Dementia 06122022 072427pm

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Dementia

Objectives
• At the end of the session student will be able to define
• What is Dementia?
• Prevalence
• Symptoms
• Causes
• Treatments for Dementia
Age-related changes in cognitive function
 With normal aging there may be some changes in cognitive function.
Memory loss is one of the most important cognitive components
associated with aging.

 The older person may exhibits subjective problems such as difficulty in


recalling names or where an object was placed. However, the
characteristic feature of age-related memory loss is that older person
recalls with cues or remembers the information later.

 Compared with younger adults, older adults perform more slowly on


timed tasks and have slower reaction times.

 Nevertheless the learning capacity usually remains intact.


Dementia
 Dementia is not a disease, but a group of symptoms that are
associated with a decline in thinking, reasoning, and/or
remembering.

 Dementia can be defined as an acquired decline in memory


and in at least one cognitive function (e.g. language, visual
spatial, executive function) sufficient to affect daily life in an
alert person.

 Dementia is most severe type of cognitive impairment with


gradual onset and continuing decline.
Types of dementia
Cortical dementia: dementia where the brain damage
primarily affects the brain’s cortex, or outer layer.
Cortical dementias tend to cause problems with
memory, language, thinking, and social behavior
Subcortical dementia: dementia that affects
parts of the brain below the cortex. Sub-
cortical dementia tends to cause changes in
emotions and movement in addition to
problems with memory.

Progressive dementia: dementia that gets


worse over time, gradually interfering with
more and more cognitive abilities.
 Primary dementia: dementia such as Alzheimer's
disease that does not result from any other disease.

 Secondary dementia: dementia that occurs as a


result of a physical disease or injury.
 Stages of dementia:
Stage I: Early stage (2 to 4 years):
• Forgetfulness
• Declining interest in environment
• Hesitancy in initiating actions
• Poor performance at work
Stage II: Middle stage (2 to 12 years):
• Progressive memory loss
• Hesitates in response to questions
• Has difficulty in following simple instructions
• Irritable, anxious
• Wandering
• Neglects personal hygiene
• Social isolation
Stage III: Final stage (up to a year):
• Marked loss of weight because of
inadequate intake of food
• Unable to communicate
• Does not recognize family
• Incontinence of urine and feces
• Loses the ability to stand and
walk
• Death is caused by aspiration
pneumonia
STAGES
Mild Moderate Severe
(2-4 years) (2 – 12years) (upto a year)

Loss of memory Inability to retain new Gait and motor


Language info disturbances
difficulties Behavioral, personality Bedridden
changes
Mood swings Increasing long-term Unable to
Personality memory loss perform ADL
changes Wandering, agitation, Incontinence
aggression,
Diminished confusion Requires long
judgment Requires assistance term care
Apathy placement
Common Symptoms of Dementia
• Problems with short term
memory
o Appointments
o Conversations
o Events
o Repeating stories

• Difficulty remembering
names, faces
o Forgetting friends
CAUSES OF DEMENTIA

 Alzheimer’s disease accounts for 60-70 percent cases of


dementia.

 Correctable conditions such as


 Drug complications, Infectious diseases, Metabolic and
Nutritional disorders, Subdural hematoma, Thyroid
dysfunction accounts for 2-5 percent cases of dementia.
This is known as reversible dementia.

 Progressive disorders such as vascular and Lewy bodies


accounts for 15-30 percent cases of dementia.
Vascular Dementia
 The second most common type of dementia describes as loss of
mental ability (cognitive impairment) associated with gradual
death of brain caused by decreased blood flow to the brain

 Behavioral and psychological problems same as AD


 Less severe memory impairments and recall problems than AD
 More severe depression than AD.
Dementia with Lewy Bodies

 Parkinsonism that is manifested primarily by rigidity and


bradykinesia rather than tremor

 Although there is fluctuation in cognitive impairment, onset is


insidious and nature of disease is progressive similar to AD.

