Dementia Care Midterm

Dementia Review Notes 
 
Dementia: is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life. Alzheimer's is the most common cause of dementia.  

Dementia is an umbrella term - not a single disease. It's an overall term to describe a collection of symptoms that one may experience if they are living with a variety of diseases, including Alzheimer's disease. 

  •  Diseases grouped under the general term "dementia" are caused by: abnormal brain changes. Dementia symptoms trigger: a decline in thinking skills, also known as cognitive abilities, severe enough to impair daily life and independent function.  

  • They also affect behavior, feelings and relationships. 

  • Our brain is like a computer: input/output of information systems.  
    Key structures & regions of the brain affect: the progressive degeneration which impairs cognitive functions such as memory, attention, problem solving, language, perception, emotion, and planning. 
     
    Signs & Symptoms of Dementia: 
    PRE-DEMENTIA: No functional impairment up to 10 years before dementia: anosmia and forgetful 

  • EARLY: Forgetting medication, misplacing, difficulty with finances 2 years: trouble planning 

  • MIDDLE: New info not acquired, personal care needs, restless 2-4 years: lack of insight and disoriented 

  • LATE: Time shift, nonverbal, mood disorders, aggression, poor recognition 1-2 years: decrease mobility and poor nutrition 

 

Alzheimer’s Disease: 

  • 70% of Dementia 

  • B Amyliod plaque in non- dementia brains but higher quantity in Alzheimer's mostly in the hippocampus, parietal and temporal lobes 

  • SYMPTOMS: short term memory loss, disorientation, difficulty finding words, poor insight 

 

Vascular Dementia 

  •  15% of Dementia 

  • Involves reduced blood flow to neurons giving ischemia and cell death  

      1) Multi infarct Dementia – series of small strokes together cause symptoms 

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

      3) Stroke Related Dementia – 30% of Ischemic Strokes 
 
Dementia with Lewy Bodies  

  • 10%  

  • No antipsychotics for people with Lewy Bodies dementia due to high risk factors 
    Core Symptoms: 
    1. Fluctuating Cognition 
    2. Visual Hallucinations 
    3. Parkinsonian Features  

  • Suggestive Symptoms 

1. REM Sleep Disturbance         
2. Sensitivity to Antipsychotics 

 
Frontotemperal Dementia: 

  • the most common 

1. Behavioral Variant with Pick’s Disease: 

- Personality/ Behavior Changes Early 

- Disinhibition/ Social Withdrawal 

 

PICK BODIES: spherical intracellular collections of Tau Fibrils 

 

2. Semantic Variant  

- Difficulty Finding Correct Words  

- Fluent Aphasia 

RISK FACTORS: 
- Age  

- Genetics – 10% to 30% increased risk in 1st degree relative 

- Gender – higher in females than male 

  • - Cognitive Reserve – social isolation/left education early/low job complexity 
     
    How to Diagnose Dementia: 
    Post-mortem Brain Biopsy traditionally 

  • PET Scan – can determine changes in brain 

  • Clinical history and physical exam 

  • Lab Investigations 

  • CT Head scan 

  • Genetic Testing 
     

Treatment & Management: 

  • No cure currently 

  • One year Mortality 30-40%   

  • Five year Mortality 65% 

Medication:   

1) Cholinesterase inhibitors –Donepezil, Galatamine, Rivastigmine 

2) NDMA Antagonists - Memantine 

Risk Reduction 

Behavior and Environment Support: 

  • maintain familiarity, monitor personal comfort, attention redirection 

  • Mental Health support 

  • Aerobic Exercise   

Pneumonia is the most common cause of death 

 

 

The 7 A’s of Dementia: 

  
1. ANOSOGNASIA is often mistaken for denial, stubbornness, or embarrassment. In fact, it is brain damage that can make it difficult for dementia patients to recognize their impairment. Awareness can change from day to day or even hour to hour, and this can make your loved one’s behaviour unpredictable. They may resist help, refuse treatment, become angry and defensive, or dangerously overestimate their abilities.  

 
2. AGNOSIA is the inability to recognize people or objects using the senses. For example, a dementia patient may burn themselves with hot water, eat something that isn’t food, or brush their hair using a toothbrush. Agnosia can also cause distress during personal grooming times as a caregiver can be mistaken for a stranger.  

 
3. APHASIA refers to impaired communication skills affecting the ability to speak, understand language, and read and write. Early in the disease’s progression you. May not notice that you loved one is struggling to understand you, but with time they may inappropriate or non-existent words, revert to a first language, or become very difficult to understand.  

 
4. APRAXIA is the loss of motor skills needed for movement or coordination. Activities of daily living like bathing, dressing, walking and eating can become difficult and a loved one may struggle with buttons on remote controls, phones, and 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.  

 
5. 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.  

 
6. AMNESIA is 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. Amnesia is often the most obvious sign of dementia and is also thought to be the most heartbreaking.  

 
7. 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:  
Ex: 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.  
 
V.I.P.S: 
 

  • Valuing the person regardless of cognitive ability 

  • Individual Approach 

  • Perspective of each person – putting ourselves in shoes 

  • Social environment -- consider surroundings/relationships 

 
The 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: 

 
Types of psychotic symptoms and behaviors: 

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  
 
 

  • Delirium, depression, and psychosis is NOT dementia.