Wednesday, September 28, 2011

What are the different types of vascular dementia?

There are two main types of vascular dementia: one caused by stroke and one caused by small vessel disease. A third type is a mixture of the two. There are many other types of vascular dementia.
Stroke-related dementia

Stroke is the term used to describe permanent brain damage caused by an interruption in the supply of blood to specific parts of the brain. The symptoms that a person experiences as a result of a stroke depend on which area of the brain has been damaged. If the area in question is responsible for movement of a limb, paralysis might occur. If it is responsible for speech, the person might have problems communicating. Equally, damage to particular areas in the brain can cause the symptoms of dementia.

When vascular dementia is caused by a single stroke, it is sometimes called single-infarct dementia. Vascular dementia can also be caused by a series of small strokes. These can be so tiny that the person might not notice any symptoms, or the symptoms may be only temporary. This is called multi-infarct dementia.

Always consult a doctor if you experience any sudden symptoms, such as slurred speech, weakness on one side of the body, or blurred vision - even if they are only temporary. These episodes may be caused by temporary interruptions in the blood supply within the brain, known as transient ischaemic attacks. If left untreated, they can lead to permanent damage.
Small vessel disease-related dementia

This type of dementia, also known as sub-cortical vascular dementia or, in a severe form, Binswanger's disease, is caused by damage to tiny blood vessels that lie deep in the brain. The symptoms develop more gradually and are often accompanied by walking problems.
Vascular dementia and Alzheimer's disease (mixed dementia)

A diagnosis of mixed dementia means that Alzheimer's disease, as well as stroke or small vessel disease, may have caused damage to the brain.

Tuesday, September 27, 2011

What is vascular dementia?

Vascular dementia is the second most common form of dementia after Alzheimer's disease. This factsheet will help you to understand vascular dementia by explaining the causes, symptoms and treatments available.

What do we mean by 'vascular dementia'?

The term 'dementia' is used to describe the symptoms that occur when the brain is damaged by specific diseases. These diseases include Alzheimer's disease and vascular dementia. Someone with dementia may have difficulties remembering, solving problems or concentrating. Vascular dementia is a type of dementia caused by problems in the supply of blood to the brain.
How does it develop?

To be healthy and function properly, the brain cells need a good supply of blood. The blood is delivered through a network of blood vessels called the vascular system. If the vascular system within the brain becomes damaged and blood cannot reach the brain cells, the cells will eventually die. This can lead to the onset of vascular dementia.

What causes damage to the vascular system in the brain?

There are a number of conditions that can cause or increase damage to the vascular system. These include high blood pressure, heart problems, high cholesterol and diabetes. This means it is important that these conditions are identified and treated at the earliest opportunity.
What are the symptoms?

Vascular dementia affects different people in different ways and the speed of the progression varies from person to person. Some symptoms may be similar to those of other types of dementia.

However, people with vascular dementia may particularly experience:

* problems concentrating and communicating
* depression accompanying the dementia
* symptoms of stroke, such as physical weakness or paralysis
* memory problems (although this may not be the first symptom)
* a 'stepped' progression, with symptoms remaining at a constant level and then suddenly deteriorating
* epileptic seizures
* periods of acute confusion.

Other symptoms associated with vascular dementia may include:

* visual mistakes and misperception
* walking about and getting lost
* changes in behaviour
* restlessness
* problems with continence.

Monday, September 26, 2011

Types of Dementia

There are many different types of dementia although some are far more common than others. They are often named according to the condition that has caused the dementia. Some of the more common types are outlined below.

Alzheimer's disease
vascular dementia
dementia with Lewy bodies (DLB)
fronto-temporal dementia (including Pick's disease)
Korsakoff's syndrome
Creutzfeldt-Jakob disease (CJD)
HIV-related cognitive impairment
Mild cognitive impairment


Dementia is a term used to describe various different brain disorders that have in common a loss of brain function that is usually progressive and eventually severe. There are many types of dementia. The most common are Alzheimer's disease, vascular dementia and dementia with Lewy bodies.

The term 'dementia' is used to describe the symptoms that occur when the brain is affected by specific diseases and conditions.

Symptoms of dementia include
-loss of memory
-confusion and problems with speech and understanding.

