Dementia ppt msc nursing

Dementia consists of verity of symptoms that suggest chronic dysfunction. Global impairment of intellect is the essential feature, manifested as difficulty with memory, attention, thinking, and comprehension
Approximately 15% of people with dementia have reversible illness if treatment is initiated before irreversible damage takes place.

1. DEMENTIA MR. VIHANG TAYDE

2. INTRODUCTION Dementia consists of verity of symptoms that suggest chronic dysfunction. Global impairment of intellect is the essential feature, manifested as difficulty with memory, attention, thinking, and comprehension

3. Other mental function can also be affected including mood, personality, judgment, and social behavior. Although specific diagnostic criteria are found for various dementias, such as Alzheimer’s diseases or vascular dementia, all dementia have certain common elements that results in significant impairment in social or occupational functioning and causes a significant decline from a previous level of function.

4. Approximately 15% of people with dementia have reversible illness if treatment is initiated before irreversible damage takes place.

5. EPIDEMIOLOGY Dementia occurs more commonly in the elderly than the middle aged. It increases with the age from 0.1% in those below 60years of age to 15 to 20% in those who are 80years of age.

6. With the aging population, the prevalence of dementia is rising; the prevalence of moderate to severe dementia in different population groups is approximately 5% in the general population older then 65years of age, 20 to 40% in the general population older than 85 years of age, 15 to 20% in outpatient general medical practices and 50% in chronic care facilities.

7. Off all patients with dementia, 50 to 60% have the most common type of dementia, dementia of the Alzheimer’s type. The second common type of dementia is vascular dementia which is causally related to cerebrovascular diseases. Vascular dementia account for 15 to 30% of all dementia.

8. ETIOLOGY Significant loss of neurons and volume in brain regions devoted to memory and higher mental functioning Environmental factors: infection, metals and toxins.

9. 3. Excessive amount of metal ions, such as zinc and copper, in brain 4. Early depression: common genetic factors seen in those with early depression and Alzheimer's disease.

10. Untreatable and irreversible cause of dementia Degenerating disorders of CNS Alzheimer’s disease (this is the most common of all dementing illnesses) Pick’s disease Huntington’s chorea Parkinson’s disease

11. Treatable and reversible causes of dementia Vascular-multi-infarct dementia Intracranial space occupying lesions Metabolic disorders-hepatic failure, renal failure Endocrine disorders- myxedema, Addison’s disease

12. Infections- AIDS, meningitis, encephalitis Intoxication- Alcohol, heavy metals (lead, arsenic), Anoxia- Anemia, post-anesthesia, chronic respiratory failure

13. STAGES OF DEMENTIA Stage I: Early stage (2 to 4 years): Stage II: Middle stage (2 to 12 years): Stage III: Final stage (up to a year):

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

15. Stage II: Middle stage (2 to 12 years): Progressive memory loss Hesitates in response to questions Has difficulty in following simple instructions Irritable, anxious

16. Wandering Neglects personal hygiene Social isolation

17. 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

18. Incontinence of urine and feces Loses the ability to stand and walk Death is caused by aspiration pneumonia

19. TYPES OF DEMENTIA: 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 behavior

20. 2. Subcortical dementia : Dementia that affects parts of the brain below the cortex. Subcortical dementia tends to cause changes in emotions and emotions and movement in addition to problems with memory.

21. 3. Progressive dementia Dementia that gets worse over time, gradually interfering with more and more cognitive abilities.

22. 4. Primary dementia Dementia such as Alzheimer's disease, in which the dementia itself is the major signs of some organic brain diseases not directed related to any other organic illness.

23. 5. Secondary dementia : Dementia that occurs as a result of a physical disease or injury, such as HIV diseases or cerebral trauma.

24. DIAGNOSTIC CRITERIA DSM-IV-TR Diagnostic Criteria for dementia of the Alzheimer’s Type: The development of multiple cognitive defects manifested by both, Memory impairment (impair ability to learn new information or recoll the learn information)

25. 2. One or more of the following cognitive disturbances: Aphasia (language disturbance) Apraxia (impair ability to carry out motor activity’s) Agnosia ( failure to recognized of identify objects) Disturbance in executive functioning ( i.e : planning, organizing, abstracting, sequencing) B) The course is characterized by gradual onset and continuing cognitive decline.

26. 2. DSM-IV-TR Diagnostic Criteria for Vascular Dementia: The development of multiple cognitive defects manifested by both, Memory impairment (impair ability to learn new information or recall the learn information)

27. 2. One or more of the following cognitive disturbances: Aphasia (language disturbance) Apraxia (impair ability to carry out motor activity’s) Agnosia ( failure to recognized of identify objects) Disturbance in executive functioning ( i.e : planning, organizing, abstracting, sequencing)

28. B) Focal neurological signs and symptoms ( e.g : exaggeration of deep tendon reflex, extensor planter response, weakness of an extremity. C) The defect does not occur during the onset of a delirium .

