ALZHEIMER DISEASE/DEMENTIA

Dementia is a loss of brain function that occurs twith certain diseases. It affects memory, thinking, language, judgment, and behavior.

Causes

Dementia usually occurs in older age. Most types are rare in people under age 60. The risk of dementia increases as a person gets older.
Most types of dementia are nonreversible (degenerative). Nonreversible means the changes in the brain that are causing the dementia cannot be stopped or turned back. Alzheimer disease is the most common type of dementia.
Another common type of dementia is vascular dementia. It is caused by poor blood flow to the brain, such as with stroke.
Lewy body disease is a common cause of dementia in older adults. People with this condition have abnormal protein structures in certain areas of the brain.

The following medical conditions can also lead to dementia:

Huntington disease
Brain injury
Multiple sclerosis
Infections such as HIV/AIDS, syphilis, and Lyme disease
Parkinson disease
Pick disease
Progressive supranuclear palsy
Some causes of dementia may be stopped or reversed if they are found soon enough, including:
Brain injury
Brain tumors
Long-term (chronic) alcohol abuse
Changes in blood sugar, sodium, and calcium levels (dementia due to metabolic causes)
Low vitamin B12 level
Normal pressure hydrocephalus
Use of certain medicines, including cimetidine and some cholesterol drugs
Some brain infections

Symptoms

Dementia symptoms include difficulty with many areas of mental function, including:
Emotional behavior or personality
Language
Memory
Perception
Thinking and judgment (cognitive skills)
Dementia usually first appears as forgetfulness.
Mild cognitive impairment (MCI) is the stage between normal forgetfulness due to aging and the development of dementia. People with MCI have mild problems with thinking and memory that do not interfere with daily activities. They often know about their forgetfulness. Not everyone with MCI develops dementia.

Symptoms of MCI include:

Difficulty doing more than one task at a time
Difficulty solving problems or making decisions
Forgetting recent events or conversations
Taking longer to do more difficult mental activities

Early symptoms of dementia can include:

Difficulty with tasks that take some thought, but that used to come easily, such as balancing a checkbook, playing games (such as bridge), and learning new information or routines
Getting lost on familiar routes
Language problems, such as trouble with the names of familiar objects
Losing interest in things previously enjoyed, flat mood
Misplacing items
Personality changes and loss of social skills, which can lead to inappropriate behaviors
As dementia becomes worse, symptoms are more obvious and interfere with the ability to take care of oneself.

Symptoms may include:
Change in sleep patterns, often waking up at night
Difficulty with basic tasks, such as preparing meals, choosing proper clothing, or driving
Forgetting details about current events
Forgetting events in one's own life history, losing self-awareness
Having hallucinations, arguments, striking out, and violent behavior
Having delusions, depression, and agitation
More difficulty reading or writing
Poor judgment and loss of ability to recognize danger
Using the wrong word, not pronouncing words correctly, speaking in confusing sentences
Withdrawing from social contact

People with severe dementia can no longer:

Perform basic activities of daily living, such as eating, dressing, and bathing
Recognize family members
Understand language
Other symptoms that may occur with dementia:
Problems controlling bowel movements or urine
Swallowing problems

Exams and Tests

A skilled health care provider can often diagnose dementia using the following:

Complete physical exam, including nervous system exam
Asking about the person's medical history and symptoms
Mental function tests (mental status examination)
Other tests may be ordered to find out if other problems may be causing dementia or making it worse.

These conditions include:

Anemia
Brain tumor
Long-term (chronic) infection
Intoxication from medicines
Severe depression
Thyroid disease
Vitamin deficiency

The following tests and procedures may be done:

B12 level
Blood ammonia levels
Blood chemistry (chem-20)
Blood gas analysis
Cerebrospinal fluid (CSF) analysis
Drug or alcohol levels (toxicology screen)
Electroencephalograph (EEG)
Head CT
Mental status test
MRI of head
Thyroid function tests, including thyroid stimulating hormone (TSH)
Thyroid stimulating hormone level
Urinalysis

Testament

Treatment depends on the condition causing the dementia. Some people may need to stay in the hospital for a short time.
Sometimes, dementia medicine can make a person's confusion worse. Stopping or changing these medicines is part of the treatment.
Certain mental exercises can help with dementia.
Treating conditions that can lead to confusion often greatly improve mental function. Such conditions include:
Anemia
Congestive heart failure
Decreased blood oxygen (hypoxia)
Depression
Heart failure
Infections
Nutritional disorders
Thyroid disorders

Medicines may be used to:

Slow the rate at which symptoms get worse, though improvement with these drugs may be small
Control problems with behavior, such as loss of judgment or confusion

Coronary heart disease is a narrowing of the small blood vessels that supply blood and oxygen to the heart. Coronary heart disease (CHD) is also called coronary artery disease.

