This factsheet is for people who have Alzheimer's disease, or who would like information about it.

Alzheimer's disease gradually damages the way the brain works, which affects a person's memory, ability to communicate, and their ability to make decisions and carry out their daily activities. The disease develops slowly, usually over many years. About Alzheimer's disease Symptoms of Alzheimer's disease Causes of Alzheimer's disease Diagnosis of Alzheimer's disease Treatment of Alzheimer's disease Help and support Video

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About Alzheimer's disease

Alzheimer's disease is the most common cause of dementia. Dementia is the medical term used to describe a number of conditions that cause a change in the way your brain works. These changes can cause memory problems and can alter your behaviour and emotions. You may also have problems making decisions and solving problems, or be unable to carry out your usual daily activities, such as driving, getting dressed or eating. The effects of dementia are different for each individual. Alzheimer's disease changes the structure of your brain and causes your brain cells to die. It also affects the connections between brain cells, which means that nerve messages aren't passed on properly. Over time, as more and more areas of your brain become damaged, your symptoms will get progressively worse. People with Alzheimer's disease usually live with the illness for several years but this depends on when you are diagnosed. Eventually, Alzheimer's disease is fatal. However, some people with Alzheimer's disease may die from other conditions, such as pneumonia, as their health gets worse.

Of the 750,000 people living with dementia in the UK, about 460,000 have Alzheimer's disease. Most people who develop the condition are over 65, although it can also develop in younger people. There is no cure for Alzheimer's disease, but there are treatments that can help to control your symptoms for a period of time.

Symptoms of Alzheimer's disease

Alzheimer's disease is a condition that develops over a period of years. The symptoms get progressively worse over time. If you develop Alzheimer's disease before you're 65 (early onset), your symptoms may get worse more rapidly than in people who develop it later. Alzheimer's disease affects everyone differently. You may have some but not all of the symptoms listed below. One of the first symptoms of Alzheimer's disease is forgetfulness for example, forgetting the name of an acquaintance or forgetting where you have put something. However, this isn't always caused by dementia and may just be a sign of getting older or simply the stress of a busy life. You might also have trouble finding the right words to speak or write. As Alzheimer's disease develops you, or your family or friends, may notice other symptoms. The main ones are listed below.

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You may become confused or disorientated for example, you may not know what time of day it is, feel bemused and believe you're somewhere you're not, or you may not recognise familiar places or people. Your behaviour may change and you may have mood swings, become less interested in life, or become depressed or anxious. You may have problems doing everyday tasks such as preparing a meal, laying the table, getting dressed, shopping or dealing with money. You may take less care of yourself, for example not washing regularly or eating properly. Communicating may become more difficult. You may struggle to complete sentences or understand all of what is being said to you. You may also have difficulty finding the words you need. During the later stages of the disease, you're likely to be frail and increasingly dependent on other people. In general, your memory loss will get worse, although you may have times when you know what is going on around you. You may not recognise your close family or your partner and you may have trouble walking and eating. Eventually, you will become dependent on others to care for you. The symptoms of Alzheimer's disease can cause a great deal of distress and upset for you, and your carers and family, who may feel they have lost the person they once knew.

Causes of Alzheimer's disease

Doctors don't know exactly why people develop Alzheimer's disease and dementia, but it's associated with a number of risk factors. These may include:

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ageing Alzheimer's disease mainly affects older people genetics you may be more likely to develop Alzheimer's disease if your parents or a close relative has it a previous severe head injury lifestyle factors such as smoking or obesity diabetes raised blood pressure and raised blood cholesterol levels People who have Down's syndrome are also more likely to develop Alzheimer's disease as they get older.

Diagnosis of Alzheimer's disease

Alzheimer's disease can be difficult to diagnose, especially in the early stages. Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history. Your GP may ask you a series of questions designed to test your memory and thinking. He or she may also test your urine or do blood tests to see whether any other condition may be causing your symptoms. If your GP thinks that you may have Alzheimer's disease, he or she is likely to refer you to a Memory Assessment Service to see specialist doctors and nurses for more tests. These may include further tests to check your memory and thinking, and observation of your behaviour. Your may be asked to have a brain scan.

Treatment of Alzheimer's disease

Treatments for Alzheimer's disease can't cure the condition but, for some people, treatment may slow down the development of the disease for a period of time.

Medicines
People with Alzheimer's disease dont have enough of a chemical called acetylcholine in their brain. Acetylcholine helps nerve signals to travel across the gaps (synapses) between nerve cells (neurones). Medicines called acetylcholinesterase inhibitors can help to stop the level of acetylcholine in the brain from falling any further. There are three acetylcholinesterase inhibitors available: donepezil hydrochloride, rivastigmine and galantamine. You may be given these medicines to take if you have mild or moderately severe Alzheimer's disease because they can help to slow down the development of your symptoms for a period of time. If you have late-stage Alzheimer's disease, your doctor may prescribe a medicine called memantine. This works in a different way to acetylcholinesterase inhibitors. It may help to improve your thinking and memory and allow you to do more basic everyday activities such as washing and eating. Your doctor may also prescribe medicines to help treat some of the symptoms of Alzheimer's disease, such as anxiety, sleep disturbance or irritability. If you also have depression, your doctor may prescribe antidepressants to treat it.

Talking therapies
Your doctor may suggest other treatments that can help you to deal with memory loss, emotional symptoms and changes in your behaviour. Some of the main ones are listed below.

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A structured group cognitive development programme. This uses memory and thinking exercises, as well as reminiscence and multisensory stimulation. This is useful if you have mild to moderate dementia and usually runs as a course over several weeks. The programme helps with memory problems, day-to-day activities and reality orientation. Multisensory stimulation. This can help to improve your quality of life and includes music and pet therapy, aromatherapy and massage. Behaviour management. This can help to treat problems such as depression and aggression. Behaviour management is usually given by your carer with support from your doctor or nurse. Meaningful activities and engagement such as having conversations, painting and drawing, cooking and games can help you to express yourself and improve your quality of life and sense of wellbeing. Early psychological therapy can also be helpful. Counselling can help you to deal with feelings of insecurity, hopelessness and loss of control, and talking about how you feel and what you want in the future can be therapeutic. Group therapy, sometimes involving family supporters, to talk about the future and practical support can also help to make you feel happier and less isolated.

