Dementia is a growing public health problem for which early detection may be beneficial. Currently, the diagnosis of dementia in primary care is dependent mostly on clinical suspicion on the basis of patient symptoms or caregivers' concerns and is prone to be missed or delayed. We conducted a systematic review of the literature to ascertain the prevalence and contributing factors for missed and delayed dementia diagnoses in primary care. Prevalence of missed and delayed diagnosis was estimated by abstracting quantitative data from studies of diagnostic sensitivity among primary care providers. Possible predictors and contributory factors were determined from the text of quantitative and qualitative studies of patient, caregiver, provider, and system-related barriers. Overall estimates of diagnostic sensitivity varied among studies and seemed to be in part a function of dementia severity, degree of patient impairment, dementia subtype, and frequency of patient-provider contact. Major contributory factors included problems with attitudes and patient-provider communication, educational deficits, and system resource constraints. The true prevalence of missed and delayed diagnoses of dementia is unknown but seems to be high. Until the case for dementia screening becomes more compelling, efforts to promote timely detection should focus on removing barriers to diagnosis.
By Bradford, Andrea MA; Kunik, Mark E. MD; Schulz, Paul MD; Williams, Susan P. MD; Singh, Hardeep MD, MPH
Showing posts with label wernicke-korsakoff syndrome. Show all posts
Showing posts with label wernicke-korsakoff syndrome. Show all posts
Monday, January 25, 2010
Tuesday, January 5, 2010
Wernicke-Korsakoff Syndrome Defined
Wernicke-Korsakoff syndrome is a two-stage brain disorder caused by a deficiency of thiamine (vitamin B-1). Wernicke encephalopathy is the first, acute phase and Korsakoff psychosis is the long-lasting, chronic stage. The most common cause is alcoholism, but the syndrome can also be associated with AIDS, cancers that have spread through the body, very high levels of thyroid hormone, and certain other conditions.
Symptoms of Wernicke-Korsakoff
By Alzheimer's Association
•Confusion, permanent gaps in memory and problems with learning new information.
•Individuals may have a tendency to “confabulate,” or make up information they can’t remember; they are not “lying,” but may actually believe the invented explanation.
•Unsteadiness, muscle weakness and lack of coordination.
•Recent research suggests a genetic variation called APOE-e4 may be associated with a higher risk of Wernicke-Korsakoff in individuals who drink heavily. APOE-e4 is also linked to a higher risk of developing Alzheimer’s disease.
Symptoms of Wernicke-Korsakoff
By Alzheimer's Association
•Confusion, permanent gaps in memory and problems with learning new information.
•Individuals may have a tendency to “confabulate,” or make up information they can’t remember; they are not “lying,” but may actually believe the invented explanation.
•Unsteadiness, muscle weakness and lack of coordination.
•Recent research suggests a genetic variation called APOE-e4 may be associated with a higher risk of Wernicke-Korsakoff in individuals who drink heavily. APOE-e4 is also linked to a higher risk of developing Alzheimer’s disease.
Monday, January 4, 2010
Huge wave of dementia cases coming, warns report
By CTV.ca News Staff
So many Canadians are expected to develop Alzheimer's disease and dementia in the next 30 years that a new case will develop every two minutes unless preventive measures are taken, a new report says.
The report, released Monday by the Alzheimer Society, says the prevalence of dementia will more than double in the next 30 years.
By 2038, almost three per cent of Canada's population will be affected by dementia, and about 257,800 new cases will be diagnosed per year.
Today, dementia costs Canada about $15 billion a year; those costs could soon increase by 10-fold.
"If nothing changes, this sharp increase in the number of people living with dementia will mean that by 2038, the total costs associated with dementia will reach $153 billion a year," David Harvey, principal spokesperson for the Alzheimer Society project called "Rising Tide: The Impact of Dementia on Canadian Society," said in a statement.
That amounts to a cumulative total of $872 billion over the 30-year period.
Much of the increase in cases can be attributed to the "greying" of Canada. With Canadians living longer and baby boomers aging, there is expected to be a spike in many chronic diseases that come with age, such as heart disease, arthritis and cancer.
