Showing posts with label Alzheimer. Show all posts
Showing posts with label Alzheimer. Show all posts

Thursday, October 21, 2010

Family Caregiving

By : Lamiaa Moustafa Elbosaty


There are only four kinds of people in the world, those who have been caregivers, those who currently are caregivers, those who will be caregivers, and those who will need caregivers. The family has remained the strongest and the only supportive and long-term care institution for demented persons in most of developing countries (Prince, 2004).
          Family members or others caring for a person with dementia have an extremely difficult and stressful job, which become harder as the disease prognosis. Dementia caregivers spend significantly more time on caregiving than do people proving care for those with other type of illnesses. These types of caregiving also had a greater impact in terms of employment complications, caregiver strain, mental and physical health problems, time for leisure, and family conflict then do other types of caregiving. It's common for dementia caregivers to develop feelings of anger, resentment, guilt, and hopelessness, in addition to the sorrow they feel for their loved one and for themselves.
Depression an extremely common consequence of being a full time caregiver for a person with dementia (Nauert, 2006).
          It's estimated that more than 7 of 10 people with Alzheimer's live at home. Almost 75% of home care is provided by family and friends. Mostly, given with love and it is usually the best form of care. The remainder is paid care, costing upward of $12.5 billion per year, most of which is covered by families (Alzheimer Disease and Related Disorders Association, 2001).
          The average family caregivers provide 18 hours of care per week; 20% provide "constant care" or 40 hours a week. Ninety-two percent of elders are related to their working caregivers, and two – thirds of caregivers work full or part time, over half make adjustments in their work schedules, e.g., coming in late, taking time off, dropping back to part time or quitting. The average out-of-pocket expense for a family caregiver is $171 per month. Total un-reimbursed monthly expenses for family caregivers in $1.5 billion. Family caregivers account for and estimated $ 257 billion annually in services, if they were paid (Wart, 2005) .
          Caregivers provide many kinds of help; house cleaning, letter writing, financial management, grocery shopping, bathing, feeding, transportation, dressing, help with walking and much more (Musolf, 2004). Family caregivers provide services to elderly relatives in the home, usually without the benefit of formal training, and they usually don't have choice about assuming care, since the costs for their family person's care often too high for the financial resources available. The numbers of people surviving into their 80s and 90s are expected to grow because of advances in medicine, medical technology, social and environmental conditions. Since the incidence and prevalence of Alzheimer's disease and dementia increases with age, the number of people with these conditions will also grow rapidly (Leahy, 2005).
        Nearly one out of every four US household (23%) is involved in care- giving to persons aged 50 and over-one-quarter of the adult population worldwide help care for family members or friends. While, one in three family caregivers cares for two or more persons. Approximately 64% of caregivers of elderly are employed; they spend an average of 18 to 40 hours per month care giving. The need for health care workers will be tripled by 2050 (Thiemen, 2006).

Friday, October 15, 2010

Community services can be divided into two groups which are:

