Understanding Parts Of The Brain
Learn about the parts of the brain and how dementia damages them, as well as about the symptoms the damage causes.
Dementia is caused when the brain is damaged by diseases, such as Alzheimers disease or a series of strokes. Alzheimers disease is the most common cause of dementia, but not the only one.
A person with dementia will experience symptoms depending on the parts of the brain that are damaged, and the disease that is causing the dementia.
Structural Signs Of Dementia
Structural imaging of the brain consists of computed tomography and the popularly known magnetic resonance imaging scans. This kind of imaging focuses on the morphology as well as the structural details of the brain’s composition. It is a very physical kind of scan, searching for solid, visible signs of degeneration or abnormalities.
Degenerative dementia causes a number of visible physical signs in the brain in some patients, but is not always easy to detect. CT scans can usually observe some atrophy of the brain’s medial temporal lobe, but the CT scans’ lack of sensitivity can occasionally be problematic. MRI scans, of much higher resolution, can capture atrophy of the hippocampus in nearly 90 percent of all cases of Alzheimer’s disease.
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Granulovacuolar Degeneration And Neuropil Threads
Granulovacuolar degeneration occurs almost exclusively in the hippocampus. Neuropil threads are an array of dystrophic neurites diffusely distributed in the cortical neuropil, more or less independently of plaques and tangles. This lesion suggests neuropil alterations beyond those merely due to NFTs and SPs and indicates an even more widespread insult to the cortical circuitry than that visualized by studying only plaques and tangles.
What Medications Treat Dementia Symptoms
Dementia treatment focuses on correcting all reversible factors and slowing irreversible factors. Some of the important drug treatment strategies in dementia are described. Except for the cholinesterase inhibitors, the U.S. Food and Drug Administration has not approved any drug specifically for dementia. The drugs listed here are some of the most frequently prescribed from each class.
Slowing the progression of dementia
Dementia due to some conditions, such as Alzheimer’s disease, can sometimes be slowed in the early-to-intermediate stages with medication. Many different types of medications have been or are being tried in dementia. The medications that have worked the best so far are the cholinesterase inhibitors.
Because depression is so common in people with dementia, treatment of depression can at least partially relieve symptoms.
- Depression is usually treated with any of a group of drugs known as antidepressants.
- The most important of these are the drugs known as selective serotonin reuptake inhibitors , for example, Fluoxetine , sertraline , paroxetine , citalopram .
- Stimulant drugs such as methylphenidate may sometimes be used to treat depression in people with dementia.
- Some of the medications that treat depression also help with anxiety.
Correcting drug doses and/or withdrawing misused drugs
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Change Your Diet And Don’t Panic
“If you have the ApoE 4 genotype, there are immediate steps you can take to side-step the activation of this gene,” Dr. Hirt explains. “First is your diet. Sugar, fat , and alcohol can activate this gene. The best diet for patients with the ApoE 4 gene is a Pritikin-like diet that is ultra low in fat, about 10-15% of your total calories, low in processed sugar , and alcoholic beverages. You ask: ‘I thought healthy fats and red wine were good for you and help French people live to 100?’ Well, healthy fats and modest alcohol consumption may be good for some people, but not everybodyand certainly not those with the ApoE 4 genotype.”
Its Not Necessarily Alzheimers
More than 50 conditions can cause or mimic the symptoms of dementia, and a small percentage of dementias are reversible. Two common examples are dementia caused by vitamin B12 deficiency or an underactive thyroid . Getting the right diagnosis is important so that you know what options you have, because symptoms subside when the underlying problem is treated.
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Causes Of Dementia With Lewy Bodies
Lewy bodies are tiny clumps of a protein called alpha-synuclein that can develop inside brain cells.
These clumps damage the way the cells work and communicate with each other, and the brain cells eventually die.
Dementia with Lewy bodies is closely related to Parkinson’s disease and often has some of the same symptoms, including difficulty with movement and a higher risk of falls.
Read more about dementia with Lewy bodies.
What Are The Early And Later Signs And Symptoms Of Dementia
Early signs of dementia may include:
- Simple forgetfulness
- Problems performing tasks or activities that were previously done without effort.
- Difficulty with learning new material is frequently one of the earliest signs of dementia.
Many patients with early Alzheimer’s disease or other types of dementia are unaware that they have any problem. As the disease progresses, behavioral changes can become evident.
- Patients have difficulty performing basic tasks, such as getting dressed or using the bathroom.
- Some patients begin to forget pieces of information about themselves, including their address or telephone number, or even their date of birth.
- They may have difficulty understanding what is occurring around them.
- Some patients have problems remembering to eat and may develop pronounced weight loss.
- In the late stages of dementia, patients often cannot recognize family members and their ability to communicate effectively is markedly impaired.
- They are no longer able to effectively care for themselves and require assistance for all activities of daily living.
- Over time, patients can forget how to walk or even how to sit up.
The stages of dementia are loosely grouped into mild, moderate, and severe categories by some doctors. However, there is another system of staging for dementia.
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Causes Of Alzheimer’s Disease
Alzheimer’s disease is the most common type of dementia.
