dementia

1. G
O
O
D
morning
Ambika Gaur

2. Organic brain disorder
Dementia
Ambika Gaur Bhatt
Senior Nursing Tutor
HIN Pounta Sahib

4. Introduction:
• Chronic organic brain syndrome
• Organic mental disorders are behavioural or
psychological disorder associated with
transient or permanent brain dysfunction
• Alzheimer's type dementia is an irreversible
disease marked by global, progressive
impairment of cognitive functioning, memory
& personality

5.  Classification of organicbrain
disorders:
• (F00-f09) organic, including
symptomatic, mentaldisorders
• (F00) Dementia in Alzheimer’sdisease
• (F01) Vascular dementia
• (F02) Dementia in other
diseases classified elsewhere
• (F03) unspecified dementia
• (F04) organic amnestic syndrome,
not induced by alcohol and other
psychoactive substances

6. • (F05)delirium not induced by alcoholand
other psychoactivesubstances
• (F06) Other mental disorders due to brain
damage and dysfunction and to physical
disease
• (F07)personality and behavioural disorders
due to brain disease, damage anddysfunction
• (F09)unspecified organic or symptomatic
mental disorder.

7. History of dementia:
• Dementia wasfirst described in abook about
mental illness in 1893. In 1894, Dr.Alois
Alzheimer, a German neuropathologist who
hasaparticular interest in “nervousdisorders”
described changesin the brain causedby
vascular disease(now known asvascular
dementia).

8. DEFINITION:
• “Dementia is an acquired globalimpairment
of intellect, memory and personality but
without impairment ofconsciousness”

9. Incidence:
• Dementia occurs more commonly in the
elderly than in themiddle-aged.

10. Etiology:
• Significant loss of neurons and volume inbrain
regions devoted to memory and highermental
functioning
• Neurofibrillary angles (twisted nerve cellfibers
that are the damagedremains ofmicrotubules

11. • Environmental factors: infection, metals
and toxins.
• Excessiveamount of metal ions, suchas
zinc and copper, in brain
• Deficiencies of vitamin B6,B12And
Folate Possible RiskFactor DueT
o
Increased LevelsOf Hemocysteine
(amino acid that may interfere with
nerve cell repair)
• Early depression: common genetic
factors seenin those with early
depression andAlzheimer's disease

12. Untreatable and irreversible
cause of dementia
• Degenerating disorders of CNS
• Alzheimer’s disease(this is the mostcommon
of all dementingillnesses)
• Pick’sdisease
• Huntington’s chorea
• Parkinson’s disease

13. Treatable and reversible
causes of dementia
• Vascular-multi-infarct dementia
• Intracranial spaceoccupying lesions
• Metabolic disorders-hepatic failure, renalfailure
• Endocrine disorders- myxedema, Addison’s
disease
• Infections- AIDS,meningitis, encephalitis
• Intoxication- Alcohol, heavy metals(lead,
arsenic),
• Anoxia- Anemia, post-anesthesia,chronic
respiratory failure

14. • Vitamin deficiency, especially deficiency ofthiamine
and nicotine
Physiologic:
• Normal pressurehydrocephalus
Metabolic:
• Endocrinopathies (e.g. hypothyroidism)
Tumor:
• Primary or metastatic (e.g. meningiomaor
metastatic breast or lungcancer)
Traumatic:
• Subduralhematoma

15. Types of dementia:
the classificationsinclude.
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 behaviour.

16. Subcortical dementia: dementia that affects
parts of the brain below the cortex. Sub-
cortical dementia tends to causechangesin
emotions and emotions and movement in
addition to problems withmemory.
Progressive dementia: dementia that gets
worse over time, gradually interfering with
more and more cognitiveabilities.

17. Primary dementia: dementia suchas
Alzheimer's diseasethat does not resultfrom
any other disease.
Secondary dementia: dementia that occursas
aresult of aphysical diseaseor injury.

