Dementia

What is dementia?

Dementia is a loss of mental functions that is severe enough to affect your daily life and activities. These functions include:

• Memory
• Language skills
• Visual perception (your ability to make sense of what you see)
• Problem solving
• Trouble with everyday tasks
• The ability to focus and pay attention

It is normal to become a bit more forgetful as you age. But dementia is not a normal part of aging. It is a serious disorder that interferes with your daily life.

What are the types of dementia?

The most common types of dementia are known as neurodegenerative disorders. These are diseases in which the cells of the brain stop working or die. They include:

• Alzheimer's disease, which is the most common form of dementia among older people. People with Alzheimer's have plaques and tangles in their brain. These are abnormal buildups of different proteins. Beta-amyloid protein clumps up and forms plaques in between your brain cells. Tau protein builds up and forms tangles inside the nerve cells of your brain. There is also a loss of connection between nerve cells in the brain.
• Lewy body dementia, which causes movement symptoms along with dementia. Lewy bodies are abnormal deposits of a protein in the brain.
• Frontotemporal disorders, which cause changes to certain parts of the brain:
  • Changes in the frontal lobe lead to behavioral symptoms
  • Changes in the temporal lobe lead to language and emotional disorders
• Vascular dementia, which involves changes to the brain's blood supply. It is often caused by a stroke or atherosclerosis (hardening of the arteries) in the brain.
• Mixed dementia, which is a combination of two or more types of dementia. For example, some people have both Alzheimer's disease and vascular dementia.

Other conditions can cause dementia or dementia-like symptoms, including:

• Creutzfeldt-Jakob disease, a rare brain disorder
• Huntington's disease, an inherited, progressive brain disease
• Chronic traumatic encephalopathy (CTE), caused by repeated traumatic brain injury
• HIV-associated dementia (HAD)

Who is at risk for dementia?

Certain factors can raise your risk for developing dementia, including:

• Aging. This is the biggest risk factor for dementia.
• Smoking
• Uncontrolled diabetes
• High blood pressure
• Drinking too much alcohol
• Having close family members who have dementia

What are the symptoms of dementia?

The symptoms of dementia can vary, depending on which parts of the brain are affected. Often, forgetfulness is the first symptom. Dementia also causes problems with the ability to think, problem solve, and reason. For example, people with dementia may:

• Get lost in a familiar neighborhood
• Use unusual words to refer to familiar objects
• Forget the name of a close family member or friend
• Forget old memories
• Need help doing tasks that they used to do by themselves

Some people with dementia cannot control their emotions and their personalities may change. They may become apathetic, meaning that they are no longer interested in normal daily activities or events. They may lose their inhibitions and stop caring about other peoples' feelings.

Certain types of dementia can also cause problems with balance and movement.

The stages of dementia range from mild to severe. In the mildest stage, it is just beginning to affect a person's functioning. In the most severe stage, the person is completely dependent on others for care.

How is dementia diagnosed?

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A physical exam
• Tests of your thinking, memory, and language abilities
• Other tests, such as blood tests, genetic tests, and brain scans
• A mental health evaluation to see whether a mental disorder is contributing to your symptoms

What are the treatments for dementia?

There is no cure for most types of dementia, including Alzheimer's disease and Lewy body dementia. Treatments may help to maintain mental function longer, manage behavioral symptoms, and slow down the symptoms of disease. They may include:

• Medicines, which may temporarily improve memory and thinking or slow down their decline. They only work in some people. Other medicines can treat symptoms such as anxiety, depression, sleep problems, and muscle stiffness. Some of these medicines can cause strong side effects in people with dementia. It is important to talk to your health care provider about which medicines will be safe for you.
• Occupational therapy to help find ways to more easily do everyday activities
• Speech therapy to help with swallowing difficulties and trouble speaking loudly and clearly
• Mental health counseling to help people with dementia and their families learn how to manage difficult emotions and behaviors. It can also help them plan for the future.
• Music or art therapy to reduce anxiety and improve well-being

Can dementia be prevented?

