Re: Obama and Russia

On Feb 17, 5:50 am, Vladimir Makarenko <vmak...@xxxxxxxxx> wrote:

Petya, let's get serious: your country is in havoc. It needs a Saviour,
me - speaking plainly. Look - you, Amerilatvains did no good for the
country.  Indeed you hurt it badly. Now think about me when your head is
on a pillow - whom you want to talk to Putin, - me or one of your
Georgian wine buddies? I can talk to Putin and cut a deal. You can't.
Are you for Latvia or for your Ego?
I am such a Latvian patriot. You just underestimate my humanity at large.
Keep well.
VM.

ps. at least 350 grands a year plus bonuses. Not negotiable.

Maka, take hope: "The brain damage produced by alcohol may be arrested
by cessation of drinking. Prolonged periods of sobriety for patients
with alcohol induced dementia may result in slow small improvements of
intellectual function." But watch out for those falls: "Patients with
alcohol-induced dementia are at high risk for falls because of damage
to nerves and the cerebellum. Alcoholic patients are at high risks for
sub-dural haematomas, i.e., collections of blood between the brain
tissue and outer covering, produced by trauma. Any time an alcoholic
patient sustains a fall and subsequent alteration of function or
conscienceness the patient should be examined for new neurological
findings and the treatment team should consider the performance of a
CAT scan to exclude a sub-dural haematoma."

Alcohol-Induced Dementia
Richard E. Powers, MD
DEMENTIA EDUCATION & TRAINING PROGRAM – 1-800-457-5679

Alcohol-induced dementia is the third or fourth most common type of
intellectual
loss in older persons. Alcoholic dementia is produced by long term
heavy drinking
that directly damages brain cells or causes health problems that
produce brain
damage. Alcohol abuse is common in older persons. Eight percent of
elders have a
serious drinking problem. Sixty percent of elders drink and some
elders (5-10%)
are binge drinkers. Medicare spends more money on alcohol related
problems than
the treatment of heart attacks, i.e., myocardial infarctions. Alcohol-
related
dementia is under-diagnosed because primary care doctors fail to
recognize
alcoholism in majority, (i.e., 60%) of older patients. Families adopt
the “let granny
have her drinks” attitude that prolongs heavy drinking amongst older
persons.
The diagnosis of alcohol related dementia requires a careful clinical
history and
physical examination. The DSM-IV states that patients with alcohol-
induced
dementia must have sufficient cognitive deficits to meet criteria for
dementia and a
history of substance abuse based on clinical history, physical
examination, or
laboratory studies. The clinical manifestations of alcohol induced
dementia
resemble those of other types of dementia and this diagnosis can not
be confirmed
with a simple clinical history. Patients develop memory problems,
language
impairment, and inability to perform complex motor tasks, like
dressing. Patients
cannot be diagnosed with dementia while they are in withdrawal or
experiencing
serious medical complications resulting from the substance abused,
e.g., liver
failure, GI bleeds.

Psychiatric problems are common in patients with alcohol-induced
dementia. These
patients develop apathy, irritability, and anti-social behaviour that
result from damage to the frontal lobes. Korsakoff’s psychosis (KP)
is frequently confused with alcoholic dementia. KP is not a dementia
but rather a pure amnesia. The KP patient has severely impaired short-
term recall but his patient has excellent long-term memory and other
intellectual functions. Patients with KP should be treated with
thyamin but this
amnesia is usually permanent.

Alcohol abuse will worsen intellectual and psychiatric symptoms in
patients with
other types of dementia. Alzheimer’s or vascular dementia patients
should not be
allowed to drink except for ceremonial situations such as weddings,
etc.
The physical examination of a patient with alcohol induce dementia may
reveal
evidence of neurological damage from heavy drinking. Heavy alcohol
abuse
damages the nerves in arms and legs, i.e., peripheral neuropathy as
well as the
cerebellum that controls coordination i.e., cerebellar ataxia. These
patients
frequently have problems with sensation in their extremities and may
demonstrate
unsteadiness on their feet. Alcohol also damages the heart and liver.
These
individuals may have abnormalities of liver studies and heart damage
termed
“alcoholic cardiomyopathy”. This heart damage may produce additional
brain
complications such as strokes or hypo profusion, i.e., low blood flow
to the brain.
Brain imaging or other clinical studies are not helpful in
distinguishing alcoholic
dementia from other diseases. Neuropsychological testing can sometimes
help
clarify this diagnosis.

Psychiatric manifestations may proceed intellectual loss in some
patients. Alcohol-induced dementia can produce any type of psychiatric
problem associated with
dementia to include psychosis, depression anxiety, and personality
changes.
Patients with alcoholic dementia often develop apathy related to
frontal lobe
damage that may mimic depression. These individuals become irritable
or
resistive when caregivers attempt to assist with basic care. These
individuals also
demonstrate impulsive hostile behaviour that requires medication.

The brain changes associated with alcohol are very non-specific. The
lack of
specific brain pathology has caused alcohol-induced dementia to be
under-recognised
as a cause of intellectual loss. Alcohol damages neurons, i.e., brain
cells, throughout the brain; however, the frontal lobes and cerebellum
are particularly prone to injury.
Treatment of alcoholic dementia requires sobriety, vitamin
replacement, correction
of medical problems, and management of behavioural problems. The brain
damage
produced by alcohol may be arrested by cessation of drinking.
Prolonged periods
of sobriety for patients with alcohol induced dementia may result in
slow small
improvements of intellectual function. Unlike Alzheimer’s disease
where patients
lose two or three points on their mini mental per year, alcoholic
dementia patients
may regain 0.5 points per year with prolonged sobriety. Many patients
have
nutritional deficiencies that produce thiamin or folic acid deficiency
state. Patients
with alcoholic related medical problems need careful medical attention
to assure
that heart or liver disease does not contribute to confusion.

Patients with alcohol-induced dementia are at high risk for falls
because of damage
to nerves and cerebellum. Alcoholic patients are at high risks for sub-
dural
haematomas, i.e., collections of blood between the brain tissue and
outer covering
produced by trauma. Any time an alcoholic patient sustains a fall and
subsequent
alteration of function or conscienceness the patient should be
examined for new
neurological findings and the treatment team should consider the
performance of a
CAT scan to exclude a sub-dural haematoma. New drugs for Alzheimer’s
disease
are not shown beneficial for patients with alcohol induced dementia.

Psychiatric problems produced by alcohol-induced dementia are treated
with
appropriate psychotropic medications. Antidepressants or
antipsychotics are more
effective for alcohol-induced psychiatric problems. Apathy rarely
responds to antidepressants or other psychotropic medications.
Impulsive or hostile behaviour can
be managed with anti-convultants, anti-psychotics, or Lithium.
Benzodiazepines
can sometimes be use to manage irritability or anxiety.

Alcohol-induced dementia is a common form of intellectual loss.
Patients with
alcoholic dementia frequently manifest behavioural as well as
intellectual
symptoms. Alcoholic dementia differs from Alzheimer’s disease because
many
patients have discrete neurological abnormalities. Patients with
alcohol induced
dementia may improve over time if they maintain continuous sobriety.

Although some patients stabilise or improve with time, other patients
demonstrate
progressive cognitive loss. The cause of this ongoing intellectual
decline is not
understood.
.

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