Dementia+(Chi+Dai)

//Western Diagnosis:// Structurally caused permanent or progressive decline in several dimensions of intellectual function that interferes substantially with the person’s normal social or economic activity

Etiology and classification
any age from any injury where enough to cause widespread damage to associative cortical areas

Static dementia
---from single major injury ---nonprogressive dementia: severe head injury

**Progressive dementia**
many different types: tumors, congenital, degenerative, metabolic ---degenerative - loss of cells ---ACh neurons affected ---atrophy of brain ---senile plaques, neurofibrillary tangles ---abnormally increased proteins in brain ---memory loss is early sx ---presenile: 40’s and 50’s ---senile: 60’s and 70’s ---> 65% of dementias in elderly ---20% familial ---genetic components - primarily in early onset [before age 60] ---4 major components: Heart disease of any kind, hypertension, diabetes, obesity ---Alzheimer-like changes ---multiple infarcts ---age associated abN ---small and large cerebral infarcts of varying age ---more in men after age 70 - worse in hypertensives ---step-wise intellectual dysfunction ---development of neuro sns ---depression ---late stage HIV ---cognitive, emotional, motor deficits ---progressive dementia from repeated head injury ---memory problems better than expected for one's age
 * Alzheimer’s** [risk doubles every 5 years after age of 65]
 * idiopathic, or simple, presenile dementia**
 * multi-infarct dementia**
 * AIDS dementia**
 * chronic progressive traumatic encephalopathy**
 * Mild Cognitive Impairment**

medium level alzheimers Hard to learn new things, hard to do task that involve multiple steps, impulsivity, paranoid thinking, forgets friends

severe alzheimers: difficulty communicating, don't recognize family, sleep alot, lose bowel/bladder, lose weight

7 warning signs: 1. Asking the same question over & over again 2. Repeating the same story over again - word for word 3. Forgeting how to do an activity that used to be easy 4. Lose the ability to balance your checkbook 5. Getting lost and misplacing things 6. Neglecting to bath and wearing the same clothes over and over again while thinking there is no problem 7. Rely on someone else to answer questions & make decisions for you

Signs & Symptoms
1. slow disintegration of personality and intellect 2. impaired insight and judgment 3. loss of affect 4. depression, paranoia, anxiety often presenting sx 5. restricted interests, rigid outlook, difficult conceptual thinking 6. difficulty acquiring new skills 7. dec initiative 8. distractible 9. aphasia (speech disturbance), apraxia (motor), agnosia (recognition of perceptions) 10. spatial disorientation 11. memory impairment 12. blunted affect 13. deteriorated habits 14. personality traits exaggerated 15. insidious, progressive 16. initially more of a problem for family

Diagnosis
difficult a. memory impairment b. aphasia, apraxia, agnosia, or disturbed executive function c. continuing cognitive decline
 * clinical**

3. Alzheimer’s dx - above sx not due to specific causes - rule out chronic alcohol use, vitamin B12 deficiency, drug side-effects 4. must distinguish from primary psychiatric disorder 5. sometimes secondary to a treatable condition

Lab
1. CBC 2. chem screen 3. thyroid function 4. serum B12 5. drug levels 6. HIV

Other studies
a. often N cortical atrophy with age and no sx b. must correlate with clinical state a. wave slowing
 * CT scan**
 * EEG**

Treatment
1. tx underlying cause if one found 2. Ginkgo biloba - 80 mg TID 3. acetyl-L-carnitine - 500 mg TID 4. vit. E - 2,000 IU/day -Curcumin -decreased inflammation enough that it may inhibit neurofibrillary tangles

Beneficial Activities Learn a new language puzzles, crosswords, brain games play a musical instrument

Studies: Proteins in the brain that scoured for fragments to avoid neurofibrillary tangles. Those w/ alzheimer's seem to have lower levels of this protein -Low levels of insulin and insulin-like growth factor in the brain, more degenerative change is found. glucose metabolism is a large component -Suggests that the hippocampus is working at a lower level -Fruit/vegetable juice intake 4-5x/week lowered risk 4x

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========================================================================== //TCM Pathology:// Dementia or feeblemindedness refers to a chronic or persistent disturbance of the intelligence that is characterized by mental sluggishness, lack of intelligence, foolishness, and/or clumsiness. In minor cases, it manifests as spirit mind abstraction, diminished speech, mental torpor, or impaired memory. In severe cases, there may be absence of speech or muttering to oneself, deranged speech, crying or laughing for no reason, or no desire for food.

