User:Malmims/Dementia

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Dementia manifests as a set of related symptoms, which usually surface when the brain is damaged by injury or disease. The symptoms involve progressive impairments to memory, thinking, and behavior, which negatively impact a person's ability to function and carry out everyday activities. Aside from memory impairment and a disruption in thought patterns, the most common symptoms include emotional problems, difficulties with language, and decreased motivation. Dementia is not a disorder of consciousness, and consciousness is not usually affected. Dementia has a significant effect on the individual, relationships, and caregivers.

The symptoms may be described as occurring in a continuum over several stages. A diagnosis of dementia requires a change from a person's usual mental functioning and a greater cognitive decline than that due to normal aging. Several diseases and injuries to the brain, such as a stroke, can give rise to dementia. However, the most common cause is Alzheimer's disease, a neurodegenerative disorder. More than 95% of people suffering from Alzheimer's disease have the sporadic form (late onset, 80- 90 years of age).

While in DSM-5, dementia has been re-described as a major neurocognitive disorder, with varying degrees of severity, and many causative subtypes, the International Classification of Diseases (ICD-10) differentiates the disease as an organically situated disorder with symptoms found in the mental and behavioral aspects of the patient, similarly, with sub-classifications. Causative subtypes of dementia may be based on a known potential cause such as Parkinson's disease, for Parkinson's disease dementia; Huntington's disease for Huntingtons disease dementia; vascular disease for vascular dementia; brain injury including stroke often results in vascular dementia; or many other medical conditions including HIV infection for HIV dementia; and prion diseases. Subtypes may be based on various symptoms as may be due to a neurodegenerative disorder such as Alzheimer's disease; frontotemporal lobar degeneration for frontotemporal dementia; or Lewy body disease for dementia with Lewy bodies. More than one type of dementia, known as mixed dementia, may exist together. Diagnosis is usually based on history of the illness and cognitive testing with imaging. Blood tests may be taken to rule out other possible causes that may be reversible such as an underactive thyroid, and to determine the subtype. The Mini-Mental State Examination is one commonly used cognitive test. The greatest risk factor for developing dementia is aging, however dementia is not a normal part of aging. Several risk factors for dementia, such as smoking and obesity, is preventable by lifestyle changes. Screening the general population for the disorder is not recommended.

There is no known cure for dementia. Acetylcholinesterase inhibitors such as donepezil are often used and may be beneficial in mild to moderate disorder. The overall benefit, however, may be minor. There are many measures that can improve the quality of life of people with dementia and their caregivers. Cognitive and behavioral interventions may be appropriate. Educating and providing emotional support to the caregiver is important. Exercise programs may be beneficial with respect to activities of daily living and may potentially improve outcomes. 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.

It was estimated in 2020 that dementia affected about 50 million people worldwide. This is an increase on the 2016 estimate of 43.8 million, and more than double the estimated 20.2 million in 1990. The number of cases is increasing by around 10 million every year. About 10% of people develop the disorder at some point in their lives, commonly as a result of aging. 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. In 2016 dementia resulted in about 2.4 million deaths, up from 0.8 million in 1990. In 2020 it was reported that dementia was listed as one of the top ten causes of death worldwide.Another report stated that in 2016 it was the fifth leading cause of death. As more people are living longer, dementia is becoming more common. For people of a specific age, however, it may be becoming less frequent in the developed world, due to a decrease in modifiable risk factors made possible by greater financial and educational resources. It is one of the most common causes of disability among the old. '''However, dementia does not only impact the elderly. Onset of the condition before the age of 65 is less common, and little research as to why it happens has been done. This form of dementia is defined by the term "Early-Onset Dementia" (EOD) or “Presenile Dementia." Less than 1% of patients with Alzheimer's have gene mutations that cause development of the disease much younger, around the age of 45. This is known as Early- Onset Alzheimer's.''' Worldwide the cost of dementia in 2015 was put at US $818 billion. People with dementia are often physically or chemically restrained to a greater degree than necessary, raising issues of human rights. Social stigma against those affected is common.

Subtypes[edit]
Many of the subtypes of dementia are neurodegenerative, and protein toxicity is a cardinal feature of these.

