Straighten spine (Flatback syndrome)

       Straighten spine (Flatback syndrome)

   The flatback syndrome is an abnormal condition where the spine loses its natural low back curve to become flat. It is a type of sagittal imbalance or front to back imbalance in the spine. 

    Normally the spine has several gentle fronts to back curves. The Lumbar (Lower) spine has a lordosis or inward curve. The thoracic (Middle) spine has kyphosis or outward curve, and the cervical spine (neck) has a lordosis. These curves usually work in harmony to keep the body's center of gravity aligned over the hips and pelvis. If the lumbar lordosis is lost the center of gravity can be put too far forward. This is the case in flatback syndrome. 

  The human spine has natural curvatures. When you look at a back from behind, the spine should be straight and centered over the pelvis. However, when you look at the spine from the side, the curves are designed to maintain balance as the spine is behind organs in the chest and abdomen. The spine has two alternating curves to create an "S" like shape. 

  In the neck and low back, there is normally an inward curvature or sway back known as lordosis. I the thoracic spine and sacrum there is an outward curvature known as Kyphosis or hunchback. These curves normally balance out each other so that when the patient stands they are well balanced with their head straight above their hips when viewed from the side. Standing in this position minimizes the effect of gravity and allows the patient to stand with the best posture and use the least energy when moving or walking.

 The flatback syndrome is an abnormal condition where the spine loses its natural low back curve to become flat. The spine becomes imbalanced and the patient leans forward. Patients with flat back syndrome typically notice troubles standing upright or have ongoing back or leg pain. Symptoms usually worsen as the day goes on and the patient feels they lean further and further forward the longer they tey to stand upright. The severity of the symptoms usually depends on the amount of curvature present and difficulties with standing erect.  

 In patients with the flat back syndrome, a loss of normal lumbar curvature causes an imbalance of the spine. The patient's head begins to lean forward, away from the body and they may have trouble standing upright. This imbalance can cause muscle fatigue and pain. 

 The flatback syndrome was first noted in patients who received a specific type of spinal instrumentation for scoliosis treatment. Early types of scoliosis implants, called Harrington rods, allowed the surgeon to straighten the back curvature but also decreased the spine's normal side curvature. 

Causes:
  
  Term flat back syndrome has been broadened to include any patient with a decrease in lumbar lordosis causing symptoms. As such, flat back syndrome can occur as a result of any condition that shortens the front portion of the spine, causing the patient to lean forward. 

   The flatback syndrome may develop as the result of the following causes: Degenerative Disc Disease, Lumbar post Laminectomy syndrome, compression fractures, Ankylosing spondylitis. 

Degenerative Disc Disease:
  
  The progressive degeneration of the intervertebral disc or the shock absorbers of the spine may lead to a loss of height in the front part of the spine. As discs degenerate the spine begins to lean forward and lumbar lordosis decreases. The patient may develop pain as a result of the degenerative disc disease or a result of the spinal imbalance. 

Lumbar post Laminectomy syndrome:

 The lumbar flat back syndrome may develop in patients previously treated with a laminectomy or other lumbar surgery to decompress the spinal nerves to treat stenosis. These procedures can lead to a decrease in lumbar lordosis and in some cases spinal instability. 

Vertebral compression fractures:

  Compression fractures are often the result of weak spinal bones due to Osteoporosis. A fracture can lead to loss of height of the bone in the thoracic and lumbar spine. This may occur in one bone or in multiple bones throughout the spine, resulting in flatback syndrome. 

Ankylosing spondylitis:

 Ankylosing spondylitis is a chronic inflammatory disease that causes stiffness and arthritis throughout the entire spine. Some patients with AS notice an increasing forward posture of the spine, including an increase in thoracic kyphosis or a decrease in lumbar lordosis.  

Symptoms:

  The flatback syndrome can cause difficulty standing upright, chronic pain, and difficulty with daily tasks. In order to stand upright, a person with flatback syndrome must contract the back muscles, and possibly flex at the hips and knees. These maneuvers may temporarily help a person stand upright, but over time, they may result in severe pain. 