 By : Lamiaa Moustafa Elbosaty


   A: Types of Services provided:
           1- Adult Day Centers: They provide a place for individuals to socialize, exercise, and interact with others, they are generally geared to older adults and offer programs that are designed to promote services often tailored for individuals with cognitive impairments who might be in need of a safe place to be supervised or assisted in their activities of daily living. It provides a variety of mental, physical, and emotional services which benefit both the individual and their families. It offers transportation to and from their center, it also provides nutrition meals and snacks and can accommodate particular diets (e.g. diabetes). Adult day centers employ trained staff and volunteers who are able to assist with numerous aspects of daily living. (e.g., toileting, help with eating /drinking, assistance with walking) (Rose et al., 2000).        
2- Adult Day Service: Users reported greater decrease in hours spent on behavior problems when compared to non users, even after controlling for baseline differences between two groups. They also reported decrease frequency of behavior problems in their relatives who attended adult day programs. Adult day services are effective in restructuring caregiving time and may offer potential benefits not only to family caregivers but also to community-residing older adult who have dementia well (Gauglar et al, 2003).
         3- Special Geriatric Clinics: The goal of these clinics has been to offer coordinated medical and social services to the population of independent, working elderly to aid them in retaining their independence. In addition, they provide important diagnostic services to the elderly (Abido, 2000).
4 - Nursing Homes: There are many forms of these homes, however they could be roughly grouped into three categories. The first type is called the skilled nursing care home, in which residents receive a level of nursing care that requires professional nursing supervision. The second type could be called the personal care with nursing home, in which there may be substantial numbers of residents who require minimal or intermittent nursing and personal care assistance. The last type of homes is the residential homes, which the residents may need assistance with daily living activities but don't require nursing care (Abido, 2000).
       5- Support Groups: Families caring for patients often find it helpful to share their experiences and thoughts in a group setting. Support groups provide an opportunity for family person to come together with others in similar situation. Strategies on providing care can be exchanged in a group, problems can be discussed, feelings can be aired and medical information or research on dementia can be discussed. More recently, support groups are also being offered for patients in the early stages of the illness (Haley, 2001).
The support groups are groups of people who have lived through the same difficult experiences and want to help themselves and others by sharing coping strategies. Mental health professionals strongly recommend that family caregivers take part in support groups (Rodring & Nestor, 2007).
There are several types of support groups such as the Alzheimer's association support groups which provide information about care receiver management, share coping strategies and provide support in discussion group with others caregivers. This type of support group may be more important to caregivers who are concerned about the future of their relatives who are in the later stage of Alzheimer's disease (Parks & Novielli, 2000).
In Egypt, Alzheimer's association address is Center for Psychiatric Hospitals, Ain Shams University - Cairo, Tel. +0223920074. Unfortunately, there are no institutions or qualified for care of those patients, which make up the psychological and physical burden on their families a great. Furthermore, there are a number of cases without detection, especially in the non-educated group of society and they will be having lack of patience and neglect for the treatment of their condition and requirement (Abyad et al., 2001).
Alternatively, educational support groups are self-limited and provide information to assist caregivers. This groups provide information about Alzheimer's disease; patient care; legal and financial resources; and available community services. Caregivers who have relatives in the early stages of Alzheimer's disease may be more in join to favor educational group rather than Alzheimer's association support group. Finally, stress management support group helps caregivers identify stresses, and develop strategies to cope with stresses of care giving. Nevertheless, caregivers in a stress management support group were shown to have used more effective coping skills at home, but have not reported reduced stress (Smyer & Qualls, 1999).
6- Home Care: It refers to health care and social services provided to individuals in their homes or in community and home like settings. Home care may include nursing rehabilitation, social work, home health, home care can unable elders to remain in their own homes for as long as possible, relieve the burden on hospitals and improve the quality of life for the elder and the caregiver. As well, home visiting nursing services can be used to good advantages especially when only part-time nursing care is needed such as physical therapy, home delivered meals and assistance in rending care (Jamieson, 2002)
7- Receipt Care Facilities: Provide overnight, weekend, and long stays for someone with Alzheimer's or related dementia, so a caregiver can have longer periods of time off. These facilities provide meals, help with activities of daily living, therapeutic activities to fit the need of residents, and a safe, supervised environment. Examples of such facilities include nursing homes, and residential care facilities (Lawton et al., 2001).
8- Emergency Respite: Is often offered in many nursing homes, residential care facilities, and assessed living facilities. It may be needed when a caregiver becomes ill or must go out of town unexpected by or if the care recipient is at risk of abuse or neglection (Rodring & Nestor, 2007).
9- Other services:
§        Transportation services  
§        Social security services and protective services
§        Short-stay residential accommodation so that the caregiver of an elderly may go away on a holiday.
§        Leisure –time activities (recreational and educational programs).
§        Communication services "phones, emergency access to health care".
§        Visual services, out –patient clinic and dental care services.
§        Dietary guidance and food services
§        Exercise and fitness programs
§        Financial aid, counseling and social assistance services
Home repair and pest control(Lund & Wright, 2001).

Tuesday, October 12, 2010

Prognosis

By : Lamiaa Moustafa Elbosaty


Irreversible dementia is difficult to diagnose, especially in the early stages. Once diagnosed, patients must undergo a complete medical and neurological workup, because 10 to 15 percent of all patients have a potentially reversible condition if treatment is initiated before permanent brain damage occurs and therefore inevitably have a poor prognosis (Sadock & Sadock, 2005).

