Midlife Migraine Diagnosis Boosted Dementia Rate By 50% Danish Study Shows
byJudy George, Senior Staff Writer, MedPage Today June 18, 2020
Migraine patients had a higher rate of subsequent dementia than people who did not have a history of migraine, a population-based longitudinal study in Denmark showed.
People who had a hospital diagnosis of migraine in midlife — at ages 31 to 58 — had a 50% higher dementia rate after age 60 than people without a migraine diagnosis, reported Sabrina Islamoska, PhD, of the University of Copenhagen, in a virtual presentation at the American Headache Society annual scientific meeting.
Compared with people who did not have a hospital-based migraine diagnosis, dementia rates were doubled in migraine patients with aura. Migraineurs who did not have aura had a nonsignificant 20% higher rate. Dementia rate also was higher for patients who had frequent hospital contacts with migraine.
“Our study is the first national register-based study investigating migraine diagnoses in midlife and dementia risk in later life,” Islamoska told MedPage Today.
“The results show that migraine is a risk factor for dementia, especially migraine with aura,” she added. “This adds to previous studies supporting stronger vascular mechanisms in migraine with aura.”
Identifying midlife risk factors for dementia is important because “it means we can detect earlier those who may be at increased risk,” noted Suzanne Tyas, PhD, of the University of Waterloo in Canada, who wasn’t involved with the study.
The Start Of The Dying Process
As someones condition worsens and they get to within a few days or hours of dying, further changes are common. The person will often:
- deteriorate more quickly than before
- lose consciousness
- develop an irregular breathing pattern
- have cold hands and feet.
These changes are part of the dying process. Healthcare professionals can explain these changes so you understand what is happening. The person is often unaware of what is happening, and they should not be in pain or distress.
Medication can be used to treat the persons symptoms. If the person cant swallow, there are other ways of providing this, such as medication patches on the skin, small injections or syringe drivers . Speak to a GP or another health professional about this.
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Conditions With Symptoms Similar To Dementia
Remember that many conditions have symptoms similar to dementia, so it is important not to assume that someone has dementia just because some of the above symptoms are present. Strokes, depression, excessive long-term alcohol consumption, infections, hormonal disorders, nutritional deficiencies and brain tumours can all cause dementia-like symptoms. Many of these conditions can be treated.
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What You Can Do For Your Loved One
As an individual with dementia declines, you can help them by providing a loving and supportive presence. Sit with them. Hold their hand. Play music they enjoy.
One of the greatest gifts you can give your loved one is helping to get their affairs in order. Ensure that financial and healthcare powers of attorney are put in place, so you can make decisions when your loved one is no longer able. Look into funeral arrangements before you need them, so you dont need to make important decisions in a time of crisis.
Talk to your loved ones physician about the possibility of palliative care support in the home and hospice care when your loved one is ready.
How Can You Cope With Being The Caretaker Of Someone With Dementia
It is important for someone who is the primary caregiver of a patient with dementia to have a strong network of support. This is needed both to aid in caring for the patient and to give the caregiver some intermittent relief. In the early stages, many caregivers function more as a helper or guide, providing reminders for different tasks. Later in the disease, caregivers may have to supply basic care to the patient, including assistance with bathing, dressing, and going to the bathroom.
Obtaining power of attorney status for financial and medical matters and determining when a patient is no longer able to perform certain activities, such as driving, are difficult but necessary actions. Local Alzheimer’s Association chapters are often helpful in completing these tasks. Enlisting the help of a patient’s physician or mandating an on-the-road driving assessment can place the responsibility of determining when a patient is no longer safe to drive on someone other than a caregiver or family member, as driving is often an action that many patients attempt to perform far past the time when it is safe to continue. There are many sources of assistance for caregivers of patients with dementia:
Alzheimer’s and Dementia Caregiver CenterAlzheimer’s Association
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What Is Vascular Dementia
Vascular dementia is the second most common form of dementia after Alzheimer’s disease. It’s caused when decreased blood flow damages brain tissue. Blood flow to brain tissue may be reduced by a partial blockage or completely blocked by a blood clot.