But the expected rising rates of dementia are not just about demographics; poor lifestyles also play a role.
It's been well documented that regular physical and mental exercise can delay the onset of dementia, which includes Alzheimer's disease and other progressive diseases that destroy brain cells. For that reason, the report recommends that all Canadians over 65 without dementia increase their physical activity by 50 per cent.
"Prevention is where we need to be starting," Harvey told Canada AM.
"We know that healthy eating and active living are antidotes to dementia."
The "Rising Tide" report calls on government to fund more health promotion to remind Canadians of the benefits of a healthy lifestyle.
"This intervention would reduce the number of people diagnosed with dementia, resulting in a reduction in the pressure on long-term care facilities, community care services and informal caregivers," the report says.
Need for national strategy
Just as important, Harvey says, is the need for Canada's health care system to adapt to accommodate the projected rise in dementia cases.
"Dementia is one of the leading cases of disability amongst older people," Harvey said, noting that the flood of dementia expected in the next 30 years could overwhelm emergency rooms and hospitals.
His group's report calls for more support for informal caregivers -- generally, family members -- who tend to be the ones who care for patients with dementia in the early stages of the disease.
"There are services that can be put in place to support caregivers, and also economic and financial support for caregivers," he said.
By also providing caregivers with skill-building and support programs, caregivers struggling with the overwhelming emotional and financial hardships of providing care may feel better equipped to care for their loved one.
That could go far to delay admission of patients into long-term care facilities, thereby lessening the burden on the health care system.
The report also suggests assigning "system navigators" to each newly diagnosed dementia patient and their caregivers. These case managers would help families navigate the health system to find the right social services for their loved one depending on their stage of dementia.
Some facts about dementia:
The symptoms of dementia include a gradual and continuing decline of memory, changes in judgment or reasoning, mood and behaviour, and an inability to perform familiar tasks.
Dementia can strike adults at any age, but has traditionally been diagnosed in people over 65. However, symptoms start much earlier, and an increasing number of people are being diagnosed in their 50s and early 60s.
Age is the number one risk factor for dementia
Alzheimer's disease, the most common form of dementia, accounts for approximately 64 per cent of all dementias in Canada.
Other related dementias include Vascular Dementia, Frontotemporal Dementia, Creutzfeldt-Jakob Disease and Lewy body Dementia.
There is no known cure for dementia. However, some medications can delay progression of the disease.
Researchers are confident that within five to seven years, there will be treatments that attack the disease process itself, not just the symptoms.
So many Canadians are expected to develop Alzheimer's disease and dementia in the next 30 years that a new case will develop every two minutes unless preventive measures are taken, a new report says.
The report, released Monday by the Alzheimer Society, says the prevalence of dementia will more than double in the next 30 years.
By 2038, almost three per cent of Canada's population will be affected by dementia, and about 257,800 new cases will be diagnosed per year.
Today, dementia costs Canada about $15 billion a year; those costs could soon increase by 10-fold.
"If nothing changes, this sharp increase in the number of people living with dementia will mean that by 2038, the total costs associated with dementia will reach $153 billion a year," David Harvey, principal spokesperson for the Alzheimer Society project called "Rising Tide: The Impact of Dementia on Canadian Society," said in a statement.
That amounts to a cumulative total of $872 billion over the 30-year period.
Much of the increase in cases can be attributed to the "greying" of Canada. With Canadians living longer and baby boomers aging, there is expected to be a spike in many chronic diseases that come with age, such as heart disease, arthritis and cancer.
But the expected rising rates of dementia are not just about demographics; poor lifestyles also play a role.
It's been well documented that regular physical and mental exercise can delay the onset of dementia, which includes Alzheimer's disease and other progressive diseases that destroy brain cells. For that reason, the report recommends that all Canadians over 65 without dementia increase their physical activity by 50 per cent.
"Prevention is where we need to be starting," Harvey told Canada AM.
"We know that healthy eating and active living are antidotes to dementia."
