Tuesday, February 5, 2013

Dementia




Dementia
Abstract
Brain injury is a widespread problem, affecting millions of people in different countries worldwide. Damage on the brain can result to brain split which is the separation of the right and left parts of the brain. There are two types of brain injury that are discussed: Traumatic Brain Injury (TBI) and Acquired Brain Injury (ABI). Various causes of brain injury such as brain tumors, cerebrovascular disorders, closed-head injuries, infections of the brain, neurotoxins and genetic factors are discussed in the paper. Statistics of brain damage in the US are given as well as the diagnosis and different types of treatment. Both physical and psychological symptoms of brain damage are discussed in details.














Brain Damage
What is the brain?
People are living in an age in which individuals are more and more accepting the idea that the emotional, intellectual and even biological processes are controlled uniquely by the brain. The question then is what is the brain? Tramo et al (1995) defines it as center of the nervous system. The human brain has a structure similar to the structure of the brains of all mammals. The location of the brain is in the head, normally near to primary sensory functionality like hearing, vision, taste, smell and balance. The brain is the most complex body organ in vertebrates (Funnell, Colvin and Gazzaniga, 2007).
 Split Brain
Split brain is the term that describes the result of severing to some degree of the corpus callosum that connects the right and the left hemispheres of the brain. The surgical procedure that produces this condition is referred to as corpus callosotomy and is considered as the last result in the treatment of some of the brain disorders such as intractable epilepsy. The two hemispheres of the brain are connected by the corpus callosum which is the means by which their coordinate and communicate (Gazzaniga, 2005).  
Right hemisphere
This is the right side of the brain that is the seat of language and processes information logically and sequentially. The side stands out in nonverbal and spatial functions (Gazzaniga, 2005).  


