Dementia and Related Disorders

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Dementia

Dementia is defined as the loss of intellectual functions (such as thinking, remembering and reasoning) of sufficient severity to interfere with a person's daily functioning. It is not a disease in itself, but rather a group of symptoms which may accompany certain diseases or physical conditions. Dementia's cause and rate of progression varies. Some of the more well-known diseases that produce dementia include Alzheimer's disease, Diffuse Lewy Body Disease,  Frontotemporal Dementia (also known as Pick's disease), Vascular (Multi-infarct) dementia, Depression, Parkinson's disease, Normal Pressure Hydrocephalus, Huntington's disease, and Creutzfeldt-Jakob Disease (CJD).  Other conditions which may cause or mimic dementia include depression, brain tumors, nutritional deficiencies, head injuries, hydrocephalus, infections (AIDS, meningitis, syphilis), drug reactions and thyroid problems.  It is imperative that all persons experiencing memory deficits or confusion undergo a thorough diagnostic work up.  This requires examination by a physician experienced in the diagnosis of dementia disorders and detailed laboratory testing.  The examination should include a re-evaluation of all medications.  This process will help the patient obtain treatment for reversible conditions, aid the patient and family in planning future care, and provide important medical information for future generations.

Diffuse Lewy Body Disease

Another degenerative brain disorder, now thought to be the second most common type of dementia. Lewy Bodies are small round inclusions that are found within nerve cells.  These Lewy Bodies are found in both Parkinson's and Alzheimer's. However, in Diffuse Lewy Body Disease, pathological features that overlap both Alzheimer's and Parkinson's symptoms include cognitive impairments, fluctuation in level of alertness, visual hallucinations, severe motor defects, reduced facial expression, shuffling gate, tremors, rigidity and unsteady gate and balance.  These patients may have frequent falls.

Vascular Dementia

Vascular dementia, also known as multi-infarct dementia (MID), is a deterioration of mental capabilities caused by multiple strokes (infarcts) in the brain. The onset of MID may be relatively sudden as many strokes can occur before symptoms appear.  These strokes may damage areas of the brain responsible for a specific function as well as produce generalized symptoms of dementia. As a result, MID may appear similar to Alzheimer's disease. MID is not reversible or curable, but recognition of an underlying condition (i.e. high blood pressure, atrial fibrillation, diabetes, etc.) often leads to a specific treatment that may modify the progression of that disorder.  MID is usually diagnosed through neurological examination and brain scanning techniques, such as computerized tomography (CT scan) or magnetic resonance imaging (MRI), in order to identify strokes in the brain.

Frontotemporal Dementia (FTD - Also known as Pick's Disease)

FTD is now thought to be responsible for up to 10-15% of all cases of dementia symptoms.  FTD impacts personality and behavior.  The tissue shrinkage in the brain’s frontal and temporal lobes also produces difficulty with speaking and understanding speech, and may ultimately impact movement.  

Depression

A psychiatric disorder marked by sadness, inactivity, difficulty in thinking and concentration, feelings of hopelessness and sometimes suicidal tendencies.  Many severely depressed patients will have some mental deficits including poor concentration and attention.  When dementia and depression are present together, intellectual deterioration may be exaggerated.  Depression, whether present alone or in combination with dementia, can be reversed with proper treatment.

Parkinson's Disease

A progressive disorder of the central nervous system, which affects more than one million Americans. Individuals with Parkinson's lack the substance dopamine, which is important for the central nervous system's control of muscle activity. Parkinson's disease is often characterized by tremors, stiffness in limbs and joints, speech impediments and difficulty in initiating physical movement.  Late in the course of the disease, some patients develop dementia and eventually Alzheimer's disease. Conversely, some Alzheimer's disease patients develop symptoms of Parkinson's. Medications such as Levodopa, which converts itself into dopamine once inside the brain and depreynl, which prevents degeneration of dopamine-containing neurons, are used to diminish or reduce motor symptoms in Parkinson's patients but do not correct the mental changes that occur.

Normal Pressure Hydrocephalus

This is an uncommon disorder which involves an obstruction in the normal flow of cerebrospinal fluid. This blockage causes a buildup of cerebrospinal fluid on the brain. Symptoms of Normal Pressure Hydrocephalus include dementia, urinary incontinence and difficulty in walking. The patient may walk with a wide stance (standing and walking with feet wider than the hips). Presently, the most useful diagnostic tools are neuroimaging techniques (e.g., MRI). Normal pressure hydrocephalus may be caused by any of several factors including menigitis, encephalitis and head injuries. In addition to the treatment of the underlying cause, the condition may be corrected by a neurosurgical procedure (insertion of a shunt) to divert the fluid away from the brain. 

Huntington's Disease

An inherited, degenerative brain disease, which affects the mind and body.  The disease usually begins during mid-life, and is characterized by intellectual decline, and irregular and involuntary movements of the limbs or facial muscles.  Other symptoms of Huntington's disease include personality change, memory disturbance, slurred speech, impaired judgment and psychiatric problems. Huntington's disease currently affects more than 25,000 Americans. The diagnostic process for Huntington's disease includes an evaluation of family medical history, recognition of typical movement disorders and CT brain scanning.  A genetic marker linked to Huntington's disease has been identified on chromosome 4 and researchers are working on locating the gene itself.  Although there is no treatment available to stop the progression of the disease, the movement disorders and psychiatric symptoms can be controlled by drugs.

Creutzfeldt-Jakob Disease (CJD)

A rare, fatal brain disorder caused by a transmissible infectious protein called a “prion”.   Early symptoms of CJD include failing memory, changes in behavior and lack of coordination.   As the disease progresses, usually very rapidly, mental deterioration becomes pronounced. Involuntary movement - (especially muscle jerks) appears, and the patient may become blind, develop weakness in the arms or legs and ultimately lapse into a coma.  The death of CJD patients is usually caused by infection, heart failure or respiratory failure.   A definitive diagnosis of CJD can be made with a brain biopsy or at autopsy.

 

To learn more about dementia disorders, or to speak with one of Alzheimer's Community Care's Family Nurse Consultants, please call the organization at (561) 683-2700 or contact the organization via email.

 

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