Health and Me

Ishita Roy

New Hope For Heart Transplants: Researchers Look At Methods That Could Preserve Heart For Longer Duration

In a major step forward for heart transplants, doctors at two leading U.S. hospitals — Duke University and Vanderbilt University — have developed simpler and potentially life-saving methods to recover hearts from donors whose hearts have already stopped beating. Their research, published Wednesday in the <em>New England Journal of Medicine</em>, could expand the pool of viable donor hearts, especially for babies and young children who often face the longest waits and highest risks.

<h4>Rethinking Heart Donation After Cardiac Death</h4>

Most donor hearts used for transplants come from people who are declared brain-dead but whose hearts are still beating. In these cases, organs are kept alive on a ventilator until they’re retrieved. However, another type of donor, someone whose heart has stopped after life support is withdrawn, often goes unused. These are known as DCD (donation after circulatory death) donors.

While DCD organs are commonly used for kidneys and livers, using their hearts is more complicated. Once the heart stops, oxygen is cut off, and even a short delay before retrieval can make the heart unusable. That’s why new methods are needed to safely assess and preserve these hearts for transplant.

<h4>Controversial and Costly Options</h4>

One current method to save DCD hearts is called normothermic regional perfusion (NRP). It involves restarting blood flow to the heart and other organs, but only after clamping off the arteries leading to the brain. While effective, this technique is ethically controversial because it reintroduces circulation after death, which some hospitals do not allow.

Another alternative is to use high-tech machines to “reanimate” the heart outside the body, pumping it with blood and nutrients to keep it functioning until it reaches the transplant hospital. These machines, however, are expensive and complex, and not suitable for infants, whose small hearts can’t be supported by the equipment.

In response to these challenges, the Duke team developed a new, less invasive technique. Instead of reanimating the heart or using costly machinery, they simply removed the heart and briefly tested it by pumping blood and oxygen through it on a sterile table. This short test, done without restoring full-body circulation, was enough to confirm the heart was still viable.

The method was first tested on piglets and then used in a real case: a 1-month-old infant at another hospital became a donor, and Duke surgeons transported the heart to save a 3-month-old baby. The retrieval took just minutes and the heart showed clear signs of life , “it’s pink, it’s beating,” said Dr. Joseph Turek of Duke.

Meanwhile, Vanderbilt’s team took an even more streamlined approach. They simply flushed the heart with a cold, nutrient-rich solution, similar to what’s done for brain-dead donors, before transporting it. “You don’t necessarily need to reanimate the heart,” said Dr. Aaron Williams, the lead author of the Vanderbilt study. The hospital has already completed about 25 such heart transplants using this method.

<h4>A New Chance for Patients Waiting in Line</h4>

The need for more donor hearts is urgent. Each year, around 700 children in the U.S. are added to the transplant waiting list, and nearly 20% of them die before receiving a new heart. Infants are especially vulnerable due to their small size and limited donor pool.

Last year, 43% of organ donors were DCD, yet only 793 out of 4,572 heart transplants came from this group. That’s a huge gap many experts hope to close.

Brendan Parent, a transplant ethics expert at NYU Langone Health, called the research “promising and essential.” He added, “Innovation to find ways to recover organs successfully after circulatory death is key to reducing the organ shortage.”

As these new techniques continue to be tested and refined, they may offer fresh hope to thousands of patients, especially the youngest ones, waiting for a second chance at life.