Symptoms of vascular dementia may develop gradually, or may become apparent after a stroke or major surgery, such as heart bypass surgery or abdominal surgery.
Dementia and other related diseases and conditions are hard to tell apart because they share similar signs and symptoms. Although vascular dementia is caused by problems with blood flow to the brain, this blood flow problem can develop in different ways. Examples of vascular dementia include:
- Mixed dementia. This type occurs when symptoms of both vascular dementia and Alzheimer’s exist.
- Multi-infarct dementia. This occurs after repeated small, often “silent,” blockages affect blood flow to a certain part of the brain. The changes that occur after each blockage may not be apparent, but over time, the combined effect starts to cause symptoms of impairment. Multi-infarct dementia is also called vascular cognitive impairment.
Researchers think that vascular dementia will become more common in the next few decades because:
How Is Vascular Dementia Diagnosed
In addition to a complete medical history and physical exam, your healthcare provider may order some of the following:
- Computed tomography . This imaging test uses X-rays and a computer to make horizontal, or axial images of the brain. CT scans are more detailed than general X-rays.
- FDG-PET scan. This is a PET scan of the brain that uses a special tracer to light up regions of the brain.
- Electroencephalogram . This test measures electrical activity in the brain
- Magnetic resonance imaging . This test uses large magnets, radiofrequencies, and a computer to make detailed images of the brain.
- Neuropsychological assessments. These tests can help sort out vascular dementia from other types of dementia and Alzheimer’s.
- Neuropsychiatric evaluation. This may be done to rule out a psychiatric condition that may resemble dementia.
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Dementia And Pain Management: A Personal Story
My father was screaming in the nursing home. The staff had tried changing any number of his medications, but nothing stopped his agitation until the physician ordered Vicodin, a strong painkiller. I called the physician and asked him to assess what might be causing my fatherâs pain. The physician suggested it might be arthritis. In a calm voice, I suggested that perhaps the pain was from something more seriousâwould he please do an evaluation? He told me that this would be hard to do since my father has dementia and canât tell him what hurts. I pointed out to the physician that, although limited in his speech, my father does respond to âyesâand ânoâ questions and that the doctor might be able to tell what hurt by looking at my fatherâs facial expression.
Having recently attended a meeting of the American Chronic Pain Association, I was very aware of the undertreatment of pain, especially in certain population groupsâ the old myth is that people with dementia had less sensitivity or awareness of pain.
I started to look at what was available for assessing and managing pain for people with dementia. Unfortunately, I found that there currently is not a lot of literature on how to assess and treat pain in people with cognitive impairments. As we become aware of the importance of pain management for all people, however, more helpful information will become available.
For more information on pain management:
American Chronic Pain Association, www.theacpa.org
How Do You Prevent Dementia In Head Injury Cases
Head injury and its resulting complications, such as dementia, are highly preventable.
- Use of protective gear in contact sports, seat belts and bicycle and motorcycle helmets aboard conveyances, and hard hats and safety equipment at work prevent head injuries.
- For elderly persons, altering the surroundings to lower the risk of falls is important.
- Protecting children from child abuse helps prevent head injuries.
A person who has experienced a head injury is at risk for further head injuries. Lower the danger by being aware of risk factors.
- Avoiding substance abuse makes further injury less likely.
- Some patients with head injury have suicidal thoughts. These people require immediate medical attention. In many cases, suicide can be prevented with treatment of depression, counseling, and other therapy.
- Athletes should not return to play until they have been cleared by their health care provider.
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Lewy Body Dementia Canada
Learn to live best with LBD
Pain seems to be more related to autonomic issues than mobility issues in a new Parkinsons Disease pain study. And by extension, it seems likely thatd be the same with Lewy Body Dementia.
