This document provides an overview of dementia, including its definition, classification, types, stages, symptoms, diagnosis, treatment and nursing management. Dementia is defined as the progressive decline in cognitive functions such as memory, thinking, and reasoning due to brain damage or disease. The most common types of dementia discussed are Alzheimer's disease, vascular dementia, Lewy body dementia, and frontotemporal dementia. Dementia is diagnosed based on cognitive assessments and brain imaging and progresses through early, middle, and late stages. Nursing care focuses on safety, communication, and maintaining routines and independence.
This PPT contains all the important guidelines that are needed to manage a patient of Dementia. It involves diagnosis, psychosocial treatment, non-pharmacological management and pharmacological management. This PPT is prepared from NICE, APA and SIGN guidelines.
Dementia is a broad term which describes symptoms affecting memory, thinking ability that creates hindrance in performing daily activities. Two important brain functions are badly hit namely- memory and judgement.
This PPT contains all the important guidelines that are needed to manage a patient of Dementia. It involves diagnosis, psychosocial treatment, non-pharmacological management and pharmacological management. This PPT is prepared from NICE, APA and SIGN guidelines.
Dementia is a broad term which describes symptoms affecting memory, thinking ability that creates hindrance in performing daily activities. Two important brain functions are badly hit namely- memory and judgement.
The world’s population is ageing rapidly, and with it is coming to a significant increase in the number of
older people with dementia. This increase presents major challenges for the provision of healthcare
generally and for dementia care in particular, for as more people have dementia, there will be more
people exhibiting behavioural and psychological symptoms of dementia (BPSD).
BPSD exact a high price from both the patient and the caregiver in terms of the distress and disability
they cause if left untreated. BPSD is recognisable, understandable and treatable. The recognition and
appropriate management of BPSD are important factors in improving our care of dementia patients
and their caregivers,
Dementia is a type of Organic brain disorder . Mainly Alzheimer's type is described in the given ppt . Warning signs and nursing management and also treatment modalities have discussed in the ppt .
The world’s population is ageing rapidly, and with it is coming to a significant increase in the number of
older people with dementia. This increase presents major challenges for the provision of healthcare
generally and for dementia care in particular, for as more people have dementia, there will be more
people exhibiting behavioural and psychological symptoms of dementia (BPSD).
BPSD exact a high price from both the patient and the caregiver in terms of the distress and disability
they cause if left untreated. BPSD is recognisable, understandable and treatable. The recognition and
appropriate management of BPSD are important factors in improving our care of dementia patients
and their caregivers,
Dementia is a type of Organic brain disorder . Mainly Alzheimer's type is described in the given ppt . Warning signs and nursing management and also treatment modalities have discussed in the ppt .
SO GUYS ONCE AGAIN HERE I PRESENT U THE OWN MADE PRESENTATION ON THE TOPIC DEMENTIA I HOPE U LIKE THAT IT IS BEEN USEFUL U WHILE MAKING PSYCHIATRIC PRESENTATION
Organic mental disorders are disturbances that may be caused by injury or disease affecting brain tissues as well as by chemical or hormonal abnormalities.
common ask question:
Is memory loss a natural part of ageing?
Why can’t I remember as well as my wife?
Is it normal to write notes to myself?
Why can’t I remember names?
Is it normal to forget why I went into the kitchen?
Sometimes my mind just goes blank, normal?
Can I slow age related memory changes?
Understand the relation of psychiatry and some common cause of organic brain diseases.
Identify common organic causes of psychiatric presentations
Differentiate dementia and delirium
Principle management of dementia
Identify neuro cognitive domains, differences between major and minor neurocognitive disorders
Dementia is a broad category of brain diseases that cause a long term and often gradual decrease in the ability to think and remember such that a person's daily functioning is affected.
Dementia is acquired global impairment of intellectual, memory and personality but without impairment of consciousness.
This slide contains information regarding Dementia. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated. Thank you!
