MyMedExpert Health Articles

What is Dementia?
Dementia is not a specific disease. It is a descriptive term for a collection of symptoms that can be caused by a number of disorders that affect the brain. People with dementia have significantly impaired intellectual functioning that interferes with normal activities and relationships. They also lose their ability to solve problems and maintain emotional control, and they may experience personality changes and behavioral problems, such as agitation, delusions, and hallucinations. While memory loss is a common symptom of dementia, memory loss by itself does not mean that a person has dementia. Doctors diagnose dementia only if two or more brain functions - such as memory and language skills — are significantly impaired without loss of consciousness.  Some of the diseases that can cause symptoms of dementia are Alzheimer’s disease, vascular dementia, Lewy body dementia, frontotemporal dementia, Huntington’s disease, and Creutzfeldt-Jakob disease.  Doctors have identified other conditions that can cause dementia or dementia-like symptoms including reactions to medications, metabolic problems and endocrine abnormalities, nutritional deficiencies, infections, poisoning, brain tumors, anoxia or hypoxia (conditions in which the brain’s oxygen supply is either reduced or cut off entirely), and heart and lung problems.  Although it is common in very elderly individuals, dementia is not a normal part of the aging process.

Is there any treatment?
Drugs to specifically treat Alzheimer’s disease and some other progressive dementias are now available.  Although these drugs do not halt the disease or reverse existing brain damage, they can improve symptoms and slow the progression of the disease. This may improve an individual’s quality of life, ease the burden on caregivers, or delay admission to a nursing home. Many researchers are also examining whether these drugs may be useful for treating other types of dementia.  Many people with dementia, particularly those in the early stages, may benefit from practicing tasks designed to improve performance in specific aspects of cognitive functioning. For example, people can sometimes be taught to use memory aids, such as mnemonics, computerized recall devices, or note taking.

What is the prognosis?
There are many disorders that can cause dementia. Some, such as Alzheimer’s disease or Huntington’s disease, lead to a progressive loss of mental functions. But other types of dementia can be halted or reversed with appropriate treatment. People with moderate or advanced dementia typically need round-the-clock care and supervision to prevent them from harming themselves or others. They also may need assistance with daily activities such as eating, bathing, and dressing.

What research is being done?
The National Institute of Neurological Disorders and Stroke (NINDS) and other institutes of the National Institutes of Health (NIH) conduct research related to dementia in laboratories at the NIH and also support additional dementia research through grants to major medical institutions across the country.  Current research focuses on many different aspects of dementia. This research promises to improve the lives of people affected by the dementias and may eventually lead to ways of preventing or curing these disorders

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 Introduction
Dementia is a brain disorder that seriously affects a person’s ability to carry out daily activities. The most common form of dementia among older people is Alzheimer’s disease (AD), which initially involves the parts of the brain that control thought, memory, and language. Although scientists are learning more every day, right now they still do not know what causes AD, and there is no cure.

Scientists think that as many as 4.5 million Americans suffer from AD. The disease usually begins after age 60, and risk goes up with age. While younger people also may get AD, it is much less common. About 5 percent of men and women ages 65 to 74 have AD, and nearly half of those age 85 and older may have the disease. It is important to note, however, that AD is not a normal part of aging.

AD is named after Dr. Alois Alzheimer, a German doctor. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. He found abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary tangles). Today, these plaques and tangles in the brain are considered signs of AD.

Scientists also have found other brain changes in people with AD. Nerve cells die in areas of the brain that are vital to memory and other mental abilities, and connections between nerve cells are disrupted. There also are lower levels of some of the chemicals in the brain that carry messages back and forth between nerve cells. AD may impair thinking and memory by disrupting these messages.

What Causes AD?
Scientists do not yet fully understand what causes AD. There probably is not one single cause, but several factors that affect each person differently. Age is the most important known risk factor for AD. The number of people with the disease doubles every 5 years beyond age 65.

Family history is another risk factor. Scientists believe that genetics may play a role in many AD cases. For example, early-onset familial AD, a rare form of AD that usually occurs between the ages of 30 and 60, is inherited. The more common form of AD is known as late-onset. It occurs later in life, and no obvious inheritance pattern is seen in most families. However, several risk factor genes may interact with each other and with non-genetic factors to cause the disease. The only risk factor gene identified so far for late-onset AD is a gene that makes one form of a protein called apolipoprotein E (ApoE). Everyone has ApoE, which helps carry cholesterol in the blood. Only about 15 percent of people have the form that increases the risk of AD. It is likely that other genes also may increase the risk of AD or protect against AD, but they remain to be discovered.