 Visual hallucinations are more commonly found than AD

 Sensitivity to antipsychotic medications suggest that caution


should be exercised while using these medications.
Frontotemporal Dementia

• Develops at a relatively young age and very uncommon


 Clinical presentation of fronto temporal lobar degeneration

• Early changes in personality and behavior with relative sparing


of memory
•Hyperorality (A condition characterized by insertion of
inappropriate objects in the mouth)
• Primary progressive aphasia (Aphasia is an inability to
comprehend and formulate language )
• Sparing of visuospatial abilities
EVALUATION AND ASSESSMENT
 History
 Duration of symptoms:
 Type of onset
 Rate and nature of decline in cognitive function:
 Social history may help to assess recent memory
 Medical history may give idea about remote memory
 Drug history
 Language problems
 Family members or caregivers should be involved to obtain complete
information.
 Physical and neurological examination
 Sensory examination

 Gait and balance: Modified performance-oriented mobility


assessment (POMA) is used for the assessment of balance
and gait

 Postural assessment: Elderly patients with dementia are


usually found to be in sitting position with feet unsupported
and hips flexed, head forward, hands resting unnaturally.

 Cardiovascular examination
Assessment of functional status:
 ADL
 IADL
 Mental state: The Mini-Cog assessment instrument.
 Geriatric depression scale (GDS
 Higher the score on GDS, greater is the severity of
depression.

 Laboratory testing.
 Neuroimaging
MANAGEMENT
 Aims of Treatment
 • To identify and treat secondary cause
 • To maintain and maximize function
 • To improve the efficiency
Data to be included for nursing assessment
• Disorientation
• Mood changes
• Fear
• Suspiciousness
• Self-care deficit
• Social behaviour
• Level of mobility, wandering behaviour
• Judgement ability
• Sleep disturbances
• Speech or language impairment
• Hallucinations, illusions or delusions
• Bowel and bladder incontinence
• Apathy
• Any decline in nutritional status
• Recognition of family members
• Identify primary care giver, support system
and the knowledge base of the family
members.
Pharmacological Treatment

 Cholinesterase inhibitors: Cholinesterase inhibitors


have been shown to improve cognitive function
probably by increasing level of acetylcholine in brain.
At present, FDA (Food and Drug Administration) has
approved four drugs for the treatment of mild to
moderate AD
 – Donepezil
 – Rivastigmine
 – Galantamine
 – Tacrine
Environmental Modifications and
Behavior Modifications
Environmental Modifications and
Behavior Modifications
 Music during meals

 Family member’s presence with video or audio conversation

 Good, nonglare lighting

 Quiet room with no distractions such as background noise

 Low-vision aids such as magnifying glass

 A systematic storage of clothes and toilet articles

 Contrasting colors for identifying doors, windows, cupboards and corners


Improving the Efficiency of Learning

 The time given for learning or relearning should be as


much as elderly patients want because elderly
persons with or without dementia perform best when
learning is self-paced.

 Self-paced A Learning program designed to be


accomplished at the patient's own speed
Advice to Caregivers

 Explain the importance of touch as the means of


communication.

 Try to know about the interests of patient such as


hobby, favorite game or favorite food.

 Use the way of communication that patient enjoys


most.

 Avoid the activity that patient does not like to


participate in.
Physiotherapy
 Massage:
 Breathing exercises
 Relaxation exercises
 Passive therapeutic.
 Active participation.
 PNF techniques
Movement Therapy Approaches

 Feldenkrais method: The mainstay of Feldenkrais method is


that people can change and all people can learn.
 Movement is the medium by which one learns, essentially, how to learn.

 The method has two components:


 1. Awareness through movement (ATM): ATM is verbally directed
movement lessons. In a one-year follow-up study responses to ATM
were a greater ease of movement, better functional balance, enhanced
mental outlook and improved quality of life.

 2. Functional integration (FI): FI is one-on-one hands-on nonverbal


dialogue related to movement awareness and options.
•Tai chi:
 Tai chi is a slow moving, meditative exercise

 Tai chi is an exercise form that allows the individual to assume an


active role recognizing the mind-body interaction. Many forms of
Tai chi exercise are available, involving 109 postures and
transitions of controlled movement.

 It has cardiovascular, neuromuscular and psychological benefits.

 Tai chi exercise is especially important in elderly people because


of its slow, controlled, non-impact and graceful nature of
movement
To Summarize

The role of physical therapy is most


challenging and deeply rewarding in working
with cognitively impaired patients.
 However, it needs the effective and timely

assessment; the creation of a therapeutic


environment; training and education to
caregivers; and modifications of treatment
program including movement therapy
approaches

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