Dementia is an acquired global impairment of intellect, memory and personality but without impairment of consciousness“ Or According to WHO Dementia is a syndrome in which there is deterioration in cognitive function beyond what might be expected from the usual consequences of biological ageing. 

1. Dementia
By
• Nikita Gankure
• Ty Basic B.sc Nursing

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. History of Dementia
In 1906, Alzheimer, who looked at post-mortem brains of
affected younger people, published the first case - a 50-
year-old woman with dementia symptoms. After her death,
Alzheimer saw the microscopic plaques and tangles now
known as hallmarks of the disease.

4. Dr. Alois Alzheimer
(German psychiatrist and neuropathologist)
(14 June 1864 - 19 December 1915)

5. Definition
"Dementia is an acquired global impairment of intellect, memory
and personality but without impairment of consciousness“
Or
According to WHO
Dementia is a syndrome in which there is deterioration in
cognitive function beyond what might be expected from the
usual consequences of biological ageing.

6. CLASSIFICATION OF DEMENTIA -BASED ON SITE :
Cortical
# Higher Cortical
Abnormalities
#Dysphasia, Agnosia,
Apraxia
# Eg. Alzheimer’s
Disease
Sub Cortical
# APATHETIC
# FORGETFUL & SLOW, POOR
ABILITY TO USE KNOWLEDGE
# ASSOCIATED WITH OTHER
NEUROLOGICAL SIGNS &
MOVEMENT DISORDERS
#Eg PARKINSON'S DISEASE,
AIDS DEMENTIA COMPLEX

8. Anterior Posterior
# FRONTAL PREMOTOR CORTEX
# BEHAVIOURAL CHANGES,LOSS
OF INHIBITION,ANTI-SOCIAL
BEHAVIOUR, FACILE &
IRRESPONSIBLE
# Eg: NORMAL PRESSURE
HYDROCPHALUS,HUNTINGTON’S
CHOREA, METABOLIC DISEASE
#PARIETAL & TEMPORAL LOBES.
#DISTURBANCE OF COGNITIVE
FUNCTION (MEMORY &
LANGUAGE) WITHOUT
MARKED CHANGE IN
BEHAVIOUR.
#Eg: ALZHEIMER'S DISEASE

9. Types of Dementia (Based on Cause) :
• Alzheimer's disease.
• Vascular dementia.
• Dementia with Lewy Bodies (DLB)
• Parkinson's Disease dementia
• Mixed Dementia
• Frontotemporal Dementia(FTD)
• Huntington's Disease
• Creutzfeldt-Jakob Disease
• Normal Pressure Hydrocephalus
• Wernicke-Korsakoff Syndrome
• AIDS-Dementia complex

10. Alzheimer's Disease :
Experts think between 60% to 80% of people with dementia have this disease. More
than 5 million Americans have been diagnosed with Alzheimer's. It's what most people
think of when they hear "dementia.
"If someone you know has Alzheimer's, you'll notice symptoms such as memory loss and
trouble planning and doing familiar tasks. The symptoms are mild at first but get worse
over a number of years.
The victim might :
• Be confused about where they are or what day or year it is
• Have problems speaking or writing
• Lose things and be unable to backtrack to find them
• Show poor judgment
• Have mood and personality changes.

12. Vascular Dementia :
It's usually because they had a major stroke, or one or more
smaller, "silent" strokes, which can happen without them realizing
it.
The symptoms depend on which part of their brain was affected
by the stroke.
While Alzheimer's usually begins with memory problems, vascular
dementia more often begins with poor judgment or trouble
planning, organizing, and making decisions.

13. Other symptoms of vascular dementia may include:
• Memory problems that disrupt your loved one's daily life
• Trouble speaking or understanding speech
• Problems recognizing sights and sounds that used to be familiar
• Being confused or agitated
• Changes in personality and mood
• Problems walking and having frequent falls

14. Vascular Dementia

15. Dementia With Lewy Bodies (DLB):
Lewy bodies are microscopic deposits of a protein that
form in some people's brains. They're named after the
scientist who discovered them. If someone you know gets
DLB, it's because these deposits have formed in the part of
the brain called the cortex.

