Dementia
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Dementia
Dementia is a term used to refer to a decline in mental function which is serious enough such that the individual’s normal activity is affected. The most frequently observed symptom among patients is memory loss. Although dementia is more commonly seen among elderly, the condition can arise due to other causes such as illnesses like Alzheimer’s disease and Parkinson’s disease and as consequence of chronic alcohol abuse. [1] [2] [3]
Causes
The condition is brought about by injury to brain cells. The manifestations depend on which area has been damaged. [2] The progressive type gets worse over time. This is often linked to diseases including Alzheimer’s disease and Lewy body dementia, Other disorders associated to dementia are Huntington’s disease and Creutzfeldt-Jakob disease. Repetitive head trauma such as in boxing may cause the condition as well. The human immunodeficiency virus (HIV) has also been reported to damage brain matter eventually leading to dementia.
In some cases, dementia can be reversed. Reversible dementia can be caused by infections such as meningitis, immune diseases like multiple sclerosis, endocrine problems such as thyroid disease, under nutrition specifically lack of vitamin B1 or thiamine, poisoning, adverse drug reaction, brain tumor, subdural hematoma, normal pressure hydrocephalus and heart and lung diseases. Anoxia or a condition when the organ tissues do not acquire an adequate amount of oxygen may lead to dementia. This may occur in cases like carbon monoxide poisoning. [5]
Symptoms
Dementia may manifest as difficulty in performing tasks related to language, memory, perception and cognitive abilities like calculation. In can also affect the patient’s behavior leading to personality changes. The first sign is often forgetfulness. The person may forget recent conversations or activities done and may misplace things frequently. Familiar names cannot be recalled as well. The patient may lose interest in activities previously regarded as enjoyable. As the condition progresses, the patient usually have changes in sleeping patterns, fails to remember notable events in his or her own life history, judges poorly, have hallucinations or delusions and have difficulty executing basic tasks like dressing and taking a bath. [3]
Diagnosis
A diagnosis can be arrived at after investigating the patient’s medical history and performing a physical examination which includes a neurological exam. Laboratory tests may be done to check for the possible causes. [3]
Treatment
Treatment depends upon the cause. If there is a medication that make the condition worse, stopping or changing it is necessary. If there is an underlying organic cause, proper medical intervention should be done. Behavior problems may be controlled using some drugs such as antipsychotics and mood stabilizers. Social support is highly important. [3]
References:
1. http://www.medicalnewstoday.com/articles/142214.php
2. http://www.alz.org/what-is-dementia.asp
3. http://health.nytimes.com/health/guides/disease/dementia
4. http://www.nlm.nih.gov/medlineplus/dementia.html
5. http://www.mayoclinic.com/health/dementia/DS01131/DSECTION=causes
Efficacy of Alternative and Other Treatments According to GRADE* Ranking:
Gingko [1, 2, 3, 4, 5]:
Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: No recommendation (Research on claims that Ginkgo helps to treat symptoms of dementia have yielded mixed results)
Grade of Evidence: Low quality of evidence
Hyperbaric Oxygen Therapy (HBOT):
NOT RECOMENDED
Recommendation: Strongly against (Available evidence shows that HBOT is in no way useful in treating dementia, and can have harmful effects. NOT RECOMENDED)
Grade of Evidence: Moderate quality of evidence
Qigong:
Recommendation: No Recommendation (There is insufficient evidence to support claims that Qigong can help treat dementia)
Grade of Evidence: Very low quality of evidence
Dance and Movement Therapy [7, 8, 9 ,10]:
Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support.
Recommendation: Weakly in favor (Studies show that dance and movement therapy may be helpful for those with dementia)
Grade of Evidence: Low level of evidence
Ba Wei Di Huang Wan (BDW) [11, 12, 13]:
Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support.
Recommendation: Weakly in favor (Studies show that dance and movement therapy may be helpful for those with dementia)
Grade of Evidence: Low level of evidence
Choto-San [6, 14, 15, 16]:
Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support.
Recommendation: Weakly in favor (Studies show that choto-san may be able to help those with dementia. More studies are needed)
Grade of Evidence: Low level of evidence
* www.gradeworkinggroup.org
Summary References
Treatments:
1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009
2. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/ginkgo
3. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html
4. http://nccam.nih.gov/news/newsletter/2010_may/ginkgostudy.htm
5. http://www.ncbi.nlm.nih.gov/pubmed/20040554
6.
7. http://www.researchgate.net/publication/5471351_Dance_and_movement_therapeutic_methods_in_management_of_dementia_A_randomized_controlled_study
8. http://www.adta.org/Resources/Documents/Harkonnen%20et%20al%20dementia%20extracted.pdf
9. http://rohricht.dot5hosting.com/media/e11c85ca6bf8f9cffff8674ffffe415.pdf
10. http://www.academia.edu/6477830/Dance_movement_therapy_for_dementia
11. http://onlinelibrary.wiley.com/doi/10.1111/j.1447-0594.2004.00175.x/abstract
12. http://www.researchgate.net/publication/229539496_Effects_of_the_Chinese_herbal_medicine_Ba_Wei_Di_Huang_Wan_in_the_treatment_of_dementia_A_SPECT_cerebral_blood_flow_examination_and_a_randomized_doubleblind_placebocontrolled_clinical_trial_for_cognitive_function_and_ADL
13. http://www.ncbi.nlm.nih.gov/pubmed/15341554
14. http://www.ncbi.nlm.nih.gov/pubmed/10656534
15. http://www.ncbi.nlm.nih.gov/pubmed/23195240
Public Discussion
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