Sreeja V, RN,BSN, DPN*

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

 XII. PRE AND POST TEST

Time – 1 hour
Total Mark – 25

XIII  ANSWER KEY

1). ICD – 10 define 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, consciousness is not clouded, occasionally deterioration in emotional control, social behaviour or motivation seen.

2)

a)  Alzheimer’s disease
b)  Pick’s disease
c)  Huntington’s chorea
d)  Lewy body disease

3)   

a)  Sustained uremia
b)  Liver failure
c)  Hyponatremia
d)  Hypocalcemia

4) 

a)  Dementia is Alzheimer’s disease
b)  VAScular dementia
c)  Dementia in Parkinson's disease
d)  Alcoholism dementia

5)       a)  Simple deterioration
          b)   Paranoid  reaction

6)  

a)  Rigidity
b)  Shuffling gait
c)  Mask like face
d)  Mumbling of speech
e)  Hypokinesia
f)  Difficulty in co-ordination

7)

a) emotional blunting
b)  Coarsening of social behaviour
c)  Disinhibition
d)  Apathy & Aphasia

8)

a)  Pyramidal symptoms
b)  Extra pyramidal symptoms
c)  Cerebellar symptoms
d)  Visual impairment

9)     

a)  Emotional in continence
b) Threshold effect
c) Incongruous emotion
d) Catastrophic reaction

10.     False
11.     True
12)

a) Maintenance of optimal cognitive  functions.
b) Maintenance of Physical safety.
c) Maintenance of an optimal level of psychological functioning .
d) Attainment of an optimal exchange of ideas between the patient and others.
e) Maintenance of maximum independence in activities of daily living.
f) Maintenance of optimal level of nutrition .
g) Maintenance of optimum personnel hygiene.
h) Maintenance of a balance of sleep and activity.
i) Enhancement of socialization and fulfillment of intimacy needs.
j) Provide Rehabilitation.

XIV.  BIBLIOGRAPHY

1. Gelder M, Gath D, Mayou R, owen P. Oxford Textbook of Psychiatry. Third Edition. Oxford University Press. New delhi 2000.
2. Ahuja,N. A short Textbook of Psychiatry. 5th Edition Jaypee Brothers New Delhi 2002.
3. Alan Jacques. Under standing dementia, Churchill Livingstone, New York,  1988.
4. Murray and Huelskoetter – Psychiatric  Mental health Nursing: Giving Emotional care; 2nd edn, Prentice Hall, Englewood cliffs, New Jersey , 1989 PP 567 – 87.