The "Rising Tide" report calls on government to fund more health promotion to remind Canadians of the benefits of a healthy lifestyle.
"This intervention would reduce the number of people diagnosed with dementia, resulting in a reduction in the pressure on long-term care facilities, community care services and informal caregivers," the report says.
Need for national strategy
Just as important, Harvey says, is the need for Canada's health care system to adapt to accommodate the projected rise in dementia cases.
"Dementia is one of the leading cases of disability amongst older people," Harvey said, noting that the flood of dementia expected in the next 30 years could overwhelm emergency rooms and hospitals.
His group's report calls for more support for informal caregivers -- generally, family members -- who tend to be the ones who care for patients with dementia in the early stages of the disease.
"There are services that can be put in place to support caregivers, and also economic and financial support for caregivers," he said.
By also providing caregivers with skill-building and support programs, caregivers struggling with the overwhelming emotional and financial hardships of providing care may feel better equipped to care for their loved one.
That could go far to delay admission of patients into long-term care facilities, thereby lessening the burden on the health care system.
The report also suggests assigning "system navigators" to each newly diagnosed dementia patient and their caregivers. These case managers would help families navigate the health system to find the right social services for their loved one depending on their stage of dementia.
Some facts about dementia:
The symptoms of dementia include a gradual and continuing decline of memory, changes in judgment or reasoning, mood and behaviour, and an inability to perform familiar tasks.
Dementia can strike adults at any age, but has traditionally been diagnosed in people over 65. However, symptoms start much earlier, and an increasing number of people are being diagnosed in their 50s and early 60s.
Age is the number one risk factor for dementia
Alzheimer's disease, the most common form of dementia, accounts for approximately 64 per cent of all dementias in Canada.
Other related dementias include Vascular Dementia, Frontotemporal Dementia, Creutzfeldt-Jakob Disease and Lewy body Dementia.
There is no known cure for dementia. However, some medications can delay progression of the disease.
Researchers are confident that within five to seven years, there will be treatments that attack the disease process itself, not just the symptoms.
Monday, December 28, 2009
Dementia and How it is Diagnosed
Many of us may from time to time, forget our neighbor’s name or the items to purchase at the grocery store, and we wonder if this is part of normal aging. Your doctor is the best person to speak with regarding these concerns. There are many conditions that are treatable that may be contributing to periodic memory lapses.
Often when we think of dementia we think of Alzheimer’s disease. While Alzheimer’s disease is considered to be the underlying cause of between 60 and 80% of all dementia cases, there are also other conditions that might cause dementia. It is important to know about the other types and causes of dementia because treatment can vary between diseases and early detection can be beneficial in slowing the progression of incurable dementia's.
According to Dr. Harvey Gilbert, MD of the Gilbert Guide, some of the most common types of dementia and their causes are:
1. Vascular Dementia
This type of dementia is the second most common. It is caused by poor blood flow to the brain, depriving brain cells of the nutrients and oxygen they need to function normally. Vascular dementia can be caused by any number of conditions which narrow the blood vessels, including stroke, diabetes and hypertension.
2. Mixed Dementia
Sometimes dementia is caused by more than one medical condition. Most commonly, mixed dementia is caused by both Alzheimer's and vascular disease.
3. Dementia with Lewy Bodies (DLB)
Sometimes called Lewy Body Disease, this type of dementia is characterized by abnormal protein deposits called Lewy bodies that develop in nerve cells in the brain stem. This disrupts the brain’s ability to function normally and impairs cognition and behavior. It can also cause tremors and is often linked with Parkinson’s Disease and dementia. It is not reversible and there is no known cure.
4. Parkinson’s Disease Dementia (PDD)
Parkinson's disease is a chronic, progressive neurological condition, and in its later stages can affect cognitive functioning. Not all people with Parkinson’s disease will develop dementia, however. This type of dementia is also a lewy body dementia. Symptoms include tremors, muscle stiffness and speech problems. Reasoning, memory, speech, and judgment are also usually affected.
