CHAPTER I

INTRODUCTION
1.1.

Background
There are many sorts of dementia such as Alzheimers disease. They all affect the

brain. Gradually the person loses his memory. He cant do the things he used to. In the
end he cannot speak.
This doesnt happen overnight. It happens gradually, bit by bit. In the middle of it
is a person who knows he is losing his mind, his independence, and his place in the
world. Alongside him is his family, who know they are losing him. Just because he
cannot speak, it does not mean he cannot understand
Dementia affects the brain. The person gradually loses his intelligence, his
memory and his personality. Some go quietly, others rebel. They can shout or swear or
even strike out. This is distressing for people close to them.
People with dementia become muddled. They forget where they are. They may
act as if they are somewhere else. They may not know what time it is. They may mix
up night and day. They can wander out of their houses in the small hours believing it
is time to go shopping.
1.2.

Problems
Alzheimer's disease is a progressive, degenerative and irreversible brain disorder

that causes intellectual impairment, disorientation and eventually death and the most
common cause of dementia.
There is no cure. It is estimated that 2-5% of people over 65 years of age and up
to 20% of those over 85 years of age suffer from the disease.
1.3.

Methods of Writing
This topic is approached through a selective literature review. This study used the

database assembled by the Indonesian Heart Health Surveys Research Group between
1992 and 2009 a stratified representative sample comprising Indonesian men residents
aged 45.

1.4.

Frame of Writing

CHAPTER I

INTRODUCTION
1.1. Background
1.2. Problems
1.3. Methods of Writing
1.4. Frame of Writing

CHAPTER II

HYPERTENSION
2.1. Definition of hypertension
2.2. Symptoms of hypertension
2.3. Causes of hypertension
2.4. Risk factors of hypertension
2.5. Complications of hypertension
2.6. Tests and diagnosis of hypertension
2.7. Treatments and drugs of hypertension

CHAPTER III

DECOMPENSATIO CORDIS
3.1. Definition of decompensatio cordis
3.2. Symptoms of decompensatio cordis
3.3. Causes of decompensatio cordis
3.4. Risk factors of decompensatio cordis
3.5. Complications of decompensatio cordis
3.6. Tests and diagnosis of decompensatio cordis
3.7. Treatments and drugs of decompensatio cordis
3.8. Prevention of decompensatio cordis

CHAPTER IV

THE

CORRELATION

BETWEEN

HYPERTENSION

AND DECOMPENSATIO CORDIS

CONCLUSION
REFERENCES

CHAPTER II
DEMENTIA

2.1. DEFINITION
Dementia isn't a specific disease. Instead, it describes a group of symptoms
affecting intellectual and social abilities severely enough to interfere with daily
functioning. It's caused by conditions or changes in the brain. Different types of
dementia exist, depending on the cause. Alzheimer's disease is the most common type.
Memory loss generally occurs in dementia, but memory loss alone doesn't mean
you have dementia. Dementia indicates problems with at least two brain functions,
such as memory loss along with impaired judgment or language. Dementia can make
you confused and unable to remember people and names. You may also experience
changes in personality and social behavior. However, some causes of dementia are
treatable and even reversible.

2.2. SYMPTOMS
Dementia symptoms vary depending on the cause, but common signs and
symptoms include:

Memory loss
Difficulty communicating
Inability to learn or remember new information
Difficulty with planning and organizing
Difficulty with coordination and motor functions
Personality changes
Inability to reason
Inappropriate behavior
Paranoia
Agitation
Hallucinations

2.3. CAUSES
Dementia has many causes. It's not always caused by the same disease. And some
dementias such as Alzheimer's disease occur on their own, not as a result of
another disease. Much is still unknown about how some diseases may be linked to
dementia.
Dementias can be classified in a variety of ways and are often grouped together

by what they have in common, such as what part of the brain is affected, or whether
they get worse with time (progressive dementias). Some dementias, such as those
caused by a reaction to medications or an infection, are reversible with treatment.
Progressive dementiasSeveral main types of progressive dementia dementias that
get worse with time exist.

Alzheimer's disease.
Alzheimer's disease is caused by the destruction of brain cells. Although the
exact cause isn't known, two types of brain cell (neuron) damage are common
in people who have Alzheimer's disease. These include plaques (clumps of a
normally harmless protein called beta-amyloid) and tangles (fibrous tangles
made up of an abnormal protein called tau protein). Alzheimer's disease
usually progresses slowly, over seven to 10 years, causing a gradual decline in
cognitive abilities. Eventually, the affected part of the brain isn't able to work
properly because of limited functions, including those involving memory,
movement, language, judgment, behavior and abstract thinking. Alzheimer's
disease is the most common cause of dementia in people age 65 and older.
Symptoms usually appear after age 60, although early-onset forms of the

disease can occur, usually as the result of a defective gene.

