GOOD morning By:

Mr. Pranay P Shelokar

PRANAY SHELOKAR

PRACTICE TEACHING

ON DEMENTIA

DEMENTIAS

ByPRANAY SHELOKAR

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.

Classification of organic brain disorders:

• (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• (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

• (F07) personality and behavioural disorders due to brain disease, damage and dysfunction

• (F09) unspecified organic or symptomatic mental disorder.

History of dementia:• Dementia was first described in a book about

mental illness in 183. In 1894, dr. alois Alzheimer, a German neuropathologist who has a particular interest in “nervous disorders” described changes in the brain caused by vascular disease (now known as vascular dementia).

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.

Etiology:• Significant loss of neurons and volume in brain

regions devoted to memory and higher mental functioning

• Neurofibrillary angles (twisted nerve cell fibers that are the damaged remains of microtubules

• 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 Possible Risk Factor Due To Increased Levels Of Hemocysteine (amino acid that may interfere with nerve cell repair)

• Early depression: common genetic factors seen in those with early depression and Alzheimer's disease

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

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• Infections- AIDS, meningitis, encephalitis• Intoxication- Alcohol, heavy metals (lead, arsenic), • Anoxia- Anemia, post-anesthesia, chronic

respiratory failure

• 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

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.

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.

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.

Stages of dementia:

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

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

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

STAGES

Mild Moderate Severe(2-4 years) (2 – 12years) (upto a year)

Loss of memoryLanguage difficultiesMood swingsPersonality changesDiminished judgmentApathy

Inability to retain new info

Behavioral, personality changes

Increasing long-term memory loss

Wandering, agitation, aggression,

confusionRequires assistance

Gait and motor disturbancesBedriddenUnable to perform ADLIncontinenceRequires long term careplacement

Warning signs of Alzheimer’s dementia:

• Memory loss• Difficulty performing familiar tasks• Problems with language• Disorientation to time and place• Poor or decreased judgement• Problems with abstract thinking• Misplacing things• Changes in mood or behaviour• Changes in personality• Loss of initiative

Clinical features (For Alzheimer’s type)

• Personality changes: lack of interest in day-to-day activities, easy mental fatigability, self-centred, withdrawn, decreased self-care.

• Memory impairment: recent memory is prominently affected.

• Cognitive impairment: disorientation poor judgement, difficulty in abstraction, decreased attention span.

Although there are some decreases in metabolism associated with age, in most patients with Alzheimer’s disease, there are marked decreases in the temporal lobe, an area important in

memory functions.

• 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,

Diagnosis:• Following test are used for diagnosis:• Cognitive assessment evaluation- mini

mental status examination (MMSE) – shows cognitive impairment

• Functional dementia scale (to indicate the degree of dementia)

• Magnetic resonance imaging (MRI): of the brain shows structural and neurologic changes.

• Spinal fluid analysis shows increased beta amyloid deposits

Treatment modalities:

• Tacrine hydrochloride (cognex)• Donepezil hydrochloride (Aricept) NMDA ANTAGONISTS.• Memantine

ANTIPSYCHOTIC AGENTS• Risperidone, quetiapine, and • olanzapine

ANTIDEPRESSANT AGENTS AND MOOD STABILIZERS• Low doses of the selective serotonin reuptake

inhibitors and other newer antidepressive agents should be considered.

Nursing Management:

• Assessment data for the patient with dementia should include a past health and medication history.

Data to be included for nursing assessment• Disorientation• Mood changes• Fear• Suspiciousness• Self-care deficit• Social behaviour• Level of mobility, wandering behaviour• Judgement ability• Sleep disturbances• Speech or language impairment• 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.

Nursing intervention:• Daily routine• Nutrition & body weight• Personal hygiene• Toilet habits and incontinence• Accidents• Fluid management• Moods and emotions• Wandering• Disturbed sleep• Interpersonal relationship

Summary: Introduction Classification History Definition Etiology Types Stages Warning signs Clinical features Diagnosis Treatment modalities Nursing management

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

Bibliography:• R Sreevani, a guide to mental health and

psychiatric nursing, jaypee publishers, 3rd edition, pg.no: 310-311• Townsend c Mary, text book on “Psychiatric

Mental Health Nursing.” Jaypee publications. 5th edition, page 387-405

Thank you!