Dementia

Definition of dementia + confusion 

	Definition
Dementia	Loss of mental power due to pathological changes in brain
Confusion	State of being mixed up/ disoriented

Causes of delirium

1. Dehydration 

2. Infection 

3. Drugs 

4. hypoxia 

5. Anaemia 

6. Low blood glucose 

7. Electrolyte imbalance 

8. Blood loss 

9. Pain

Implications for physios

1. How long will it take for state of confusion be reversed 

2. Severity of confusion determines degree of compliance 

• X RMB instructions 

• X assist w/ goal setting

Communication w/ confused Pts

1. Ask simple questions 

2. Give one stage commands 

3. Speak slowly + clearly 

4. Wait for reply → slow central processing 

5. X shout 

Treatment of confused patients

1. Reduce noise + people distractions in environment 

2. Change focus of attention if too agitated when X understand 

3. Assessment + treatment of main problem → short 

4. No options 

Presentation of dementia 1

Memory loss	Early: short term memory loss  Later: long term memory loss
Confused ( agnosia )	Mixing up people Confusing place/ time/ objs
Misunderstanding + X using words properly
Difficulty coordinating thoughts + actions	E.g. getting in wrong bed

Presentation of dementia 2

Altered perception	Visual: patterns may lead to thinking that the floor is moving/ exaggeration of visual declines of ageing  Verbal: X understand concept words  Somatosensory:  → touch perceived as painful → e.g. spray from shower head needs to be more dispersed/ at skin temp
Walking + wandering	Agitation due to noxious stimulus ?
Delusions + hallucinations
Paranoia
Mood + personality change
Emotional liability	Rage + tears

5 As of dementia 

1. Apraxia: X have purposeful body 

2. Amensia: loss of memory 

3. Agnosia: X recognize ppl/ obs/ sounds/ shapes 

4. Aphasia: X ability to understand + express speech 

5. Atypical depression → irritability + aggression 

Impact of dementia on mobility

1. Slower movement due to impaired muscular control 

2. Inability to perform learned movements 

3. X Rmb purpose of movement 

4. Distracted from task by anything that draws attention 

5. X detect obstacles in path 

Prevention of falls in dementia patients ( environmental )

1. Adequate lighting → more lighting + less glare + less shadows 

2. Provide visual contrast: obj + X patterned background 

3. Keep pathways clear 

4. Increase accessibility → easy to reach items + low bed 

Communication w/ dementia patients 

1. Obtain attention → less distractions + eye contact 

2. Watch non-verbal cues to understand actions 

3. Calm approach 

4. Short + simple cues + instructions 

Early dementia presentation + Mx

Presentation	Mx
Apathetic  Unwilling to try new things Able to perform concrete manual + functional tasks independently  Forgetful of recent events  Early signs of confusion	Can still be involved in directed activities

Moderate dementa + Mx 

Presentation	Mx
Confusion of time + place  More forgetful of recent events  Visual + auditory hallucinations  Wandering  Follow one step of very familiar action	Manage by keeping a predictable routine

Advanced dementia presentation + Mx

Presentation	Mx
X remember occurrences for even a few minutes  Requires assistance eating/ washing/ toileting  Uncontrolled movement  Immobility X understand/ use speech	Prevent MSK complications:  Passive movements: slow full range w/ gentle prolonged pressure at end ROM → 3-5s  → daily  → improve joint ROM  Education  → X movement in non-anatomical planes + careful handling  → soft tissue tears + #

General Mx of dementia: 

1. Maintain mobility in safe environment 

2. Prevent joint contractures 

3. Validate family + patient to accept problems 

4. Time out when catastrophic reaction happens 

5. One word instructions for profoundly impaired