Diagnosis:

 To determine the degree of the flatback syndrome, the doctor may order an X-ray test that produces images of the spine and other bones and tissues using invisible electromagnetic rays. This may be a long cassette upright scan that shows the entire spine in a single image. The doctor may also order additional diagnostic procedures to obtain a more detailed image of the spine:

- Magnetic resonance (MR) imaging scan- uses a magnet and radio waves to provide detailed images of the spinal cord, can help identify whether the spinal cord (the bundle of nerves connecting brain and body) has been affected by the spinal curvature. 

- Computed tomography (CT) scan- uses x-rays and a computer to produce detailed images of the body. CT scans are more detailed than general X-rays. 

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Alcoholism

                                                        Alcoholism

Alcoholism is the inability to control drinking due to both a 

physical and emotional dependence on alcohol. 


Symptoms include repeated alcohol consumption despite

related legal and health issues.

  Those with alcoholism may begin each day with a drink, feel guilty about their drinking and have the desire to cut down on the amount of drinking. 

 Treatment involves counseling by a healthcare professional. A detoxification program in a hospital or medical facility is an option for those who need additional assistance. Medications are available that reduce the desire to drink. 

Usually self- diagnosable:

 Symptoms include repeated alcohol consumption despite related legal and health issues. Those with alcoholism may begin each day with a drink, feel guilty about their drinking and have the desire to cut down on the amount of drinking. 

People experience:

whole body: blackout, dizziness, shakiness, craving, or sweating

Behavioral: aggression, agitation, compulsive behavior, self- destructive behavior, or lack of restraint 

mood: anxiety, euphoria, general discontent, guilt, or loneliness

gastrointestinal: nausea or vomiting

psychological: delirium of fear

also common: physical substance dependence, problems with coordination, slurred speech, or tremor. 

Symptoms of alcohol abuse:

  If left untreated, alcohol abuse can spiral out of control quickly. When alcohol abuse begins to negatively impact a person's life and causes harm, it is diagnosed as an alcohol use disorder (AUD). Recognizing the warning signs of alcohol abuse and getting proper treatment can make a significant difference in someone's recovery process. While there is no exact formula for determining whether or not someone is an alcoholic, symptoms often co-occur. One symptom may snowball into another, fueling additional problems down the road. 

- Experiencing temporary blackouts or short-term memory loss

- Exhibiting signs of irritability and extreme mood swings

- Making excuses for drinking such as to relax, deal with stress or feel normal

- Choosing to drink over other responsibilities and obligations

- Becoming isolated and distant from friends and family members. 

- Drinking alone or in secrecy

- Feeling hungover when not drinking

- Changing appearance and group of acquaintances you hang out with

Stages of alcoholism

1- Occasional abuse and binge drinking

 The first stage of alcoholism is a general experimentation with alcohol. These drinkers may be new to different forms of alcohol and likely to test their limits. This experimental stage is commonly seen in young adults. These experimental drinkers also frequently in binge drinking. Many binge drinkers exceed this amount. 

2- Increased drinking 

Drinkers leave the experimental stage when their alcohol consumption becomes more frequent. Instead of just drinking at parties once in a while, you may find yourself drinking every weekend. Increased alcohol consumption can also lead to drinking for these reasons
- as an excuse to get together with friends
- to alleviate stress
- out of boredom
- to combat sadness or loneliness

Regular alcohol use is different from moderate drinking. 

3- Problem drinking

 Frequent, uncontrolled alcohol abuse eventually leads to problem drinking. While any form of alcohol abuse is problematic, the term problem drinking refers to someone who starts experiencing the impacts of their habit. 
- relationship issues 
- decreased social activity because of erratic behavior
- sudden change in friends 
- Difficulty conversing with strangers 

4- Alcohol dependence 

Alcoholism has two facets: dependence and addiction. It's possible for a person to be dependent on alcohol, but not yet addicted. Dependence forms after the problem drinking stage. Another characteristic of dependence is withdrawal. As you sober up, you may feel undesirable symptoms such as:
- nausea that is unrelated to a hangover
- body tremors
- sweating
- severe irritability
- a racing heart
- trouble sleeping

5- Addiction and alcoholism:

 The final stage of alcoholism is an addiction. At this stage, you no longer want to drink just for pleasure. Alcohol addiction is characterized by a physical and psychological need to drink. 

