dementia causes and clinical features

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:
• (F00-f09) organic, including
symptomatic, mental disorders
• (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

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. History of dementia:
• Dementia was first described in a book about
mental illness in 1830. In 1894, Dr. Alois
Alzheimer, a German neuropathologist who
has a particular interest in “nervous disorders”
described changes in the brain caused by
vascular disease (now known as vascular
dementia).

6. DEFINITION:
• “Dementia is an acquired global impairment
of intellect, memory and personality but
without impairment of consciousness”

7. Incidence:
• Dementia occurs more commonly in the
elderly than in the middle-aged.

8. Etiology:
• Significant loss of neurons and volume in brain
regions devoted to memory and higher mental
functioning
• Neurofibrillary angles (twisted nerve cell fibres
that are the damaged remains of microtubules

9. • 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 Possible Risk Factor Due To
Increased Levels Of Hemocysteine
(amino acid that may interfere with
nerve cell repair)
• Early depression: common genetic
factors seen in those with early
depression and Alzheimer's disease

10. Untreatable and irreversible
cause of dementia
• Degenerating disorders of CNS
• Alzheimer’s disease (this is the most common
of all dementing illnesses)
• Pick’s disease
• Huntington’s chorea
• Parkinson’s disease

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

12. • 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

13. 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.

14. 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.

15. 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.

17. Stages of dementia:
Stage I: Early stage (2 to 4 years):
• Forgetfulness
• Declining interest in environment
• Hesitancy in initiating actions
• Poor performance at work

18. 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

19. 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

20. STAGES
Mild Moderate Severe
(2-4 years) (2 – 12years) (upto a year)
Loss of memory
Language
difficulties
Mood swings
Personality
changes
Diminished
judgment
Apathy
Inability to retain new
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

21. Warning signs of
Alzheimer’s dementia:
• Memory loss
• Difficulty performing familiar tasks
• Problems with language
• Disorientation to time and place
• Poor or decreased judgement
• Problems with abstract thinking
• Misplacing things
• Changes in mood or behaviour
• Changes in personality
• Loss of initiative

22. Clinical features (For
Alzheimer’s type)
• Personality changes: lack of interest in
day-to-day activities, easy mental
fatigability, self-centred, withdrawn,
decreased self-care.
• Memory impairment: recent memory is
prominently affected.
• Cognitive impairment: disorientation
poor judgement, difficulty in
abstraction, decreased attention span.

23. Although there are some decreases in metabolism associated with age, in most patients with
Alzheimer’s disease, there are marked decreases in the temporal lobe, an area important in
memory functions.

24. • 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,

25. Diagnosis:
• Following test are used for diagnosis:
• Cognitive assessment evaluation- mini
mental status examination (MMSE) –
shows cognitive impairment
• Functional dementia scale (to indicate
the degree of dementia)
• Magnetic resonance imaging (MRI): of
the brain shows structural and
neurologic changes.
• Spinal fluid analysis shows increased
beta amyloid deposits

27. Treatment modalities:
• Tacrine hydrochloride (cognex)
• Donepezil hydrochloride (Aricept)
NMDA ANTAGONISTS
(N-Methyl-D-aspartate)
• Memantine
ANTIPSYCHOTIC AGENTS
• Risperidone, quetiapine, and
• olanzapine

28. ANTIDEPRESSANT AGENTS AND MOOD
STABILIZERS
• Low doses of the selective serotonin reuptake
inhibitors and other newer antidepressive
agents should be considered.

29. Management:
• Assessment data for the patient with
dementia should include a past health and
medication history.

30. Data to be included for 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

31. • 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.

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

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

34. 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

35. Bibliography:
• R Sreevani, a guide to mental health and
psychiatric nursing,
jaypee publishers,
3rd edition, pg.no: 310-311
• Townsend c Mary, text book on “Psychiatric
Mental Health Nursing.”
Jaypee publications.
5th edition, page 387-405