Lewy body dementia.
Lewy bodies are abnormal clumps of protein that have been found in the
brains of people with Lewy body dementia, Alzheimer's disease and
Parkinson's disease. The symptoms of this dementia are similar to Alzheimer's
disease, but its unique features often include fluctuations in confusion and
clear thinking (lucidity), visual hallucinations and Parkinson's signs like
tremor and rigidity. These people will often have a condition called REM sleep
behavior disorder (RBD) that involves acting out dreams, including thrashing
or kicking during sleep.

Vascular dementia.
This dementia is a result of damage to your brain caused by problems with the
arteries serving your brain or heart. Symptoms begin suddenly, often after a
stroke, and may occur in people with high blood pressure, or previous strokes
or heart attacks. Vascular dementia may also be caused by infection of a heart
valve (endocarditis) or a buildup of amyloid protein in the brain's blood
vessels (amyloid angiopathy) that sometimes causes "bleeding" (hemorrhagic)

strokes. Several types of vascular dementia exist and vary in their causes and
symptoms. Some types only affect one side of the body, and some cause
memory loss, confusion and mood changes. In some forms, symptoms may
progressively worsen while in others, they may appear only temporarily. In
general, vascular dementia is more common with age. Often this dementia

coexists with Alzheimer's disease.

Frontotemporal dementia.
This is a group of diseases characterized by the degeneration of nerve cells in
the frontal and temporal lobes of the brain the areas generally associated
with personality, behavior and language. The cause isn't known, although in
some cases this dementia is related to certain genetic mutations. But many
people have no family history of dementia. Also, for some people with a form
of this condition called Pick's disease, the affected parts of the brain contain
fibrous tangles made up of the abnormal protein called tau protein. Pick's
disease causes progressive dementia. Signs and symptoms of frontotemporal
dementia which can include socially inappropriate behaviors, loss of
mental flexibility, language problems and difficulty with thinking and
concentration usually appear between the ages of 40 and 65.

Other disorders linked to dementia

Huntington's disease.
This inherited disease causes certain nerve cells in your brain and spinal cord
to waste away. Signs and symptoms typically appear during your 30s or 40s.
They may include mild personality changes at first irritability, anxiety and
depression and progress to severe dementia. Huntington's disease also
causes difficulty with walking and movement, weakness and clumsiness.

Dementia pugilistica.
This condition, also called chronic traumatic encephalopathy or boxer's
dementia, is caused by repetitive head trauma, such as experienced by boxers.
Depending on the part of the brain injured, it can cause dementia signs and
symptoms such as memory problems, poor coordination and impaired speech,
as well as tremors, slow movement and muscle stiffness (parkinsonism).
Symptoms may not appear until many years after the actual trauma. A single
traumatic head injury can cause posttraumatic dementia, which is much like
5

dementia pugilistica, but may include long-term memory problems.

HIV-associated dementia.
Infection with the human immunodeficiency virus (HIV), which causes AIDS,
leads to widespread destruction of brain matter and results in impaired
memory, apathy, social withdrawal and difficulty concentrating. Often,

problems with movement also develop.

Creutzfeldt-Jakob disease.
This rare, fatal brain disorder most often occurs sporadically in people with
no known risk factors. However, a few cases are hereditary or caused by
exposure to diseased brain or nervous system tissue. Signs and symptoms
usually appear around age 60 and initially include problems with coordination,
personality changes and impaired memory, judgment, thinking and vision.
Mental impairment becomes severe as the illness progresses, and it often leads

to blindness. Pneumonia and other infections also are common.

Secondary dementias.
Sometimes, people with other disorders that primarily affect movement, for
example, Parkinson's disease, may eventually develop symptoms of dementia.
The relationship between these disorders and dementia isn't completely
understood.

Dementia causes that can be reversedSome causes of dementia or dementia-like

symptoms can be reversed. Your doctor can identify and treat causes such as:

Infections and immune disorders.

Dementia can result from fever or other side effects of your body's attempt to
fight off an infection. Examples of such infections include brain infections like
meningitis and encephalitis, untreated syphilis, Lyme disease, and conditions
that cause a completely compromised immune system, such as leukemia.
Conditions such as multiple sclerosis that arise from the body's immune

system attacking nerve cells also can cause dementia.

Metabolic problems and endocrine abnormalities.
These include thyroid problems, too little sugar in the bloodstream
(hypoglycemia), too little or too much sodium or calcium, and an impaired

ability to absorb vitamin B-12.