 People with alcohol addiction physically crave the substance and are often inconsolable until they start drinking again. They may be addicted to other drugs as well. Compulsive behaviors are prominent in addiction, and people with alcohol addiction often drink whenever and wherever they desire. 

Diseases associated with alcoholism:

 There are several scientific reasons for the prohibition of consumption of intoxicants i.r. alcohol. The maximum number of deaths in the world related to any one particular cause is due to the consumption of alcohol. Millions of people die every year only because of the intake of alcohol. 
List of few alcohol-related illnesses

- Cirrhosis of the liver is the most well-known alcohol-associated disease

- Other are cancer of the esophagus, cancer of head and neck, cancer of the liver (Hepatoma), cancer of the bowel, etc

- Oesophagitis, gastritis, pancreatitis, and hepatitis are linked with alcohol consumption. 

- Cardiomyopathy, Hypertension, coronary atherosclerosis, angina and heart attacks are linked with heavy alcohol intakes. 

- Stroke, Apoplexy, Fits and different types of paralysis are linked with alcohol intake. 

- Peripheral neuropathy. cortical atrophy, cerebellar atrophy is well- known syndromes caused by alcohol consumption. 

- Wernicke- Korsakoff syndrome with amnesia of recent events, confabulations and retainment of memory to old events with different types of paralysis are mainly due to thiamine deficiency due to excessive alcohol intake. 

- Beriberi and other deficiencies are not uncommon among alcoholics. Even pellagra occurs in alcoholics. 

- Delerium Tremens is a serious complication that may occur during recurrent infection of alcoholics or postoperatively. It occurs during abstentions as a sign of withdrawal effect. It is quite serious and may cause death even if treated in well-equipped centers. 

- Numerous endocrine disorders have associated with alcoholism ranging from Myxodema to Hyperthyroidism and florid Cushing syndrome. 

- Hematological ill effects are long and variable, Folic acid deficiency, however, is the most common manifestation of alcoholic abuse resulting in Macrocytic anemia. Zieve's syndrome is a triad of hemolytic anemia, jaundice, and hyperlipidemia that follows alcoholic binges. 

- Thrombocytopenia and other platelet abnormalities are not rare in alcoholics. 

- The commonly used tablet metronidazole interacts badly with alcohol. 

 - Recurrent infection is very common among chronic alcoholics. The resistance to disease and the immunological defense system are compromised by alcohol intake. 

- Chest infection is notorious in alcoholics. Pneumonia, lung abscess, Emphysema and pulmonary, tuberculosis are all common in alcoholics. 

- During acute alcoholic intoxication, the drunk person usually vomits, the cough reflexes which are protective are paralyzed. The vomitus thus easily passes to the lung causing Pneumonia or lung abscess. Occasionally it may even cause suffocation and death.

- The ill-effects of alcohol consumption on women deserves special women. Females are more vulnerable to alcohol-related cirrhosis than men. During pregnancy alcohol consumption has a severely detrimental effect on the fetus. Fetal alcohol syndrome is being recognized more and more in the medical profession.   

- Skin diseases are also related to alcohol indulgence. 

- Eczema, alopecia, nail dystrophy, paronychia, and angular stomatitis are common diseases among alcoholics. 

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Cystitis

                                                           Cystitis

    Is the medical term for inflammation of the bladder. Most of the time, the inflammation is caused by a bacterial infection, and it's called a urinary tract infection UTI. 

   Cystitis usually occurs when the urethra and bladder, which are normally sterile, or microbe-free, become infected with bacteria.      Cystitis is an infection of the bladder wall that can lead to ongoing discomfort. Bacteria fasten to the lining of the bladder and cause the area to become irritated and inflamed. 

