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SHAAKERA SUBJEE AND SHAREEKA ANGAMIA-DEMENTIA PRESENTATION
- 6. Dementia IS NOT a specific disease. Dementia is a GROUP OF SYMPTOMS affecting intellectual and social abilities severely enough to interfere with daily functioning. Memory loss generally occurs in dementia, but memory loss alone does not imply you have dementia. DEMENTIA Alzheimer's disease is the most common cause of a progressive dementia. There are many causes of dementia symptoms.
- 8. Normal cognitive decline associated with age: *Structural changes –size, weight and neurons *Varying degrees of cortical atrophy *Memory and speed of processing decline Normal Cognitive Decline Dementia Mild Cognitive Decline (MCD)
- 9. Transitional Phase-increased probability of developing dementia AGE-INCREASES PROBABILITY! Amnestic type: memory impairment (without the generalized deficits) Non-amnestic: other domain is affected Dementia Normal Aging Mild Cognitive Decline (MCD)
- 10. Dementia Normal Cognitive Decline Mild Cognitive Decline (MCD) Behavioural Syndrome with cognitive and emotional symptoms that affect everyday life. Memory impairment + Other cognitive impairments More than 50 known causes Generally Progressive
- 11. Develops due to brain disease Chronic and progressive in nature Consciousness remaining intact Deterioration of higher order cognitive functioning Disturbances in social behaviour, emotional control and motivation
- 12. The essential feature of any dementia is the development of multiple cognitive deficits that include: • memory impairment and at least one of the following cognitive disturbances: • • • • aphasia (language disturbance), apraxia (impaired ability to carry out motor activities despite intact motor function), agnosia (failure to recognize or identify objects despite intact sensory function), and executive dysfunction (difficulty in planning, organizing, sequencing, abstracting). The deficits must also be sufficiently severe and must represent a decline from a previously higher level of functioning. The diagnosis of dementia may be accompanied by subtypes and specifiers such as • Early (before the age of 65) or Late Onset (after 65) • With Behavioral Disturbance (e.g., wandering, striking out during care); • With Delirium (if delirium is superimposed on dementia); • With Delusions (if delusions are most prominent feature); • With Depressed Mood (if depressed mood is most prominent feature); and • Uncomplicated (if none of the aforementioned predominates the clinical presentation).
- 15. Changes in mood and personality Withdrawal from work or social activities Decreased or poor judgment Memory loss that disrupts daily functioning Challenges in planning or solving problems WARNING SIGNS Misplacing things and losing the ability to retrace steps New problems with words in speaking or writing Difficulty completing familiar tasks at home, at work or at leisure Confusion with time or place Trouble understanding visual images and spatial relationships
- 16. CLINICAL DEMENTIA RATING SCALE NONE (O) QUESTIONNABLE (0.5) MILD (1) MODERATE (2) SEVERE (3) MEMORY OK CONSISTENT FORGETFULNES S MEMORY LOSS FOR RECENT EVENTS ONLY HIGH LEARNING MATERIAL RETAINED ONLY FRAGMENTS REMAIN ORIENTATI-ON FULLY DIFFICULTY WITH TIME GEOGRAPHIC TIME AND PLACE ONLY PERSON JUDGEME-NT AND PROBLEM SOLVING GOOD SLIGHT IMPAIRMENT SOCIAL JUDGMENT OK, DIFFICULTIES WITH SIMILARITIES AND DIFFERENCES ISSUES WITH SOCIAL JUDGEMENT SEVERELY IMPAIRED PROBLEM SOLVING UNABLE TO MAKE JUDGEMENTS
- 17. NONE 0 QUESTIONABLE 0.5 MILD 1 MODERA-TE 2 SEVERE 3 COMMUNITY AFFAIRS Independent to work, shop and have social life Slight impairment Unable to be independent but still engaged Well at home but not outside No responsibilities in or out the home HOME & HOBBIES Maintained Slight impairment Complicated hobbies or chores abandoned Only simple chores maintained. Low interest No function PERSONAL CARE Fully capable Fully capable Needs prompting Need assistance Help with personal care & incontinence
