INTRODUCTION
Dementia (from Latin de- "apart, away" + mens "mind") is the progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging .
DEFINITION
Dementia is defined as impairment of persistent intellect memory, and personality but without impairment of consciousness.
CLASSIFICATION
Primary or secondary
· Primary dementias as those, such as, Alzheimer’s disease, in which the dementia itself is the major signs of some organic brain disease not directed related to any other organic illness. (Devanand & Mayeux 1992)
· Secondary dementias are those caused by or related to another disease or condition, such as HIV disease or a cerebral trauma. There are many causes of dementia.
EPIODEMIOLOGY
v Estimated prevalence of dementia is 1.03% of the population.
v Rises to between 16% and 25%for those over 85 ages.
v Approximately 5% of person older, age 65 have severe dementia and 15% have mild dementia.
v The most common is Alzheimer's disease, which accounts for up to 70% of all cases. Alzheimer's disease is caused by the destruction of certain brain cells leading to the loss of the neurotransmitter acetylcholine.
v Multi-Infract Dementia (MID): MID are second commonest causes of dementia, seen in 10-15% of all cases.
v Hypothyroid Dementia: This is one of the important and reversible causes of dementia. It accounts for less than 1% of dementia. Since clinical diagnosis may be difficult, laboratory tests have to be resorted to for correct diagnosis.
v AIDS Dementia Complex: About 50-70%of the patients suffering from AIDS. Dementia due to HIV virus. The immune dysfunction associated with HIV disease
RISK FACTORS
v Increasing age -By the age of 90, around 1 in 3 people affected.
v A family history
v high blood pressure, diabetes, smoking, poor diet and excessive alcohol intake.
v vitamin B12 deficiency
STAGES OF DEMENTIA
v Early stage(2-4years)
o Forgetfulness
o Decline interest in environment
o Hesitancy in initiating action
o Poor performance at work
v Middle stage(2-12)
o Progressive memory loss
o Hesitancy in response to questions
o Has difficulty in following simple instructions
o Irritable, anxious, wandering, neglect personal hygiene and social isolation.
v Final stage (up to 12)
o Marked loss of weight
o Unable to communicate
o Does not recognize family
o Loss the ability to stand and walk
o Death is usually caused by aspiration pneumonia
SYMPTOMS
v Memory loss, especially of more recent events.
v Difficulty finding their way around, especially in new or unfamiliar surroundings poor concentration
v problems learning new ideas or skills
v Psychological problems such as becoming irritable, saying or doing inappropriate .
v Severe mental and physical problems, including loss of speech, immobility, incontinence and frailty
v Urinary and fecal incontinence may develop in late stage.
v Disorientation in time, place and person develop in last stages.
v Thinking is impaired, the flow of ideas is reduced and the reasoning capacity is also impaired.
DIAGNOSIS
v Presence of clear consciousness
v Duration of at least 6 month
1. Memory impairment
2. At least one of the following:
o Aphasia
o Apraxia
o Agnosia
Disturbance in executive functioning
3. Disturbance in 1 and 2 interferes with daily function
4. Does not occur exclusively during delirium
DEMENTIA/DEPRESSION
DEMENTIA
v Pt rarely complains of the cognitive impairment.
v Pt, emphasizes achievement
v Patient appears unconcerned.
v Usually labile affect.
v Pt. makes takes in examination.
v Recent memory impairment.
v Confabulation may be present.
v Poor performance.
v History of depression uncommon.
DEPRESSION
v Pt. usually complains about the impairment.
v Patient emphasizes disability.
v Patient communicates distress.
v Severe depression.
v Don’t know answers are frequent.
v Recent memory rarely found.
v Confabulation very rare.
v Marked variability in performance on similar test.
TREATMENT:
v Treatment of the underline cause- for example the management of hypertension in multi-infracts dementia.
v Symptomatic management
o Environment manipulation to reduce stress in day to day activities
o Treatment of medical complications. Care of food and hygiene supportive care for the patient.
o Anxiety can be treated by short acting benzodiazepines.
o Depression can be treated with low doses of SSRIs.
o Psychotic symptoms and disruptive can be treated with antipsychotic. Short term hospitalization.
v Drug Therapy-
o Cholinesterase inhibitors' (are thought to work by increasing the levels of acetylcholine in the synapses) Examples include donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl). They can improve memory, as well as slow down some of the changes in personality and mood. They may also be of benefit in Lewy body dementia.
o NMDA Antagonists- Mementine
NURSING MANAGEMENT
v Assessment:
o Confusion with or without period of awareness.
o Feeling of frustration
o Impaired memory
o Disinterest in surrounding
o Socially inappropriate behavior
o Decreased social interaction
v Nursing diagnosis:
o Self care deficit-bathing/hygiene; dressing /Grooming, Feeding and Toileting
o Impaired Social interaction
v Nursing Intervention:
o Provide a safe environment
o Establish good interpersonal relationship
o Facilitate adequate grooming hygiene and other activities of daily living. Maintain adequate food and fluid intake
o Facilitate adequate rest and sleep
o Facilitate orientation Decrease socially inappropriate behavior and facilitate the development of acceptable social skill.
o Increase interest in surrounding.
o Involve the family and community in treatment and rehabilitation programme.
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