The time from diagnosis to death in Alzheimer's disease is usually estimated to be 8 to 10 years, and the morbidity and mortality of vascular dementia may by worse than Alzheimer's disease, presumably because of risk of further cerebrovascular events, as well as other atherosclerotic disease. The 5– year's survival rate is 40 percent for patients with vascular dementia (Wancata et al., 2003). In general, irreversible dementias have an insidious onset and are gradually declined, followed by a more rapid progression. The most frequent cause of death is pneumonia, and other infections, with malnutrition and dehydration as contributing factors (Gelder & Harrison, 2006).

Saturday, October 9, 2010

Severe Alzheimer's Disease

By : Lamiaa Moustafa Elbosaty


At this stage of Alzheimer's disease only fragments of memory remain. There may be emotional recognition of family, but names and relationships identification are lost. There is orientation to self only. Language is limited to short phrases and repeated words, and only simple spoken language is understood. The individual may eventually become mute and unable to communicate. There is complete dependence on others for all care, behavior manifestation disappear, although vocalization (screaming, cursing, or crying) may continue at this stage (Cotter, 2002).
Neurological changes may include Parkinsonism (slow, shuffling gait, falls, rigidity, and brady kinesis), occurrence of generalized tonic–colonic seizures, and myoclonus, weight loss, dysphagia, increased sleeping, fecal and urinary incontinence. At the end, the individual spends most of time in bed. Death is frequently attributed to complications associated with chronic debilitation, aspiration pneumonia, sepsis, urinary tract infection, pulmonary embolus or inanition (NIH, 2003).

Friday, October 8, 2010

Mild Alzheimer's Disease

By : Lamiaa Moustafa Elbosaty



          The individual with mild Alzheimer's disease continues to look and act normally to others, and only close family or friends may note any change. There is moderate memory loss, more marked for recent events that interfere with every day activities. The individual has difficulty learning and retaining new information. In addition, there may be disorientation in familiar places, difficulty handling complex financial transactions (paying bills, balancing a check book), and poor problem solving (Reisberg, et al., 2003).
The individual is independent in completing usual activities of daily livings (ADLs) but may need prompting to complete tasks. The ability to participate in complex home repairs and hobbies is reduced. The individual may experience personality changes of withdrawal from usual social activities because of fear of others detecting changes, lack of confidence in function, or lack of interest in his/her usual activities (Linton & Lach, 2007).
·        Moderate Alzheimer's Disease:
In moderate Alzheimer's disease, memory loss is sever and only highly learned material or established memory is retained, while new material is lost rapidly. As the damage of Alzheimer's disease spreads in cerebral cortex, language, reasoning, sensory processing, and conscious thought are impaired. The individual may be confused about the identity and relationships of relatives. The individual becomes increasingly dependent on the others and assistance is needed to carry out ADLs (Monias & Meier, 2003).
The individual may get lost in familiar settings, language changes are revealed as incomplete sentences and poor comprehension of written and spoken language. At this stage of Alzheimer's disease, disruptive behavioral changes often emerge. Agitation, restlessness (including wandering), sleep disturbances, day-night disorientation, verbal or physical aggression, suspiciousness, and hallucinations are common behaviors manifested (ADRDA, 2004).
The individual has decreased tolerance for stress and can't reliably interpret the environment. Disinhibition, socially in appropriate behaviors, and saying or doing things not usually said or done in public occur at this stage. Also there are weight loss, and dehydration which require careful monitoring (Monias & Meier, 2003).