Health Conditions A-Z

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heart health

health and wellness

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us health news

preserving heart

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In a major step forward for heart transplants, doctors at two leading U.S. hospitals — Duke University and Vanderbilt University — have developed simpler and potentially life-saving methods to recover hearts from donors whose hearts have already stopped beating. Their research, published Wednesday in the New England Journal of Medicine, could expand the pool of viable donor hearts, especially for babies and young children who often face the longest waits and highest risks.Rethinking Heart Donation After Cardiac DeathMost donor hearts used for transplants come from people who are declared brain-dead but whose hearts are still beating. In these cases, organs are kept alive on a ventilator until they’re retrieved. However, another type of donor, someone whose heart has stopped after life support is withdrawn, often goes unused. These are known as DCD (donation after circulatory death) donors.While DCD organs are commonly used for kidneys and livers, using their hearts is more complicated. Once the heart stops, oxygen is cut off, and even a short delay before retrieval can make the heart unusable. That’s why new methods are needed to safely assess and preserve these hearts for transplant.Controversial and Costly OptionsOne current method to save DCD hearts is called normothermic regional perfusion (NRP). It involves restarting blood flow to the heart and other organs, but only after clamping off the arteries leading to the brain. While effective, this technique is ethically controversial because it reintroduces circulation after death, which some hospitals do not allow.Another alternative is to use high-tech machines to “reanimate” the heart outside the body, pumping it with blood and nutrients to keep it functioning until it reaches the transplant hospital. These machines, however, are expensive and complex, and not suitable for infants, whose small hearts can’t be supported by the equipment.Simpler, Safer Methods EmergingIn response to these challenges, the Duke team developed a new, less invasive technique. Instead of reanimating the heart or using costly machinery, they simply removed the heart and briefly tested it by pumping blood and oxygen through it on a sterile table. This short test, done without restoring full-body circulation, was enough to confirm the heart was still viable.The method was first tested on piglets and then used in a real case: a 1-month-old infant at another hospital became a donor, and Duke surgeons transported the heart to save a 3-month-old baby. The retrieval took just minutes and the heart showed clear signs of life , “it’s pink, it’s beating,” said Dr. Joseph Turek of Duke.Meanwhile, Vanderbilt’s team took an even more streamlined approach. They simply flushed the heart with a cold, nutrient-rich solution, similar to what’s done for brain-dead donors, before transporting it. “You don’t necessarily need to reanimate the heart,” said Dr. Aaron Williams, the lead author of the Vanderbilt study. The hospital has already completed about 25 such heart transplants using this method.A New Chance for Patients Waiting in LineThe need for more donor hearts is urgent. Each year, around 700 children in the U.S. are added to the transplant waiting list, and nearly 20% of them die before receiving a new heart. Infants are especially vulnerable due to their small size and limited donor pool.Last year, 43% of organ donors were DCD, yet only 793 out of 4,572 heart transplants came from this group. That’s a huge gap many experts hope to close.Brendan Parent, a transplant ethics expert at NYU Langone Health, called the research “promising and essential.” He added, “Innovation to find ways to recover organs successfully after circulatory death is key to reducing the organ shortage.”As these new techniques continue to be tested and refined, they may offer fresh hope to thousands of patients, especially the youngest ones, waiting for a second chance at life.

new hope for heart transplants: researchers look at methods that could preserve heart for longer duration

Aarushi Bhadury

Nutrition

Neurologist Shares 10 Eating Habits For A Longer, Healthier Life

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Health News

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Parenting

The Dream Of 'Super Breed Babies' Is Becoming A Reality In Silicon Valley, Babies Are Now Not Just Born, But Selected

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<span>Dementia</span> is a condition that can effectively dismantle a person’s life and everything they have worked for. Your memories, the way you think and behave, and all of these factors will slowly change as dementia progresses. While we have known about the disease for quite some time now, there are many aspects of it that we are still exploring, like what are some of its risk factors and causes, as these will help us find a cure for the disease. 

New research suggests that developing conditions like heart disease and diabetes before age 55 could significantly raise your chances of <span>developing dementia later in life</span>. The study also indicates that experiencing strokes or <span>mental health issues</span> such as anxiety and depression between ages 55 and 70 might double that risk. 

<h2>Key Conditions and <span rel="noindex">Critical Time Windows</span> </h2>

The study, published in Brain Communications, revealed that heart conditions, including heart disease and an irregular heartbeat called atrial fibrillation, along with diabetes, were most strongly linked to an increased <span>risk of dementia</span> when they appeared before age 55. However, for those between 55 and 70, mental health disorders like anxiety and depression, as well as strokes, were found to double the dementia risk. This suggests different conditions pose a higher risk at different stages of life. 

<h2>Link Between Chronic Conditions and Dementia </h2>

Researchers at the University of Oxford found that a large majority, about 80%, of people with dementia also have two or more chronic health problems. However, there hasn't been a clear understanding of how specific diseases, and when they occur, are connected to dementia. This study aimed to identify important periods in life where certain illnesses pose the biggest threat. They analysed health information from over 282,000 individuals in the UK Biobank, looking at patterns across 46 long-term health conditions. 