XV. GLOSSARY   

1. Acetylcholine: A chemical transmitter that is released by some nerve ending at the synapse. 
2. Acromegaly: A chronic condition producing gradual enlargement of the hands feel and bones of the head and chest Associated with over activity of the anterior lobe of the pitutary gland in adults.
3. Addison’s disease:    deficiency disease of the suprarenal cortex, often tuberculosis. There is wasting, brown pigmentation of the skin and extreme debility.
4. Agnosia: Difficulty in recognizing familiar objects a symptoms of organic   brain disease.
5. Agitation: Anxiety associated with severe motor restlessness.
6. Alzheimer’s disease:  more currently referred to as dementia of the Alzheimer’s type
7. (DAT). DAT is the common type of dementia.
8. Amyloid:1. pertaining to starch 2. A waxy starch that forms in certain tissues.
9. Aphasia: A communication disorder due to brain damage, characterized by complete or partial disturbance of language, comprehension, formulation or expression.
10. Apraxia: The inability to perform correct movements because of a brain lesion.
11. Arteriosclerosis: A gradual loss of elasticity in the walls of arteries due to thickening and calcification
12. Autopsy:  Postmortem examination of a body to determine the cause of death.
13. Brady Kinesia: Slow or retarded movement
14. Chromosome: In animal cells, a structure in the nucleus containing a linear thread of DE OXY RIBONUCLEIC ACID (DNA) which transmits genetic information and is associated with ribonucleic acid and histones.
15. Comprehension:  The capacity to perceive and understand.
16. Cognition: The act or Process of knowing and perceiving. 
17. Consciousness: State of awareness
18. Confusion: Disturbed orientation, some times accompanied by disordered consciousness.
19. Corticotrophin: Advenocorticotrophic hormone – (ACTH)
20. Cushing’s disease:  A condition of over secretion by the adrenal cortex due to an adenoma of the pituitary gland.
21. Dementia: A disorder that causes pronounced memory and cognitive disturbances. Typically dementia are gradual in onset and progressive in course.
22. Delusion: A false idea or belief held a person which cannot be corrected by reasoning.
23. Development :the process of growth and differentiation.
24. Delirium:  A disorder with alteration in consciousness and changes in cognition, which is usually caused by a general medical condition or is substance induced. Typically, delirium  develop over a short period of time and are treatable. A (usually) reversible bewildered state of clouded consciousness, generally accompanied by restlessness, disorientation and fear, may include periods of hallucination.
25. Dopamine: A substance allied to noradrenaline and used in the treatment of cardiogenic shock. Also occurs naturally in the adrenal medulla and the brain where it functions as a transmitter of nervous impulses.
26. Dysphagia:  Difficulty in swallowing
27. Dyspraxia:   Partial loss of ability to perform coordinated movements.
28. Encephalitis:  Inflammation of brain. There are many types of encephalitis depending on the causative agent and the structure involved.
29. Hallucination: A sensory impression (sight, touch, sound, smell or taste) that has no basis in external stimulation
30. Heredity: the transmission of both physical and mental characteristics to the offspring from parents.
31. Hypocalcaemia: An excess of calcium in the blood may be caused by over administration of Vitamin D, hyper parathyrodism, thyrotoxicosis, break down of bone by malignant disease, or impaired renal function.
32. Hyper insularism: 1- excessive secretion of insulin, 2. Shock produced by an overdoes of insulin .   
33. Hyperkalaemia: An excess of potassium in the blood. If untreated it will lead to cardiac attest.
34. Hypochondria: A morbid pre-occupation or anxiety about one’s health . The sufferer feels that first one part of his body and then another part is the seat of some serious disease.
35. Impairment:  Any loss or abnormality of psychological, physiological or anatomical structure or function.
36. Infarct: The wedge shaped area of necrosis is an organ produced by the blocking of blood vessel , usually due to an embolus. The area is suddenly deprived of blood and is pale in colour.
37. Insomnia: Inability to sleep.
38. Insight: Mental awareness . The capacity of an individual to estimate a situation or his own behaviours or the connection between his present attitudes and past experience.
39. Judgment: The ability of an individual to estimate a situation , to arrive at reasonable conclusions and to decide on a course of action.
40. Memory: The mental capacity that enables one to retain and recall previously experienced , sensations , impressions , information and ideas.
41. Meninges: the membranes covering the brain and spinal cord.
42. Meningitis: Inflammation of the meninges due  to miroorganisms , such as bacteria viruses and fungi.
43. Neurosyphilis: Manifestation of third stage syphilis in which the nervous system is involved.
44. Nihilism: In psychiatry , a term used to describe feelings of not existing and hopelessness, that all is lost or destroyed.
45. Nystagmus: An involuntary rapid movement of the eyeball .it may be hereditary or result from disease of the semi circular canals of the central nervous system.  
46. Organic: Pertaining to the organs disease of an organ accompanied by structural changes.
47. Orientation: A sense of direction . The ability of a person to estimate his position of a person to estimate his position in regard to time, and person.
48. Paranoia: A mental disorder characterized by delusion of grandeur or persecution which may be fully systematized in logical form , with the personality remaining fairly well preserved.
49. Pathological : Pertaining to pathology causing or arising from disease.
50. Psychometrics :The measurement of mental characteristics by means of a series of tests.
51. Rapport: In psychiatry, a satisfactory relationship between two persons , either the doctor and patient or nurse and patient or the patient with any other person significant to him. 
52. Rehabilitation: Re-education , particularly of one who has been ill or injured, so that he may become capable of useful activity.
53. Senile: Related to the involuntional changes associated with old age.
54. Schizophrenia: A general term encompassing a large group of mental disorder characterized by mental deterioration from a previous level of functioning and characteristic disturbances of multiple psychological processes .
55. Stroke: A popular term to describe the sudden onset of symptoms, especially those of cerebral origin. 
56. Sub arachnoids: Below the arachnoids space between the arachnoids and piamater of brain and spinal cord, and containing cerebrospinal fluid.
57. Subdural: below the dura mater space between the arachnoids and durra mater