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6. Introduction
Cognition is that operation of the mind process
by which we become aware of objects , thought
and perception
Organic brain / mental disorder is a general term
refering to many physical disorder that causes
impaired mental functioning resulting in
abnormal behavioural and psychological
symptoms
7. Definition:-
According to WHO Dementia is, 'The
progressive decline in cognitive
functions (particularly affected areas
like thinking, reasoning, memory,
attention, language and problem
solving) due to damage or disease in
the brain beyond, what might be
expected from normal aging.’
8. Classification of organic mental disorder
F00--09- Organic, including symptomatic, mental dysfunction and Disorder
F00 –Dementia in azheimer’s disease
F01- Vascular dementia
F02- Dementia in other disease classified elsewhere
F03- Unspecified dementia
F04- Organic amnestic syndrome
F05- Delirium
F06 –Other mental disorder due to brain damage , dysfunction
and physical disease
F07- Personality and behavioural disorder due to brain
disease,damage and dysfunction
9. Incidence
It Occurs more commonly in the elderly than in middle age.
It increases with age from 0.1% in the below 6 Of years of
age and 15-20% in people above 80 years of age
10.
11. Types of Dementia
There are generally 10 types of Dementia. That are:-
1. Alzheimer’s disease:- It is a progressive condition
that causes neuronal loss in the part of the brain
that responsible for learning, creating memories
and expressing emotions. It’s the most common
form of Dementia.
12. 2. Lewy- body Disease ( LBD ):- LBD is the 2nd most common
type of Dementia. This progressive disease occurs when protein
deposits build up on the nerve cells of the brain stem. Signs of LBD
include the following:
• Muscle rigidity
• Uncontrollable behaviour issues
• Tremors
• Recurring hallucination
• Aggressive behaviour
• Difficulty in sleeping
• Cognitive loss
13. 3. Vascular Dementia:- This form of Dementia
occurs when blood flow to the brain is interpreted.It
is often caused by a stroke, coronary heart disease
or advanced diabetes . Early signs ofvascular
Dementia includes the following:
• Difficulty in concentration
• Inability to communicate thought
• A decline in analytical Thinking
14.
15. 4. Huntington’s Disease (HD):- This form of Dementia is caused by an
inherited defective gene. When a person has HD, there is a 50%
likelihood that their children will develop it too. Signs of HD includes the
following:
• Impaired judgement
• Speech problem
• Depression and Mood diaorders
• Forgetfulness
• Unsteady gait while walking
16. 5. Parkinson’s Dementia:- Parkinson’s disease often
progress to parkinson’s Dementia. Dementia causes
the patient to develop the following symptoms:
• Memory loss
• Poor judgement
• Speech problem
• Difficulty with abstract thoughts
17. 6. Wernicke-korsakoff syndrome (WKS):- This syndrome is
caused by lack of Vitamin B1 or thiamine .It is commonly seen in
alcoholics, cancer patients,long term dialysis patients and people
who are malnourished.Signs of WKS include the following:
• Dropping eyelid
• Double vision
• Hallucination
• Difficulty in processing information
• Aggressive behaviour
18. 7. Frontotemporal Dementia(pick’s disease)
This form of Dementia affects the part of the brain that are
responsible for one’s personality.Signs of this includes:
• Socially inappropriate behaviour
• Impulsive behaviour
• Lack of empathy
• Lack of judgement
• A decline in personal hygiene
19. 9. Creutzfeldt-Jakob Disease:- Creutzfeldt-Jakob disease is one of
the rarest forms of dementia, with only one in a million being
diagnosed with this condition. It progresses rapidly, and people
often die within a year of diagnosis.
Its symptoms are similar to other forms of dementia,
including confusion, memory loss, agitation and
depression. Those with Creutzfeldt-Jakob disease
may also experience muscle twitching and stiffness.
8. Mixed Dementia:- This form of dementia occurs when
a patient experiences two or more types of dementia
simultaneously.