Thursday, October 7, 2010

Clinical features

By : Lamiaa Moustafa Elbosaty


Alzheimer's disease is classified according to the stage of the degenerative process. The number of stages defined ranges from three to seven, depending on the source. However, four stages, as discussed subsequently, are commonly to categorize the progressive deterioration seen in those diagnosed with Alzheimer's disease (Varcarolis, 2006).
· Very Mild Alzheimer's Disease: At this stage, cognitive changes is subtle, typically this stage of the disease is only detected by dementia specialists because of the very mild nature of the changes. Individuals may dismiss these very mild changes as normal aging (National Institute on Aging, 2007).
Memory is consistently impaired, and details of recent events are only partially recalled. Although the individual may be fully oriented, there may be difficulty with time relationships, knowing when events happen in relation to one another. The family/individual may note slight impairment in community activities or slight change in interest or participation in hobbies. Complex tasks take longer and errors are evident. The working individual may continue to work but will require support to function at the same level or will assume decreased responsibility (Galvin et al., 2005).
Personality changes such as lack of spontaneity and initiative, loss of a previously sharp sense of humor, lack of energy and enthusiasm, or decreased interest in work, family may be noted at this stage. Anxiety and depression are not uncommon at this stage and should be treated. The duration of the disease from onset to death a mostly average 8 to 10 years, but can range from 3 to 10 years (Duchek et al., 2003).

Wednesday, October 6, 2010

Ten Warning Signs of Alzheimer's Disease

By : Lamiaa Moustafa Elbosaty

Ten Warning Signs of Alzheimer's Disease:
Alzheimer's Association (2008) provides this warning signs of Alzheimer's disease to allow early detection of the patients, it includes the following:
1- Recent memory loss:  It's normally to occasionally forget an assignment, deadline, or friends' name, but frequent forgetfulness, our unexplainable confusion at home or in the work place may signal problems.
2- Difficulty performing familiar tasks: Busy people frequently get distracted, for example, you might leave something on the stove too long or not remember to serve part of a meal. People with Alzheimer's disease might prepare a meal and not only forget to serve it, but forget they made it.
3- Problems with language: Everyone has trouble finding the right word sometimes, but person with Alzheimer's may forget simple words or substitute inappropriate words, making his or her sentences difficult to  understand.      
4- Disorientation of time and place: It's normal to momentarily forget the day of the week or what you need from the stove. But people with Alzheimer's disease can become lost on their own street, not knowing where they are, how they get there or how to get home.
5- Poor or decreased judgment: Choosing not to bring a sweater or coat along on a chilly night is a common mistake. A person with Alzheimer's, however, may dress inappropriately in more noticeable ways, wearing a bathrobe to the stove or several blouses on a hot day.
6- Problems with abstract thinking: Balancing a check book can be challenging for many people, but for someone with Alzheimer's, recognizing numbers or performing basic calculations may be impossible.
7- Misplacing things: Everyone temporarily misplaces a wallet or keys from time to time. A person with Alzheimer's disease may put these and other items in inappropriate place – such as an iron in the freezer, or a wrist watch in the sugar bowl, then not recall how they got there.
8- Changes in mode or behavior: Everyone experiences a broad range of emotions, it is part of being human. People with Alzheimer's tend to exhibit more rapid mood swings for no apparent reason.
9- Changes in personality: People personalities may change somewhat as they age. But a person with Alzheimer's can change dramatically, either suddenly or over a period of time. Someone who is generally easy going may become angry, suspicious or fearful.
10- Loss of initiative: It's normal to tire of house work, business activities, or social obligations, but most people retain eventually regain their interest. The person with Alzheimer's may remain disinterested and uninvolved in many or all her/his usual pursuits.

