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Types of Dementia and symptoms

Types of Dementia

Dementia is a general term for loss of memory and other mental abilities severe enough to interfere with daily life. It is caused by physical changes in the brain.

 

 

Alzheimer’s disease

Most common type of dementia; accounts for an estimated 60 to 80 percent of cases.

Symptoms: Difficulty remembering recent conversations, names or events is often an early clinical symptom; apathy and depression are also often early symptoms. Later symptoms include impaired communication, poor judgment, disorientation, confusion, behavior changes and difficulty speaking, swallowing and walking.

Revised criteria and guidelines for diagnosing Alzheimer’s were published in 2011 recommending that Alzheimer’s be considered a slowly progressive brain disease that begins well before symptoms emerge.

Brain changes: Hallmark abnormalities are deposits of the protein fragment beta-amyloid (plaques) and twisted strands of the protein tau (tangles) as well as evidence of nerve cell damage and death in the brain.

 

Vascular dementia:

Previously known as multi-infarct or post-stroke dementia, vascular dementia is less common as a sole cause of dementia than Alzheimer’s, accounting for about 10 percent of dementia cases.

Symptoms: Impaired judgment or ability to make decisions, plan or organize is more likely to be the initial symptom, as opposed to the memory loss often associated with the initial symptoms of Alzheimer’s. Occurs from blood vessel blockage or damage leading to infarcts (strokes) or bleeding in the brain. The location, number and size of the brain injury determines how the individual’s thinking and physical functioning are affected.

Brain changes: Brain imaging can often detect blood vessel problems implicated in vascular dementia. In the past, evidence for vascular dementia was used to exclude a diagnosis of Alzheimer’s disease (and vice versa). That practice is no longer considered consistent with pathologic evidence, which shows that the brain changes of several types of dementia can be present simultaneously. When any two or more types of dementia are present at the same time, the individual is considered to have “mixed dementia” (see entry below).

 

Dementia with Lewy bodies (DLB):

Symptoms: People with dementia with Lewy bodies often have memory loss and thinking problems common in Alzheimer’s, but are more likely than people with Alzheimer’s to have initial or early symptoms such as sleep disturbances, well-formed visual hallucinations, and slowness, gait imbalance or other parkinsonian movement features.

Brain changes: Lewy bodies are abnormal aggregations (or clumps) of the protein alpha-synuclein. When they develop in a part of the brain called the cortex, dementia can result. Alpha-synuclein also aggregates in the brains of people with Parkinson’s disease, but the aggregates may appear in a pattern that is different from dementia with Lewy bodies.

The brain changes of dementia with Lewy bodies alone can cause dementia, or they can be present at the same time as the brain changes of Alzheimer’s disease and/or vascular dementia, with each abnormality contributing to the development of dementia. When this happens, the individual is said to have “mixed dementia.”

 

Mixed dementia:

In mixed dementia abnormalities linked to more than one cause of dementia occur simultaneously in the brain. Recent studies suggest that mixed dementia is more common than previously thought.

Brain changes: Characterized by the hallmark abnormalities of more than one cause of dementia —most commonly, Alzheimer’s and vascular dementia, but also other types, such as dementia with Lewy bodies.

 

Parkinson’s disease:

As Parkinson’s disease progresses, it often results in a progressive dementia similar to dementia with Lewy bodies or Alzheimer’s.

Symptoms: Problems with movement are common symptoms of the disease. If dementia develops, symptoms are often similar to dementia with Lewy bodies.

Brain changes: Alpha-synuclein clumps are likely to begin in an area deep in the brain called the substantia nigra. These clumps are thought to cause degeneration of the nerve cells that produce dopamine.

 

Frontotemporal dementia:

Includes dementias such as behavioral variant FTD (bvFTD), primary progressive aphasia, Pick’s disease, corticobasal degeneration and progressive supranuclear palsy.

Symptoms: Typical symptoms include changes in personality and behavior and difficulty with language. Nerve cells in the front and side regions of the brain are especially affected.

