NURSING
NURSING
MANAGEMENT OF
MANAGEMENT OF
DEMENTIA
DEMENTIA
“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
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.
DEMENTIA
-the most common type of dementia is
ALZHEIMER’S DISEASE
named after Dr.
Alois Alzheimer.
-There are no specific interventions for the
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.
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.
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
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)
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
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
RISK FACTORS OF DEMENTIA
1. AGE
-doubles every 5 years after age 65 years
2. FAMILY HISTORY
-first degree relative with AD
3. GENETICS
RISK FACTORS OF DEMENTIA
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)
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
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
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
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.
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
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.
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.
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
DELIRIUM
CONFUSION ASSESSMENT METHOD
1. Acute Onset or fluctuating course 2. Inattention
3. Disorganized thinking
4. Altered Level of Consciousness
DELIRIUM
CONFUSION ASSESSMENT METHOD
1. Acute Onset or fluctuating course 2. Inattention
3. Disorganized thinking
4. Altered Level of Consciousness
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
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)
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.
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