Dementia - B.sc Nursing BFUHS Students.pdf

dementia in Organic mental disorders for the nursing students in the subject of mental health and psychiatric nursing under Baba Farid university of health sciences Faridkot.

1. DEMENTIA

SIMRANJEET KAUR
MENTAL HEALTH NURSING

2. Content


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3. Introduction
Organic mental disorders are behavioral
or psychological disorders associated with
transient or permanent brain dysfunction.
These disorders have a demonstrable and
independently diagnosable cerebral disease or
disorder.

4. INTRODUCTION
DEMENTIA-De means
going down
Mentia means Mental
Abilities

5. DEFINITION
Dementia is an acquired global impairment of
intellect, memory and personality but without
impairment of consciousness.

6. Cont……
Dementia is defined by a loss of previous levels of cognitive,
executive, and memory function in a state of full alertness.
(Bourgeois, Seaman, & Servis, 2008).

7. Multiple cognitive
deficits of dementia.
EXECUTIVE
FUNCTIONING
AGNOSIA APRAXIA APHASIA

8. Cont........
APHASIA APRAXIA
AGNOSIA EXECUTIVE
FUNCTIONING
Deterioration of language
function

Impaired ability to execute motor
functions despite intact motor
abilities
Inability to recognize or name
objects despite intact sensory
abilities
Disturbance in executive functioning, which is
the ability to think abstractly and to plan, initiate,
sequence, monitor, and stop
complex behavior

9. Stages of dementia
Stage 1: No Apparent Symptoms.
In the first stage of the
illness, there is no apparent
decline in memory.

10. Stages of dementia
Stage 2. Forgetfulness.
The individual begins to lose things or forget names of people.
Losses in short-term memory are common.
The individual is aware of the intellectual decline and may feel
ashamed, becoming anxious and depressed, which in turn may
worsen the symptom.
Maintaining organization with lists and a structured routine
provide some compensation.
 These symptoms often are not observed by others.

11. Stages of dementia
Stage 3: Mild Cognitive Decline.
 There is interference with work performance, which
becomes noticeable to co-workers.
 The individual may get lost when driving his or her car.
 Concentration may be interrupted.
 There is difficulty recalling names or words, which
becomes noticeable to family and close associates.
 A decline occurs in the ability to plan or organize.

12. Stages of dementia
Stage 4: Mild-to-Moderate Cognitive
Decline; Confusion.
At this stage, the individual may forget major events in
personal history, such as his or her own child’s birthday.

Experience declining ability to perform tasks, such as
shopping and managing personal finances; or be unable to
understand current news events.

He or she may deny that a problem exists by covering up
memory loss with confabulation (creating imaginary events
to fill in memory gaps).

Depression and social withdrawal are common.

13. Stages of dementia
Stage 5: Moderate Cognitive Decline;
Early Dementia.
The early stages of dementia, individuals lose the ability to
perform some activities of daily living (ADLs) independently,
such as hygiene, dressing, and grooming, and require some
assistance to manage these on an ongoing basis.

They may forget addresses, phone numbers, and names of close
relatives.

They may become disoriented about place and time, but they
maintain knowledge about themselves.

Frustration, withdrawal, and self-absorption are common.

14. Stages of dementia
Stage 6: Moderate-to-Severe Cognitive
Decline; Middle Dementia

 At this stage, the individual may be unable to recall recent major life
events or even the name of his or her spouse.
 Disorientation to surroundings is common, and the person may be
unable to recall the day, season, or year.
 The person is unable to manage ADLs without assistance.
 Urinary and fecal incontinence are common.
 Sleeping becomes a problem.

15. Stages of dementia
Stage 7: Severe Cognitive Decline; Late
Dementia.
During late-stage dementia, the person becomes more
chairbound or bedbound.
Muscles are rigid, contractures may develop, and primitive
reflexes may be present.
The person may have very active hands and repetitive
movements, grunting, or other vocalizations.
There is depressed immune system function, and this
impairment coupled with immobility may lead to the
development of pneumonia, urinary tract infections, sepsis,
and pressure ulcers.

16. Stages of dementia
Continued Stage 6: Moderate-to-Severe
Cognitive Decline; Middle Dementia

Psychomotor symptoms include wandering, obsessiveness, agitation,
and aggression.
Symptoms seem to worsen in the late afternoon and evening—a
phenomenon termed sundowning.
Communication becomes more difficult, with increasing loss of
language skills.
Institutional care is usually required at this stage.

17. Stages of dementia
Continued Stage 7: Severe Cognitive
Decline; Late Dementia.

Appetite decreases and dysphagia is present; aspiration is common.
Weight loss generally occurs.
Speech and language are severely impaired, with greatly decreased
verbal communication.
The person may no longer recognize any family members.
Bowel and bladder incontinence are present and caregivers need to
complete most ADLs for the person.

18. Stages of dementia
Continued Stage 7: Severe Cognitive
Decline; Late Dementia.

 The sleep-wake cycle is greatly altered.
 The person spends a lot of time dozing
 He or she may appears socially withdrawn.
 He or she may become more unaware of the environment or
surroundings.

19. 1. Acetylcholine Alterations.
2. Plaques and Tangles.
3. Head Trauma.
4. Genetic Factors.

ETIOLOGICAL
FACTORS

20. Research has indicated that the enzyme required to
produce acetylcholine is dramatically reduced.

This decrease in production of acetylcholine reduces the
amount of the neurotransmitters(norepinephrine,
serotonin, dopamine, and the amino acid glutamate.)
that is released to cells in the cortex and hippocampus.

resulting in a disruption of the cognitive processes.
1.
Acetylcholine
Alterations.