Tuesday, October 5, 2010

Alzheimer's Disease

By : Lamiaa Moustafa Elbosaty


Alzheimer's Disease : Is the most common cause of dementia in older adults, representing 60% to 80% of dementias. Subtypes of Alzheimer's disease are defined by age of onset; early onset Alzheimer's disease is used to define onset in age 65 or under, late onset Alzheimer's disease for onset after age 65. The late onset Alzheimer's disease is much more common than early onset Alzheimer's disease, but the early onset Alzheimer's disease has a more rapid progression" (NIH, 2004). The female to male ratio is approximately 2 to 1. It will become a greater public health problem as the society continues to grow (Sadock and Sadock, 2005).
Alzheimer's disease is a degenerative, progressive neuropsychiatric disorder that results in cognitive impairment, emotional and behavioral changes, physical and functional decline, and ultimately death. This disease robs its victims of every thing learning in life, so that they are unable to fall back on preserved intelligence (Boyd, 2005).
A simple way to describe the difference between normal forget- fullness of aging and Alzheimer's disease is seen in the behavior described below: With advancing age or with increased stress, an individual may say "where are my keys? Where I did place them? I can't find them anywhere?" After several stressful moments, the keys are usually found and events are over. However, if a person with Alzheimer's disease is handed a set of keys, he or she looks at them blankly, handles them awkwardly, and has no idea about what they are for or what to do with them (Allender, 2001).
Onset is gradual, and verbal memory is often affected first. Alzheimer's disease loses judgment and reasoning and safety becomes an issue early in the disease process. Victims of Alzheimer's disease may wander away from home and can't tell anyone exactly where they live, or they may forget that a stove can get hot and burn themselves while trying to cook. They neglect their health and are even unaware of whether they are experiencing major health problems (Mace & Rabins, 2001).
The client demonstrates depression, agitation, sleeplessness, and anxiety which upset the family normal routine. The motor activity increases in the evening (sundowning), aggression is common, both verbal and physical often takes the form of resistance to help with personal care. Serious physical violence to others is rare. Mood changes are common, and more than half suffers of depressive symptoms. Hallucinations occasionally occur in late stage of Alzheimer's disease .Client may under or over eat, with associated changes in weight and nutritional state. Changes in sexual behavior occur, usually with reduction in drive (Ritchie & Lovestone, 2002).

Sunday, October 3, 2010

Types of Dementia -7

By : Lamiaa Moustafa Elbosaty

Dementia due to Pick's Disease: The onset of Pick's disease is between 40 and 60 years of age; it occurs slightly more in men, usually those with first degree relative with the illness. Although the cause is unknown, genetic factors are suspected (Sadock & Sadock, 2003). Pick's disease is another degenerative cognitive disorder that resembles Alzheimer's disease in its clinical picture that in several instances it is only at autopsy that differentiation can take place. General microscopic findings include atrophy of the front temporal regions of the brain, in contrast to the more parietal-temporal distribution in Alzheimer's disease (Arciniegas & Dubovsky, 2001). The victims of this disorder have less disorientation and memory loss than those with Alzheimer's disease and more personality changes, including loss of social constraints (resulting in frequent behavioral problems) (Mohr, 2006).
- Dementia due to Vitamin B12 Deficiency: The prevalence of vitamin B12 deficiency in patients with dementia varies significantly, but the incidence of reversible vitamin B12 deficiency as the primary etiology is probably less than one percent. Cognitive deficits may include poor spatial coping skills, diminished episodic memory, and impaired abstract thinking (Whyte et al., 2002).

Wednesday, September 29, 2010

Types of Dementia -3

By : Lamiaa Moustafa Elbosaty

Dementia due to Parkinson's Disease: Risk factors for dementia include increased age and a typical presence of speech changes and axial involvement, severe motor involvement, rapid progression of Parkinson's disease, and depression. It occurs in later stage of the Parkinson's disease. Behavioral and personality changes occur in dementia caused by Parkinson's disease, with increased incidence of depression and visual hallucinations when compared with the behavioral changes of Alzheimer's disease (Meara, 2003).
- Front-temporal Dementia: is estimated to account for between 5 and 15 percent of degenerative dementias. In younger populations (younger than 65 years of age). Front-temporal dementia probably accounts for a larger percentage of total dementia cases, but overall prevalence rates remain relatively low. Men and women are probably equally affected, and studies have documented that between 20 and 40 percent of patients have a family history of front-temporal dementia (Dawson & Hodges, 2002).  
v    Clinical criteria:
1.       The development of behavioral or cognitive deficits manifested by :
(a) Early and progressive change in personality, characterized by diffi­culty in modulating behavior, often resulting in inappropriate responses or activities .
(b) Early and progressive change in language, characterized by prob­lems with expression of language or severe naming difficulty and problems with word meaning.
The deficits outlined in 1a or 1b cause significant impairment in social or occupational functioning and represent a significant decline from a previous
2.     level of functioning.
3.       The course is characterized by a gradual onset and continuing decline in function.
4.            The deficits in la or 1b are not due to other nervous system conditions (e.g., cerebrovascular disease), systemic conditions (e.g., hypo- thyroidism), or substance-induced conditions.
5.            The deficits do not occur exclusively during a delirium.
6.            The disturbance is not better accounted for by a psychiatric diagnosis (e.g., depression) (McKhann et al., 2001).

