dementia

Dementia is a broad category of brain diseases that cause a long-term and often gradual decrease in the ability to think and remember that is severe enough to affect daily functioning.[2] Other common symptoms include emotional problems, difficulties with language, and a decrease in motivation.[2][3] Consciousness is usually not affected.[11] A diagnosis of dementia requires a change from a person’s usual mental functioning and a greater decline than one would expect due to aging.[2][12] These diseases have a significant effect on caregivers.[2]

The most common type of dementia is Alzheimer’s disease, which makes up 50% to 70% of cases.[2][3] Other common types include vascular dementia (25%), dementia with Lewy bodies (15%), and frontotemporal dementia.[2][3] Less common causes include normal pressure hydrocephalusParkinson’s disease dementiasyphilisHIV, and Creutzfeldt–Jakob disease.[13] More than one type of dementia may exist in the same person.[2] A small proportion of cases run in families.[14] In the DSM-5, dementia was reclassified as a neurocognitive disorder, with degrees of severity.[15] Diagnosis is usually based on history of the illness and cognitive testing with medical imaging and blood tests used to rule out other possible causes.[4] The mini mental state examination is one commonly used cognitive test.[3] Efforts to prevent dementia include trying to decrease risk factors such as high blood pressuresmokingdiabetes, and obesity.[2] Screening the general population for the disorder is not recommended.[16]

There is no known cure for dementia.[2] Cholinesterase inhibitors such as donepezil are often used and may be beneficial in mild to moderate disorder.[7][17][18] Overall benefit, however, may be minor.[7][8] There are many measures that can improve the quality of life of people with dementia and their caregivers.[2] Cognitive and behavioral interventions may be appropriate.[2] Educating and providing emotional support to the caregiver is important.[2] Exercise programs may be beneficial with respect to activities of daily living and potentially improve outcomes.[19] Treatment of behavioral problems with antipsychotics is common but not usually recommended, due to the limited benefit and the side effects, including an increased risk of death.[20][21]

Globally, dementia affected about 46 million people in 2015.[9] About 10% of people develop the disorder at some point in their lives.[14] It becomes more common with age.[22] About 3% of people between the ages of 65–74 have dementia, 19% between 75 and 84, and nearly half of those over 85 years of age.[23] In 2013 dementia resulted in about 1.7 million deaths, up from 0.8 million in 1990.[24] As more people are living longer, dementia is becoming more common.[22] For people of a specific age, however, it may be becoming less frequent, at least in the developed world, due to a decrease in risk factors.[22] It is one of the most common causes of disability among the old.[3] It is believed to result in economic costs of US$604 billion a year.[2] People with dementia are often physically or chemically restrained to a greater degree than necessary, raising issues of human rights.[2] Social stigma against those affected is common.[3]

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