DEMENTIA

BY M.H.SIMUKONDA
 DEMENTIA

INTRODUCTION

• Poor memory and disorientation were once considered a

normal part of aging.

• It was believed that if one lived long enough, such

impairments were unavoidable.

• Currently, dementia is considered an abnormal state with

many causes that can often be identified.
 Introduction cont’

• Dementia is an important concern in the field of

psychiatry and in Zambia dementia is a condition
that has not been understood quite well.
• The Zambian culture strongly believes in magic and
witchcraft and most people with dementia have
become victims of torture and even death.
 Introduction cont’

• The Malota compound in Livingstone and

Kalulushi cases were both dementia victims.
• Both cases became suspects of witchcraft and
unfortunately the elderly lady in Kalulushi was
even murdered.
GENERAL OBJECTIVES
 At the end of the discussion/ lesson, the students
should acquire knowledge on Dementia disorder.
Specific Objectives
At the end of this lesson, students should be able to;
Define Dementia.
State the causes of Dementia.
List the clinical features of Dementia.
Differentiate Dementia and Delirium.
Describe the Management of Dementia.
Definition of dementia

1. Global or total intellectual decline of sufficient severity to

impair social and/or occupational functioning that occurs
in normal consciousness, (Steele,2010 :3).

2. The term dementia describes symptoms of a large group of

illnesses that cause a progressive decline in a person’s
functioning such as loss of memory, intellect, rationality
and social skills.
There are four key elements to the definition of dementia

Global impairment.

The impairments occur in more than just memory.

Most dementia patients experience impairments in

reasoning, using and understanding language,
recognizing what one perceives through the senses,
coordinating learned motor movements, planning and
decision-making.
The key elements of dementia

Decline.
The impairments represent a decrease from a
previous level of functioning.
To recognize a reduction, it is crucial for the nurse
to know the patient’s previous level of functioning
unless members of the family or significant others
give correlated information.
The key elements of dementia

Severity
• Impairments are severe enough to interfere with normal
functioning in everyday life.
• Examples are a person who was living independently and begins
to make poor financial decisions or forgets how to cook a meal,
although the person could previously perform those tasks.
• Getting lost while walking from a nearby church, neighborhood
and driving can also indicate severe impairment.
The key elements of dementia

Normal consciousness.
• These impairments occur in a normal state of
consciousness; patients are awake and alert.
• This is distinguished from an abnormal state of
consciousness, such as drowsiness, stupor or coma,
seen in delirium.
 CAUSES OF DEMENTIA

1. Alzheimer’s dementia 50%

2. Vascular dementia 10%-due to cerebrovascular disease such as

intracranial hemorrhage.

3. Frontal-Temporal Lobe 15%.

4. Dementia with Lewy bodies 15%-due to abnormal deposits of a

protein alpha-synuclein in the brain leading to problems of
thinking, movement, behavior and mood.

5. Other 10%: trauma, alcohol, poisoning, severe anemia, Cushing

syndrome, neurosyphilis, Huntington's disease.
 ALZHEIMER’S DISEASE

Alzheimer disease (AD) is the most common cause of dementia

and thus the most common type that nurses encounter in clinical
practice.

AD is an incurable neuro- degenerative disease.

The hallmark pathology of AD includes amyloid plaques and

neurofibrillary tangles in the brain.

One also sees general shrinkage of the brain and a decrease in

the number of functioning neurons.
 The Four A’s of Alzheimer Disease

• Amnesia: Memory impairment especially short-term.

• Aphasia: Communication impairment.

• Apraxia: Impairment in performing motor movements.

• Agnosia: Impairment in recognition of what is taken in

through the senses. The sense of smell is impaired.
 SIGNS AND SYMPTOMS OF DEMENTIA

Difficulty with speech and language

poor judgment

 lack of insight.

Difficulty with personal care tasks (such as

bathing) and other everyday tasks (such as cooking,
shopping and managing money).
SIGNS AND SYMPTOMS OF DEMENTIA

People with dementia can be perceived to be aggressive,

uncooperative and unpredictable.

They may also present with hallucinations and delusions.

All signs and symptoms are due to progressive
damage to the brain for example, damage to the
limbic system is associated with memory
dysfunction, unstable mood and personality
changes.
The behaviours are not the result of deliberate
attempts to be difficult or to upset careers.
 TYPES OF DEMENTIA

Dementia can be caused by a number of disease processes.

Approximately 60 per cent of people with dementia have

(i)Alzheimer’s disease, a consequence of degenerative

brain changes as an individual age.

(ii) Vascular dementia result from small brain infarcts;

small brain hemorrhages.

(iii) Parkinson’s disease is also common and

 TYPES OF DEMENTIA

(iv) Excessive alcohol consumption is another

prevalent cause.

Other illnesses

(v) multiple sclerosis,

(vi) HIV/AIDS,

(vii) Huntington’s disease and

 ONSET AND COURSE OF DEMENTIA

• Dementia is an incurable illness with failing brain

functioning and increasing physical disability
leading to total dependence on others for all care.
 DIFFICULTIES WITH DIAGNOSIS


It is important to understand the difference between

dementia, delirium and depression.

Delirium is global impairment of consciousness causing

reduced levels of alertness, attention, disorientation to place

and time, memory impairment especially immediate memory

and perception of the environment is impaired. Patient can

develop illusions and hallucinations.

DIFFICULTIES WITH DIAGNOSIS

Depression and delirium are treatable conditions that present

similar to dementia.

Common precipitating factors for delirium include infection,

medication interactions and surgery, alcohol intoxication, .

• Differentiating between Dementia, Delirium and Depression

and (three Ds) requires skilled assessment.