Tuesday, September 28, 2010

Types of Dementia -2

By : Lamiaa Moustafa Elbosaty


Dementia with Lewy Bodies: Is the third most frequent cause of dementia, unlike Alzheimer's disease, it is more likely to be seen in men than women (Knopman, et al., 2003). Like Alzheimer's disease pathology (neurofibrillary tangles and senile plaques) it is a common concomitant finding in about 66% of dementia with Lewy bodies cases. It is a heterogeneous disorder characterized pathologically by neuronal loss and the presence of Lewy bodies in the cerebral cortex. There is some neuropathological evidences which suggest that visual hallucinations are associated with the quantity of Lewy bodies in the temporal lobes (Morris, 2005).
v    Clinical presentation:
          The criteria for dementia with Lewy bodies are a progressive dementia accompanied by at least two of the following: Parkinsonian signs, a fluctuating course, and prominent visual hallucinations. Other clinical symptoms include frequent unexplained falls, delusions (misidentifications and paranoid delusions), and auditory or olfactory hallucinations, behavioral changes, depression, apathy, anxiety and irritability (Knopman et al., 2003). There are also fluctuations and delirium, presence of fluctuations of daytime drowsiness, daytime sleep of  2 hours or more, periods of disorganized speech, flow of ideas, and long period of starting into space (Ferman  et al., 2004).

Monday, September 27, 2010

Types of Dementia

By : Lamiaa Moustafa Elbosaty


 Vascular Dementia: It is slightly more common in men than in women. The prevalence increases with age, approximately doubling every 5 years. There appear to be geographical differences, with high rates reported in china, Japan, and the Russian Federation (O'Brien & Elias, 2004). Risk factors for vascular dementia include hypertension, cardiac abnormalities, diabetes mellitus, smoking, lipid abnormalities, autoimmune and infectious vasculitis. The age of onset is usually between 55 and 70 years (Gorelick, 2004).  
v    Clinical presentation: 
The wide variation in symptomatology of vascular dementia depends on the areas of infarction. Patient may recover initially from the neurological and cognitive deficits associated with each infarct depending on the location and extent of damage (Esiri & Nagy, 2002). The presentation of vascular dementia is an abrupt onset of cognitive loss with onset of dementia within 3 months of asymptomatic cerebrovascular accident. The progression of dementia is stepwise, with paroxysmal deterioration of intellectual function (Román, 2002).
Emotional and personality changes may appear first, followed by impairments of memory and intellect that characteristically progress in steps. Depression is frequent and confusion is common, especially at night. Transient ischemic attacks or mild strokes may recur from time to time. Behavioral retardation and anxiety are more common than in Alzheimer's disease (Gold et al., 2002).
According to Román (2002), there is a history of frequent unexplained falls, urinary frequency, urgency or other urinary changes not explained by urological disease, emotional liability, and personality/mood changes. Cognitive changes of memory loss occur but are not always as prominent as with the presentation of Alzheimer's disease. Executive function as the ability to execute complex behavior, sequence information, and problem solve, changes are the more prominent cognitive changes of vascular dementia.
Other cognitive change of problems with concentration and comprehension and disturbances in abstract thinking, judgment, and impulse control (Gorelick, 2003).
The course of vascular dementia is usually a stepwise progression with periods of deterioration that are sometimes followed by partial recovery for a few months. About 50% of the patients die from ischemic heart disease and others die from cerebral infarction or renal complications. From the time of diagnosis, the life span varies widely; most studies showed somewhat shorter survival in than in Alzheimer's disease (Kuller et al., 2005).