Left hemisphere
This is the left part of brain that is more visual and processes information holistically, intuitively and randomly. This side is more dominant in verbal functions such as speaking and writing (Gazzaniga, 2005).   
Functions of the brain
The brain has very many functions some of which will be discussed in this section of the paper. From an evolutionary biological point of view, the function of this organ is providing coherent control over all the actions of a human being. One of the specific functions of the brain is information processing. The brain receives input and processes it to information just like a computer system. The other function of the brain is perception. The brain extracts biologically relevant information from the inputs (Champion, Holcomb and Young, 2009). The brain is fed with the information concerning sound, light, the chemical makeup of the atmosphere, head orientation, temperature, limb positioning, and the chemical makeup of the bloodstream and the like. Motor control is another function of the brain. These are the areas of the brain that are concerned with the body movement. Arousal is the other function of the human brain. This is involved with the daily cycle between waking and sleeping. Homeostasis which is the maintenance of balance in the bodily states is controlled by the brain. Motivation in human beings is a process that is controlled by the brain. Learning and memory is also a function of the brain (Funnell, Corballis and Gazzaniga, 2000).
Types of brain damage
All traumatic brain injuries are injuries on the head. However, head injury is not necessarily brain injury. There are two main types of brain injury: traumatic brain injury and acquired brain injury. The two types of brain injury affect the normal functioning of the brain (Zink, 2001).
Traumatic brain injury (TBI)
This is a kind of brain injury that results from an external force like a blow to the head. Such a blow can cause damages to the skull or brain movement inside the skull. The major causes of traumatic brain injury are falls, violence and accidents. It can be as a result of direct impact or acceleration. The impact can result to immediate traumatic brain injury or secondary brain injury, which are the events that happen sometime after the initial injury. The secondary processes including cerebral blood flow as well as the pressure within the skull can result to considerable damage to the brain from the initial injury. Traumatic brain injury can be classified on the basis of severity and mechanism (closed or penetrating) among other features, such as taking place in a particular location or over a wide-spread area of the brain (Champion, Holcomb and Young, 2009). Head injury normally refers to traumatic head injury; however, it is a general category as it can refer to damage on other structures in the head such as scalp or skull. Traumatic head injury is known to be a major cause of death and disability in the entire world. This is particularly in children as well as young adults. Traumatic brain injury can result in a host of cognitive, emotional, social, behavioral and physical effects. The result can be complete recovery, permanent disability or death (McIntosh and McCrory, 2005).  
Acquired brain injury (ABI)
This type of brain injury happens at the cellular level. This is in most cases connected with pressure to the brain. This pressure can be caused by a tumor or can be as a result of neurological disorder such as stroke. ABI is caused by events that happen after birth. It is not as a result of congenital or genetic disorder like perinatal illness, perinatal hypoxia or fetal alcohol syndrome. Acquired brain injury can cause cognitive, emotional, behavioral or physical disorders that can result in temporary or permanent changes in brain functioning. The injury can be caused by TBI or nontraumatic injury resulting from either internal or external source like brain tumors, stroke, poisoning, infection, ischemia, hypoxia or substance abuse. Acquired brain injury does not include brain damage that result from neurodegenerative illness. When the brain is damaged, there are obvious effects on the person’s life. Results of acquired brain injury normally necessitate major life adjustments around the individual’s new condition. Making such adjustments is important in the recovery and rehabilitation of the affected person (McIntosh and McCrory, 2005).    
Causes of Brain Damage
Brain tumors
Cancer is one of the major non-infectious diseases and more recognized over the past decade, more causes of brain tumors are detected with the current medical technologies and more sophisticated medical techniques. Cancerous cells are known to continue growing after the onset. This ongoing growth of the cells can exert pressure on the brain. This pressure can in turn cause blood to clot or directly result in brain damage as a result of the pressure the tumor exerts against it. Tumors can also cause brain damage through invasion of the brain spaces. Surgical procedures that are performed to remove tumors can also cause brain damage (Majdan et al, 2011). 
Cerebrovascular disorders
One of the common cerebrovascular disorders is stroke. Such disorders block the flow of blood. Incase a cerebrovascular accident such as stroke blocks the flow of blood, the result is normally death of cells in the areas where the blood is not reaching. Incase of hemorrhage in or over the blood because of such a cerebrovascular accident there will be loss of flow of blood. Such loss of blood flow or injury to tissues in the brain can result in brain damage. This is a common cause of brain damage (Zink, 2001).  
Closed-head injuries
These are the types of injuries that case brain movement back and forth inside the skull. Closed-head injuries can result from slip and fall, or from car accidents. Shaken Body Syndrome is another kind of closed-head injury that can cause brain injury. They include the injuries that result fast deceleration or acceleration of the head. In this case, there is no penetration to the skull. The movement of the brain within the skull results in nerve fibers within the separating and damaging the brain tissue. This causes focal damage as well as diffuse damage to axons. Diffuse damage is when the effects are broad (Majdan et al, 2011).   
Infections of the brain
The brain can be infected by different agents and in different ways. The brain as well as the membranes that surround it is prone to various infections. This infection particularly happens incase the unique blood-brain protective system is violated. Some of the agents that cause these infections are viruses and bacteria. These agents are known to cause severe and life-threatening illness of the brain (Zink, 2001).  
Neurotoxins
These are the toxins that act particularly on nerve cells (neurons) normally through interaction with membrane proteins like ion channels. Some sources of neurotoxins are more general and describe the effects of neurotoxins that occur at nerve tissue. Brain damage caused by the neurotoxins happens when the harmful agents damage the nerve cells (Zink, 2001).  