Scientists still need to learn a lot more about what causes AD. In addition to genetics and ApoE, they are studying education, diet, and environment to learn what role they might play in the development of this disease. Scientists are finding increasing evidence that some of the risk factors for heart disease and stroke, such as high blood pressure, high cholesterol, and low levels of the vitamin folate, may also increase the risk of AD. Evidence for physical, mental, and social activities as protective factors against AD is also increasing.
What Are the Symptoms of AD?
AD begins slowly. At first, the only symptom may be mild forgetfulness, which can be confused with age-related memory change. Most people with mild forgetfulness do not have AD. In the early stage of AD, people may have trouble remembering recent events, activities, or the names of familiar people or things. They may not be able to solve simple math problems. Such difficulties may be a bother, but usually they are not serious enough to cause alarm.

However, as the disease goes on, symptoms are more easily noticed and become serious enough to cause people with AD or their family members to seek medical help. Forgetfulness begins to interfere with daily activities. People in the middle stages of AD may forget how to do simple tasks like brushing their teeth or combing their hair. They can no longer think clearly. They can fail to recognize familiar people and places. They begin to have problems speaking, understanding, reading, or writing. Later on, people with AD may become anxious or aggressive, or wander away from home. Eventually, patients need total care.
How is AD Diagnosed?
An early, accurate diagnosis of AD helps patients and their families plan for the future. It gives them time to discuss care while the patient can still take part in making decisions. Early diagnosis will also offer the best chance to treat the symptoms of the disease.

Today, the only definite way to diagnose AD is to find out whether there are plaques and tangles in brain tissue. To look at brain tissue, however, doctors usually must wait until they do an autopsy, which is an examination of the body done after a person dies. Therefore, doctors can only make a diagnosis of “possible” or “probable” AD while the person is still alive.

At specialized centers, doctors can diagnose AD correctly up to 90 percent of the time. Doctors use several tools to diagnose “probable” AD, including:

questions about the person’s general health, past medical problems, and ability to carry out daily activities,
tests of memory, problem solving, attention, counting, and language,
medical tests—such as tests of blood, urine, or spinal fluid, and
brain scans.
Sometimes these test results help the doctor find other possible causes of the person’s symptoms. For example, thyroid problems, drug reactions, depression, brain tumors, and blood vessel disease in the brain can cause AD-like symptoms. Some of these other conditions can be treated successfully.
How is AD Treated?
AD is a slow disease, starting with mild memory problems and ending with severe brain damage. The course the disease takes and how fast changes occur vary from person to person. On average, AD patients live from 8 to 10 years after they are diagnosed, though some people may live with AD for as many as 20 years.

No treatment can stop AD. However, for some people in the early and middle stages of the disease, the drugs tacrine (Cognex, which is still available but no longer actively marketed by the manufacturer), donepezil (Aricept), rivastigmine (Exelon), or galantamine (Razadyne, previously known as Reminyl) may help prevent some symptoms from becoming worse for a limited time. Another drug, memantine (Namenda), has been approved to treat moderate to severe AD, although it also is limited in its effects. Also, some medicines may help control behavioral symptoms of AD such as sleeplessness, agitation, wandering, anxiety, and depression. Treating these symptoms often makes patients more comfortable and makes their care easier for caregivers.
New Areas of Research
The National Institute on Aging (NIA), part of the National Institutes of Health (NIH), is the lead Federal agency for AD research. NIA-supported scientists are testing a number of drugs to see if they prevent AD, slow the disease, or help reduce symptoms. Researchers undertake clinical trials to learn whether treatments that appear promising in observational and animal studies actually are safe and effective in people. Some ideas that seem promising turn out to have little or no benefit when they are carefully studied in a clinical trial.