Alzheimer's disease[edit]
Main article: Alzheimer's disease

Alzheimer's disease accounts for 60–70% of cases of dementia worldwide. The most common symptoms of Alzheimer's disease are short-term memory loss and word-finding difficulties. Trouble with visuospatial functioning (getting lost often), reasoning, judgment and insight fail. Insight refers to whether or not the person realizes they have memory problems.

Common early symptoms of Alzheimer's include repetition, getting lost, difficulties tracking bills, problems with cooking especially new or complicated meals, forgetting to take medication and word-finding problems.

The part of the brain most affected by Alzheimer's is the hippocampus. Other parts that show atrophy (shrinking) include the temporal and parietal lobes. Although this pattern of brain shrinkage suggests Alzheimer's, it is variable and a brain scan is insufficient for a diagnosis. The relationship between general anesthesia and AD in elderly people is unclear.[why?]

'''Little is known about the pathogenic events that occur during and cause Alzheimer's disease. This is due to the fact that brain tissue from patients with the disease can only be studied after the person's death. However, it is know that one of the first aspects of the disease is a dysfunction in the gene that produces amyloid. Amyloid causes inflammation around the senile plaques of the brain, and too much build up of this inflammation leads to a spiral of changes in the brain that cannot be controlled (the symptoms of Alzheimer's).'''

Dementia due to prion disease[edit]
Creutzfeldt-Jakob disease is a rapidly progressive prion disease that typically causes dementia that worsens over weeks to months. '''Prions are disease causing pathogens created from abnormal protein. They lead to deadly neurodegenerative conditions (such as Creutzfeldt-Jakob disease).'''

Society and culture[edit]
Woman with dementia being cared for at home in Ethiopia The societal cost of dementia is high, especially for family caregivers. '''As of 2015, the annual cost per Alzheimer's patient in the United States was around $19, 144.36. The total costs for the nation is estimated to be about $167.74 billion. By 2030, it is predicted the annual socioeconomic cost will total to about $507 billion, and by 2050 that number is expected to reach $1.89 trillion. This steady increase will be seen not just within the United States but globally. Global estimates for the costs of dementia were $957.56 billion in 2015, but by 2050 the estimated global cost is 9.12 trillion.'''

Many countries consider the care of people living with dementia a national priority and invest in resources and education to better inform health and social service workers, unpaid caregivers, relatives and members of the wider community. Several countries have authored national plans or strategies.These plans recognize that people can live reasonably with dementia for years, as long as the right support and timely access to a diagnosis are available. Former British Prime Minister David Cameron described dementia as a "national crisis", affecting 800,000 people in the United Kingdom. In fact, dementia has become the leading cause of death for women in England.

There, as with all mental disorders, people with dementia could potentially be a danger to themselves or others, they can be detained under the Mental Health Act 1983 for assessment, care and treatment. This is a last resort, and is usually avoided by people with family or friends who can ensure care.

Some hospitals in Britain work to provide enriched and friendlier care. To make the hospital wards calmer and less overwhelming to residents, staff replaced the usual nurses' station with a collection of smaller desks, similar to a reception area. The incorporation of bright lighting helps increase positive mood and allow residents to see more easily.

Driving with dementia can lead to injury or death. Doctors should advise appropriate testing on when to quit driving. The United Kingdom DVLA (Driver & Vehicle Licensing Agency) states that people with dementia who specifically have poor short-term memory, disorientation, or lack of insight or judgment are not allowed to drive, and in these instances the DVLA must be informed so that the driving licence can be revoked. They acknowledge that in low-severity cases and those with an early diagnosis, drivers may be permitted to continue driving.

Many support networks are available to people with dementia and their families and caregivers. Charitable organizations aim to raise awareness and campaign for the rights of people living with dementia. Support and guidance are available on assessing testamentary capacity in people with dementia.

In 2015, Atlantic Philanthropies announced a $177 million gift aimed at understanding and reducing dementia. The recipient was Global Brain Health Institute, a program co-led by the University of California, San Francisco and Trinity College Dublin. This donation is the largest non-capital grant Atlantic has ever made, and the biggest philanthropic donation in Irish history.

On 2 November 2020, Scottish billionaire Sir Tom Hunter donated £1 million to dementia charities, after watching a former music teacher with dementia, Paul Harvey, playing piano using just four notes in a viral video. The donation was announced to be split between the Alzheimer's Society and Music for Dementia.