Dementia
IS NOT a
specific
disease.

Dementia is a
GROUP OF SYMPTOMS
affecting intellectual and
social abilities severely
...
PROGRESSSIVE BRAIN
DETERIORATION

Dementia

Normal
Aging

Mild
Cognitive
Decline
(MCD)
Normal
cognitive decline
associated with
age:
*Structural
changes –size,
weight and
neurons
*Varying
degrees of
cortical a...
Transitional Phase-increased
probability of developing dementia
AGE-INCREASES PROBABILITY!
Amnestic type: memory impairmen...
Dementia

Normal
Cognitive
Decline

Mild
Cognitive
Decline
(MCD)

Behavioural Syndrome
with cognitive and
emotional sympto...
Develops due to brain disease
Chronic and progressive in nature
Consciousness remaining intact
Deterioration of higher...
The essential feature of any dementia is the development of multiple cognitive deficits that
include:
• memory impairment
...
Changes in
mood and
personality

Withdrawal
from work or
social activities

Decreased or
poor judgment

Memory loss
that d...
CLINICAL DEMENTIA RATING SCALE
NONE
(O)

QUESTIONNABLE (0.5)

MILD
(1)

MODERATE (2)

SEVERE (3)

MEMORY

OK

CONSISTENT
F...
NONE
0

QUESTIONABLE
0.5

MILD
1

MODERA-TE
2

SEVERE
3

COMMUNITY
AFFAIRS

Independent to
work, shop
and have
social life...
CORTICAL
• ALZHEIMER’S DISEASE
• Genetic hypothesis: chromosomes 1, 14, 21
• Neuropathology: cortical atrophy, amyloid pla...
Neurofibrillary
&
Tangles
AMYLOID
PLAQUES
NEUROANATOMY OF ALZHEIMER’S
DISEASE…
NEUROANATOMY OF HUNTINGTON’S
DISEASE…
STATIC
• Heavy Metal Poisoning
• The whole system is affected, including the brain
• Cognitive decline and behavioural cha...
REVERSIBLE
•
•
•
•

Severe Anemia
Memory loss (holes).
Cognitive decline similar to AD
Lack of vitamin B12 that can be rev...
personality
/ mood

behavior

navigation

memory

language

thought
PSYCHOLOGICAL AND BEHAVIOURAL DISTURBANCES

Depression
• Reaction to early cognitive
decline
• Less prevalent in severe
de...
Shultz (2004) defines the role of
caregiving as:
“… the provision of extraordinary care,
exceeding the bounds
of what is n...
“Stigma is an attribute, behaviour, or reputation which is socially
discrediting in a particular way: it causes an individ...
CAREGIVER &
PATIENT
COUNSELLING FOR
ACCEPTANCE

COMBATING
STIGMA
INVOLVE MEDIA,
GOVERNMENT,O
THER
STRUCTURAL
SERVICES

RAI...
-2011, 5.5 million
individuals living
with HIV in S.A

Challenges when
screening for
HAD:language, culture,
inadequate res...
FREQUENTLY
ENGAGE IN
MENTALLY
STIMULATING
ACTIVITIES

REGULAR
PHYSICAL
ACTIVITY

NUTRITION
AL DIETS,
MODERATELOW
ALCOHOL
I...
• Nerve growth factor (NGF)
• No fewer than 10 drugs
• Cognitive training
• Reality orientation
• Reminiscence therapy
• C...
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
SHAAKERA SUBJEE AND SHAREEKA  ANGAMIA-DEMENTIA PRESENTATION
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SHAAKERA SUBJEE AND SHAREEKA ANGAMIA-DEMENTIA PRESENTATION

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PART OF HEALTH PSYCHOLOGY-DEMENTIA-ALZHEIMER'S
SHAAKERA SUBJEE
SHAREEKA ANGAMIA
PSYCHOLOGY

