care of patients with dementia

1. DEMENTIA

2. INTRODUCTION
Cognition is that operation of the mind process by which
we become aware of objects of thought and perception,
including all aspects of perceiving, thinking &
remembering.
Organic brain syndrome is general term referring to
many physical disorders that cause impaired mental
function.

3. CLASSIFICATION OF
ORGANIC BRAIN
DISORDERS (DSM)
(F00) Dementia in
Alzheimer’s disease
(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
(F00-F09) organic, including
symptomatic, mental disorders

4. (F05) delirium not induced by alcohol and other psychoactive
substances
(F06) Other mental disorders due to brain damage and dysfunction
and to physical disease
(F07) personality and behavioural disorders due to brain disease,
damage and dysfunction
(F09) unspecified organic or symptomatic mental disorder.

5. DEFINITION:
“Dementia is an acquired global impairment of intellect, memory
and personality but without impairment of consciousness”
Incidence:
Dementia occurs more commonly in the elderly than in the middle-
aged.

6. ETIOLOGY
Significant loss of neurons and volume in brain
Neurofibrillary angles (twisted nerve cell fibers)
Environmental factors: infection, metals and toxins.
Excessive amount of metal ions, such as zinc and copper, in brain
Deficiencies of vitamin B6,B12 And Folate
Early depression
genetic factors

7. UNTREATABLE &
IRREVERSIBLE CAUSE OF
DEMENTIA
Degenerating disorders of CNS
Alzheimer’s disease
Pick’s disease
Huntington’s
Parkinson’s disease

8. TREATABLE AND REVERSIBLE
CAUSES OF DEMENTIA
Vascular-multi-infarct dementia
Intracranial space occupying lesions
Metabolic disorders-hepatic failure, renal failure
Endocrine disorders
Infections- AIDS, meningitis, encephalitis
Intoxication- Alcohol, heavy metals (lead, arsenic),
Anoxia- Anemia, post-anesthesia, chronic respiratory failure

9. Vitamin deficiency, especially deficiency of
thiamine and nicotine
Physiologic:
Normal pressure hydrocephalus
Metabolic:
Endocrinopathies (e.g. hypothyroidism)
Tumor:
Primary or metastatic (e.g. meningioma or
metastatic breast or lung cancer)
Traumatic:
Subdural hematoma

10. TYPES OF DEMENTIA
The Classifications Include.
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.
Subcortical dementia: dementia that affects parts of the
brain below the cortex. Sub-cortical dementia tends to cause
changes in emotions and emotions and movement in addition
to problems with memory.

11. 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.

12. STAGES OF DEMENTIA
Stage I: Early stage (2 to 4 years):
Forgetfulness
Declining interest in environment
Hesitancy in initiating actions
Poor performance at work

13. Stage II: Middle stage (2 to 12 years):
Progressive memory loss
Hesitates in response to questions
Has difficulty in following simple instructions
Irritable, anxious
Neglects personal hygiene
Social isolation

14. 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 feaces
Loses the ability to stand and walk
Death is caused by aspiration pneumonia

15. STAGES
Inability to retain new
info
Behavioral, personality
changes
Increasing long-term
memory loss
agitation, aggression,
confusion
Requires assistance
MILD MODERATE SEVERE
•Loss of memory
•Language
difficulties
•Mood swings
•Personality
changes
•Diminished
judgment
•Apathy
•Gait and motor
disturbances
•Bedridden
•Unable to
perform ADL
•Incontinence
•Requires long
term care
•placement

16. WARNING SIGNS OF
ALZHEIMER’S DEMENTIA
Memory loss
Difficulty performing
familiar tasks
Problems with language
Disorientation
Poor or decreased
judgement
Problems with abstract
thinking
Misplacing things
Changes in mood or
behaviour
Changes in personality
Loss of initiative

17. CLINICAL FEATURES (FOR
ALZHEIMER’S TYPE)
Personality changes: lack of interest in day-to-day activities,
mental fatigue, self-centred, withdrawn, decreased self-care.
Memory impairment: recent memory is prominently affected.
Cognitive impairment: disorientation poor judgement,
decreased attention span.

18. Affective impairment: labile mood, irritableness, depression
Behavioural impairment: stereotyped behaviour, alteration in
sexual drives and activities, psychotic behaviour.
Neurological impairment: stereotyped behaviour, alteration in
sexual drives and activities,

19. DIAGNOSIS
Cognitive assessment evaluation- mini mental status
examination (MMSE) – shows cognitive impairment
Functional dementia scale
MRI
Spinal fluid analysis shows increased beta amyloid deposits

20. TREATMENT MODALITIES
Tacrine hydrochloride (cognex)
Donepezil hydrochloride (Aricept)
NMDA ANTAGONISTS.
Memantine
ANTIPSYCHOTIC AGENTS
Risperidone,
Olanzapine
ANTIDEPRESSANT AGENTS AND MOOD STABILIZERS
Low doses of the selective serotonin reuptake inhibitors
and antidepressive agents should be considered.

21. NURSING
MANAGEMENT:
Disorientation
Mood changes
Fear
Suspiciousness
Self-care deficit
Social behaviour
Level of mobility, wandering
behaviour
Judgement ability
Sleep disturbances
Speech or language impairment
Assessment data for the patient with
dementia should include a past health and
medication history.
Data to be included for nursing
assessment

22. 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.

23. NURSING
INTERVENTION
Daily routine
Nutrition & body weight
Personal hygiene
Toilet habits and incontinence
Accidents
Fluid management
Moods and emotions
Wandering
Disturbed sleep
Interpersonal relationship
Provide intervention related to

24. CONCLUSION
Dementia is a serious cognitive disorder all together dementia is a
far common in the geriatric population, it may be occur in any stage
of childhood
So as a nurse we need to get aware about the preventive measures
of dementia and educative the individuals about its signs and
symptoms with its treatment

25. THANK YOU