What is Dementia? What Causes Dementia? Symptoms of Dementia

The word dementia comes from the Latin de meaning "apart" and mens from the genitive mentis meaning "mind". Dementia is the progressive deterioration in cognitive function - the ability to process thought (intelligence). Progressive means the symptoms will gradually get worse. The deterioration is more than might be expected from normal aging and is due to damage or disease. Damage could be due to a stroke, while an example of a disease might be Alzheimer's.
Dementia is a set of signs and symptoms
Dementia is a non-specific syndrome in which affected areas of brain function may be affected, such as memory, language, problem solving and attention. Dementia, unlike Alzheimer's, is not a disease in itself. When dementia appears the higher mental functions of the patient are involved initially. Eventually, in the later stages, the person may not know what day of the week, month or year it is, he may not know where he is, and might not be able to identify the people around him.

Dementia is significantly more common among elderly people. However, it can affect adults of any age.
What are the symptoms of dementia?

* Memory loss - the patient may forget his way back home from the shops. He may forget names and places. He may find it hard to remember what happened earlier on during the day.

* Moodiness - the patient may become more and more moody as parts of the brain that control emotion become damaged. Moods may also be affected by fear and anxiety - the patient is frightened about what is happening to him.

* Communicative difficulties - the affected person finds it harder to talk read and/or write.

As the dementia progresses, the patient's ability to carry out everyday tasks diminishes and he may not be able to look after himself.
Diseases that cause dementia

brain neurones
* Alzheimer's disease - This is by far the most common cause of dementia. The chemistry and structure of the brain of a person with Alzheimer's disease changes and his brain cells die prematurely.

* Stroke (Vascular problems) - this means problems with blood vessels (veins and arteries). Our brain needs a good supply of oxygen-rich blood. If this supply is undermined in any way our brain cells could die - causing symptoms of vascular dementia. Symptoms may appear suddenly, or gradually. A major stroke will cause symptoms to appear suddenly while a series of mini strokes will not.

* Dementia with Lewy bodies - spherical structures develop inside nerve cells. Brain cells are nerve cells; they form part of our nervous system. These spherical structures in the brain damage brain tissue. The patient's memory, concentration and ability to speak are affected. Dementia with Lewy bodies is sometimes mistaken for Parkinson's disease because the symptoms are fairly similar.

* Fronto-temporal dementia - this includes Pick's disease. The front part of the brain is damaged. The patient's behavior and personality are affected first, later his memory changes.

* Other diseases - progressive supranuclear palsy, Korsakoff's syndrome, Binswanger's disease, HIV and AIDS, and Creutzfeldt-Jakob disease (CJD). Dementia is also more common among patients who suffer from Parkinson's disease, Huntington's disease, Motor Neurone disease and Multiple Sclerosis. People who suffer from AIDS sometimes go on to develop cognitive impairment.

There are two main categories of dementia
According to most experts, there are two main categories of dementia - cortical and subcortical dementias.

* Cortical Dementia - The cerebral cortex is affected. This is the outer layer of the brain. The cerebral cortex is vital for cognitive processes, such as language and memory. Alzheimer's disease is a form of cortical dementia, as is CJD (Creutzfeldt-Jakob disease).

* Subcortical Dementia - A part of the brain beneath the cortex (deeper inside) becomes affected or damaged. Language and memory are not usually affected. A patient with subcortical dementia will usually experience changes in his personality, his thinking may slow down, and his attention span may be shortened. Dementias which sometimes result from Parkinson's disease are subcortical dementias, as are those caused by AIDS and Huntington's disease.

A patient with multi-infarct dementia will have both the cortical and subcortical parts of the brain affected or damaged.
Diagnosis of dementia
Although there are some brief tests, a more reliable diagnosis needs to be carried out by a specialist, such as a geriatric internist, geriatric psychiatrist, neurologist, neuropsychologist or geropsychologist.

The following tests are commonly used:

* AMTS (Abbreviated Mental Test Score) A score lower than six out of ten suggests a need for further evaluation.
* MMSE (Mini Mental State Examination) A score lower than twenty-four out of thirty suggests a need for further evaluation)
* 3MS (Modified Mini-Mental State Examination)
* CASI (Cognitive Abilities Screening Instrument)

It is important that the patient's score is interpreted in context with his socio-economic, educational and cultural background. The tester must also factor in the patient's present physical and mental state - does the patient suffer from depression, is he in great pain?