Nutritional deficiencies.
Symptoms can occur as a result of dehydration, not having enough thiamin
(vitamin B-1) a condition common in people with chronic alcoholism
and deficiencies in vitamins B-6 and B-12. Bananas, lentils, spinach, fortified
6

breakfast cereals, salmon, pork, chicken, whole-wheat bread, milk and eggs

are all good sources of these B vitamins.

Reactions to medications.
Dementia may occur as a reaction to a single medication or because of an

interaction of several drugs.

Subdural hematomas.
These are caused by bleeding between the brain's surface and its outer

covering.
Poisoning.
Dementia symptoms can occur as a result of exposure to heavy metals, such as
lead or manganese, and other poisons, such as pesticides. People who have
abused alcohol and recreational drugs also sometimes display symptoms. In all
of these instances, symptoms may go away after treatment or after exposure to

the substance has ended.

Brain tumors.
It's rare, but dementia can be the result of damage caused by a brain tumor.
Anoxia.
This condition, also called hypoxia, occurs when not enough oxygen gets to
organ tissue. Causes include heart attack, severe asthma, carbon monoxide
poisoning, strangulation, high-altitude exposure or an overdose of anesthesia.
Recovery depends on the severity of the oxygen deprivation. Symptoms may
occur during recovery.

Heart and lung problems.

Your brain can't survive without oxygen. Symptoms may occur in people with
chronic lung problems or a heart condition that deprives the brain of the
oxygen it needs.

2.4. RISK FACTORS

Many factors can eventually lead to dementia. Some, such as age, can't be
changed. Others can be addressed to reduce your risk.
Risk factors that can't be changed

Age.
The risk of Alzheimer's disease, vascular dementia and several other
dementias increases significantly with age. However, dementia isn't a normal

part of aging.
Family history.
People with a family history of dementia are at greater risk of developing it.

However, many people with a family history never develop symptoms, and
many people without a family history do. If you have specific genetic
mutations, you're at significantly greater risk of developing certain types of
dementia. Tests to determine whether you have such genetic mutations are
only available for the disorders in which the specific mutation is known, for
example Huntington's disease.
Risk factors you can changeTo reduce your risk of dementia, you can take steps
to control the following factors.

Alcohol use.
Consuming large amounts of alcohol appears to increase the risk of dementia.
Although studies have shown that moderate amounts of alcohol one drink a
day for women and two for men especially red wine, have a protective

effect, abuse of alcohol puts you at increased risk of developing dementia.

Atherosclerosis.
This buildup of fats and other substances in and on your artery walls (plaques)
is a significant risk factor for vascular dementia because it interferes with
blood flow to your brain. This can lead to stroke. Studies have also shown a

possible link between atherosclerosis and Alzheimer's disease.

Blood pressure.
Blood pressure that's too high, and also possibly too low, can put you at risk of
developing Alzheimer's disease and vascular dementia.
Cholesterol.
High levels of low-density lipoprotein (LDL) cholesterol, the "bad"
cholesterol, can significantly increase your risk of developing vascular
dementia. Some research has also linked it to an increased risk of developing
Alzheimer's disease.

Depression.
Although not yet well understood, late-life depression, especially in men, may

be an indication for the development of Alzheimer's-related dementia.

Diabetes.
If you have type 2 diabetes, you're at increased risk of developing both

Alzheimer's disease and vascular dementia.

High estrogen levels.
High levels of total estrogen in women have been associated with greater risk

of developing dementia. This can be determined through a blood test.

Homocysteine blood levels.

Elevated blood levels of homocysteine a type of amino acid produced by

your body may increase your risk of developing Alzheimer's disease and
vascular dementia. When working properly, your body breaks down
homocysteine using vitamins B-6, B-12 and folic acid. If this isn't happening
properly, it may be because you don't metabolize these vitamins well, or you
don't have enough of them in your diet. Blood tests can determine whether you

have elevated homocysteine levels.

Smoking.
Smoking likely increases the risk of developing dementia because it puts you
at a higher risk of atherosclerosis and other types of vascular disease.

2.5. COMPLICATIONS
Dementia can affect the functioning of many body systems and, therefore, the
ability to carry out day-to-day tasks. Dementia may lead to problems such as:

Inadequate nutrition.
Nearly everyone who has dementia will at some point reduce or stop eating
and drinking. Often, advanced dementia causes people to lose control of the
muscles used to chew and swallow, putting them at risk of choking or
aspirating food into their lungs. If this happens, it can block breathing and
cause pneumonia. People with advanced dementia also lose the feeling of
hunger and, with it, the desire to eat. Depression, side effects of medications,
constipation, and other conditions such as infections also can decrease a

person's interest in food.

Reduced hygiene.
In the moderate to severe stages of dementia, you lose the ability to
independently complete daily living tasks. You may no longer be able to bathe,

dress, brush your teeth and go to the toilet on your own.