5. Frontotemporal Dementia
Pick's disease is the most common and recognized form of frontotemporal dementia. It is a rare disorder which causes damage to brain cells in the frontal and temporal lobes. This affects the individual’s personality significantly, usually resulting in a decline in social skills, along with emotional apathy. Unlike other dementia's, Pick’s disease usually results in behavior and personality changes occurring before memory loss and speech problems.
6. Creutzfeldt-Jacob Dementia (CJD)
A degenerative neurological disorder, CJD is also known as “mad cow disease”. The incidence is very low, occurring in only about one in one million people. There is no cure. Caused by viruses, CJD progresses rapidly, usually over a period of several months. Symptoms include memory loss, speech impairment, confusion, muscle stiffness and twitching, and a general lack of coordination, which makes the individual susceptible to falls. Sometimes blurred vision and hallucinations also occur with this form of dementia.
7. Normal Pressure Hydrocephalus (NPH)
Normal pressure hydrocephalus involves an accumulation of cerebrospinal fluid in the brain's cavities. When this fluid does not drain as it should, the associated build-up results in added pressure on the brain, interfering with the brain’s ability to function normally. Individuals with dementia caused by normal pressure hydrocephalus often experience problems with ambulation, balance and bladder control, as well as cognitive impairments involving speech, problem-solving abilities and memory.
8. Huntington’s Disease
Huntington's disease is an inherited progressive dementia that affects the individual’s cognition, behavior and movement. Symptoms include memory problems, impaired judgment, mood swings, depression and speech problems (especially slurred speech). Delusions and hallucinations may also occur. Individuals with Huntington’s disease may also experience difficulty walking, and uncontrollable jerking movements of the face and body
9. Wernicke-Korsakoff SyndromeWernicke-Korsakoff syndrome is caused by a vitamin B1 (Thiamine)deficiency and often occurs in alcoholics, although it can also result from malnutrition, cancers, abnormally high thyroid hormone levels, long-term dialysis and long-term diuretic therapy (used to treat congestive heart failure). The symptoms include confusion, permanent gaps in memory, and impaired short-term memory. Hallucinations may also occur. If treated early by supplement, this dementia can be reversed.
10. Mild Cognitive Impairment (MCI)
Dementia can be due to illness, medications and a host of other treatable causes. With mild cognitive impairment, an individual will experience memory loss, and sometimes impaired judgment and speech, but they are usually aware of this decline. These problems usually don’t interfere with the normal activities of daily living. Individuals with mild cognitive impairment may also experience behavioral changes that involve depression, anxiety, aggression and emotional apathy. This is often due to the awareness of and frustration related to his or her condition.
With an understanding of the types of dementia, questions begin to arise about how these diseases are diagnosed. What can a patient expect when trying to determine whether he or she has some form of dementia? What can a caregiver expect?
When you initially meet with your doctor, it is important to be honest with them about the symptoms the patient is experiencing, their duration, frequency and rate of progression. The doctor will then review your current health status, family history and medication history. This includes evaluating the patient for depression, substance abuse and nutrition, and other conditions that can cause memory loss, including anemia, vitamin deficiency, diabetes, kidney or liver disease, thyroid disease, infections, cardiovascular and pulmonary problems. The patient also undergoes a physical exam and blood tests. Diagnosing specific diseases causing dementia can be difficult and it may be necessary to ask for a referral to a doctor with expertise in this area. Additional tests that may be used in conjunction with the aforementioned approaches include the Mini Mental State Evaluation (MMSE), the Mini Cog Screen, and Medical Imaging (CT, MRI and PET scans).
The MMSE is an evaluation of the patient’s cognitive status. The patient is required to identify the time, date and place where the test is taking place, be able to count backwards, identify objects previously known to him or her, be able to repeat common phrases, perform basic skills involving math, language use and comprehension, and demonstrate basic motor skills.
The Mini Cog Screen takes only a few minutes to administer, and is used as an initial screening for dementia. The patient is required to identifying three objects in the office, then draw the face of a clock in its entirety from memory, and finally, recall the three items identified earlier.