Relevant Western Diseases: Many kinds of dementia can be found in Western medical clinics, Alzheimer’s disease, Pick’s disease, cerebral atherosclerosis, transient ischemic attack, autism, hypertension and Attention disorders

Diagnosis: A. Shen insufficiency: working, learning and daily life are disturbed. -**Moderate type:** working and learning ability are disturbed. Memory is getting worse, especially short-term memory. Patient needs help from others for most daily life, except eating and bathroom use -**Severe type:** totally incapable of self care. Memory is lost and there may be delirium, illogical talking, and misunderstanding, decreased Shen clarity, improper emotional expressions; there can also be Shen numbness and autism B. Short term memory disability C. High level Shen processing ability has been disturbed at least for three months D. Medical evidence from Western medicine diagnosis Diagnosis depends on clinic exams, especially short-term memory exams. Comparing information from each will confirm.
 * -Mild type:** working and learning ability is diminished but patient can function independently in daily life

Prognosis: In the world of psychiatry, there is no effective and reliable treatment for curing dementia; today many patients who suffer from this condition stay at home and are cared for by family members or live in nursing homes with professional help. Using TCM methods of treatment however, a certain number of patients are improving their quality of life; these results are very encouraging.

Differential Diagnosis: A. Normal pressure hydrocephalus and other CNS mass lesion B. Long-term cognitive effects of poorly controlled seizure disorders C. Chronic vitamin deficiencies, especially B-vitamins D. Endocrinological Disorders (including hypothyroidism) E. Vascular diseases of the CNS F. Delirium G. History of traumatic brain injury A. Chronic heavy alcohol abuse B. Chronic abuse of marijuana, heroin and other illicit substances C. Long-term cognitive side effects of certain typical antipsychotic medications A. Cognitive impairment concomitant with chronic severe schizophrenia B. Pseudodementia of severe recurring major depressive disorder C. Learning Disorders
 * Medical Disorders:**
 * Effects of Substances:**
 * Psychiatric Disorders:**

TCM Etiology & Pathogenesis: “The clarity and function of the spirit brilliance depends upon effulgent spirit. Spirit is nothing other than an accumulation of Qi in the heart. However, Qi is engendered from a transformation of blood, Yin and essence, and, once engendered, is also nourished by those Yin substances. Feeblemindedness is an inability of the spirit brilliance to function correctly. This in turn may be due to either malnourishment of the heart by blood, Yin, and/or essence or some evil Qi cofounding the spirit, such as phlegm dampness or blood stasis blocking the clear orifices. The types of vacuity leading to malnourishment are blood vacuity mixed with Qi depression, liver blood-kidney Yin vacuity, and sea of marrow emptiness and vacuity” 1

“Aging is the main etiological factor for this disease, overworking, mental exhaustion and in TCM excessive sexual activity also are the factors to cause this disease. Pre-heaven insufficiency can also cause dementia, as well as, long term emotional disharmony, phlegm misting and blood stagnation. In the elderly, the five Zang essences, especially kidney essence, become depleted and fail to nourish the brain (the sea of marrow); this causes Brain Shen weakness and Shen Qi deficiency and leads to Bai Chi. Pre-heaven deficiency factors passed from the parents are considered weak constitution; poor nutritional status, alcohol and drug abuse, or extreme frightening during pregnancy can injure the fetus and cause diminished intellectual ability, noticeable even at a young age. Emotional disharmony, shock, or phlegm obstructs the Clear Yang cavity that causes Brain Shen dysfunction. Birth trauma or physical injury are also considered factors which cause Qi and blood stagnation to obstruct clear cavity causing Shen injury.”2

TCM Pattern Differentiation: Phlegm Dampness Clouding the Clear Orifices 1,2 Spirit mind abstraction, a flat wooden affect, poverty of thinking and emotion, autism, lack of speech or speaking to oneself, disinclination to talk or to meet visitors, prefers staying alone, poor memory and thinking, profuse phlegm, no appetite, heavy-headedness, chest and abdominal fullness and oppression, vomiting profuse phlegm, phlegm souns in throat, pale complexion, shortness of breath, may not be able to take care of themselves in daily life, very sleepy and tired, may be overweight -GV-22, SP-9, ST-40, CV-12, ST-36. Draining technique1 -ST-25, ST-40, ST-41, SP-3, SP-6, SP-9, HT-7, PC-7, GB-15, Yintang2 -[Ban Xia, Bai Zhu, Chen Pi, Shi Chang Pu, Zhi Nan Xing, Fu Shen, Ze Xie, Shen Qiu, Mai Ya, Sha Zha, Lai Fu Zi2
 * Tongue:** swollen tongue w/ teeth marks, thick white coat
 * Pulse:** deep, weak, slippery
 * Treatment Principles:** Transform dampness and flush away phlegm, open the orifices and boost the intelligence
 * Acupuncture Treatment:**
 * Herbal Treatment:**
 * -** Zhi Mi Tang Jia Jian1 - [Ban Xia (10g.), Chen Pi (10g.), Bai Zhu (10g.), Shen Qu (6g.), Shi Chang Pu (10g.), Fu Shen (12g.), Yuan Zhi (6g.), Ren Shen (3g.), Dan Nan Xing (5g.), Fu Zi (3g.), Gan Cao (6g.)]1