20. 10. Normal Pressure Hydrocephalus:- Normal pressure
hydrocephalus (NPH) is a condition that causes fluid build-up in
the brain’s ventricles, affecting its tissue and leading to
dementia symptoms. Some potential causes of this condition
includes injury, bleeding, infection, brain tumour and previous
brain surgeries.
Those with the condition may experience poor balance,
forgetfulness, mood swings, depression, frequent falls and loss
of bowel or bladder control.
21.
22. Etiology
Significant loss of neurons and volume in brain regions devoted to memory and higher
mental functioning
Neurofibrillary tangels
Buildup of amyloid
Accumulation of beta amyloid,an insoluble protein,which form sticky patches surrounded
by debris of dying neurones
Environmental factors like Infection,metals,toxins
Excessive amount of metal ions such as zinc and coppy ,in brain
Deficiencies of vitamins B6,B12 and folate
23. Possible risk factor due to increase level of
homocysteine ( an amino acid that interfere
with nerve cell repair)
Early depression
Serious head injury
Education level
Increase risk in those with less education than in
those who remain mentally active
24. Untreatable and Irreversible cause of
Dementia
Degenerating disorder of CNS
Alzheimer’s disease ( most common form of Dementing illness)
Pick’s disease
Huntington’s chorea
Parkinson’s disease
25. Treatable and reversible cause of
dementia
Vascular – Multi infract Dementia
Intracranial space occupying lesions
Metabolic diaorder like hepatic failure and renal failure
Endocrine disorder like myxedema, Addison’s disease
Infection like AIDS, meningitis, encephalitis etc
Intoxication- alcohol, heavy metals( lead, arsenic ), chronic barbiturates
poisoning
Anoxia- Anemia ,post anesthesia, Chronic respiratory failure
Vitamin deficiency Especially deficiency of nicotin and thiamine
26.
27.
28. Stages are
1. Stage 1 – Early stage
2. Stage 2- Middle stage
3. Stage 3-late stage
29. 1. Stage 1 ( Early stage)
2 to 4 year of disease
Forgetfullness
Declining Interest in environment
Hesitancy in initiating action
Poor performance at work
30. Stage 2(middle stage)
2 to 12 years of disease
Progressive memory loss
Hesitate in response to questions
Has difficulty in following simple instruction
Irritable, anxious
Wandering
Neglect personal hygiene
Social isolation
31. Stage-3( Final stage )
After 12 years of disease onwards till death
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 usually causes by aspiration pneumonia
32.
33. Clinical features
Personality changes :- Lack of interest in day to day
activities, easy mental fatigability,self centred,
withdrawn, decreased self care.
Memory impairment :- Especially recent memory is
prominently affected.
Cognitive impairment :- Disorientation,poor
judgement, difficulty in abstraction, decreased
attention span.
34. Affective impairment:- Labile mood, irritableness,
depression.
Behavioural impairment:- Stereotyped behaviour, alteration
in sexual drives and activities, neurotic/psychotic behaviour.
Neurological impairment:- Aphasia, apraxia,agnosia, seizure,
headache.
35. Catastrophic reaction:- Agitation, attempt to compensate for defects
by using strategies to avoid demonstrating failure in intellectual
performance, such as changing the subject, cracking jokes,or
otherwise diverting the interviewer.
Sundowner 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.
36.
37. DIAGNOSIS:-
Based on ICD 10 criteria.
Following tests are used for diagnosis:-
1. Cognitive assessment evaluation – Mini Mental Status Examination – Shows
cognitive impairment
2. Functional dementia scale (to indicate degree of dementia)
3. Magnetic resonance imaging (MRI) of the brain shows structural and
neurologic changes
4. Spinal fluid analysis shows increased beta amyloid deposits.
38.
39. TREATMENT MODALITIES:-
Tacrine hydrochloride (Cognex)
Donepezil hydrochloride (Aricept)
Antipsychotic Agents :- Risperidone,
quetiapine and Olanzapine.
Antidepressant Agents and Mood
Stabilizers :- Low doses of the selective
serotonin reuptake inhibitors and other
new antidepressive agents should be
considered.
