Week 6: Dementia

What is dementia?

An irreversible loss of cognitive functioning

What are key features dementia?

Aphasia -> unable to talk

Apraxia -> can't do something you used to know how to do (eat, walk..)

Agnosia -> memory, recognition

- Disturbances in executive functioning

What is the cause of dementia?

Damage to or loss of nerve cells and their connections in the brain

What are 4 types of dementia?

1. Alzheimer's —> majority of dementia, advances rapidly, downwards decline rather than fluctuating

2. Vascular dementia —> related to blood flow not reaching areas of the brain via diseased blood vessels in brain, heart conditions are a risk factor

3. Lewy Body dementia —> presence of abnormal proteins that damage neurons, comes with strange psychiatric symptoms (hallucinations, etc), fluctuates

4. Frontotemporal dementia —> deterioration of frontotemporal lobe, some skills can be retained but the essence/personality of the person becomes unrecognizable

"Unspecified dementia" -> referring to the broad umbrella of dementia

Functional consequences of dementia

- loss of personhood and self worth

- feeling isolated and depressed

Nursing assessment tools for dementia

For initial and ongoing assessment, use

- MMSE

- BPSD (Behaviour & Psychological Symptoms of Dementia)

Pharmacological Interventions for Dementia

- Most medications for dementia are to stabilize disease etiology & progression & manage symptoms

- Alzheimer's does have specific medications

- Underlying cardiac factors for vascular dementia can be treated

- Adverse affects are complex to resolve

Non-pharmacological Interventions for Dementia

- education - acknowledge the future

- environmental modifications —> increase independence as long as possible (rails, nonskid socks)

- communication skills —> find ways to communicate w pt as they lose ability to speak

- alternative therapies

ADPIE process for those with dementia:

Assessment - assess factors affecting quality of life

Planning - plan for quality of life and function

Diagnosis - function, cognition, behavioural, caregiver

Interventions - interproffessional

Evaluation - quality of life

Primary characteristics of Dementia:

- slow change in mental status

- develops in months to years

- symptoms progress

- dementia is terminal

- nursing care focused on safety, caregiver strain and quality of life

Why is dementia challenging to determine?

It is a group of diseases, each with different manifestations and combinations of symptoms

- specific dementias may not be identified until after death (we don't cure it, we slow progression and treat symptoms)

What % of dementia is Alzheimer's?

60-80%

What % of dementia is vascular?

11-18%

What % of dementia is Lewy Body and Parkinson's?

15-20%