ANEMIA IN DEMENTIA PATIENTS

Abstract

Aim. The aim of this study was the examination of the dementia’s patients with anemia and their outcomes before and after the treatment of the anemia.

Methods.This pilot study involved the investigation of dementia patients with and with secondary anemia and how it affected the patient’s outcome from a neurological point of view. Patients were evaluated using the red cell count, hemoglobin concentration, hematocrit, reticulocytes count and red cell indices during the study.

Results. The beneficial treatment of the anemia is well known and in our case was demonstrate amongst the dementia patients.

Conclusions. Based on this clinical study, the idea of anemia in dementia patients’ was discussed and the outcomes of the patients before and after the treatment of anemia showed a clinically significant difference that anemia has on the outcome of dementia patients.

Introduction

Dementia is a progressive and irreversible neurodegenerative disorder, characterized by a variety of symptoms: cognitive impairment, memory impairment, progressive impairment of the ability to perform daily activities, as well as a range of neuropsychiatric symptoms. Neurodegenerative diseases such as Alzheiemer’s disease, frontotemporal dementia and dementia with Lewy bodies appear in the context of neuronal deterioration and cognitive functions. Other types of dementia may be improved or even partially reversible under treatment. Dementia is not a disease in itself, but rather a number of symptoms that may accompany certain diseases or conditions. It is a common condition among the elderly, but it can start at any age. [3] About 5% of people between the ages of 65 and 70 and 40% of those over 85 are diagnosed with dementia. The presence of this disease decreases life expectancy, but estimates of survival rate vary. Statistical data show that the survival of patients since the onset of dementia diagnosis is between 7 and 10 years. [4] Dementia is an irreversible condition if it is caused by degenerative diseases or trauma, but is potentially reversible when the main cause is depression, hormonal imbalance, vitamin deficiency or alcohol consumption. [3] In order to identify the potentially treatable forms, a more complex evaluation of the symptoms of dementia is recommended. The frequency of “treatable” causes of dementia is considered to be about 20 percent.

There are many factors that lead to dementia, such as neurological diseases, vascular diseases or inherited conditions.

The most common causes of dementia include: degenerative neurological diseases, such as Alzheimer’s disease, frontotemporal lobar degeneration, dementia with Lewy bodies, Parkinson’s disease and Huntington’s disease; cerebrovascular disorders, such as dementia. Its occurrence is caused by multiple strokes; infections affecting the central nervous system: dementia associated with HIV infection and Creutzfeldt-Jakob disease; drug use; depression; certain types of hydrocephalus. Fluid accumulation can result from developmental abnormalities, infections, lesions or brain tumor.

Anemic syndromes are common in elderly patients, their prevalence increasing with age. Epidemiological studies found anemia prevalence between 8-44% in the elderly, the highest prevalence being in men over 85 years.

This increased incidence of anemia in the elderly led to the hypothesis that lower hemoglobin levels would be a normal consequence of aging. However, there are at least two reasons why anemia should be considered a sign of an underlying disease. First, the majority of the elderly maintain a normal level of hemoglobin and hematocrit in the blood, and secondly, in most elderly patients with anemia a pathological cause of this anemia can be detected [5].

From the point of view of clinical manifestations, the onset of anemia symptoms in the elderly is insidious, the typical symptoms such as fatigue, asthenia and dyspnea are not specific, patients tending to attribute them to older age. Tegumentary pallor can be an important diagnostic clue, but can often be difficult to observe in the elderly. Conjunctival pallor is a valuable sign, the presence of which should alert the doctor to perform a hemogram [6]. In addition to conjunctival disorder, patients with chronic disease may experience worsening symptoms of these diseases, such as worsening symptoms of heart failure, cognitive impairment, dizziness, or apathy.

Cohort studies in the elderly found that chronic disease and iron deficiency were common causes of anemia. No cause is found in 15-25% of elderly anemic patients.

Methods

In this pilot study, 10 patients with moderate dementia were observed. The patients were diagnosed in doctor’s Docu Axelerad Any private clinic and treated from the disease’s debut. Ten patients with dementia that were medically followed and cured by the doctor cited before, showed a decline in their physical state and the neurologist recomanded them to make a complete blood test, that showed anemia in each case, later they were guided to other physicians and with the recommandation to be neurologically evaluated six months later, when the anemia will be cured. The selection criteria followed: moderate dementia.

The first patient, Z.P., female, 77 years, being diagnosed with dementia for 5 years. Her result at the Dementia Severity Rating scale was 23 points at the last check and at the anemia’s diagnosis her result on this scale was 29 points, with increased memory losses, her orientation to time was decreased, the ability to make decisions was decreased, her social and community activity and had difficulties in doing home activities and responsibilities. At the Fatigue Severity Scale, the patient presented at the last check the average of 5 points and at the anemia’s diagnosis her average result on this scale was 7 points. At the moment of anemia’s diagnosis, the patient showed a decrease in her daily activities, an increase in her falls, fatigue, tiredness, headaches in the most days. The patient also presented shortness of breath and accelerated cognitive disfunctions. Her blood test results were: Haemoglobin level = 10 g/dL, The mean cell volume = 70 fL,  Hematocrit= 20%, serum ferritin = 11 g/dL, serum iron= 62 g/dL, transferrin saturation= 10%, Mean corpuscular hemoglobin concentration= 31 g/dL, reticulocytes= 2%. Her anemia was hypochromic microcytic. After the patient was investigated for anemia and treated, the patient returned to the neurological consultation and the results of the scales have improved at the Fatigue Severity Scale she obtained the average of 6 points, her result at the Dementia Severity Rating scale was 25 points.