16. The symptoms of DLB includes :
• Problems thinking clearly, making decisions, or paying attention Memory trouble
• Seeing things that aren't there, known as visual hallucinations
• Unusual sleepiness during the day
• Periods of "blanking out" or staring
• Problems with movement, including trembling, slowness, and trouble walking
• Dreams where you act out physically, including, talking, walking, and kicking

17. Dementia With Lewy Body

18. Parkinson's Disease Dementia :
People with the nervous system disorder Parkinson's
disease get this type of dementia about 50% to 80% of
the time. On average, the symptoms of dementia
develop about 10 years after a person first gets
Parkinson’s. This type is very similar to DLB (dementia
with lewy bodies). They have the same symptoms, and
people with both conditions have signs of Lewy bodies in
their brains.

19. What is difference between
PARKINSON'S and LEWY BODIES
DEMENTIA ?

20. PARKINSON’S LEWY BODIES
When motor deficits
(eg, tremor, bradykinesia,
rigidity) precede and are
more severe than cognitive
impairment, Parkinson
disease dementia is usually
diagnosed.
When early cognitive
impairment (particularly
executive dysfunction) and
behavioral disturbances
predominate, dementia with
Lewy bodies is usually
diagnosed

21. Mixed Dementia

22. Mixed Dementia is a combination of two
types of dementia. The most common
combination is Alzheimer's disease and
vascular dementia.

23. Frontotemporal Dementia (FTD)
The victim with an FTD, they have developed cell damage in areas of
the brain that control planning, judgment, emotions, speech, and
movement.
Someone with FTD may have:
• Personality and behavior changes
• Sudden lack of inhibitions in personal and social situations
• Problems coming up with the right words for things when speaking
• Movement problems, such as shakiness, balance problems, and muscle
spasms

24. Fronto-temporal Dementia (FTD)

25. Huntington's Disease :
This is a brain disorder caused by a genetic defect that's passed down through
family members. While victim might have the gene for Huntington's
disease at birth, the symptoms don’t usually start to show up until they are
between the ages of 30 and 50.
People with Huntington's get some of the same symptoms seen in other
forms of dementia,
including problems with:
• Thinking and reasoning
• Memory
• Judgment
• Planning and organizing
• Concentration

26. Huntington's Disease

27. Creutzfeldt-Jakob Disease :
This is a rare condition in which proteins called prions cause normal proteins in the
brain to start folding into abnormal shapes. The damage leads to dementia symptoms
that happen suddenly and quickly get worse.
Victim might have:
• Memory and concentration problems
• Poor judgment
• Confusion
• Mood swings
• Depression
• Sleep problems
• Twitching or jerky muscles
• Trouble walking

28. Normal Pressure Hydrocephalus :
This type of dementia is caused by a buildup of fluid in the
brain. The symptoms include problems walking, trouble thinking
and concentrating, and personality and behavior changes.
Some symptoms can be treated by draining the extra fluid from
the brain into the abdomen through a long, thin tube, called a
shunt.

29. Symptoms of normal pressure Hydrocephalus may
includes :
• Trouble walking (feels like the feet are stuck to the
ground)
• Poor balance.
• Falling.
• Changes in the way you walk.
• Forgetfulness and confusion.
• Mood changes.
• Depression.
• Difficulty responding to questions.

30. Normal Pressure Hydrocephalus
Shunt

31. Wernicke-Korsakoff Syndrome :
This disorder is caused by a severe shortage of thiamine (vitamin
B-1) in the body. It most commonly happens in people who are
long-term heavy drinkers.
The dementia symptom that's most common with this condition
is a problem with memory. Usually a person's problem-solving
and thinking skills aren't affected.