Neuroimaging. Scientists are finding that damage to parts of the brain involved in memory, such as the hippocampus, can sometimes be seen on brain scans before symptoms of the disease occur. An NIA public-private partnership—the AD Neuroimaging Initiative (ADNI)—is a large study that will determine whether magnetic resonance imaging (MRI) and positron emission tomography (PET) scans, or other imaging or biological markers, can see early AD changes or measure disease progression. The project is designed to help speed clinical trials and find new ways to determine the effectiveness of treatments. For more information on ADNI, call the  NIA’s Alzheimer’s Disease Education and Referral (ADEAR) Center at 1-800-438-4380, or visit www.alzheimers.nia.nih.gov.

AD Genetics. The NIA is sponsoring the AD Genetics Study to learn more about risk factor genes for late onset AD. To participate in this study, families with two or more living siblings diagnosed with AD should contact the National Cell Repository for AD toll-free at 1-800-526-2839. Information may also be requested through the study’s website: http://ncrad.iu.edu.

Mild Cognitive Impairment. During the past several years, scientists have focused on a type of memory change called mild cognitive impairment (MCI), which is different from both AD and normal age-related memory change. People with MCI have ongoing memory problems, but they do not have other losses such as confusion, attention problems, and difficulty with language. The NIA-funded Memory Impairment Study compared donepezil, vitamin E, or placebo in participants with MCI to see whether the drugs might delay or prevent progression to AD. The study found that the group with MCI taking donepezil were at reduced risk of progressing to AD for the first 18 months of a 3-year study, when compared with their counterparts on placebo. The reduced risk of progressing from MCI to a diagnosis of AD among participants on donepezil disappeared after 18 months, and by the end of the study, the probability of progressing to AD was the same in the two groups. Vitamin E had no effect at any time point in the study when compared with placebo.

Inflammation. There is evidence that inflammation in the brain may contribute to AD damage. Some studies have suggested that drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs) might help slow the progression of AD, but clinical trials thus far have not demonstrated a benefit from these drugs. A clinical trial studying two of these drugs, rofecoxib (Vioxx) and naproxen (Aleve) showed that they did not delay the progression of AD in people who already have the disease. Another trial, testing whether the NSAIDs celecoxib (Celebrex) and naproxen could prevent AD in healthy older people at risk of the disease was suspended due to concerns over possible cardiovascular risk. Researchers are continuing to look for ways to test how other anti-inflammatory drugs might affect the development or progression of AD.

Antioxidants. Several years ago, a clinical trial showed that vitamin E slowed the progress of some consequences of AD by about 7 months. Additional studies are investigating whether antioxidants—vitamins E and C—can slow AD. Another clinical trial is examining whether vitamin E and/or selenium supplements can prevent AD or cognitive decline, and additional studies on other antioxidants are ongoing or being planned, including a study of the antioxidant treatments—vitamins E, C, alpha-lipoic acid, and coenzyme Q—in patients with mild to moderate AD.

Ginkgo biloba. Early studies suggested that extracts from the leaves of the ginkgo biloba tree may be of some help in treating AD symptoms. There is no evidence yet that ginkgo biloba will cure or prevent AD, but scientists now are trying to find out in a clinical trial whether ginkgo biloba can delay cognitive decline or prevent dementia in older people.

Estrogen. Some studies have suggested that estrogen used by women to treat the symptoms of menopause also protects the brain. Experts also wondered whether using estrogen could reduce the risk of AD or slow the disease. Clinical trials to test estrogen, however, have not shown that estrogen can slow the progression of already diagnosed AD. And one study found that women over the age of 65 who used estrogen with a progestin were at greater risk of dementia, including AD, and that older women using only estrogen could also increase their chance of developing dementia.

Scientists believe that more research is needed to find out if estrogen may play some role in AD. They would like to know whether starting estrogen therapy around the time of menopause, rather than at age 65 or older, will protect memory or prevent AD.
Participating in Clinical Trials
People with AD, those with MCI, or those with a family history of AD, who want to help scientists test possible treatments may be able to take part in clinical trials. Healthy people also can help scientists learn more about the brain and AD. The NIA maintains the AD Clinical Trials Database, which lists AD clinical trials sponsored by the Federal government and private companies. To find out more about these studies, contact the NIA’s ADEAR Center at 1-800-438-4380 or visit the ADEAR Center website at www.nia.nih.gov/Alzheimers/ResearchInformation/ClinicalTrials. You also can sign up for e-mail alerts on new clinical trials as they are added to the database. Additional clinical trials information is available at www.clinicaltrials.gov.

