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Samenvatting taak 8 t/m 11 PGZ2024: Disease and Prevention
Samenvatting van de laatste 4 taken van PGZ2024: Disease and Prevention
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Taak 8: dementiaWhat is the normal aging brain? And what is the difference between dementia and normal aging?
Diagnosing dementia can be difficult owing to its insidious (verradelijke) onset, symptoms resembling “normal
ageing” memory loss, and a diversity of other presenting symptoms—for example, difficulty in finding words or
making decisions.
Dementia is a progressive disease that causes cognitive function to break down abnormally, causing cognitive
and physical symptoms that worsen over time. Normal aging is much more minor, with changes resulting from a
natural slowing or decrease in efficiency in the body. (google)
Many persons get a little more forgetful as we get older. Most people will need a bit longer to remember things,
get distracted more easily or struggle to multitask as well as they once did. This may become noticeable
particularly from middle age - usually taken as during our 40s, 50s and early 60s - onwards. For most people
those changes will be the result of normal ageing and won't be down to dementia.
Cell devision à cognitive cells don’t devide anymore. If you lose any cells they are not replaced.
Thinking à making connections between cells (neurons)
Older à harder to make connections
Ability to make connections à slower when you get older.
Brain reserve: 2 mensen die evenveel cellen verliezen kan de ene dementia hebben en de andere niet want brain
reserve is groter.
What is dementia?
Dementia is the term for a group of symptoms that occur when the brain is damaged by diseases. This includes
Alzheimer's disease or diseases of the blood vessels that can cause a stroke. These diseases can cause a
significant decline in a person's mental abilities or 'cognitive function' - our capacity for things like memory,
thinking and reasoning.
Dementia describes a clinical syndrome that encompasses difficulties in memory, language, and behaviour that
leads to impairments in activities of daily living.
Dementia is the loss of cognitive functioning - thinking, remembering, and reasoning - to such an extent that it
interferes with a person's daily life and activities. (google)
Risk factors for dementia
Several risk factors have been identified. In addition to non-modifiable (niet-aanpasbaar) risk factors, such as
age, gender and genetics, there is good support for modifiable risk factors as contributing to the risk of
developing dementia later in life.
Recent estimates suggest that one in three cases of dementia can be attributed to common modifiable risk
factors. Several healthy lifestyle habits have been identified, e.g. regular exercise, high mental activity, and
adequate blood pressure control.
• Age.
The risk of Alzheimer's disease, vascular dementia, and several other dementias goes up significantly
with advancing age.
• Genetics/family history.
Abnormal genes are also clearly implicated as risk factors in Huntington's disease, FTDP-17, and
several other kinds of dementia.
Many people with Down's syndrome show neurological and behavioral signs of Alzheimer's disease by
the time they reach middle age.
• Smoking and alcohol use.
People who smoke have a higher risk of atherosclerosis and other types of vascular disease, which may
be the underlying causes for the increased dementia risk.
• Atherosclerosis.
Atherosclerosis is the buildup of plaque – deposits of fatty substances, cholesterol, and other matter –
in the inner lining of an artery.
, Atherosclerosis is a significant risk factor for vascular dementia because it interferes with the delivery
of blood to the brain and can lead to stroke.
• Cholesterol.
High levels of low-density lipoprotein (LDL), the so-called "bad" form of cholesterol, appear to
significantly increase a person's risk of developing vascular dementia. Some research has also linked
high cholesterol to an increased risk of Alzheimer's disease
• Plasma homocysteine.
Research has shown that a higher-than-average blood level of homocysteine, a type of amino acid, is a
strong risk factor for the development of Alzheimer's disease and vascular dementia.
• Diabetes.
Diabetes is a risk factor for both Alzheimer's disease and vascular dementia. It is also a known risk
factor for atherosclerosis and stroke, both of which contribute to vascular dementia.
• Mild cognitive impairment
While not all people with mild cognitive impairment develop dementia, people with this condition do
have a significantly increased risk of dementia compared to the rest of the population.
Symptoms of dementia
Signs and symptoms of dementia result when once-healthy neurons, or nerve cells, in the brain stop working,
lose connections with other brain cells, and die. While everyone loses some neurons as they age, people with
dementia experience far greater loss.
