulties of people with dementia – check with your Doctor before taking to make sure it doesn’t interfere with any other medication.
Another Chinese herb huperzine A has properties similar to cholinesterase inhibitors and is being tested in clinical trials. It has shown to be effective in small studies, but it is not known how it reacts with medications.
Omega-3 fatty acids are believed to reduce the risk of heart attack and stroke. Omega-3 also is shown to protect nerves and elevate mood. These fatty acids are found in fish and plants such as flax. The U.S. Food and Drug Administration recommends that no more than 3 grams be consumed. Since fish often are contaminated with mercury and other toxins, it is important to use pharmaceutical grade oil.
Phosphatidylserine is a type of lipid that makes up the membranes around nerve cells. Since these membranes deteriorate in dementia, it is believed that phosphatidylserine may help slow the progression of the disease. However, little official research has been done. B vitamins are vital for mental health and a deficiency in any of these will rapidly affect how someone thinks and feels. Because B vitamins are water soluble you need to make sure you get a daily intake, either from food or taking vitamin supplements.

Do mental exercises help?
All kinds of exercise help the brain – physical, mental and social. It’s a case of use it or lose it. Several studies have found that physically exercising at least twice a week can reduce the risk of developing dementia by between 40 and 60 percent.
Researchers recommend a 20-minute walk twice a day as a way to increase blood flow to the brain.
Mental exercises such as solving puzzles or pursuing hobbies help stimulate the brain. It’s probably best to stick to familiar activities like crosswords and jigsaw puzzles. People with dementia find it harder to learn new things and if they’re not used to puzzles like Sudoku, may find it difficult to master!
Cognitive Stimulation Therapy (CST) has been shown to have a positive effect on dementia sufferers. CST consists of activities like word games, reality orientation and other information processing activities. It's been shown to improve cognitive ability and quality of life for participants.
Contact your local support group or speak to your physician about whether this is available in your area.
Social interaction also is valuable. It stimulates the brain and improves emotional health. Having friends and family visit or phone on a regular basis is a good way of ensuring the dementia patient gets adequate social contact.
And, finally, good nutrition is important. A diet with lots of fresh fruits and vegetables is good for the whole body.

What are the care options?
Dementia is a progressive disease and the types of care required will change as the disease changes.
Many families try to care for their loved one at home, which can be very challenging. In the early stage of the disease, the patient will have lucid times and confused times. A familiar face often is reassuring. But homecare requires a support network of family and friends to provide respite for the caregiver. Some visiting nurse agencies now provide nursing and personal care services for dementia patients.
Assisted living facilities are becoming a popular choice. Many of these facilities offer several levels of care so the patient’s needs can be addressed in one place. Often the spouse can live at the facility with the patient and can participate in their care without bearing the full brunt of it. These facilities provide food, laundry, maid, personal hygiene and nursing services. Many of them cater to Alzheimer’s patients and offer recreation and other stimulating activities.
Nursing homes often become necessary in the late stage of the disease as the patient loses the ability to care for themselves or communicate with others.

What to do in the early stages of dementia
Candid conversations on a variety of subjects are important in the early phases. Sit down with family, close friends and a trusted financial adviser to talk about the financial situation.
Set up direct deposit of checks and direct payment of bills, and make sure someone is double-checking that nothing falls through the cracks.
Consider establishing a joint bank account.
Check insurance policies so that everyone knows what medical and long term care options are available.
Consult with a lawyer about power of attorney, guardianships and other legal avenues for caregivers. This also is a good time to update wills and living wills to make wishes known about end of life care.
Let people around you know what is happening. A neighbor, the mailman or the gardener can be alert to problems. And get acquainted with services available in your community such as respite care and adult day care.
Write it down - in the early phases of dementia, it can be helpful to post a daily schedule, including meals and medication times, to help the patient keep track of their day. You could use an erasable white board placed somewhere prominent, such as the kitchen.
Be aware that early on the patient wants to stay as independent as possible and may become hostile or sullen if they feel people are trying to take over their life. Make sure you allow them to be as independent as possible.

Keeping their long-term memory
Being surrounded by familiar possessions can be a comforting thing early on but later as cognition begins to decline, too many objects can be confusing.
There will come a time when the patient’s environment needs to be simplified.
A few family photos, labelled with names, can help stimulate the memory. But a treasured collection of porcelain figurines should probably be put out of harm’s way. Throw rugs and electrical wires should be eliminated from frequently travelled areas.
Use what’s known as “Reminiscence therapy”. This is where you help to stimulate your loved one’s long term memory by showing them pictures, or objects from the past. Or talk to them about past events. Additionally, you could use music, videotapes etc. You’ll find when it comes to talking about their younger days; most dementia patients’ memories are as good as ours!
Rather than starting your loved one on new hobbies or tasks, try to stick to familiar tasks that they can do almost automatically – without having to think about it. This could be things like; folding laundry, making beds, setting out cutlery, gardening, washing and drying plates and the like. This makes it more likely that they’ll be able to remember what to do and in carrying out the task successfully, they’ll feel satisfied that they’re being useful. Share Health|Fitness
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What is dementia?
Dementia is caused by the destruction of brain cells from ageing, illness or injury. It is commonly associated with aging, although it can affect adults of all ages. The first sign is usually memory loss, although not all memory loss is an indication of dementia.
A person with dementia might forget where he lives or how to put away the groceries. Over time, dementia affects a person’s ability to reason,communicate and focus. It can cause their personality to change.