   Cystitis affects people of both sexes and all ages. It is more common among females than males because women have shorter urethras. 

    Around 80% of all urinary tract infections are caused by bacteria from the bowel that reach the urinary tract. Most of these bacteria form part of the healthy intestinal flora, but once they enter the sterile space in the urethra and bladder, they can cause a UTI. UTIs are the most common hospital-acquired infections in the united states, especially among patients using urinary catheters. 

  A urinary tract infection is a bacterial infection that affects any part of the urinary tract. The main etiologic agent is Escherichia coli. Although urine contains a variety of fluids, salts, and waste products. It does not usually have bacteria in it. When bacteria get into the bladder or kidney and multiply in the urine, they may cause a UTI. 

 The most common type of UTI is acute cystitis often referred to as a bladder infection. An infection of the upper urinary tract or kidney is known as pyelonephritis and is potentially more serious. Symptoms include frequent feeling and need to urinate, pain during urination, and cloudy urine. 

 Urinary tract infections are more common in women. They usually occur in the bladder or urethra, but more serious infections involve the kidney. A bladder infection may cause pelvic pain, increased urge to urinate, pain with urination and blood in the urine. A kidney infection may cause back pain, nausea, vomiting, and fever. 

Symptoms:

 The most common symptoms of a bladder infection are burning with urination dysuria, frequency of urination, an urge to urinate, without vaginal discharge or significant pain. An upper urinary tract infection or pyelonephritis may additionally present with flank pain and fever.

   The symptoms of urinary tract infections may vary with age and the part of the urinary system that was affected. In young children, urinary tract infection symptoms may include diarrhea, loss of appetite, nausea, and vomiting, fever and excessive crying that cannot be resolved by typical measures.  Older children, on the other hand, may experience abdominal pain, or incontinence.       Lower urinary tract infections in adults may manifest with symptoms including hematuria, inability to urinate despite the urge and malaise. 

  Other signs of urinary tract infections include foul-smelling urine and urine that appears cloudy. Depending on the site of infection, urinary tract infections may cause different symptoms.  

   Urethritis does not usually any other symptoms besides dysuria. If the bladder is however affected (cystitis), the patient is likely to experience more symptoms including lower abdomen discomfort, low-grade fever, pelvic pressure and frequent urination all together with dysuria. 
   Infection of the kidneys(acute pyelonephritis) typically causes more serious symptoms such as chills, nausea, vomiting and high fever. 

  Common symptoms:

 - Trace of blood in the urine
- Dark, cloudy, or strong-smelling urine
- Pain just above the pubic bone, in the lower back, or in the abdomen
- Burning sensation when urinating
- Urinating frequently or feeling the need to urinate frequently 

 Elderly individuals may feel weak and feverish but have none of the other symptoms mentioned above. They may also present with altered mental status. There is a frequent need to urinate, but only small amounts of urine are passed each time. 

 When children have cystitis, they may have any of the symptoms listed above, plus vomiting and general weakness. Some other illness or conditions have similar symptoms to cystitis, these include:
  
 Urethritis, or inflammation of the urethra
 Bladder pain syndrome
 Prostatitis, or inflammation of the prostate gland
 Benign prostatic hyperplasia, in men 
 Lower urinary tract syndrome 
 Gonorrhea
 Chlamydia 
 Candida, or Thrush

Causes: 

 There are many possible causes of cystitis. Most are infectious, and the majority of these cases stem from an ascending infection. The bacteria enter from the external genitourinary structures.

- Tampon use: when inserting a tampon, there is a slight risk of bacteria entering via the urethra. 

- Inserting, changing, or prolonged use of a urinary catheter, there is a chance the catheter will carry bacteria along the urinary tract. 

- Diaphragm for birth control: There is a higher incidence of cystitis among women who use the diaphragm with spermicides, compared with sexually active women who do not use one.    

- Full bladder: If the bladder is not emptied completely, it creates an environment for bacteria to multiply. This is fairly common among pregnant women or men whose prostates are enlarged. 

- Sexual activity: Sexually active women have a higher risk of bacteria entering via the urethra. 