Help and support

If you have Alzheimer's disease, you may be looked after at home, in a care home or sometimes in hospital. The people who care for you can help you to look after yourself and stay healthy and safe. If you're looking after someone with Alzheimer's disease at home, you're likely to need extra help and support. Looking after someone with dementia can be stressful and sometimes carers can neglect their own health and wellbeing. As a caring partner, child or sibling it's important to take regular breaks from caring so that you can look after yourself and take some time to relax. Respite care is when someone comes into your home to care for the person with dementia while you take a break, or when the person with dementia attends a day centre, or goes into a care home or hospital for a period of time. Organisations such as the Alzheimer's Society and Carers UK can give you more information about respite care.

Dementia is a loss of brain function that occurs with certain diseases. Alzheimer's disease (AD), is one form of dementia that gradually gets worse over time. It affects memory, thinking, and behavior. Memory impairment, as well as problems with language, decision-making ability, judgment, and personality, are necessary features for the diagnosis.
Recent findings and perspectives on medical research.

REPORTER'S NOTEBOOK

For Edge on Alzheimers, Testing Early Treatments

By PAM BELLUCK

Researchers are trying to determine when and how the brain begins to deteriorate. If drugs can be given sooner, they say, treatment might be more successful.

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EXPERT Q & A

Tracing the Path from DNA to Dementia

QUESTIONS FOR YOUR DOCTOR

What to Ask About Alzheimer's Disease

CLINICAL TRIALS

Selected Studies: Alzheimer's Disease

See All NEWS & FEATURES

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Cardiovascular Risk in Middle Age May Hasten Mental Decline 7 Things You Can Do to Fight Alzheimers Isnt So Certain
REFERENCE FROM A.D.A.M.
Back to TopAlternative

Names

Senile dementia - Alzheimer's type (SDAT); SDAT

Back to TopCauses

Age and family history are risk factors for AD.

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As you get older, your risk of developing AD goes up. However, developing Alzheimer's disease is not a part of normal aging. Having a close blood relative, such as a brother, sister, or parent who developed AD increases your risk. Having certain combination of genes for proteins that appear to be abnormal in Alzheimer's disease also increases your risk. Other risk factors that are not as well proven include:

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Longstanding high blood pressure History of head trauma Female gender There are two types of AD -- early onset and late onset.

In early onset AD, symptoms first appear before age 60. Early onset AD is much less common than late onset. However, it tends to progress rapidly. Early onset disease can run in families. Several genes have been identified.

Late onset AD, the most common form of the disease, develops in people age 60 and older. Late onset AD may run in some families, but the role of genes is less clear. The cause of AD is not entirely known, but is thought to include both genetic and environmental factors. A diagnosis of AD is made when certain symptoms are present, and by making sure other causes of dementia are not present. The only way to know for certain that someone has AD is to examine a sample of their brain tissue after death. The following changes are more common in the brain tissue of people with AD:

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"Neurofibrillary tangles" (twisted fragments of protein within nerve cells that clog up the cell) "Neuritic plaques" (abnormal clusters of dead and dying nerve cells, other brain cells, and protein) "Senile plaques" (areas where products of dying nerve cells have accumulated around protein). When nerve cells (neurons) are destroyed, there is a decrease in the chemicals that help nerve cells send messages to one another (called neurotransmitters). As a result, areas of the brain that normally work together become disconnected.

The buildup of aluminum, lead, mercury, and other substances in the brain is no longer believed to be a cause of AD.
In-Depth Causes
Back to TopSymptoms

Dementia symptoms include difficulty with many areas of mental function, including:

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Language Memory Perception Emotional behavior or personality Cognitive skills (such as calculation, abstract thinking, or judgment) Dementia usually first appears as forgetfulness. Mild cognitive impairment is the stage between normal forgetfulness due to aging, and the development of AD. People with MCI have mild problems with thinking and memory that do not interfere with everyday activities. They are often aware of the forgetfulness. Not everyone with MCI develops AD. Symptoms of MCI include:

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Forgetting recent events or conversations Difficulty performing more than one task at a time Difficulty solving problems Taking longer to perform more difficult activities The early symptoms of AD can include:

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Language problems, such as trouble finding the name of familiar objects Misplacing items Getting lost on familiar routes Personality changes and loss of social skills Losing interest in things previously enjoyed, flat mood Difficulty performing tasks that take some thought, but used to come easily, such as balancing a checkbook, playing complex games (such as bridge), and learning new information or routines As the AD becomes worse, symptoms are more obvious and interfere with your ability to take care of yourself. Symptoms can include:

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Forgetting details about current events Forgetting events in your own life history, losing awareness of who you are Change in sleep patterns, often waking up at night Difficulty reading or writing Poor judgment and loss of ability to recognize danger Using the wrong word, mispronouncing words, speaking in confusing sentences Withdrawing from social contact Having hallucinations, arguments, striking out, and violent behavior

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Having delusions, depression, agitation Difficulty doing basic tasks, such as preparing meals, choosing proper clothing, and driving People with severe AD can no longer:

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Understand language Recognize family members Perform basic activities of daily living, such as eating, dressing, and bathing Other symptoms that may occur with AD:

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Incontinence Swallowing problems

In-Depth Symptoms
Back to TopExams

and Tests

AD can often be diagnosed through a history and physical exam by a skilled doctor or nurse. A health care provider will take a history, do a physical exam (including a neurological exam), and perform a mental status examination. Tests may be ordered to help determine whether other medical problems could be causing dementia or making it worse. These conditions include:

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Thyroid disease Vitamin deficiency Brain tumor Stroke Intoxication from medication Chronic infection Anemia Severe depression Computed tomography (CT) or magnetic resonance imaging (MRI) of the brain may be done to look for other causes of dementia, such as a brain tumor or stroke.