Brain changes: No distinguishing microscopic abnormality is linked to all cases. People with FTD generally develop symptoms at a younger age (at about age 60) and survive for fewer years than those with Alzheimer’s.

 

Creutzfeldt-Jakob disease:

CJD is the most common human form of a group of rare, fatal brain disorders affecting people and certain other mammals. Variant CJD (“mad cow disease”) occurs in cattle, and has been transmitted to people under certain circumstances.

Symptoms: Rapidly fatal disorder that impairs memory and coordination and causes behavior changes.

Brain changes: Results from misfolded prion protein that causes a “domino effect” in which prion protein throughout the brain misfolds and thus malfunctions.

 

Normal pressure hydrocephalus:

Symptoms: Symptoms include difficulty walking, memory loss and inability to control urination.

Brain changes: Caused by the buildup of fluid in the brain. Can sometimes be corrected with surgical installation of a shunt in the brain to drain excess fluid.

 

Huntington’s Disease:

Huntington’s disease is a progressive brain disorder caused by a single defective gene on chromosome 4.

Symptoms: Include abnormal involuntary movements, a severe decline in thinking and reasoning skills, and irritability, depression and other mood changes.

Brain changes: The gene defect causes abnormalities in a brain protein that, over time, lead to worsening symptoms.

 

Wernicke-Korsakoff Syndrome:

Korsakoff syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1). The most common cause is alcohol misuse.

Symptoms: Memory problems may be strikingly severe while other thinking and social skills seem relatively unaffected.

Brain changes: Thiamine helps brain cells produce energy from sugar. When thiamine levels fall too low, brain cells cannot generate enough energy to function properly.

Ultrasonic scaling and polishing in dental treatments

During a routine Scale and Polish at Smiles Dental, your hygienist will thoroughly clean all deposits and stains from teeth. They will scale away tartar build-up from tooth surfaces and polish your teeth using special dental instruments. You can feel tartar build up on the backs of your teeth with your tongue.

The ultrasonic scaling device removes tartar (calculus), plaque and bio film from the tooth surface and underneath the gum line. A manual instrument may be used next to remove the remainder. Root planing involves detailed scaling of the root surface to decrease inflammation of the gum tissue.

Ultrasonic scalers are used to remove calculus rapidly from the tooth surface. The scaling tip vibrates in the ultrasonic range of 20-45 kHz (i.e. 20,000 to 45,000 times per second), with an optimum frequency between 18 kHz and 32kHz.

What are dental cleanings (scale and polish) and why have them?

Dental cleanings involve removing plaque (soft, sticky, bacteria infested film) and tartar (calculus) deposits that have built up on the teeth over time. Your teeth are continually bathed in saliva which contains calcium and other substances which help strengthen and protect the teeth. While this is a good thing, it also means that we tend to get a build-up of calcium deposits on the teeth. This chalky substance will eventually build up over time, like limescale in a pipe or kettle. Usually it is tooth coloured and can easily be mistaken as part of the teeth, but it also can vary from brown to black in colour.

If the scale, or calculus (tartar, as dentists like to call it) is allowed to accumulate on the teeth it will unfortunately provide the right conditions for bacteria to thrive next to the gums. The purpose of the cleaning and polishing is basically to leave the surfaces of the teeth clean and smooth so that bacteria are unable to stick to them and you have a better chance of keeping the teeth clean during your regular home care.

 

Also it leaves your teeth feeling lovely and smooth and clean, which is nice when you run your tongue around them. Actually, come to think of it, there’s nothing worse than someone you fancy running their tongue around your teeth and finding a piece of spinach or something! Still, if they’re hungry…

The professional cleaning of teeth is sometimes referred to as prophylaxis (orprophy for short). It’s a Greek word which means “to prevent beforehand” – in this case, it helps prevent gum disease.

How are dental cleanings done?

The dental hygienist or dentist uses specialized instruments to gently remove these deposits without harming the teeth. The instruments which may be used during your cleaning, and what they feel like, are described below.