Difficulty taking medications.
Because a person's memory is affected, remembering to take the correct

amount of medications at the right time can be challenging.

Deterioration of emotional health.
Dementia changes behaviors and personality. Some of the changes may be
caused by the actual deterioration happening in a person's brain, while other
behavioral and personality changes may be reactions to the emotional
challenges of coping with the deterioration changes. Dementia may lead to
depression, aggression, confusion, frustration, anxiety, a lack of inhibition and

disorientation.
Difficulty communicating.
As dementia progresses, the ability to remember the names of people and
things may be lost. This makes communication difficult at all levels, whether
to let a caregiver know what you need and how you feel or simply to
communicate socially. Difficulty communicating can lead to feelings of

agitation, isolation and depression.

Delirium.
This state is characterized by a decline in attention, awareness and mental
clarity. Delirium is common in people with dementia, especially when
admitted to the hospital. It appears that the sudden change in surroundings,

activity level and other routines may be the cause.

Problems sleeping.
Disruption of the normal sleep-wake cycle being up at night and sleeping
during the day is very common. Insomnia is another common complication,
as are restless legs syndrome and sleep apnea, which can also interfere with

sleep.
Personal safety challenges.
Because of a reduced capacity for decision making and problem solving, some
day-to-day situations can present safety issues for people with dementia. These
include driving, cooking, falling and negotiating obstacles.

2.6. TESTS AND DIAGNOSIS

Memory loss and other dementia symptoms have many causes, so diagnosis can
be challenging and may require several doctor visits. Diagnosis involves a number of
tests.
Medical history and physical exam

Medical history.
The doctor will ask about how and when symptoms began and about any
health issues that may help identify the cause of the problem, for example
diabetes, high blood pressure or a family history of dementia. In addition, the
doctor may request information from your caregiver or family member to find
out whether your concerns represent a change from your earlier level of

functioning.
Physical examination.
A physical exam helps your doctor rule out treatable causes of dementia and
identify signs of stroke or other disorders that may cause similar symptoms. It
10

also helps your doctor determine the best course of treatment. As part of an
exam, your doctor may collect urine or blood samples, check blood pressure
and review what medications you're using. This examination can also help
identify signs of other illnesses, such as heart disease, diabetes or thyroid
abnormalities and any medication side effects, which can overlap with

dementia.
Cognitive and neuropsychological tests.
Anyone screened for dementia needs his or her cognitive function evaluated. A
number of tests measure orientation, general intellectual skills, academic
skills, language skills, spatial skills, attention, memory, reasoning and
judgment. The goal is to determine whether dementia is present, how severe it

is and what part of the brain is affected.

Neurological evaluation.
This part of the examination evaluates balance, sensory function and reflexes
to identify conditions that may affect the diagnosis or are treatable with

medication.
Brain scans.
A look at your brain can help your doctor identify strokes, tumors or other
problems that can cause dementia. Alzheimer's disease changes brain structure
over time and can also be seen with a brain scan. Several types of scans are

used.
CT and MRI scans.
The most common imaging techniques for identifying dementia are
computerized tomography (CT) and magnetic resonance imaging (MRI). A CT
scan is an X-ray technique that produces images of your body that show
internal structures in cross section. MRI is a technique that uses a magnetic
field and radio waves to create detailed images of the organs and tissues in
your body. These scans help identify brain-size changes, strokes and other
problems such as excess fluid in the brain (hydrocephalus) or bleeding on the

surface of the brain (subdural hematoma).

Electroencephalogram (EEG).
Using electrodes placed on your scalp, your doctor can detect and record
patterns of electrical activity and check for abnormalities. If found, these
abnormalities can indicate cognitive dysfunction, a condition common in
people with moderate to severe Alzheimer's disease. An EEG may also detect
seizures, Creutzfeldt-Jakob disease and other disorders associated with

11

dementia.
Laboratory tests. A variety of lab tests can help rule out other conditions, such as
kidney failure, that can contribute to symptoms. Treatable medical conditions are
often associated with dementia. Medication and other treatments can improve many
symptoms and quality of life.
Tests that help identify treatable medical conditions include:

A complete blood count (CBC) to rule out anemia

A blood glucose test to rule out diabetes
Blood tests to estimate kidney function, to estimate liver function and to

measure vitamin B-12 levels

A blood or urine screen to identify drugs or alcohol
Cerebrospinal fluid analysis (spinal tap) to rule out brain infections
Analysis of thyroid and thyroid-stimulating hormone levels to rule out
hypothyroidism

Psychiatric evaluation. This examination may be performed to determine whether

depression or another psychiatric disorder is contributing to symptoms.
2.7. TREATMENTS AND DRUGS
Treatment of dementia may help slow or minimize the development of
symptoms.

