Multi-infarct dementia, also known as vascular dementia, occurs when blood flow in the small blood vessels supplying the brain is obstructed by blood clots. Each of these clots prevents oxygen from reaching a small part of the brain, and this causes tissue death (infarcts) in the affected parts. Infarcts occur in a number of distinct episodes. People who have multiple small infarcts are at increased risk of a major stroke, which can be life-threatening.

The risk of multi-infarct dementia is increased by atherosclerosis in which fatty deposits build up in the artery walls, causing them to become narrowed and increasing the risk of clots forming. The risk of atherosclerosis is increased if a person has high blood pressure. Lifestyle factors, such as eating a high-far diet and smoking, can also contribute to the development of atherosclerosis. Multi-infarct dementia is more common in men and is more likely to occur in people over the age of 60.

What are the symptoms?

Symptoms of multi-infarct dementia vary from one individual to another because they depend on the part of the brain affected. Unlike other types of dementia, multi-infarct dementia gets incrementally worse following each separate episode. Symptoms are similar to those that occur with other forms of dementia and include:

- Poor memory, particularly when trying to recall recent events.
- Difficulty in making decisions.
- Problems with simple, routine tasks, such as getting dressed.
- Tendency to wander and get lost in familiar surroundings.

It is common for a person with multi-infarct dementia to develop depression and have episodes of agitation. There may be other symptoms, depending on which part of the brain is affected. These may include partial loss of sight and slow, sometimes slurred, speech. Some people begin to walk with very small steps, or develop a weakness or partial paralysis in one leg that can make walking difficult.

What might be done?

Diagnosis of multi-infarct dementia is usually possible from the symptoms, although various tests, such as blood tests, may also be carried out to rule out other types of dementia. The doctor may arrange for CT scanning or MRI of the brain to look for evidence of multiple small infarcts. Although the dementia itself cannot be cured, treatment can help to prevent further infarcts that would make the condition worse. A person with multi-infarct dementia should eat a low-fat diet and take regular exercise. Smokers should stop smoking immediately. Anti-hypertensive drugs, which help to control raised blood pressure, and a daily dose of aspirin, which reduces the risk of blood clots, may be prescribed.

Weakness and loss of movement can be treated with physiotherapy, and speech therapy can help to alleviate speech problems. Antidepressants and counseling maybe used to treat depression.

What is the prognosis?

Many people with multi-infarct dementia find that their symptoms improve for short periods of time but later become worse again. Early recognition of the condition and treatment of risk factors, such as high blood pressure, may prevent further progression of the disorder and increasing disability and reduce the risk of a future, potentially fatal stroke.

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It is normal to become mildly forgetful with increasing age, but severe impairement of short-term memory may be a sign of Alzheimer’s disease. In this disorder, brain cells gradually degenerate and deposits of an abnormal protein build up in the brain. As a result, the brain tissue shrinks, and there is a progressive loss of mental abilities, known as dementia.

Alzheimer’s disease is the most common cause of dementia. In developed countries, the condition affects about 7 in 100 people by the age of 65 and 3 in 100 people by the age of 85. Sometimes, younger people are affected. The underlying cause of the tissue destruction is unknown, although genetic factors may be involved (liên quan). Studies have found that 15 in 100 people with Alzheimer’s disease have a parent affected by the disorder.

What are the symptoms?

The first symptom of Alzheimer’s disease is usually forgetfulness. The normal deterioration of memory that occurs in old age becomes much more severe and begins to affect intellectual ability. Memory loss is eventually accompanied by other symptoms, which may include:

- Poor concentrarion.
- Difficulty in understanding written and spoken language.
- Wandering and getting lost, even in familiar surroundings.

In the early stages of the disease, people are usually aware that they have become more forgerful. This may lead to derpression and anxiety. Over a longer period, the existing symptoms may get worse and additional symptoms may develop. These may include:

- Slow movements and unsteadiness when walking.
- Rapid mood swings from (thay đổi) happiness to tearfulness.
- Personality changes, aggression, and feelings of persecution.

Sometimes people find it difficult to sleep and become restless at night. After several years, most people with the disease cannot look after themselves and need full-time care.

How is it diagnosed?

