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Impaired mental functioning care Dementia (Clinical manifestations…
Impaired mental functioning care
Dementia
Definition
Dementia isn't a specific disease. Instead, dementia describes a group of symptoms affecting memory,
thinking and social abilities severely enough to interfere with daily functioning.
Dementia indicates problems with at least two brain functions, such as memory loss and impaired judgment or language,
and the inability to perform some daily activities such as paying bills or becoming lost while driving.
Though memory loss generally occurs in dementia, memory loss alone doesn't mean you have dementia.
There is a certain extent of memory loss that is a normal part of aging.
Many causes of dementia symptoms exist.
Alzheimer's disease is the most common cause of a progressive dementia.
Some causes of dementia may be reversible.
Clinical manifestations
COGNITIVE CHANGES
Memory loss
Difficulty communicating or finding words
Difficulty with complex tasks
Difficulty with planning and organizing
Difficulty with coordination and motor functions
Problems with disorientation, such as getting lost
PSYCHOLOGICAL CHANGES
Personality changes
Inability to reason
Inappropriate behavior
Paranoia
Agitation
Hallucinations
Pathophysiology
Dementia involves damage of nerve cells in the brain, which may occur in several areas of the brain.
Dementia may affect people differently, depending on the area of the brain affected.
Dementias can be classified in a variety of ways and are often grouped by what they have in common,
such as what part of the brain is affected, or whether they worsen over time (progressive dementias).
Some dementias, such as those caused by a reaction to medications or an infection,
are reversible with treatment.
Risk factors
Age.
As you age, the risk of Alzheimer's disease, vascular dementia and several other dementias greatly increases, especially after age 65.
However, dementia isn't a normal part of aging, and dementia can occur in younger people.
Family history.
If you have a family history of dementia, you're at greater risk of developing the condition.
However, many people with a family history never develop symptoms, and many people without a family history do.
If you have specific genetic mutations,
you're at significantly greater risk of developing certain types of dementia.
Down syndrome.
By middle age, many people with Down syndrome develop the plaques and tangles in the brain that are associated with Alzheimer's disease.
Diagnostic test
Cognitive and neuropsychological tests
In these tests, doctors will evaluate your thinking (cognitive) function. A number of tests measure thinking skills such as memory, orientation, reasoning and judgment, language skills, and attention.
Doctors use these tests to determine whether you have dementia, how severe it is and what part of your brain is affected.
Neurological evaluation
In a neurological evaluation, doctors will evaluate your movement, senses, balance, reflexes and other areas.
Doctors may use the neurological evaluation to diagnose other conditions.
Brain scans
Doctors may order brain scans, such as a CT or MRI,
to check for evidence of stroke or bleeding and to rule out the possibility of a tumor.
Laboratory tests
Simple blood tests can rule out physical problems that can affect brain function
, such as vitamin B-12 deficiency or an underactive thyroid gland.
Psychiatric evaluation
You may meet with a mental health specialist (psychologist or psychiatrist)
who may evaluate whether depression or another psychological condition may be causing your symptoms
Treatment
Cholinesterase inhibitors. These medications — including donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) — work by boosting levels of a chemical messenger involved in memory and judgment.
Side effects can include nausea, vomiting and diarrhea. Although primarily used to treat Alzheimer's disease, these medications may also treat vascular dementia, Parkinson's disease dementia and Lewy body dementia.
Memantine. Memantine (Namenda) works by regulating the activity of glutamate. Glutamate is another chemical messenger involved in brain functions, such as learning and memory. A common side effect of memantine is dizziness.
Some research has shown that combining memantine with a cholinesterase inhibitor may have beneficial results.
Other medications. Your doctor may prescribe other medications to treat other symptoms or conditions, such as a sleep disorder.
Occupational therapy. Your doctor may suggest occupational therapy to help you adjust to living with dementia. Therapists may teach you coping behaviors and ways to adapt movements and daily living activities as your condition changes.