- Blockage in part of the urinary system that prevents the flow of urine. 

- Other bladder or kidney problems. 

- Frequent or vigorous sex: This increases the chances of physical damage, which in turn increases the likelihood of cystitis. This is sometimes called honeymoon cystitis. 

- Falling estrogen levels: During menopause, estrogen levels drop, and the lining of a women's urethra gets thinner. The thinner the lining becomes, the higher the chances are of infection and damage. After menopause, the risk is higher. 

- Gender: A woman's urethral opening is nearer the anus than a man's, so there is a higher risk of bacteria from the intestines the urethra. 

- Mucus reduction: During menopause, women produce less mucus in the vaginal area. This mucus normally acts as a protective layer against bacteria. 

- Radiotherapy: Damage to the bladder can cause late radiation cystitis. Women on hormone replacement therapy. Lower risk of developing cystitis compared with menopausal women not on HRT. However, HRT has its own set of risks, so it is not routinely used for the treatment of infections cystitis in postmenopausal women. 

Types of Cystitis:

  Cystitis can be either acute or interstitial. Acute cystitis is a case of cystitis that occurs suddenly. Interstitial cystitis is a chronic or long- term case of cystitis that affects multiple layers of bladder tissue. 

Both acute and interstitial cystitis have a range of possible causes. The cause of cystitis determines the type. The following are types of cystitis: 

Bacterial Cystitis:

 Bacterial cystitis occurs when bacteria enter your urethra or bladder and cause an infection. This can also result when normally growing bacteria in your body becomes imbalanced. The infection leads to cystitis or inflammation in your bladder. 

It is important to treat a bladder infection. I the infection spreads you your kidneys it can become a serious health issue. 

 Drug-induced cystitis: 

  Certain medications can cause your bladder to become inflamed. Medicines pass through your body and eventually exit through your urinary system. Some medications can irritate your bladder as they exit your body. For example, the chemotherapy drugs cyclophosphamide and ifosfamide can cause cystitis.

Radiation cystitis:

 Radiation therapy is used to kill cancer and shrink tumors, but it can also damage healthy cells and tissues. Radiation treatment in the pelvic area can cause your bladder to become inflamed. 

Foreign body cystitis:

 Ongoing use of a catheter, a tube used to facilitate the release of urine from the bladder, can increase your risk of bacterial infection, and damage tissues in the urinary tract. Both bacteria and damaged tissues can cause inflammation. 

Chemical cystitis: 

 Certain hygiene products can irritate your bladder. Products that may cause cystitis to include: 

- Spermicidal jellies
- Use of a diaphragm with spermicide
- Feminine hygiene sprays
- Chemicals from a bubble bath

 Cystitis associated with other conditions:

Sometimes cystitis occurs as a symptom of other medical conditions, such as: 

- Diabetes
- Kidney stones
- HIV
- Enlarged prostate 
- Spinal injuries 

Diagnosis:

 A doctor will ask the patient some questions, carry out an examination, and do a urine test. The urine test will either be sent to a laboratory, or the doctor may use a dipstick. Urine dipstick result comes back quickly while the patient is still in the office. 

Urine culture or catheterized urine specimen may be performed to determine the type of bacteria in the urine. After finding out which specific bacterium is causing the infection, the doctor will prescribe an oral antibiotic. 

Most doctors will also offer to test for a sexually transmitted infection. SITs often have similar symptoms to cystitis.  

Home care:

 Home care treatments can help ease discomfort. Common methods are:

- Applying heating pads abdomen or back
- Over- the - counter pain relievers, such as ibuprofen and acetaminophen 
- Sitz baths to cleanse the pelvic area 

   Sometimes you can manage cystitis symptoms at home, without taking medication. These should not replace antibiotics if they are needed to treat a UTI. 

Common home therapy methods are:

- Cranberry juice or tablets
- Drinking lots of fluids 
-  Wearing cotton underwear and loose-fitting clothes
- Avoiding any food or beverages that you suspect make your symptoms worse. 

