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Dementia

Dementia is the gradual loss of brain function caused by injury to or loss of brain cells.

Dementia may be suspected when someone starts to lose abilities with memory, language, social skills, or organizing skills. For dementia to be diagnosed there has to be some effect on daily life, and there has to be a change from the person’s usual abilities.

Some examples include:

  • Conversation: becoming lost in conversation, repeating the same story in one sitting
  • Work: making mistakes in routine work, declining work performance
  • Money: forgetting to pay bills or overpaying bills, overdue notices
  • Shopping: leaving spoiled food in fridge, overstocking food, running out of food
  • Social skills: obvious change in personality such as new aggression or acting out
  • Speech: difficulty remembering common words, using wrong words

It is normal to occasionally forget the name of distant friends or relatives or the name for uncommon objects (tip-of- the-tongue). By itself this type of forgetfulness is not usually a sign of dementia, especially if it is not worsening over time.

Not everyone with memory problems has dementia. Sometimes a problem like depression or low thyroid can look like dementia. Sometimes there may be another reason for changes in the person’s life, like not having enough money or abusing alcohol or drugs.

Any person with dementia that seems to be changing over days or weeks should be seen in a hospital emergency room. People with dementia that progresses over months to years may be seen by their family doctor. If possible, family or friends should come to the doctor’s visit because their description of the problem can help the doctor decide if there is a problem. In most cases patients will need a pen-and- paper test of thinking and memory to help understand whether there is a problem.

If the doctor believes there may be a dementia, then further testing may be needed to find out the cause. This may include blood tests, brain scan (CAT scan or MRI), or spinal fluid analysis.

Different patients will need different tests, depending on the person’s age and medical problems.

The treatment for dementia depends on the cause. Some types of dementia have a reversible cause, like certain brain infections. Other types of dementia do not have a reversible cause, like Alzheimer’s disease. Medicine cannot cure Alzheimer’s dementia, but can help with some of the memory or mood symptoms.

Taking care of the brain’s blood vessels helps to prevent some types of dementia, especially dementia due to stroke. Quitting smoking is one of the most important things that you can do for your brain’s health. Staying physically active and keeping blood pressure, cholesterol, and blood sugar under control also help to prevent stroke. All of this also helps to keep your heart and kidneys healthy too.

Keeping your brain active can help lower your chances of developing dementia. Low cost ways to keep your brain active include learning a second language, learning to play a musical instrument, learning new skills for work or school, and remaining socially active with friends.

Stroke

Stroke is a problem with the blood supply to the brain. There are two types of stroke – clot-type strokes (“ischemic”) and bleeding-type strokes (“hemorrhagic”).

Stroke is a 9-1-1 emergency. Call 9-1-1 as soon as you think there might be a stroke. Do not wait to see if the problem gets better.

The FAST signs of stroke include:

  • Face – is it drooping?
  • Arms – can you raise both arms?
  • Speech – is it slurred or jumbled?
  • Time to call 9-1-1 right away

The doctor or nurse will ask you about the problem, the time that it started, and will examine you to look for signs of a stroke. If there are signs of a stroke you will probably have a brain scan (CAT scan) right away and blood tests.

Sometimes the signs of stroke start to disappear a few minutes after starting. This is called a TIA (“transient ischemic attack”). In some patients this is a warning sign of a future big stroke. Even if the problem has gotten better, it is still important to get to the hospital right away.

 

Some clot-type (ischemic) strokes can be treated to limit damage to the brain. Unfortunately, not all ischemic strokes can be treated. When treatment can be given it works best when started quickly – minutes count. Current treatments include:

  •  TPA – a clot-busting drug to break apart the blood clot in the brain
  • Thrombectomy – removal of the blood clot during a special procedure guided by an x-ray.

Bleeding-type (hemorrhagic) strokes can be very serious. Some require surgery to prevent worsening of the stroke, especially if the bleeding is from a weakened blood vessel (aneurysm).

A warning stroke is usually treated with a mild blood thinner like acetylsalicylic acid (ASA, Aspirin). Some patients may need a stronger blood thinner if there is an irregular heartbeat (“atrial fibrillation”). A few patients will need an operation to open up a narrowed artery in the neck.

Taking care of the brain’s blood vessels helps to prevent stroke. Quitting smoking is one of the most important things that you can do for your brain’s health. Staying physically active and keeping blood pressure, cholesterol, and blood sugar under control also help. All of this also helps to keep your heart and kidneys healthy too.

Headache

Headache is any type of head pain. Headache is rarely a symptom of a dangerous disease.

Almost everyone will have a mild headache at some point in their life. These headaches last a few hours and don’t limit activity. They may be triggered by stress or alcohol. Such headaches do not need a doctor’s attention if they are similar to past headaches.

Headaches with warning signs:

Some headache are serious and have important warning signs. If you have a headache with any of the following characteristics you should go immediately to a hospital emergency room:

  • Head pain that starts suddenly or explosively – like a firecracker
  • Head pain with fever or stiff neck
  • Head pain with other symptoms such as weakness, numbness, clumsiness, unsteadiness, change in vision, change in speaking or difficulty understanding what people are saying
  • Head pain that is different from usual headaches (different feeling, different location, more severe, lasting longer, getting worse with time)
  • Head pain that gets worse when lying down or resting
  • Head pain that is lasting longer than usual

Migraine

Migraines are repeated headaches with severe pain. Some migraines can be accompanied by a change in vision or speaking. Despite these symptoms, migraines are not dangerous. Migraine is usually diagnosed if there is a pattern of headaches with:

  • Throbbing pain or one-sided pain
  • Nausea
  • Sensitivity to light and sound
  • Worse with activity and better with rest

Your description of the headache and a doctor’s examination of you are the most important tools in finding the cause of your headache. Only a few headaches need special tests (blood test, spinal fluid test, or brain scan such as CAT scan or MRI).

The best treatment for headache depends on the cause of the headache.

Headaches with warning signs should be seen by a doctor on the same day. You should not try to treat these headaches by yourself.

Occasional mild headaches can be treated with over the counter medications such as acetaminophen (Tylenol) or ibuprofen (Advil). It is important to follow the package directions.

Ask your pharmacist before starting any new over the counter medicine. There are many medicines that can be used to treat migraine headache.

  • Some people get good relief using over the counter medications like naproxen or ibuprofen
  • Other people may need special migraine medicines called ‘triptans.’ Triptans work very well for migraine, but they are prescription medicines and are not safe for everyone. You should speak with your doctor before trying these medications.
  • Some people like to use vitamin treatment on top of or instead of treatment with medications. Riboflavin (vitamin B2) and magnesium have shown some benefit in preventing headache in people prone to migraine