Sunday, September 26, 2010

Etiology

Lamiaa Moustafa Elbosaty

The causes of dementia: can be divided into two groups:
1.     Potentially reversible dementia:
        It also known as secondary dementia, it occurs as a result of some other pathological processes and has a specific treatable cause, it includes the following:
§        Metabolic causes:
As renal failure (diuretics, dehydration, obstruction), hyponatromia, salt wasting, hypoglycemia or hyperglycemia, hepatic encephalopathy, hypothyroidism or hyperthyroidism, and Wilson's disease. Other associated causes are anoxia, anemia, congestive heart failure, chronic obstructive pulmonary disease, and vitamin deficiencies, e.g., B12, folic acid, thiamin (Keltner et al., 2003). 
§        Psychiatric causes:
These include depression, schizophrenia, toxic, drugs (prescription or stress), alcohol, and chemical poisoning (e.g., arsenic, mercury, lead, lithium) and other metals as organic compounds and solvents (Harvey et al., 2003).
§        Infection agents:
They include infection and/or fever particularly in elders, e.g., pneumonia, urinary tract infections, AIDS, neuro syphilis, chronic meningitis, brain abscess, and progressive multifocal leukoencephalopathy (Schultz & Videbeck, 2002). The exact prevalence of AIDS related dementia is not known, although it is estimated to occur in as many as 40% of individuals with (HIV) infection and in up to 90% of clients dying of AIDS (Ress, 2003).
§        Miscellaneous causes:
Neoplasm's, cerebral vasculitis, normal pressure hydrocephalus, and multiple sclerosis as well as brain disorders such as stoke and trauma, e.g., subdural hematoma and post concussion syndrome. It is estimated that 30- 40% of persons with memory disturbance have a reversible dementia, therefore, can be treated (Newell et al., 2000).
1.     Irreversible dementia :
It is known also as primary dementia, it is not reversible, progressive, and not secondary to any other disorder and when reversible causes of intellectual impairment can't be identified, the clinical diagnosis is presumed to be a non reversible dementia.  It includes Alzheimer's diseased, vascular dementia, dementia with Lewy bodies, dementia due to Parkinson's disease, front-temporal dementia, dementia due to Creutzfeldt-Jakob disease, Huntington's disease, HIV disease, normal pressure hydrocephalus, subdural hematoma, Pick's disease, vitamin B12 deficiency, substance-induced persisting dementia, and alcohol related dementia  (Kochanek et al., 2001).

Saturday, September 25, 2010

Epidemiology

By : Lamiaa Moustafa Elbosaty

Currently, dementia follows heart disease, cancer and stroke as the fourth leading cause of death among elderly people in the United States. There is one out of six people over age 65, are affected and out three families with a member aged 65 or older will include a person with dementia (Alzheimer's Association National Office, 2006).
           The prevalence of dementia is estimated as 10% of adults over 65 years of age and 30% of those over 85 years of age, for individuals over 85 years of age with a first degree relative with dementia, prevalence approaches 50% (Kennedy, 2003).
The most common type of dementia is Alzheimer's disease, accounts for 60- 80%. Its incidence increases sharply with age ; it is estimated 0.5% per year from age 65 to 69, 1% per year from age 70 to 74, 2% per year from age 75 to 79, 3% per year from age 80 to 84, and 8% per year from age 85 on world (ADRDA, 2004).
While the second common type of dementia is vascular dementia, it accounts 15-30% of all cases of dementia; it is most common in people between the ages of 60 to 70 years and is more common in men than women. Other common types of dementia each representing less than 15% of all cases, include head trauma, alcohol-related dementia, dementia related to Huntington's disease, Parkinson's disease, Lewy bodies, normal-pressure hydrocephalus, vitamin B12 deficiency, and AIDS (Biswas et al., 2005).
Currently, an estimated 4.5 million Americans have Alzheimer's disease and by year 2050 the number of people with Alzheimer's disease will range from 11.3 to 16 million. In Europe, North America, and Australia the Alzheimer's disease is more common. However, vascular dementia is apparently more prevalent in a number of countries in the Far East. There is much less information about other parts of the world (Michel et al., 2002).
In Egypt, those above 60 years of age constitute nearly 8% of whole population, which is expected to increase over the next few decades. However, there are 200.000 cases of Alzheimer's disease which is expected to become one million case by year 2030 (Abyad et al., 2001).
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