Causes
CHD is the leading cause of death in the United States for men and women. CHD is caused by the buildup of plaque in the arteries to your heart. This may also be called hardening of the arteries. Fatty material and other substances form a plaque buildup on the walls of your coronary arteries. The coronary arteries bring blood and oxygen to your heart. This buildup causes the arteries to get narrow. As a result, blood flow to the heart can slow down or stop. A risk factor for heart disease is something that increases your chance of getting it. You cannot change some risk factors for heart disease, but you can change others.

Symptoms
In some cases, symptoms may be very noticeable. But, you can have the disease and not have any symptoms. This is more often true in the early stages of heart disease. Chest pain or discomfort (angina) is the most common symptom. You feel this pain when the heart is not getting enough blood or oxygen. The pain may feel different from person to person. It may feel heavy or like someone is squeezing your heart. You may feel it under your breast bone (sternum). You may also feel it in your neck, arms, stomach, or upper back. The pain most often occurs with activity or emotion. It goes away with rest or a medicine called nitroglycerin. Other symptoms include shortness of breath and fatigue with activity (exertion).
Some people have symptoms other than chest pain, such as:
Fatigue
Shortness of breath
General weakness

Exams and Tests
Your health care provider will examine you. You will often need more than one test before getting a diagnosis. Tests to evaluate for CHD may include:
Coronary angiography -- An invasive test that evaluates the heart arteries under x-ray.
Echocardiogram stress test.
Electrocardiogram (ECG).
Electron-beam computed tomography (EBCT) to look for calcium in the lining of the arteries. The more calcium, the higher your chance for CHD. Exercise stress test.
Heart CT scan.
Nuclear stress test.

Treatment
You may be asked to take one or more medicines to treat blood pressure, diabetes, or high cholesterol levels. Follow your provider's directions closely to help prevent CHD from getting worse.
Goals for treating these conditions in people who have CHD:
The most commonly used blood pressure target for people with heart disease is less than 130/80, but your provider may recommend a different blood pressure target.
If you have diabetes, your HbA1c levels will be monitored and brought down to the level your provider recommends. Your LDL cholesterol level will be lowered with statin drugs.
Treatment depends on your symptoms and how severe the disease is. You should know about:
Other medicines used to treat angina.
What to do when you have chest pain.
Being active when you have heart disease.
Eating a heart-healthy diet.

Never stop taking your medicines without first talking to your provider. Stopping heart medicines suddenly can make your angina worse or cause a heart attack. You may be referred to a cardiac rehabilitation program to help improve your heart's fitness.
Procedures and surgeries used to treat CHD include:
Angioplasty and stent placement, called percutaneous coronary interventions (PCIs)
Coronary artery bypass surgery
Minimally invasive heart surgery

Outlook (Prognosis)
Everyone recovers differently. Some people can stay healthy by changing their diet, stopping smoking, and taking their medicines as prescribed. Others may need medical procedures such as angioplasty or surgery. In general, early detection of CHD generally leads to a better outcome.

When to Contact a Medical Professional
If you have any risk factors for CHD, talk to your provider about prevention and possible treatment steps. Call your provider, call the local emergency number (such as 911), or go to the emergency room right away if you have:
Angina or chest pain
Shortness of breath
Symptoms of a heart attack

Prevention Take these steps to help prevent heart disease.
If you smoke, stop. There are many resources available to help you stop smoking. Learn how to eat a heart-healthy diet by making simple substitutions. For example, choose heart-healthy fats over butter and other saturated fats.
Get regular exercise, ideally at least 30 minutes most days. If you have heart disease, talk with your provider about starting an exercise routine.
Maintain a healthy body weight.
Lower high cholesterol with lifestyle changes, and if needed, statin medicines.
Lower high blood pressure using diet and medicines.
Talk with your provider about aspirin therapy.
If you have diabetes, keep it well-managed to help prevent heart attack and stroke.
Even if you already have heart disease, taking these steps will help protect your heart and prevent further damage.

