Dementia
It is the development of memory decline slowly over a period of time, interfering with functioning, not accounted for by other causes.
2-4% people over the age of 65 have a dementia and around 20% over the age of 80 develop dementia, the risk increases with age.
Alzheimer’s disease is most common type of dementia accounts for> 64% of all dementia types.
Vascular dementia is second common cause of dementia of all dementia types
– 60% of people with dementia have delusions
Dementia: Signs
– Aphasia – inability to understand what is being said, naming items, reading and/or writing
– Apraxia – inability to follow certain movements when asked or imitated
– Agnosia – inability to recognize familiar objects or people
– Short –term memory loss
– Unable to think in the abstract
Personality changes
– Poor judgment
– Unable to perform normal routine or activities
– Trouble with remembering events from the past
– Unable to learn new information
– Anxiety
– Depression
– Suspiciousness
Dementia: Causes
Dementia always has a physical cause
– Changes in the structure of the brain
– Chemical imbalance
– Viral infection
– Environmental toxins
– Strokes / heart disease
– Brain infections
– Hypoxia
– Alcoholism
– Lack of sugar to the brain
– Build-up of pressure in the brain
Dementia: Types
– Alzheimer's Type Dementia
– Vascular Dementia
– Lewy-Body Dementia
– Pick’s Disease/Frontal Lobe Dementia
– Creutzdelt – Jacob Disease
– Alcohol Dementia
– Aids- Related Dementia
Alzheimer’s Type Dementia
Alzhiemer’s develops slowly over years and is the most common type of dementia
– Slow functional deterioration over a period of time (months to years).
– Regression in stages of life.
Vascular Dementia
Occurs when blood clots small vessels in the brain (TIA’s).
– Risk factors include HTN and advanced age.
– Symptoms include problems with recent memory, wandering, getting lost in familiar places, incontinence, mood lability, and trouble following simple instructions
Lewy-Body Dementia
– Is characterized by fluctuating confusion, disturbance of consciousness, visual hallucinations, delusions, falls, and significant parkinsonism.
– Cholinesterase inhibitors have been found to be somewhat beneficial
Pick’s Disease/ Frontal Lobe Dementia
– Behavioural symptoms are usually first sign
– Behaviours include the person being withdrawn or disinhibited, disinterested in hygiene, easily distracted, repetitive mannerisms, over eating or compulsively putting objects in mouth
– Speech difficulties
– Incontinence sometimes is an early sign
The person often remains oriented to time and has preserved memory in the early stages.
Dementia: Screening
– Recent symptom profile
– Recent changes – very important
– Collateral history from family/ significant others
– Past psychiatric history
– Past medical history
– Current medical issues/medications
– Updated blood work and urines
– MRI BRIAN
– History of recent medication changes
– Functional ability – recent changes with Activities of daily living
– Social Factors
– Personal History
– Social Factors
– Current Stressors
– Neuropsych testing
– Mini-mental status exam
– Cohen-Mansfield Scale if indicated
– Depression Scale if indicated
– Confusion Assessment Method (CAM)
Dementia: Interventions
– Maintain a regular routine.
– Ensure familiar objects are around
– Orientation board for early stages
– Ensure person’s safety. Make regular checks of his/her whereabouts
– Ensure proper nutrition and hydration.
– Promote independence; help with the person’s personal care.
– Use proper communication techniques.
– Keep it simple. Do not give the person too many choices.
– Use a calm soothing voice.
– Provide regular exercise and social activities.
– Ensure the person receives regular medical check-ups.
If the person becomes agitated – use distraction.
– Do not use restraints unless absolutely necessary.
– Ensure the person takes his/her meds regularly and as prescribed.
– Give emotional support to the family.
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