The document outlines objectives and information regarding dementia, specifically focusing on Alzheimer's disease, its etiology, incidence, risk factors, stages, symptoms, diagnosis, and management. It emphasizes the importance of nursing diagnosis and interventions, along with treatment and rehabilitation strategies for both patients and caregivers. The document aims to enhance understanding of dementia-related disorders and their impact on individuals and families.

1. DEMENTIA

3. OBJECTIVES
At the end of the class the student will be able to,
understand the various terms of organic brain disorder.
describe the etiology of organic mental disoder
list out the classification of organic mental disorders
define dementia of Alzheimer
understand the incidence of Alzheimer dementia
explain the etiology of Alzheimer dementia
enumerate the risk factors of Alzheimer dementia
understand the stages of Alzheimer dementia

4. • identify the signs and symptoms of Alzheimer dementia in patients
• diagnose the Alzheimer dementia through various assessment
• understand the management of Alzheimer dementia
• formulate the nursing diagnosis and its intervention

5. ICD CLASSIFICATION
• F00 –F01 ORGANIC,INCLUDING SYMTOMATIC, MENTAL
DISORDERS
• F00 – Dementia in Alzheimer,s disease
• F01 – Vascular dementia
• F04 – Organic amnestic syndrome
• F05 – Delirium
• F06 – Other mental disorders due to brain damage and dysfunction and
physical disease
• F07 – Personality and behavioral disorders due to brain disease, damage
and dysfunction.

6. INTRODUCTION
Organic brain disorder (OBD) also know as organic
mental syndrome (OMS)
Organic mental disorder is a syndrome or disorder of mental
function whose cause is alleged to be known as organic
(physiologic) rather than purely of mind. As per the DSMV
Classification organic brain disorder has been renamed as
Neuro cognitive disorder.

7. • Dementia was first described by Dr. Alois Alzheimer, a German
neuro pathologist.

10. DEFINITION
Dementia is an acquired global impairment of
intellect, memory and personality but without impairment of
consciousness
(APA
2000)
Dementia as a syndrome due to disease of the brain
usually of chronic or progressive in nature. In which, there is
disturbances of multiple higher cortical functions including memory,
thinking, orientation, comprehension, calculating, learning, capacity,
language and judgment, and consciousness in not clouded.
Occasionally deterioration in emotional control and social behavior

11. INCIDENCE
• According to WHO around 50 million people have dementia and every year there are
nearly 10 million new cases
• One study from north India on Alzheimer disease has shown an incidence of 4.7 per
1000 person
• TN 3 TO 4 % in rural and urban
• In Chennai approximately 10000 peoples affected.

12. COMMON REASONS FOR ALZEMERS
• Alzheimer’s disease caused by a combination of gentle lifestyle and
environmental factors that affect the brain over time.
• The exact cause of Alzheimer’s disease is not fully understood, but at if
core are problems with Brain Proteins such as plagues and tangles.

16. ETIOLOGY
• Significant loss of neurons
• Neurofibrillary tangles – Twisted nerve cell fibers that are the damage
remains of microtubles
• Buildup of amyloid
• Accumulation of beta amyloid, an insoluble protein ( sticky patches)
• Environmental factors: infection, metals, and toxins
• Excessive amount of metal ions, such as zinc and copper, in brain
• Other factors:
• Deficiencies of vitaminsB6,B12
• Early depression
• Serious head injury

17. Untreatable & Irreversible cause:
• Degenerating disorders of CNS
• Alzheimer’s disease – A progressive disease that destroys memory and
other important mental functions.
• Pick’s disease – type of frontotemporal dementia, a neurodegenerative
disease.
• Huntington disease – An inherited condition in which nerve cells in the
brain break down over time.
• Parkinson’s disease – A disorder of the central nervous system that
affects movement, often including tremors. (nerve cell damage in the
brain causes dopamine levels to drop, leading to the symptoms of
Parkinson’s.)

18. Treatable Reversible cause
• Vascular multi – infarct dementia
• Intra cranial space occupying lesion
• Metabolic disorders – hepatic and renal failure
• Endocrine disorders – myxedema & Addison's disease
• Infections – AIDS, Meningitis & encephalitis
• Intoxication – Alcohol, metals
• Anoxia –chronic respiratory disease, anemia
• Vitamin deficiency – thiamine and nicotine
• Miscellaneous – heat stroke & epilepsy

20. RISK FACTORS
• Age: Increasing age is the greatest risk factor for Alzheimer’s Dementia
Alzheimer’s Dementia is not a part of normal aging, but as you grow older the
likelihood of developing Alzheimer’s Dementia increases.
• Family history and genetics: Risk of developing Alzheimer’s is higher if a 1st
degree relative – parent/sibling has the disease.
• Sex: There are more women with the disease because they generally live longer
than men.