Finally, medical imaging helps doctors see images of the patient’s brain to determine whether there are any growths, abnormalities or general shrinkage which occurs in Alzheimer’s disease. These medical imaging tests can help improve the accuracy of a dementia diagnosis to 90%.
Once a diagnosis has been made, doctors can help patients to look at various treatment options and can often provide information for caregivers and families about support groups and organizations that can provide them with information about their specific diagnosis. It is recommended that patients and their families try to learn as much as they can about the disease and how it is expected to progress. Organizations like Alzheimer’s Association or the Parkinson's Society can provide valuable information about the disease, its progression and tips on how to slow the progression of the disease and deal with symptoms. These organizations also provide support groups to both the patient and their caregivers to help deal with the blow of a dementia diagnosis. As mentioned earlier, early detection is often key in being able to reverse or slow the progression of many of these diseases. Having a basic understanding of the many dementia's that may occur and how they are diagnosed will be beneficial to physicians and families alike.
If you find that you simply do not know where to begin or how to handle this change in status and what it means for your future, a Geriatric Care Manager can assist you in making plans for the future.
For information on Care Managers in your area go to http://www.caremanager.org/ or for a care manager in Maricopa County click here.
By ElderCaring.ca
Often when we think of dementia we think of Alzheimer’s disease. While Alzheimer’s disease is considered to be the underlying cause of between 60 and 80% of all dementia cases, there are also other conditions that might cause dementia. It is important to know about the other types and causes of dementia because treatment can vary between diseases and early detection can be beneficial in slowing the progression of incurable dementia's.
According to Dr. Harvey Gilbert, MD of the Gilbert Guide, some of the most common types of dementia and their causes are:
1. Vascular Dementia
This type of dementia is the second most common. It is caused by poor blood flow to the brain, depriving brain cells of the nutrients and oxygen they need to function normally. Vascular dementia can be caused by any number of conditions which narrow the blood vessels, including stroke, diabetes and hypertension.
2. Mixed Dementia
Sometimes dementia is caused by more than one medical condition. Most commonly, mixed dementia is caused by both Alzheimer's and vascular disease.
3. Dementia with Lewy Bodies (DLB)
Sometimes called Lewy Body Disease, this type of dementia is characterized by abnormal protein deposits called Lewy bodies that develop in nerve cells in the brain stem. This disrupts the brain’s ability to function normally and impairs cognition and behavior. It can also cause tremors and is often linked with Parkinson’s Disease and dementia. It is not reversible and there is no known cure.
4. Parkinson’s Disease Dementia (PDD)
Parkinson's disease is a chronic, progressive neurological condition, and in its later stages can affect cognitive functioning. Not all people with Parkinson’s disease will develop dementia, however. This type of dementia is also a lewy body dementia. Symptoms include tremors, muscle stiffness and speech problems. Reasoning, memory, speech, and judgment are also usually affected.
5. Frontotemporal Dementia
Pick's disease is the most common and recognized form of frontotemporal dementia. It is a rare disorder which causes damage to brain cells in the frontal and temporal lobes. This affects the individual’s personality significantly, usually resulting in a decline in social skills, along with emotional apathy. Unlike other dementia's, Pick’s disease usually results in behavior and personality changes occurring before memory loss and speech problems.
6. Creutzfeldt-Jacob Dementia (CJD)
A degenerative neurological disorder, CJD is also known as “mad cow disease”. The incidence is very low, occurring in only about one in one million people. There is no cure. Caused by viruses, CJD progresses rapidly, usually over a period of several months. Symptoms include memory loss, speech impairment, confusion, muscle stiffness and twitching, and a general lack of coordination, which makes the individual susceptible to falls. Sometimes blurred vision and hallucinations also occur with this form of dementia.
7. Normal Pressure Hydrocephalus (NPH)
Normal pressure hydrocephalus involves an accumulation of cerebrospinal fluid in the brain's cavities. When this fluid does not drain as it should, the associated build-up results in added pressure on the brain, interfering with the brain’s ability to function normally. Individuals with dementia caused by normal pressure hydrocephalus often experience problems with ambulation, balance and bladder control, as well as cognitive impairments involving speech, problem-solving abilities and memory.