Ultrasonic instrument

Commonly used first is an ultrasonic instrument which uses tickling vibrations to knock larger pieces of tartar loose. It also sprays acooling mist of water while it works to wash away debris and keep the area at a proper temperature. The device typically emits a humming or high pitched whistling sound. This may seem louder than it actually is because the sound may get amplified inside your head, just like when you put an electric toothbrush into your mouth.

The ultrasonic instrument tips are curved and rounded and are always kept in motion around the teeth. They are by no means sharp since their purpose is to knock tartar loose and not to cut into the teeth. It is best to inform the operator if the sensations are too strong or ticklish so that they can adjust the setting appropriately on the device or modify the pressure applied.

With larger deposits that have hardened on, it can take some time to remove these, just like trying to remove baked-on grime on a stove that has been left over a long time. So your cleaning may take longer than future cleanings. Imagine not cleaning a house for six months versus cleaning it every week. The six-month job is going to take longer than doing smaller weekly jobs.

Fine hand tools

Once the larger pieces of tartar are gone, the dental worker will switch to finer hand tools (called scalers and curettes in dental-speak) to remove smaller deposits and smoothen the tooth surfaces. These tools are curved and shaped to match the curves of the teeth. They allow smaller tartar deposits to be removed bycarefully scraping them off with a gentle to moderate amount of pressure. Just like taking a scrubbing brush to a soiled pot, the dental worker has to get the areas clean and smooth.

Polishing

Once all the surfaces are smooth, the dental worker may polish your teeth. Polishing is done using a slow speed handpiece with a soft rubber cup that spins on the end. Prophylaxis (short for prophy) paste – a special gritty toothpaste-like material – is scooped up like ice cream into the cup and spun around on the teeth to make them shiny smooth.

Fluoride


Your dentist may also apply fluoride. This is the final, and my favorite part of the dental cleaning! Fluoride comes in many different flavours such as chocolate, mint, strawberry, cherry, watermelon, pina colada and can be mixed and matched just like ice cream at a parlour for a great taste sensation! Make no mistake though, this in-office fluoride treatment is meant for topical use only on the surfaces of the teeth and swallowing excessive amounts can give a person a tummy ache as it is not meant to be ingested.

Fluoride foam or gel is then placed into small, flexible foam trays and placed over the teeth for 30 seconds. Afterwards the patient is directed to spit as much out as possible into a saliva ejector. The fluoride helps to strengthen the teeth since the acids from bacteria in dental tartar and plaque will have weakened the surfaces. It is best not to eat, drink or rinse for 30 minutes after the fluoride has been applied.

Is it going to be painful?

Most people find that cleanings are painless, and find the sensations described above – tickling vibrations, the cooling mist of water, and the feeling of pressure during “scraping” – do not cause discomfort. A lot of people even report that they enjoy cleanings and the lovely smooth feel of their teeth afterwards! There may be odd zingy sensations, but many people don’t mind as they only last a nanosecond.

Be sure to let your dentist/hygienist know if you find things are getting too uncomfortable for your liking. They can recommend various options to make the cleaning more enjoyable.

How Is Iron-Deficiency Anemia Treated?

Treatment for iron-deficiency anemia will depend on its cause and severity. Treatments may include dietary changes and supplements, medicines, and surgery.

Severe iron-deficiency anemia may require a blood transfusion, iron injections, or intravenous (IV) iron therapy. Treatment may need to be done in a hospital.

The goals of treating iron-deficiency anemia are to treat its underlying cause and restore normal levels of red blood cells, hemoglobin, and iron.

Dietary Changes and Supplements

Iron

You may need iron supplements to build up your iron levels as quickly as possible. Iron supplements can correct low iron levels within months. Supplements come in pill form or in drops for children.

Large amounts of iron can be harmful, so take iron supplements only as your doctor prescribes. Keep iron supplements out of reach from children. This will prevent them from taking an overdose of iron.

Iron supplements can cause side effects, such as dark stools, stomach irritation, and heartburn. Iron also can cause constipation, so your doctor may suggest that you use a stool softener.