19. Stages ofdementia:
Stage I: Early stage (2 to4years):
• Forgetfulness
• Declining interest in environment
• Hesitancy in initiating actions
• Poor performance at work

20. Stage II: Middle stage (2 to12years):
• Progressive memory loss
• Hesitates in response to questions
• Hasdifficulty in following simpleinstructions
• Irritable, anxious
• Wandering
• Neglects personal hygiene
• Social isolation

21. Stage III: Final stage (up to a year):
• Marked loss of weight becauseof
inadequate intake of food
• Unable to communicate
• Doesnot recognizefamily
• Incontinence of urine andfeces
• Losesthe ability to stand andwalk
• Death is causedby aspiration
pneumonia

22. STAGES
Mild Moderate Severe
(2-4 years) (2 – 12years) (upto ayear)
Loss of memory
Language
difficulties
Mood swings
Personality
changes
Diminished
judgment
Apathy
Inability to retainnew
info
Behavioral, personality
changes
Increasing long-term
memory loss
Wandering,agitation,
aggression,
confusion
Requires assistance
Gait and motor
disturbances
Bedridden
Unable to
perform ADL
Incontinence
Requires long
term care
placement

23. Warning signs of
Alzheimer’sdementia:
• Memory loss
• Difficulty performing familiartasks
• Problems with language
• Disorientation to time andplace
• Poor or decreasedjudgement
• Problems with abstractthinking
• Misplacing things
• Changesin mood or behaviour
• Changesin personality
• Lossof initiative

24. Clinical features(For
Alzheimer’stype)
• Personality changes: lack of interestin
day-to-day activities, easymental
fatigability, self-centred, withdrawn,
decreased self-care.
• Memory impairment: recent memoryis
prominently affected.
• Cognitive impairment: disorientation
poor judgement, difficulty in
abstraction, decreased attention span.

25. Although thereare some decreasesin metabolism associated with age, in most patients with
Alzheimer’sdisease, there are marked decreases in the temporal lobe, an area important in
memoryfunctions.

26. • Affective impairment: labile mood,
irritableness, depression
• Behavioural impairment: stereotyped
behaviour, alteration in sexualdrivesand
activities, psychoticbehaviour.
• Neurological impairment: stereotyped
behaviour, alteration in sexualdrivesand
activities,

27. Diagnosis:
• Following test are used fordiagnosis:
• Cognitive assessmentevaluation- mini
mental status examination (MMSE)–
showscognitive impairment
• Functional dementia scale(to indicate
the degree of dementia)
• Magnetic resonance imaging (MRI):of
the brain showsstructural and
neurologic changes.
• Spinal fluid analysis showsincreased
beta amyloid deposits

29. Treatmentmodalities:
•Tacrinehydrochloride (cognex)
•Donepezil hydrochloride(Aricept)
NMDAANTAGONISTS.
•Memantine
ANTIPSYCHOTICAGENTS
•Risperidone, quetiapine, and
•olanzapine

30. ANTIDEPRESSANTAGENTSANDMOOD
STABILIZERS
• Low dosesof the selective serotoninreuptake
inhibitors and other newer antidepressive
agents should be considered.

31. Nursing Management:
• Assessment data for the patient with
dementia should include apast health and
medication history.

32. Data to be included for nursingassessment
• Disorientation
• Mood changes
• Fear
• Suspiciousness
• Self-care deficit
• Social behaviour
• Levelof mobility, wanderingbehaviour
• Judgement ability
• Sleep disturbances
• Speechor language impairment
• Hallucinations, illusions or delusions

33. • Bowel and bladder incontinence
• Apathy
• Any decline in nutritional status
• Recognition of familymembers
• Identify primary care giver, supportsystem
and the knowledge baseof the family
members.

34. Nursing intervention:
• Daily routine
• Nutrition & bodyweight
• Personal hygiene
• Toilet habits and incontinence
• Accidents
• Fluid management
• Moods and emotions
• Wandering
• Disturbed sleep
• Interpersonal relationship

35. Summary:
 Introduction
 Classification
 History
 Definition
 Etiology
 Types
 Stages
 Warning signs
 Clinical features
 Diagnosis
 Treatment modalities
 Nursing management

36. Conclusion:
• Dementia is aserious cognitive disorder all
together dementia is afar common in the
geriatric population, it may be occur inany
stageof childhood
• Soasanurse we need to get aware aboutthe
preventive measures of dementia and
educative the individuals about its signsand
symptoms with its treatment

37. Bibliography:
• RSreevani, aguide to mental health and
psychiatric nursing,
jaypee publishers,
3rd edition, pg.no:244-246
• Townsend cMary, text book on “Psychiatric
Mental Health Nursing.”
Jaypeepublications.
5th edition, page 387-405