Genetic factors
There are some dysfunctional genes that are hereditary. Because they are genetic or hereditary, they can be passed from a parent to an offspring. Such genes have been known to prevent complete development of a normal brain. The genes can be said to cause damage to the brain (Majdan at al, 2011).   
Statistics
Brain damage is a serious problem not only in the United States, but in all other countries. Each year, brain damage in the United States contributes to a number of deaths and many cases of permanent disability (Majdan et al, 2011).
Incidence and prevalence
Statistics from Centers for Disease Control and Prevention (CDC) approximate that 1.4 million individuals suffer brain injury every years in the United States. The same report suggests that about 50,000 individuals dies every year from brain injury. From the Centers for Disease Control and Prevention, approximations of the number of individuals who have survived a brain injury are ranging from 2.5 million to 6.5 million. This range is big due to the fact that most of the minor injuries are never reported. The current number of people living with brain injury in the United States is estimated to 3.17 million individuals. About 475,000 brain injury cases take place among children between the ages of 0 and 14 years. Falls are the main cases of these injuries with the rates being highest for children between the ages of 0 and 4 years and for the elderly 75 years and above (Majdan et al, 2011). 
            Estimates on the cost of treating brain injuries in the country are at 48.3 billion dollars per year. This cost is categorized as 31.7 billion dollars for hospitalization and another 16.6 billion dollars in the costs that are related to fatalities. The Centers for Disease Control and Prevention approximates the full cost of acute care as well as rehabilitation for traumatic brain injury patients in the country ranges between 9 billion dollars to 10 billion dollars per annum.  This cost is excluding the direct costs to members of the family and community (for example lost earnings, productivity for members of the family, work time, employers, care givers, and the costs that are associated with provision of social services). It is approximated that over a lifetime, it costs between 600,000 dollars and 1.875 million dollars in caring for a senior of serious brain damage (Majdan et al, 2011).
For both males and females native born, there are high rates of brain injury-associated hospitalizations. This number is followed by the people born in other English-speaking nations and then the non-English speaking nations. This pattern was also evident in the brain-injury related disabilities in men, though standard errors related with small samples reveal that it is not likely to tell whether the difference in groups is significant. Females appear to have lower rates of brain injuries when compared with men. The rates of hospitalization due to brain injuries seem to be higher in men that in females, particularly those born in the country. Demographic patterns of the incidence of brain injury-related disability should not essentially be expected to reflect demographic patterns of hospitalization for injury-related conditions. As research reveals, whites may be fewer in terms of traumatic brain injuries, but they are not immune to acquired brain injuries (Majdan et al, 2011).  
Disease
Diagnosis
Neurological examination
Diagnosis of head damage is suspected on the basis of lesion circumstances as well as clinical evidence. Neurological examination is one of the ways of getting clinical evidence of brain injury or damage, for instance testing if the pupils constrict in a normal way in response to light. Another way is assigning Glasgow Coma Score. In determining diagnosis and prognosis and determining the kind of treatment to give, particularly in traumatic brain injury, neuroimaging is used. Neoroimaging is effective in detecting increased intracranial pressure (Shaw, 2002).
Diagnostic Tests
There are other specialized radiologic tests used in the diagnosis of brain damage.
a) Magnetic resonance imaging (MRI)
This is a diagnostic test that shows more details than others such as the CT scan. This test is capable of adding information on the expected results in the long-term. This test is effective in detecting the characteristics of injury such as diffuse axonal injury in the long-term (Boake and Diller, 2005).
b) Computerized tomography (CT)
This is the kind of test that is more effective in the emergency situations because it is fast, accurate as well as widely available. Once the first CT has been done, others can follow later to see how the injury is progressing. This test is preferred in emergency situations because of its ability to detect fractures and bleeds and its fast acquisition of images (Boake and Diller, 2005).
c) Evoked potentials
These are electrical potentials that are recorded from the nervous system of a person after presentation of a stimulus. They are different from the spontaneous potentials. The ability of the test to determine the time for the nervous system to respond to stimulus is useful in the diagnosis of brain damage (Granacher, 2007).

