NURSING

MANAGEMENT OF
DEMENTIA
3dS OF GERIATRICS

COMMON IN OLDER ADULTS AND THEIR SIGNS AND SYMPTOMS

OFTEN OVERLAP
DEMENTIA

- A general term that refers to progressive,

degenerative brain dysfunction, including
deterioration in memory, concentration,
language skills, visuospatial skills, and
reasoning that interferes with a persons
daily functioning.
DEMENTIA

-the most common type of dementia is

ALZHEIMERS DISEASE named after Dr.
Alois Alzheimer.
-There
are no specific interventions for the
prevention of AD
DEMENTIA

ALZHEIMERS DISEASE
-Although the aging brain undergoes
many developmental changes, these
changes do not significantly interfere with
the daily functioning of most older adults.
DEMENTIA

ALZHEIMERS DISEASE
-HALLMARKS OF AD:
1. Beta-Amyloid Plaques
2. Neurofibrillary tangles

-theplaques and tangles interfere with

normal nerve cell function and lead to
neuronal death.
TYPES OF DEMENTIA

1. ALZHEIMERS DEMENTIAL
-most common type of dementia ; (50%-
70% of all cases)
2. VASCULAR DEMENTIA
-2nd most common type
3. MIXED DEMENTIA
-AD plus Vascular Dementia
TYPES OF DEMENTIA

4.Demential with Lewy bodies or Lewy

body dementia (LBD)
-witha specific pathological finding in the
bran (abnormal deposits of a protein,
alpha-synuclein)
TYPES OF DEMENTIA

4. Demential with Lewy bodies or Lewy body

dementia (LBD)
Motor symptoms n the early stage of LBD
(which occur in the late stage of AD)
Visual hallucinations in early LBD (which
occur in the middle stage of AD, if at all)
Fluctuating mental status as a feature of LBD
(which usually occurs only due to delirium in
AD
TYPES OF DEMENTIA

5. Frontotemporal dementia or Frontal

lobe dementia (FLD)
-affectsthe frontal and temporal lobes of
the brain and is often characterized by
early deficiencies in executive functioning
-personality changes & disinhibition
RISK FACTORS OF DEMENTIA

1. AGE
-doubles every 5 years after age 65 years
2. FAMILY HISTORY
-first degree relative with AD
3. GENETICS
-APOLIPOPROTEIN E-e4 (APOE-e4)
RISK FACTORS OF DEMENTIA

4. HISTORY OF HEAD INJURY

DIAGNOSTIC CRITERIA FOR
ALZHEIMERS DISEASE
Multiple Cognitive Deficits/impairment
1. Impaired short-or long-term memory AND
2. At least one of the following:
Impaired executive function (abstraction, planning, organizing,
sequencing)
Aphasia (language disturbance)
DIAGNOSTIC CRITERIA FOR
ALZHEIMERS DISEASE
Apraxia (impaired purposeful movements)
Agnosia (inability to recognize sensory stimuli)
3. The changes signifantly interfere with social and /or occupational function
and represent a decline from previous level of function.
4. The course has been a gradual onset and continuing decline
5. The changes do not occur exclusively during delirium
6. The changes are not better accounted for by another condition
Medical diagnosis of Alzheimers
Disease/Dementia
1. Visit a primary care provider
Goal: Identify and treat dementia in the early stage, before the
symptoms are more apparent and when interventions tend to be more
successful.
2. PCP will conduct a history and physical examination and medical
history
3. Brain imaging-CT-scan/MRI
-it will rule out other possible causes of cognitive decline
Medical diagnosis of Alzheimers
Disease/Dementia
3. PCP will do simple paper and pencil screening test
-to determine the presence and degree of cognitive impairment
-diagnosis is made by: physicians with experience in geriatrics
-Geriatric internist, geriatric psychiatrist
Ex. MINI MENTAL STATE EXAMINATION
Medical diagnosis of Alzheimers
Disease/Dementia
-Many persons with a new diagnosis of demention and /or their families
may believe that the diagnosis is INCORRENT- DENIAL.