Many of these studies are being done at NIA-supported Alzheimer’s Disease Centers located throughout the United States. These centers carry out a wide range of research, including studies of the causes, diagnosis, treatment, and management of AD. To get a list of these centers, contact the ADEAR Center.

Advancing Our Understanding
Scientists have come a long way in their understanding of AD. Findings from years of research have begun to clarify differences between normal age-related memory changes, MCI, and AD. Scientists also have made great progress in defining the changes that take place in the AD brain, which allows them to pinpoint possible targets for treatment.
These advances are the foundation for the NIH Alzheimer’s Disease Prevention Initiative, which is designed to:

understand why AD occurs and who is at greatest risk of developing it,
improve the accuracy of diagnosis and the ability to identify those at risk,
discover, develop, and test new treatments, and
discover treatments for behavioral problems in patients with AD.

Is There Help for Caregivers?
Most often, spouses and other family members provide the day-to-day care for people with AD. As the disease gets worse, people often need more and more care. This can be hard for caregivers and can affect their physical and mental health, family life, job, and finances.

The Alzheimer’s Association has chapters nationwide that provide educational programs and support groups for caregivers and family members of people with AD. Contact information for the Alzheimer’s Association is listed at the end of this fact sheet.

What I need to know about erection problems
Some people can talk with their doctors about sex. Others feel that sex is private. They do not want to share details with anyone. But if you have problems getting or keeping an erection, you have good reasons to talk to a doctor: your health and your quality of life.

Erection problems used to be called “impotence.” Now the term “erectile dysfunction” is more common. Sometimes people just use the initials ED.

ED can be a sign of health problems. It may mean your blood vessels are clogged. It may mean you have nerve damage from diabetes. If you don’t see your doctor, these problems will go untreated.
ED is a medical problem. Your doctor can help.
Another reason to see your doctor is to treat ED itself. Your doctor can offer several new treatments. For many men, the answer is as simple as taking a pill. Other men have to try two or three options before they find a treatment that works for them. Don’t give up if the first treatment doesn’t work. Finding the right treatment can take time.

What causes an erection?
Hormones, blood vessels, nerves, and muscles must all work together to make an erection. Your brain starts an erection by sending nerve signals to the penis when it senses sexual stimulation. Touching may cause this arousal. Another trigger may be something you see or hear. It may be a sexual thought or dream.
Your brain starts an erection by sending nerve signals to the penis.
The nerve signals cause the muscles within the penis to relax and let blood flow into the spongy tissue within the penis. Blood collects in this tissue like water filling a sponge. The penis becomes larger and firmer, like an inflated balloon. The veins then get shut off to keep blood from flowing out.

After climax, or after the sexual arousal has passed, the veins open back up and blood flows back into the body.
Healthy blood vessels are needed for an erection.

What causes erectile dysfunction?
Many different conditions can lead to ED. Most of the causes of ED are health problems requiring treatment to help prevent more serious complications than ED:

High blood pressure and high cholesterol can injure the arteries that supply blood to the penis.
Diabetes injures blood vessels and the nerves that control erections.
Alcohol and drug abuse can cause ED by damaging blood vessels and deadening the nerves that control erections.
Some prescription drugs such as some antidepressants or some high blood pressure medicines can cause ED. Your doctor may be able to change your drug treatment. Never stop taking a prescribed drug without talking to your doctor.
Unhealthy habits like smoking, overeating, and avoiding exercise can also contribute to ED.
Anything that’s bad for your heart is also bad for your sexual health.
An injury to the spinal cord can cause ED by interfering with nerve signals.
Treatments for prostate cancer, including radiation and prostate removal, can damage the nerves that control erections.
Diseases that affect the nerves, like multiple sclerosis, can also lead to erection problems.
A small number of ED cases result from a reduced level of the male hormone testosterone.
Doctors used to believe that most cases of ED resulted from mental or emotional problems. We now know that most ED has a physical cause. But depression and worry or anxiety can still cause ED. And ED from physical causes can lead to depression and worry, making physical ED worse.
A person should not assume that ED is part of the normal process of aging. There is quite likely an underlying cause.

