dementia (1). الخرف عند كبار المسنين pdf

الخرف عند كبار المسنين

1. The Dementia
BY DR: KHALED ALSAYANI

2. Definition
Dementia is a general term for loss of memory,
language, problem-solving and other thinking
abilities that are severe enough to interfere with
daily life.

3. Symptoms and signs of dementia
Signs of dementia can vary greatly. Examples include problems with:
Short-term memory.
Keeping track of a purse or wallet.
Paying bills.
Planning and preparing meals.
Remembering appointments.
Traveling out of the neighborhood.

4. Risk factors
Risk factors that can't be changed
Age
Family history
Down syndrome

5. Risk factors you can change
Diet and exercise
Excessive alcohol use
Cardiovascular risk factors.
Depression
Diabetes
Head trauma
Vitamin and nutritional deficiencies
Medications that can worsen memory

6. Types of Dementia
1) Alzheimer's
2) Dementia with Lewybodies
3) Vascular (multi-infarct)

7. Common factors Influencing the Treatment
Aphasia receptive/ expressive impaired language
Apraxia inability to perform motor function, individual understands
task
Agnosiainability to recogniseobjects in spite if intact sensory
capabilities
disturbances in executive functioning

9. ASSESSMENT AND DIAGNOSIS
History
Duration of symptoms: Since how long the symptoms have been
present ?
Type of onset: Whether the symptoms started gradually or suddenly?
Rate and nature of decline in cognitive function: Whether the
decline was stepwise or continuous?
Social history may help to assess recent memory: For example, How
often do you visit your relative?

10. Medical history may give idea about remote memory: For example,
Where you operated for fractured femur?
–Language problems: This can be primarily assessed while talking to
patient.
–(Family members or caregivers should be involved to obtain
complete information)

11. NEUROMUSCULAR EXAMINATION:
The presence of rigidity, bradykinesia and tremor indicates
dementia with Lewy bodies.
SENSORY EXAMINATION:
There may be disturbances in visual acuity, depth perception, color
differentiation
GAIT AND BALANCE:
Modified performance-oriented mobility assessment (POMA) is used
for the assessment of balance and gait.

12. LABORATORY TESTING:
CBC,TSH, Liver and renal function tests may be recommended to
find out secondary cause or comorbid conditions in patients with
dementia.
NEUROIMAGING:
CT scan or MRI scan to rule out the secondary cause of dementia
such as subdural hematoma or normal-pressure hydrocephalus.

13. ASSESSMENT OF FUNCTIONAL STATUS
ADL scale
IADL scale
MENTAL STATE AND COGNITIVE FUNCTION
Mini Mental Scale Examination (MMSE)
The Mini-Cog assessment instrument
Geriatric depression scale (GDS)
Dementia Severity Rating Scale (DSRS)

14. PHYSIOTHERAPY REHABILITATION
Education tocaregivers
Explain the importance of touch as the means of communication.
Try to know about the interests of patient such as hobby, favorite
game or favorite food.
Use the way of communication that patient enjoys most.
Avoid the activity that patient does not like to participate in.

15. Environmental Modifications Goals :-
To compensate for cognitive loss.
Safety
To orient them to time, the place, and care-giver identity by
constant reminders
To improve the level of independence

16. Music duringmeals and bathing
Simulate family member’s presence with video or audio tapes
Good, nonglare lighting
Quiet room with no distractions such as background noise
Low-vision aids such as magnifying glass
A systematic storage of clothes and toilet articles
Contrasting colors for identifying doors, windows, cupboards and
corners

17. To improve physical function (mobility, strength, coordination)
Strength training Resisted exercises : 10 -15 repetitions of 8-10
exercises using TheraBand, weight cuffs, light weight dumbells
Traditional Stretching Techniques: (15 –30 seconds hold 3-5
repetitions)
• Gentle stretching of elbow flexors,
• Hip, knee flexors and ankle plantar flexors.
PNF –Hold relax PNF technique

18. To reduce therisk of falling and improve Gait
Balance training
Reaching activities
Activities on Swiss ball
Perturbations in sitting and standing
Heel-toe standing,
Partial wall squats and chair rises,
Single limb stance with side kicks or back kicks
Marching in place

19. To improve urinaryincontinence
• Pelvic floor strengthening exercise 10 reps 4-5 times per day
• Electrical stimulation
• Biofeedback

20. RECENT ADVANCE The Effect of Electrical Muscle Stimulation on
Muscle Mass and Balance in Older Adults with Dementia
Yuichi Nishikawa et.al Journal : Brain sciences, March 2021
CONCLUSION These findings suggest that EMS is a useful intervention
for increasing muscle mass and maintaining balance function in
older adults with dementia.

21. The role of the Occupational Therapist
A holistic approachleisure, personal care and occupation in relation
to the physical, psychological, social, economic spiritual aspects of
life,
Maintaining, restoring improving occupational performance,
promoting health and quality of life and easing caregiver's burden