While recovering from cystitis, you should:

- Drink plenty of fluids
- Avoid caffeinated drinks, as these can irritate your bladder
- Urinate frequently, rather than holding it
- Wear cotton underwear and loose-fitting clothes 

Outlook for cystitis:

 The outlook of cystitis is dependent on the cause of the symptoms. In general, the outlook for cystitis is good. However, it is important to treat the underlying condition as soon as possible. 

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Dementia

                                                             Dementia

(please remember the real me when I can not remember you)

       Dementia comes from a Latin word "Demens" which means "Absence of mind" chronic impairment of thinking that affects a persons ability to function in a social or occupational setting. The impairment is severe enough to interfere with the patient's ability to perform routine activities. 

According to WHO: 

    Dementia is a syndrome, usually of a chronic or progressive nature, in which there is deterioration in cognitive function beyond what might be expected from normal aging. It affects memory, thinking, orientation, comprehension, calculating, learning capacity, language, and judgment. Consciousness is not affected. The impairment in cognitive function is commonly accompanied and occasionally preceded, by deterioration in emotional control, social behavior, or motivation.  

     Dementia is not a specific disease. It's an overall term that describes a group of symptoms associated with a decline in memory or other thinking skills severe to reduce a person's ability to perform everyday activities. Alzheimer's disease accounts for 60 to 80% of cases. Vascular dementia, which occurs after a stroke, is the second most common dementia type. But there are many other conditions that can cause symptoms of dementia, including some that are reversible, such as thyroid problems and vitamin deficiencies. Dementia is often incorrectly referred to as senility or senile dementia which reflects the formerly widespread but incorrect belief that serious mental decline is a normal part of aging. 

  Dementia is not a specific disease. It is a descriptive term for a collection of symptoms that can be caused by a number of disorders that affect the brain. A progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging. Areas particularly affected include memory, attention, judgment, language, and problem solving, madness or insanity. Alzheimer's disease international estimates that are currently 30 million people with dementia in the world with 4.6 million new cases annually. The number of people affected will over 100 million by 2050. 

  The age group most commonly affected by this illness is 60 and over still, there is some risk group that is not age-dependent, such as people that suffer from high blood pressure, smokers high cholesterol patients and so on. Dementia is a brain disorder, beings after the age of 60 that seriously affects a person's ability to carry out daily activities. It begins slowly, involving the parts o the brain that control thought, memory & language. People with AD may have trouble remembering recent events, name of people.
 Over times symptoms get worse and the patient might have trouble in speaking, reading & writing. They may forget how to brush their teeth or comb their hair, become anxious or aggressive, and wander away from home. 

Causes:

  Dementia is caused by damage to brain cells, this dan-mages interferes with the ability of brain cells to communicate with each other. When brain cells can not communicate normally, thinking, behavior and feeling can be affected. The brain has many distinct regions, each of which is responsible for different function (for example, memory, judgment, and movement). When cells in a particular region are damaged, that region cannot out its functions normally. 

Causes divided into primary and secondary causes. 

 Primary Causes:

 - Alzheimer's disease: 
  Is the most common form of dementia, and the disease most people associate with memory loss. Usually diagnosed after age 80 and is uncommon in people under the age of 65. 

-Vascular dementia:
   Occurs when small strokes or brain lesions impair blood flow to the brain. It is the cause of 20% of dementia cases, making it the second most common cause after Alzheimer's disease. 

- Pick's Disease:
   Symptoms are often hard to distinguish from Alzheimer's disease. Pick's disease damages nerve cells in the brains frontal and temporal lobes. Nerve cells affected by Pick's disease weaken and eventually die. 

-Huntington's disease:
   Is a genetically inherited neurological disease that can dementia. Huntington disease causes behavioral changes and chorea. The usual age of Huntington's disease onset is between forty and sixty years old. 

- Parkinson's disease:
   Is a progressive neurological disease that affects movement and muscle control. Symptoms of Parkinson's disease include tremors, balance problems, difficulty walking, and a rigid posture. 