What is the treatment for dementia?
In the majority of cases dementia is incurable. Researchers are making inroads into treatments that may slow down dementia's progress. Cholinestaerase inhibitors are frequently administered during the early stages. Cognitive and behavioral therapies may also be useful. Several studies have found that music therapy helps patients with dementia. It is important to remember that the patient's caregiver also needs training and emotional support.

In the USA, Tacrine (Cognex), donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon) have been approved for the treatment of dementia caused by Alzheimer's disease - some physicians prescribe these drugs for vascular dementia as well. Selegiline, which is used for treating Parkinson's disease, has been found to slow down the progress of dementia.

In Canada, a country where two languages are spoken, English and French, researchers found that bilingual people who develop dementia do so four years later than monolingual people who develop dementia. The four year difference prevails even after factoring for such variables as cultural differences, education, employment, gender and immigration.
How common is dementia?

* United Kingdom - According to a report by the Alzheimer's Society (UK), approximately 700,000 people in the United Kingdom have dementia, out of a total population of about 61 million. Your chances of having dementia are 1 in 100 during your late 60s, this rises to 6 in 100 in your late 70s, and 20 in 100 in your late 80s. As people live longer experts predict dementia will rise significantly. According to predictions, there will be 940,000 people with dementia in the United Kingdom by 2021.

* Worldwide - According to a study published in The Lancet, approximately 24.3 million people had dementia worldwide in 2005, with 4.6 new cases every year. The number of people with dementia will double every two decades and reach 81.1 million by 2040. The rate of increase is expected to be faster in developing countries which have rapidly-growing life expectancies. (Lancet. 2005 Dec 17;366(9503):2112-7)

Sources - The Alzheimer's Society (UK), NIH, Wikipedia, The Lancet

UK Conductor And HIs Wife End Their Own Lives At Swiss Assisted Suicide Clinic

A well known UK orchestra conductor Sir Edward Thomas Downes, CBE, and his wife Lady Joan Downes have died after choosing to end their lives together at the Swiss assisted suicide clinic Dignitas.

Sir Edward who was 85 and suffering from a terminal illness, and his wife Joan who was 74 "died peacefully, and under circumstances of their own choosing" according to a statement issued by their family and reported by the BBC earlier today.

Their family said that the couple decided to end their lives together as they did not wish to struggle with health problems.

According to a statement issued by their son and daughter, Caractacus and Boudicca, who announced the death of their parents with "great sadness", the couple died on Friday 10 July, reported the Daily Telegraph.

Lady Joan was thought to have been suffering with cancer and Sir Edward was nearly blind and had lost much of his hearing.

The statement from the family said that the couple had been together for "54 happy years".

Sir Edward had led a vigorous, long and distinguished career as a conductor, including a 40-year association with the BBC Philharmonic Orchestra; and before becoming her husband's personal assistant, Lady Joan had been a ballet dancer, a choreographer and a TV producer.

"They both lived life to the full and considered themselves to be extremely lucky to have lived such rewarding lives, both professionally and personally," said the statement.

A spokesman for the Metropolitan Police said their deaths were being investigated but there were no further details at this stage.

Sir Edward was born in Birmingham in 1924 and started playing the violin when he was 5 years old. Later on he won a scholarship to Aberdeen and then studied with the eminent German conductor Hermann Scherchen.

In the decades that followed he became Associate Music Director of the Royal Opera, and conducted over 50 seasons at Covent Garden.

He was Chief Guest Conductor at the BBC Philharmonic, and served as Principal Conductor from 1980 to 1991 and later became Conductor Emeritus.

Sir Edward, who became CBE in 1986 and was knighted in 1991, also held other positions with world famous orchestras in Australia and The Netherlands, and was showered with honours from several music colleges, universities, and other organizations, and won many awards, including the Laurence Olivier award.

The Swiss right-to-die organisation Dignitas that helped Sir Edward and Lady Joan end their lives has been in the news in the UK quite a lot recently.

More than 100 people from the UK have chosen to end their lives there, most of them because they were terminally ill.

In an interview on BBC Radio 4 in January this year, the founder and current leader of the clinic, lawyer-trained Ludwig Minelli defended helping Britons, including some psychiatric patients, to kill themselves.

He said that failed attempts to commit suicide were a huge cost for the NHS.

"I have a totally different attitude to suicide. I say suicide is a marvellous marvellous possibility given to a human being," said Minelli, who has since complained that many people took his phrase " I say suicide is a marvellous marvellous possibility" out of context.

On the Dignitas website is a defence of this statement that points out Minelli meant in the context of what he said next in the interview:

"Suicide is a very good possibility to escape a situation which you can't alter."

