dementia

The dementia - A condition characterized by a generalized deterioration in brain function. Dementia most commonly affects the elderly; about 1 in 20 people over the age of 65, and up to 1 in 5 people over the age of 80, have the disorder.

CAUSES AND TYPES
Dementia is caused by damage to brain tissue. It is most commonly due to Alzheimer’s disease, which causes changes in the structure and chemistry of the brain. The second most common form is multi-infarct dementia. In this condition, narrowed or blocked arteries in the brain deprive the tissue of blood and oxygen; repeated small strokes (episodes of tissue damage due to a lack of blood) occur, causing deterioration that develops gradually and in stages. Other, rare forms of dementia include Lewy body dementia (in which small, spherical structures called Lewy bodies appear in the brain tissue); AIDSrelated dementia; and deterioration that occurs as a result of progressive brain disorders such as Parkinson’s disease.

SYMPTOMS
The main symptoms of dementia are progressive memory loss, disorientation, and confusion. The affected person may not remember recent events, he or she may become easily lost in a familiar neighbourhood, and may be confused over days and dates.

These symptoms may come on gradually and they may be hardly noticeable at first; in addition, the person may cover up any problems by confabulation (making up explanations in order to fill the gaps in his or her memory). Sudden outbursts or embarrassing behaviour may be the first obvious signs of dementia. Unpleasant personality traits may be magnified; families of those affected may have to endure accusations, unreasonable demands, or even assault.

Paranoia, depression, and delusions may occur as the disease progresses. Irritability or anxiety gives way to indifference towards all feelings and events. Personal care and hygiene are neglected, and speech becomes incoherent. Affected people may eventually need total nursing care.

TREATMENT
The management of the most common Alzheimer-type illness is based on the treatment of symptoms. The affected person should be kept clean and wellnourished, in comfortable surroundings and with good nursing care. Sedative drugs may be given to reduce restlessness or paranoid beliefs.

These measures can help to ease distress for both the patient and their family. For some people with mild to moderate Alzheimer’s disease, drug treatment with acetylcholinesterase inhibitors such as donepezil may halt the deterioration in mental function, or may even restore function to the level the person experienced six months previously. Regardless of treatment, however, Alzheimer’s disease is progressive, and usually leads to death within 10 years of onset.