Alzheimer’s disease is thought to be caused by the abnormal build-up of 2 proteins called amyloid and tau.
Deposits of amyloid, called plaques, build up around brain cells. Deposits of tau form “tangles” within brain cells.
Researchers do not fully understand how amyloid and tau are involved in the loss of brain cells, but research into this is continuing.
As brain cells become affected in Alzheimer’s, there’s also a decrease in chemical messengers involved in sending messages, or signals, between brain cells.
Levels of 1 neurotransmitter, acetylcholine, are particularly low in the brains of people with Alzheimer’s disease.
Medicines like donepezil increase levels of acetylcholine, and improve brain function and symptoms.
These treatments are not a cure for Alzheimer’s disease, but they do help improve symptoms.
Read more about treatments for dementia.
The symptoms that people develop depend on the areas of the brain that have been damaged by the disease.
The hippocampus is often affected early on in Alzheimer’s disease. This area of the brain is responsible for laying down new memories. That’s why memory problems are one of the earliest symptoms in Alzheimer’s.
Unusual forms of Alzheimer’s disease can start with problems with vision or with language.
Read more about Alzheimer’s disease.
Are Dementia Senility And Alzheimer’s Disease The Same Things
- Dementia occurs most commonly in elderly people it used to be called senility and/or senile dementia, and was considered a normal part of aging. Affected people were labeled as demented. The term “senile dementia” is infrequently used in the current medical literature and has been replaced by the term “dementia.”
- “Senile dementia,””senility,” and “demented” are older outdated terms that incorrectly label people with memory loss, confusion and other symptoms as a normal part of aging.
- Dementia, as defined above, is a constellation of ongoing symptoms that are not part of normal aging that have a large number of different causes, for example, Alzheimer’s disease is the major cause of dementia in individuals but it is only one of many problems that can cause dementia.
Symptoms of dementia vary considerably by the individual and the underlying cause of the dementia. Most people affected by dementia have some of these symptoms. The symptoms may be very obvious, or they may be very subtle and go unrecognized for some time. The first sign of dementia is usually loss of short-term memory. The person repeats what he just said or forgets where she put an object just a few minutes ago. Other symptoms and signs are as follows:
Early dementia symptoms and signs
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How Is Dementia Diagnosed
Confirming the diagnosis of dementia can be difficult due to the many diseases and conditions that cause it as well as because its symptoms are common to many other illnesses. However, doctors are able to make the diagnosis based on the results of personal medical history, review of current symptoms, neurological and cognitive tests, laboratory tests, imaging tests and by interacting with the patient.
Current general symptoms that would indicate dementia are, by definition, a decline in such mental functions as memory, thinking, reasoning, personality, mood or behavior that are severe enough to interfere with the ability to accomplish everyday tasks. Patients undergo mental function testing to identify problems in these areas. Interviews with family members and/or close friends who may have noticed changes in these areas are helpful as well.
Laboratory tests rule out other diseases and conditions as the cause of dementia, such as thyroid problems and vitamin B12 deficiency. Similarly, brain scans can look for signs of a stroke or tumor that may be the source of the dementia. A PET scan can determine if amyloid proteins are present in the brain, a marker for Alzheimers disease.
Oftentimes, neurologists and geriatricians assist in making the diagnosis.
Ps1 And Ps2 Mutations
Approximately 50-70% of early-onset autosomal-dominant AD cases appear to be associated with a locus mapped by genetic linkage to the long arm of chromosome 14 . Numerous missense mutations have been identified on a strong candidate gene, called PS1.
At the same time, another autosomal dominant locus responsible for early-onset AD was localized to chromosome 1. Two mutations were identified on the candidate gene, designated PS2. The physiological role of presenilins and the pathogenic effects of their mutations are not yet well understood.
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What Is The Treatment For Symptoms And Complications Of Dementia
Some symptoms and complications of dementia can be relieved by medical treatment, even if no treatment exists for the underlying cause of the dementia.
- Behavioral disorders may improve with individualized therapy aimed at identifying and changing specific problem behaviors.
- Mood swings and emotional outbursts may be treated with mood-stabilizing drugs.
- Agitation and psychosis may be treated with antipsychotic medication or, in some cases, anticonvulsants.
- Seizures usually require anticonvulsant medication.
- Sleeplessness can be treated by changing certain habits and, in some cases, by taking medication.
- Bacterial infections require treatment with antibiotics.
- Dehydration and malnutrition may be treated with rehydration and supplements or with behavioral therapies.
- Aspiration, pressure sores, and injuries can be prevented with appropriate care.
What Medications Are Available To Treat Dementia
Drugs approved for the most common form of dementia, Alzheimers disease, are discussed below. These drugs are also used to treat people with some of the other forms of dementia.
- cholinesterase inhibitors
- NMDA receptor antagonist memantine
These two classes of drugs affect different chemical processes in the brain. Both classes have been shown to provide some benefit in improving or stabilizing memory function in some patients. Although none of these drugs appear to stop the progression of the underlying disease, they may slow it down.
If other medical conditions are causing dementia or co-exist with dementia, the appropriate drugs used to treat those specific conditions are prescribed.