What will happen in the doctor’s office?
Talking about ED can be difficult. You might use a phrase like “I’ve been having problems in the bedroom” or “I’ve been having erection problems.” Remember that a healthy sex life is part of a healthy life. Don’t feel embarrassed about seeking help. ED is a medical problem, and your doctor treats medical problems every day.

If the interaction with your doctor doesn’t put you at ease, ask for a referral to another doctor. Your doctor may send you to a urologist-a doctor who specializes in sexual and urologic problems.

Your partner may want to come with you to see the doctor. Many doctors say ED is easier to treat when both partners are involved.

To find the cause of your ED, your doctor will take a complete medical history and do a physical examination.

Medical History
Your doctor will ask general questions about your health, as well as specific questions about your erection problems and your relationship with your partner. Bring a list of all the medications you take, or bring them with you to show to your doctor. Tell your doctor about any surgery you have had.

Your doctor will ask about habits like alcohol use, smoking, and exercise.

Your doctor might ask you questions like

How do you rate your confidence that you can get and keep an erection?
When you have erections with sexual stimulation, how often are your erections hard enough for penetration?
During sexual intercourse, how often are you able to maintain your erection after you have penetrated (entered) your partner?
When you attempt sexual intercourse, how often is it satisfactory for you?
How would you rate your level of sexual desire?
How often are you able to reach climax and have an ejaculation?
Do you have an erection when you wake up in the morning?

The answers to these questions will help your doctor understand the problem.

Physical Exam
A physical exam can help your doctor find the cause of your ED. As part of the exam, the doctor will examine your testes and penis, take your blood pressure, and check your reflexes. A blood sample will be taken to test for diabetes, cholesterol level, and other conditions that may be associated with ED.

How is erectile dysfunction treated?
Your doctor can offer a number of treatments for ED. You may want to talk with your partner about which treatment fits you best as a couple. Most people want the simplest treatment possible. You may need to try a number of treatments before you find the one that works best for you.

Lifestyle Changes
For some men, the answer is to make a few lifestyle changes. Getting more exercise, quitting smoking, losing weight, and cutting back on alcohol solve some erection problems.

Counseling
Even though most cases of ED have a physical cause, counseling can help couples deal with the emotional effects. Some couples find that counseling adds to the medical treatment by making their relationship stronger.

Oral Medication
Since 1998, doctors have been able to prescribe a pill to treat ED. Current brands include Viagra, Levitra, and Cialis. If your doctor finds that your health is generally good, you may be given a prescription for one of these drugs. You should not take any of these pills to treat ED if you take any of the heart medicines called nitrates. All of the ED pills work by increasing blood flow to the penis. They do not cause automatic erections. Talk with your doctor about when to take the pill. You may need to experiment to find out how soon the pill takes effect.

Even if taking a pill solves your erection problem, you should still take care of the other health issues that may have caused your ED.

Injection
Taking a pill doesn’t work for everybody. Many men use medicines that go directly into the penis. Caverject and Edex are injected into the shaft of the penis with a needle. MUSE is a tiny pill inserted into the urethra at the tip of the penis. These medicines usually cause an erection within minutes. These medications can be very successful, even if other treatments fail.

Vacuum device
Another way to create an erection is to use a vacuum tube. The penis is inserted in the tube. As air is pumped out of the tube, the volume of the penis expands. Blood then flows into the penis and makes it larger. A specially designed rubber band is then placed at the base of the penis to keep the blood from flowing out.
When air is pumped out of the tube, blood flows into the penis and makes an erection.
Penile Implant
If the other options fail, some men need surgery to treat ED. A surgeon can implant a device that inflates or unbends to create an erection. Implanted devices do not interfere with the way sex feels.

This operation cannot be reversed. Once a man has a penile implant, he must use a device to have an erection. Talk with your doctor about the advantages and possible drawbacks of having a penile implant.

Points to Remember

Erection problems may be a sign of health problems.
A doctor can help you overcome erection problems.
Smoking, being overweight, and avoiding exercise can contribute to erection problems.
Most cases of ED have a physical cause, but counseling can help couples build a stronger relationship.
Many men can take a pill to treat ED. These men should still treat the health conditions that caused ED.
Taking a pill doesn’t work for everybody.
Men who take any of the medicines called nitrates should not take a pill to treat ED

Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). , National Institutes of Health

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