-Lewy- body dementia:
  Related to Alzheimer's disease. The cause is the presence of abnormal substances called Lewy-body in parts of the brain such as cortex and brain stem. Lewy body dementia causes classical dementia symptoms, including memory loss. The disease can also cause hallucinations, depression, and paranoia. 

Secondary causes:

 Dementia like symptoms can develop as a result of an underlying condition can be treated, the symptoms will generally improve. The following are some of the common secondary causes that can lead to dementia. 

-Alcohol Dementia and substance abuse:
 Alcohol abuse can lead to symptoms of dementia. The long term toxic effects of alcohol on the brain are enough to cause it. Symptoms can often be improved by abstaining from alcohol. 

-Infections diseases:
  A number of infections that affect the central nervous system have been known to cause dementia symptoms, including HIV, meningitis, and encephalitis. 

Medication:
  As people age, they tend to require more medication for their health. Many of the medications include dementia symptoms as aside effect. The list of medications is incredibly long and includes such common medication as anti-diarrhea medication, anti-epileptic medications, antihistamines, cold and flu medication, sleeping pills, tricyclic antidepressants. 

Pseudo Dementia:
  Depression can result in dementia symptoms, including memory loss and a lack of motivation. Elderly people dealing with health problems, the loss of spouse, or loneliness are particularly susceptible to depression. Treating depression often result in the reversal of dementia symptoms. 

Metabolic disorders: 
    Metabolic disorders can also symptoms of dementia. These disorders include cortisol hormone imbalances, diabetes, electrolyte levels, kidney failure, liver diseases, and thyroid disorders. 

Wernicke- Korsakoff syndrome:
    It results from a deficiency in thiamine (Vitamin B1) and is often due to chronic, severe alcoholism. It can also result from general malnutrition, eating disorders, or the effects of chemotherapy. Dementia due to Wernicke- Korsakoff syndrome involves confusion, apathy, hallucination, communication problems, and severe memory impairment.  

Brain Tumors:
   Brain tumors put pressure on and damage the surrounding brain tissue. A brain tumor can cause a number of symptoms, including dementia. The tumor may originate in the brain or may have spread to the brain from other organs. 

Signs and symptoms:
  
 Dementia affects each person in a different way, depending upon the impact of the disease and the person before becoming ill. The signs and symptoms linked to dementia can be understood in three stages. 

Early-stage:
   The early stage of dementia is often overlooked because the onset is gradual. Common symptoms include: 
- Forgetfulness
- Losing track of the time
- Becoming lost in familiar places. 

Middle stage:
  As dementia progresses to the middle stage, the signs and symptoms become and more restricting. These include:
- Becoming forgetful of recent events and people's names
- Becoming lost at home
- Having increasing difficulty with communication
- Needing help with personal care
- Experiencing behavior changes, including wandering and repeated questioning. 

Late-stage:
  The late stage of dementia is one of near-total dependence and inactivity. Memory disturbances are serious and the physical signs and symptoms become more obvious. Symptoms include:
- Becoming unaware of the time and place
- Having difficulty recognizing relatives and friends
- Having an increasing need for assisted self-care
- Having difficulty walking
- Experiencing behavior changes that may escalate and including aggression. 

Handling Money:
  Trouble remembering simple words, often dementia sufferers will substitute inappropriate words without realizing. 

Common forms of dementia:
  There are many different forms of dementia. Alzheimer disease is the most common form and may contribute to 60-70% of cases. Other major forms include vascular dementia, dementia with Lewy bodies, and a group of diseases that contribute to frontotemporal dementia. The boundaries between different forms of dementia are indistinct and mixed forms often co-exist. 

Rates of dementia:
  Worldwide, around 50 million people have dementia, with nearly 60% living in low and middle-income countries. Every year, there are nearly 10 million new cases. The estimated proportion of the general population aged 60 and over with dementia at a given time is between 5-8%. The total number of people with dementia is projected to reach 82 million in 2030 and 152 in 2050. Much of this increase is attributable to the rising numbers of people with dementia living in low and middle-income countries. 