Researchers have not found a proven way to prevent dementia. Living a healthy lifestyle might influence some of your risk factors for dementia.

Diabetes

What is diabetes?

Diabetes, also known as diabetes mellitus, is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose is your body's main source of energy. Your body can make glucose, but it also comes from the food you eat. Insulin is a hormone made by your pancreas. Insulin helps move glucose from your bloodstream into your cells, where it can be used for energy.

If you have diabetes, your body can't make insulin, can't use insulin as well as it should, or both. Too much glucose stays in your blood and doesn't reach your cells. This can cause glucose levels to get too high. Over time, high blood glucose levels can lead to serious health conditions. But you can take steps to manage your diabetes and try to prevent these health problems.

What are the types of diabetes?

There are different types of diabetes:

• Type 1 diabetes. If you have type 1 diabetes, your body makes little or no insulin. It happens when your immune system attacks and destroys the cells that produce insulin.
• Type 2 diabetes. This is the most common form of diabetes. If you have type 2 diabetes, your body may still be able to make insulin, but your cells don't respond well to insulin. They can't easily take up enough glucose from your blood.
• Gestational diabetes. This is a form of diabetes that develops during pregnancy. It happens when your body can't make the extra insulin it needs during pregnancy.

What causes diabetes?

The different types of diabetes have different causes:

• Researchers think type 1 diabetes is caused by genes and factors in the environment that might trigger the disease.
• Type 2 diabetes is caused by several factors, including lifestyle factors and genes. The lifestyle factors include not being physically active and being overweight or having obesity.
• Researchers think gestational diabetes is caused by the hormonal changes of pregnancy along with genetic and lifestyle factors.

Who is more likely to develop diabetes?

The different types of diabetes have different risk factors:

• You can develop type 1 diabetes at any age, but it most often starts in childhood. Having a parent or sibling with type 1 diabetes may increase your chance of developing it.
• You are at higher risk of developing type 2 diabetes if you:
• Are overweight or have obesity.
• Are over age 35. Children, teenagers, and younger adults can get diabetes, but it is more common in middle-aged and older adults.
• Have a family history of diabetes.
• Have prediabetes. This means that your blood glucose is higher than normal, but it's not high enough to be called diabetes.
• Had gestational diabetes.
• Have given birth to a baby weighing 9 pounds or more.
• Are African American, American Indian, Asian American, Hispanic/Latino, or Pacific Islander.
• Are not physically active.
• Have certain other health conditions, such as high blood pressure or polycystic ovary syndrome (PCOS).
• You are at higher risk of developing gestational diabetes if you:
• Are overweight or have obesity.
• Have a family history of diabetes.
• Had gestational diabetes in a previous pregnancy.
• Have given birth to a baby weighing 9 pounds or more.
• Have polycystic ovary syndrome (PCOS).
• Are African American, Hispanic/Latino, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander.

What are the symptoms of diabetes?

The symptoms of diabetes may include:

• Feeling very thirsty
• Feeling very hungry
• Urinating (peeing) more often, including at night
• Fatigue
• Blurry vision
• Numbness or tingling in the feet or hands
• Sores that do not heal
• Losing weight without trying

But it's important to know that your symptoms may vary, depending on which type you have:

• The symptoms of type 1 diabetes usually come on quickly and can be severe.
• With type 2 diabetes, the symptoms often develop slowly, over several years. The symptoms can be so mild that you might not even notice them.
• Gestational diabetes often has no symptoms. If you do have symptoms, they may be mild. If you are pregnant, you will usually be screened for this condition between 24 and 28 weeks of pregnancy.

How is diabetes diagnosed?

To find out if you have diabetes, your health care provider will use one or more glucose blood tests. There are several types, including the A1C test.

What are the treatments for diabetes?

