Sunday, October 10, 2010

Pharmacologic Treatment

By : Lamiaa Moustafa Elbosaty


There is no medication can completely cure of degenerative dementia but there is some medications used for help in the treatment of degenerative dementia. Table (1): Pharmacologic treatment

Drug
Targeted symptoms
Cholinesterase inhibitors
-         Donepezil
-         Galantamine
-         Rivastigmine
Cognitive and functional decline
N- methyl-D-Aspartate Receptor antagnosit Memantine
Cognitive and function decline
Atypical Antipsychotics
-         Olanzapine
-         Quetiapine
-         Risperidone
-         Ziprasidone
Psychosis and agitation
Neuroleptic
-         Haloperidol
Psychosis and agitation
Mood stabilizers
-         Garbamazepine
-         Divalproex sodium
 Agitation
Selective Serotonin Reuptake Inhibitors
-         Citalopram
-         Fluoxetine
-         Paroxetine
-         Setraline
Depress, anxiety, psychosis and agitation
Tricyclic antidepressants
-         Desipramine
-         Nortriptyline
Depression
Serotonin and Norepinephrine Reuptake Inhibitor
-         Venlafaxine
Depression and anxiety
General α2-Adrenergic Autoreceptor and Heterorecptor Antagonist
-         Mirtazapine
Depression

                                                        Adopted from Friedlander et al.(2006).

Treatment of Dementia

By : Lamiaa Moustafa Elbosaty


The treatment of dementia can be divided into two parts as the following:
Non-Pharmacologic Treatment:
-         Provide client with a structured, predictable routine (exercise, meals, and bed time should be routine and punctual).
-         Explain all procedures and activities in simple and straight forward terms to the client before performing them.
-         Simplify tasks, allow clients to dress in their own clothing, and maintain possessions.
-         Use calendars, clocks, labels, or newspapers for orientation to time.
-         Reduce excess stimulation and outings to crowded places (overexposure to environmental stimulation can lead to agitation and disorientation)
-         Avoid glare from windows and mirrors, noise from TV, household clutter
-         Equip doors and gates with safety locks
-         Install grab bars by the toilet and in the shower
-         Use lighting to reduce confusion and restlessness at night
-         Use distraction and redirection of activities provide music, especially during meals and bathing (Cohen-Mansfied, 2003).
-      Provide a safe environment: no sharp-edged furniture, slippery floors and throw rugs, and obtrusive electric cords. The following measures may be useful :
Safe: Extra safety measures are usually needed. For example, large signs can be posted as safety reminders (such as “remember to turn the
§        stove off”), or timers can be installed on stoves or electrical equipment. Hiding car keys may help prevent accidents and placing detectors on doors may help prevent wandering. If wandering is a problem, an identification bracelet or necklace is helpful.
§        Familiar: People with dementia usually function best in familiar surroundings. Moving to a new home or city, rearranging furniture, or even repainting can be disruptive.
§        Stable: Establishing a regular routine for bathing, eating, sleeping, and other activities can give people with dementia a sense of stability. Regular contact with the same people can also help.
§        Planned to help with orientation: A large daily calendar, a clock with large numbers, a radio, well-lit rooms, and a night-light can help with orientation. Also, family members or caregivers can make frequent comments that remind people with dementia of where they are and what is going on (Huang, 2008). 

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).

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).
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