<h2>Other Risk Factors for Dementia </h2>

According to Stanford Health Care, many things can raise a person's chance of getting dementia, though some factors we can change and others we can't. Growing older significantly increases the risk for common types like Alzheimer's and vascular dementia. Your genes and family history also play a role, as certain genes can increase the risk for Alzheimer's and other rarer forms like Creutzfeldt-Jakob disease. 

However, having a family member with Alzheimer's doesn't guarantee you'll get it, and many without a family history still develop it. People with Down's syndrome often show signs of Alzheimer's in middle age. 

Lifestyle choices matter too. For example, smoking heavily increases dementia risk, possibly due to its link with hardened arteries. While heavy alcohol use seems to increase risk, moderate drinking might actually lower it compared to drinking a lot or not at all. Health conditions are also key factors. Atherosclerosis, where arteries harden, is a big risk for vascular dementia and might be linked to Alzheimer's. 

High "bad" cholesterol (LDL), high levels of an amino acid called homocysteine, and diabetes all raise the risk for both Alzheimer's and vascular dementia. Finally, if someone has mild cognitive impairment, they are at a much higher risk of developing dementia, with about 40% of those over 65 progressing to dementia within three years in one study. 

This research highlighted that individuals who had conditions like heart disease and diabetes in middle age and then later developed strokes and mental health disorders faced the highest chance of getting dementia. Experts em that considering all existing health issues is important when assessing someone's dementia risk, which could help in creating strategies to lower that risk at particular life stages. Future studies will explore if managing or preventing these health problems during these critical periods could reduce dementia rates. 

dementia

critical time windows

Risk Of Dementia

Health Conditions that Double The Risk Of Dementia

developing dementia later in life

mental health issues

Dementia is a condition that can effectively dismantle a person’s life and everything they have worked for. Your memories, the way you think and behave, and all of these factors will slowly change as dementia progresses. While we have known about the disease for quite some time now, there are many aspects of it that we are still exploring, like what are some of its risk factors and causes, as these will help us find a cure for the disease. New research suggests that developing conditions like heart disease and diabetes before age 55 could significantly raise your chances of developing dementia later in life. The study also indicates that experiencing strokes or mental health issues such as anxiety and depression between ages 55 and 70 might double that risk. Key Conditions and Critical Time Windows The study, published in Brain Communications, revealed that heart conditions, including heart disease and an irregular heartbeat called atrial fibrillation, along with diabetes, were most strongly linked to an increased risk of dementia when they appeared before age 55. However, for those between 55 and 70, mental health disorders like anxiety and depression, as well as strokes, were found to double the dementia risk. This suggests different conditions pose a higher risk at different stages of life. Link Between Chronic Conditions and Dementia Researchers at the University of Oxford found that a large majority, about 80%, of people with dementia also have two or more chronic health problems. However, there hasn't been a clear understanding of how specific diseases, and when they occur, are connected to dementia. This study aimed to identify important periods in life where certain illnesses pose the biggest threat. They analysed health information from over 282,000 individuals in the UK Biobank, looking at patterns across 46 long-term health conditions. Other Risk Factors for Dementia According to Stanford Health Care, many things can raise a person's chance of getting dementia, though some factors we can change and others we can't. Growing older significantly increases the risk for common types like Alzheimer's and vascular dementia. Your genes and family history also play a role, as certain genes can increase the risk for Alzheimer's and other rarer forms like Creutzfeldt-Jakob disease. However, having a family member with Alzheimer's doesn't guarantee you'll get it, and many without a family history still develop it. People with Down's syndrome often show signs of Alzheimer's in middle age. Lifestyle choices matter too. For example, smoking heavily increases dementia risk, possibly due to its link with hardened arteries. While heavy alcohol use seems to increase risk, moderate drinking might actually lower it compared to drinking a lot or not at all. Health conditions are also key factors. Atherosclerosis, where arteries harden, is a big risk for vascular dementia and might be linked to Alzheimer's. High "bad" cholesterol (LDL), high levels of an amino acid called homocysteine, and diabetes all raise the risk for both Alzheimer's and vascular dementia. Finally, if someone has mild cognitive impairment, they are at a much higher risk of developing dementia, with about 40% of those over 65 progressing to dementia within three years in one study. Insights for Future Prevention This research highlighted that individuals who had conditions like heart disease and diabetes in middle age and then later developed strokes and mental health disorders faced the highest chance of getting dementia. Experts em that considering all existing health issues is important when assessing someone's dementia risk, which could help in creating strategies to lower that risk at particular life stages. Future studies will explore if managing or preventing these health problems during these critical periods could reduce dementia rates. 

developing these health conditions before 55 can double the risk of dementia

You Are Much Less Likely To Get Opioid Prescriptions For Lower Back Pain Than Before- Is Healthcare Getting Better?

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Emergency rooms are handing out significantly fewer <span>opioid prescriptions</span> to people experiencing <span>lower back pain</span>. Researchers reported in the Annals of Emergency Medicine on July 12 that the rate of opioid prescriptions for back pain in ERs dropped by more than half between 2016 and 2022. 

<h2>Dramatic <span rel="noindex">Decline in Opioid Prescribing</span> </h2>

Just a few years ago, in 2016, almost one out of every three visits to the ER for back pain ended with a prescription for opioid painkillers. But by 2022, that number had fallen dramatically to just over one in ten visits. This big drop means that doctors are learning from the available information and changing the way they practice medicine, especially as more people become aware of the widespread problems caused by opioid addiction. It's a positive sign that medical professionals are actively working to curb the opioid crisis. 

<h2>Understanding the Study and Patient Experience </h2>

To figure this out, researchers looked at records from nearly 53 million ER visits for low back pain that happened between 2016 and 2022. These records were gathered by a national health statistics centre. The study found that when people went to the ER for back pain, they were usually in a lot of discomfort, rating their pain at more than 7 out of 10. On average, they had to wait about 37 minutes before a doctor saw them and spent around four hours in the emergency room getting treatment. 

<h2>Why Opioid Usage Is Risky For Patients</h2>

A 2023 study even found that opioids may not be as effective for back pain. Published in the JAMA network, a 2023 study conducted a trial on those who were experiencing back pain. The trial involved 347 adults who had been experiencing pain for up to 12 weeks. Everyone in the study received standard care, which included reassurance, advice to avoid bed rest, and encouragement to stay active. Half of the participants also received a combination of oxycodone and naloxone (an opioid), while the other half received a placebo (a dummy pill).

The study also revealed that while side effects were similar for both groups, there was a significant difference in the risk of opioid misuse. One year later, 20% of the participants who took opioids were at risk of misusing them, compared to only 10% of those who received the placebo. This suggests that even for short-term pain relief, opioids carry a greater risk of future misuse.

<h2><span rel="noindex">NSAIDs</span> Emerge as Preferred Treatment </h2>

Now, when you go to the ER with low back pain, nonsteroidal anti-inflammatory drugs, often called NSAIDs (like ibuprofen), are the most common painkillers prescribed. They're given to almost 29% of patients. It's not just about prescriptions either; fewer patients are actually given opioids while they are being treated in the ER. That number went down from 35% of cases in 2016 to less than 25% by 2020, showing a clear shift away from immediate opioid use during emergency care for back pain.

Even though there's good progress with reducing opioids, ER doctors still have some areas where they could improve how they treat back pain. For example, many patients with back pain are still getting X-rays that they don't really need. In 2022, about 37% of patients had an X-ray, which is pretty much the same as in 2015. In fact, in 2021, almost 44% of cases involved an X-ray, which was the highest rate. It's tough to get this number down because deciding whether to order an X-ray can be complicated and depends on what both the doctor and the patient think is best.