Qi Depression-Blood Vacuity 1 Feeblemindedness, emotional depression, possible insomnia with impetuosity and impatience, frequent sighing, grief with a tendency to cry. Chest and rib-side oppression distention, pale nails and lips [Chai Hu (10g.), Bai Shao (10g.), Bai Zhu (10g.), Dang Gui (10g.), Fu Ling (10g.), Bo He (3g.), Sheng Jiang (3g.), Da Zao (6 pieces), Fu Xiao Mai (15g.), Gan Cao (10-15g.)] Severe liver depression: + Yu Jin, He Huan Pi Marked Depressive heat: - Sheng Jiang, Bo He; + Zhi Zi, Dan Pi Insomnia: + He Huan Hua, Suan Zao Ren
 * Tongue:** pale tongue
 * Pulse:** bowstring, fine
 * Treatment Principles:** Course the liver and rectify the Qi, nourish the blood and boost the intelligence
 * Acupuncture Treatment:** Yintang, HT-7, LR-3, LR-14, ST-36
 * Herbal Treatment:** Xiao Yao San He Gan Mai Da Zao Tang1
 * Modifications:**

Liver Blood-Kidney Yin Vacuity 1 Feeblemindedness, lack of spirit in the eyes, motor ataxia, paraphasia, dizziness, tinnitus, low back and knee soreness and limpness, numbness of the limbs with inhibited flexion and extention, possible 5-palm heat or night sweats, possible malar flushing and/or emaciation [Shu Di (12g.), Gou Qi Zi (10g.), Shan Zhu Yu (10g.), Du Zhong (10g.), Ren Shen (3-6g.), Shan Yao (10g.), Yuan Zhi (10g.), He Shou Wu (12g.), Gan Cao (3g.) ]
 * Tongue:** red or pale tongue, red tip, scanty coat
 * Pulse:** fine, commonly bowstring, possibly rapid
 * Treatment Principles:** Supplement the liver and nourish the blood, enrich the kidneys and boost the intelligence
 * Acupuncture Treatment:** Si Shen Cong, GB-20, SP-6, KI-3, KI-4. Tonifying technique
 * Herbal Treatment:** Da Bu Yuan Jian1

Sea of Marrow & Pre-Heaven Essence Emptiness and Vacuity 1 Patients can begin this problem in childhood. Feeblemindedness, poor memory, developmental retardation, the five retardations (standing, walking, hair, teeth, language) and the five soft tissue weaknesses (head, neck, hands, feet, and mouth) in infants and children, late closure of the fontanelle in infants, fragile bones, low back and lower limbs soreness and weakness, inability to stand for a long period of time, unsteady walking, inability to hold up the head, a high level of Shen processing is slowed down, may age more rapidly than normal -GV-20, BL-23, GV-4, BL-20, ST-36. Tonifying technique1 -KI-3, KI-4, KI-6, SP-6, CV-6, ST-36, GV-20, BL-20, BL-23, BL-52, GV-42 -[Ren Shen, Dang Gui, Lu Jiao Jiao, Gui Ban Jiao, Shu Di, Yuan Zhi, Shi Chang Pu, Bai Zhu Xing Ren]2
 * Tongue:** pale tongue, scanty coat
 * Pulse:** fine, weak
 * Treatment Principles:** Supplement the kidneys and foster the essence, fill the marrow and boost the intelligence
 * Acupuncture Treatment:**
 * Herbal Treatment:**
 * -**He Che Da Zao Wan Jia Jian1 - [Zi He Che (3g.), Shu Di (12g.), Gui Ban (12g.), Niu Xi (10g.), Du Zhong (10g.), Mai Dong (12g.), Tian Dong (12g.), Gou Qi Zi (10g.), Huang Jing (10g.), Lu Jiao Jiao (3g.)]1