8. Huntington’s Disease
Huntington's disease is an inherited progressive dementia that affects the individual’s cognition, behavior and movement. Symptoms include memory problems, impaired judgment, mood swings, depression and speech problems (especially slurred speech). Delusions and hallucinations may also occur. Individuals with Huntington’s disease may also experience difficulty walking, and uncontrollable jerking movements of the face and body
9. Wernicke-Korsakoff SyndromeWernicke-Korsakoff syndrome is caused by a vitamin B1 (Thiamine)deficiency and often occurs in alcoholics, although it can also result from malnutrition, cancers, abnormally high thyroid hormone levels, long-term dialysis and long-term diuretic therapy (used to treat congestive heart failure). The symptoms include confusion, permanent gaps in memory, and impaired short-term memory. Hallucinations may also occur. If treated early by supplement, this dementia can be reversed.
10. Mild Cognitive Impairment (MCI)
Dementia can be due to illness, medications and a host of other treatable causes. With mild cognitive impairment, an individual will experience memory loss, and sometimes impaired judgment and speech, but they are usually aware of this decline. These problems usually don’t interfere with the normal activities of daily living. Individuals with mild cognitive impairment may also experience behavioral changes that involve depression, anxiety, aggression and emotional apathy. This is often due to the awareness of and frustration related to his or her condition.
With an understanding of the types of dementia, questions begin to arise about how these diseases are diagnosed. What can a patient expect when trying to determine whether he or she has some form of dementia? What can a caregiver expect?
When you initially meet with your doctor, it is important to be honest with them about the symptoms the patient is experiencing, their duration, frequency and rate of progression. The doctor will then review your current health status, family history and medication history. This includes evaluating the patient for depression, substance abuse and nutrition, and other conditions that can cause memory loss, including anemia, vitamin deficiency, diabetes, kidney or liver disease, thyroid disease, infections, cardiovascular and pulmonary problems. The patient also undergoes a physical exam and blood tests. Diagnosing specific diseases causing dementia can be difficult and it may be necessary to ask for a referral to a doctor with expertise in this area. Additional tests that may be used in conjunction with the aforementioned approaches include the Mini Mental State Evaluation (MMSE), the Mini Cog Screen, and Medical Imaging (CT, MRI and PET scans).
The MMSE is an evaluation of the patient’s cognitive status. The patient is required to identify the time, date and place where the test is taking place, be able to count backwards, identify objects previously known to him or her, be able to repeat common phrases, perform basic skills involving math, language use and comprehension, and demonstrate basic motor skills.
The Mini Cog Screen takes only a few minutes to administer, and is used as an initial screening for dementia. The patient is required to identifying three objects in the office, then draw the face of a clock in its entirety from memory, and finally, recall the three items identified earlier.
Finally, medical imaging helps doctors see images of the patient’s brain to determine whether there are any growths, abnormalities or general shrinkage which occurs in Alzheimer’s disease. These medical imaging tests can help improve the accuracy of a dementia diagnosis to 90%.
Once a diagnosis has been made, doctors can help patients to look at various treatment options and can often provide information for caregivers and families about support groups and organizations that can provide them with information about their specific diagnosis. It is recommended that patients and their families try to learn as much as they can about the disease and how it is expected to progress. Organizations like Alzheimer’s Association or the Parkinson's Society can provide valuable information about the disease, its progression and tips on how to slow the progression of the disease and deal with symptoms. These organizations also provide support groups to both the patient and their caregivers to help deal with the blow of a dementia diagnosis. As mentioned earlier, early detection is often key in being able to reverse or slow the progression of many of these diseases. Having a basic understanding of the many dementia's that may occur and how they are diagnosed will be beneficial to physicians and families alike.
If you find that you simply do not know where to begin or how to handle this change in status and what it means for your future, a Geriatric Care Manager can assist you in making plans for the future.
For information on Care Managers in your area go to http://www.caremanager.org/ or for a care manager in Maricopa County click here.
By ElderCaring.ca
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