Monday, September 19, 2011

Vitamin B may lower Alzheimer's risk

Daily consumption of B- vitamins and folic acid may considerably slow the onset of memory loss in older people and even prevent Alzheimer's disease.

A study of 266 people aged 70 and older showed that large doses of B6, B12 and folic acid reduced the overall senile shrinkage of brains by 30 percent.

Participants were suffering mild cognitive impairment (MCI), a condition which is an intermediate stage between the expected cognitive decline of normal aging and the more pronounced decline of dementia. It involves problems with memory, language, thinking and judgment and increases the risk of developing dementia and Alzheimer's disease.

According to the results published in the International Journal of Geriatric Psychiatry, and PLoS One, brain scans of those who took the prescribed supplements showed that the vitamin pills reduced brain atrophy by 30 percent on average.

Taking the vitamins was even more effective on patients with high levels of an amino acid called homocysteine and reduced brain atrophy among them by 50 percent.

"High homocysteine is a known risk factor for cognitive decline in the elderly and Alzheimer's disease and also for other kinds of dementia like vascular dementia," said lead researcher Celeste de Jager. "It can be damaging to the endothelial lining of the blood cells. It also binds to receptors in the brain that are on the neurons and it seems to contribute the atrophy that's associated with Alzheimer's."

Taking B vitamins and folic acid is known to control the levels of homocysteine, which increases in old age, added the scientist who works with Oxford University.

The new findings "definitively" showed that the vitamins were a good way of preventing mental decline, the study concluded.

"A lot of the time brain changes start in your 40s and 50s before you get clinical symptoms," de Jager told the British Science Festival. "I would think that in middle age people should start thinking about their vitamin levels."

Researchers, however, warned people not to take vitamins without consulting their doctors because supplements can cause some harmful impact on other conditions such as cancer.

Asked if she would take the vitamins as a precaution, Dr de Jager said: "I would ask the doctor to check my B12 and my folic acid levels for starters. "I take supplements when I'm feeling a bit low, I don't take one every day but I would certainly have multi-vitamins and B vitamins in my cupboard."

Alzheimer's drug guidelines

What are the drugs involved?

The three drugs which look likely to be available to patients with "mild" Alzheimer's are Aricept (donepezil), Reminyl (galantamine) and Exelon (rivastigmine).

In addition, NICE says a fourth drug, Ebixa, should be prescribed to patients with more advanced Alzheimer's.

How do they work?

One theory of the origins of Alzheimer's disease in some patients is damage to the "cholinergic" system in the brain, which leads to a shortage of a neurotransmitter called acetylcholine which has been linked to memory function in Alzheimer's.

All of the three drugs work by inhibiting an enzyme which breaks down acetylcholine - hopefully boosting levels of the brain chemical.

What benefits have been seen?

The drugs do not cure Alzheimer's. There is no proof that the drugs can alter the course of the disease or extend life. However, there is evidence that they can lessen symptoms such as memory loss and confusion in patients with "mild" Alzheimer's. This in turn can improve quality of life, and allow patients to live more independently for longer. One analysis conducted by NICE suggests that they could delay the need for someone to go into full-time care by over six weeks.

However, they do not work for everyone. It is estimated that between 40% and 70% of patients achieve some kind of benefit, and side effects can include dizziness, insomnia and nausea.

Why have the guideline changes been proposed?

NICE says that the publication of further clinical studies into the drugs in the five years since they were last appraised show more clearly the benefits to patients with "mild" Alzheimer's.

Campaigners had argued that the "economic model" used to calculate whether the drugs offered economic "value for money", did not accurately reflect the hidden economic costs of extra care outside hospital.

NICE says this time around it considered new evidence on the possible cost savings of treating early Alzheimer's patients.

How much more will it cost the NHS?

This is not entirely clear yet. The cost of the drugs themselves is roughly £1,000 per year, per patient, but the benefits of the treatment do not continue forever, and the exact number of patients who will benefit has yet to be determined. NICE calculates that more than 380,000 have Alzheimer's, approximately half of these being in the "mild to moderate" group.

The Alzheimer's Society believes the number is higher, but with an estimated 62,000 people developing Alzheimer's each year, it is likely that hundreds of thousands of people could potentially be eligible over the next few years.

