COGNITIVE DISORDERS
17 NCM 117: Psychiatric Nursing
Dr. SOCCORO SALVACION-GASCO • JUNE 24, 2021
1 o
SOMATIC SYMPTOM ILLNESSESS
→ The term psychosomatic began to be used to
convey the connection between the mind (psyche)
and the body (soma) in states of health and illness.
Essentially, the mind can cause the body either to
create physical symptoms or to worsen physical
illnesses. Real symptoms can begin, continue, or be
worsened as a result of emotional factors. Examples
include diabetes, hypertension, and colitis, all of
which are medical illnesses influenced by stress and
emotions. When a person is under a lot of stress or
is not coping well with stress, symptoms of these
medical illnesses worsen. In addition, stress can
cause physical symptoms unrelated to a diagnosed
medical illness. After a stressful day at work, many
people experience “tension headaches” that can be
quite painful. The headaches are a manifestation of
stress rather than a symptom of an underlying
medical problem.
→ The term hysteria refers to multiple physical
complaints with no organic basis; the complaint are
usually described dramatically. The concept of
hysteria is believed to have originated in Egypt and
is about 4,000 years old. In the Middle Ages,
hysteria was associated with witchcraft, demons,
and sorcerers. People with hysteria, usually women,
were considered evil or possessed by evil spirits.
Paul Briquet and Jean-Martin Charcot, both French
physicians, identified hysteria as a disorder of the
nervous system.
OVERVIEW OF SOMATIC SYMPTOM
ILLNESSES
• Somatization is defined as the transference of
mental experience and states into bodily symptoms.
Somatic symptom illnesses can be characterized as
the presence of physical symptoms that suggest a
medical condition without a demonstrable organic
basis to account fully for them.
• Somatoform disorders can be characterized as
the presence of physical symptoms that suggest
medical condition without a demonstrable organic
basis to account fully for them.
• The three central features of somatoform disorders
are as follows:
o Physical complaints suggest major medical
illness but have no demonstrable organic
basis.
o Psychological factors and conflicts seem
important in initiating, exacerbating, and
maintaining the symptoms.
ALGO, APOSTOL
Symptoms or magnified health concerns are
not under the client’s conscious control.
The five specific somatoform disorders are as
follows:
1. Somatization disorder- is characterized
by multiple physical symptoms.
- it begins by 30 years of age, extends
over several years, and includes a
combination of pain and
gastrointestinal, sexual, and
pseudoneurologic symptoms.
SYMPTOM OF SOMATIZATION DISORDER
o Pain Symptoms: complaints of
headache; pain in the abdomen, head,
joints, back, chest, rectum; pain during
urination, menstruation, or sexual
intercourse.
o Gastrointestinal Symptoms: nausea,
bloating, vomiting (other than during
pregnancy), diarrhea, or intolerance of
several foods.
o Sexual Symptoms: sexual
indifference, erectile or ejaculatory
dysfunction, irregular menses, excessive
menstrual bleeding, vomiting
throughout pregnancy.
o Pseudoneurologic Symptoms:
conversion symptoms such as impaired
coordination or balance, paralysis or
localized weakness, difficulty swallowing
or lump in throat, aphonia, urinary
retention, hallucinations, loss of touch
or pain sensation, double vision,
blindness, deafness, seizures;
dissociative symptoms such as amnesia;
or loss of consciousness other than
fainting.
2. Conversion Disorder- sometimes called
conversion reaction, involves unexplained,
usually sudden deficits in sensory or motor
function (e.g. blindness, paralysis).
- These deficits suggest a neurologic
disorder but are associated whit
psychological factors. An attitude of
a la belle indifference, a seeming
lack of concern or distress, is a key`
feature.
3. Pain Disorder- has the primary physical
symptom of pain, which generally is
unrelieved by analgesics and greatly
affected by psychological factors in terms of
onset, severity, exacerbation, and
maintenance.
 COGNITIVE DISORDERS
17 NCM 117: Psychiatric Nursing
Dr. SOCCORO SALVACION-GASCO • JUNE 24, 2021
1 4. Hypochondriasis- is preoccupation with
the fear that one has a serious disease
(disease conviction) or will get a serious
disease (disease phobia). Iton tawo nga
hypochondriac, pagbabasa niya hit medical
surgical na libro hit mga sakit masing hiya
na “mayda ak hini”. Mabasa hiya hit
oxygenation masing hiya “mayada ak hini”,
pagbabasa hit gastrointestinal, “mayada ak
hini”, pagbabasa hit metabolic “mayada ak
hini”, and etc. basta iton hiya mayada hiya
fear nga haros na tanan nga sakit mayada
hiya. An tawag hito hypochondriac.
- It is thought that clients with this
disorder misinterpret bodily
sensations or functions.
5. Body Dysmorphic Disorder- is
preoccupation with an imagined or
exaggerated defect in physical appearance
such as thinking one’s nose is too large or
teeth are crooked and unattractive. Kun
sumugad ka ngani ha imo sarili habang
nakita ha mirror na “wow kahuhusay ko”
that is not body dysmorphic, that is illusion,
pero kun sumiring ka ngani na “hagi
kadadako ko, kadadako hit ak suso/soso,
kadadako akon lubot, it akon ngipon bag
ana yaik nah in gorilya”, that is body
dysmorphic disorder.
RELATED DISORDERS
Somatic symptom illnesses need to be distinguished
from other body-related mental disorders such as
malingering and factitious disorders, also known as
fabricated or induced illness, in which people feign or
intentionally produce symptoms for some purpose or
gain. In malingering and factitious disorders, people
willfully control the symptoms. In somatic symptom
illnesses, clients do not voluntarily control their physical
symptoms.
• Malingering is the intentional production of
false or grossly exaggerated physical or
psychological symptoms; it is motivated by
external incentives such as avoiding work,
evading criminal prosecution, obtaining
financial compensation, or obtaining drugs.
People who malinger have no real physical
symptoms or grossly exaggerate relatively
minor symptoms. Their purpose is some
external incentive or outcome that they view as
important and results directly from the illness.
People who malinger can stop the physical
symptoms as soon as they have gained what
they wanted.
ALGO, APOSTOL
• Factitious Disorder- imposed on self, occurs
when a person intentionally produces or feigns
physical or psychological symptoms solely to
gain attention. People with factitious disorder
may even inflict injury on themselves to receive
attention. The common term for factitious
disorder imposed on self is Munchausen
syndrome.
o Munchausen Syndrome by Proxy- a
variation of factitious disorder, imposed
on others.
- Occurs when a person inflicts illness
or injury on someone else to gain
the attention of emergency medical
personnel or to be a “hero” for
saving the victim.
- An example would be a nurse who
gives excess intravenous potassium
to a client and then “saves his life”
by performing cardiopulmonary
resuscitation. Although factitious
disorders are uncommon, they occur
most often in people who are in or
are familiar with medical
professions, such as nurses,
physicians, medical technicians, or
hospital volunteers. People who
injure clients or their children
through Munchausen syndrome by
proxy generally are arrested and
prosecuted in the legal system.
Factitious disorders are also called
fabricated or induced illnesses.
PSYCHOSOCIAL THEORIS
• Psychosocial Theorists believe that people
with somatic symptom illnesses keep stress,
anxiety, or frustration inside rather than
expressing them outwardly. This is called
internalization. Clients express these
internalized feelings and stress through physical
symptoms (somatization). Both internalization
and somatization are unconscious defense
mechanisms. Clients are not consciously aware
of the process, and they do not voluntarily
control it. People with somatic symptom
illnesses do not readily and directly express
their feelings and emotions verbally. Some
experience alexithymia, or the inability to
identify emotions. This is different than an
unwillingness or refusal to identify emotions.
They have tremendous difficulty dealing with
interpersonal conflict. When placed in situations
involving conflict or emotional stress, their
physical symptoms appear to worsen. The
 COGNITIVE DISORDERS
17 NCM 117: Psychiatric Nursing
Dr. SOCCORO SALVACION-GASCO • JUNE 24, 2021

