Dementia consists of verity of symptoms that suggest chronic dysfunction. Global impairment of intellect is the essential feature, manifested as difficulty with memory, attention, thinking, and comprehension Approximately 15% of people with dementia have reversible illness if treatment is initiated before irreversible damage takes place.

1. DEMENTIA
MR. VIHANG TAYDE

2. INTRODUCTION
Dementia consists of verity of symptoms that
suggest chronic dysfunction. Global impairment
of intellect is the essential feature, manifested as
difficulty with memory, attention, thinking, and
comprehension

3. Other mental function can also be affected
including mood, personality, judgment, and
social behavior. Although specific diagnostic
criteria are found for various dementias, such as
Alzheimer’s diseases or vascular dementia, all
dementia have certain common elements that
results in significant impairment in social or
occupational functioning and causes a significant
decline from a previous level of function.

4. Approximately 15% of people with dementia
have reversible illness if treatment is initiated
before irreversible damage takes place.

5. EPIDEMIOLOGY
Dementia occurs more commonly in the elderly
than the middle aged. It increases with the age
from 0.1% in those below 60years of age to 15 to
20% in those who are 80years of age.

6. With the aging population, the prevalence of
dementia is rising; the prevalence of moderate to
severe dementia in different population groups is
approximately 5% in the general population
older then 65years of age, 20 to 40% in the
general population older than 85 years of age, 15
to 20% in outpatient general medical practices
and 50% in chronic care facilities.

7. Off all patients with dementia, 50 to 60% have
the most common type of dementia, dementia of
the Alzheimer’s type. The second common type
of dementia is vascular dementia which is
causally related to cerebrovascular diseases.
Vascular dementia account for 15 to 30% of all
dementia.

8. ETIOLOGY
1.Significant loss of neurons and volume in
brain regions devoted to memory and higher
mental functioning
2.Environmental factors: infection, metals and
toxins.

9. 3. Excessive amount of metal ions, such as zinc
and copper, in brain
4. 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

12.  Infections- AIDS, meningitis, encephalitis
 Intoxication- Alcohol, heavy metals (lead,
arsenic),
 Anoxia- Anemia, post-anesthesia, chronic
respiratory failure

13. STAGES OF DEMENTIA
1.Stage I: Early stage (2 to 4 years):
2.Stage II: Middle stage (2 to 12 years):
3.Stage III: Final stage (up to a year):

14. Stage I: Early stage (2 to 4 years):
 Forgetfulness
 Declining interest in environment
 Hesitancy in initiating actions
 Poor performance at work

15. Stage II: Middle stage (2 to 12
years):
 Progressive memory loss
 Hesitates in response to questions
 Has difficulty in following simple instructions
 Irritable, anxious

16.  Wandering
 Neglects personal hygiene
 Social isolation

17. 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

18.  Incontinence of urine and feces
 Loses the ability to stand and walk
 Death is caused by aspiration pneumonia

19. TYPES OF DEMENTIA:
1.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 behavior

20. 2. Subcortical dementia:
Dementia that affects parts of the brain below
the cortex. Subcortical dementia tends to cause
changes in emotions and emotions and
movement in addition to problems with
memory.

21. 3. Progressive dementia
Dementia that gets worse over time, gradually
interfering with more and more cognitive
abilities.

22. 4. Primary dementia
• Dementia such as Alzheimer's disease, in
which the dementia itself is the major signs of
some organic brain diseases not directed
related to any other organic illness.

23. 5. Secondary dementia:
• Dementia that occurs as a result of a physical
disease or injury, such as HIV diseases or
cerebral trauma.

24. DIAGNOSTIC CRITERIA
1.DSM-IV-TR Diagnostic Criteria for dementia
of the Alzheimer’s Type:
A)The development of multiple cognitive defects
manifested by both,
1.Memory impairment (impair ability to learn new
information or recoll the learn information)

25. 2. One or more of the following cognitive disturbances:
 Aphasia (language disturbance)
 Apraxia (impair ability to carry out motor activity’s)
 Agnosia ( failure to recognized of identify objects)
 Disturbance in executive functioning (i.e: planning,
organizing, abstracting, sequencing)
B) The course is characterized by gradual onset and
continuing cognitive decline.

26. 2. DSM-IV-TR Diagnostic Criteria for
Vascular Dementia:
A)The development of multiple cognitive defects
manifested by both,
1.Memory impairment (impair ability to learn
new information or recall the learn
information)

27. 2. One or more of the following cognitive
disturbances:
 Aphasia (language disturbance)
 Apraxia (impair ability to carry out motor
activity’s)
 Agnosia ( failure to recognized of identify
objects)
 Disturbance in executive functioning (i.e:
planning, organizing, abstracting, sequencing)

28. B) Focal neurological signs and symptoms
(e.g: exaggeration of deep tendon reflex,
extensor planter response, weakness of an
extremity.
C) The defect does not occur during the onset
of a delirium.

29. 3. DSM-IV-TR Diagnostic Criteria For
Dementia Due To Other Medical Conditions.
A)The development of multiple cognitive defects
manifested by both,
1.Memory impairment (impair ability to learn
new information or recall the learn
information)

30. 2. One or more of the following cognitive
disturbances:
o Aphasia (language disturbance)
o Apraxia (impair ability to carry out motor
activity’s)
o Agnosia ( failure to recognized of identify objects)
o Disturbance in executive functioning (i.e:
planning, organizing, abstracting, sequencing)

31. • E.g: HIV infection, traumatic brain injury,
Parkinson diseases, Huntington’s diseases,
pick diseases, hypothyroidism, normal –
pressure hydrocephalus, brain tumor, etc.

