Frequently asked questions

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  1. What are Transient Ischaemic Attacks (TIAs)?
  2. What is a feeding tube, and when is it needed?
  3. What does a new symptom/sign/behaviour mean?
  4. Why are there so few sensible questions on this page?

Question 1: What are Transient Ischaemic Attacks (TIAs)?

TIA stands for Transient (short-lived, not lasting more than 24 hours) Ischaemic (not enough blood) Attack (ouch!). A TIA may present suddenly as weakness of an arm and/or leg, loss or slurring of speech, loss of balance, loss of vision, or an episode of confusion or memory loss. TIAs occur because the blood supply to the brain is insufficient for the usual brain function to continue, but they always resolve completely within 24 hours leaving no residual disability. If they last longer than 24 hours and then completely resolve, they may be called Reversible Ischaemic Neurological Deficits (RINDs). If they do not resolve then the patient has had a stroke (CVA, cerebrovascular accident) with some residual disability.

When a TIA occurs, it is vital that medical advice is sought because the TIA can sometimes act as a warning sign of an impending stroke, and certain forms of treatment can sometimes prevent such strokes happening, or reduce their likelihood. Treatments might include various forms of anti-coagulation (including aspirin) or surgical procedures like carotid endarterectomy where areas of narrowing inside the main neck arteries are squashed outwards by a temporary balloon to make more room for the blood to get through.

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Question 2: What is a feeding tube, and when is it needed?

The simplest feeding tube is a Naso-Gastric Tube (NGT), a small plastic tube about 6mm (~1/4 inch) wide, inserted through the nose, down the back of the throat, passing through the oesophagus to the stomach. Fluids, liquid nourishment, and crushed and dissolved medications can be given, and fluids also can be removed from the stomach if necessary, through the NGT. A much finer tube 2-3mm (~1/8 inch) wide is sometimes placed via the same route but passed further down through the stomach and into the upper small bowel. This sort of fine tube is often attached to a pump through which continuous feeding can take place. Such an arrangement is rare for cases of dementia, and usually occurs for serious medical/surgical conditions involving the stomach, bowel and other abdominal organs where better nutrition is vital to treatment.

The other main type of feeding tube is a Percutaneous (through the skin) Endoscopic (using an endoscope to put the tube into position) Gastrostomy (cut in the wall of the stomach) or PEG tube. To insert a PEG tube, the patient is put under a light anaesthetic, and an endoscope is passed through the mouth into the stomach and pushed against the inner wall out towards the skin. From the outside a small cut is made in the skin down towards the light of the endoscope through all the intervening tissues, and the end of the PEG tube is gripped by forceps at the end of the endoscope and pulled into the stomach through the hole cut. There is usually a balloon which can be inflated inside the stomach to prevent the tube being pulled out again, or on occasions the PEG tube can be stitched into position to the skin to make it more permanent.

PEG tubes may be useful when a patient has lost the ability to swallow, or where it is likely food or fluids given by mouth will pass into the lungs (aspiration) leading to pneumonia. Concern has recently been expressed that PEG tubes are not helpful in cases of severe dementia, that they do not prolong life or ensure better comfort, and that they can make a patient's condition worse if, for example, s/he attempts successfully to pull it out. The decision to PEG-feed a person, or not to, is never easy and is best made in possession of as much information as possible concerning the illness of the person. The doctor caring for the person may be in the best position to help with that information.

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Question 3: What does a new symptom/sign/behaviour mean?

Dementia tends to be a progressive disorder and new symptoms, signs and behaviours usually appear with increasing dependency on the part of the patient. Some guide as to what to expect can be gleaned from the description of the stages of dementia, but these are not precise and may bear no relation to an individual's situation. Remember, too, that having dementia does not protect a person from getting other illnesses, so if a person with dementia develops a new behaviour or symptom or sign it is vital that a medical opinion is sought. Reversible conditions, such as a urinary tract infection causing incontinence, can be treated, thereby improving the quality of life of the person. On the other hand, the new factor may just be part of the progressing dementia and may not be treatable. Without a medical opinion you may never be sure, so get the person's doctor to have a look.

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Question 4: Why are there so few sensible questions on this page?

That's all that have been asked of me so far. Feel free to add to the list.

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