Dementia

organic brain disorder : dementia

1. DEMENTIA By: MS NEHA BHATT

2. Introduction Cognition is that operation of the mind process by which we become aware of objects of thought and perception, including all aspects of perceiving, thinking & remembering. Organic brain syndrome is general term referring to many physical disorders that cause impaired mental function.

3. Classification of organic brain disorders ( F00) Dementia in Alzheimer’s disease (F01) Vascular dementia (F02) Dementia in other diseases classified elsewhere (F03) unspecified dementia (F04) organic amnestic syndrome, not induced by alcohol and other psychoactive substances (F00-f09) organic, including symptomatic, mental disorders

4. (F05) delirium not induced by alcohol and other psychoactive substances (F06) Other mental disorders due to brain damage and dysfunction and to physical disease (F07) personality and behavioural disorders due to brain disease, damage and dysfunction (F09) unspecified organic or symptomatic mental disorder.

5. DEFINITION: “Dementia is an acquired global impairment of intellect, memory and personality but without impairment of consciousness ” Incidence: Dementia occurs more commonly in the elderly than in the middle-aged.

6. Etiology Significant loss of neurons and volume in brain Neurofibrillary angles (twisted nerve cell fibers ) Environmental factors: infection, metals and toxins. Excessive amount of metal ions, such as zinc and copper, in brain Deficiencies of vitamin B6,B12 And Folate Early depression genetic factors

7. Untreatable & Irreversible Cause Of Dementia Degenerating disorders of CNS Alzheimer’s disease Pick’s disease Huntington’s Parkinson’s disease

8. Treatable And Reversible Causes Of Dementia Vascular-multi-infarct dementia Intracranial space occupying lesions Metabolic disorders-hepatic failure, renal failure Endocrine disorders Infections- AIDS, meningitis, encephalitis Intoxication- Alcohol, heavy metals (lead, arsenic), Anoxia- Anemia , post- anesthesia , chronic respiratory failure

9. Vitamin deficiency, especially deficiency of thiamine and nicotine Physiologic: Normal pressure hydrocephalus Metabolic: Endocrinopathies (e.g. hypothyroidism ) Tumor: Primary or metastatic (e.g. meningioma or metastatic breast or lung cancer ) Traumatic: Subdural hematoma

10. Types Of Dementia The Classifications Include. Cortical dementia : dementia where the brain damage primarily affects the brain’s cortex, or outer layer. Cortical dementias tend to cause problems with memory, language, thinking, and social behaviour.

11. Subcortical dementia : dementia that affects parts of the brain below the cortex. Sub-cortical dementia tends to cause changes in emotions and emotions and movement in addition to problems with memory. Progressive dementia : dementia that gets worse over time, gradually interfering with more and more cognitive abilities.

12. Primary dementia : dementia such as Alzheimer's disease that does not result from any other disease. Secondary dementia : dementia that occurs as a result of a physical disease or injury.

13. Stages of dementia Stage I: Early stage (2 to 4 years): Forgetfulness Declining interest in environment Hesitancy in initiating actions Poor performance at work

14. Stage II: Middle stage (2 to 12 years): Progressive memory loss Hesitates in response to questions Has difficulty in following simple instructions Irritable, anxious Neglects personal hygiene Social isolation

15. Stage III: Final stage (up to a year): Marked loss of weight because of inadequate intake of food Unable to communicate Does not recognize family Incontinence of urine and feces Loses the ability to stand and walk Death is caused by aspiration pneumonia

16. STAGES Mild Moderate Severe (2-4 years) (2 – 12years) ( upto a year) Loss of memory Language difficulties Mood swings Personality changes Diminished judgment Apathy Inability to retain new info Behavioral, personality changes Increasing long-term memory loss agitation, aggression, confusion Requires assistance Gait and motor disturbances Bedridden Unable to perform ADL Incontinence Requires long term care placement

17. Warning Signs Of Alzheimer’s Dementia Memory loss Difficulty performing familiar tasks Problems with language Disorientation Poor or decreased judgement Problems with abstract thinking Misplacing things Changes in mood or behaviour Changes in personality Loss of initiative

18. Clinical Features (For Alzheimer’s Type) Personality changes : lack of interest in day-to-day activities , mental fatigue, self-centred, withdrawn, decreased self-care. Memory impairment : recent memory is prominently affected . Cognitive impairment : disorientation poor judgement, decreased attention span.

19. Affective impairment : labile mood, irritableness, depression Behavioural impairment : stereotyped behaviour, alteration in sexual drives and activities, psychotic behaviour. Neurological impairment : stereotyped behaviour, alteration in sexual drives and activities,

20. Diagnosis Cognitive assessment evaluation- mini mental status examination (MMSE) – shows cognitive impairment Functional dementia scale MRI Spinal fluid analysis shows increased beta amyloid deposits

21. Treatment Modalities Tacrine hydrochloride ( cognex ) Donepezil hydrochloride (Aricept) NMDA ANTAGONISTS. Memantine ANTIPSYCHOTIC AGENTS Risperidone , olanzapine

22. ANTIDEPRESSANT AGENTS AND MOOD STABILIZERS Low doses of the selective serotonin reuptake inhibitors and antidepressive agents should be considered.

23. Nursing Management: Disorientation Mood changes Fear Suspiciousness Self-care deficit Social behaviour Level of mobility, wandering behaviour Judgement ability Sleep disturbances Speech or language impairment Assessment data for the patient with dementia should include a past health and medication history. Data to be included for nursing assessment

24. Hallucinations, illusions or delusions Bowel and bladder incontinence Apathy Any decline in nutritional status Recognition of family members Identify primary care giver, support system and the knowledge base of the family members.

25. Nursing intervention Daily routine Nutrition & body weight Personal hygiene Toilet habits and incontinence Accidents Fluid management Moods and emotions Wandering Disturbed sleep Interpersonal relationship Provide intervention related to

26. Conclusion Dementia is a serious cognitive disorder all together dementia is a far common in the geriatric population, it may be occur in any stage of childhood So as a nurse we need to get aware about the preventive measures of dementia and educative the individuals about its signs and symptoms with its treatment