Cholinesterase inhibitors.
These drugs donepezil (Aricept), rivastigmine (Exelon) and galantamine
hydrobromide (Razadyne) are Alzheimer's drugs that work by boosting
levels of a chemical messenger involved in memory and judgment. Side
effects can include nausea, vomiting and diarrhea. Although primarily used as
Alzheimer's drugs, they're also used to treat vascular, Parkinson's and Lewy

body dementias.
Memantine (Namenda).
This drug for Alzheimer's disease works by regulating the activity of
glutamate, another chemical messenger involved in all brain function,
including learning and memory. Its most common side effect is dizziness.
Some research has shown that combining memantine with a cholinesterase
inhibitor may have even better results. Although primarily used to treat
Alzheimer's disease, it may help improve symptoms in other dementias.
12

Other medications. Although no standard treatment for dementia exists, some

symptoms can be treated. Additional treatments aim to reduce the risk factors for
further brain damage. Treatment of the underlying causes of dementia can also slow
or sometimes stop its progress. To prevent a stroke, for example, your doctor may
prescribe medications to control high blood pressure, high cholesterol, heart disease
and diabetes. Doctors may also prescribe medication to treat conditions such as blood
clots, anxiety and insomnia for people with vascular dementia. In addition, some
specific symptoms and behavioral problems can be treated with sedatives,
antidepressants and other medications, but some of these drugs may worsen other
symptoms. Creutzfeldt-Jakob disease has no known treatments. Care is focused on
making sure the person is comfortable.
2.8. PREVENTION
Although research is still ongoing, you can take steps to prevent or delay the
onset of dementia.

Keep your mind active.

Mentally stimulating activities may increase your ability to cope with or
compensate for the changes associated with dementia. This includes such
things as puzzles and word games, learning a language, playing an instrument,
reading, writing, painting or drawing. Not only can these activities delay the
onset of dementia but also can help decrease its effects the more frequent

the activity, the more beneficial the effects.

Be physically and socially active.
Physical and social activities can delay the onset of dementia and also reduce
its symptoms. The more frequent the activities, the more significant their
effects. Examples of physical activity are walking, swimming and dancing.
Social activities include traveling, attending the theater and art exhibits, and

playing cards or games.

Lower your homocysteine levels.
Early research has shown that high doses of three B vitamins folic acid, B6 and B-12 help lower homocysteine levels and appear to slow the

progression of Alzheimer's disease.

Lower your cholesterol levels.
The deposits that occur in the brains of people with high cholesterol are one of
the causes of vascular dementia. So lowering your cholesterol levels can help
13

prevent this condition. Statin drugs, which help lower cholesterol levels, also

may help lower the risk of developing dementia.

Control your diabetes.
Controlling diabetes can reduce your risk of developing Alzheimer's disease

and vascular dementia.

Lower your blood pressure.
Keeping blood pressure at normal levels can significantly reduce your risk of

Alzheimer's disease and vascular dementia.

Pursue education.
People who've spent more time in formal education appear to have a lower
incidence of mental decline, even when they have brain abnormalities.
Researchers think that education may help your brain develop a strong nerve
cell network that compensates for nerve cell damage caused by Alzheimer's

disease.
Maintain a healthy diet.
Eating a healthy diet is important for many reasons, but studies show that a
diet rich in fruits, vegetables and omega-3 fatty acids, commonly found in
certain fish and nuts, can have a protective effect and decrease your risk of

developing dementia.
Get your vaccinations.
Those who receive vaccinations for influenza, tetanus, diphtheria and polio
appear to have a significantly reduced risk of Alzheimer's disease, so staying
current on your vaccinations could have a protective effect against developing
dementia.

14

CHAPTER III
ALZHAIMERS DISEASE
2.1. DEFINITION
Alzheimer's disease is the most common cause of dementia the loss of
intellectual and social abilities severe enough to interfere with daily functioning. In
Alzheimer's disease, healthy brain tissue degenerates, causing a steady decline in
memory and mental abilities.
Alzheimer's disease is not a part of normal aging, but the risk of the disorder
increases with age. About 5 percent of people between the ages of 65 and 74 have
Alzheimer's disease, while nearly half the people over the age of 85 have Alzheimer's.
Although there's no cure, treatments may improve the quality of life for people
with Alzheimer's disease. Those with Alzheimer's as well as those who care for
them need support and affection from friends and family to cope.
2.2. SYMPTOMS
Alzheimer's disease may start with slight memory loss and confusion, but it
eventually leads to irreversible mental impairment that destroys a person's ability to
remember, reason, learn and imagine.
Memory lossEveryone has occasional lapses in memory. It's normal to forget
where you put your car keys or to blank on the names of people whom you rarely see.
But the memory problems associated with Alzheimer's disease persist and worsen.
People with Alzheimer's may:

Repeat things
Often forget conversations or appointments
Routinely misplace things, often putting them in illogical locations
Eventually forget the names of family members and everyday objects
Problems with abstract thinking.
People with Alzheimer's may initially have trouble balancing their checkbook,
a problem that progresses to trouble recognizing and dealing with numbers.
Difficulty finding the right word.
It may be a challenge for those with Alzheimer's to find the right words to
express thoughts or even follow conversations. Eventually, reading and

15

writing also are affected.