Your doctor may advise you to eat more foods that are rich in iron. The best source of iron is red meat, especially beef and liver. Chicken, turkey, pork, fish, and shellfish also are good sources of iron.

The body tends to absorb iron from meat better than iron from nonmeat foods. However, some nonmeat foods also can help you raise your iron levels. Examples of nonmeat foods that are good sources of iron include:

  • Iron-fortified breads and cereals
  • Peas; lentils; white, red, and baked beans; soybeans; and chickpeas
  • Tofu
  • Dried fruits, such as prunes, raisins, and apricots
  • Spinach and other dark green leafy vegetables
  • Prune juice

The Nutrition Facts labels on packaged foods will show how much iron the items contain. The amount is given as a percentage of the total amount of iron you need every day.

Vitamin C

Vitamin C helps the body absorb iron. Good sources of vitamin C are vegetables and fruits, especially citrus fruits. Citrus fruits include oranges, grapefruits, tangerines, and similar fruits. Fresh and frozen fruits, vegetables, and juices usually have more vitamin C than canned ones.

If you’re taking medicines, ask your doctor or pharmacist whether you can eat grapefruit or drink grapefruit juice. Grapefruit can affect the strength of a few medicines and how well they work.

Other fruits rich in vitamin C include kiwi fruit, strawberries, and cantaloupes.

Vegetables rich in vitamin C include broccoli, peppers, Brussels sprouts, tomatoes, cabbage, potatoes, and leafy green vegetables like turnip greens and spinach.

Treatment To Stop Bleeding

If blood loss is causing iron-deficiency anemia, treatment will depend on the cause of the bleeding. For example, if you have a bleeding ulcer, your doctor may prescribe antibiotics and other medicines to treat the ulcer.

If a polyp or cancerous tumor in your intestine is causing bleeding, you may need surgery to remove the growth.

If you have heavy menstrual flow, your doctor may prescribe birth control pills to help reduce your monthly blood flow. In some cases, surgery may be advised.

Treatments for Severe Iron-Deficiency Anemia

Blood Transfusion

If your iron-deficiency anemia is severe, you may get a transfusion of red blood cells. A blood transfusion is a safe, common procedure in which blood is given to you through an IV line in one of your blood vessels. A transfusion requires careful matching of donated blood with the recipient’s blood.

A transfusion of red blood cells will treat your anemia right away. The red blood cells also give a source of iron that your body can reuse. However, a blood transfusion is only a short-term treatment. Your doctor will need to find and treat the cause of your anemia.

Blood transfusions are usually reserved for people whose anemia puts them at a higher risk for heart problems or other severe health issues.

For more information, go to the Health Topics Blood Transfusion article.

Iron Therapy

If you have severe anemia, your doctor may recommend iron therapy. For this treatment, iron is injected into a muscle or an IV line in one of your blood vessels.

IV iron therapy presents some safety concerns. It must be done in a hospital or clinic by experienced staff. Iron therapy usually is given to people who need iron long-term but can’t take iron supplements by mouth. This therapy also is given to people who need immediate treatment for iron-deficiency anemia.

 

How Can Iron-Deficiency Anemia Be Prevented?

Eating a well-balanced diet that includes iron-rich foods may help you prevent iron-deficiency anemia.

Taking iron supplements also may lower your risk for the condition if you’re not able to get enough iron from food. Large amounts of iron can be harmful, so take iron supplements only as your doctor prescribes.

For more information about diet and supplements, go to “How Is Iron-Deficiency Anemia Treated?”

Infants and young children and women are the two groups at highest risk for iron-deficiency anemia. Special measures can help prevent the condition in these groups.

Infants and Young Children

A baby’s diet can affect his or her risk for iron-deficiency anemia. For example, cow’s milk is low in iron. For this and other reasons, cow’s milk isn’t recommended for babies in their first year. After the first year, you may need to limit the amount of cow’s milk your baby drinks.

Also, babies need more iron as they grow and begin to eat solid foods. Talk with your child’s doctor about a healthy diet and food choices that will help your child get enough iron.