1.2 What are the different types of dementia?
Alzheimer’s is the best-known and most common type of dementia – it accounts for about half of all cases. Over time, people with Alzheimer’s lose their memory and their ability to speak or understand language. They cannot make decisions or solve problems. They don’t recognize friends or family. They don’t know their own name or know where they are.
Vascular dementia is the result of small strokes that cause bleeding in the brain. The bleeding damages that area of the brain. If the bleeding occurs in the language area of the brain, for instance, the speech will be affected.
The damage is not always reversible but if the cause of the strokes is treated, then further bleeding can be stopped. This type of dementia is the second most common type (around 20% of dementia patients suffer from vascular dementia).

Dementia with Lewy bodies is similar to Alzheimer’s. It gets its name from abnormal collections of protein (Lewy bodies) which occur in the nerve cells of the brain. But unlike Alzheimer’s, it includes elements of Parkinson’s disease such as muscle rigor, trembling, shuffling gait and slurred speech. Hallucinations may also be experienced.
Pick’s Disease is the rarest form of dementia and causes personality and behavior changes. It is caused by degeneration in the front temporal lobe of the brain that controls judgment and social behavior. This type of dementia can occur in people in their 40s.

1.3 What causes dementia?
All dementia is caused by damage in the brain. Sometimes the damage is reversible, sometimes not. It is important not to jump to conclusions.
Memory loss or some other symptom of dementia could be caused by something minor and treatable. You should always consult a knowledgeable physician.
Alzheimer’s and Lewy body dementias are caused by areas of protein that develop in the brain. The clumps of protein – called plaques and tangles -- scramble the messages sent in the brain. Researchers aren’t sure what causes the proteins to develop, but they suspect inflammation is partly responsible.
Vascular dementia is caused by strokes that produce bleeding in the brain. Treating the underlying cause can stop further damage.
Certain lifestyle choices can cause dementia, too. Poor diet, smoking, excessive drinking, not exercising, can all adversely affect brain health.
Recent studies have found that being a smoker increases your risk of dementia by 50% - another great reason to give it up! Something as simple as dehydration can affect mental function.
Severe head trauma such as is seen in boxers can also result in dementia.
Researchers are now seeing a link between head trauma and the onset of dementia years later.
Reactions to medications, especially in older people with slower liver function, can also cause dementia. Dementia from these causes can usually be reversed by lifestyle changes.
Several research studies have suggested a possible link between aluminium and Alzheimer’s disease and some research suggest that people living in an area where there is a high concentration of aluminium in the water supply may be more likely to develop Alzheimer’s – but this evidence is not conclusive. Using deodorants or drinking tea, where there is low exposure to aluminium has not been linked to an increased risk of Alzheimer’s disease.
Exposure to mercury (e.g. in dental fillings) is also unproven to cause Alzheimer’s although mercury can be toxic to the central nervous system.
A variety of diseases can be accompanied by dementia:
1 Sexually transmitted diseases like syphilis and AIDS
2 Pellagra, a lack of niacin or B-3
3 Pernicious anaemia, a lack of B-12
4 Hypoglycaemia, caused by lack of sugar in the bloodstream
5 Hypothyroidism, decreased thyroid function
6 Severe brain infections like meningitis and encephalitis
7 Creutzfeldt-Jakob disease, a brain infection
8 Huntington’s, a hereditary brain disease
9 Parkinson’s
10 Down’s syndrome
It’s interesting that in countries like India and China, people are less than half as likely as people in western countries to suffer from Alzheimer’s. This is a clear sign that the difference is to do with diet, lifestyle or other environmental factors. It’s unlikely to be due to the difference in genetics, as people emigrating from these countries to western regions, soon catch up in terms of a greater risk of dementia.

1.4 Who is at risk?
Dementia can occur at any age, although it is typically a disease of old age. Almost half of people over 85 suffer from Alzheimer’s, but only about 5% of people between 65 and 74 are diagnosed with it.
A person with a parent or sibling with Alzheimer’s has a higher risk of developing it. Early onset dementia that occurs at midlife is believed to be hereditary.
Women are more likely than men to have Alzheimer’s, possibly because they live longer. Researchers also think women who take hormone replacement therapy after age 65 increase their risk for dementia.
Researchers are finding that people who chronically use antacids such as Tagamet, Pepcid and Zantac have 2 ½ times the normal risk for Alzheimer’s.
In addition to acting on stomach acid, the drugs also inhibit the brain’s cholinergic system, which is involved in memory and cognition.
Education levels also seem to be an indicator. Research has found that people with lower levels of education are at greater risk. The theory is that mental stimulation may be a preventive.
Relationships have also been found between the development of Alzheimer’s and disturbances in insulin and glucose metabolism. This may explain why people with diabetes have a much higher risk of developing Alzheimer’s disease.

1.5 Is dementia preventable?
There’s is no proven way to prevent dementia such as Alzheimer’s but keeping to a healthy diet and staying physically and mentally active seems to reduce the risk. Mental fitness is particularly important. Solving puzzles and engaging in hobbies are recommended as ways to exercise the brain.
Studies show that the use of anti-inflammatory drugs such as ibuprofen (Motrin and Advil), naproxen sodium (Aleve) and indomethacin (Indocin) may reduce the risk. But they should be used with caution because they can cause gastrointestinal bleeding.
Statin drugs like atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor) that are used to treat high cholesterol may also reduce the risk, but researchers are not sure how.
Another drug, raloxifene (Evista), that is used to treat osteoporosis seems also to reduce mild cognitive impairment, a memory disorder that precedes Alzheimer’s. Share Health|Fitness
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