However, NICE says it is confident that the extra cost of caring for these patients outweighs the cost of the drugs themselves.

Friday, September 16, 2011

Coffee protects brain from Alzheimer's

For years we’ve been told that was bad for us. It’s unhealthy and addictive, doctors warned. But as vindication for all who stuck by their energizing elixir, a new study shows that coffee may actually be good for our brains. In fact, it may help keep Alzheimer disease away.

The study, which was published early online in the Journal of Alzheimer’s Disease, was in mice whose DNA had been tweaked to contain a human Alzheimer’s gene. Just like humans with familial Alzheimer’s, these mice become increasingly forgetful as they age.

Amazingly, the equivalent of four to five cups of caffeinated coffee every few days led to much improved memories in the Alzheimer’s mice, says study co-author Gary Arendash, a scientist at the Florida Alzheimer’s Disease Research Center in Tampa.

Earlier research by Arendash and his colleagues showed that caffee could at least partially block the production of beta amyloid, the sticky protein that clogs the brains of Alzheimer’s patients. They also found that a substance called granulocyte-colony stimulating factor, or GCSF, sparked the production of new axons, the communication cables that link nerve cells together, as well as new nerve cells themselves.

What’s really interesting is that caffeinated coffee and decaffeinated coffee -help us to keep away Alzheimer disease.

For the new study, Arendash and his colleagues “treated” healthy mice and Alzheimer’s mice with either caffeinated or decaffeinated coffee. Then the researchers ran a test to see if either beverage led to better memories.

The test they used mimics one that is given to humans to diagnose Alzheimer’s. In that test, people are given a bag of objects to look through (we’ll call that Bag A). And then they’re shown another bag of objects (Bag B). Later on, they’re asked to remember what was in Bag A.

Studies have shown that people with Alzheimer’s have a tough time remembering what was in Bag A because the distraction of looking through the objects from Bag B gets in the way of storing the contents of A in their long term memories. That’s generally not a problem for people with healthy brains.

The two part mouse test involved water mazes. The mice has to find -- and remember -- the location of a submerged platform in a tub of water that is deep enough that they need to swim till they find the platform.

After they find the platform in one tub, they’re moved to another tub where they have to find yet another platform. Mice with Alzheimer’s generally have a tough time remembering the location of the first platform when they’re placed in the original tub. But in Arendash’s study, Alzheimer’s mice that got caffeinated coffee and decaffeinated coffee had memories that were just as good as those of normal mice.

Lest you dismiss this study because it’s just in rodents, Arendash says he’s got new data in humans. That data is still being analyzed, he says, but so far it looks like caffeinated and decaffeinated coffee has the same impact in people as it does in mice.

Insulin spray slows Alzheimer's disease

Using a nasal insulin spray twice a day may slow and even reverse the symptoms of memory loss in patients with early Alzheimer's disease.

During a four months study, researchers tested the effectiveness of using insulin spray for people without diabetes who had been diagnosed with mild memory problems related to Alzheimer's disease or with amnestic mild cognitive impairment (aMCI).

Participants were divided into three groups either receiving 20 milligrams of insulin twice a day, 40 mg twice a day or a saline solution as a placebo.

Findings showed those who received 20 mg of insulin improved performance on a memory test after two months. Improvements persisted after four months and were still observable some time after the insulin treatment stopped.

Patients on higher doses of insulin had no change in their memory status, while those who got the placebo showed a decline.

The differences between those on insulin and those on the placebo were "small in absolute terms" but they were robust enough, authors wrote in the Archives of Neurology.

"Our results suggest that the administration of intranasal insulin may have a therapeutic benefit for adults with aMCI or Alzheimer's disease," wrote Suzanne Craft of the Veterans Affairs Puget Sound Health Care System and the University of Washington School of Medicine.

"The results of our pilot trial demonstrate that the administration of intranasal insulin stabilized or improved cognition, function and cerebral glucose metabolism for adults with aMCI or AD [Alzheimer's disease]," the researcher added.

According to the report, "these results provide an impetus for future clinical trials of intranasal insulin therapy and for further mechanistic studies of insulin's role in the pathogenesis of AD."