40. NURSING MANAGEMENT:-
Assessment data for the patient with dementia should include a past health and
medication history.
Data to be included for nursing assessment:
1. Disorientation
2. Mood changes
3. Fear
4. Suspiciousness
5. Self care deficit
6. Social behaviour
41. 7. Level of mobility, wandering behavior
8. Judgement ability
9. Sleep disturbances
10. Apathy
11. Speech or language impairments
12. Hallucinations, illusions or delusions
13. Bowel & bladder incontinence
14. Any decline in nutritional status
15. Recognition of family members
16. Identify primary caregiver, support system
and the knowledge base of the family
members
43. 1. Disturbed thought process may be related to impaired
memory evidenced by memory loss.
Goal:- patient’s impaired thought process will be maintained at a baseline level.
Interventions:-
Assess patient’s ability for thought processing in every shift. Observe patient
for cognitive functioning and memory changes, disorientation, difficulty with
communication or changes in thinking patterns.
Label drawers, use written reminder notes, pictures or color-coding articles to
assist patients.
Provide positive reinforcement and feedback for positive behaviors.
44. Limit decision that patient makes. Be supportive and convey warmth and
concern when communicating with patient.
Provide opportunity for social interaction.
Instruct family members about the
disease process, what can be expected
and assist with providing a list of community
resources for support.
45. 2. Risk for injury r/t disorientation, confusion, impaired
decision making as evidenced by hallucination and delusion.
Goal:- Patient will remain in a safe environment with no complications or injuries obtained.
Interventions:-
Assess patient’s surroundings for hazards and eliminate or minimize their sources.
Divert attention to a patient when agitated or dangerous behaviors like getting out of bed by
climbing the fence bed.
Maintain adequate lighting and clear pathways.
Assess patient for hyperorality.
During the middle and later stages of dementia, the patient must not be left unattended.
Instruct family to keep all the sharp, poisonous and hazardous things away from the patient.
Also instruct family to ensure that patient has hearing aids, glasses if they have a sensory deficit.
46. 3. Impaired Verbal Communication may be related to
Dementia as evidence by aphonia, dyslalia, dysarthria,
inappropriate verbalizations, aphasia, dysphasia, apraxia, dyslexia.
Goal:- Patient will be able to have effective speech and understanding of
communication, or will be able to use another method of communication
and make needs known.
Interventions:-
Monitor the patient for nonverbal communication, such as facial
grimacing, smiling, pointing, crying, and so forth; encourage use of
speech when possible.
Attempt to anticipate patient’s needs.
When communicating with patient, face patient and maintain eye
contact, speaking slowly and enunciating clearly in a moderate or
low-pitched tone.
47. Utilize pencil and paper to write
messages.
Encourage patient to control the
length and rate of phrases, over
articulate words, and separate
syllables, emphasizing consonants.
Provide consultation with speech
therapists, as appropriate.
48. Other nursing interventions for Dementia
includes:-
Maintaining daily routine of the patient.
Providing the patient with appropriate nutrition, fluid and
maintaining their body weight of the patient
Maintaining patient’s personal hygiene , toilet habits and
incontinence
The patient’s wandering symptom must be maintained by
providing them with a identifying bracelet or card.
51. DEMENTIA is one of the most common disease in the older
age group. Also it may occur in any stage of childhood.
Most of the patients with Dementia are misbehaved and
isolated by their family members and the society.
Hence, it’s the duty of the nurse to take the preventive
measures for Dementia and make aware the patients and their
family members about the sign and symptoms of Dementia.
The nurse should also instruct the patient’s family members
about how to take care of the patient at home.
52. BIBLIOGRAPHY:-
Sreevani R , A Guide to Mental Health & Psychiatric Nursing,4th edition, JAYPEE
Publication,page no-304 to 309
K.P
. Neeraja ,Essential of mental health and psychiatric Nursing,3rd Edition.
https://www.slideshare.net/pranayshelokar143/dementia-presentation-57420552
https://www.homage.com.au/health/dementia/