Prognosis
Prognosis of brain injury becomes worse with its severity. Most of the injuries are minor and do not result in permanent disability. However, severe damages have the possibility of causing permanent disability. Permanent disability is found to happen in 10 percent of minor injuries, 66 percent of moderate injuries and a 100 percent of severe injuries. Minor cases can be solved within a few weeks and the patient is able to return to his normal life, though a few have mild social and cognitive impairment. Over 90 percent of those with moderate injury are able to resume normal functioning though a few will require assistance physical capabilities, employment and financial management. Most of those with severe injuries will die or have permanent disability. Coma is closely connected with severity. Prognosis also differs with severity and location of the injury as well as the ability to seek timely medical care (Granacher, 2007).  
Symptoms
Physical
Brain injuries normally result in different impairments which can differ in severity. The symptoms also depend on the cause of the brain injury. As already noted, in case of severe injuries, the person can have permanent disabilities such as delusions, neurocognitive deficits, speech and movement impairment, and mental disability. Personality changes have also resulted in some cases of brain damage. The very severe cases of brain damage result in coma or even vegetative state. Even minor injuries can cause serious damage and have symptoms showing up later in life. Brain damage disrupts the normal functioning of the brain. Some of the physical symptoms that are caused by brain damage include: 1) slowed thinking processes; 2) difficulty switching between tasks; 3) diminished libido; 4) disturbed sleep; 5) emotional outbursts; 6) irritability; 7) depression; 8)  faulty judgment; 9) impaired memory (Some individuals with head damage engage in confabulations. This is the incapability to tell daydream memory from the real memory. Some of the patients suffer memory lapses and tend to fill the lapses with daydreams); 10) difficulty concentrating; and 11) inattention and excessive sleepiness (Coles, 2007).
Psychological
At times it is hard to differentiate actual brain damage from other emotional disorders of issues. However, after testing for brain damage in a person showing these symptoms it is possible to tell. Specialists use tests to make it possible to figure out the problem in a particular area of the brain. The frontal lobe of the brain is responsible for controlling inhibition of unsuitable behavior, attention, foresight, interpersonal behavior, personality, mood, judgment, and drive. Sometimes, the symptoms lessen as the injury heals, but in a few cases, they get worse. This causes psychological symptoms such as Depression, Cognitive/Intellectual difficulties (effects on the Short Term Memory or the Long Term Memory, impairment in information processing (Semantic Encoding, Verbal Abstraction, and Implicit Learning) (Race, Keane and Verfaellie, 2011).  
The symptoms vary depending on the area of the brain that is injured. Incase the brain is injured at the forehead or the frontal lobe, symptoms that are likely to occur include: incapacity to express oneself, problems in solving problems, personality change, social behavior change, mood changes, incapability to focus on tasks, persisting on a single thought, lack of flexibility in thinking, problems in interacting with other people, incapability to organize a series of complex movements, and loss of body movement (Race, Keane and Verfaellie, 2011).   
Incase the parietal lobe is injured, possible symptoms include: problems in coordination, loss of self-awareness of some parts of the body, difficulties in reading, problems doing mathematics problems, problems in telling right from left, problems with drawing, problems in naming objects, and problems in attending to more than one object at the same time (Race, Keane and Verfaellie, 2011).  
If it is the occipital lobes that are injured, possible symptoms include: problems in reading and writing, problems with recognizing objects’ movement, problems in recognizing drawings, problem with seeing objects, problems with recognizing words, problems with identifying color and hallucinations (Race, Keane and Verfaellie, 2011).   
Treatment
Brain treatment helps patients with neurological impairments to manage their physical, psychological and cognitive damages. While these symptoms can be effectively managed, there is no cure for congenial brain injury. However, besides medications, doctors prescribe therapies to help the patients in regaining some of the lost functions and abilities such as communication skills. Treatment for congenial traumatic brain injury differs from the treatment for acquired brain injury (Tompkins, Blake, Wambaugh and Meigh, 2011). While treatment for traumatic brain injury help the patient in managing impairments, treatment for acquired brain injury tries to fix the injury as well as prevent more damage to the brain. If it is untreated, other life-threatening conditions such as swelling of the brain and raised intracranial pressure. Intracranial pressure refers to the amount of pressure exerted on the skull by the brain blood as well as cerebrospinal fluid. The brain can swell because of this pressure that result from brain injury. In some cases, a hole is drilled into the skull by a surgeon to relieve the pressure. Another treatment for increased intracranial pressure is simply tilting the bed of the patient and straightening the head. This is effective in flow of blood through the veins in the neck (Hamed, 2009).  