Many, if not most, people with Lewy Body Dementia have Parkinsonism mobility issues. Pain, of an often inexplicable source is very common, and has often been believed to be related to lack of mobility from the condition. However, this study concludes that perception of pain is mostly related to central nervous system issues. This implies that for the same pathology two people with the same degree of arthritis can sense pain very differently.
- There was no correlation between musculoskeletal pain and motor symptoms
- There was also no correlation between radicular pain and motor symptoms
- Very weak correlation between lower abdominal pain and constipation scores
Get as much exercise as possible, and as is safe and approved by a specialist. There are few situations when it will be bad, and even if it doesnt fix all the pain issues, it will aid in sleep improvement. It also usually leads to better mood and any method of maintaining as much mobility and flexibility is beneficial.
Treatments For Vascular Dementia
There’s currently no cure for vascular dementia and there’s no way to reverse any loss of brain cells that happened before the condition was diagnosed.
But treatment can sometimes help slow down vascular dementia.
Treatment aims to tackle the underlying cause, which may reduce the speed at which brain cells are lost.
This will often involve:
- taking medicines, such as those used to treat high blood pressure, lower cholesterol or prevent blood clots
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Medicating For Pain Control
While non-drug approaches are important, many people will still benefit from prescribed pain medications. If you’ve ruled out other causes of behaviors , and you’ve determined that the person is likely experiencing pain, getting a prescription for pain medicine is a good idea.
Be wary of pain medications that are ordered on a PRN basis. Because the person with dementia might not be able to express their pain well, or might not be aware of a gradual increase in discomfort until she’s in a lot of pain, PRN pain medications are more likely to result in poorly controlled pain. Either the person doesn’t ask for it so she doesn’t receive it, or she gets it later than would have been ideal and her pain is beyond what’s normally controllable by the medication and dose prescribed. If at all possible, a routine order for pain medicine is preferable for the person with dementia.
Although family members may express the worry of possible addiction to pain medications, this is usually not a primary concern since drug-seeking behavior is not common in people with dementia. Additionally, many value quality of life which is likely to improve with adequate pain control.
What Is The Medical Treatment For Dementia In Head Injury Cases
The head-injured person who has become demented benefits from emotional support and education. This may include any of the following:
- Behavior modification
- Family or network intervention
- Social services
One goal of these interventions is to help the head-injured person adapt to his or her injury mentally and emotionally. Another is to help the person master skills and behaviors that will help him or her reach personal goals.
- These interventions also help family members learn ways that they can help the head-injured person and themselves cope with the challenges a head injury poses.
- These interventions can be especially important in establishing realistic expectations for outcome and pace of improvement.
Behavior modification has been shown to be very helpful in rehabilitation of brain-injured persons. These techniques may be used to discourage impulsive, aggressive, or socially inappropriate behavior. They also help counteract the apathy and withdrawal common in head-injured persons.
In general, cognitive rehabilitation is based on the results of neuropsychological testing. This testing clarifies problems and strengths in persons with dementia. The goals of cognitive rehabilitation are as follows:
- Encouraging recovery in functions that can be improved
- Compensating for areas of permanent disability
- Teaching alternative means of achieving goals
Family or network intervention
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What Are The Symptoms Of Vascular Dementia
The symptoms of vascular dementia depend on the location and amount of brain tissue involved. Vascular dementia symptoms may appear suddenly after a stroke, or gradually over time. Symptoms may get worse after another stroke, a heart attack, or major surgery. These are signs and symptoms of vascular dementia
- Increased trouble carrying out normal daily activities because of problems with concentration, communication, or inability to carry out instructions
- Memory problems, although short-term memory may not be affected
- Confusion, which may increase at night
- Stroke symptoms, such as sudden weakness and trouble with speech
- Personality changes
- Mood changes, such as depression or irritability
- Stride changes when walking too fast, shuffling steps
- Problems with movement and/or balance
- Urinary problems, such as urgency or incontinence
New Developments In Nonpharmacological Management
Complexities of pain in older persons with dementia necessitate a comprehensive pain management approach that encompasses more than pharmacotherapy. For years, clinical practice guidelines have recommended incorporation of nonpharmacologic approaches as part of the pain management plan for older adults, but recent concern related to opioid use for chronic pain has increased attention to the effective use of nondrug approaches. Incorporation of nondrug techniques involves careful consideration of the unique patient circumstances, patient preferences, and evidence of effectiveness and guidance for selection of these interventions in the frail older person with dementia. Although evidence is growing, the majority of evidence for nondrug pain interventions has been conducted in cognitively intact older adults because those with dementia are typically excluded from most randomized control trials . Evidence is accumulating on nondrug interventions to manage behavioral and psychological symptoms of dementia , but few studies focus specifically on pain as the outcome of interest.