Your child’s doctor may recommend iron drops. However, giving a child too much iron can be harmful. Follow the doctor’s instructions and keep iron supplements and vitamins away from children. Asking for child-proof packages for supplements can help prevent overdosing in children.

Because recent research supports concerns that iron deficiency during infancy and childhood can have long-lasting, negative effects on brain health, the American Academy of Pediatrics recommends testing all infants for anemia at 1 year of age.

Women and Girls

Women of childbearing age may be tested for iron-deficiency anemia, especially if they have:

  • A history of iron-deficiency anemia
  • Heavy blood loss during their monthly periods
  • Other risk factors for iron-deficiency anemia

The Centers for Disease Control and Prevention (CDC) has developed guidelines for who should be screened for iron deficiency, and how often:

  • Girls aged 12 to 18 and women of childbearing age who are not pregnant: Every 5 to 10 years.
  • Women who have risk factors for iron deficiency: Once a year.
  • Pregnant women: At the first prenatal visit.

For pregnant women, medical care during pregnancy usually includes screening for anemia. Also, your doctor may prescribe iron supplements or advise you to eat more iron-rich foods. This not only will help you avoid iron-deficiency anemia, but also may lower your risk of having a low-birth-weight baby.

Living With Iron-Deficiency Anemia

If you have iron-deficiency anemia, get ongoing care to make sure your iron levels are improving. At your checkups, your doctor may change your medicines or supplements. He or she also may suggest ways to improve your diet.

Take iron supplements only with your doctor’s approval, and only as he or she prescribes. It’s possible to have too much iron in your body (a condition called iron overload). Too much iron in your body can damage your organs.

You may have fatigue (tiredness) and other symptoms of iron-deficiency anemia until your iron levels return to normal, which can take months. Tell your doctor if you have any new symptoms or if your symptoms get worse.

Bile duct cancer: Symptoms, Causes& Treatments

Bile duct cancer starts in the bile duct. Cancers can develop in any part of the bile duct and, based on their location, are classified into three types:

  • Intrahepatic bile duct cancers
  • Perihilar (also called hilar) bile duct cancers
  • Distal bile duct cancers

Cancers in these different areas may cause different symptoms.

Intrahepatic Bile Duct Cancers – These cancers develop in the smaller bile duct branches inside the liver. They can sometimes be confused with cancers that start in the liver cells, which are called hepatocellular carcinomas, and are often treated the same way. Only about 1 in 10 bile duct cancers are intra-hepatic.

Perihilar Bile Duct Cancers – These cancers develop at the hilum, where the hepatic ducts join and consequently leave the liver. They are also called Klatskin tumours. These are the most common type of bile duct cancers, making up 6 or 7 of every 10 bile duct cancers. These cancers are grouped with distal bile duct cancers as extrahepatic bile duct cancers.

Distal bile duct cancers – These bile duct cancers are found further down the bile duct, closer to the small intestine. Because these bile ducts are outside the liver, these cancers are grouped with perihilar cancers as extrahepatic bile duct cancers. Distal bile duct cancers make up 2 to 3 of every 10 bile duct cancers.

Symptoms:

Signs and symptoms may not be present until the later stages of bile duct cancer, but in some cases they may lead to an early diagnosis. The following are some symptoms associated with bile duct cancer:

  • Jaundice
  • Itching
  • Light-coloured stools
  • Dark urine
  • Abdominal pain
  • Loss of appetite
  • Weight loss
  • Fever
  • Nausea and vomiting

Bile duct cancer is uncommon. However, certain factors and conditions may put you at greater risk for developing this type of cancer.

Long-standing Inflammation
Long-standing inflammation is a key risk factor in developing bile duct cancer. Conditions that are associated with this kind of inflammation include:

  • Sclerosing cholangitis, which causes inflammation, scarring and sometimes destruction of the bile ducts
  • Ulcerative colitis, which causes ulcers in the rectum lining and colon
  • Bile duct stones
  • Cirrhosis, which is progressive scarring of the liver and is most often caused by alcohol abuse and infections such as hepatitis C and B

Age
Nearly 60% who develop bile duct cancer are over the age of 65.