29. 3. DSM-IV-TR Diagnostic Criteria For Dementia Due To Other Medical Conditions. The development of multiple cognitive defects manifested by both, Memory impairment (impair ability to learn new information or recall the learn information)

30. 2. One or more of the following cognitive disturbances: Aphasia (language disturbance) Apraxia (impair ability to carry out motor activity’s) Agnosia ( failure to recognized of identify objects) Disturbance in executive functioning ( i.e : planning, organizing, abstracting, sequencing)

31. E.g : HIV infection, traumatic brain injury, Parkinson diseases, Huntington’s diseases, pick diseases, hypothyroidism, normal –pressure hydrocephalus, brain tumor, etc.

32. 4. DSM-IV-TR Diagnostic Criteria For Dementia Due To Multiple Etiologies The development of multiple cognitive defects manifested by both, Memory impairment (impair ability to learn new information or recall the learn information)

33. 2. One or more of the following cognitive disturbances: Aphasia (language disturbance) Apraxia (impair ability to carry out motor activity’s) Agnosia ( failure to recognized of identify objects) Disturbance in executive functioning ( i.e : planning, organizing, abstracting, sequencing)

34. ICD 10 CLASSIFICATION: (F00-f09) organic, including symptomatic, mental disorders (F00) Dementia in Alzheimer’s disease (F01) Vascular dementia (F02) Dementia in other diseases classified elsewhere (F03) unspecified dementia

35. (F04) organic amnestic syndrome, not induced by alcohol and other psychoactive substances (F05) delirium not induced by alcohol and other psychoactive substances (F06) Other mental disorders due to brain damage and dysfunction and to physical disease

36. (F07) personality and behavioral disorders due to brain disease, damage and dysfunction (F09) unspecified organic or symptomatic mental disorder.

37. F00 Dementia in Alzheimer's disease F00.0Dementia in Alzheimer's disease with early onset F00.1Dementia in Alzheimer's disease with late onset F00.2Dementia in Alzheimer's disease, atypical or mixed type F00.9Dementia in Alzheimer's disease, unspecified

38. F01Vascular dementia F01.0Vascular dementia of acute onset F01.1Multi-infarct dementia F01.2Subcortical vascular dementia F01.3Mixed cortical and subcortical vascular dementia F01.8Other vascular dementia F01.9Vascular dementia, unspecified

39. F02Dementia in other diseases classified elsewhere F02.0Dementia in Pick's disease F02.1Dementia in Creutzfeldt-Jakob disease F02.2Dementia in Huntington's disease F02.3Dementia in Parkinson's disease F02.4Dementia in human immunodeficiency virus [HIV] disease F02.8Dementia in other specified diseases classified elsewhere

40. F03Unspecified dementia   A fifth character may be added to specify dementia in F00-F03, as follows: F03.0 Without additional symptoms F03.1 Other symptoms, predominantly delusional F03.2 Other symptoms, predominantly hallucinatory F03.3 Other symptoms, predominantly depressive F03.4 Other mixed symptoms

41. CLINICAL FEATURE OF DEMENTIA Forgetfulness (loses things, forget numbers) Confusion with performing simple tasks Poor concentration, Confusion about month and season

42. Problems in learning new skills and ideas Disorientation in time, place, and person Aphasia (impairment in speech) Amnesia. Suspiciousness

43. Inappropriate sexual behavior Unable to dress, groom and toilet self. Wondering Misplacing things Changes in personality

44. TREATMENT: Medications used in treating the Alzheimer’s diseases are, Tacrine hydrochloride ( cognex ) Donepezil hydrochloride (Aricept)

45. 3. ANTIPSYCHOTIC AGENTS Risperidone , Quetiapine , And Olanzapine 4. Anticonvulsant to control seizures

46. 5. ANTIDEPRESSANT AGENTS AND MOOD STABILIZERS Low doses of the selective serotonin reuptake inhibitors and other newer anti-depressive agents should be considered.

47. NURSING DIAGNOSIS Potential for injury related to disorientation as evidence by muscular in co-ordination. Potential for violence related to hallucination as evidence by agitation

48. 3. Alteration thought process related to vascular diseases as evidence by delusional/memory defect. 4. Disturbance is self-concept related to loss of independent functioning a evidence by social isolation.

49. NURSING INTERVENTION Daily routine Nutrition & body weight Personal hygiene Toilet habits and incontinence Accidents Fluid management

50. Moods and emotions Wandering Disturbed sleep Interpersonal relationship

51. CONCLUSION Dementia is an acquired global impairment of intellect, memory an personality but without impairment of consciousness. Dementia occurs more commonly in the elderly than the middle aged. It increases with the age from 0.1% in those below 60years of age to 15 to 20% in those who are 80years of age

52. Dementia consists of verity of symptoms that suggest chronic dysfunction. Global impairment of intellect is the essential feature, manifested as difficulty with memory, attention, thinking, and comprehension

53. SUMMARY:

54. BIBLIOGRAPHY Kaplan And Sadock’s , Synopsis Of Psychiatric Behaviour Sciences, 10 th Edition , Page No: 329, 335, 337 R. Sreevani , A Guide To Mental Health & Psychiatric Nursing, JAYPEE BROTHERS, 3rd Edition 2010; Page No – 245-249

55. 3. Anbu.T ; Text Book Of Psychiatric Nursing; EMMESS., 1st Edition 2010; Page No- 190-192. 4. R.K.Gupta , New Approach To Mental Health Nursing, 2011 Edition

56. Thank you….