• The differences and similarities are outlined in the Table below.

DELIRIUM, DEMENTIA AND DEPRESSION

The three Ds Dementia Delirium Depression

• Repetitiveness of • Bizarre and vivid • Often slowed

thought thoughts thought
• Reduced interests • Frightening processes
• Difficulty making thoughts and ideas • May be
Thoughts
logical connections • Often paranoid preoccupied by
• Slow processing thoughts sadness and
of thoughts hopelessness
• Negative
thoughts about self
• Reduced interest
 The Dementia Delirium Depression
three Ds
• Often a disturbed • Confusion disturbs • Early morning
24 hour sleep (may have a waking or
clock mechanism reverse sleep-wake intermittent
(later in cycle) sleeping
Sleep
the disease process) • Nocturnal confusion patterns (in
• Vivid and disturbing atypical cases,
nightmares too much sleep)
 The three Ds Dementia Delirium Depression

• Increasingly • Fluctuating • Usually normal

Orientation impaired sense impairment of
of time and place sense of
time, place and
person
• Usually gradual, • Acute or sub • Usually over
Onset over acute (hours or days or weeks
several years days) • May coincide
• Insidious in with
nature life changes
 The three Dementia Delirium Depression
Ds
• Impaired recent memory • Immediate • Recent memory
• As disease progresses, memory impaired sometimes
Memory long • Attention and impaired
and term memory also concentration • Long-term
cognition affected impaired memory
• Other cognitive deficits generally intact
such as in word finding, • Patchy memory
judgment and abstract loss
thinking • Poor attention
 The three Ds Dementia Delirium Depression

Duration • Months or • Usually brief • At least two

years and — hours to weeks (but can
progressive days (but can be several
degeneration last months in months to years
some cases)
 The three Ds Dementia Delirium Depression

Course throughout • May be variable • Fluctuates — usually • Commonly

depending worse worse in the
the Day on type of at night in the dark morning with
dementia • May have lucid improvement as
periods the day
continues.

Alertness • Usually normal • Fluctuates — • Normal

lethargic or
hypervigilant
 The three Ds Dementia Delirium Depression

• May be able to • May occur as a • Often masked

conceal consequence • May or may not
Other or compensate for of a drug have past history.
deficits (early) interaction or
reaction, physical
disease,
psychological issue
or environmental
changes
 TREATMENT FOR DEMENTIA

• Non-pharmacological approaches are first-line

treatment for behavioral and psychological
symptoms of dementia.
• If symptoms are moderate to severe and impact on
the person’s (or the career's) quality of life or
functioning, medication may be needed, often in
conjunction with non-pharmacological
interventions.
PHARMACOLOGICAL STRATEGIES
 Currently there is no cure for dementia, but drugs such as
cholinesterase inhibitors (for example, donepezil,
galantamine and/or rivastigmine) may help to slow the
progress of the disease in the early stages. Memantine,
which inhibits the release of glutamate (a
neurotransmitter), is indicated for more advanced disease.
 Antipsychotic medication for hallucinations and delusions
and behavioral symptoms (such as physical aggression).
NON-PHARMACOLOGICAL APPROACHES

The person with dementia, the family and careers will need:

Family care-education and counselling to help them understand and

cope with what can be a distressing illness.

Group therapy- address areas of self care, social, and family

relationship.

Communication strategies- use clear, plain language and short

sentences that convey one idea at a time. Use of gestures, pictures

and body language can enhance the effectiveness of the message.

 NURSING A PERSON WITH DEMENTIA

• Develop a relationship with the person based on empathy

and trust. Provide an environment that supports flexible but
anticipated routines.

• Maintain a safe environment for the person, yourself and

other staff.

• Promote the person’s engagement with their social and

support network.
• Ensure effective collaboration with other relevant service
providers, through development of effective working
relationships and communication.
 Support and promote self care activities for families and
careers of the person with dementia.
 Explain to the patient who you are, what you want to do and
why.
 Smile — the pt is likely to take cues from you, and will mirror
your relaxed and positive body language and tone of voice.
 If the patient is resistant or aggressive but is not causing
harm, leave him or her alone. Give the patient time to
settle down and approach the task later.
 Distract the patient by talking about things he or she
enjoyed in the past .
 Do not argue with the patient. The brain of a pt with
dementia tells the patient that he or she cannot be wrong.
 If the pt is agitated, maintain a quiet environment.
Check noise levels regularly and reduce them if
necessary by turning off the radio and television.
 Give the pt a comfortable space. Any activity that
involves invasion of personal space increases the
risk of assault and aggression.

 Keep all medication away from patient

 Make sure you do regular sight test
 Put signs on the doors of rooms so that patient
knows where they are going
 Provide orienting cues such as a clock and calendar
- These indicate the day and date
 If they cant read remind them regularly.
 Make a bracelet with their name, address and
phone number of a relative.
Always provide care from the side (not the front) of
the person. If you stand in front, you are easily hit or
kicked if the person becomes aggressive
 Monitor compliance with medication and general
physical health (including nutrition, weight, blood
pressure, etc).
 Monitor food and fluid intake and elimination —
dehydration or constipation can exacerbate
• Provide family members and carers with information about
the illness if appropriate, as well as reassure and validate
their experiences with the person.

• Encourage family members and carers to look after

themselves and seek support if required.

• Be aware of your own feelings when nursing a patient with

dementia.

• Arrange for debriefing for yourself or any colleague who

may need support or assistance — this may occur with a
NURSING PROBLEMS.
1.Risk of injury
2.Self care deficit
3.Altered nutrition
4.Knowledge deficit
5.Disturbed sleep pattern
 The end
Enjoy your
stay in Lusaka