21. Contd…
• Down syndrome: Many people with Down syndrome develop Alzheimer’s
Disease.
Signs and symptoms of Alzheimer’s tend to appear 10 to 20years earlier in
people with Down syndrome than they do for the general population.
• Mild cognitive impairment: People who have MCI have a significant risk of
developing dementia.
• Past head trauma: People who have had a severe head trauma have a greater
risk of Alzheimer’s disease.

22. • Poor sleep patterns: Research has shown that poor sleep patterns, such as
difficulty falling asleep of staying asleep, are associated with an increased risk
of Alzheimer’s disease.
• Lifestyle and health/ cardio vascular disease:
Smoking
Diabetes
Obesity
High BP, High Cholesterol

23.  Environmental factors – Infections, metals, such as
excessive amount of zinc and Copper in Brain,
Deficiencies of vitamin B6,B12 and folate
OTHER RISK FECTORS:
Hearing Loss
Untreated Depression
Loneliness / social Isolation
A Sedentary lifestyle

24. PSYCHOPATHOLOGY OF DEMENTIA

25. STAGES OF DEMENTIA

26. STAGE I : EARLY STAGE ( 2 to 4 years )
• Forgetfulness
• Declining interest in environment
• Poor performance at work
• Hesitancy in initiating actions

27. STAGE II : MIDDLE STAGE ( 2 to 12 years )
• Progressive memory loss
• Difficulty in following in simple instructions
• Irritable
• Anxious
• Wandering
• Neglects personal hygiene
• Social isolation

28. STAGE III : FINAL STAGE ( up to a years )
• Weight loss
• Unable to communicate
• Does not recognize family
• Incontinence of urine and feces
• Loses the ability to stand and walk
• Death is usually caused by aspiration pneumonia

29. WARNING SIGNS OF DEMENTIA

30. WARNING SIGNS OF DEMENTIA
• Memory loss
• Difficulty in performing familiar task
• Problem with language
• Disorientation to time and place
• Poor or decreased judgment
• Problems with abstract thinking
• Misplacing the things
• Changes in mood or behavior
• Changes in personality
• Loss of initiatives

31. CLINICAL FEATURES
• Personality changes :
lack of interests in day – to – day activities , easy mental fatigability, self centered &
withdrawn
• Memory impairment:
Recent memory is prominently affected
• Cognitive function
Disoriented , poor judgment and difficulty in abstraction
• Affective impairment:
Labile mood , irritability and depression
• Behavioral impairment:
Stereotyped behavior , alteration in sexual drives and activities

32. • Catastropic reaction:
Agitation, attempt to compensate for defects by
using strategies to avoid demonstrating failures in intellectual
performances, such as changing the subject, cracking joke

33. Neurological impairment:
Aphasia , Agnosia, seizures and headache.

34. Sundowning syndrome:
It is characterized by drowsiness, confusion, ataxia, accidental falls may occur at night when external stimuli, such as light and interpersonal orienting cues are diminished

35. DIAGNOSTIC EVALUATION

36. Physical Investigation
• Hemoglobin , TLC, DLC,
• Blood sugar – In diabetes
• Blood Urea- For renal disease
• Serum creatinine
• Thyroid function test –
Hypo/Hyperthyroidism.
• Liver function test – Liver
disease
• Serum calcium – Para thyroidism
• VDRL – Neurosyphilis
• Serum copper – Wilson’s disease
• HIV – AIDS
• EEG – To find out the focal sign
• ECG – To find out cardiac
problems
• CT – Scan
• MRI – structural and
neurological changes
• CSF - shows increased beta
amyloid deposits

37. Psychological Testing
• History collection
• Psychometric tests usually employed in dementia are:
• a). Wechsler Adult Intelligence Scale (WAIS)
• b). Perceptual functions ,
• c). New Learning as a test of memory
• e). Functional Dementia Scale
• 5).Mini Mental Status Examination

39. MANAGEMENT OF ALZHEIMER’S DISEASE
As is a complex one hence none of the medications
stop or treat the disease but it helps to maintain mental
function, manage behavioral symptoms, and slow down the
symptoms of diseases, thereby it can provide people with
comfort, dignity and independence for a longer period of time.

