Lec-18g Dementia

DEMENTIA
Topics
• Definition
• prevalence
• Etiology
• Symptoms and signs
• Diagnosis
• Evaluation for Contributing factor
• General Management Strategies
Dementia
• Progressive deterioration in
intellectual function and
other cognitive skills,
leading to a decline in the
ability to perform activity of
daily living
• Diagnosis is by history and
physical examination
Geriatric Essentials
 One of the most common causes of
institutionalization, morbidity, and mortality among
the elderly
 Mild slowing of the cognitive processes is with
normal aging and by itself doesn't suggest dementia
 Self reported memory loss in elderly patients who
function normally is often caused by aging or
depression rather than dementia
 Dementia is typically preceded by a state of mild
cognitive impairment, which may lasts for several
years
Geriatric Essentials
• For most patients with mild to moderate dementia, being as a
familiar, supportive environment and remaining active enable them to
compensate and may slow the decline in function
• Treating depression, which is common among patients with dementia,
may improve function and quality of life
Dementia (prevalence)
• Dementia is characterized by cognitive decline and a normal
sensorium
• Prevalence of dementia doubles every 5 years after age 60 until about
age 90
• Dementia affects only 1 % of people aged 60 to 64 but 30 to 50 % of
those >85
• Dementia is the leading cause of institutionalization among the
elderly
• Prevalence among elderly nursing home residents is estimated to be
60% to 80%
Dementia (prevalence)
 Dementia is different from age-related loss in memory, which is
much milder, is not substantially progressive, and doesn't
significantly impair the function
 In people with age-related memory loss, cognitive performance is
essentially unimpaired, but they may require extra time and care.
 they learn new information and recall previously learned information
but do so less effectively
Dementia (Etiology)
 Associated with Amyloid beta protein-Alzheimer’s disease
 Associated with tau protein disturbance-front temporal dementia,
corticobasal ganglionic degeneration, progressive supranuclear
dementia
 Associated with lewy bodies-dementia with lewy bodies, and
Parkinson's-associated dementia
 Vascular- lacunar state, multi-infarct dementia, and strategic infarct
dementia
Dementia (Etiology)
• Due to ingestion of alcohol, drugs or toxins-alcohol associated
dementia and dementia due to exposure to heavy metals
• Due to structural brain disorder- brain tumors, chronic subdural
heamatomas, and normal pressure hydrocephalus
• Due to other potentially reversible disorders-depression,
hypothyroidism, and vitamin B 12 deficiency
Symptoms and signs
• The natural history varies depending on the causes of dementia
• Typically intellectual and other cognitive functions decline
• Symptoms can be divide into mild (early), moderate, and sever (late)
• Personality and behavior changes can be develop during any stage
Symptoms and signs
 Depression affects 40% patients with dementia, usually when
dementia is mild or moderate
 weight loss, insomnia
 Depression can aggravate disability in dementia
 Patients with dementia starting lose weight before other symptoms
appear
 Motor and other focal neurologic deficits occurs on different stages,
depending on type of dementia
Symptoms and signs (mild dementia)
• Short term memory is impaired-language function-word finding
• Aphasia-impaired ability to comprehend or use language
• Agnosia-impaired ability to identify objects despite intact sensory
function
• Apraxia-impaired ability to perform previously learned motor
activities despite intact motor function
• Executive function is impaired-planning and organization
Symptoms and signs (mild dementia)
• Progressive difficulty with formerly mastered complex activities-
driving
• Moderately complex daily activities-instrumental activities
• Less likely to take initiatives
• Difficulty in following directions
• Emotional labiality is common-irritable and agitated
• May not compromise sociability
Symptoms and signs (moderate dementia)
 Impaired ability to perform simple daily activities
 Cannot learn new information
 Normal environmental and social cues are not registered-time and
place-increase disorientation
 Lost familiar surroundings-bath room, bed room
 Ambulatory but on increase risk of fall
 Personality changes-irritable,, self-centered, inflexible, or angry more
easily, more passive, general withdrawal from social situations, and
depression
 Basic ADL
• Fundamental tasks and activities necessary for survival
• Eating
• Bathing
• Grooming
• Dressing
• Bed mobility
• Transfers
• reach in appropriate time period, move safely on and off the receptacle(object
or space) and to perform self hygiene tasks
Symptoms and signs (moderate dementia)
• Psychotic symptoms may occur
• Loss of self recognition in the mirrors
• Worry that strangers are entered the home
• Misidentify other people
• Physically aggressive and agitated
• Sleep pattern are often disorganized
Symptoms and signs (severe dementia)
• Impaired the most basic activities
• Totally dependent on other people
• Memory for recent and remote activities is completely lost
• Unable to recognize even close family members
• Ability to walk is affected and lost in the last stages
• Patient may become incontinent
• Reflex motor function is lost-dehydration, undernutrition, and aspirations
• Increase risk of pressure ulcers-immobility and dehydration
• Patient become mute
Symptoms and signs (severe dementia)
• Total functional dependents require that the patient be placed in

nursing home
• Nursing care may delay complications
• Inability to describe symptoms
• Weak response to infections
• End stage of dementia results in coma and death, usually due to
infections originating in the respiratory, skin and urinary tract
Diagnosis
• Mental status should be evaluated at each regular
checkup
• Initial evaluation is based on interviews with the
patient and the family members
• Appearance of the patient should be observed-poor
hygiene
• Complete physical examination
• Diagnosis focuses first on determining weather
dementia, another disorder with similar symptoms or
combination
History
 Essential information about the presence and nature of
impairments, time of onset and pattern of progression
 Family members should be interviewed about contributing factors
and symptoms
 Symptoms begin gradually, and family members may notice
symptoms only after the patient reaches to certain threshold-specific
event
 precipitate a more abrupt decline after some events
Mental Status Examination
• Assess attention ,
• Test the short term memory
• Test instrumental and complex activities
• Tests for Simple activities
Evaluation for Contributing factor
• Drug history
• Psychoactive drugs
• Sedative-hypnotic, antidepressant, antcholenergic drugs and opioids
• Many drugs can affects the cognition
• History of alcohol use should also be obtain
General Management Strategies
“FUNCTIONAL”
• F is for “familiarity”
• U is for “understanding”
• N is for no “distractions”
• C is for “cues and contact”
• T is for “touch”
• I is for “intact abilities”
• O is for “one step at a time”
• N is for “never rush”
• A is for “automatic activities”
• L is for “limit choices”

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DEMENTIA

• Total functional dependents require that the patient be placed in

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