Alternative Names
Heart disease, Coronary heart disease, Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD

Patient Instructions
After weight-loss surgery - what to ask your doctor
Antiplatelet drugs - P2Y12 inhibitors
Aspirin and heart disease
Before weight-loss surgery - what to ask your doctor
Cholesterol - drug treatment
Controlling your high blood pressure
Dietary fats explained
Fast food tips
Gastric bypass surgery - discharge
Heart bypass surgery - discharge
Heart bypass surgery - minimally invasive - discharge
Heart disease - risk factors
Heart failure - discharge
Heart failure - fluids and diuretics
Heart failure - home monitoring
Heart pacemaker - discharge
How to read food labels
Implantable cardioverter defibrillator - discharge
Laparoscopic gastric banding - discharge
Low-salt diet
Mediterranean diet

Human immunodeficiency virus (HIV) is the virus that causes AIDS. When a person becomes infected with HIV, the virus attacks and weakens the immune system. As the immune system weakens, the person is at risk of getting life-threatening infections and cancers. When that happens, the illness is called AIDS. Once a person has the virus, it stays inside the body for life.

Causes
The virus is spread (transmitted) person-to-person through certain body fluids:
Blood
Semen and preseminal fluid
Rectal fluids
Vaginal fluids
Breast milk

HIV can be spread if these fluids come in contact with:
Mucous membranes (inside of the mouth, penis, vagina, rectum)
Damaged tissue (tissue that has been cut or scraped)
Injection into the blood stream
HIV cannot be spread through sweat, saliva, or urine.

In the United States, HIV is mainly spread:
Through vaginal or anal sex with someone who has HIV without using a condom or is not taking medicines to prevent or treat HIV
Through needle sharing or other equipment used to inject drugs with someone who has HIV

Less often, HIV is spread:
From mother to child. A pregnant woman can spread the virus to her fetus through their shared blood circulation, or a nursing mother can pass it to her baby through her breast milk. Testing and treatment of HIV-positive mothers has helped lower the number of babies getting HIV. Through needle sticks or other sharp objects that are contaminated with HIV (mainly health care workers).

The virus is NOT spread by:
Casual contact, such as hugging or closed-mouth kissing
Mosquitoes or pets
Participating in sports
Touching items that were touched by a person infected with the virus
Eating food handled by a person with HIV

HIV and blood or organ donation:
HIV is not spread to a person who donates blood or organs. People who donate organs are never in direct contact with the people who receive them. Likewise, a person who donates blood is never in contact with the person receiving it. In all of these procedures, sterile needles and instruments are used. While very rare, in the past HIV has been spread to a person receiving blood or organs from an infected donor. However, this risk is very small because blood banks and organ donor programs thoroughly check (screen) donors, blood, and tissues.
Risk factors for getting HIV include:
Having unprotected anal or vaginal sex. Receptive anal sex is the riskiest. Having multiple partners also increases the risk. Using a new condom correctly every time you have sex greatly helps lower this risk.
Using drugs and sharing needles or syringes.
Having a sexual partner with HIV who is not taking HIV medicines.
Having a sexually transmitted disease (STD).

Symptoms
Symptoms related to acute HIV infection (when a person is first infected) can be similar to the flu or other viral illnesses. They include:
Fever and muscle pains
Headache
Sore throat
Night sweats
Mouth sores, including yeast infection (thrush)
Swollen lymph glands
Diarrhea
Many people have no symptoms when they are first infected with HIV.
Acute HIV infection progresses over a few weeks to months to become an asymptomatic HIV infection (no symptoms). This stage can last 10 years or longer. During this period, the person might have no reason to suspect they have HIV, but they can spread the virus to others.
If they are not treated, almost all people infected with HIV will develop AIDS. Some people develop AIDS within a few years of infection. Others remain completely healthy after 10 or even 20 years.
People with AIDS have had their immune system damaged by HIV. They are at very high risk of getting infections that are uncommon in people with a healthy immune system. These infections are called opportunistic infections. These can be caused by bacteria, viruses, fungi, or protozoa, and can affect any part of the body. People with AIDS are also at higher risk for certain cancers, especially lymphomas and a skin cancer called Kaposi sarcoma. Symptoms depend on the particular infection and which part of the body is infected. Lung infections are common in AIDS and usually cause cough, fever, and shortness of breath. Intestinal infections are also common and can cause diarrhea, abdominal pain, vomiting, or swallowing problems. Weight loss, fever, sweats, rashes, and swollen lymph glands are common in people with HIV infection and AIDS.