DisorientationPeople with Alzheimer's disease often lose their sense of time and
dates, and may find themselves lost in familiar surroundings.
Loss of judgmentSolving everyday problems, such as knowing what to do if food on
the stove is burning, becomes increasingly difficult, eventually impossible.
Alzheimer's is characterized by greater difficulty in doing things that require planning,
decision making and judgment.
Difficulty performing familiar tasksOnce-routine tasks that require sequential
steps, such as cooking, become a struggle as the disease progresses. Eventually,
people with advanced Alzheimer's may forget how to do even the most basic things.
Personality changesPeople with Alzheimer's may exhibit:

Mood swings
Distrust in others
Increased stubbornness
Social withdrawal
Depression
Anxiety
Aggressiveness

2.3. CAUSES
No one factor appears to cause Alzheimer's disease. Instead, scientists believe
that it may take a combination of genetic, lifestyle and environmental factors to
trigger the onset of symptoms. While the causes of Alzheimer's are poorly understood,
its effect on brain tissue is clear. Alzheimer's disease damages and kills brain cells.
Two types of brain cell (neuron) damage are common in people who have
Alzheimer's:

Plaques.
Clumps of a normally harmless protein called beta-amyloid may interfere with
communication between brain cells. Although the ultimate cause of neuron
death in Alzheimer's isn't known, mounting evidence suggests that the
abnormal processing of beta-amyloid protein may be the culprit.

Tangles.
The internal support structure for brain cells depends on the normal
functioning of a protein called tau. In people with Alzheimer's, threads of tau

16

protein undergo alterations that cause them to become twisted. Many

researchers believe this may seriously damage neurons, causing them to die.
2.4. RISK FACTORS

Age.
Alzheimer's usually affects people older than 65, but can, rarely, affect those
younger than 40. Less than 5 percent of people between 65 and 74 have

Alzheimer's. For people 85 and older, that number jumps to nearly 50 percent.
Heredity.
Your risk of developing Alzheimer's appears to be slightly higher if a firstdegree relative parent, sister or brother has the disease. Although the
genetic mechanisms of Alzheimer's among families remain largely
unexplained, researchers have identified several genetic mutations that greatly

increase risk in some families.

Sex.
Women are more likely than men are to develop the disease, in part because

they live longer.

Mild cognitive impairment.
People who have mild cognitive impairment have memory problems that are
worse than what might be expected for people of their age, yet not bad enough
to be classified as dementia. Many of those who have this condition go on to

develop Alzheimer's disease.

Lifestyle.
The same factors that put you at risk of heart disease may also increase the
likelihood that you'll develop Alzheimer's disease. Examples include:
High blood pressure
High cholesterol
Poorly controlled diabetes
Education levels.
Studies have found an association between less education and the risk of
Alzheimer's. But the precise reason why this occurs is unknown. Some
researchers theorize that the more you use your brain, the more synapses you
create, which provides a greater reserve as you age. But it may simply be
harder to detect Alzheimer's in people who exercise their minds frequently or
who have more education.

And keeping your body fit isn't your only concern you've got to exercise your
mind as well. Some studies have suggested that remaining mentally active throughout

17

your life, especially in your later years, reduces the risk of Alzheimer's disease.
2.5. COMPLICATIONS
In advanced Alzheimer's disease, people may lose all ability to care for
themselves. This can make them more prone to additional health problems such as:

Pneumonia.
Difficulty swallowing food and liquids may cause people with Alzheimer's to
inhale (aspirate) some of what they eat and drink into their airways and lungs,

which can lead to pneumonia.

Infections.
Urinary incontinence may require the placement of a urinary catheter, which
increases the risk of urinary tract infections. Untreated urinary tract infections

can lead to more-serious, life-threatening infections.

Injuries from falls.
People with Alzheimer's may become disoriented, increasing their risk of falls.
Falls can lead to fractures. In addition, falls are a common cause of serious
head injuries, such as bleeding in the brain.

