Ms. Sreeja V, RN,BSN, DPN, Central Institute of Psychiatry, Ranchi, India

Outline

• Introduction
• Etiology
• Epidemiology
• Sign & Symptoms
• Types of Dementia
• Assessment & Management
• Nursing Management
• Nursing care plan
• Problems of the carer
• Pre and Post Test
• Bibliography
• Glossary

I. INTRODUCTION
Dementia is the most common psychiatric disorder on the later age. It is an irreversible disorder a general description of dementia is to indicate the minimum requirement for diagnosis of dementia is followed by the criteria that govern the diagnosis of more specific years. The word dementia has been in use for at least 200 years, in 1874, Maudesley used the term “Dementia” in relation to memory impairment.

Dementia is a chronic organic mental disorder and it is a syndrome due to disease of brain, chronic or progressive nature. Dementia is characterized by generalized Psychological dysfunction of higher cortical functions, with out impairment of consciousness. In fully developed dementia the higher cortical, functions affected include memory thinking, orientation, and comprehension, calculation, learning capacity, language and judgment.

The critical clinical points of dementia are the identification of the syndrome and the clinical workup of the cause.  The disorder may be progressive or static permanent or reversible. An underlying cause is always assumed, although in rare cases it is impossible to determine a specific cause. The potential reversibility of dementia is related to the underlying pathological condition and availability and application of effective treatment. Approximately 15 percent of people with dementia have reversible illness, if treatment is initiated before irreversible damage takes place.

In assessing the presence or absence of dementia special care should be taken to avoid false, positive, identification motivational or emotional factors. Dementia produces an appreciable decline in intellectual functioning, interference with personnel activities of daily living such as washing, dressing, eating, personal hygiene, excretory and toilet activities changes in role performance occur such as lowered ability to keep or find job should not be used as criteria of dementia because of the large cross cultural difference exist in appropriate because frequent, externally imposed changes in the availability or work.

The term dementia has been used in a variety of way. It was introduced in to American Neuropsychiatric Terminology by Benjamin Rush in 1812. He borrowed the term from Pinel , the great French Psychiatrist who has used it to refer to patients with intellectual deterioration and idiocy . Since its introduction the term has been defined and redefined each new meaning reflecting the progressive evolution of knowledge concerning the types of disorders that produce intellectual deterioration as well as changing conceptions about criteria for identifying and diagnosing dementia.

Currently dementia is often used synonymously with organic brain syndrome. The later is too broad to be used meaningfully since it includes focal syndromes such as aphasia and amnesia as well as the Dementias.

DEFINITION

According to ICD – 10

1). ICD- 10 defines 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 social behaviour or motivation also seen.

2). Dementia is characterized by multiple cognitive defects that include impairment in memory without impairment in consciousness. The cognitive functions that can be affected in dementia include general intelligence, learning and memory, language, problem solving, orientation, perception, attention and concentration, judgment and social abilities.

3). Dementia can be considered as a global impairment of intelligence, memory and personality in clear consciousness . It can occur a any age but become more frequent with age, with a prevalence of 5% - 10% in the over 65s and 20% in the over 80s. It is seen more frequently in women, due to their increased longevity.