In the early stages of dementia, brain image scans may be normal. In later stages, an MRI may show a decrease in the size of different areas of the brain.

While the scans do not confirm the diagnosis of AD, they do exclude other causes of dementia (such as stroke and tumor).
In-Depth Diagnosis
Back to TopTreatment

Unfortunately, there is no cure for AD. The goals in treating AD are to:

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Slow the progression of the disease (although this is difficult to do) Manage behavior problems, confusion, sleep problems, and agitation Modify the home environment Support family members and other caregivers

DRUG TREATMENT Most drugs used to treat Alzheimer's are aimed at slowing the rate at which symptoms become worse. The benefit from these drugs is often small, and patients and their families may not always notice much of a change. Patients and caregivers should ask their doctors the following questions about whether and when to use these drugs:

What are the potential side effects of the medicine and are they worth the risk, given that there will likely be only a small change in behavior or function?

When is the best time, if any, to use these drugs in the course of Alzheimer's disease? Two types of medicine are available:

Donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne, formerly called Reminyl) affect the level of a chemical in the brain called acetylcholine. Side effects include indigestion, diarrhea, loss of appetite, nausea, vomiting, muscle cramps, and fatigue.

Memantine (Namenda) is another type of drug approved for treating AD. Possible side effects include agitation or anxiety. Other medicines may be needed to control aggressive, agitated, or dangerous behaviors. These are usually given in very low doses. It may be necessary to stop any medications that make confusion worse. Such medicines may include painkillers, cimetidine, central nervous system depressants, antihistamines, sleeping pills, and others. Never change or stop taking any medicines without first talking to your doctor. SUPPLEMENTS Many people take folate (vitamin B9), vitamin B12, and vitamin E. However, there is no strong evidence that taking these vitamins prevents AD or slows the disease once it occurs. Some people believe that the herb ginkgo biloba prevents or slows the development of dementia. However, high-quality studies have failed to show that this herb lowers the chance of developing dementia. DO NOT use ginkgo if you take blood-thinning medications like warfarin (Coumadin) or a class of antidepressants called monoamine oxidase inhibitors (MAOIs). If you are considering any drugs or supplements, you should talk to your doctor first. Remember that herbs and supplements available over the counter are NOT regulated by the FDA.
In-Depth Treatment
Back to TopSupport

Groups

For additional information and resources for people with Alzheimer's disease and their caregivers, see Alzheimer's disease support groups.
Back to TopOutlook

(Prognosis)

How quickly AD gets worse is different for each person. If AD develops quickly, it is more likely to worsen quickly. Patients with AD often die earlier than normal, although a patient may live anywhere from 3 - 20 years after diagnosis. The final phase of the disease may last from a few months to several years. During that time, the patient becomes immobile and totally disabled. Death usually occurs from an infection or a failure of other body systems.
Back to TopPossible

Complications

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Loss of ability to function or care for self Bedsores, muscle contractures (loss of ability to move joints because of loss of muscle function), infection (particularly urinary tract infections and pneumonia), and other complications related to immobility during end stages of AD

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Falls and broken bones Loss of ability to interact Malnutrition and dehydration Failure of body systems Harmful or violent behavior toward self or others Abuse by an over-stressed caregiver
Back to TopWhen

to Contact a Medical Professional

Call your health care provider if someone close to you experiences symptoms of senile dementia/Alzheimer's type. Call your health care provider if a person with this disorder experiences a sudden change in mental status. (A rapid change may indicate other illness.) Discuss the situation with your health care provider if you are caring for a person with this disorder and the condition deteriorates to the point where you can no longer care for the person in your home.
Back to TopPrevention

Although there is no proven way to prevent AD, there are some practices that may be worth incorporating into your daily routine, particularly if you have a family history of dementia. Talk to your doctor about any of these approaches, especially those that involve taking a medication or supplement.

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Consume a low-fat diet. Eat cold-water fish (like tuna, salmon, and mackerel) rich in omega-3 fatty acids, at least 2 to 3 times per week. Reduce your intake of linoleic acid found in margarine, butter, and dairy products. Increase antioxidants like carotenoids, vitamin E, and vitamin C by eating plenty of darkly colored fruits and vegetables. Maintain a normal blood pressure. Stay mentally and socially active throughout your life. Consider taking nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin), sulindac (Clinoril), or indomethacin (Indocin). Statin drugs, a class of medications normally used for high cholesterol, may help lower your risk of AD. Talk to your doctor about the pros and cons of using these medications for prevention. In addition, early testing of a vaccine against AD is underway.

Diagnosing Deafness Doctors who specialize in hearing disorders (otologistsor otolaryngologists) use many tests to measure hearing loss or track down its cause. A tuning fork helps the physician determine if hearing loss is conductive or sensorineural.