2.6. TESTS AND DIAGNOSIS

Doctors can accurately diagnose 90 percent of Alzheimer's cases. Alzheimer's
disease can be diagnosed with complete accuracy only after death, when microscopic
examination of the brain reveals plaques and tangles.
To help distinguish Alzheimer's disease from other causes of memory loss,
doctors typically rely on the following types of tests.

Lab testsBlood tests may be done to help doctors rule out other potential

causes of the dementia, such as thyroid disorders or vitamin deficiencies.

Neuropsychological testing.
Sometimes doctors undertake a more extensive assessment of thinking and
memory skills. This type of testing, which can take several hours to complete,
is especially helpful in trying to detect Alzheimer's and other dementias at an

early stage.
Brain scans.
By looking at images of the brain, doctors may be able to pinpoint any visible
abnormalities such as clots, bleeding or tumors that may be causing
signs and symptoms. Positron emission tomography (PET) can reveal areas of
the brain that may be less active and the density of amyloid plaques.

18

Magnetic resonance imaging (MRI).

An MRI machine uses radio waves and a strong magnetic field to produce
detailed images of your brain. You lie on a narrow table that slides into the
tube-shaped MRI machine, which makes loud banging noises during scans.
The entire procedure can take an hour or more. MRIs are painless, but some

people feel claustrophobic in the machine.

Computerized tomography (CT).
For a CT scan, you lie on a narrow table that slides into a small chamber. Xrays pass through your body from various angles, and a computer uses this
information to create cross-sectional images, or slices, of your brain. The test

is painless and takes about 20 minutes.

Positron emission tomography (PET).
During a PET scan, you'll be injected with a low-level radioactive material,
which binds to chemicals that travel to the brain. You lie on a table while an
overhead scanner tracks the radioactive material. This helps show which parts
of your brain aren't functioning properly. The test is painless and can be
particularly useful in distinguishing between different types of dementia.

2.7. TREATMENTS AND DRUGS

Currently, there's no cure for Alzheimer's disease. Doctors sometimes prescribe
drugs to improve signs and symptoms that often accompany Alzheimer's, including
sleeplessness, wandering, anxiety, agitation and depression. But only two varieties of
medications have been proved to slow the cognitive decline associated with
Alzheimer's.

Cholinesterase inhibitors.
This group of medications which includes donepezil (Aricept), rivastigmine
(Exelon) and galantamine (Razadyne) works by improving the levels of
neurotransmitters in the brain. But cholinesterase inhibitors don't work for
everyone. As many as half the people who take these drugs show no
improvement. Other people may choose to stop taking the drugs because of

the side effects, which include diarrhea, nausea and vomiting.

Memantine (Namenda).
The first drug approved to treat moderate to severe stages of Alzheimer's,
memantine protects brain cells from damage caused by the chemical
messenger glutamate. It sometimes is used in combination with a
cholinesterase inhibitor. Memantine's most common side effect is dizziness,
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although it also appears to increase agitation and delusional behavior in some

people.
2.8. PREVETION
Right now, there's no proven way to prevent the onset of Alzheimer's disease.
Human trials of a promising vaccine against Alzheimer's had to be stopped several
years ago because some of the people who received the vaccine developed a serious
inflammation of the brain.
However, you may be able to reduce your risk of Alzheimer's disease by reducing
your risk of heart disease. Many of the same factors that increase your risk of heart
disease can also increase your risk of dementia. The main players appear to be blood
pressure, cholesterol and blood glucose levels.
Keeping active physically, mentally and socially also seems to reduce the
risk of Alzheimer's disease.

CHAPTER IV
THE CORRELATION BETWEEN DEMENTIA AND
ALZHAIMERS DISEASE TO MEN AT THE AGE OF 45 YEARS
OLD IN SOUTH JAKARTA IN 2009