Treatment for diabetes involves managing your blood glucose levels:

• If you have type 1 diabetes, you will need to take daily doses of insulin, either by injection or through a special pump. Some people also need to take another type of diabetes medicine that works with insulin.
• If you have type 2 diabetes, you may be able to manage or even reverse it by making lifestyle changes. These include eating a healthy diet, staying at healthy weight, and getting regular physical activity. Some people also need to take diabetes medicines to manage their diabetes.
• If you have gestational diabetes, you may be able to lower your glucose levels by eating a healthy diet and getting regular exercise. But be sure to talk to your provider about your treatment options. Gestational diabetes usually goes away after you give birth. But you will have a higher risk of developing type 2 diabetes later.

Checking your blood glucose levels is also an important part of managing your diabetes. Ask your provider about the best way to check your blood glucose level and how often you should check it.

Can diabetes be prevented?

Type 1 diabetes can't be prevented.

You may be able to delay or prevent type 2 diabetes through the same lifestyle changes that are used to manage diabetes (eating a healthy diet, staying at a healthy weight, and getting regular physical activity). These lifestyle changes may also help prevent gestational diabetes.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Diabetes Type 2

What is type 2 diabetes?

Type 2 diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose is your main source of energy. It comes from the foods you eat. A hormone called insulin helps the glucose get into your cells to give them energy. If you have diabetes, your body doesn't make enough insulin or doesn't use insulin well. The glucose then stays in your blood and not enough goes into your cells.

Over time, having too much glucose in your blood can cause health problems. But you can take steps to manage your diabetes and try to prevent these health problems.

What causes type 2 diabetes?

Type 2 diabetes may be caused by a combination of factors:

• Being overweight or having obesity
• Not being physically active
• Genetics and family history

Type 2 diabetes usually starts with insulin resistance. This is a condition in which your cells don't respond normally to insulin. As a result, your body needs more insulin to help the glucose enter your cells. At first, your body makes more insulin to try to get cells to respond. But over time, your body can't make enough insulin, and your blood glucose levels rise.

Who is at risk for type 2 diabetes?

You are at higher risk of developing type 2 diabetes if you:

• Are over age 45. Children, teenagers, and younger adults can get type 2 diabetes, but it is more common in middle-aged and older people.
• Have prediabetes, which means that your blood sugar is higher than normal but not high enough to be called diabetes
• Had diabetes in pregnancy or gave birth to a baby weighing 9 pounds or more.
• Have a family history of diabetes
• Are overweight or have obesity
• Are Black or African American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander
• Are not physically active
• Have other conditions such as high blood pressure, heart disease, stroke, polycystic ovary syndrome (PCOS), or depression
• Have low HDL (good) cholesterol and high triglycerides
• Have acanthosis nigricans - dark, thick, and velvety skin around your neck or armpits

What are the symptoms of type 2 diabetes?

Many people with type 2 diabetes have no symptoms at all. If you do have them, the symptoms develop slowly over several years. They might be so mild that you do not notice them. The symptoms can include:

• Increased thirst and urination
• Increased hunger
• Feeling tired
• Blurred vision
• Numbness or tingling in the feet or hands
• Sores that do not heal
• Unexplained weight loss

How is type 2 diabetes diagnosed?

Your health care provider will use blood tests to diagnose type 2 diabetes. The blood tests include:

• A1C test, which measures your average blood sugar level over the past 3 months
• Fasting plasma glucose (FPG) test, which measures your current blood sugar level. You need to fast (not eat or drink anything except water) for at least 8 hours before the test.
• Random plasma glucose (RPG) test, which measures your current blood sugar level. This test is used when you have diabetes symptoms and the provider does not want to wait for you to fast before having the test.

What are the treatments for type 2 diabetes?