Medication
Strong medication is used instead of relieving the pressure by drilling the skull. Such medications that are available include corticosteroids. Other medicines that can be used are analgesics, sedatives and paralytic agents depending with the kind of injury and the extent of the damage. Diuretics which are medicines that increase the output of urine can remove excessive fluid in the body. Though useful in treating ICPs, it can cause insufficient blood volume. Therefore it should be used carefully. While traumatic brain injury can be treated with the use of benzodiazepins, these medicines are used cautiously as they can lower blood pressure by repressing breathing (Hamed, 2009).   
Corticosteroids
This medicine is used in reducing brain inflammation as well as swelling. Given the fact that this medication is used in treatment of other conditions such as skin diseases, allergic reactions, certain tumors, digestive problems, blood disorders arthritis, eye problems, and for hormone replacement, it is important for it to be prescribed by the doctor. This is because it is only a specialist who can know the dosage of the medication required by the patient depending on the brain injury (Hamed, 2009).    
Physical therapy
Physical therapy is one of the treatments that are recommended for people with brain injuries. This program is aimed at promoting health of the brain damage patient by making it possible for him or her to perform purposeful and meaningful activities. Physical therapists work with the patient by using treatments that recover, develop and maintain activities of day to day living. The physical therapist not only helps the patient to improve their motor and reasoning skills, but also to deal with any complete loss of function. The main aim of physical therapy is helping the patient to have an independent, productive and fulfilling life (Tompkins, Blake, Wambaugh and Meigh, 2011).  
Psychological
Counseling
Counseling is important in helping the patient deal with the problem and adapt to the disability. This is therefore more effective where it is done by a professional counselor who understands the problem (Tompkins, Blake, Wambaugh and Meigh, 2011).
Cognitive rehabilitation
Cognitive rehabilitation is the main treatment for acute and subacute stages of recovery. It is a program that assists patients to restore their normal functioning or in compensating for cognitive deficits. The aim of rehabilitation is to improve independence at home and in the community. Rehabilitation is more effective in cases where it is done by a group of professionals who are knowledgeable in head trauma. As for any person with neuralgic disability, a multidisciplinary approach is more effective for better results. Rehabilitation physicians are possibly the major medical staff involved in the rehabilitation process, but based on the patient, other doctors and physicians can be involved. In this program, the patient is individually trained on particular skills as well as metacognitive strategies. Metacognitive abilities entail assisting the patient in increasing self-awareness concerning problem-solving abilities. This is done through learning how to observe the success of these abilities as well as self-correct where possible (Tompkins, Blake, Wambaugh and Meigh, 2011).  



Conclusion
Analysis
It has emerged from research that brain damage is a serious issues in the world, affecting millions of people in different nations every year. Statistics reveal that in the United States, more that a million people suffer brain injury every year. It has also emerged that treatment of brain injury costs the country more that 48 billion dollars every year. This problem is not isolated to the United States because all the other countries have reported cases of brain damage. The injuries range from minor to severe. It has also emerged that most of the traumatic brain injuries result from falls and this is the reason why majority of the affected are children between the age of 0 and 4 and the elderly 75 years and above. Several ways have been discussed of how people can snuffer brain injury. In the past decade, technology has developed such that it is possible to effectively manage most cases of brain injury. Diagnosis of brain injury is possible as there are various tests that are available for brain specialists. There are also non-based programs of behavioral, social, cognitive, vocational and educational treatments that address the problem of brain damage.
Evaluation
With the current development in medical technology, it is possible to manage cases of brain damage effectively. Research reveals that most of the brain damage cases that are treated effectively are the ones that are reported in time. It is thus important to seek medical attention immediately one falls or has a blow on the head that could result to brain injury. Patients who suffer brain injury are not only at the risk of suffering primary injury, but also secondary injury. This is the reason why immediate care is essential as some of the symptoms of brain injury will emerge later as secondary injury. Majority of the minor injuries are treated and the patient able to return his or her normal functioning. The injuries that are likely to cause permanent disabilities are the severe injuries, but the effects can also be effectively managed by seeking immediate treatment and going through the entire treatment and rehabilitation process. Many hospitals in the country are equipped with effective equipments for identifying the kind of injury a patient has suffered and thus the doctors are able to have the knowledge of what procedure to follow. Various cases of brain injuries have been treated in the past and the technology continues to develop such that it will be able to handle more complicated cases.
Interpretation
Forecasting recovery in brain damage is a complicated but significant task. Important information is important in order for such prediction to be made and the treatment and rehabilitation program tailored to the needs of a particular patient. The information is of value when dealing with the patient as well as for policy makers in deciding the most effective ways of preventing brain injury and designing treatment programs. They are also important when looking at the wider issue of resource allocation, comparison of results in different treatment and rehabilitation programs and looking at the effects of different procedures on recovery. Brain damage is a serious issue and looking at the statistics it is evident that it is one that requires immediate attention. People require being educated on the ways of preventing brain damage for their own health and to save the country on the increasing cost of treating these injuries. It is important that children and the elderly are protected from avoidable falls and for people engaging in sports and such activities to wear protective gears. This way, such accidents that can be prevented will save the country, families and the society a lot. Brain injury is a serious problem and every person has a responsibility in preventing it where possible. More research is necessary to develop more advanced technologies of dealing with brain injuries such that more permanent disabilities can be avoided.





















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