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Description


The term 'dementia' is used to describe the pattern of deteriorating intellectual function ? particularly (although not exclusively) in the elderly ? that can occur as a result of various neurological disorders. Identifying the underlying cause of dementia is important in targeting appropriate drug therapies to treat the behavioural disturbances of sufferers. The different types of dementia include:


Vascular dementia, which has been found to occur in approximately 25?30 % of patients after a stroke. In Western societies it is the second most common type of dementia, and may occur after either:
   - large vessel strokes, which cause problems with speech, walking and vision, as well as weakness in the limbs; or
   - small vessel strokes, which may cause the same problems as large vessel strokes, but often less severely, and problems with balance and falling. Patients may not be aware that they have had a small vessel stroke.


Patients with vascular dementia have impaired judgment, slowness, difficulty planning and organising tasks, but generally have less severe memory loss than patients with Alzheimer's disease.

Lewy body disease, in which degenerating cells are found in certain areas of the brain. As well as memory loss and confusion, sufferers may also have visual or auditory hallucinations and the tremor, shuffling gait and muscle rigidity seen in Parkinson's disease.
Frontotemporal dementia [or Pick's disease] in which there is a slow deterioration in social behaviour, problems using language, intellectual impairment, and personality change. Its cause is unknown.
'Mixed dementia' which is used to describe patients suffering more than one type at once, the most common being Alzheimer's disease and vascular dementia.


Other causes of dementia include alcohol abuse, HIV/AIDS, certain vitamin deficiencies, brain tumours, Creutzfeldt-Jakob Disease, Huntington's Disease, and thyroid disease.


Treatment

Dementia patients need a safe, familiar environment, either at home or in long-term residential care. Support services for dementia patients are available in each State and Territory through local Council, State Health Departments and voluntary, non-government organisations.

Recent advances in targeting drug therapy according to the underlying cause of the dementia, allow for better management of patients' behavioural and psychological problems Treatment is usually directed at slowing the progress of the disease wherever possible, and alleviating symptoms. Any underlying disease (e.g. high blood pressure) must also be diagnosed and treated. A range of drugs may be used in treatment:

acetylcholinesterase inhibitors have been shown to be effective when used for patients with psychoses (e.g. Lewy body dementia, as well as Alzheimer's disease or mixed dementia);
anti-psychotic drugs may be prescribed for patients suffering from delusions or hallucinations;
anti-depressants may be prescribed for patients suffering from depression; they have also been effective in controlling mood disturbances, irritability and anxiety;
anti-convulsants may be effective in treating some behavioural disturbances.

Treatment should be reviewed regularly, because patients' behaviour alters with the progression of the dementia.


Prognosis

Dementia is a progressive disease for which there is no cure. However, targeted drug therapy can improve the quality of life for both the patient and the carer.

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