Treatment for type 2 diabetes involves managing your blood sugar levels. Many people are able to do this by living a healthy lifestyle. Some people may also need to take medicine:

• A healthy lifestyle includes following a healthy eating plan and getting regular physical activity. You need to learn how to balance what you eat and drink with physical activity and diabetes medicine, if you take any.
• Medicines for diabetes include oral medicines, insulin, and other injectable medicines. Over time, some people will need to take more than one type of medicine to control their diabetes.
• You will need to check your blood sugar regularly. Your health care provider will tell you how often you need to do it.
• It's also important to keep your blood pressure and cholesterol levels close to the targets your provider sets for you. Make sure to get your screening tests regularly.

Can type 2 diabetes be prevented?

You can take steps to help prevent or delay type 2 diabetes by losing weight if you are overweight, eating fewer calories, and being more physically active. If you have a condition which raises your risk for type 2 diabetes, managing that condition may lower your risk of getting type 2 diabetes.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Diabetic Eye Problems

What is diabetes?

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from foods you eat. The cells of your body need glucose for energy. A hormone called insulin helps the glucose get into your cells.

With type 1 diabetes, your body doesn't make insulin. With type 2 diabetes, your body doesn't make or use insulin well. Without enough insulin, glucose builds up in your blood and causes high blood glucose levels.

What eye problems can diabetes cause?

Over time, high blood glucose may damage the blood vessels and lenses in your eyes. This can lead to serious diabetic eye problems which can harm your vision and sometimes cause blindness. Some common diabetic eye problems include:

• Diabetic retinopathy, which is the leading cause of blindness in American adults. It affects blood vessels in the retina (the light-sensitive layer of tissue in the back of your eye). The blood vessels may swell and leak fluid into your eye. If it's not treated, it can cause serious problems such as vision loss and retinal detachment, where the retina is pulled away from its normal position at the back of your eye.
• Diabetic macular edema (DME), which happens when blood vessels in the retina leak fluid into the macula (the part of the retina needed for sharp, central vision). This usually develops in people who already have other signs of diabetic retinopathy.
• Glaucoma, a group of eye diseases that can damage the optic nerve (the bundle of nerves that connects the eye to the brain). Glaucoma from diabetes happens when the blood vessels in the front of your eye are damaged, and new blood vessels grow near the iris (the colored part of your eye). The blood vessels block the space where fluid drains from your eye. This causes fluid to build up and pressure to increase inside your eye.
• Cataract, which is the leading cause of blindness worldwide. It happens when the clear lens in the front of your eye becomes cloudy. Cataracts are common as people age. But people with diabetes are more likely to develop cataracts younger and faster than people without diabetes. Researchers think that high glucose levels cause deposits to build up in the lenses of your eyes.

Who is more likely to develop diabetic eye problems?

Anyone with diabetes can develop diabetic eye disease. But your risk of developing it is higher if you have diabetes and:

• Have had diabetes for a long time
• Don't have good control over your high blood glucose or high blood pressure
• Are pregnant
• Have high blood cholesterol
• Smoke tobacco

What are the symptoms of diabetic eye problems?

In the early stages, diabetic eye problems usually don't have any symptoms. That's why regular dilated eye exams are so important, even if you think your eyes are healthy.

You should also watch for sudden changes in your vision that could be signs of an emergency. Call your eye care professional right away if you notice any of these symptoms:

• Many new spots or dark wavy strings floating in your vision (floaters)
• Flashes of light
• A dark shadow over part of your vision, like a curtain
• Vision loss
• Eye pain or redness

Talk with your eye care professional if you have these symptoms, even if they come and go:

• Spots or dark wavy strings floating in your vision
• Blurry or wavy vision
• Vision that changes a lot
• Trouble seeing colors

How are diabetic eye problems diagnosed?

Eye care professionals do dilated eye exams to diagnose eye problems. A dilated eye exam uses eye drops to open your pupils wide so your eye care professional can look for signs of eye problems and treat them before they harm your vision. They will also test your vision and measure the pressure in your eyes.