32. HIV Infection (AIDS-Dementia complex) :
A condition that leads to the loss of intellectual abilities such as memory, judgment, and
abstract thinking. It can also cause changes in personality.
AIDS Dementia Complex (or ADC) is a type of dementia that occurs in advanced stages of
AIDS (acquired immune deficiency syndrome)
These are some of the first signs :
• Short attention span
• Trouble remembering
• Poor judgment
• Slowed thinking and longer time needed to do tasks
• Irritability
• Unsteady gait, tremor, or trouble staying balanced
• Poor hand coordination
• Social withdrawal or depression

33. AIDS-Dementia complex

34. Stages of Dementia
Stage 1 : Early Stage (2 to 4 years)
Stage 2 : Middle Stage (2 to 12 years)
Stage 3 : Final Stage ( up to a year)

35. Mid (2 to 4 years) Moderate (2 to 12 years) Severe (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

36. Diagnosis Stage Signs and Symptoms Expected Duration of Stage
No Dementia
Stage 1:
No Cognitive Decline
– Normal function
– No memory loss
– People with NO dementia are considered in
Stage 1
N/A
No Dementia
Stage 2:
Very Mild Cognitive Decline
– Forgets names
– Misplaces familiar objects
– Symptoms not evident to loved ones or doctors
Unknown
No Dementia
Stage 3:
Mild Cognitive Decline
– Increased forgetfulness
– Slight difficulty concentrating
– Decreased work performance
– Gets lost more frequently
– Difficulty finding right words
– Loved ones begin to notice
Average duration of this stage
is between 2 years and 7 years.
Global Deterioration Scale (CGS) / Reisberg Scale :

37. Diagnosis Stage Signs and Symptoms Expected Duration of Stage
Early-stage
Stage 4:
Moderate Cognitive
Decline
– Difficulty concentrating
– Forgets recent events
– Cannot manage finances
– Cannot travel alone to new places
– Difficulty completing tasks
– In denial about symptoms
– Socialization problems: Withdraw from
friends or family
– Physician can detect cognitive problems
Average duration of this stage
is 2 years.
Mid-Stage
Stage 5:
Moderately Severe
Cognitive Decline
– Major memory deficiencies
– Need assistance with ADLs (dressing, bathing,
etc.)
– Forgets details like address or phone number
– Doesn’t know time or date
– Doesn’t know where they are
Average duration of this stage
is 1.5 years.

38. Diagnosis Stage Signs and Symptoms Expected Duration of Stage
Mid-Stage
Stage 6:
Severe Cognitive Decline
(Middle Dementia)
– Cannot carry out ADLs
without help
– Forgets names of family
members
– Forgets recent events
– Forgets major events in past
– Difficulty counting down
from 10
– Incontinence (loss of bladder
control)
– Difficulty speaking
– Personality and emotional
changes
– Delusions
– Compulsions
– Anxiety
Average duration of this stage
is 2.5 years
Late-Stage
Stage 7:
Very Severe Cognitive Decline
(Late Dementia)
– Cannot speak or
communicate
– Require help with most
activities
– Loss of motor skills
– Cannot walk
Average duration of this stage
is 1.5 to 2.5 years.

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

40. • 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.

41. Causes of Dementia :
Degenerative
Alzheimer's disease
Parkinson's disease
Pick's disease
Emotional
Depression
psychosis
Metabolic
liver/kidney failure,
toxins,
Endocrine
Hypothyroidism
Neurologic
Normal pressure
hydrocephalus
Traumatic/ tumors
brain injury
cancer
Infectious
Bacterial
Fungal
viral
prion
Autoimmune
multiple sclerosis
lupus
Stroke
brain infarction
hemorrhage

42. • 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
Treatable and reversible causes of dementia :

43. • 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:
• Di Subdural hematoma

44. 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

45. • 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."
Clinical features

46. • 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,

47. Diagnostic Evaluation :
• 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.

48. Pharmacological Management :
• Tacrine hydrochloride (cognex)
• Donepezil hydrochloride (Aricept)
NMDA ANTAGONISTS.
• Memantine
ANTIPSYCHOTIC AGENTS
• Risperidone, quetiapine, and
olanzapine

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

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

51. 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

52. • 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.

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

54. 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 we need to get aware about the preventive
measures of dementia and educative the individuals
about its signs and symptoms with its treatment.