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(1)

NURSING

NURSING

MANAGEMENT OF

MANAGEMENT OF

DEMENTIA

DEMENTIA

(2)

“3dS” OF GERIATRICS

“3dS” OF GERIATRICS

 COMMON IN OLDER ADULTS AND THEIR SIGNS AND SYMPTOMSCOMMON IN OLDER ADULTS AND THEIR SIGNS AND SYMPTOMS

OFTEN OVERLAP

(3)

DEMENTIA

- A general term that refers to progressive,

degenerative brain dysfunction, including

deterioration in memory, concentration,

language

skills,

visuospatial

skills,

and

reasoning that interferes with a person’s

daily functioning.

(4)

DEMENTIA

-the most common type of dementia is

ALZHEIMER’S DISEASE

named after Dr.

Alois Alzheimer.

-There are no specific interventions for the

(5)

DEMENTIA

ALZHEIMER’S DISEASE

-Although the aging brain undergoes

many

developmental

changes,

these

changes do not significantly interfere with

the daily functioning of most older adults.

(6)

DEMENTIA

ALZHEIMER’S DISEASE

-HALLMARKS OF AD:

1. Beta-Amyloid Plaques

2. Neurofibrillary tangles

-the plaques and tangles interfere with

normal nerve cell function and lead to

neuronal death.

(7)

TYPES OF DEMENTIA

1. ALZHEIMER’S DEMENTIAL

-most common type of dementia ;

(50%-70% of all cases)

2. VASCULAR DEMENTIA

-2

nd

most common type

3. MIXED DEMENTIA

(8)

TYPES OF DEMENTIA

4. Demential with Lewy bodies or Lewy

body dementia (LBD)

-with a specific pathological finding in the

bran (abnormal deposits of a protein,

alpha-synuclein)

(9)

TYPES OF DEMENTIA

4. Demential with Lewy bodies or Lewy body

dementia (LBD)

Motor symptoms n the early stage of LBD

(which occur in the late stage of AD)

Visual hallucinations in early LBD (which

occur in the middle stage of AD, if at all)

Fluctuating mental status as a feature of LBD

(which usually occurs only due to delirium in

(10)

TYPES OF DEMENTIA

5. Frontotemporal dementia or Frontal

lobe dementia (FLD)

-affects the frontal and temporal lobes of

the brain and is often characterized by

early deficiencies in executive functioning

(11)

RISK FACTORS OF DEMENTIA

1. AGE

-doubles every 5 years after age 65 years

2. FAMILY HISTORY

-first degree relative with AD

3. GENETICS

(12)

RISK FACTORS OF DEMENTIA

(13)

DIAGNOSTIC CRITERIA FOR

ALZHEIMER’S DISEASE

Multiple Cognitive Deficits/impairment

1.

Impaired short-or long-term memory AND

2. At least one of the following:

 Impaired executive function (abstraction, planning, organizing, sequencing)

(14)

DIAGNOSTIC CRITERIA FOR

ALZHEIMER’S DISEASE

 Apraxia (impaired purposeful movements)  Agnosia (inability to recognize sensory stimuli)

3. The changes signifantly interfere with social and /or occupational function and represent a decline from previous level of function.

4. The course has been a gradual onset and continuing decline 5. The changes do not occur exclusively during delirium

(15)

Medical diagnosis of Alzheimer’s

Disease/Dementia

1. Visit a primary care provider 

Goal: Identify and treat dementia in the early stage, before the

symptoms are more apparent and when interventions tend to be more successful.

2. PCP will conduct a history and physical examination and medical history

3. Brain imaging-CT-scan/MRI

(16)

Medical diagnosis of Alzheimer’s

Disease/Dementia

3. PCP will do simple ‘paper and pencil’ screening test

-to determine the presence and degree of cognitive impairment -diagnosis is made by: physicians with experience in geriatrics -Geriatric internist, geriatric psychiatrist

(17)

Medical diagnosis of Alzheimer’s

Disease/Dementia

-Many persons with a new diagnosis of demention and /or their families may believe that the diagnosis is INCORRENT- DENIAL.

