TEXTBOOK DISCUSSION

Dementia is a cognitive disruption that features a loss of intellectual abilities

and interferes with usual social or occupational activities. Dementia is not a specific
disease but rather a general term for the impaired memory, with at least one of the
following cognitive deficits: aphasia (impaired language), apraxia (impaired motor
function), agnosia (impaired object recognition), and impaired executive functioning
(abstract thinking and the ability to plan and execute complex behaviors). Symptoms of
dementia can also include disorientation, poor judgment, lack of insight, socially
inappropriate behavior, anxiety, mood disturbances, sleep disturbances, delusions, and
hallucinations. Dementia results from the direct effects of one or more medical
conditions or the persistent effects of substance use (APA, 2000).
The prevalence of severe dementia has been reported to be 3% in adults, with
increasing prevalence in older age groups, to as high as 25% in people older than 85
years (APA, 2000). Some minor forgetfulness usually occurs in elderly clients, but this
differs drastically from the changes seen in dementia. The prevalence of chronic
illnesses, including dementia, increases as average life expectancy increases. However,
dementia is not necessarily a component of the aging process, and it is erroneous to
assume that because a client is elderly he or she will be confused, forgetful, or
demented. Although dementia is generally considered to be progressive, symptoms can
also stabilize for a period or resolve, as sometimes seen in vascular dementia. In
progressive dementia, symptoms may begin as mild memory impairment with slight
cognitive disturbance and progress to profoundly impaired memory and cognitive
functioning. The specific course of dementia varies according to the underlying disorder.
Clients with dementia have an impaired ability to learn new material and
eventually forget previously learned material. Deterioration of memory and language
function, including loss of the ability to correctly identify familiar people or objects or
remember their relationships or function, and the loss of ability to comprehend written or
spoken language, as well as speech pattern disturbances (e.g., echolalia,
perseveration) present tremendous challenges for both the client and caregiver(s).
Wandering, confusion, disorientation, and the inability to correctly use items such as
eating utensils produce significant safety issues and profound functional impairment.
Common forms of dementia
There are many different forms of dementia. Alzheimer's disease is the most common
form and may contribute to 60-70% of cases. Other major forms include vascular
dementia, dementia with Lewy bodies (abnormal aggregates of protein that develop
inside nerve cells), and a group of diseases that contribute to frontotemporal dementia
(degeneration of the frontal lobe of the brain). Dementia may also develop after a stroke
or in the context of certain infections such as HIV, harmful use of alcohol, repetitive
physical injuries to the brain (known as chronic traumatic encephalopathy) or nutritional
deficiencies. The boundaries between different forms of dementia are indistinct and
mixed forms often co-exist.

Symptoms of Dementia
Symptoms of dementia can also include impaired memory, Impaired Social Interaction,
disorientation, socially inappropriate behavior, anxiety, and delusions.

Impaired Memory Inability to remember or recall bits of information or behavioral skills.

Many medical problems can cause memory loss or other dementia-like symptoms. This
involves a notable decline in at least one area of thinking skills, such as memory, that's
greater than the changes of aging and less than those of dementia. Having mild
cognitive impairment doesn't prevent you from performing everyday tasks and being
socially engaged. For many people, the condition eventually progresses to dementia
due to Alzheimer's disease or another disorder causing dementia. For people with
normal age-related memory loss, symptoms usually don’t progress much, and they don't
develop the spectrum of symptoms associated with dementia.

Impaired Social Interaction Insufficient or excessive quantity or ineffective quality of

social exchange. These symptoms can make sociability much more difficult, and in
many cases, dementia patients are dealing with more than one of these symptoms at a
time. So all of them need to be on the minds of anyone who is in a care giving position.

Disorientation a usually transient state of confusion especially as to time, place, or

identity often as a result of disease or drugs. Signs that a person is disoriented may
include: an inability to focus their attention. being 'slow' and uncertain.

Socially inappropriate behavior socially inappropriate behavior as well as social

disinhibition, is defined as inappropriate behaviours in term of verbal, physical or sexual
acts which reflect a loss of inhibition or an inability to conform to social or cultural
behavioural norms.

Anxiety is a feeling of apprehension or dread that develops when the self or

self-concept is threatened. It is distinct from fear, which is a response to an identifiable,
external threat. It is thought to be essential for human survival. The discomfort people
feel when they are anxious provides the impetus for learning and change. Anxiety is
observable through behavior and physiologic phenomena (e.g., elevated blood
pressure, pulse, and respiratory rate; diaphoresis; flushed face; dry mouth; trembling;
frequent urination; and dizziness). The client also may report nausea, diarrhea,
insomnia, headaches, muscle tension, blurred vision, and palpitations or chest pain.
Physiologic symptoms vary but usually become more intense as the level of anxiety
increases.