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What Causes Vascular Dementia
Vascular dementia is caused by a lack of blood flow to a part of the brain. Blood flow may be decreased or interrupted by:
- Blood clots
- Bleeding because of a ruptured blood vessel
- Damage to a blood vessel from atherosclerosis, infection, high blood pressure, or other causes, such as an autoimmune disorder
CADASIL is a genetic disorder that generally leads to dementia of the vascular type. One parent with the gene for CADASIL passes it on to a child, which makes it an autosomal-dominant inheritance disorder. It affects the blood vessels in the white matter of the brain. Symptoms, such as migraine headaches, seizures, and severe depression, generally start when a person is in his or her mid-30s but, symptoms may not appear until later in life.
What Is The Treatment For Dementia In Head Injury Cases
Head injuries often bring an abrupt coping crisis. The sudden adverse changes that go with a head injury inevitability cause many emotions. Anxiety is a common response, and the person may become demoralized or depressed. Damage to the brain may impair the persons ability to cope at a time when the need to adapt is greatest. Persons with head injury typically are more distressed and have more difficulty coping with their injury than persons who have other types of injuries.
Usually, a particular family member assumes most of the responsibility for the injured persons care. Ideally, more than one family member should be closely involved in caregiving. This helps family members share the burdens of providing care and helps the primary caregiver keep from becoming isolated or overwhelmed. Caregivers should be included in all significant interactions with health care professionals.
Caregivers must encourage and expect the injured person to be as independent and productive as possible. At the same time, caregivers need to be patient and tolerant. They should accept that the person may have real limitations and that these will likely worsen if the person is tired, ill, or stressed. Emphasizing what the person can still do, rather than what seems to be lost, is helpful.
With head injuries, the greatest improvement is expected in the first 6 months, but delayed improvement is possible as long as 5 years after injury.
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What Do We Know Of Pain In The Different Subtypes Of Dementia
Dementia is a syndrome that can lead to confusion, memory loss, neuropsychiatric symptoms, and sometimes physical challenges. The Diagnostic and Statistic Manual of Mental Disorders Fifth Edition does not mention dementia, but instead uses the term neurocognitive disorders, and classifies it as mild or major, on how severely the symptoms impact a person’s ability to function independently in everyday activities.
In a recent U.S. study, most patients with dementia were diagnosed with dementia not otherwise specified, with Alzheimer’s disease being the most prevalent subtype. In the early stages, people with AD may find it hard to remember recent events, conversations, and names of people. In time, it becomes harder to communicate and judgment may become impaired. The person may feel disoriented and confused. Their behavior can change, and physical activities, such as swallowing and walking, will become harder. Vascular dementia is another highly prevalent cause of dementia, followed by Lewy body dementia and frontotemporal dementia . Often, people have mixed types of dementia, with both aspects of AD and VD . Also, other neurodegenerative diseases such as Parkinson disease and Huntington disease often are accompanied by dementia in the last stages of the disease. To know what the effects of pain are in different subtypes of dementia, several things have to be taken into account: