How to Get Rid of Multi Infarct Dementia

Multi-infarct Dementia

Multi-infarct dementia (MID), a common cause of dementia in the elderly, occurs when blood clots block small blood vessels in the brain and destroy brain tissue. Probable risk factors are high blood pressure and advanced age. CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is an inherited form of MID. This disease can cause stroke, dementia, migraine-like headaches, and psychiatric disturbances. Symptoms of MID, which often develop in a stepwise manner, include confusion, problems with recent memory, wandering or getting lost in familiar places, loss of bladder or bowel control (incontinence), emotional problems such as laughing or crying inappropriately, difficulty following instructions, and problems handling money. Usually the damage is so slight that the change is noticeable only as a series of small steps. However over time, as more small vessels are blocked, there is a gradual mental decline. MID, which typically begins between the ages of 60 and 75, affects men more often than women.

Causes, incidence of Multi-infarct dementia

MID affects approximately 4 out of 10,000 people. It is estimated that 10 to 20% of all dementias are caused by strokes, making MID the third most common cause of dementia in the elderly, behind Alzheimer's disease and DLBD (dementia of Lewy bodies). MID affects men more often than women. The disorder usually affects people over 55, with the average onset at age 65.

The affects of MID vary depending on the location and severity of the infarctions. Memory impairment is often an early symptom of the disorder, followed by judgment impairment. This often progresses in a stepwise manner to delirium, hallucinations, and impaired thinking. Personality and mood changes accompany the deteriorating mental condition. Apathy and lack of motivation are common. Catastrophic reactions, such as withdrawal or extreme agitation, are also common. Confusion that occurs or is worse at night is another common symptom.

Risk factors that make the development of MID likely include a history of stroke, hypertension, smoking, and atherosclerosis. Atherosclerosis is the cause of numerous serious vascular problems, including heart attacks, cerebrovascular diseases, and peripheral vascular diseases. Cerebrovascular disease affects the vessels in the brain and spine, and peripheral vascular disease involves the vessels of the body, especially the limbs. Atherosclerosis may be associated with conditions such as diabetes mellitus, obesity, high cholesterol, and kidney disorders that require dialysis.

Some research suggests that MID may cause or hasten the progression of Alzheimer's disease. MID may be misdiagnosed as Alzheimer's, or may be found in addition to Alzheimer's disease. Since the difference cannot always be determined without brain biopsy, and since there is little effective treatment for either condition, the distinction is mainly useful to researchers, not patients. However, once better therapies become available, the independent contribution of MID and Alzheimer's disease to dementia might become more important in tailoring treatments to individuals.

What is the prognosis of Multi-infarct Dementia?

Prognosis for patients with MID is generally poor. Individuals with the disease may improve for short periods of time, then decline again. Early treatment and management of blood pressure may prevent further progression of the disorder.

Symptoms of Multi-infarct Dementia

Sudden onset of any of the following symptoms may be a sign of multi-infarct dementia:

• confusion and problems with recent memory
• wandering or getting lost in familiar places
• moving with rapid, shuffling steps
• loss of bladder or bowel control
• laughing or crying inappropriately
• difficulty following instructions
• problems handling money

Treatment of Multi-infarct Dementia

There is no known definitive treatment for MID. Treatment is based on control of symptoms and the correction of the precipitating risk factors (high blood pressure and high cholesterol, especially). Other treatments may be advised based on the individual condition.

INITIAL DIAGNOSIS AND TREATMENT:
The person should be in a pleasant, comfortable, non-threatening, physically safe environment for diagnosis and initial treatment. Hospitalization may be required for a short time. The underlying causes should be identified and treated as appropriate.

Discontinuing or changing medications that worsen or even cause confusion, or that are not essential to the care of the person, may improve cognitive function. Medications that may cause confusion include anticholinergics (including antidepressants with anticholinergic properties, such as amitriptyline or imipramine), analgesics, cimetidine, central nervous system depressants, lidocaine, and other medications.

Disorders that contribute to confusion should be treated as appropriate. These may include heart failure, decreased oxygen (hypoxia), thyroid disorders, anemia, nutritional disorders, infections, and psychiatric conditions such as depression. Correction of coexisting medical and psychiatric disorders often greatly improves the mental functioning.

Medications may be required to control aggressive or agitated behaviors or behaviors that are dangerous to the person or to others. These are usually given in very low doses, with adjustment as required. Such medications may include antipsychotics (especially the newer atypical agents, olanzapine and quetiapine), beta-blockers, and serotonin-affecting drugs such as trazodone (which may lower the blood pressure), buspirone, or fluoxetine. Medications used to treat Alzheimer's disease have NOT been proven effective in MID.

Sensory function should be evaluated and augmented as needed by hearing aids, glasses, or cataract surgery.

LONG-TERM TREATMENT:
Provision of a safe environment, control of aggressive or agitated behavior, and the ability to meet physiologic needs may require monitoring in the home or in an institutionalized setting. This may include in-home care, boarding homes, adult day care or convalescent homes. Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services and other community resources may be helpful in caring for the person with MID. In some communities, there may be access to support groups.

In any care setting, there should be familiar objects and people. Leaving lights on at night may reduce disorientation. The schedule of activities should be simple.

Behavior modification may be helpful for some persons in controlling unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety). Reality orientation, with repeated reinforcement of environmental and other cues, may help reduce disorientation.

Legal advice may be appropriate early in the course of the disorder. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of the person with MID.

Facts and Tips about Multi infarct Dementia

• Multi-infarct dementia is second most form of dementia which involves damage to brain because of lack of blood.
  
• Multi-infarct dementia (MID) is caused by destroyed brain tissue because of several strokes which results in memory loss.
  
• MID is affected to person having age between 60 to 75. It is more common in male than female.
  
• Person having MID shows memory loss, confusion, judgment problem, agitation, wondering, fast walking, loss of bladder or bowel control, laughing or crying improperly.
  
• No treatment is available for MID because you can not cure or reverse damaged tissue but you may avoid future stoke.
  
• Maintaining healthy diet, exercising, avoiding smoking and alcohol, treating high blood pressure, diabetes, high cholesterol and cardiovascular disease is useful in prevention of MID.

Dementia Overview
Multi infarct Dementia
Fronto Temporal dementia
Lewy Body dementia
Frontal Lobe dementia
Parkinsons-Dementia
Pick's disease
Niemann-Pick Disease

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