What are the treatments for diabetic eye problems?

Treatment for diabetic eye problems depends on the problem and how serious it is. Some of the treatments include:

• Lasers to stop blood vessels from leaking
• Injections (shots) in the eye to stop new, leaky blood vessels from growing
• Surgery to remove blood and scar tissue or replace a cloudy lens
• Eye drops to lower fluid pressure in the eye

But these treatments aren't cures. Eye problems can come back. That's why your best defense against serious vision loss is to take control of your diabetes and get regular eye exams. It's also important to keep your blood pressure and cholesterol in a healthy range.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Diabetic Heart Disease

What is diabetes?

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from foods you eat. The cells of your body need glucose for energy. A hormone called insulin helps the glucose get into your cells.

With type 1 diabetes, your body doesn't make insulin. With type 2 diabetes, your body doesn't make or use insulin well. Without enough insulin, glucose builds up in your blood and causes high blood sugar levels.

What is diabetic heart disease?

Diabetic heart disease is a term for heart disease in people who have diabetes. If you have diabetes, you are much more likely to develop heart disease or have a stroke than people who don't have diabetes. And you may start having these problems at a younger age.

Over time, the effects of high blood sugar from diabetes can include damage to the blood vessels and nerves in your heart. This damage increases your chance of developing heart diseases, including:

• Coronary artery disease (CAD). It happens slowly as a sticky material called plaque builds up in the arteries that supply your heart muscle with blood.
• Heart failure. With this condition, your heart can't pump enough oxygen-rich blood to meet the needs of your body.
• Cardiomyopathy. This is a group of diseases in which the heart muscle may become thick or stiff.

Who is more likely to develop diabetic heart disease?

Diabetes puts you at serious risk for heart disease. It also makes you more likely to develop other conditions that raise your risk even more, including:

• High blood pressure
• High blood levels of LDL "bad" cholesterol
• High triglycerides (a type of fat in your blood) with low blood levels of HDL "good" cholesterol

Your risk for heart disease is also higher if you

• Are male
• Smoke
• Have obesity
• Have too much belly fat around your waist, even though you're at a healthy weight:
  • For men, that's a waist more than 40 inches
  • For women, that's a waist more than 35 inches
• Have a family history of heart disease
• Have chronic kidney disease

What are the symptoms of diabetic heart disease?

In the early stages, heart disease usually doesn't have any symptoms. But if your heart disease worsens, you can have symptoms. Your symptoms will depend on the type of heart disease you have. They might include:

• Shortness of breath
• Fatigue
• Dizziness or fainting
• Arrhythmia (problem with the rate or rhythm of your heartbeat)
• Swollen feet and ankles
• Chest pain

It's important to know that people with diabetes may not feel chest pain. That's because diabetes can damage the nerves in your heart. If you have any symptoms that could be heart disease, talk with your health care provider.

How is diabetic heart disease diagnosed?

To find out if you have diabetic heart disease, your provider will:

• Ask about your medical history, including your symptoms and other health conditions you may have
• Ask about your family history, to find out if you have relatives who have or had heart disease
• Do a physical exam
• Likely run some tests to help understand your personal risk for heart disease, including:
  • Blood tests to check your cholesterol, triglycerides, and blood sugar levels
  • A blood-pressure check
  • Heart tests, if needed

Depending on your risk level, your provider may send you to a cardiologist (a doctor who specializes in heart diseases) for care. If you do have heart disease, treatment will depend on the type of heart disease you have.

How can I prevent diabetic heart disease?

You may be able to prevent heart disease or keep it from getting worse by working with your provider to:

• Control your blood sugar levels
• Manage other conditions you may have that can raise your risk for heart disease
• Take any medicines your provider prescribed
• Make heart-healthy habits part of your daily life
• Follow a healthy eating plan for diabetes

NIH: National Institute of Diabetes and Digestive and Kidney Diseases