Dementia Care

What is the most common cause of Dementia?

Alzheimer’s Disease.

Dementia

An umbrella term used to describe disease symptoms caused by abnormal brain changes. Symptoms trigger a severe decline in cognitive abilities, impairing daily life and independent function. Affects patient behavior, feelings and relationships.

Pre-Dementia Symptoms

No functional impairment up to 10 years before

Anosmia (Loss of smell)

Forgetful

Early Dementia Symptoms

Forgetting Medication

Misplacing things

Difficulty with finances (2 years)

Trouble planing

Middle Dementia Symptoms

New info not acquired

Personal care needs

Restless (2-4 years)

Lack of insight

Disoriented

Late Dementia Symptoms

Time Shift

Poor Recognition (1-2 years)

Non-Verbal

Mood Disorders

Aggression

Mobility decrease

Poor nutrition

Alzheimer Disease

70% of Dementia.

B Amyloid plaque in higher quantity, located mostly in hippocampus, parietal and temperal lobes.

Alzheimer Symptoms

short term memory loss

disorientation

difficulty finding words

poor insight

Vascular Dementia

15% of Dementia. Reduced blood flow to neurons giving ischemia and cell death.

Vascular Dementia Symptoms

Multi infarct Dementia – series of small strokes together cause symptoms

Sub cortical Dementia – small penetrating arteries affected (small vessel disease)

Stroke Related Dementia – 30% of Ischemic Strokes

Lewy Body Dementia

10% of Dementia. Abnormal deposits of alpha-synuclein affecting the brains chemical messengers.

Lewy Body Dementia Symptoms

Fluctuating Cognition

Visual Hallucinations

Parkinsons-like features

Suggestive Symptoms of Lewy Body

REM sleep disturbance

Antipsychotic sensitivity

Frontotemporal Dementia Symptoms

Behavioural Variant/Picks disease (most common):

Early behaviour/personality changes

Disinhibition/Social withdraw

Semantic Variant

Difficulty finding the correct words

Fluent aphasia (speech difficulties)

Pick Bodies

Spherical intracellular collections of Tau Fibrils

Frontotemporal dementia risk factors

Age

Genetics (10-30% increase for 1st degree relative)

Gender/Sex (Females)

Cognitive reserve

Diagnosing Dementia

Brain biopsy post-mortem

PET scan

Clinical history/ physical exam

Lab work

CT headscan

Genetic testing

Dementia Treatment

Medications: Cholinesterase inhibitors, NDMA antagonists.

Risk reduction

Behaviour/enviroment support (Familiarity, comfort, attention, redirection)

Mental health support

Aerobic exercise

There is no cure.

Mortality Rates for dementia

1 year: 30-40%

5 year: 65%

Pneumonia is #1 cause.

The 7 A’s of Dementia

ANOSOGNASIA

AGNOSIA

APHASIA

APRAXIA

ALTERED PERCEPTION

AMNESIA

APATHY

ANOSOGNASIA

Brain damage making awareness of impairments difficult. Awareness fluctuates, causes unpredictable behaviour.

Often mistaken for denial, stubbornness, embarrassment.

May resist help, refuse treatment, become angry/defensive, overestimate abilities (dangerous).

Agnosia

Inability to recognize people/objects using senses.

(Ex. Burn self with hot water, eat non-foods, brush hair with toothbrush, mistake caregiver for a stranger - leading to distress surrounding personal grooming.)

Aphasia

Impaired communication skills affecting speech, language comprehension, read and writing.

Examples: Using inappropriate/ made up words, revert to their first language, become difficult to understand.

Apraxia

Loss of motor skills needed for movement or coordination.

ADL becomes difficult (bathing, dressing, walking, eating). Can struggle with remote control buttoms, phones, microwaves.

These cognitive changes can cause dementia patients to say “no” when they’re encouraged to do something – not because they don’t want to, but because they forget how.

Altered Perception

Can make someone living with dementia misinterpret their environment and struggle with how high, low, wide, deep, or near things are.

This can make it hard to move through physical spaces and can cause paranoia and delusions.

A dementia patient may think that bathwater is too deep, dark floors are a dangerous ditch, or scattered clothes are a stranger.

Amnesia

Memory loss that usually impacts short term memory first and eventually effects long term memories as the disease advances.

Damage to the brain can cause a person living with dementia to repeat things over and over, become overwhelmed by too much or new information, forget loved ones and lose their sense of time.

Apathy

Can make someone with dementia lose interest in what is happening around them because of problems with the brain’s motivation pathways.

They may find it hard to start and complete a task, have low energy, or show very little emotional response to events – both good or bad.

Korsakoff’s Syndrome

Chronic deficiency of vitamin B12 - episodic memory severely impaired/ amnesia – psychosis due to alcohol related dementia.

Common cause: alcoholism, eating disorders and chemotherapy. New learning is possible

Creutzfeldt-Jakob Disease

Rare degenerative disease - rapid deterioration - 90% die within year.

Huntington’s Disease

Inherited degenerative disease of movement with behavioral disturbance and progressive dementia that begins during mid-life.

Mental Well Being

Cognitive skills not just memory but learning, problem solving and decision making.

- learn new skills

- develop social networks

5 Wellness Domains

Intellectual, emotional, spiritual, physical, social

Advantages of Early Diagnosis

- future planning, legal arrangements, access local services, access financial services

- network and gain support from work, friends and family, lifestyle changes

- connect and continue normal with the discussion/knowledge that changes are coming

Disadvantages of Early diagnosis

- overshadowing fears impact current living

- feeling stigmatized-focusing on deficits/no longer taken seriously

- relationship changes – friends/family

- worrying about becoming a burden

Signposting

Refers to the process of directing people towards further assistance.

Advice, information, care, support, networks, caregiver supports, volunteers and health professionals.

VIPS

Valuing the person regardless of cognitive ability

Individual Approach

Perspective of each person – putting ourselves in shoes

Social environment -- consider surroundings/relationships

6 C’s of care

Care

Compassion

Competence

Communication

Courage

Commitment

P.I.E.C.E.S

Physical, Intellectual, Emotional, Capability, Environment and Social

D.O.S.

dementia observational system

Tom Kitwood

Dementia Care Pioneer
Promoter of person-centered approach to care – not a “one size fits all” care culture.

He challenged medicalized view of dementia – broadened the definition to include person’s history, personality and the social environment in which they live.

His Equation: Dementia = Personality + Health + Neurological Impairment + Social Psychology

Delirium in Dementia

Defined as a syndrome involving temporary or acute confusioned states resulting from illness or infection. Caused by infection or illness.

Triggered by dehydration, malnutrition, constipation or pain, some medication reactions.

Psychosis in Persons with Dementia

1. Hallucinations

Useful responses for Hallucinations:

Don’t correct/ no reality orientation – distract

2. Delusions: “someone has taken my purse”

Useful responses for Delusions

Avoid contradicting – remain on the same side

Rule out abuse – financial & other

3. Misidentification: don’t contradict - stop and go approach. Try environmental adjustments, are they wearing glasses/hearing aides