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Article title: DEMENTIA: NWHIC
Dementia is a clinical diagnosis made by a physician. Although there are a number of different checklists available, the "Diagnostic and Statistical Manual-IV" is the most widely accepted list of criteria for dementia. A patient, who has an acquired problem of memory, cognitive ability, and problems with functional abilities, may have a dementia syndrome. The patient must not have a confusional state, such as delirium or drug intoxication, at the time of diagnosis. A skilled physician can apply these criteria to detect the presence of dementia, but some physicians may be far more skilled than others in this regard.
There are over 60 different causes of the dementia syndrome, with Alzheimer's disease being the most common.
The elderly, those with family histories of dementia, and those with stroke risk factors. Often it is assumed that women are more susceptible to dementia than men. This is not quite true. However, since on average women live longer than men and dementia is age-related, more women live long enough to get dementia, than men. In addition, some preliminary evidence suggests that estrogen; a hormone produced naturally in greater amounts in women than in men may help prevent dementia. This had not yet been proven, but is currently under study in the Women's Health Initiative-Memory Study, a large nation-wide clinical trial directed by Dr. Sally A. Shumaker at the Wake Forest University School of Medicine.
No. Dementia is a syndrome with over 60 causes. There are a number of causes with a direct genetic basis. For example, Huntington's disease, early onset familial Alzheimer's disease, trisomy 21 (Down syndrome), acute intermittent porphyris (a disorder which causes neurological symptoms), Wilson's disease (a hereditary disorder in which copper accumulates in tissues), mitochondrial encephalopathies, and several other causes of the dementia syndrome have a definite genetic origin. The genetic basis of Alzheimer's disease is quite complex, and there are many distinct chromosomes implicated at this time, including chromosomes 1, 2, 14, 17, 19, and 21. Genetic testing is available for only a few dementia syndromes, and the genetic counseling that is available is consequently quite limited unless a patient happens to have a family and genetic history precisely identified, and that has a well understood pattern of inheritance.
Treatment must be directed at the underlying cause(s) of the dementia. So, the first step in management is to identify the contributing factors responsible for the dementia syndrome. Then, each contributing factor can be treated or managed. Initially, treatment usually includes a combination of medications, behavioral strategies, and environmental interventions. In the early stages of dementia family interventions and education are foremost. As the disease progresses, treatment generally shifts to include management of disruptive behaviors and can include drug and non-drug interventions.
There are drugs available to enhance cognition in Alzheimer's disease, to reduce stroke risk in-patients with vascular dementia, and to treat depression in-patients (often part of a dementia syndrome.) The few drugs available have limited efficacy, but more drugs are in development. Drug therapies are almost universally required at some point in the progression of a dementia syndrome, however, for the management of the many side effects and neurophsychiatric problems that arise in these patients (e.g., depression, anxiety attacks, psychosis, agitation, etc.). Psychotherapy and counseling may be important not only for the patient, but also for the family and other caregivers. Placement for temporary respite care or permanent institutional care may be required, although the majority of patients may be managed at home with appropriate in-home support. There is even surgical treatment available for the rare patients who have a surgically remediable cause of dementia, such as normal pressure hydrocephalus or chronic subdural hematomas.
Huntington's Disease Society of America
158 West 29th St 7th floor
National Institute of Neurological Diseases and Stroke, (301) 496-5751
National Institute on Aging, (800) 222-2225, (800) 222-4225 TTY
Contributions to this FAQ on Dementia: Wake Forest University Baptist Medical Center, a National Center of Excellence in Women's Health sponsored by the Office on Women's Health in the Department of Health and Human Services
All material contained in the FAQs is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women's Health in the Department of Health and Human Services; citation of the source is appreciated.
Publication date: 1998
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