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SHAAKERA SUBJEE AND SHAREEKA ANGAMIA-DEMENTIA PRESENTATION

  1. 1. Dementia IS NOT a specific disease. Dementia is a GROUP OF SYMPTOMS affecting intellectual and social abilities severely enough to interfere with daily functioning. Memory loss generally occurs in dementia, but memory loss alone does not imply you have dementia. DEMENTIA Alzheimer's disease is the most common cause of a progressive dementia. There are many causes of dementia symptoms.
  2. 2. PROGRESSSIVE BRAIN DETERIORATION Dementia Normal Aging Mild Cognitive Decline (MCD)
  3. 3. Normal cognitive decline associated with age: *Structural changes –size, weight and neurons *Varying degrees of cortical atrophy *Memory and speed of processing decline Normal Cognitive Decline Dementia Mild Cognitive Decline (MCD)
  4. 4. Transitional Phase-increased probability of developing dementia AGE-INCREASES PROBABILITY! Amnestic type: memory impairment (without the generalized deficits) Non-amnestic: other domain is affected Dementia Normal Aging Mild Cognitive Decline (MCD)
  5. 5. Dementia Normal Cognitive Decline Mild Cognitive Decline (MCD) Behavioural Syndrome with cognitive and emotional symptoms that affect everyday life. Memory impairment + Other cognitive impairments More than 50 known causes Generally Progressive
  6. 6. Develops due to brain disease Chronic and progressive in nature Consciousness remaining intact Deterioration of higher order cognitive functioning Disturbances in social behaviour, emotional control and motivation
  7. 7. The essential feature of any dementia is the development of multiple cognitive deficits that include: • memory impairment and at least one of the following cognitive disturbances: • • • • aphasia (language disturbance), apraxia (impaired ability to carry out motor activities despite intact motor function), agnosia (failure to recognize or identify objects despite intact sensory function), and executive dysfunction (difficulty in planning, organizing, sequencing, abstracting). The deficits must also be sufficiently severe and must represent a decline from a previously higher level of functioning. The diagnosis of dementia may be accompanied by subtypes and specifiers such as • Early (before the age of 65) or Late Onset (after 65) • With Behavioral Disturbance (e.g., wandering, striking out during care); • With Delirium (if delirium is superimposed on dementia); • With Delusions (if delusions are most prominent feature); • With Depressed Mood (if depressed mood is most prominent feature); and • Uncomplicated (if none of the aforementioned predominates the clinical presentation).
  8. 8. Changes in mood and personality Withdrawal from work or social activities Decreased or poor judgment Memory loss that disrupts daily functioning Challenges in planning or solving problems WARNING SIGNS Misplacing things and losing the ability to retrace steps New problems with words in speaking or writing Difficulty completing familiar tasks at home, at work or at leisure Confusion with time or place Trouble understanding visual images and spatial relationships
  9. 9. CLINICAL DEMENTIA RATING SCALE NONE (O) QUESTIONNABLE (0.5) MILD (1) MODERATE (2) SEVERE (3) MEMORY OK CONSISTENT FORGETFULNES S MEMORY LOSS FOR RECENT EVENTS ONLY HIGH LEARNING MATERIAL RETAINED ONLY FRAGMENTS REMAIN ORIENTATI-ON FULLY DIFFICULTY WITH TIME GEOGRAPHIC TIME AND PLACE ONLY PERSON JUDGEME-NT AND PROBLEM SOLVING GOOD SLIGHT IMPAIRMENT SOCIAL JUDGMENT OK, DIFFICULTIES WITH SIMILARITIES AND DIFFERENCES ISSUES WITH SOCIAL JUDGEMENT SEVERELY IMPAIRED PROBLEM SOLVING UNABLE TO MAKE JUDGEMENTS
  10. 10. NONE 0 QUESTIONABLE 0.5 MILD 1 MODERA-TE 2 SEVERE 3 COMMUNITY AFFAIRS Independent to work, shop and have social life Slight impairment Unable to be independent but still engaged Well at home but not outside No responsibilities in or out the home HOME & HOBBIES Maintained Slight impairment Complicated hobbies or chores abandoned Only simple chores maintained. Low interest No function PERSONAL CARE Fully capable Fully capable Needs prompting Need assistance Help with personal care & incontinence