32. 4. DSM-IV-TR Diagnostic Criteria For
Dementia Due To Multiple Etiologies
A)The development of multiple cognitive defects
manifested by both,
1.Memory impairment (impair ability to learn
new information or recall the learn
information)

33. 2. One or more of the following cognitive
disturbances:
o Aphasia (language disturbance)
o Apraxia (impair ability to carry out motor activity’s)
o Agnosia ( failure to recognized of identify objects)
o Disturbance in executive functioning (i.e: planning,
organizing, abstracting, sequencing)

34. ICD 10 CLASSIFICATION:
(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

35.  (F04) organic amnestic syndrome, not induced
by alcohol and other psychoactive substances
 (F05) delirium not induced by alcohol and
other psychoactive substances
 (F06) Other mental disorders due to brain
damage and dysfunction and to physical
disease

36.  (F07) personality and behavioral disorders due
to brain disease, damage and dysfunction
 (F09) unspecified organic or symptomatic
mental disorder.

37. • F00 Dementia in Alzheimer's disease
o F00.0Dementia in Alzheimer's disease with early
onset
o F00.1Dementia in Alzheimer's disease with late
onset
o F00.2Dementia in Alzheimer's disease, atypical or
mixed type
o F00.9Dementia in Alzheimer's disease, unspecified

38. • F01Vascular dementia
o F01.0Vascular dementia of acute onset
o F01.1Multi-infarct dementia
o F01.2Subcortical vascular dementia
o F01.3Mixed cortical and subcortical vascular
dementia
o F01.8Other vascular dementia
o F01.9Vascular dementia, unspecified

39. • F02Dementia in other diseases classified
elsewhere
o F02.0Dementia in Pick's disease
o F02.1Dementia in Creutzfeldt-Jakob disease
o F02.2Dementia in Huntington's disease
o F02.3Dementia in Parkinson's disease
o F02.4Dementia in human immunodeficiency virus
[HIV] disease
o F02.8Dementia in other specified diseases
classified elsewhere

40. • F03Unspecified dementia
A fifth character may be added to specify
dementia in F00-F03, as follows:
o F03.0 Without additional symptoms
o F03.1 Other symptoms, predominantly delusional
o F03.2 Other symptoms, predominantly
hallucinatory
o F03.3 Other symptoms, predominantly depressive
o F03.4 Other mixed symptoms

41. CLINICAL FEATURE OF
DEMENTIA
 Forgetfulness (loses things, forget numbers)
 Confusion with performing simple tasks
 Poor concentration,
 Confusion about month and season

42.  Problems in learning new skills and ideas
 Disorientation in time, place, and person
 Aphasia (impairment in speech)
 Amnesia.
 Suspiciousness

43.  Inappropriate sexual behavior
 Unable to dress, groom and toilet self.
 Wondering
 Misplacing things
 Changes in personality

44. TREATMENT:
Medications used in treating the Alzheimer’s
diseases are,
1.Tacrine hydrochloride (cognex)
2.Donepezil hydrochloride (Aricept)

45. 3. ANTIPSYCHOTIC AGENTS
 Risperidone,
 Quetiapine, And
 Olanzapine
4. Anticonvulsant to control seizures

46. 5. ANTIDEPRESSANT AGENTS AND
MOOD STABILIZERS
Low doses of the selective serotonin reuptake
inhibitors and other newer anti-depressive agents
should be considered.

47. NURSING DIAGNOSIS
1.Potential for injury related to disorientation as
evidence by muscular in co-ordination.
2.Potential for violence related to hallucination
as evidence by agitation

48. 3. Alteration thought process related to vascular
diseases as evidence by delusional/memory
defect.
4. Disturbance is self-concept related to loss of
independent functioning a evidence by social
isolation.

49. NURSING INTERVENTION
 Daily routine
 Nutrition & body weight
 Personal hygiene
 Toilet habits and incontinence
 Accidents
 Fluid management

50.  Moods and emotions
 Wandering
 Disturbed sleep
 Interpersonal relationship

51. CONCLUSION
• Dementia is an acquired global impairment of
intellect, memory an personality but without
impairment of consciousness.
• Dementia occurs more commonly in the elderly
than the middle aged. It increases with the age
from 0.1% in those below 60years of age to 15 to
20% in those who are 80years of age

52. Dementia consists of verity of symptoms that
suggest chronic dysfunction. Global impairment
of intellect is the essential feature, manifested as
difficulty with memory, attention, thinking, and
comprehension

53. SUMMARY:

54. BIBLIOGRAPHY
1.Kaplan And Sadock’s, Synopsis Of Psychiatric
Behaviour Sciences, 10th Edition , Page No:
329, 335, 337
2.R. Sreevani, A Guide To Mental Health &
Psychiatric Nursing, JAYPEE BROTHERS,
3rd Edition 2010; Page No – 245-249

55. 3. Anbu.T; Text Book Of Psychiatric Nursing;
EMMESS., 1st Edition 2010; Page No- 190-192.
4. R.K.Gupta, New Approach To Mental Health
Nursing, 2011 Edition

56. Thank you….