There is no single test that can be used to diagnose Alzheimer’s disease. The doctor will discuss the symptoms with the affected person and his or her family. Tests may be arranged to exclude other possible causes of dementia. For example, blood tests may be carried out to check for vitamin B deficiencies. CT scanning, PET scanning, or MRI may be carried out to exclude other brain disorders, such as multi-infarct dementia, subdural haemorrhage, or a brain tumour. An assessment of mental ability, which may include memory and writing tests, may be used to determine the severity of the dementia.

What is the treatment?

There is no cure for Alzheimer’s disease, but drugs such as donepezil may slow the loss of mental function in mild to moderate cases. Some of the symptoms that are sometimes associated with Alzheimer’s desease, such as depression and sleeping problems, can be relieved by antidepressant drugs. A person who is agitated may be given a sedative drugs to calm him or her down.

Eventually, full-time care may be necessary, either at home or in a nursing home. Caring for person who has Alzheimer’s disease is often stressful, and cares need practifal and emotional support, especially if the affected person starts to become hostile and aggressive. Support groups can help a person to cope with caring for an elderly relative with the disease. Most people with Alzheimer’s disease survive for up to 10 years from the time of diagnosis.

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Dementia is a combination of memory loss, confusion, and general intellectual decline. The affected person may not realize that there is anything wrong, but his or her condition is usually distressing for close friends and family. Poor memory alone is not a sign of dementia because some memory impairment is a natural part of aging. Dementia is relatively common in elderly people, with about 1 in 10 people in the UK over the age of 65 affected to some degree. Although dementia is usually progressive and cannot be treated, in about 1 in 10 cases the underlying cause is treatable. An elderly person with severe depression may seem to have dementia because the conditions have similar features, such as forgetfulness.

What are the causes?

The underlying abnormality in dementia is a decline in the number of brain cells, resulting in shrinkage of brain cells. Alzheimer’s disease, which occurs mainly in people over 65 and may run in families, is the most common cause of dementia. In multi-infract dementia, blood flow in the small vessels of the brain is blocked by blood clots. Less common causes of dementia include other brain disorders, such as Huntington’s disease. Parkinson’s disease, and Creutzfeldt-Jacob disease.

Dementia may also occur in young people. For example, people with AIDS related dementia. Long-term abusers of alcohol are at risk of dementia because of derect damage to the brain tissue and because their poor diet often leads to vitamin B1 deficiency. Severe vitamin B1 can cause the brain disorder called as WernickeKorsakoff syndrome. In pernicious anaemia, there is a deficiency of vitamin B12 due to impaired absorption in the digestive tract. A severe deficiency can result in dementia. The disorder may also follow a serious head injury. Certain drugs, such as anticovulsant drugs and mood-stabilizing drugs, may cause memory impairment similar to that of dementia.

What are the symptoms?

The symptoms may develop gradually over a few months or years, depending on the cause. They may include:

- Impairment of short-term memory.
- Gradual loss of intellect, affecting reasoning and understanding.
- Difficulty engaging in conversations.
- Reduced vocabulary.
- Emotional outbursts.
- Wandering and restlessness.
- Urinary incontinence.

In the early stages of the disorder, a person is prone to becoming anxious or depressed due to awareness of the memory loss. As the dementia gets worse, the person may become more dependent on others.

What might be done?

The doctor may arrange for the person to have tests to look for the underlying cause and to exclude other disorders. If memory loss is due to a deficiency of one or more of the B vitamins, injections of vitamin supplements may be given. Symptoms that are caused by certain drugs may be relieved by a change of medication. Most other causes of dementia cannot be treated, but drugs may relieve some symptoms. For example, depression may be treated with antidepressants.

A person who has dementia usually needs support at home and may eventually need full-time care in a nursing home. Carers may also need support.

CARING FOR SOMEONE WITH DEMENTIA

If you are taking care of someone with dementia, you need to balance his or her needs with your own. In the early stages, it is important to allow the person to remain as independent and active as possible. As the disorder progresses, there are several measures you can take which help to compensate for the person’s failing memory, loss of judgment, and unpredictable behaviour:

- Put up a bulletin board with a list of things that need to be done during each day.
- If wandering is a problem, persuade the person to wear a badge with your contact details and phone number on it.
- Place notes around the house that help the person to remember to turn off appliances.
- Consider installing bath aids to make washing easier.
- Try to be patient. It is common for people with dementia to have frequent mood changes.
- Give your self a break whenever you can by finding someone who can help for a few hours.
- Join a carers’ support group and investigate day centres and respite care opinions.

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