(18)

STAGES OF ALZHEIMER’S DISEASE

 3 STAGES  1. MILD

Subtle, unnoticed, “just getting older”  2. MODERATE

Behavioral and psychological symptoms of demential (BPSD)  3. SEVERE

(19)

Pharmacological Intervention for

Dementia

1. Cholinesterase inhibitors (CEIs)

-blocks cholinesterase enzyme ;

(DONEPEZIL, RIVASTIGMINE, GALANTAMINE) Acetylcholine

-is a neurotransmitter in the brain, known to be important for memory. Medication/Disease that inhibit acetylcholine interfere with memory.

(20)

Pharmacological Intervention for

Dementia

2. N-methyl-D-Aspartate (NMDA) Receptor antagonist

-protect neurons from glutamate excitotoxicity without completely eliminating the glutamate necessary for normal neurological function.

(21)

DELIRIUM

 Is a syndrome that occurs acutely is and often called acute confusion, unlike dementia which is called chronic confusion.  Hours or days and is caused by some other underlying medical

(22)

DELIRIUM

CONFUSION ASSESSMENT METHOD

1. Acute Onset or fluctuating course 2. Inattention

3. Disorganized thinking

4. Altered Level of Consciousness

(23)

DELIRIUM

CONFUSION ASSESSMENT METHOD

1. Acute Onset or fluctuating course 2. Inattention

3. Disorganized thinking

4. Altered Level of Consciousness

(24)

DELIRIUM

 The nurse plays a critical role in identifying whether an older adult has experienced an acute change in mental status

 The primary treatment for delirium is to discover or treat the etiology or cause.

 Report the changes to the HCP/physician

 Identify medications that can cause confusion  Keep the patient comfortable

 Hypoactive vs. Hyperactive delirum

 Avoid physical restraints because they tend to cause more panic and agitation

(25)

DELIRIUM

 Move the patient to room near the nurse’s station  Implement ris for fall protocols

 One to one care and supervision

 Eliminate tethers as ordered (catheter, oxygen tubings)  Elimination of confusing external stimuli ( television)

(26)

DEPRESSION

 A disorder that includes changes in feelings or mood, described as feeling sad , hopeless, pessimistic or blue lasting most of the day, with loss of interest in pleasurable activities.

(27)

COMPARISON OF SIGNS AND SYMPTOMS OF

DEMENTIA, DEPRESSION AND DELIRIUM

DEMENTIA DEPRESSION DELIRIUM ONSET GRADUAL OVER MONTHS TO

YEARS

USUALLY GRADUAL ACUTE OVER HOURS TO DAYS

COURSE SLOWLY PROGRESSIVE, IRREVERSIBLE, MINIMALLY TREATABLE

CHRONIC, SOMETIMES

ABRUPT WITH PSYCHOSOCIAL STRESSORS, TREATABLE

FLUCTUATING. REVERSIBLE WITH IDENTIFICATION AND TREATMENT OF CAUSE LEVEL OF CONSCIOUSNESS ALERT ALERT ALTERED, CLOUDED,

FLUCTUATING MEMORY IMPAIRED. SHORT-T. AND

LONG T.

INTACT, MAY EXHIBIT POOR EFFORT IN MEMORY TESTS

SHORT-TERM MEMORY LOSS

ORIENTATION IMPAIRED TO TIME, PLACE , PERSON THEN SELF

INTACT IMPAIRED, FLUCTUATING

PSYCHOMOTOR SPEED NORMAL. SLOWED IN ADVANCED STAGES

MAY BE NORMAL,

HYPOACTIVE, HYPERACTIVE

HYPOACTIVE, HYPERACTIVE OR MIXED

LANGUAGE WORD-FINDING DIFF. IMPAIRED INCREASES W/ DISEASE PROG.

NORMAL, MAY NOT INITIATE MUCH CONVERSATION

OFTEN INCOHERENT

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