Opioid Prescriptions

Lower Back Pain

Opioid Prescriptions For Lower Back Pain

Healthcare

Decline in Opioid Prescribing

NSAIDs

Emergency rooms are handing out significantly fewer opioid prescriptions to people experiencing lower back pain. Researchers reported in the Annals of Emergency Medicine on July 12 that the rate of opioid prescriptions for back pain in ERs dropped by more than half between 2016 and 2022. Dramatic Decline in Opioid Prescribing Just a few years ago, in 2016, almost one out of every three visits to the ER for back pain ended with a prescription for opioid painkillers. But by 2022, that number had fallen dramatically to just over one in ten visits. This big drop means that doctors are learning from the available information and changing the way they practice medicine, especially as more people become aware of the widespread problems caused by opioid addiction. It's a positive sign that medical professionals are actively working to curb the opioid crisis. Understanding the Study and Patient Experience To figure this out, researchers looked at records from nearly 53 million ER visits for low back pain that happened between 2016 and 2022. These records were gathered by a national health statistics centre. The study found that when people went to the ER for back pain, they were usually in a lot of discomfort, rating their pain at more than 7 out of 10. On average, they had to wait about 37 minutes before a doctor saw them and spent around four hours in the emergency room getting treatment. Why Opioid Usage Is Risky For PatientsA 2023 study even found that opioids may not be as effective for back pain. Published in the JAMA network, a 2023 study conducted a trial on those who were experiencing back pain. The trial involved 347 adults who had been experiencing pain for up to 12 weeks. Everyone in the study received standard care, which included reassurance, advice to avoid bed rest, and encouragement to stay active. Half of the participants also received a combination of oxycodone and naloxone (an opioid), while the other half received a placebo (a dummy pill).The study also revealed that while side effects were similar for both groups, there was a significant difference in the risk of opioid misuse. One year later, 20% of the participants who took opioids were at risk of misusing them, compared to only 10% of those who received the placebo. This suggests that even for short-term pain relief, opioids carry a greater risk of future misuse.NSAIDs Emerge as Preferred Treatment Now, when you go to the ER with low back pain, nonsteroidal anti-inflammatory drugs, often called NSAIDs (like ibuprofen), are the most common painkillers prescribed. They're given to almost 29% of patients. It's not just about prescriptions either; fewer patients are actually given opioids while they are being treated in the ER. That number went down from 35% of cases in 2016 to less than 25% by 2020, showing a clear shift away from immediate opioid use during emergency care for back pain.Next Issues People Must Tackle Even though there's good progress with reducing opioids, ER doctors still have some areas where they could improve how they treat back pain. For example, many patients with back pain are still getting X-rays that they don't really need. In 2022, about 37% of patients had an X-ray, which is pretty much the same as in 2015. In fact, in 2021, almost 44% of cases involved an X-ray, which was the highest rate. It's tough to get this number down because deciding whether to order an X-ray can be complicated and depends on what both the doctor and the patient think is best.

you are much less likely to get opioid prescriptions for lower back pain than before- is healthcare getting better?

Dr. Jeyhan B. Dhabhar

Understanding Soft Tissue Sarcoma: When Should You Be Concerned About A Lump?

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<span>Soft tissue sarcoma</span> (STS) is a rare type of cancer that can quietly grow in the connective tissues of the body—such as fat, muscles, nerves, blood vessels, or beneath the skin. Although it represents less than 1% of all cancers, its quiet nature often leads to late detection, making treatment more challenging. 

<h4>When a Lump Deserves Closer Attention </h4>

It’s common for people to dismiss a lump under the skin as harmless—perhaps a cyst or muscle knot. However, some features can indicate something more serious. You should consult a doctor if the lump is: 

<ul><li>Larger than 5 cm (roughly the size of a golf ball), </li><li>Located deep under the muscle, </li><li>Firm and doesn’t move easily, </li><li>Or steadily increasing in size.</li></ul>

Pain is not always present in the early stages. Often, discomfort only appears when the lump starts pressing against nearby nerves or tissues. Unfortunately, the absence of pain can lead to delayed diagnosis. 

<h4>*Aryan’s  Story: The Power of Acting Quickly </h4>

Twelve-year-old a=Aryan's parents noticed a firm swelling on his thigh. At first, they thought it was a sports injury as he had a recent fall while playing football. Since it didn’t hurt, they waited. But the lump continued to grow. When Aryan finally underwent imaging, doctors diagnosed him with a high-grade synovial <span>sarcoma</span>. 

It was a heart-wrenching moment no parent is ready for. Yet, prompt medical attention changed everything. Aryan received surgery, chemotherapy, and radiation over several months. Now, two years later, he’s cancer-free and back on the football field. His story is a powerful testament to timely diagnosis, expert medical care, and quiet strength. 

<h4>Diagnosing STS: A Careful, Coordinated Approach </h4>

Diagnosing soft tissue sarcoma involves multiple steps: 

<ul><li>MRI or CT scans to assess the tumour’s size and how far it has spread. </li><li>A biopsy, performed or guided by a cancer specialist, to avoid compromising future surgery. </li><li>PET-CT scans in aggressive cases to check if the cancer has spread.</li></ul>

It’s crucial to involve a specialized sarcoma team—surgical, medical, and radiation oncologists—for accurate diagnosis and an effective treatment plan.