Audiometry is a test that measures hearing loss with an electronic device. To find out whether babies and children have profound hearing loss, doctors use otoacoustic emissions testing (OAEs). If an infant or child fails otoacoustic emissions testing, auditory brain stem response (ABR) testing is performed. Neurological tests including a magnetic resonance imaging (MRI) test, or a computerized tomography (CT) scan may be performed to check for possible tumours involving the auditory (hearing) nerve, especially for people with hearing loss that is significantly worse in one ear. Treating and Preventing Deafness Sensorineural hearing loss and deafness tends to be permanent because it involves damage to nerves or to the inner ear. The only method of treatment is a hearing aid worn in the ear, a device that amplifies the volume of sound electronically. Hearing aids are usually some variation of an in-the-ear or behind-the-ear device. Many are programmable to make them more effective for use in a variety of situations, such as noisy environments or talking on the phone. The body aid, although rarely used now, is the most powerful kind of hearing aid for profound deafness, and is worn in a harness on the chest. A bone-conducting hearing aid may be used if someone was born without anear canal (the opening leading to the inner ear). The aid conducts sound through the skull to the inner ear, and can be implanted surgically in the bone behind the ear. Conductive hearing loss and deafness may at times be treatable by removing the cause of the blockage, for example, wax in the ear canal or fluid in the middle ear. Problems with the hearing bones (called otosclerosis) can be treated with surgery. If a person can't hear sounds even with a hearing aid, they may benefit from acochlear implant. Very thin wires are implanted in the inner ear. They connect the auditory nerve with a device that converts sound into electrical impulses. These stimulate the auditory nerve, which then sends the impulses to the brain. Many people with modern, multi-channel cochlear implants are able to understand speech without lip reading, including speech over the telephone. Other tools to help the profoundly deaf include light alerting systems (e.g., they flash if a doorbell is ringing) and telephone communication devices. In order to communicate, many deaf people lip-read or use sign language. Deaf infants and older children need special language training that should begin as soon as deafness is identified. This involves the teaching of sign language and lip reading, as well as speech therapy. Hearing problems can be prevented by reducing exposure to noise. Hearing protection should be used when using machinery or when exposed to loud noises of any sort. People should not listen to excessively loud music on headphones. It is important that children get all their vaccinations to lower the risk of infectious diseases that may lead to permanent hearing loss or deafness. Avoiding certain medications can prevent drug-induced ear damage. If complete avoidance is not possible, monitoring levels of these medications in the blood allows health professionals to keep them at safe levels in the body.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.

Polio
In this factsheet:

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The Facts on Polio Causes of Polio Symptoms and Complications of Polio Diagnosing Polio Treating and Preventing Polio

The Facts on Polio

Also known as poliomyelitis, polio is a highly infectious viral disease. Although most of the world's countries are free from polio, this condition still exists in parts of Africa and south Asia. In particular, it is found in areas where water treatment and sanitation facilities are not properly maintained or nonexistent. Although children under 3 years of age represent more than half of all cases, polio can affect people of any age. According to the Pan American Health Organization, Canada has been free of polio since 1994. The World Health Organization is at the heart of a plan to help make the world free from the disease. Through vaccination, the spread of polio and the complete removal of the disease from the human population is possible. The number of polio-endemic countries in 1988 was over 125; in early 2006, this number had been reduced to just 4.

Causes of Polio
Polio is caused by infection with the poliovirus. This virus is highly contagious, and is passed on through food and water contaminated with the stool (feces) of infected people. It can take 4 to 21 days before symptoms appear and an infected person can pass the virus on to other people even before symptoms appear. Infection with polio happens when the virus enters the body through the mouth, multiplies in the throat and intestine, and spreads through the blood to the central nervous system. There, the virus attacks nerve cells, which can lead to paralysis.

Symptoms and Complications of Polio

Polio is a serious condition that causes paralysis in less than 1% of those infected (paralytic polio). However, most people do not become sick at all. In a small number of cases, the disease causes flu-like symptoms but does not lead paralysis (non-paralytic polio). Non-paralytic polio causes symptoms that mimic the flu. A person may experience a sore throat, fatigue, nausea, diarrhea, a fever, or vomiting. Most cases of non-paralytic polio clear up in a number of days, but some people go on to developmeningitis, a condition in which the lining of the brain is infected. Meningitis can be fatal if it is not treated quickly. When a person develops paralytic polio, the symptoms are more serious. As the virus spreads through the nerves it destroys nerves that control muscles. The infection may be fatal if the brain and respiratory organs become affected. n this factsheet:

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The Facts on Polio Causes of Polio Symptoms and Complications of Polio Diagnosing Polio Treating and Preventing Polio

Diagnosing Polio
The doctor may suspect a person has polio if they show symptoms of the condition, such as stiff neck and back, trouble breathing, or nausea. This is particularly true for people who come from a high-risk area or those who have not been vaccinated against polio. To confirm the diagnosis, the doctor will take samples from the throat, stool, and the fluid surrounding the brain and spinal cord.

Treating and Preventing Polio

Because there is no cure for polio, supportive therapy is the main treatment. Improving a person's chance of recovery is the main goal of treatment. This type of treatment helps minimize discomfort and prevent complications while the person recovers. Supportive treatment may include medications for polio symptoms, ventilators to help the person breathe, exercise, and a balanced diet.

Polio is not a treatable disease, yet it is almost completely preventable. Vaccination with the polio vaccine provides the most effective form of prevention. Childhood immunization programs protect Canadians from infection by the poliovirus. Health Canada recommends you check with your family doctor before traveling overseas as you may be going to a high-risk area. Getting the vaccination before you leave may protect you while traveling, especially if you have never been vaccinated against polio.

What is the history of polio?

Polio is caused by a virus and has been around for thousands of years. There are even Egyptian artifacts portraying individuals with typical features of post-polio paralysis. Polio has been called many different names, including infantile paralysis, debility of the lower extremities, and spinal paralytic paralysis. We now refer to the virus and disease as polio, which is short for poliomyelitis and has Greek derivation: polios (gray), myelos(marrow), and itis (inflammation). Polio is caused by a very infectious enterovirus, poliovirus (PV), which primarily affects young children and is spread through direct person-to-person contact, with infected mucus, phlegm, feces, or by contact with food and water contaminated by feces of another infected individual. The virus multiplies in the gastrointestinal tract where it can also invade the nervous system, causing permanent neurological damage in some individuals. Most individuals infected with polio remain asymptomatic or develop only mild flu-like symptoms, including fatigue, malaise, fever, headache, sore throat, and vomiting. In fact, the symptoms, if present, may only last 48-72 hours; however, those individuals will continue to shed virus in their stools for a prolonged period, serving as a reservoir for subsequent infections. About 2%-5% of infected individuals go on to develop more serious symptoms that may include respiratory problems and paralysis. Currently, there is no cure for polio; only vaccination can prevent the spread of the disease, and although in the developed world it is almost unheard of, globally, polio remains a fairly common disease. Originally, international organizations believed it possible to eradicate polio by 2000, though this has been more difficult than initially hoped for.

