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At the initial stages of dementia, patients show fatigue, difficulty in sustaining mental performance, and a tendency to fail when a task is novel or complex or requires a shift in problem– solving strategy. The inability to perform tasks becomes increasingly severe and spreads to every day tasks, such as grocery shopping as the dementia progresses. Eventually, patients with dementia may require constant supervision and help to perform even the most basic tasks of daily living. The major defects in dementia involve orientation, memory, perception, intellectual functioning and reasoning and all these functions become progressively affected as the disease process advance. Affective and behavioral changes, such as defective control of impulses and liability of mood, are frequent, as are accentuations and alterations of premorbid personality traits.
a). Memory: - Memory impairment is typically an early and prominent feature in dementia, especially in dementias involving the cortex, such as dementia of the Alzheimer’s type. Early in the course of dementia, memory impairment is mild and is usually most marked for recent events; people forget telephone numbers, conversations and events of the day. As the course of dementia progresses, memory impairment becomes severe and only the earliest learned information is retained. b). Orientation: - In as much as memory is important for orientation to person, place and time, orientation can be progressively affected during the course of a dementing illness. For example, patients with dementia may forget how to get back to their rooms after going to the bathroom. No matter how severe the disorientation seems, how every, patients show no impairment in their level of consciousness. c). Language:- Dementing processes that affect the cortex, primarily dementia of the Alzheimer’s type and vascular dementia, can affect patient’s language abilities . Aphasia is one of the diagnostic criteria of dementia . The language difficulty may be characterized by a vague, stereotyped, imprecise or circumstantial locution , and patients may also have difficulty in naming objects. d). Thinking & Judgment:- Thinking becomes slower with reduced flow of ideas and impaired concentration; Judgment is impaired from early on and leads to poor insight; Paranoid thoughts and ideas of reference are common and may develop into delusions. e). Comprehension of Learning Capacity:- The brains ability to process incoming information is impaired. f). Calculation:- This cognitive skill is usually impaired from early on Dementia. g). Insight i). Concentration
Emotions become too easily stimulated, and has reduced control over laughter or tears.
a) Increasing tendency to selfishness. b). Lack of consideration for other people’s feelings. c). Personal habits, table manners, toilet, habits and hygiene deteriorate. d). Sexual offences may be committed.
A). Cardio vascular system . --Decreased cardiac output. --Diminished ability to respond to stress. --Slower heart recovery rate, increased B.P. --Leads to fatigue with increased activity. B). Respiratory System:- -Increase in the residual lung volume -Decrease in vital capacity -Decreased gas exchange of diffusing capacity. -Decreased cough efficiency -Leads to fatigue and breathlessness with sustained activity, impaired healing of tissue due to decreased oxygenation , difficulty in coughing up secretions. C). Integumentary system :- -Decreased protection against trauma -Decreased protection against temperature extremes. -Diminished secretion of natural oils and perspiration. -Thin and wrinkled skin -Complaints of injuries bruises and sunburns. -Complaints of intolerance to heat. -Bone structure is prominent Dry skin. D). Reproductive system:- Female -vaginal narrowing and decreased elasticity . -Decreased vaginal secretion Causes :-Painful intercourse, Vaginal bleeding following Intercourse , vaginal Itching and irritation delayed orgasm. Male -Decreased size of penis and testes slower sexual response. Causes :- Delayed erection and achievement of orgasm E). Genito Urinary System :- Male and Female:- Bladder capacity decrease, Delayed sensation to void leads to urinary retention and difficulty to voiding . Male:- Benign prostatic hypertrophy Female :- Relaxed perineal muscle frequency and Incontinence of urine F). Gastro – intestinal system :- - Decreased salivation -Difficulty in swallowing food -Complaints of dry mouth . -Delayed esophageal and gastric emptying leads to complaints -Of fullness , heartburn and indigestion . -Reduced gastrointestinal mobility leads to constipation , flatulence and abdominal discomfort G). Musculoskeletal System :- -Loss of bone density , muscle strength and size -Degenerated joint cartilage leads to height loss, kyphosis , fracture, complaints of back pain , loss of strength , flexibility and endurance and joint pain. H) .Nervous system :- -Reduced speed in nerve conduction . -Increased confusion with physical illness and loss of environmental cues , reduced cerebral circulation causes slower to respond and react , learning takes longer , becomes confused, complaints of faintness and frequent falls.
-Vision: Diminished ability to focus on close objects , inability to tolerate glare, difficulty in adjusting changes of light intensity , decreased ability to distinguish colors. As a result holds objects for away from face, complaints of glare , complaints of poor night vision and confusion co lour.
-Taste and smell: Decreased ability to taste and smell, results in excessive use of sugar and salt.
-Psychiatric: 40 to 50 percent of patients with dementia are having anxiety and depression , in addition to psychosis and personality changes patients with dementia may also exhibit pathological laughter or crying , extremes of emotions – with no apparent provocation . -Neurological: In addition to the aphasias in patients with dementia, apraxias and agnosias are common other neurological signs that can be associated with dementia are seizures, seen in approximately 10 percent of patients with dementia of Alzheimer’s type and in 20 percent of patients with vascular dementia ,and atypical neurological presentations , such as nondominant parietal lobe syndromes , primitive reflex – such as the grasp , snout , suck , tonic – foot and palmomental reflexes – may be present on neurological examination and myoclonic jerks are present in 5 to 10% of patients.. Headaches, dizziness , faintness , weakness , focal , neurological signs and sleep disturbance are some of the additional neurological symptoms in-patient with vascular dementia. Cerebrovascular disease pseudobulbar palsy , dysarthria and dysphagia are also more common in vascular dementia than in other dementing conditions. -Catastrophic reaction: Patients with dementia also exhibit reduced ability in abstract attitude patients have difficulty in generalizing from a single instance , in forming concepts and in grasping similarities and differences among concepts. Catastrophic reaction marked by agitation secondary to the subjective awareness of intellectual deficits under stressful circumstances.
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