Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
Dementia. This devastating disease begins with memory loss,
and quickly progresses to inability to work, understand, and
things like getting lost while going home or being confused
about one's surroundings. Often, long-term memory is
preserved for a while, that is, the social graces,
pleasantness, and memories of childhood may be retained. Then
sets in an inability to care for oneself, an inability to
talk and to control bodily functions.
This disease comes in many forms, and we discussed multi
infarct dementia last week. Alzheimer's is a similar dementia
that many times strikes earlier and lasts longer. There are
several other forms that differ slightly in their
presentation but are no different in the final result.
Other dementias that are of interest but are not treatable
include the brain virus call Creuzfedlt-Jakob disease, of
which mad cow disease is a variant, and it is the reason many
cows in the UK were recently put to sleep. Huntington's
Chorea is an unfortunate disease in which young people
suddenly have uncontrolled movements of their body and become
uncontrollably insane and often violent. As this is a genetic
disease, counselling is important. Kuru is a dementia that is
seen only in the Pacific islands, where cannibalism is
practiced on relatives, spreading the disease. Guam dementia
is thought to occur because of eating a common palm product
in that region. Anoxic encephalopathy is due to lack of
oxygen to the brain. It can be due to trauma or a cardiac
arrest, as brain cells start to die four minutes after lack
of circulation. One should learn CPR to prevent this
consequence.
Some -- albeit few -- dementias are treatable. Hypothyroidism
can cause a dementia-type state. Thyroid replacement may
help. Lack of thiamine in an alcoholic's diet may lead to
Wernicke's encephalopathy. Thiamine will alleviate the
problem, but Korsakoff's Psychosis -- due to chronic drinking
-- is loss of short-term memory that is incurable. Normal
Pressure Hydrocephalus has a disturbance -- patients waddle,
have urinary incontinence and memory loss. It is
overabundance of fluid in the brain. A neurosurgical drainage
helps in 30-50 percent of cases. Severe depression can cause
catatonia, which looks like dementia. Parkinson's can look
like dementia, and vice versa.
These causes though are rare. Once the disease starts
progressing, little can be done.
We spoke about prevention last week. Anti-cholesterol drugs
may help prevent the disease as well. A new drug Aricept
(also Memorit) does help somewhat to slow the progression.
Ginko balboa is now thought not to help. Alzheimer's centers
do help families deal with these problems, but little can be
done to reverse the disease. Keep in mind that better days
and worse days is the common course. Hashem Yishmor.
Write me in care of the Yated.
A message from Glaxo, sponsor of this column. Often
infections that are localized can be treated with a cream
such as Bactroban. Impetigo responds well, but so do minor
wound infections and carrier states of dangerous bacteria in
the nose. What's more, there are no pills to take and no
pain! Good for burns as well.