Diagnosis:

 There is no one test to determine if someone has dementia. Doctors diagnose Alzheimer's and other types of dementia based on a careful medical history, a physical examination, laboratory tests, and the characteristic changes in thinking, day-to-day function and behavior associated with each type. Doctors can determine that a person has dementia with a level of certainty. But it's harder to determine the exact type of dementia because of the symptoms and brain changes of different dementias can overlap. In some cases, a doctor may diagnosis dementia and not specify a type. If this occurs it may be necessary to see a specialist such as a neurologist or a psychologist.     

    Diagnosis requires a medical history, physical examination, including neurological examination and appropriate laboratory tests. 
Taking a thorough medical history involves gathering information about the onset duration, and progression of symptoms, any possible risk factors for dementia, such as a family history of the disorder or other neurological diseases, history of stroke, and alcohol or other drug use. 

The various laboratory investigations include: 

- Thyroid hormone tests to check for an underactive thyroid.
- Vitamin B12 blood test to look for a vitamin deficiency. 
- Complete blood count, or CBC, to look for infection.
- ALT or AST, blood tests that check liver function. 
- Syphilis test to look for this disease. 
- Chemistry screen to check the level of electrolytes in the blood and to check kidney function. 
- Glucose test to check the level of sugar in the blood. 
- MRI or CT to look for tumors. 

Other lab tests that may be done include:

- HIV testing to look aids
- Erythrocyte sedimentation rate, a blood test that looks for signs of inflammation in the body. 
- Toxicology screen, which examines blood, urine, or hair to look for drugs that could be causing problems. 
- Antinuclear antibodies, a blood test used to diagnose autoimmune diseases
- Testing for heavy metals in the blood, such as a lead test. 

Risk factors and prevention:

 Although age is the strongest known risk factor for dementia, it is not an inevitable consequence of aging. Further, dementia does not exclusively affect older people- young-onset dementia accounts for up to 9% of cases. Studies show that people can reduce their risk of dementia by getting regular exercise, not smoking, avoiding harmful use of alcohol, controlling and blood sugar levels, Additional risk factors include depression, low educational attainment, social isolation, and cognitive inactivity. 

Social and economic impact:

 Dementia has significant social and economic implications in terms of direct medical and social care costs, and the costs of informal care. In 2015, the total global societal cost of dementia was estimated to be 818 billion, equivalent to 1.1% of global gross domestic product. The total cost as a proportion of GDP varied from 0.2% in low and middle-income countries to 1.4% in high-income countries. 

Impact on families and carers:

 Dementia can be overwhelming for the families of affected people and for their carers. Physical, emotional and financial pressure can cause great stress to families and carers, and support is required from the health, social and legal systems. 

WHO response:

 WHO recognizes dementia as a public health priority. On May 2017, the World Health Assembly endorsed the Global action plan on the public health response to dementia 2017- 2025. The plan provides a comprehensive blueprint for action, for policy-makers, international, regional and national partners, and WHO as in the following areas, addressing dementia as a public health priority, increasing awareness of dementia and establishing dementia-friendly initiatives, reducing the risk dementia, diagnosis, treatment and care, information systems for dementia, support for dementia carers, and research and innovation. An international surveillance platform, the global Dementia Observatory, has been established for policymakers and researchers to facilitate monitoring and sharing of information on dementia policies, service delivery, epidemiology, and research. 

 WHO has developed Towards a dementia plan, a WHO guide, which provides guidance to the Member States in creating and operationalizing a dementia plan. The guide is closely linked to WHO's GDO and includes associated tools such as a checklist to guide the preparation, development, and implementation of a dementia plan. It can be used for stakeholder mapping and priority setting. 

  WHO Guidelines on risk reduction of cognitive decline and dementia provide evidence-based recommendations on interventions for reducing modifiable risk factors for dementia, such as physical inactivity and unhealthy diets, as well as controlling medical conditions linked to dementia, including hypertension and diabetes. Dementia is also one of the priority conditions in the WHO mental health gap action program, which is a resource for generalists, oarticular in low- and middle-income countries, to help them provide first-line care for mental, neurological and substance use disorders.  



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