The main treatment for STS is surgery to remove the tumor completely. Depending on the type and grade of the sarcoma, doctors may recommend radiation or chemotherapy before or after the operation. 

For advanced or metastatic sarcomas, new therapies such as targeted drugs and immunotherapy are sometimes used. Research shows that outcomes are significantly better when patients are treated at specialised sarcoma centres. 

<h4>Don’t Ignore a Suspicious Lump </h4>

Most lumps are harmless. But overlooking a cancerous one could be life-changing. If a lump is growing, unusual, or doesn’t go away—get it checked.

<strong>Golden rule:</strong> “If it’s growing, deep, or persistent—see a doctor.” 

<em>*Names have been changed to protect the identity of the individual. </em>

Sarcoma awareness month

soft tissue sarcoma

sarcoma

sarcoma case study

Soft tissue sarcoma (STS) is a rare type of cancer that can quietly grow in the connective tissues of the body—such as fat, muscles, nerves, blood vessels, or beneath the skin. Although it represents less than 1% of all cancers, its quiet nature often leads to late detection, making treatment more challenging. When a Lump Deserves Closer Attention It’s common for people to dismiss a lump under the skin as harmless—perhaps a cyst or muscle knot. However, some features can indicate something more serious. You should consult a doctor if the lump is: Larger than 5 cm (roughly the size of a golf ball), Located deep under the muscle, Firm and doesn’t move easily, Or steadily increasing in size.Pain is not always present in the early stages. Often, discomfort only appears when the lump starts pressing against nearby nerves or tissues. Unfortunately, the absence of pain can lead to delayed diagnosis. *Aryan’s  Story: The Power of Acting Quickly Twelve-year-old a=Aryan's parents noticed a firm swelling on his thigh. At first, they thought it was a sports injury as he had a recent fall while playing football. Since it didn’t hurt, they waited. But the lump continued to grow. When Aryan finally underwent imaging, doctors diagnosed him with a high-grade synovial sarcoma. It was a heart-wrenching moment no parent is ready for. Yet, prompt medical attention changed everything. Aryan received surgery, chemotherapy, and radiation over several months. Now, two years later, he’s cancer-free and back on the football field. His story is a powerful testament to timely diagnosis, expert medical care, and quiet strength. Diagnosing STS: A Careful, Coordinated Approach Diagnosing soft tissue sarcoma involves multiple steps: MRI or CT scans to assess the tumour’s size and how far it has spread. A biopsy, performed or guided by a cancer specialist, to avoid compromising future surgery. PET-CT scans in aggressive cases to check if the cancer has spread.It’s crucial to involve a specialized sarcoma team—surgical, medical, and radiation oncologists—for accurate diagnosis and an effective treatment plan. Treatment: Experience Matters The main treatment for STS is surgery to remove the tumor completely. Depending on the type and grade of the sarcoma, doctors may recommend radiation or chemotherapy before or after the operation. For advanced or metastatic sarcomas, new therapies such as targeted drugs and immunotherapy are sometimes used. Research shows that outcomes are significantly better when patients are treated at specialised sarcoma centres. Don’t Ignore a Suspicious Lump Most lumps are harmless. But overlooking a cancerous one could be life-changing. If a lump is growing, unusual, or doesn’t go away—get it checked.Golden rule: “If it’s growing, deep, or persistent—see a doctor.” *Names have been changed to protect the identity of the individual. 

understanding soft tissue sarcoma: when should you be concerned about a lump?

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New Hope For Heart Transplants: Researchers Look At Methods That Could Preserve Heart For Longer Duration

Quick Stories

Think It Is Just a Cold? It Could Be Allergic Rhinitis, and Here is Why Early Testing and Treatment Matter

Developing These Health Conditions Before 55 Can Double The Risk Of Dementia

Understanding Soft Tissue Sarcoma: When Should You Be Concerned About A Lump?

Health Conditions A-Z

US President Trump Is Suffering From A Chronic Vein Condition, Venous Insufficiency, Confirms White House

Think It Is Just a Cold? It Could Be Allergic Rhinitis, and Here is Why Early Testing and Treatment Matter

Developing These Health Conditions Before 55 Can Double The Risk Of Dementia