Liver and Kidney Essence Deficiency Failing to Nourish the Brain Shen 2 Dizziness, vertigo, tinnitus, feels very weak body and has low energy, back and knees feel sore and soft, decreased power of adjustment, blurred vision, twitching and shaky hands and muscles, grey hair and hair loss, flattened emotion and Shen numbness, imbalanced walking, unclear pronunciation and slow talking, poverty of thinking and ideas, difficulty recalling the past, loses things frequently
 * Tongue:** possibly red tongue, thin coat, cracks
 * Pulse:** weak pulse
 * Acupuncture Treatment:** LR-3, LR-8, KI-3, KI-4, KI-9, SP-6, GB-5, GB-8, GB-15, GB-41, Yintang
 * Herbal Treatment:** [Shu Di, Sheng Di, Bai Zi Ren, Gui Ban Jiao, E Jiao, Ji Xue Teng, Dang Gui, Bai Shao, Wu Wei Zi, Yuan Zhi, Bai He, Fu Shen, Yi Zhi Ren] 2

Emotional Disharmony and Liver Qi Stagnation Injuring Brain Shen 2 Moody, melancholy, irritable, anxious, forgetful, depressed, feels worse when depressed, irrational concerns and worries about unrelated things, insomnia, easily angered, distention of chest and abdomen, low appetite and energy, menstrual pain, amenorrhea, can be related to menopause, working and learning ability decreasing
 * Tongue:** pink tongue, thin white coat
 * Pulse:** wiry, weak
 * Acupuncture Treatment:** LI-4, LR-3,LR-6, LR-14, GB-34, ST-40, PC-6, CV-17, SP-21, Taiyang
 * Herbal Treatment:** [Chai Hu, Qing Pi, Dang Gui, Ban Xia, Xiang Fu, Huang Qin, Fu Ling, Yuan Zhi, Ye Jiao Teng, He Huan Pi, Ji Xue Teng, Dang Gui, Gou Teng, Shi Jue Ming] 2

Heart and Liver Excess Fire Blazing Injuring Brain Shen 2 Feels tense, irritable and upset, excessively talkative, repeats the same words or stories frequently, loud voice and high pitch during talking, easily gets angry, frequently forgetful, red face and eyes, dizziness and headache, insomnia, dreams a lot at night, sweating and thirsty, scanty and dark colored urine
 * Tongue:** red tongue w/ red or purple spots, yellow, dry coat
 * Pulse:** wiry, slippery, rapid
 * Acupuncture Treatment:** HT-7, HT-9, CV-14, LR-2, GB-34, GB-43, LI-4, ST-44, GV-24, Yintang
 * Herbal Treatment:** [Huang Qi, Huang Lian, Huang Bai, Sheng Di, Xuan Shen, Zhi Zi, Long Gu, Mu Li, Suan Zao Ren, Tian Men Dong] 2

Qi Stagnation & Blood Stasis Blocking Clear Yang 1,2 Most cases have a history of traumatic injury or birth trauma. Feeblemindedness, apathy, retarded reactions, sluggishness, fearfulness, flattened emotion and Shen numbness, depression and irritability, autism, insomnia, dream disturbed sleep, dull & drooping eyes, may have headaches and dizziness, possible headache from short times of reading or watching screens for learning, diminished ability for socializing and learning -GV-20, GV-15, GV-24, Yintang, SP-10, LI-4, LR-31 -SP-6, SP-8, SP-10, LI-4, LR-3, HT-7, BL-15, BL-17, GV-17, GV-19, GV-20, GV-212 -[Chi Shao, Chuan Xiong, Tao Ren, Hong Hua, Xie Xiang, Yu Jin, Dan Shen, Shi Chang Pu, Lao Cong, Di Long, Da Zao]2 Concomitant Qi and blood vacuity1: + Dang Gui, Huang Qi
 * Tongue:** purplish tongue, purple macules on tongue
 * Pulse:** deep, fine, bowstring or wiry, choppy
 * Treatment Principles:** Quicken the blood, transform stasis, and boost the intelligence
 * Acupuncture Treatment:**
 * Herbal Treatment:**
 * -**Tong Qiao Huo Xue Tang Jia Jian - [Chi Shao (10g.), Chuan Xiong (10-15g.), Tao Ren (10g.), Hong Hua (10g.), Di Long (3g.), Shi Chang Pu (6g.), Ju Luo (10g.), Da Zao (3 pieces)]1
 * Modifications:**