Common psychological coping mechanism-- DENIAL

STAGES OF ALZHEIMERS DISEASE

3 STAGES
1. MILD
Subtle, unnoticed, just getting older
2. MODERATE
Behavioral and psychological symptoms of demential (BPSD)
3. SEVERE
requires total care and will die because of complications
Pharmacological Intervention for
Dementia
1. Cholinesterase inhibitors (CEIs)
-blocks cholinesterase enzyme ;
(DONEPEZIL, RIVASTIGMINE, GALANTAMINE)
Acetylcholine
-is a neurotransmitter in the brain, known to be important for memory.
Medication/Disease that inhibit acetylcholine interfere with memory.
Pharmacological Intervention for
Dementia
2. N-methyl-D-Aspartate (NMDA)
Receptor antagonist
-protect neurons from glutamate excitotoxicity without completely
eliminating the glutamate necessary for normal neurological function.
DELIRIUM

Is a syndrome that occurs acutely is and often called acute

confusion, unlike dementia which is called chronic confusion.
Hours or days and is caused by some other underlying medical
problem.
DELIRIUM

CONFUSION ASSESSMENT METHOD

1. Acute Onset or fluctuating course
2. Inattention
3. Disorganized thinking
4. Altered Level of Consciousness

-Diagnosis: both 1,2 are present along with either features 3 or 4

DELIRIUM

CONFUSION ASSESSMENT METHOD

1. Acute Onset or fluctuating course
2. Inattention
3. Disorganized thinking
4. Altered Level of Consciousness

-Diagnosis: both 1,2 are present along with either features 3 or 4

DELIRIUM

The nurse plays a critical role in identifying whether an older adult

has experienced an acute change in mental status
The primary treatment for delirium is to discover or treat the etiology
or cause.
Report the changes to the HCP/physician
Identify medications that can cause confusion
Keep the patient comfortable
Hypoactive vs. Hyperactive delirum
Avoid physical restraints because they tend to cause more panic
and agitation
DELIRIUM

Move the patient to room near the nurses station

Implement ris for fall protocols
One to one care and supervision
Eliminate tethers as ordered (catheter, oxygen tubings)
Elimination of confusing external stimuli ( television)
DEPRESSION

A disorder that includes changes in feelings or mood, described as

feeling sad , hopeless, pessimistic or blue lasting most of the day,
with loss of interest in pleasurable activities.
 COMPARISON OF SIGNS AND SYMPTOMS OF
DEMENTIA, DEPRESSION AND DELIRIUM
DEMENTIA DEPRESSION DELIRIUM
ONSET GRADUAL OVER MONTHS TO USUALLY GRADUAL ACUTE OVER HOURS TO DAYS
YEARS
COURSE SLOWLY PROGRESSIVE, CHRONIC, SOMETIMES FLUCTUATING. REVERSIBLE
IRREVERSIBLE, MINIMALLY ABRUPT WITH PSYCHOSOCIAL WITH IDENTIFICATION AND
TREATABLE STRESSORS, TREATABLE TREATMENT OF CAUSE
LEVEL OF CONSCIOUSNESS ALERT ALERT ALTERED, CLOUDED,
FLUCTUATING
MEMORY IMPAIRED. SHORT-T. AND INTACT, MAY EXHIBIT POOR SHORT-TERM MEMORY LOSS
LONG T. EFFORT IN MEMORY TESTS
ORIENTATION IMPAIRED TO TIME, PLACE , INTACT IMPAIRED, FLUCTUATING
PERSON THEN SELF

PSYCHOMOTOR SPEED NORMAL. SLOWED IN MAY BE NORMAL, HYPOACTIVE, HYPERACTIVE

ADVANCED STAGES HYPOACTIVE, HYPERACTIVE OR MIXED
LANGUAGE WORD-FINDING DIFF. NORMAL, MAY NOT INITIATE OFTEN INCOHERENT
IMPAIRED INCREASES W/ MUCH CONVERSATION
DISEASE PROG.
HALLUCINATION USUALLY VISUAL IF PRESENT. NONE. UNLESS PSYCHOTIC COMMON, TEND TO BE
COMMON IN MIDDLE STAGE DEPRESSION VISUAL AND TACTILE