Dementia is a term that is frequently used to describe memory loss. There is a

misconception among many people that dementia is a normal part of aging. Many of
our healthy aging population retain normal cognition well into their elder years.
Although we all feel the affects of aging which is demonstrated by diminished hearing
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and vision, mental processing may slow as well. However, the losses that occur with a
diagnosis of dementia are more profound and are a result of a disease process.
Dementia is a condition of progressive, global deterioration of memory and
cognition that impairs thought and social functioning. There are many causes of
dementia. The most common cause of dementia is Alzheimers disease. Other causes
of reversible dementia are vitamin B-12 deficiency, thyroid disease and prolonged
alcohol abuse.
Dementia is a large category of neurodegenerative conditions that affect the
brain. It includes: Alzheimer's disease, vascular dementia, frontal temporal dementia
dementia pugilistica (boxer's, or repeated traumatic, dementia), and alcoholic
dementia, as well as a few other rare conditions. Memory loss, problems with
processing information, and impaired executive and planning functions are prominent
signs of dementia. The term "senility" is a term that is not used today. The problem
with this word is that it conveys the idea that dementia is an inevitable concomitant of
aging. While aging is the key risk factor for dementia, it is not the direct cause.
Alzheimer's disease is defined as a form of dementia characterized by the gradual
loss of several important mental functions. It is perhaps the most common cause of
dementia in older people, and goes beyond just normal forgetfulness, such as losing
your car keys or forgetting where you parked. Signs of Alzheimer's disease, include
memory loss that is much more severe and more serious, such as forgetting the names
of your children or perhaps where you've lived for the last decade or two.
When looking at dementia vs. Alzheimer's disease, one type of dementia is often
confused with Alzheimer's disease. Multi-Infarct Dementia (MID) is a common cause
of dementia in the elderly and occurs when blood clots block small blood vessels in
the brain and destroy brain tissue. Symptoms of MID, which are very similar to
Alzheimer's disease, include confusion, problems with short term memory, wandering
and getting lost in familiar places, loss of bladder and bowel control, and emotional
problems such as laughing or crying during inappropriate times.
Comparing the Two Diseases
When comparing dementia vs. Alzheimer's disease it is very important to discuss
the differences between the two diseases. Although they have many similarities, there
are a number of differences that must be noted.
Alzheimer's disease is defined as a form of dementia characterized by the gradual
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loss of several important mental functions. It is perhaps the most common cause of
dementia in older Americans, and goes beyond just normal forgetfulness, such as
losing your car keys or forgetting where you parked. Signs of Alzheimer's disease
include memory loss that is much more severe and more serious, such as forgetting
the names of your children or perhaps where you've lived for the last decade or two.
Another way to compare dementia vs. Alzheimer's disease is to realize that
dementia is a medical term used to describe a number of conditions characterized by
the gradual loss of intellectual function. Certain symptoms, as defined by the
American Medical Association, of dementia include memory impairment, increased
language difficulties, decreased motor skills, failure to recognized or identify objects,
and disturbance of the ability to plan or think abstractly.
Yet another way to determine the differences of dementia vs. Alzheimer's disease
is when the onset of the disease was first noticed. Of course, this is a very difficult
thing since the progression of both is very gradual, and often there is no one point
where someone can say, "Aha!" and know that the disease has taken hold. Often the
onset of Alzheimer's can occur as early as 45 years of age. General dementia,
however, usually is noted later in life, perhaps in the 70 to 80 year range.
When looking at dementia vs. Alzheimer's disease, one type of dementia is often
confused with Alzheimer's disease Multi-Infarct Dementia or MID. MID is a
common cause of dementia in the elderly and occurs when blood clots block small
blood vessels in the brain and destroys brain tissue. Symptoms of MID, which are
very similar to Alzheimer's disease, include confusion, problems with short term
memory, wandering and getting lost in familiar places, loss of bladder and bowel
control, and emotional problems such as laughing or crying during inappropriate
times.
Alzheimer's statistics show that the disease can strike men as early as 45, while
dementia generally takes hold after age 70. The most confused form of dementia is
Multi-Infarct Dementia or MID. This condition also attacks the blood vessels in the
brain. Both disorders require testing to determine the best course of treatment.

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CONCLUTION
Dementia is a large category of neurodegenerative conditions that affect the
brain; it includes Alzhaimers disease, vascular dementia, frontal temporal dementia
dementia pugilistica (boxer's, or repeated traumatic, dementia), and alcoholic
dementia, as well as a few other rare conditions. Memory loss, problems with
processing information, and impaired executive and planning functions are prominent
signs of dementia. While aging is the key risk factor for dementia, it is not the direct
cause. Genetic factors play an important role, and environmental and behavioral
factors are probably also connected

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Dementia is a neurological disorder that affects your ability to think, speak,

reason, remember and move. While Alzhaimers disease is the most common cause of
dementia, many other conditions also can cause similar symptoms.
It is important to compare dementia vs. Alzheimer's disease to realize the
differences between the two conditions. Alzheimer's is the most common form of
dementia marked by memory loss in older people. Dementia is the gradual loss of
intellectual function. Alzheimer's statistics show that the disease can strike a person as
early as 45, while dementia generally takes hold after age 70.

REFERENCES

http://yourtotalhealth.ivillage.com/alzheimers-dementia
http://www.mayoclinic.com/health/dementia/DS01131
http://www.mayoclinic.com/health/alzheimers-disease/DS00161
http://www.mayoclinic.com/health/alzheimers-disease-and-dementia/AZ00053

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http://news.bbc.co.uk/2/hi/health/1079432.stm
http://www.rcpsych.ac.uk/default.aspx?page=1427
http://www.everydayhealth.com/specialists/senior_aging/butler/qa/Dementia-vsAlzheimers/index.aspx

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