NEUROCARE

It's normal to forget. We all forget. Our memories are remarkable - faster than the most advanced computer - but we still forget things. We usually forget those things we don't really need to remember. What were you doing at exactly this time last year? or last month? or last week? Unless those were very special days, like Christmas or anniversaries, you probably won't remember.

Even so, if we suddenly can't remember something, we don't start by worrying about it. We sort out the problem at hand, such as finding those keys or that purse. However, if this starts to happen regularly, we may start to worry about what it could mean for the future. Could it, for instance, be the start of Alzheimer's disease?

Dementia is the most serious cause of memory problems. It affects very few people under the age of 65. Dementia mainly affects older people. After the age of 65, the risk of developing it doubles every 5 years. Over the age of 80, about one in five people suffer from some degree of dementia. Having said this, it's important to remember that four out of five people over the age of 80 are not suffering from dementia.

There are several causes, but the commonest is Alzheimer's disease. Several causes are fully reversable which makes it very important to be assessed by an expert Neurologist or Neuropsychiatrist.

As well as the forgetfulness, several other problems may occur:

1. Difficulty in finding the right words. At its worse, the sufferer's speech will become completely incomprehensible.
2. Difficulty with skills learnt early in life, like dressing and using a knife and fork.
3. Failure of intelligence, judgment and logic.
4. Personality change: becoming irritable, withdrawn, rude, scruffy, idle, uninterested.
5. Suspiciousness: believing others are out to harm him/her
6. Anxiety and depression arising from the sense of 'losing one's mind'
7. Uncharacteristic behaviour, including reluctance to wash, wandering, becoming incontinent and aggressive.
8. Becoming unable to look after themselves (neglect).

Sooner or later the forgetfulness of dementia becomes a serious problem. If a person with dementia is taken away from familiar surroundings, on holiday for example, they may start to get lost. It is common to forget what time, day, date, month or year it is, or where they live or where they are now. He or she may lose things, or leave them behind, and may start to believe that someone is stealing their possessions. They may forget to pass on messages, or may repeat them in a rather scrambled way. They may say the same things again and again, because they can't remember what they have just said. As the condition worsens, someone with dementia may get lost in familiar surroundings - even in their own homes. Most distressingly, they may fail to recognize their nearest and dearest.

Dementia nearly always gets steadily worse. It may take a few months (as in the case of classical CJD) or a few years (as in Alzheimer's starting in a person over-65). It may happen quickly, but more often it is gradual.

Sometimes a series of small strokes, one after another, may cause dementia. They produce sudden, small worsening of the dementia. There may be a period of a year or so between them when there is little change. This type of dementia may run in the family.

Some people, while they have insight, realise their limitations and adapt to them. They are able to accept that they have to depend more on others, and so can have a say in the arrangements that relatives have to make for them. Others, however, vigorously refuse to admit that there is anything wrong with them - they can be particularly hard to help. What causes dementia?

The exact causes of most dementias are unknown, but there are some clues. It may run in families, as Alzheimer's sometimes does. It is very common in sufferers from Down's syndrome. A severe head injury at some point in your life may increase the risk. High blood pressure and cholesterol, diabetes, smoking, drinking, and being over-weight may all increase the risk of dementia, because they all cause problems with the blood supply to the brain. One particular type of dementia happens to people with Parkinson's disease. Korsakoff's syndrome is a type of dementia that can happen in younger people. It mainly affects the memory for recent events. This is caused by lack of vitamin B1 (thiamine) and is most often due to drinking too much alcohol. Lastly, there are infections such as Creutzfeldt-Jakob syndrome and AIDS.

Getting help

If your memory seems to be getting worse, attend your local specialist memory clinic or Neuropsychiatrist. He or she can examine you and may run some tests. They can see to any reversable medical causes, manage the lyst of symptoms described above and most importantly put you on memory medication which in most cases delay the illness significantly.

Headache can broadly and simplistically be divided in primary and secondary headaches; secondary being "secondary to something else (e.g. brain tumours etc), primary being "primary functional i.e. Neurological.

Excluding specific causes involve consulting a Neurologist and doing a brain scan or some medical investigation. Once such causes have been excluded, it is vital to carefully diagnose the exact primary type of headache, as the wrong treatment may follow if symptoms are not accurately obtained. The following descriptions will help your Doctor to make the correct primary headache diagnosis:

1. Tension-type Headache

Tension-type headache (TTH) has been known as muscle contraction headache, psychomyogenic headache, ordinary headache, idiopathic headache and even psychogenic headache. This makes no sense since so many of us have TTH and we do not differ psychologically from people without TTH. Therefore, we are in agreement that all these types of names should be commonly referred to as TTH.

The International Headache Society described tension-type headache as infrequent episodes of headache that last minutes to days. The pain is usually bilateral (both sides of the skull) in location with a pressing or tightening quality. Tension-type headache does not usually worsen with physical activity and may not cause disability. Nausea is usually not a symptom, but light sensitivity (photophobia) or sound sensitivity (phonophobia) may be present.

Tension type headaches is the most common type of headache and as many as 30% to 78% of the general population experience at some time during their lifetime. Studies further suggest that there is a biological mechanism underlying these types of headaches and they are not psychogenically based. The exact mechanisms are not known, but peripheral pain mechanisms are most likely involved. Tension-type headaches occurring frequently or even daily are classified as chronic tension-type headaches and are a serious condition that is associated with headache-induced disability and significantly impacts quality of life. Pain mechanisms peripherally and centrally may be involved in chronic tension-type headache, making treatment more challenging.

2. Migraine Headaches

Migraine headaches are less common than tension-type headaches. Nevertheless, migraines afflict about 28 million people in the United States alone. As many as 6% of all men and up to 18% of all women (about 12% of the population as a whole) experience a migraine headache at some time. Roughly three out of four migraine sufferers are female. It is important to recognize that children also get migraine and it affects between 5-10% of children under the age of 18 years.

Migraine is described as a recurrent headache lasting 4-72 hours and often has unilateral (one-sided) pulsating pain, moderate to severe intensity pain, nausea and/or photophobia. The pain of migraine can be aggravated by routine physical activity. About one in five migraine sufferers experiences an aura prior to onset of a migraine headache. Auras are neurologic symptoms that may occur before during and after a migraine. There are many different types of either visual or other sensory auras and they may differ between attacks.

3. Cluster Headaches

Cluster headaches occur in about 1% of the population and are distinct from migraine and tension-type headaches on several levels. Most of the cluster headache sufferers are men with onset between ages of 20-40 (where most migraineurs are women with onset following the start of menstruation).

These attacks are characterized by severe, unilateral (one-sided) pain that is around the eye or along the side of the head. Headache attacks last from 15 to 180 minutes and occur once every other day to up to 8 times daily. Attacks are associated with tearing on the same side of the head that the pain is located. Patients may also experience nasal congestion, runny nose, forehead and facial sweating, dropping eyelids or eyelid swelling. During an attack, patients may be restless or agitated due to excruciating pain.

In about 5% of the cases, cluster headache may be hereditary. Attacks occur in clusters or periods with weeks or months between new cluster periods; remission periods may be months or even years 10-15% of patients do not experience long periods of remission. During a cluster period, attacks may be provoked or triggered by alcohol or selected drugs like histamine or nitroglycerin. Pain usually presents on the same side each attack.