Liver Fluke Infection
Flukes are parasitic worms that can enter your body if you eat undercooked freshwater fish that contains parasites. Once they have entered the body, liver flukes go and inhabit the bile ducts. The species of fluke connected to bile duct cancer is mostly found in Southeast Asia.

Other Risk Factors:
Family history of bile duct cancer, smoking, diabetes and pancreatitis may also play a role.

 Treatments:

Most cases of bile duct cancer cannot be cured. Instead, treatment is most commonly used to relieve symptoms. The treatment plan will be determined by the stage the cancer has reached.

In \ stage 1 and stage 2 cases of bile duct cancer, a cure may be possible by surgically removing the affected part of the bile duct, and possibly some of the liver or gallbladder.

In a stage 3 case, the chances of achieving a successful cure will depend on how many lymph nodes have been affected. A cure may be possible if only a few nodes have cancerous cells in them or it may be possible to slow the spread of the cancer by surgically removing the lymph nodes.

In cases of stage 4 bile duct cancer, achieving a successful cure is highly unlikely. However, chemotherapy, radiotherapy and surgery can often be used to help relieve symptoms.

Surgery:
If it is possible to cure bile duct cancer, surgery will be needed to remove any cancerous tissue. Depending on the extent of the cancer, it may be necessary to remove:

  • the part of your bile duct that contains cancerous cells
  • your gallbladder
  • nearby lymph nodes
  • part of your liver

Unfortunately, due to the aggressive nature of bile duct cancer, fewer than one-third of patients are suitable for surgery. After surgery, it is usually possible to reconstruct what remains of the bile duct so that bile can still flow into the intestine.

Unblocking The Bile Duct:
If the bile duct becomes blocked as a result of cancer, a treatment to unblock the duct is recommended. This will help resolve symptoms such as:

  • jaundice
  • itchy skin
  • abdominal tummy) pain

Unblocking the bile duct is sometimes necessary if the flow of bile back into your liver starts to affect the normal functioning of your liver. The bile duct can be unblocked in several ways. The first is to use a variation of the Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure.

During the procedure, a surgeon will guide a long, flexible tube with a light and video camera on the end (endoscope) into the bile duct and pass down a small metal or plastic tube called a stent. The stent is used to widen the bile duct, which should help to get the bile flowing again.
Alternatively, a stent can be placed in the bile duct using a variation of the Percutaneous Transhepatic Cholangiography (PTC) procedure. This involves placing the stent in the bile duct through a small incision in the stomach.

Radiotherapy:
Radiotherapy cannot cure bile duct cancer but can help to relieve the symptoms, slow the spread of cancer and prolong life. Two types of radiotherapy are used to treat bile duct cancer:

  • External beam radiotherapy – a machine is used to target radioactive beams at your bile duct
  • Internal radiotherapy (brachytherapy) – a radioactive wire is placed inside your bile duct next to the tumour

Radiotherapy works by damaging cancerous cells. However, it can also damage healthy cells and cause side effects. Side effects of radiotherapy include:

  • nausea
  • vomiting
  • fatigue

Chemotherapy:
Chemotherapy is used in a way similar to radiotherapy to relieve the symptoms of cancer, slow down the rate at which it spreads and prolong life. It is sometimes used in combination with radiotherapy.
As with radiotherapy, medicines used in chemotherapy can sometimes damage healthy tissue as well as cancerous tissue, and adverse side effects are common. Side effects of chemotherapy can include:

  • nausea
  • vomiting
  • fatigue
  • hair loss

However, these side effects should stop once the course of treatment has finished.

Photodynamic Therapy (PDT):
Photodynamic Therapy is a new technique that can help to control – but not cure – the symptoms of bile duct cancer. A special chemical is injected into the bile duct, which makes the cancerous cells more sensitive to light. A laser is then passed through an endoscope and used to shrink the tumour.