21. Tangles are formed from a special kind of cellular
protein called tau protein, whose function it is to
provide stability to the neuron.

In dementia, the tau protein is chemically altered.
Strands of the protein become tangled together, interfering
with the neuronal transport system.

It is thought that the plaques and tangles contribute to
the destruction and death of neurons, leading to
memory failure, personality changes, inability to carry
out ADLs, and other features of the disease.
Cont….

22. Plaques: An overabundance of structures called
plaques and tangles appears in the brains of
individuals with dementia.

The plaques are made of a protein called amyloid beta
(Aβ ), which are fragments of a larger protein called
amyloid precursor protein.
Plaques are formed in the spaces between nerve cells
when these fragments clump
together and mix with molecules and other cellular
matter.
2. Plaques
and
Tangles..

23. Diagrammatic view of plaques and tangles

24. 3. Head Trauma.
Studies have shown that some
individuals who had experienced
head trauma had subsequently (after
years) developed dementia.

25. 4. Genetic Factors.
There is clearly a familial pattern with some forms of AD.
Some families exhibit a pattern of inheritance that suggests
possible autosomal dominant gene transmission.
Some researchers believe that there is a link between AD
and the alteration of a gene found on chromosome 21
(Munoz & Feldman, 2000; Saunders, 2001).
People with Down syndrome, who carry an extra copy
of chromosome 21, have been found to be unusually
susceptible to AD (Lott & Head, 2005).

26. The disorders of dementia are differentiated by their etiology,
although they share a common symptom presentation.
Categories of dementia include:
1.
Dementia of the
Alzheimer’s type
2.
Vascular dementia
3.
Dementia due to HIV
disease
4.
Dementia due to
Parkinson’s disease
5.
Dementia due to
Huntington’s disease
6.
Dementia due to
Creutzfeldt–Jakob disease

27. VASCULAR
DEMENTIA
Vascular dementia is a condition characterized
by an irreversible alteration in brain function
that results from damage or destruction of
brain tissue such as blood clots that block small
vessels in the brain.

28. Etiology
• Small focal deficits—typically
caused by a
series of small strokes
• Contributing factors
–– Advanced age
–– Cerebral emboli or thrombosis
–– Diabetes
–– Heart disease
–– High blood cholesterol level
–– Hypertension (leading to stroke)
–– Transient ischemic attacks.

29. Signs and Symptoms
Occur more abruptly
• Confusion
• Wandering or getting lost in familiar places
• Leg or arm weakness
• Slurred speech
• Problems with recent memory
• Loss of bladder or bowel control
• Inappropriate emotional reactions such as
laughing or crying inappropriately
• Problem in handling money
• Difficulty following instructions
• Depression
• Dizziness.

30. Diagnosis
• Cognitive assessment scale (shows deterioration
in cognitive ability)
• Global deterioration scale (indicates degenerative
dementia)
• MMSE (reveals disorientation and difficulty
with recall)
• MRI or Computed Tomography scan (shows
structural, vascular, and neurologic changes
in the brain)
• An abbreviated mental examination to
detect memory problems and aid differential
diagnosis, treatment, and rehabilitation

31. Treatment Modalities

●Carotid endarterectomy
●Drug therapy such as aspirin.

32. Dementia Due to Head Trauma
 Serious head trauma can result in symptoms associated with the
syndrome of dementia.
 Amnesia is the most common neurobehavioral symptom following head
trauma, and a degree of permanent disturbance may persist (Bourgeois et al.,
2008).
 Repeated head trauma, such as the type experienced by boxers, can result
in dementia pugilistica, a syndrome characterized by emotional lability,
dysarthria (slurred speech), ataxia, and impulsivity (Sadock & Sadock,2007).

33. Dementia Due to Huntington’s Disease

 Huntington’s disease is transmitted as a Mendelian dominant gene.
 Damage is seen in the areas of the basal ganglia and the cerebral cortex.
 The onset of symptoms (i.e.,involuntary twitching of the limbs or facial
muscles; mild cognitive changes; depression and apathy) is usually between
age 30 and 50 years.
 The client usually declines into a profound state of dementia and ataxia.
 The average duration of the disease is based on age at onset.

34. Dementia Due to Other General Medical Conditions

A number of other general medical conditions can cause dementia.
Some of these include endocrine conditions (e.g., hypoglycemia,
hypothyroidism), pulmonary disease, hepatic or renal failure,
cardiopulmonary insufficiency, fluid and electrolyte imbalances,
nutritional deficiencies, frontal or temporal lobe lesions, central
nervous system (CNS) or systemic infections, uncontrolled epilepsy,
and other neurological conditions such as multiple sclerosis (APA,
2000).

35. Diagnosis of dementia:
Cognitive Testing:
1. Mini Mental Status
Examination (MMSE)
2. Cognitive abilities
screening instrument
(CASI)

36. Routine blood test
Vitamin B12, Folic Acid, Thyroid
stimulating hormone (TSH)
C-Reactive Protien (CRP),
Complete Blood Count (CBC),
electrolytes, calcium, renal
function test, liver enzyme test
Cont.
Laboratory
tests

37. Imaging
CT Scan or magnetic
resonance imaging
(MRI) scan
PET scan

38. Treatment
There is no cure of dementia.
Cognitive and behavioural
interventions and emotional support
to the caregiver are important aspects
of management.

39. It functions to decrease the breakdown of
acetylcholine.
Tacrine(Cognex), Donepezil (aricept),
Galantamine (razadyne) and rivastigmine
for the treatment of dementia.
Acetylcholinesterase inhibitors
Improve the signal-to-noise ratio and preventing
excitotoxic changes.
N-Methyl-D-Aspartate (NMDA)
receptor blocker

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