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Neurofibrillary Tangles And Senile Plaques
Plaques are dense, mostly insoluble deposits of protein and cellular material outside and around the neurons. Plaques are made of beta-amyloid , a protein fragment snipped from a larger protein called amyloid precursor protein . These fragments clump together and are mixed with other molecules, neurons, and non-nerve cells .
In AD, plaques develop in the hippocampus, a structure deep in the brain that helps to encode memories, and in other areas of the cerebral cortex that are used in thinking and making decisions. Plaques may begin to develop as early as the fifth decade of life. Whether Ab plaques themselves cause AD or whether they are a by-product of the AD process is still unknown. It is known that changes in APP structure can cause a rare, inherited form of AD.
Tangles are insoluble twisted fibers that build up inside the nerve cell. Although many older people develop some plaques and tangles, the brains of people with AD have them to a greater extent, especially in certain regions of the brain that are important in memory. There are likely to be significant age-related differences in the extent to which the presence of plaques and tangles are indicative of the presence of dementia.
SPs also accumulate primarily in association cortices and in the hippocampus. Plaques and tangles have relatively discrete and stereotypical patterns of laminar distribution in the cerebral cortex, which indicate predominant involvement of corticocortical connections.
Research Into The Cause Of Alzheimers Disease
The role of plaques and tangles in Alzheimers disease
The biological causes of Alzheimer’s disease are not fully understood and research continues to examine factors involved in the development of Alzheimer’s disease.
The two most common hallmarks of Alzheimer’s disease in the brain are beta-amyloid plaques and neurofibrillary tangles. The role of plaques and tangles in Alzheimer’s disease is not fully understood. Both are present in the brains of older people who do not have Alzheimer’s disease, although they are more widespread and predominant in the brains of people with Alzheimer’s disease. Research is ongoing to determine more about the role of both plaques and tangles in the development of Alzheimer’s disease.
In Alzheimer’s disease, sticky beta-amyloid fragments clump together and form the basis of plaques. Recent research suggests that smaller clumps of beta-amyloid known as oligomers may actually be more toxic than the plaques. Researchers continue to study many aspects of beta-amyloid to establish its role in Alzheimer’s disease, including the mechanisms of plaque formation, and how plaques might be removed from the brain.
The genetics of Alzheimer’s disease
Comprehensive information about the research into the genetics of Alzheimers disease is available at the AlzGene website.
Genes that cause Alzheimers disease
Genetic risk factors for Alzheimers disease
The role of inflammation in Alzheimers disease
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Disproportionate Impact On Women
Globally, dementia has a disproportionate impact on women. Sixty-five percent of total deaths due to dementia are women, and disability-adjusted life years due to dementia are roughly 60% higher in women than in men. Additionally, women provide the majority of informal care for people living with dementia, accounting for 70% of carer hours.
Are There Medicines To Treat Dementia
There is no cure for dementia yet, but there are medicines that can help treat some of the symptoms of dementia. There are medications that may improve memory for a period of time. There are also medications that are effective for treating mood disorders, such as anxiety and depression, which commonly occur in people with dementia. It is also important that your provider carefully evaluates any medicine someone with dementia is taking, because some medications may make memory symptoms worse.
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Research Into The Cause Of Dementia With Lewy Bodies
Dementia with Lewy bodies is characterised by the presence of abnormal spherical structures, called Lewy bodies, which develop inside nerve cells in the brain. Lewy bodies are accumulations of a protein called alpha-synuclein. It is thought that these contribute to the degeneration and death of nerve cells.
Dementia with Lewy bodies sometimes co-occurs with Alzheimers disease and/or vascular dementia. It may also be hard to distinguish dementia with Lewy bodies from Parkinsons disease, which is also associated with Lewy bodies, and some people who have Parkinsons disease develop a similar dementia.
At present there is no known cause of dementia with Lewy bodies and no risk factors have been identified. In very rare cases, the disease appears to be inherited, but a genetic cause has not yet been found. In short, we do not know why Lewy bodies form in the brain and research continues in the attempt to find an answer. Much of this research is focussed on searching for the genetic roots of dementia with Lewy bodies, exploring the mechanisms of alpha-synuclein accumulation, and discovering how Lewy bodies cause the particular symptoms of dementia with Lewy bodies.
Frontotemporal Dementia With Parkinsonism
One form of familial FTD, also known as frontotemporal dementia with Parkinsonism-17 , is caused by genetic changes in the gene for tau protein, located on chromosome 17. No other risk factors for this condition are known.
FTDP-17 is rare and accounts for only three per cent of all cases of dementia. Symptoms progressively get worse over time and usually appear between the ages of 40 and 60. The condition affects both thinking and behavioural skills and movements such as rigidity, lack of facial expression and problems with balance .
It can be distressing to be told that you have a genetic disorder or are at risk of having one. Genetic counselling provides the person and their family with information about a genetic disorder and its likely impact on their lives. This can assist a person with FTDP-17 to make informed medical and personal decisions about how to manage their condition and the challenges it presents to their health and wellbeing. Prenatal genetic counselling is also available for parents to help them decide about a pregnancy that may be at risk of FTDP-17.
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