- 19. CORTICAL • ALZHEIMER’S DISEASE • Genetic hypothesis: chromosomes 1, 14, 21 • Neuropathology: cortical atrophy, amyloid plaques and neurofibrillary tangles • General cognitive decline with severe memory impairment SUBCORTICAL • Huntington’s Disease • Genetic: ITI5 on chromosome 4. Abnormal repetitions • Neuropathology: deterioration of the caudate nucleus, globus pallidus, putamen and striatum • Motor functioning and frontal functioning affected
- 23. STATIC • Heavy Metal Poisoning • The whole system is affected, including the brain • Cognitive decline and behavioural changes that can be stopped by ending the exposure or with detox treatment PROGRESSIVE • • • • Vascular Dementia Blood supply is affected (multi-infarcts) Damage to multiple areas of the brain Cognitive decline + hallucinations/delusions , personality changes
- 24. REVERSIBLE • • • • Severe Anemia Memory loss (holes). Cognitive decline similar to AD Lack of vitamin B12 that can be reverted with treatment IRREVERSIBLE • Parkinson’s Dementia • Motor symptoms of tremor, rigidity, and slowness of movement. • Loss of dopamine from the substantia nigra
- 27. PSYCHOLOGICAL AND BEHAVIOURAL DISTURBANCES Depression • Reaction to early cognitive decline • Less prevalent in severe dementia due to impaired awareness • Vascular dementia more susceptible • Early Onset-Dementia as a predictor of severity Psychotic Disturbances • Approximately 50% will display disturbances • DELUSIONS- 1/3 will display persecutory delusions not attributed to memory impairment • Moderate Level • HALLUCINATIONS- less frequent • More significant relationship with cognitive decline • Associated with a rapid decline at a more severe stage Behavioural Problems • Agitation, irritability, fatigue, tiredness, apathy, psychomotor behaviours, anxiety and sadness. • AD patients with co-morbid psychotic symptoms more likely to display severe aggression and behaviour problems • Pre-morbid communication emulated • RISK FACTORS: • Genetics, personality variables, location of deterioration • Social implications on self and caregiver
- 32. Shultz (2004) defines the role of caregiving as: “… the provision of extraordinary care, exceeding the bounds of what is normative or usual in family relationships. Caregiving typically involves a significant expenditure of time, energy, and money over potentially long periods of time; it involves tasks that may be unpleasant and uncomfortable and are psychologically stressful and physically exhausting” (259).
- 38. “Stigma is an attribute, behaviour, or reputation which is socially discrediting in a particular way: it causes an individual to be mentally classified by others in an undesirable, rejected stereotype rather than in an accepted , normal one” (Goffman, 1963, as cited in Batsch, & Mittelman, 2012).
- 39. CAREGIVER & PATIENT COUNSELLING FOR ACCEPTANCE COMBATING STIGMA INVOLVE MEDIA, GOVERNMENT,O THER STRUCTURAL SERVICES RAISE AWARENESS –CAMPAIGNS, EDUCATIONAL PROGRAMS
- 41. -2011, 5.5 million individuals living with HIV in S.A Challenges when screening for HAD:language, culture, inadequate resources., inappropriate tools, untrained staff. Risk Factors: lower CD4 count, older age, lower levels of education, depression, substance abuse . Prevalence: 25.4% of adults living with HIV met the criteria for HAD. -International HIV Dementia Scale (IHDS) Consequences: In addition to HIV, cognitive impairments such as poor concentration, attention and executive functioning Sample of 65 nonadherent HIV patients 8O% screened positive for HAD
- 42. FREQUENTLY ENGAGE IN MENTALLY STIMULATING ACTIVITIES REGULAR PHYSICAL ACTIVITY NUTRITION AL DIETS, MODERATELOW ALCOHOL INTAKE ENGAGE IN SOCIAL ACTIVITIES TAKING CARE OF MENTAL HEALTH
- 43. • Nerve growth factor (NGF) • No fewer than 10 drugs • Cognitive training • Reality orientation • Reminiscence therapy • Cognitive rehabilitation • Psychodynamic Therapy • Support groups •Public education •Training professionals •Developing programs •Integrating services