Healthplus With Benjamin: Dementia And Related Cognitive Dysfunction

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INTRODUCTION
Dementia is the progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging. Particularly affected areas may be memory, attention, language, and problem solving. Especially in the later stages of the condition, affected persons may be disoriented in time (not knowing what day of the week, day of the, month, or even what year it is), in place (not knowing what day of the week, day of the month, or even what year it is),in place (not knowing where they are), and in person( not knowing who they are).(Psychopathology and Mental Health Manual) According to Encyclopedia of Natural Medicine  by Murray et al dementia refers to a general mental deterioration. In the elderly this is referred to as senile dementia. It can be marked by progressive mental deterioration, loss of recent memory, moodiness and irritability, self-centeredness and childish behavior. This is often due to Alzheimer’s disease, although there are many other causes of senile dementia.
 
Although much remains to be known about aging, it is safe to say that Alzheimer’s disease and other senile dementia are not necessarily a normal process, and do not have to be the reward of a ripe old age. Much can be done, even though the incidence of senile dementia is likely to in increase alarmingly for a time as the median age of the population grows.   
 
SIGNS AND SYMPTOMS
Symptoms of dementia can be classified as either reversible or irreversible depending on the etiology of the disease. Less than 10 percent of cases of dementia have been reversed. Dementia is a non –specific term encompassing many disease processes, just as fever is attributed to many etiologies. With careful assessment, delirium can easily be confused with dementia and a number of other psychiatric disorders because many of the signs and symptoms are also present in dementia (as well as other mental illnesses including depression and psychosis).
 
TYPES OF DEMENTIA
According to Psychopathology and Mental Health Manual published by the Indian Board of Alternative Medicine Kolkata India, types of dementia include
(a) Alzheimer’s disease
(b) Vascular dementia(also known as multi-infarct dementia) including Binswanger’s disease
(c) Dementia with Lewy bodies(DLB)
(d) Alcohol-induced Persisting Dementia
(e) Korsakoff’s syndrome 
(f) Wernicke’s encephalopathy
(g) Frontotemporal lobar degenerative(FTLD),including Pick’s disease and frontotemporal dementia(or frontal variant FTLD
(h) Semantic dementia(FTLD)
(i) Progressive non-fluent aphasia
(j) Creutzfeldt-Jakob disease
(k) Dementia pugilistic
(l) Moyamoya disease
(m) Subcortical dementia
(n) Dementia due to Huntington’s disease
(o) Dementia due to Parkinson’s disease
(p) Dementia due to vitamin B1 deficiency
(q) Dementia due to B12 deficiency
(r) Dementia due to folate deficiency
(s) Dementia due to syphilis
(t) Dementia due to Subdural hematoma
(u) Dementia due hypercalcaemia
(v) Dementia due to hyperglycemia
(w) AIDS dementia complex
(x) Pseudo-dementia (associated with clinical depression and bipolar disorder)
(y) Substance-induced persisting dementia(related to psychoactive use and formerly called Absinthism
(z) Dementia due to multiple etiologies. Others include dementia due to other general medical conditions(i.e. end stage renal failure, cardiovascular disease etc).Dementia not otherwise specified(used in cases where no specific criteria is met)
 
IMPORTANT MEDICAL INVESTIGATIONS IN THE DIAGNOSIS OF DEMENTIA
In the diagnosis of dementia one must first try to establish the type of dementia whether it is caused by a treatable condition. Whether the dementia is reversible or not .One must rule out if the cause of dementia is as a result of an associated disease like hypertension associated with stroke as seen in vascular dementia. One must rule out anemia associated with vitamin B1 and Vitamin B12.One must make sure that the integrity of the endocrine system, the essential organs like the kidney, liver, heart and the brain is not compromised. Proper differential diagnosis between the types of anemia is very important. There are some brief 5 minutes tests that have good reliability and can be used to evaluate cognitive status. Example of such tests include the abbreviated mental test score (AMTS), the mini mental state examination (MMSE), Modified Mini Mental State examination (3MS) the Cognitive Abilities Screening Instrument (CASI) and the clock drawing test.
 