The second patient, O.I., female, 75 years, being diagnosed with dementia for 4 years. Her result at the Dementia Severity Rating scale was 25 points at the last check and at the anemia’s diagnosis her result on this scale was 30 points, with increased memory losses, her orientation to time was decreased, the ability to make decisions was decreased, her social and community activity and had difficulties in doing home activities and responsibilities. At the Fatigue Severity Scale, the patient presented at the last check the average of 6 points and at the anemia’s diagnosis her average result on this scale was 7.5 points. At the moment of anemia’s diagnosis, the patient showed a decrease in her daily activities, an increase in her falls, fatigue, tiredness, headaches in the most days. The patient also presented shortness of breath and accelerated cognitive disfunctions. Her blood test results were: Haemoglobin level = 9 g/dL, The mean cell volume = 71 fL,  Hematocrit= 30%, serum ferritin = 10 g/dL, serum iron= 58 g/dL, transferrin saturation= 20%, Mean corpuscular hemoglobin concentration= 29 g/dL, reticulocytes= 2%. Her anemia was hypochromic microcytic. After the patient was investigated for anemia and treated, the patient returned to the neurological consultation and the results of the scales have improved at the Fatigue Severity Scale she obtained the average of 6.5 points, her result at the Dementia Severity Rating scale was 26 points.

The third patient, P.B., male, 76 years, being diagnosed with dementia for 6 years. His result at the Dementia Severity Rating scale was 28 points at the last check and at the anemia’s diagnosis his result on this scale was 34 points, with more episodes of memory loss, his orientation to time was decreased, the ability to make decisions was decreased, his social and community activity and had difficulties in doing home activities and responsibilities. At the Fatigue Severity Scale, the patient presented at the last check the average of 6.3 points and at the anemia’s diagnosis his average result on this scale was 7.4 points. At the moment of anemia’s diagnosis, the patient showed a decrease in his daily activities, an increase in his falls, fatigue, tiredness, headaches in the most days. The patient also presented shortness of breath and accelerated cognitive disfunctions. His blood test results were: Haemoglobin level = 11 g/dL, The mean cell volume = 72 fL,  Hematocrit= 28%, serum ferritin = 12 g/dL, serum iron= 59 g/dL, transferrin saturation= 20%, Mean corpuscular hemoglobin concentration= 29 g/dL, reticulocytes= 2%. His anemia was hypochromic microcytic. After the patient was investigated for anemia and treated, the patient returned to the neurological consultation and the results of the scales have improved at the Fatigue Severity Scale he obtained the average of 7.1 points, his result at the Dementia Severity Rating scale was 30 points.

The fourth patient, M.O., male, 79 years, being diagnosed with dementia for 7 years. His result at the Dementia Severity Rating scale was 26 points at the last check and at the anemia’s diagnosis his result on this scale was 31 points, with increased memory losses, his orientation to time was decreased, the ability to make decisions was decreased, his social and community activity and had difficulties in doing home activities and responsibilities. At the Fatigue Severity Scale, the patient presented at the last check the average of 6.5 points and at the anemia’s diagnosis his average result on this scale was 7.1 points. At the moment of anemia’s diagnosis, the patient showed a decrease in his daily activities, an increase in his falls, fatigue, tiredness, headaches in the most days. The patient also presented shortness of breath and accelerated cognitive disfunctions. His blood test results were: Haemoglobin level = 12 g/dL, The mean cell volume = 73 fL,  Hematocrit= 31%, serum ferritin = 14 g/dL, serum iron= 61 g/dL, transferrin saturation= 22%, Mean corpuscular hemoglobin concentration= 32 g/dL, reticulocytes= 3%. His anemia was hypochromic microcytic. After the patient was investigated for anemia and treated, the patient returned to the neurological consultation and the results of the scales have improved at the Fatigue Severity Scale he obtained the average of 6.8 points, his result at the Dementia Severity Rating scale was 28 points.

Discussion

Anemia is correlated with increased period of hospitalization and more frequent hospitalizations. Low levels of hemoglobin are correlated with mental decline, depression, a decreased quality of life, decreased physical function, falls and higher mortality.

Conclusions

Recent epidemiological data show that dementia is a public health problem that has reached the proportions of an epidemic in the context of global aging. Although dementia has a low incidence among people under the age of 65, it should be included in the differential diagnosis of all patients accusing cognitive disorders, regardless of age. Globally, life expectancy is increasing, one of the side effects of population aging is the increasing incidence of Alzheimer’s disease. Currently, there is no cure for dementia caused by progressive neurodegeneration, including Alzheimer’s, frontotemporal disorders, and Lewy bodies. However, some forms of dementia are treatable. A better understanding of dementia such as their diagnosis and treatment will make it possible in the future for both patients and their carers to improve the quality of life. Early diagnosis of patients with dementia can improve the quality of life and delay the disability caused by it.

Articol semnat de : DOCU AXELERAD SILVIU, STROE ALINA ZORINA, DOCU AXELERAD ANY, DOCU AXELERAD DANIEL