Dementia and delirium

Differentiation - management challenges and treatment measures

1. Dementia & DeliriumDementia & Delirium
Hena Jawaid
Instructor
Psychiatry

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4. •Dementia is a chronic progressive mental
disorder that adversely affects higher
•cortical functions including memory, thinking,
orientation, comprehension,
•calculation, learning capacity, language and
judgement
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10. •Alzheimer's disease is the most common form
of dementia.
•Degenerative cerebral disease with
characteristic neuro-pathological and neuro-
chemical features.
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11. Incidence
•UK incidence of Alzheimer's disease in people
over the age of 65 years is estimated to be 4.9
per 1000 person-years.
•Between 50 and 64% of people with
Alzheimer's disease are estimated to have
mild to moderately severe disease, and
approximately 50% have moderately severe to
severe disease.
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12. Onset
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14. •Alzheimer's disease is usually insidious in
onset and develops slowly but steadily over
several years.
•It predominantly affects older people.
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15. • The median survival for people with
Alzheimer's disease from onset has been
estimated at 7 years
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16. •Progression is characterized by deterioration
in cognition (for example, thinking, conceiving
and reasoning)
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17. •functional ability (for example, activities of
daily living such as dressing, personal hygiene
and handling money)
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18. •behavior (for example, agitation, wandering
and uncharacteristic aggression)
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19. •and non-cognitive symptoms including
depression, delusions and hallucinations.
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20. •People with Alzheimer's disease might find it
increasingly difficult to do everyday activities,
such as shopping, socializing and recognizing
people and places. Communication may
become a problem as people find it more
difficult to find words and remember names
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21. •In later stages of disease, physical problems
can include problems with eating, swallowing,
incontinence, and unsettled and unsettling
behavior.
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22. •Alzheimer's disease may also be associated
with loss of confidence and feelings of fear,
confusion, apathy, stigma and depression. The
effects of Alzheimer's disease are
heterogeneous and vary from patient to
patient.
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23. •Carers (including friends and family) are
affected by the progressive deterioration in
cognition, function and behaviour of a person
with Alzheimer's disease. Behavioural
symptoms can have a particular impact on
carers, and are often the reason cited for a
person with Alzheimer's disease going into
full-time residential care.
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24. severity of Alzheimer's disease
•mild Alzheimer's disease: MMSE 21–26
•moderate Alzheimer's disease: MMSE 10–20
•moderately severe Alzheimer's disease: MMSE
10–14
•severe Alzheimer's disease: MMSE less than
10.
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25. There is no cure no cure for Alzheimer's disease!!!
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26. •Current management involves the treatment
of cognitive, non-cognitive and behavioral
symptoms.
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27. Aims of Treatment
•to promote independence, maintain function
and treat symptoms including cognitive, non-
cognitive (hallucinations, delusions, anxiety,
marked agitation and associated aggressive
behavior), behavioral and psychological
symptoms.
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28. •AChE inhibitors (donepezil, galantamine and
rivastigmine) and memantine are the
pharmacological treatments available
specifically for Alzheimer's disease.
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29. •social support, increasing assistance with day-
to-day activities
•information and education
•carer support groups
•community dementia teams
•home nursing and personal care
•Community services such as meals-on-wheels,
befriending services, day centers
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37. Snoezelen Therapy
• Snoezelen (“snoozelen”) is a multisensory
stimulation approach used to provide
opportunities for multi-sensory experiences in
the cognitively impaired.
•Snoezelen therapy can be used as both a
stimulating and calming technique.
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40. •Textures, smells, unusual lighting, contrasts,
nature sounds are all examples of snoezelen
stimulation.
•An entire room dedicated to Snoezelen
therapy may be hard to come by in most
settings, but a box filled with items that
provide tactile, visual, or hearing stimulation
can be a cost effective investment in multi-
sensory therapy
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51. •ICU beeping
•Constant lights
•Constant noise
•Nurses shift overs
•Lack of human touch
•Artificial environment
•Family turnover

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