Showing posts with label alcohol. Show all posts
Showing posts with label alcohol. Show all posts

Monday, October 4, 2010

Substance-Induced Persisting Dementia

Lamiaa Moustafa Elbosaty

Substance-Induced Persisting Dementia: The characteristics and course of the disease depend mostly on the causative substance. Substance known to evoke a persisting dementia are alcohol, sedatives, hypnotics, and medication such as anticonvulsants. Toxins are a well-known cause of dementia, and frequent offenders include lead mercury, carbon monoxide, organophosphate insecticides, and industrial solvents. Alcohol induced persisting dementia probably has the most data to support its description (Sadock & Sadock, 2005).
- Alcohol-Induced Persisting Dementia: It is estimated to account for approximately 4 percent of dementias. Milder forms of cognitive impairment are also frequently associated with chronic alcohol abuse but typically don't result in prolonged, irreversible cognitive deficit on cessation.  The causal relationship between alcohol use and dementia is complicated, alcohol or its metabolites acetaldehyde, may have direct central nervous system neurotoxin effects. Dementia may also result from thiamine deficiency and subsequent cortical neuronal loss. Chronic alcohol abuse impairs gastrointestinal absorption of thiamine (APA, 2000).
In addition, alcoholism frequently results in liver disease, which, in turn affects thiamine homeostasis, and may also directly cause neurotoxicity and cognitive impairment. Descriptions of alcohol-related dementia in the literature have reported many features that include memory impairment, disorganized thoughts, poor attention, impaired judgment, and disorientation. Other psychiatric symptoms may include mood liability behavioral disinhibition, irritability, aggression, apathy, and paranoid ideation (Willenbring, 2000).

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).
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