Dementia

dementia

a general term for a group of symptoms caused by serious disorders of the brain

over 250 types

a chronic, progressive, global

deterioraton of cognitve ability in multple domains

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Memory loss and other related problems that interfere

with learning, communicatng, relatng or caring for oneself

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Diagnosis is clinical; laboratory and imaging tests are

usually used to identfy treatable causes

types of dementia

vascular dementa, Lewy body dementa,frontotemporal dementa, AIDS related dementa complex, viral encephalits, Parkinson's dementa, Huntngton’s disease, and Alzheimer’s disease 

alzheimer's

most common cause of dementa in those

over age 65

• Can only be ofcially diagnosed via autopsy

cortical dementia

typically associated with the brain's

gray mater

• When these outer layers are afected, there are problems with memory, the inability to fnd the right words and in understanding what others are saying (receptve aphasia).

• Alzheimer's is a cortcal dementa

subcortical dementia

These are dementas believed to initally afect structures below

the cortex and are more associated with the brain's white mater

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Huntngton's disease

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Parkinson's dementa

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AIDS dementa complex

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It is more common to see changes in personality and a slowing

down of thought processes in subcortcal dementas

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Language and memory functons ofen appear largely unafected in

the earlier stages of these dementas

clinical criteria for dementia

the impairment should involve ≥ 2 of the following domains:

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Impaired ability to acquire and remember new informaton (e.g., asking

repettve questons, frequently misplacing objects or forgetng appointments)

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Impaired reasoning and handling of complex tasks and poor judgment (e.g., being

unable to manage bank account, making poor fnancial decisions)

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Language dysfuncton (e.g., difculty thinking of common words, errors speaking

and/or writng)

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Visuospatal dysfuncton (e.g., inability to recognize faces or common objects)

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Changes in personality, behavior, or comportment

etiology of dementia

can occur as a result of other disease processes, these can include metabolic, structural, and infectious diseases

metabolic dementia

occurs due to a change in body’s metabolism or chemical processes in the body and can be linked to specifc health problems including:

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Diabetes (repeat episodes of hypoglycemia)

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Thyroid disorders (hypothyroidism/hyperthyroidism)

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Kidney failure

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Liver cirrhosis (alcohol/drug abuse/heavy metal exposure)

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Rapid changes in sodium leve

structural dementia

caused by conditons associated with diferent structural lesions of the brain. This can include:

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Alzheimer’s

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Mult infarct

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Brain injury

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Parkinson’s disease

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ALS (Amyotrophic Lateral Sclerosis)

infectious dementia

can occur as the result of an

infecton. Some of these infectons include:

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Neurosyphilis Dementa

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Tuberculous and fungal meningits

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Viral encephalits

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HIV

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Creutzfeldt-Jacob Disease

epidemiology of dementia 

has been described as a global epidemic

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63% of people with dementa live in low-middle income

countries

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Worldwide in 2015 47.47 million people living with dementa,

increasing to 75.63 million in 2020 and 135.46 million by 2030

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Populaton aging is main driver of increase

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Populaton of clients with dementa in North America expected

to double by 2030

• asian 75-79

incidence of demetnia doubles with every 5.9 year increase in age 

dementia statistics

There is strong evidence that many adults aged 50 and older are socially isolated or lonely in ways that put their health at risk

Among adults 45 years and older, cognitve decline was lower for college graduates and nearly 3x’s greater than those without a high school diploma

Social isolaton was associated with about a 50% percent increased risk of dementa.

• Poor social relatonships were associated with a 29% increased risk of heart disease and a 32% increased risk of stroke.

early stage of dementia

Recent memory is impaired

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learning and retaining new informaton become difcult

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Language problems (especially with word fnding)

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mood swings

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personality changes develop

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Functonal ability may be further limited by the following:

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Agnosia

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Apraxia

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Aphasia

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Although early dementa may not compromise sociability, family members may report

strange behavior accompanied by emotonal lability

agnosia

Impaired ability to identfy objects despite intact sensory functon

apraxia

Impaired ability to do previously learned motor actvites despite intact motor

functon

aphasia

Impaired ability to comprehend or use language

intermediate stage of dementia 

unable to learn and recall new informaton

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memory of remote events is reduced but not totally lost

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clients may require help with basic actvites of daily living

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Personality changes may progress

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clients may begin to wander, become agitated, hostle, uncooperatve, or physically

aggressive

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clients have lost all sense of tme and place because they cannot efectvely use normal

environmental and social cues

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clients ofen get lost; they may be unable to fnd their own bedroom or bathroom

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They remain ambulatory but are at risk of falls or accidents secondary to confusion

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Altered sensaton or percepton may culminate in psychosis with hallucinatons and

paranoid and persecutory delusions

last stage of dementia

clients cannot walk, feed themselves, or do any other actvites

of daily living; they may become incontnent

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Recent and remote memory is completely lost

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clients may be unable to swallow

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They are at risk of undernutriton, pneumonia (especially due to

aspiraton) and pressure ulcers

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End-stage dementa results in coma and death, usually due to

infecton

cultural context of alzhemiers

Alzheimer’s disease maybe viewed as normal aging among Black/African American and Hispanic/

Latno culture

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Alzheimer’s disease may be looked at as ―punishment for past sins, bad blood or mental illness

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Families may not seek out services because they do not wish to bring shame upon the family

environmental structuring 

Eliminate changes in the client’s environment, instead stress

consistency

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Limit number of visitors

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Encourage the use of consistent cues, phrases among staf

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Develop daily schedules that describe specifcally when

actvites will occur

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Try to keep same caregivers/therapists when able

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Don’t move rooms, change roommates