What causes polio?

The symptoms of polio are caused by the poliovirus, which is a small RNA virus that is spread through contact with the oral mucosa (mouth, nose, etc). Most commonly, the virus attaches to and infects intestinal cells, multiplies, and is excreted in the stool of the infected individual. Rarely, in 2% of the cases, the virus spreads from the gastrointestinal tract to the nervous system and causes paralytic disease.

How is polio spread?

Polio is spread in an "oral-fecal" manner. Person-to-person infection occurs by contact with infected mucus, phlegm, feces, or by contact with food and water contaminated by feces of another infected individual.

What are signs and symptoms of polio?

The signs and symptoms of polio differ depending on the extent of the infection. Signs and symptoms can be divided into paralytic and non-paralytic polio. In non-paralytic polio which accounts for most individuals infected with polio, patients remain asymptomatic or develop only mild flu-like symptoms, including fatigue, malaise, fever, headache, sore throat, and vomiting. The symptoms, if present, may only last 48-72 hours, though usually they last for one to two weeks. Paralytic polio occurs in about 2% of people infected with the polio virus and is a much more serious disease. Symptoms occur as a result of nervous system and spinal cord infection and inflammation. Symptoms can include

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abnormal sensation, breathing difficulty, difficulty swallowing, urinary retention, constipation, drooling, headache, mood swings, muscle pain and spasms, and paralysis.

Approximately 5%-10% of patients who develop paralytic polio often die from respiratory failure, since they are unable to breathe on their own. That is why it is imperative that patients receive appropriate medical evaluation and treatment. Prior to the vaccine era and the use of modern ventilators, patients would be placed in an "iron lung" (a negative pressure ventilator, which was used to support breathing in patients suffering from paralytic polio).

How is polio diagnosed?

The diagnosis of polio is a clinical one. History of exposure with no history of previous vaccination is the initial hint. Often, a spinal tap for CSF fluid is done to help distinguish polio from other diseases that initially have similar symptoms (for example,meningitis). After that, viral cultures (taken from throat washings, stools, or CSF fluid) and measurement of polio antibodies support the diagnosis.

How is polio treated?

There is no cure for polio, so prevention is very important. Patients with non-paralytic polio need to be monitored for progression to paralytic polio. Patients with paralytic polio need to be monitored for signs and symptoms of respiratory failure, which may require lifesaving therapies such as respiratory support. In addition, a number of treatments are available to decrease some of the less severe symptoms. There are medications to treat urinary infections and urinary retention and pain management plans for muscle spasms. Unfortunately, there are only supportive measures available to treat the symptoms of paralytic polio. Patients who recover from polio may require physical therapy, leg braces, or even orthopedic surgery to improve physical function.

Is there a vaccine that prevents polio?

The story of polio vaccine is a true medical success story. It is not over yet since polio still causes significant illness in less developed areas of the world such as in India and Africa. During the last half of the 19th century and into the first half of the 20th century, polio was a global epidemic. Even the future U.S. president, Franklin D. Roosevelt, contracted paralytic polio in 1921. President Franklin D. Roosevelt was quite influential in increasing both public awareness and scientific research dedicated to eradicating the disease. In 1938, after the founding of the National Foundation for Infantile Paralysis (March of Dimes), there was a significant effort to develop a vaccine to prevent polio. This came to fruition in 1955 when Dr. Jonas Salk developed an injectable inactivated polio vaccine (IVP) which was soon distributed and administered to children all over the United States and Canada. The current inactivated polio vaccine has evolved over time, but since 1999, it has been the recommended form of the polio vaccine in developed nations. In 1961, an oral live virus vaccine against polio (OVP) was developed byAlbert Sabin which became available and widely used from 1963 to 1999 in developed countries and to present day in underdeveloped countries.

This oral virus vaccine is still recommended to control polio pandemics all over the world due to its ease of administration (no needles needed). Both vaccines were developed for children since they are the group that generally seemed to be at highest risk. However, the oral vaccine (OVP) should not be given to children who are immunodepressed as they can develop vaccine-associated paralytic poliomyelitis (VAPP). The newest injected vaccine is an enhanced inactivated polio vaccine that is more immunogenic (produces a strong immune system response) than the previous IVP and is used in the U.S.; it does not cause VAPP. The original OVP (also termed tOVP) was a trivalent oral vaccine (polio viruses types 1-3) but caused a measurable immune response in only about 40%-50% of people who obtained it. Unfortunately, this trivalent oral vaccine was often not immunogenic fast enough to withstand dilution or removal from the gastrointestinal tract by chronic diarrhea that existed in many patients. OVP was modified in 2005 to a monovalent (type 1 polio virus only) termed mOVP1. This change caused the vaccine to be three times more immunogenic than the original trivalent OVP and generated an immune response in over 80% of people who obtained this oral vaccine. This newer oral vaccine is used in many developing countries where no needles or trained personnel are available and where chronic diarrhea further reduces the effectiveness of the original trivalent OVP. Other monovalent OVP (for example, mOVP3, used for the infrequent polio type 3 outbreaks) are occasionally used. Currently, four doses of inactivated polio vaccine (IPV) are recommended for children when they are 2 months old, 4 months old, 6-18 months old, and finally at 4-6 years of age. Due to vaccination programs, there have been very few cases of polio in the western hemisphere since the 1970s, and although current worldwide eradication programs continue to be successful, there is still work to be done to eliminate polio in developing countries.

Polio At A Glance
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Polio is caused by a virus. Polio has been around for thousands of years. Polio is spread person to person by contact with infected mucus, phlegm, feces, or by contact with food and water contaminated by feces of another infected individual. Non-paralytic polio is more common than paralytic polio. There is no cure for polio. Polio can only be prevented through vaccination. IPV (inactivated polio vaccine) and OPV (oral "live" polio vaccine) are still used routinely to prevent polio. Polio still causes significant illness in lesser developed nations.