Another reason Dignitas has been in the news is because a former worker has been talking to the media about why she left the organisation and why she is campaigning to have it shut down.

In an interview with the Daily Mail in January, 51-year old nurse Soraya Wernli, who worked at Dignitas for two and a half years, accused the organisation of being more concerned with making money than about ethical euthanasia.

Wernli has issued lawsuits against Minelli, and for the last 8 months of her employ she worked as an undercover informant for the police, who according to the news report are also concerned about Minelli.

Wernli is writing a book titled The Business With The Deadly Cocktails where she promises to give details of how Dignitas was a "principled and necessary organisation gone bad", she told the Daily Mail.

She said one of the things that worried her was the speed with which people arrived, were quickly seen by Minelli, and then helped to die.

"People land at the airport, are ferried to his office, have their requisite half-an-hour with a doctor, get the barbiturates they need and are then sent off to die," she told the paper.

"This is the biggest step anyone will ever take. They should at least be allowed to stay overnight, to think about what they are doing," said Wernli.

There has also been criticism of the way that Dignitas helped a British 23-year old rugby player, Daniel James, to commit suicide last year after he was paralysed while playing rugby.

Marjorie Wallace, chief executive of mental health charity SANE told the BBC that Minelli was offering:

"A seductive but dangerous solution to the feelings of anguish and hopelessness experienced by some people with mental illness."

Instead of a "one-way ticket to despair and unnecessary death", people should have more options, such as greater access to effective treatment, she added.

H1N1 Pandemic Flu Virus More Virulent Than Previously Thought

Researchers from the US and Japan studying the new H1N1 pandemic flu virus suggest that it is more virulent than previously thought. They found the virus seizes hold in cells deep inside the lungs, leading to pneumonia and in more severe cases, death, whereas seasonal flu viruses only infect cells in the upper respiratory tract.

University of Wisconsin-Madison virologist and leading authority on influenza, Dr Yoshihiro Kawaoka led the international team of researchers in a detailed investigation of the pandemic H1N1 virus and its pathogenic properties and wrote about their findings in a fast-track report published online on 13 July in the journal Nature.

The researchers wrote that the spread of the new strain of influenza A virus that the World Health Organization declared a global pandemic on 11 June is probably due to the fact there are many humans with little or no pre-existing immunity.

Kawaoka, a professor of pathobiological sciences at the UW-Madison School of Veterinary Medicine and a professor at the University of Tokyo, said this virus was misunderstood in that many people were under the impression it was like seasonal influenza, but this study shows that is not the case:

"There is clear evidence the virus is different than seasonal influenza," said Kawaoka.

The ability to infect deep inside the lungs is similar to that of other pandemic viruses, including the 1918 strain that killed tens of millions of people around the world, said the researchers.

It also bears other similarities to the 1918 strain in that people born before 1918 have antibodies that protect against today's pandemic strain.

Kawaoka said it is also possible that the virus could evolve new properties.

For the study, the researchers infected mice, ferrets and non-human primates with pandemic H1N1 and seasonal flu from samples obtained from human patients in California, Wisconsin, the Netherlands and Japan.

They found that the pandemic flu strain replicated much more efficiently in the respiratory system than the seasonal flu. It also caused severe lesions in the lungs, closely resembling the damage caused by other pandemic strains.

Kawaoke said:

"The H1N1 virus replicates significantly better in the lungs."

Also, using specific-pathogen-free miniature pigs, the researchers found that the virus spread in pigs without showing any clinical symptoms.

The team were also able to assess the immune response of different people to the new virus. They found that those who had been exposed to the 1918 strain (all now in advanced old age) had antibodies that neutralized the novel pandemic H1N1 virus.

"The people who have high antibody titers are the people born before 1918," said Kawaoke.

But, although the discovery that the new H1N1 strain is potentially more dangerous than previously reported is a matter for concern, Kawaoke said the good thing was that it does respond to existing and experimental antivirals and these provide a potentially effective first line of defence against the virus.

From a public health point of view, a first line of defence is important because it slows down the spread of a virus for a few months while a vaccine is being mass produced.

There are three approved antivirals on the market and the team tested two of them and also two experimental ones that are not yet approved. They tested the drugs on mice and found that:

"The existing and experimental drugs work well in animal models, suggesting they will work in humans," said Kawaoka.

The research was sponsored by the U.S. National Institutes of Health, and the Japanese Ministry of Education, Culture, Sports, Science and Technology.