Exams and Tests
DIAGNOSTIC TESTS
These are tests that are done to check if you've been infected with the virus. In general, testing is a 2-step process: Screening test -- There are several kinds of tests. Some are blood tests, others are mouth fluid tests. They check for antibodies to the HIV virus, HIV antigen, or both. Some screening tests can give results in 30 minutes or less. Follow-up test -- This is also called a confirmatory test. It is often done when the screening test is positive. Home tests are available to test for HIV. If you plan to use one, check to make sure it is approved by the FDA. Follow instructions on the packaging to ensure the results are as accurate as possible.
The Centers for Disease Control and Prevention (CDC) recommends that everyone ages 15 to 65 have a screening test for HIV. People with risky behaviors should be tested regularly. Pregnant women should also have a screening test.
TESTS AFTER BEING DIAGNOSED WITH HIV
People with AIDS usually have regular blood tests to check their CD4 cell count: CD4 cells are the blood cells that HIV attacks. They are also called T4 cells or "helper T cells." As HIV damages the immune system, the CD4 count drops. A normal CD4 count is from 500 to 1,500 cells/mm3 of blood.
People usually develop symptoms when their CD4 count drops below 350. More serious complications occur when the CD4 count drops to 200. When the count is below 200, the person is said to have AIDS.
Other tests include:
HIV RNA level, or viral load, to check how much HIV is in the blood
A resistance test to see if the virus has any resistance to the medicines used to treat HIV
Complete blood count, blood chemistry, and urine test
Tests for other sexually-transmitted infections
TB test
Pap smear to check for cervical cancer
Anal Pap smear to check for cancer of the

Treatment
HIV/AIDS is treated with medicines that stop the virus from multiplying. This treatment is called antiretroviral therapy (ART). In the past, people with HIV infection would start antiretroviral treatment after their CD4 count dropped or they developed HIV complications. Today, HIV treatment is recommended for all people with HIV infection, even if their CD4 count is still normal. Regular blood tests are needed to make sure the virus level in the blood (viral load) is kept low, or suppressed. The goal of treatment is to lower the HIV virus in the blood to a level that is so low that the test can't detect it. This is called an undetectable viral load. If the CD4 count already dropped before treatment was started, it will usually slowly go up. HIV complications often disappear as the immune system recovers.

Support Groups
Joining a support group where members share common experiences and problems can often help lower the emotional stress of having a long-term illness.

Outlook (Prognosis)
With treatment, most people with HIV/AIDS can live a healthy and normal life.
Current treatments do not cure the infection. The medicines only work as long as they are taken every day. If the medicines are stopped, the viral load will go up and the CD4 count will drop. If the medicines are not taken regularly, the virus can become resistant to one or more of the drugs, and the treatment will stop working. People who are on treatment need to see their health care providers regularly. This is to make sure the medicines are working and to check for side effects of the drugs.

When to Contact a Medical Professional
Call for an appointment with your provider if you have any risk factors for HIV infection. Also call if you develop symptoms of AIDS. By law, the results of HIV testing must be kept confidential (private). Your provider will review your test results with you.

Prevention
Preventing HIV/AIDS:
Get tested. People who don't know they have HIV infection and who look and feel healthy are the most likely to transmit it to others. DO NOT use illegal drugs and do not share needles or syringes. Many communities have needle exchange programs where you can get rid of used syringes and get new, sterile ones. Staff at these programs can also refer you for addiction treatment.
Avoid contact with another person's blood. If possible, wear protective clothing, a mask, and goggles when caring for people who are injured.
If you test positive for HIV, you can pass the virus to others. You should not donate blood, plasma, body organs, or sperm.
HIV-positive women who might become pregnant should talk to their provider about the risk to their unborn child. They should also discuss methods to prevent their baby from becoming infected, such as taking antiretroviral medicines during pregnancy.
Breastfeeding should be avoided to prevent passing HIV to infants through breast milk.
Safer sex practices, such as using latex condoms, are effective in preventing the spread of HIV. But there is still a risk of getting the infection, even with the use of condoms (for example, condoms can tear). In people who aren't infected with the virus, but are at high risk of getting it, taking a drug called Truvada can help prevent the infection. This treatment is known as pre-exposure prophylaxis, or PrEP. Talk to your provider if you think PrEP might be right for you.
HIV-positive people who are taking antiretroviral medicines and have no virus in their blood do not transmit the virus.
The US blood supply is among the safest in the world. Nearly all people infected with HIV through blood transfusions received those transfusions before 1985, the year HIV testing began for all donated blood.
If you believe you have been exposed to HIV, seek medical attention right away. DO NOT delay. Starting antiviral medicines right after the exposure (up to 3 days after) can reduce the chance that you will be infected. This is called post-exposure prophylaxis (PEP). It has been used to prevent transmission in health care workers injured by needlesticks.

Alternative Names HIV infection; Infection - HIV; Human immunodeficiency virus; Acquired immune deficiency syndrome