There are few people that are born handicapped, while in most cases, it is the little carelessness of the parents that causes the children to lose their leg or arm for no good reason. One of the most common diseases in small children comes in the form of polio which can be avoided by some very simple efforts, but the negligence from the parents side renders these children handicapped for their whole life.

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Drops To Avoid Polio: The best way to avoid this disease is to make sure that these children get the required two drops annually, until they are less than five years old. The process of getting these drops is very simple and all you need to do is to go to the clinic or polio center on the date and time specified by the government and get these drops for free.

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Motivate The Handicapped And Overcome The Disease Yet there have been instances where people have defied all odds and achieved big success in their life. They have never made their life miserable by giving the reason of polio. They have achieved things such as won a racing event while competing with people who were one hundred percent fit. So if you have someone around you, who is depressed because of this problem, then increase their energy and motivation by giving them positive examples.

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A Little Care Can Go A Long Way! As parents, all we really want is that our children get the best life and best life style. This can only be achieved by making sure that all relevant facilities are given to these children. Polio is a disease that many people have caught from their childhood, where as their life could have been far more different, if only thing as small as polio drops is provided to them on the right time. There is no doubt that polio is a curse but at the same time, its cure is as simple as few drops of medicine. So plan yourself, and miss the session.

Types of Deafness
Conductive hearing loss occurs when sound vibrations don't go from the air
around a person to the moving bones of the inner ear as well as they should. If something is blocking the ear canal, like ear wax, there is a conductive hearing loss. If there is fluid inside the inner ear where the bones are, like the fluid from an inner ear infection, there is a conductive hearing loss. If the bones of the ear get a buildup of calcium, from a disease perhaps, and they can't move as freely as they need to, there is a conductive hearing loss. Generally, conductive hearing loss doesn't cause a total inability to hear, but it does cause a loss of loudness and a loss of clarity. In other words, sounds are heard, but they are weak, muffled, and distorted.

Neural hearing loss (Nerve deafness) occurs when the auditory nerve,
which goes from the inner ear to the brain, fails to carry the sound information to the brain. Neural hearing loss can cause a loss of loudness or a loss of clarity in sounds.

Mixed hearingloss is a combination of conductive and neural hearing losses.

Causes of Deafness
Heredity. Some people are born deaf. Usually the cause is unknown. Sometimes
people will say it's because of something that happened to the mother during her pregnancy, but this is often just guessing. Although deafness does sometimes "run in families," deaf parents often have hearing children and hearing parents often have deaf children.

Diseases of the Ear Ear infections are diseases which can cause fluid or mucus to build up inside the
ear. If pressure builds up inside the ear, the eardrum is less flexible than it should be. As the ear heals, the fluids drain out of the ear or are absorbed into the body. Some

hearing may be lost during the infection; it may or may not return when the infection is healed.

Otosclerosis is a common cause of hearing loss. Although in the past people have thought that it was caused by diseases such as scarlet fever, measles, and ear infections, in fact these have nothing to do with its development. It is a hereditary disease in which portions of the middle ear or inner ear develop growths like bony sponges. The disease can be in the middle ear, the inner ear, or both places. When it spreads to the inner ear a sensorineural hearing impairment may develop. Once this develops, it is permanent. If it is in the stapes bone, in the middle ear, it can cause a conductive hearing loss. The amount of hearing loss depends on the amount of otosclerosis in the area.

Meningitis is an inflammation of the membrane(called the meninges) that surrounds the brain and the spinal column. Meningitis itself doesn't cause deafness, but since the brain is so close to the ears, sometimes the inflammation of the meninges can cause the inner ear to become inflamed also, and this can result in deafness.

Injuries of the Ear Punctures of the Eardrum. Hearing loss can be the result of a hole in the
eardrum, which could be caused by either injury or disease. The eardrum is the thin membrane that separates the ear canal and the middle ear. The middle ear is connected

to the throat by the eustachian tube, which relieves the pressure in the middle ear. So a hole in the eardrum causes a loss of hearing and sometimes fluids can drain from the ear. Luckily the eardrum usually heals itself, although it can take a few weeks or months. While the eardrum is healing, it must be protected from water and from further injuries. If the eardrum doesn't heal by itself, it may need surgery. The amount of hearing that is lost depends on the size of the hole in the eardrum and a lot of other things. Injuries which can perforate the eardrum include:
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Foreign objects, such as Q-tips or hairpins, which are pushed too far into the ear canal. Explosions, which cause an abrupt and very big change in the air pressure, which can cause an eardrum to tear. Car wrecks, fights, and sporting injuries.

Nerve Damage. Damage to the auditory nerve can also be the result of an injury or a disease. Injuries can happen in auto accidents or falls. The result of nerve damage is that the electrical signals of sounds do not get transmitted from the ear to the brain.

Loud Noises. A very common cause of deafness is repeated or long-term exposure to loud noises. This is why heavy equipment operators, firefighters, factory workers, and especially rock musicians suffer hearing losses after years of their work. Usually a single incident of exposure to loud noises will not cause deafness, but a repeated exposure to loud noises over a period of time will often cause moderate to severe hearing loss.

Deafness
by Michelle Badash, MS

En Espaol (Spanish Version)

Definition
Deafness means a lack or loss of the sense of hearing, which may be partial or complete. Partial loss of hearing is often called hearing loss rather than deafness. Deafness can occur in one or both ears. There are three primary types of hearing loss:

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Conductivehearing loss caused by the inability of the sound to reach the inner ear. This can result from outer or middle ear problems, such as ear infection, excess wax, or swelling. This type of hearing loss is most likely to respond to medical or surgical treatment. Sensorineuralhearing loss caused by disorders of the inner ear or auditory nerve. This type of loss is usually permanent. It can be caused by heredity or congenital problems, excess noise, old age, medications, infections such as ear infections andmeningitis , or from tumors compressing the nerve of hearing such as an acoustic neuroma . Mixedhearing losses that are a combination of both conductive and sensorineural loss.