The symptoms of dementia can vary and may include:
• Experiencing memory loss, poor judgment, and confusion
• Difficulty speaking, understanding, and expressing thoughts, or reading and writing
• Wandering and getting lost in a familiar neighborhood
• Trouble handling money responsibly and paying bills
• Repeating questions
• Using unusual words to refer to familiar objects
• Taking longer to complete normal daily tasks
• Losing interest in normal daily activities or events
• Hallucinating or experiencing delusions or paranoia
• Acting impulsively
• Not caring about other people’s feelings
• Losing balance and problems with movement
Diagnosis of dementia
General practitioners are often the first point of contact for patients who are worried that they may have
dementia.
The role of primary care is to exclude a potentially treatable illness or reversible cause of the “dementia”—for
example, depression, vitamin B12 deficiency, or thyroid disturbance.
Patients who have mild cognitive impairment (objective cognitive loss not affecting function and daily living
activities) are followed up in primary care, and, if their symptoms become more severe, re-referred for
specialist assessment.
Initial assessment should include a careful history from both the patient and the main carer, with particular
emphasis on disturbance of cognitive function and activities of daily living. A physical examination should
be undertaken to look for any focal neurological signs and exclude any visual or auditory problems. Baseline
investigations and a brief cognitive assessment, using one of the many tools available (box 2), should also be
carried out before referral to secondary care.
To diagnose dementia, doctors first assess whether a person has an underlying, potentially treatable, condition
that may relate to cognitive difficulties.
, A physical exam to measure blood pressure and other vital signs, as well as laboratory tests of blood and other
fluids to check levels of various chemicals, hormones, and vitamins, can help uncover or rule out possible
causes of symptoms.
A review of a person’s medical and family history can provide important clues about risk for dementia. Typical
questions might include asking about whether dementia runs in the family, how and when symptoms began,
changes in behavior and personality, and if the person is taking certain medications that might cause or worsen
symptoms.
The following procedures also may be used to diagnose dementia:
• Cognitive and neurological tests. These tests are used to assess thinking and physical functioning.
These include assessments of memory, problem solving, language skills, and math skills, as well
as balance, sensory response, and reflexes.
• Brain scans. These tests can identify strokes, tumors, and other problems that can cause dementia.
Scans also identify changes in the brain's structure and function. The most common scans are:
o Computed tomography (CT), which uses X-rays to produce images of the brain and other
organs
o Magnetic resonance imaging (MRI), which uses magnetic fields and radio waves to produce
detailed images of body structures, including tissues, organs, bones, and nerves
o Positron emission tomography (PET), which uses radiation to provide pictures of brain activity
à biomarkers, detect glucose metabolism
• Psychiatric evaluation. This evaluation will help determine if depression or another mental health
condition is causing or contributing to a person's symptoms.
• Genetic tests. Some dementias are caused by a person’s genes. In these cases, a genetic test can help
people know if they are at risk for dementia. It is important to talk with a genetic counselor before and
after getting tested, along with family members and the doctor.
• Blood tests. It is now possible for doctors to order a blood test to measure levels of beta-amyloid, a
protein that accumulates abnormally in people with Alzheimer’s. Several other blood tests are in
development. However, the availability of these diagnostic tests for Alzheimer’s and related dementias
is still limited.
Early detection of symptoms is important, as some causes can be treated. However, in many cases, the cause of
dementia is unknown and cannot be treated. Still, obtaining an early diagnosis can help with managing the
condition and planning ahead.
Often a combination of different forms of dementia.
What are the types of dementia? (Focus on Alzheimers)
Alzheimer’s disease is the most common subtype of dementia, followed by vascular dementia, mixed
dementia, and dementia with Lewy bodies.
Alzheimer's is the most common cause of dementia, a general term for memory loss and other cognitive abilities
serious enough to interfere with daily life. Alzheimer's disease accounts for 60-80% of dementia cases.
Alzheimer's is a progressive disease, where dementia symptoms gradually worsen over a number of years. In its
early stages, memory loss is mild, but with late-stage Alzheimer's, individuals lose the ability to carry on a
conversation and respond to their environment. On average, a person with Alzheimer's lives 4 to 8 years after
diagnosis but can live as long as 20 years, depending on other factors.
As Alzheimer's advances through the brain it leads to increasingly severe symptoms, including
- Disorientation; deepening confusion about events, time, and place
- Mood; unfounded suspicions about family, friends, and professional caregivers
- Behavior changes; more serious memory loss and behavior changes; and difficulty speaking,
swallowing, and walking.
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