Website design By BotEap.comDementia is a deterioration of the mental condition. Dementia usually occurs in adulthood, although rarer cases of presenile dementia are diagnosed. Terms used synonymously with dementia are chronic brain syndrome, organic mental syndrome, and senile confusional state. Website design By BotEap.comThe incidence of dementia is less than 10% of people over 65, but perhaps a quarter of people over 80 and half of all nursing home patients. Dementia is not the most common mental disorder in old age (ie depression), nor should it be considered an inevitable concomitant of aging. Many people can preserve cognitive functioning until the ninth decade. Website design By BotEap.comThe onset of most cases of dementia tends to be gradual. The first mental changes can be increased rigidity, distrust, bad mood or depression. As the disorder progresses, short-term memory deficits become pronounced. Patients can remember in great detail what happened years ago, but not remember the answers to a question asked five minutes ago. A woman in a nursing home could remember how to play a song she had learned on a Prohibition-era honky tonk, but when the other residents clapped and asked for another song, she played it again. The ability to follow instructions is also diminished, causing consternation in the patient’s caregivers. Disorientation develops over time: the patient does not know what day of the week it is. Then comes the disorientation: the patient can get lost, even in familiar territory. The patient may develop aphasia, apraxia, perseverance and / or social withdrawal. In later stages, recognition of other important people may be lost, along with the functions of the bowel and bladder. Death usually occurs when the patient loses the ability to swallow. Website design By BotEap.comDementia is different in type rather than in the degree of forgetfulness that most older people complain about. Benign senescent forgetfulness is an age-associated memory impairment that does not have a serious prognostic implication. Dementia is also not analogous to a second childhood. Childish joy comes from a lack of knowledge about proper adult roles, while the insane elderly may manifest such behavior due to memory problems, confusion, or sensory / motor limitations. Some nursing home patients may act more like children if staff reward such behavior with attention, especially affection. Website design By BotEap.comMore than 50 different diseases can cause dementia. Huntington’s chorea is due entirely to the presence of a single dominant gene. Creutzfeld-Jakob disease is caused by a viral infection, perhaps due to the consumption of undercooked bovine brain. Kuru, a viral infection in Melanesia, can be spread by ritual cannibalism. Hydrocephalus is an excessive pressure of the cerebrospinal fluid in the ventricles, which impairs the functioning of the cortex. Chronic alcohol abuse, tertiary syphilis (general paresis), AIDS, encephalitis, subdural hemotomy, Parkinson’s disease, intracranial neoplasia, head trauma, and meningitis are other possible causes. Website design By BotEap.comMost geriatric patients with dementia suffer from Alzheimer’s disease (also known as senile dementia of the Alzheimer’s type), which causes specific degenerative diseases in brain tissues. A similar, although rarer, disorder is Pick’s disease, which usually affects people in their 50s and is located mainly in the frontal and temporal lobes. These changes can be observed post mortem or by computed tomography. Website design By BotEap.comBefore 1980, the main cause of dementia was assumed to be cerebral arteriosclerosis, a hardening of the arteries in the brain that causes less oxygen to be supplied to brain tissues. The current consensus is that decreased blood flow is a significant causal factor in only a minority of dementia cases in later life. Reduced oxygen may be more of a symptom of reduced cortical function than its cause. A major cause of dementia posed by the vascular system may be dementia from multiple infarcts, many tiny strokes that have the combined impact of diminishing cognitive ability without causing the paralysis characteristic of larger strokes. Website design By BotEap.comThe diagnosis of dementia cannot be based solely on the patient’s complaints of faulty memory. There is no correlation between self-reported memory capacity and memory capacity as indicated by objective tests. Many of the older people who complain the most about memory decline are within the normal range but suffer from depression. Some completely insane patients do not perceive any difficulties with their memories. Website design By BotEap.comBrief psychological screening tests should be the first step. The use of the Bender-Gestalt test scales, IQ or other tests designed for other purposes or for other age groups should be avoided. Questions that assess orientation ability in space and time are useful. The ability to draw the face of a watch with its hands and its dial is useful. Focusing the test on short-term memory tends to neutralize some of the confounding variables and give a truer indication of dementia. Many of these tests (eg, the Mental State Questionnaire or the Mini Folstein Mental State Exam) have greater sensitivity than specificity: some normal elderly are more likely to be misdiagnosed with dementia than senile individuals to score within of the normal range. Whenever these screening tests suggest the presence of dementia, a complete neurological examination is appropriate. Website design By BotEap.comA diagnostic difficulty is distinguishing organic-based dementia from pseudodementia due to depression. Dementia is generally characterized by a gradual onset, while depression can have a rapid progression of symptoms as a result of stress or environmental loss. Depressed patients are more likely to complain of memory loss and give “don’t know” answers. Purely insane patients are more likely to try to hide cognitive deficits or give ridiculous answers rather than admit that they do not know the answer. A complication of the differential diagnosis of depression is that self-rating scales (eg, the Geriatric Depression Scale) may lose their validity as senile confusion increases: the patient may not be able to understand the questions. Another problem with differential diagnosis is that the two disorders are not mutually exclusive. Awareness of cognitive impairment can produce a depressive reaction, and a significant minority of patients with early-stage dementia develop clinically significant depression. Website design By BotEap.comAnother possibility is that the cognitive impairments are the result of delirium or amnestic disorder rather than dementia. This may be the case for many confused elderly admitted to general hospitals. What is needed is a knowledge of the details about the initiation, the course, and the lab tests. Complicating factors are that delusional patients cannot perform memory tests and these disorders are not mutually exclusive. Website design By BotEap.comEven with CT scan and lumbar puncture, the diagnosis of dementia is far from accurate. Some patients are falsely labeled as insane, while other cases may go undetected until autopsy. Website design By BotEap.comTreatment for dementia can be both medical and psychosocial. About a fifth of patients with dementia have a treatable organic cause (eg, hydrocephalus, which can be treated by surgery). The use of drugs has been hotly debated. While some patients report some benefit from tacrine or hydergine, some report side effects from the former and most report little benefit from the latter. Another controversial issue is the use of psychiatric medications (eg, antidepressants, antipsychotics) in patients with dementia. In many nursing homes, antidepressants are likely underused, while antipsychotics are often given to decrease behaviors that staff may find objectionable or inconvenient.