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dementia

 

Dementia

It is the development of memory decline slowly over a period of time, interfering with functioning, not accounted for by other causes.
2-4% people over the age of 65 have a dementia and around 20% over the age of 80 develop dementia, the risk increases with age.
Alzheimer’s disease is most common type of dementia accounts for> 64% of all dementia types.
Vascular dementia is second common cause of dementia of all dementia types
– 60% of people with dementia have delusions

Dementia: Signs

  • Aphasia – inability to understand what is being said, naming items, reading and/or writing
  • Apraxia – inability to follow certain movements when asked or imitated
  • Agnosia – inability to recognize familiar objects or people
  • Short –term memory loss
  • Unable to think in the abstract

Personality changes

  • Poor judgment
  • Unable to perform normal routine or activities
  • Trouble with remembering events from the past
  • Unable to learn new information
  • Anxiety
  • Depression
  • Suspiciousness

Dementia: Causes

Dementia always has a physical cause

  • Changes in the structure of the brain
  • Chemical imbalance
  • Viral infection
  • Environmental toxins
  • Strokes / heart disease
  • Brain infections
  • Hypoxia
  • Alcoholism
  • Lack of sugar to the brain
  • Build-up of pressure in the brain

Dementia: Types

  • Alzheimer's Type Dementia
  • Vascular Dementia
  • Lewy-Body Dementia
  • Pick’s Disease/Frontal Lobe Dementia
  • Creutzdelt – Jacob Disease
  • Alcohol Dementia
  • Aids- Related Dementia

Alzheimer’s Type Dementia

Alzhiemer’s develops slowly over years and is the most common type of dementia

  • Slow functional deterioration over a period of time (months to years).
  • Regression in stages of life.

Vascular Dementia

Occurs when blood clots small vessels in the brain (TIA’s).

  • Risk factors include HTN and advanced age.
  • Symptoms include problems with recent memory, wandering, getting lost in familiar places, incontinence, mood lability, and trouble following simple instructions

 

Lewy-Body Dementia

  • Is characterized by fluctuating confusion, disturbance of consciousness, visual hallucinations, delusions, falls, and significant parkinsonism.
  • Cholinesterase inhibitors have been found to be somewhat beneficial

 

Pick's Disease/ Frontal Lobe Dementia

  • Behavioural symptoms are usually first sign
  • Behaviours include the person being withdrawn or disinhibited, disinterested in hygiene, easily distracted, repetitive mannerisms, over eating or compulsively putting objects in mouth
  • Speech difficulties
  • Incontinence sometimes is an early sign

The person often remains oriented to time and has preserved memory in the early stages.

 

Dementia: Screening

  • Recent symptom profile
  • Recent changes – very important
  • Collateral history from family/ significant others
  • Past psychiatric history
  • Past medical history
  • Current medical issues/medications
  • Updated blood work and urines
  • MRI BRIAN
  • History of recent medication changes
  • Functional ability – recent changes with Activities of daily living
  • Social Factors
  • Personal History
  • Social Factors
  • Current Stressors
  • Neuropsych testing
  • Mini-mental status exam
  • Cohen-Mansfield Scale if indicated
  • Depression Scale if indicated
  • Confusion Assessment Method (CAM)

 

Dementia: Interventions

  • Maintain a regular routine.
  • Ensure familiar objects are around
  • Orientation board for early stages
  • Ensure person’s safety. Make regular checks of  his/her whereabouts
  • Ensure proper nutrition and hydration.
  • Promote independence; help with the person’s personal care.
  • Use proper communication techniques.
  • Keep it simple. Do not give the person too many choices.
  • Use a calm soothing voice.
  • Provide regular exercise and social activities.
  • Ensure the person receives regular medical check-ups.

    If the person becomes agitated – use distraction.
  • Do not use restraints unless absolutely necessary.
  • Ensure the person takes his/her meds regularly and as prescribed.
  • Give emotional support to the family.
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