2011 Nucleus Medical Media, Inc.

Causes
Deafness may occur at any age, from birth through old age. The conditions that can cause or be associated with hearing loss include the following:

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Ear infections Middle ear fluid Earwax Hole in the ear drum (tympanic membrane perforation) Trauma may cause rupture of the tympanic membrane and disruption of the middle ear ossicles, or concussion of the inner ear

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Nose or throat problems, such as: o Nasal allergies o Sinus problems o Blockage of the eustachian tubes (tubes leading from the ears to the throat) Hereditary factors Birth defects o Trauma, injury, or fracture Noise Ear disorders, such as: o Otosclerosis o Menieres disease Infections, such as: o Viral infections o Mumps Bacterial infections, such as: o Syphilis o Meningitis o Otitis media Tumors involving the: o Ear o Brain Neurological disorders, such as: o Multiple sclerosis o Stroke Hypothyroidism (underactive thyroid) Ototoxic drugs (medications that damage the ear), such as: o Aspirin (usually reverses when aspirin is stopped) o Quinine (usually reverses when quinine is stopped) o Antibiotics: gentamicin, streptomycin, and neomycin (usually is not reversible after stopping drug)

Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for deafness include:

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Premature birth Increasing age, for age-related hearing loss ( presbycusis ) Taking ototoxic medications Exposure to loud noise on the job, such as: o Loud industrial noise o Use of heavy equipment o Being a musician Exposure to recreational loud noise, such as: o Guns (target practice) o Loud music o Family history of deafness

Symptoms
Hearing loss usually comes on gradually, but may come on suddenly. Symptoms may include:

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Difficulty hearing Ringing in the ears ( tinnitus ) Dizziness Ear pain in case of an infection Feeling of ear fullness (as in earwax or fluid)

Symptoms of deafness in infants may be noted at these stages:

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1 to 4 months: lack of response to sounds or voices 4 to 8 months: o Disinterest in musical toys o Lack of verbalization, such as babbling, cooing, making sounds 8 to 12 months: lack of recognition of childs own name 12 to 16 months: lack of speech

According to the American Academy of Pediatrics, all children (including newborns) should be screened for hearing loss so that hearing loss occurring before birth can be uniformly detected prior to three months of age.

Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. As part of the diagnosis, your doctor may try to determine the following:

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Location of the problem Degree of loss Causenot always possible to identify the exact cause of hearing loss; this information can help guide treatment

Depending on the type of hearing loss you have, the doctor may order tests to confirm your diagnosis. Tests may include:

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Otoscopyexamination of the structures inside the ear Bone vibrator (also called a tuning fork test)helps to determine the type of hearing loss Audiogram (also called a hearing test)measures the degree of hearing loss Tympanometrymeasure middle ear fluid and pressures Brainstem auditory evoked responsemeasures electrical response in the brain to sounds in order to help determine the exact location of certain hearing problems CT scan a type of x-ray that uses a computer to make pictures of the inside of the body, in this case the head MRI scan uses magnetic waves to make pictures of the inside of the body, in this case the head

Treatment
Treatment for deafness depends on the type of hearing loss. Options may include:

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Medical treatmentfor example, removal of earwax or use of antibiotics to treat an ear infection In selected cases of sudden hearing loss, medical treatment with Intratympanic steroids may be effective. Hearing aidssmall devices that are worn in or behind the ear to help amplify sounds Surgeryin some cases, surgery may be recommended to help improve hearing; types of surgery include: o Stapedectomyfor treatment of otosclerosis o Tympanoplasty for a perforated eardrum o Tympanoplasty tubesfor persistent middle ear infections or fluid Cochlear implant a surgically implanted electronic device that helps provide sound to a person with severe sensorineural hearing loss (although the devices do not completely restore hearing, improvements in implant technology continue to be made)

Prevention
To help prevent deafness, avoid loud noise. In cases when loud noise cannot be avoided, you can reduce exposure to loud noises by wearing earplugs, earmuffs, or ear protectors. Also, taking steps to reduce injuries or disease may prevent certain types of deafness. There is currently no effective way to prevent congenital or genetic deafness. Hearing screening for newborns can help insure that hearing loss in young babies is detected and treated at the earliest possible stage.
If you have hearing problems, help is available. Treatment depends on the cause and severity of your hearing loss.

Options include:

Removing wax blockage.Earwax blockage is a common reversible cause of hearing loss. Your doctor may remove earwax by loosening it with oil and then flushing, scooping or suctioning the softened wax out.

Hearing aids. If your hearing loss is due to damage to your inner ear, a hearing aid can be helpful by making sounds stronger and easier for you to hear. An audiologist can discuss with you the potential benefits of using a hearing aid, recommend a device and fit you with it. In some cases, you may be satisfied with an inexpensive, over-the-ear microphone device available at electronic stores. You may need to try more than one device to find one that works well for you.

Cochlear implants. If you have severe hearing loss, a cochlear implant may be an option for you. Unlike a hearing aid that amplifies sound and directs it into your ear canal, a cochlear implant compensates for damaged or nonworking parts of your inner ear. If you're considering a cochlear implant, your audiologist, along with a medical doctor who specializes in disorders of the ears, nose and throat (ENT), will likely discuss the risks and benefits with you.

This factsheet is for people who have hearing loss, or who would like information about it. Hearing loss can be temporary or permanent and can affect all age groups. Ageing, ear infections and loud noises all cause hearing loss.

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Animation - how the ear works About hearing loss Symptoms of hearing loss Causes of hearing loss Diagnosis of hearing loss Treatment of hearing loss

Animation - how the ear works

A Flash plug-in is required to view this animation.