A delusion (or strongly held false beliefs) are a common symptom for a person with
dementia. They can take the form of paranoia, which makes the person feel threatened,
even if there is no or little reason to feel this way. Dementia can make a person
suspicious of the people around them. A person experiencing a delusion may feel that
they are being watched, or that someone is acting against them. They may jump to
conclusions without much evidence. For example, if their neighbour has made a nasty
comment about them once, they may believe that the neighbour is directing a hate
campaign against them. Because of dementia, the person may no longer be able to
moderate intense or wild thoughts.

Psychotic Symptoms

A hallucinations are the "perception of a nonexistent object or event" and "sensory

experiences that are not caused by stimulation of the relevant sensory organs. Not only
do hallucinations occur with mental health conditions like schizophrenia and bipolar
disorder, but they can also occur with the physical and psychological conditions as well
Alcohol or drug use and/or withdrawal. Auditory hallucinations: Hearing voices or
sounds that no one else can (most common type of hallucination). Visual hallucinations:
Seeing people, colors, shapes, or items that aren't real (second most common type of
hallucination). Gustatory hallucinations: Having a taste in your mouth that has no source
(rarest type of hallucination) (Gans, Marsh, & Goldman, 2022).

Delusions is the belief that something is happening, for which there is no evidence (i.e.,
you believe that the government is controlling you through your TV). Delusion is where
a person has an unshakeable belief in something implausible, bizarre, or obviously
untrue. Paranoid delusion and delusions of grandeur are two examples of psychotic
delusions. A person with psychotic will often believe an individual or organisation is
making plans to hurt or kill them.

Risk factors of dementia

Age: This is the strongest risk factor. Dementia can happen to anybody, but the risk
increases with age. It depends on a combination of age, genes, health and lifestyle.
Over the age of 65, dementia affects almost one person in 10. Over the age of 85,
dementia affects three people in 10. People under the age of 65 can develop dementia
(called ‘younger onset dementia’), but it is less common. Dementia can sometimes be
hereditary, but this is quite rare.

Family history: If you have biological parents or siblings with dementia, you’re more
likely to develop dementia.

Race and ethnicity: If you’re a Black person, you have twice the risk as a white person
for developing dementia. If you’re a Hispanic person, you’re 1.5 times more likely than a
white person to develop dementia.

Brain injury: If you’ve had a severe brain injury, you’re at a higher risk for dementia.

Impact on families and carers

In 2019, informal carers (i.e. most commonly family members and friends) spent on
average 5 hours per day providing care for people living with dementia. This can be
overwhelming . Physical, emotional and financial pressures can cause great stress to
families and carers, and support is required from the health, social, financial and legal
systems. Fifty percent of the global cost of dementia is attributed to informal care.

Social and economic impact

Dementia has significant social and economic implications in terms of direct medical
and social care costs, and the costs of informal care. In 2019, the estimated total global
societal cost of dementia was US$ 1.3 trillion, and these costs are expected to surpass
US$ 2.8 trillion by 2030 as both the number of people living with dementia and care
costs increase.

Causes and Risk Factors of psychotic symptoms

The specific cause of a psychotic symptoms is not known, but several factors can make
you more likely to develop one. Some risk factors include: A brain injury, including a
stroke or traumatic brain injury, Dementia, such as Alzheimer's disease, Certain
prescription medications. Psychotic symptoms can occur with any type of dementia
some types of dementia have higher rates. These include Alzheimer’s disease, Lewy
body dementia, and dementia related to Parkinson’s disease.

Psychosis may become more likely as dementia advances and other symptoms
become more severe. However, in some people, psychotic symptoms may be an early
symptom of dementia. Hallucinations may occur during the early impairment stage.
They could even develop before any other symptoms.

Causes of Dementia

Dementia is caused by damage to your brain or changes in the brain. Dementia affects
your brain’s nerve cells, which destroys your brain’s ability to communicate with its
various areas. Dementia can also result from blocked blood flow to your brain, depriving
it of needed oxygen and nutrients. Without oxygen and nutrients, brain tissue dies.
Damage to your brain results in different symptoms, depending on the area of your
brain affected. Some dementias aren’t reversible and will worsen over time. Other
dementias are due to other medical conditions that also affect your brain.