  11. 11. CORTICAL • ALZHEIMER’S DISEASE • Genetic hypothesis: chromosomes 1, 14, 21 • Neuropathology: cortical atrophy, amyloid plaques and neurofibrillary tangles • General cognitive decline with severe memory impairment SUBCORTICAL • Huntington’s Disease • Genetic: ITI5 on chromosome 4. Abnormal repetitions • Neuropathology: deterioration of the caudate nucleus, globus pallidus, putamen and striatum • Motor functioning and frontal functioning affected
  12. 12. Neurofibrillary & Tangles AMYLOID PLAQUES
  13. 13. NEUROANATOMY OF ALZHEIMER’S DISEASE…
  14. 14. NEUROANATOMY OF HUNTINGTON’S DISEASE…
  15. 15. STATIC • Heavy Metal Poisoning • The whole system is affected, including the brain • Cognitive decline and behavioural changes that can be stopped by ending the exposure or with detox treatment PROGRESSIVE • • • • Vascular Dementia Blood supply is affected (multi-infarcts) Damage to multiple areas of the brain Cognitive decline + hallucinations/delusions , personality changes
  16. 16. REVERSIBLE • • • • Severe Anemia Memory loss (holes). Cognitive decline similar to AD Lack of vitamin B12 that can be reverted with treatment IRREVERSIBLE • Parkinson’s Dementia • Motor symptoms of tremor, rigidity, and slowness of movement. • Loss of dopamine from the substantia nigra
  17. 17. personality / mood behavior navigation memory language thought
  18. 18. PSYCHOLOGICAL AND BEHAVIOURAL DISTURBANCES Depression • Reaction to early cognitive decline • Less prevalent in severe dementia due to impaired awareness • Vascular dementia more susceptible • Early Onset-Dementia as a predictor of severity Psychotic Disturbances • Approximately 50% will display disturbances • DELUSIONS- 1/3 will display persecutory delusions not attributed to memory impairment • Moderate Level • HALLUCINATIONS- less frequent • More significant relationship with cognitive decline • Associated with a rapid decline at a more severe stage Behavioural Problems • Agitation, irritability, fatigue, tiredness, apathy, psychomotor behaviours, anxiety and sadness. • AD patients with co-morbid psychotic symptoms more likely to display severe aggression and behaviour problems • Pre-morbid communication emulated • RISK FACTORS: • Genetics, personality variables, location of deterioration • Social implications on self and caregiver
  19. 19. Shultz (2004) defines the role of caregiving as: “… the provision of extraordinary care, exceeding the bounds of what is normative or usual in family relationships. Caregiving typically involves a significant expenditure of time, energy, and money over potentially long periods of time; it involves tasks that may be unpleasant and uncomfortable and are psychologically stressful and physically exhausting” (259).
  20. 20. “Stigma is an attribute, behaviour, or reputation which is socially discrediting in a particular way: it causes an individual to be mentally classified by others in an undesirable, rejected stereotype rather than in an accepted , normal one” (Goffman, 1963, as cited in Batsch, & Mittelman, 2012).
  21. 21. CAREGIVER & PATIENT COUNSELLING FOR ACCEPTANCE COMBATING STIGMA INVOLVE MEDIA, GOVERNMENT,O THER STRUCTURAL SERVICES RAISE AWARENESS –CAMPAIGNS, EDUCATIONAL PROGRAMS
  22. 22. -2011, 5.5 million individuals living with HIV in S.A Challenges when screening for HAD:language, culture, inadequate resources., inappropriate tools, untrained staff. Risk Factors: lower CD4 count, older age, lower levels of education, depression, substance abuse . Prevalence: 25.4% of adults living with HIV met the criteria for HAD. -International HIV Dementia Scale (IHDS) Consequences: In addition to HIV, cognitive impairments such as poor concentration, attention and executive functioning Sample of 65 nonadherent HIV patients 8O% screened positive for HAD
  23. 23. FREQUENTLY ENGAGE IN MENTALLY STIMULATING ACTIVITIES REGULAR PHYSICAL ACTIVITY NUTRITION AL DIETS, MODERATELOW ALCOHOL INTAKE ENGAGE IN SOCIAL ACTIVITIES TAKING CARE OF MENTAL HEALTH
  24. 24. • Nerve growth factor (NGF) • No fewer than 10 drugs • Cognitive training • Reality orientation • Reminiscence therapy • Cognitive rehabilitation • Psychodynamic Therapy • Support groups •Public education •Training professionals •Developing programs •Integrating services

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