About hearing loss

Hearing loss affects around two out of 10 adults in the UK. Most of these people are over 60 and have lost their hearing gradually as part of the natural ageing process. Around seven in 10 people over 70 in the UK have some degree of hearing loss. However, hearing loss can also happen at a younger age.

Sound and the ear

Your ear consists of three parts: the outer ear, middle ear and inner ear. The outer ear is the visible part of your ear. It collects sound waves, which travel down your ear canal to your eardrum. The sound waves cause your eardrum to vibrate. This vibration is passed on to your middle ear, which consists of three small bones called ossicles. The ossicles amplify and conduct the vibrations to your inner ear. Your inner ear contains the cochlea and the auditory nerve. The cochlea is full of fluid and contains tiny hair cells. Vibrations cause the hair cells in your cochlea to move. Movement of these hair cells produces electrical signals that travel along the auditory nerve to your brain, where they are converted into meaningful information, such as language or music.

Types of hearing
There are two main types of hearing loss.

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Conductive hearing loss this is caused when sound cant move freely from your outer ear to your inner ear. Sensorineural hearing loss this happens when there is damage to the pathway between your inner ear and your brain. You may have a combination of conductive and sensorineural hearing loss this is known as mixed hearing loss. You may have hearing loss in one ear only (unilateral) or both ears (bilateral).

Symptoms of hearing loss

In adults, hearing loss may be very gradual, for example in age-related hearing loss. You may start to notice you find it difficult to hear and understand people when you're in a noisy place. Hearing loss can also be very sudden, for example if its caused by a viral infection of the inner ear. Some people find that their hearing loss is associated with a continual ringing in their ears (tinnitus). Depending on what is causing your hearing loss, you may also have some other symptoms, such as earache and discharge from your ears, if you have an infection. Hearing loss can affect speech and language development in children.

If you, or your friends and family, think that your hearing is getting gradually worse, you should see your GP. If you have sudden hearing loss in one or both ears, you should seek immediate advice, as treatment may need to be started very quickly.

Causes of hearing loss

Conductive hearing loss
The following are possible causes of conductive hearing loss.

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Middle ear infection. This is particularly common in children. Glue ear (a build-up of fluid in your middle ear). This is also common in children. Blockage of your outer ear, usually caused by a build-up of wax. Otosclerosis bone growth in the middle ear, which makes the ossicles of your middle ear harden and become less able to vibrate. Perforated (pierced) eardrum, which can be caused by an untreated ear infection, a head injury or from poking something in your ear. The causes of conductive hearing loss can often be treated, so its usually only temporary.

Sensorineural hearing loss

Most hearing loss is thought to be sensorineural. It happens when the hair cells within your cochlea are damaged. The following are some possible causes.

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Age-related hearing loss (presbycusis) a natural decline in your hearing as a result of damage that occurs to your cochlea as a part of the ageing process. Regular exposure to loud noises, for example if you work in a noisy place or listen to a lot of loud music. Certain infections such as rubella, measles or meningitis. Meniere's disease a condition that affects your inner ear, causing dizziness and tinnitus, as well as leading to hearing loss. Certain medicines, such as some strong antibiotics. Certain cancer treatments, such as chemotherapy and radiotherapy. Acoustic neuroma a benign (non-cancerous) tumour that affects your auditory nerve. Cholesteatoma benign skin growth behind your eardrum. An injury to your head. Sensorineural hearing loss is usually permanent as once the hair cells in your cochlea are damaged, they cant be repaired.

Diagnosis of hearing loss

Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history. Your GP may do a hearing test, or he or she may refer you to either an otolaryngologist (a doctor who specialises in ear, nose and throat disorders), an audiologist (a specialist in hearing) or an audiovestibular physician (a doctor who specialises in hearing, balance and communication problems). You may have the following tests.

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Whispered speech test. Your doctor will whisper a combination of numbers and letters from behind you and ask you to repeat the combination to check if you can hear anything. He or she will test each ear separately. Tuning fork test. Different tuning forks can be used to test your hearing at a variety of frequencies. They can also help determine the type of hearing loss you have. Pure tone audiometry. You will be asked to wear a set of headphones attached to a machine called an audiometer. The audiometer produces sounds of different volumes and frequencies, and you will be asked to indicate when you hear the sounds in the headphones. The level at which you cant hear the sound of a certain frequency is known as your threshold. If your hearing loss has a sensorineural cause, a number of other tests can be done to pinpoint where the problem lies. Otoacoustic emissions. This test is used to measure your cochlear function by recording signals produced by the hair cells. Auditory brainstem response. This test measures the activity of your cochlea, auditory nerve and brain when a sound is heard. If your doctor thinks your hearing loss is the result of an acoustic neuroma or cholesteatoma, you may need to have an MRI scan of your head.

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Treatment of hearing loss

Self-help

You may find it easier to hear and understand people if you:

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make sure there is light on the face of the person youre talking to, so you can see their lips moving sit close to the person youre talking to sit so that your better ear is closer to the person youre talking to

Medicines
If you have a bacterial infection of your middle ear, it can sometimes be treated with antibiotics. Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

Non-surgical treatments
If your outer or middle ears are blocked by ear wax or fluid caused by an ear infection, a nurse will be able to remove the blockage with a syringe after it has been softened. If there is no cure for your hearing loss, for example if its caused by ageing, a hearing aid for one or both of your ears may help. Hearing aids can work for both conductive and sensorineural hearing loss. Many different types of hearing aid are available, and your audiologist will advise you as to which type best suits your needs.

Surgery
If you have a large perforation of your ear, you may need to have surgery to repair it. An acoustic neuroma can be removed with surgery or treated with radiotherapy. Ossicles affected by otosclerosis can sometimes be treated with surgery. If a hearing aid doesnt help (eg in profound deafness), your doctor may suggest you have a cochlear implant. This is a device that turns sounds into electrical signals, which directly stimulate your auditory nerve allowing you to hear.