MEDICAL LABORATO RY INVESTIGATIONS
Medical laboratory tests are done to rule out treatable causes. These tests include thyroid stimulating hormone test, Vitamin B1, Vitamin B12,Folic acid assay, Full Blood Count to rule out anemia, Liver Function Tests (LFTs) Kidney Function Tests(E/U/CR) Retroviral Screening (RVT) ,VDRL test for Syphilis, C-reactive protein, Calcium, plasma homocystein, Fasting Blood Sugar/Random Blood Sugar to rule out Diabetes Mellitus. Abnormalities may suggest vitamin deficiency, infection especially Urinary Tract Infection or other problems that commonly cause confusion or disorientation in the elderly. Chronic use of substances such as alcohol can predispose the patient to cognitive changes suggestive of dementia. Abuse and over use of some medication especially allopathic medications used in the management of hypertension) can cause dementia like signs and symptoms in the elderly.
 
IMAGING
ACT scan or magnetic resonance imaging (MRI) is commonly performed as a diagnostic tool in diagnosis of dementia.
 
PREDISPOSING FACTOR TO HAVING DEMENTIA
(a) Age
(b) Genetic/family history
(c) Atherosclerosis
(d) Smoking and alcohol use
(e) Elevated lipid profile
(f) Plasma homocysteine
(g) Diabetes mellitus
(h) Mild cognitive impairment
(i) Down syndrome
 
PREVENTION OF DEMENTIA
(1) One must avoid injury to the brain.
(2) Avoid the abuse and use of drugs that have effects on the brain.
(3) Lower homocystein level
(4) Inflammations should be controlled
(5) Hypertension should be controlled.
(6) Regular exercise is important. 
(7) Maintain a healthy diet. Eating food rich in omega 3 fatty acids found in fish and nuts, fruits, vegetables.
(8) Avoid exposure to heavy metals like aluminium, lead and silicon.
(9) One should be involved with things that make the brain active.
 
MANAGEMENT AND TREATMENT OF DEMENTIA
For the treatable forms of dementia it can be reversed with good nutrition and giving the body what it lacks if that is the cause of the dementia. But for the non reversible dementia individuals should care for the patients by showing love this would make the patient live longer. Thing that can help in the treatment and management of dementia are-
 
(a) Consuming supplemental antioxidants such as carotenes, flavonoids, Vitamin C an E, zinc and selenium.
(b) Correction of any underlying thyroid abnormality.
(c) Maintenance of adequate blood and oxygen flow to the brain.
(d) The extract of Ginkgo biloba has been shown to be effective in treating ailment associated with  reversible dementia
(e) Vitamin B1 and Vitamin B12 supplementation is important.
(f) Melissa officinalis and salvia officinalis have shown good therapeutic effectiveness in the management of Alzheimer’s disease.
(g) S-adenosyl methionine (SAMe) has been suggested to have positive effects on the brain.
(h) Traditional Chinese medicine regards treating the kidney as an important factor in age related disease.
(i) Huperzine A.-it is estimate that over 100,000 have been treated with Huperzine A in China, where it is used as a treatment for Alzheimer’s disease and other kinds of dementia.
 
In addition to being less toxic than current drugs used to treat Alzheimer’s disease, it appears more effective in a number of areas. Huperzine is extracted from club moss extract (huperzia serrata; qian centa ) and has been used traditionally in treating fever and inflammations. Research carried out at the Shanghai Institute of Materia Medica found that Huperzine A improved memory significantly better than tacrine or other drug#2020 (Neuroreport 1996,Dec.20;8(1)97-101)Fifty patients with Alzheimer’s disease were administered 200mcg of Huperzine A BID for 8 weeks. Twenty-nine patients showed improvement in memory, cognitive abilities and behavioral functions on the basis of the Wechseler memory scale, Hasegawa dementia scale, and other internationally accepted standards ( Chung Kuo Yao Li Hsueh Pao 1995,Sept 116(5) 391-395).
 
REFERENCES.
Encyclopaedia of Natural Medicine (1990) Murray , MT, Pizzorno J E
Psychopathology and Mental Health Manual, Publication of Indian Board of Alternative Medicine Kolkata India pages 214-219.
http://www.webmd.com/alzheimier/tc
http://www.medicenet.com/script/mobileart.asp
http://www.ncb.nim.nih.gov/pmc/articles/pmc16933391
 
DR Benjamin Chukwunonso Ajufo is a Medical Laboratory Scientist/Doctor of Holistic Medicine wrote from Igbuzo , Delta State.
 
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