The gradual loss of memory

Dear Doc,

What is dementia?

ADW

Dementia is a disease of the brain causing a continuous decline in memory, thinking, making judgements, behaviour and personality changes that eventually affect a person’s ability to take care of him/herself and interact with others. Dementia can occur due to a number of reasons.

 It may be due to vascular dementia, where brain damage is caused by leakage or blockage of blood vessels in the brain, leading to reduced or lack of blood supply to areas of the brain.

Another possible cause is Alzheimer’s disease, where there is progressive shrinking of the brain and death of brain cells. It causes dementia and in the last stages the disease affects normal bodily functions like swallowing, bladder control and balance and increase the risk of developing other health problems like falls, poor nutrition, dehydration, constipation, diarrhoea and recurrent infections, which can eventually lead to death. Alzheimer’s is the most common cause of memory loss and dementia.

There are other possible causes of dementia including thyroid hormone disorders, medication side effects, vitamin deficiency, increased pressure in the brain, among others.

With normal aging, when there is no dementia, the decline of the body may also be associated with age-related memory changes, especially with short term and working memory, though long term memory is usually intact.

There is a higher risk of dementia in those over the age of 65 years or when there is a history of traumatic brain injury, or when there is uncontrolled diabetes or hypertension, or if there is a history of smoking, or if an individual has close relatives with a history of dementia.

If it is due to a reversible cause such as hormone imbalance, then treating the underlying cause may help the dementia to reverse. If the dementia is due to conditions that damage brain tissue, then it cannot be treated. It can be prevented or delayed by having a healthy diet, exercising, quitting smoking, treating any underlying illnesses, maintaining social contacts and staying mentally active even in old age.

Hello doctor,

I'm 28 years old. I have had stomach ulcers for quite some time and I use Proton pump inhibitors any time I feel pain or discomfort. Not long ago, the condition worsened and I started vomiting frequently. I saw a doctor and got diagnosed with hiatus hernia hill 2. The doctor told me I can undergo surgery. Is it advisable to do so?

AM

Dear AM,

A hiatus hernia occurs when the upper part of the stomach prolapses or pushes upwards through the diaphragm, into the chest region. The diaphragm is a sheet of muscle that separates the chest region from the abdominal region and it usually has a small space through which the lower end of the oesophagus (food pipe) passes to join the stomach, which is usually situated below the diaphragm. This space in the diaphragm, called a hiatus, may be wider, allowing the upper part of the stomach to push upwards into the chest region, which is called a hernia. A hernia is simply the bulging of an organ through an opening or through an area of tissue weakness.

For most people, hiatal hernias do not cause any symptoms. In a few people, a hiatus hernia may cause or worsen reflux of stomach acid and contents up the oesophagus, causing heartburn, nausea, irritation, pain and difficulty swallowing. Over time, complications may arise such as formation of an ulcer, bleeding, formation of scar tissue in the oesophagus, and inhalation of acid into the airway.

Some people are born with hiatal hernias, while some develop it later in life. Someone is more likely to develop the hernia if they are obese or pregnant, or have a condition causing build-up of fluid in the abdomen (ascites).

The severity of the hiatus hernia is determined by the symptoms and the response to treatment. The hill classification is used to grade the tightness/function of the junction between the oesophagus and the stomach, with hill 1 being normal function and hill 4 being a wide open hiatus. Hill grades 3 and 4 are usually associated with symptoms and complications of reflux.

For the majority who have hiatus hernia with no symptoms, treatment is not necessary. Initial management for those who have symptoms include medication to reduce acid production and lifestyle changes. Surgery is reserved for those who do not respond well to medical treatment and/or have complications. Since hiatal hernias cause reflux, some dietary and lifestyle changes may reduce or prevent it such as:

  Taking frequent, small meals, instead of fewer, larger meals

  Reducing/avoiding foods that may worsen symptoms such as citrus fruits, spicy foods, caffeine, alcohol …

  Taking the last meal at least two to three hours before bedtime

  Staying upright after feeding

  Raising the head of the bed about six inches

  Stopping smoking

  Maintaining a healthy weight

Dear Doctor,

Some of my finger nails have a darker colour and look disfigured. I have had this problem for the past one year. What could have caused it? Is it possible for my nails to go back to normal?

Nancy

Dear Nancy,

There are many causes for disfigured and discoloured nails, but the most common cause is fungal infection of the nail. Usually, the infection is very stubborn and can last for a long time, even years. Treatment is with anti-fungal tablets and some medication for applying on the nails.

The treatment itself may take long and it is sometimes broken into phases, otherwise known as pulsing. You should visit a doctor so that they can determine whether it is a fungal infection or it could be a result of other illnesses like psoriasis. In most cases, the nails can be treated and go back to normal.

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