40. TREATMENT MODALITIES
• T - Tacrin hydrocholoride[cognex]
• T - Donepezil hydrochloride [Aricept]
• Antipsychotic medication
• Benzodiazepines
• Antidepressants
• Anticonvulsants
• Other prophylactic nutritional agents

41. SYMPTOMATIC MANAGEMENT
• Environmental manipulation to reduce stress in day to day activities.
• Treatment of medical complications
• Care of food and hygiene and supportive care for the patient and family.
• Anxiety can be treated with short acting benzodiazepines in low doses.
• Depression can be treated with Trazodone or Miamserin as these agents
have low anticholinergic, activity and low cardiac toxicity. Agents with
anticholinergic activity can cause confusion or frank delirium.

42. 9

43. NURSING MANAGEMENT
• Daily routine
• Nutrition and body weight
• Personal hygiene
• Toilet habits and incontinence
• Accidents
• Fluid management
• Moods and emotions
• Wandering
• Disturbed sleep
• Interpersonal relationship

44. Daily routine

45. Nutrition and body weight

46. Personal hygiene

47. Toilet habits and incontinence

48. Accidents

49. Fluid management &
Moods and emotions

50. Wandering

51. Disturbed sleep

52. INTERPERSONAL RELATIONSHIP

53. NURSING DIAGNOSIS
Nursing Diagnosis for Alzheimer’s Disease (NANDA):
Disturbed Sleep Pattern related to Sensory changes.
Impaired physical mobility related to Neuromuscular damage, Decreased
muscle tone or strength.
Self – care deficit related to Cognitive decline, Physical limitations.
Disturbed Sensory Perception related to Changes in the reception,
transmission, and/or integration.

54. 6. Disturbed thought processes related to Irreversible neuronal degeneration.
7. Ineffective individual coping related to Inability to resolve the issues, intellectual
changes.
8. Impaired verbal communication related to Intellectual changes (dementia,
disorientation, decreased ability to cope with the problem).
9. Impaired social interaction related to Emotional changes (irritability, lack of
confidence).
10. Imbalanced Nutrition, Less than body requirements related to sensory changes, it
is easy to forget
11. Risk for Injury Related to weaknesses, the inability to recognize/ identify hazards
in the environment.

55. Primary Nursing Diagnosis
Self-care deficit related to impaired cognitive and motor function
• Outcomes. Self-care: Activities of daily living- Bathing, Hygiene, Eating,
Toileting; Cognitive ability; Comfort level; Role performance; Social
interaction skills; Hope
• Interventions. Self-care assistance: Bathing and Hygiene; Oral health
management; Behavior management; Body image enhancement; Emotional
support; Mutual goal setting; Exercise therapy; Discharge planning

56. Nursing Intervention:
• Establish an effective communication system with the patient and his family
to help them adjust to the patient’s altered cognitive abilities.
• Provide emotional support to the patient and his family.
• Administer ordered medications and note their effects. If the patient has
trouble swallowing, crush tablets and open capsules and mix them with a
semi soft food.
• Assist the patient with hygiene and dressing as necessary.
• Monitor the patient’s fluid and food intake to detect imbalances.
• Inspect the patient’s skin for evidence of trauma, such as bruises or skin
breakdown.

57. Risk for Injury related to:
• Unable to recognize/identify hazards in the environment.
• Disorientation, confusion, impaired decision making.
• Weakness, the muscles are not coordinated, the presence of seizure
activity.
Nursing Intervention:
• Protect the patient form injury by providing a safe, structured
environment.
• Provide rest periods between activities because the patient tires easily.
• Encourage the patient to exercise as ordered to help maintain mobility.

58. • Encourage patient independence and allow ample time for him to
perform tasks.
• Encourage sufficient fluid intake and adequate nutrition.
• Take the patient to the bathroom at least every 2 hours and make sure he
knows the location of the bathroom.
• Frequently check the patient’s vital signs.
• Encourage the family to allow the patient as much independence as
possible while ensuring safety to the patient and others.

59. FOLLOWUP , HOME CARE AND REHABILITATION
• Family members should be aware of early warning signs ,they are main pillar
support for the patient
• Home care is available through home health agencies, public health agencies &
visiting nurses
• Role of caregiver:
• Caregivers need to known about dementia
• Caregivers must deal with their feelings of loss and grief as the health of their loved
ones continually declines
• Teach the caregiver strategies that promote the patient existing memory, for
example – reminiscence activities, environmental cues, familiar songs, pictures and
pets.

60. Rehabilitation services:
• Provide practical and emotional help and information to the families,
health care professionals and the community
• Alzheimer’s and related disorders society in India ( ARDSI ) started in
1992,a national organization dedicated to dementia care, support and
research

62. THANK YOU