1 worsening of physical symptoms helps them

meet psychological needs for security,
attention, and affection through primary and
secondary gain.
(DIRE AKO MAARAM KUN ANO SUSUNDON
IBUBUTANG KO NALA NA DUHA)
AMO INI AN NAKADTO KAN DEAN PPT
• Primary gains are the direct external benefits
that being sick provides, such as relief of
anxiety, conflict, or distress.
• Secondary gains are the internal or personal
benefits received from others because one is
sick, such as attention from family members
and comfort measures (e.g., being brought tea,
receiving a back rub).
AMO INI AN NAKADTO HA BOOK
• Primary gains are the direct internal benefits
that being sick provides, such as relief of
anxiety, conflict, or distress.
• Secondary gains are the external or personal
benefits received from others because one is
sick, such as attention from family members
and comfort measures (e.g., being brought tea,
receiving a back rub).
BIOLOGIC THEORIS
• Research has shown differences in the way
clients with somatoform disorders regulate and
interpret stimuli. These clients cannot sort
relevant from irrelevant stimuli and respond
equally to both types. In other words, they may
experience a normal body sensation such as
peristalsis and attach a pathologic rather than a
normal meaning to it.
• Too little inhibition of sensory input amplifies
awareness of physical symptoms and
exaggerates response to bodily sensations.
• For example, minor discomfort such as muscle
tightness becomes amplified because of the
client’s concern and attention to the tightness.
This amplified sensory awareness causes the
person to experience somatic sensations as
more intense, noxious, and disturbing (Black &
Andreasen, 2016). Research has shown that
visceral hypersensitivity is associated with the
severity of gastrointestinal (GI) symptoms in
large cohorts of patients with functional GI
disorders in a variety of settings.
• Pseudoneurologic symptoms of somatization
disorder in Africa and South Asia include
burning hands and feet and the nondelusional
sensation of worms in the head or ants under
the skin. Symptoms related to male
reproduction are more common in some
countries or cultures—for example, men in
India often have dhat, which is a
hypochondriacal concern about loss of semen.
Somatic symptom disorder is rare in men in the
United States but more common in Greece and
Puerto Rico.
• Many cultural concepts of distress have
corresponding somatic symptoms not explained
by a medical condition (Table 21.1). Koro
occurs in Southeast Asia and may be related to
body dysmorphic disorder. It is characterized by
the belief that the penis is shrinking and will
disappear into the abdomen, causing the man
to die. Falling-out episodes, found in the
southern United States and the Caribbean
islands, are characterized by a sudden collapse
during which the person cannot see or move.
Hwa-Byung is a Korean folk syndrome
attributed to the suppression of anger and
includes insomnia, fatigue, panic, indigestion,
and generalized aches and pains. Sangue
dormido (sleeping blood) occurs among
Portuguese Cape Verde Islanders who report
pain, numbness, tremors, paralysis, seizures,
blindness, heart attacks, and miscarriages.
Shenjing shuairuo occurs in China and includes
physical and mental fatigue, dizziness,
headache, pain, sleep disturbance, memory
loss, GI problems, and sexual dysfunction.

CULTURAL CONSIDERATIONS
• The type and frequency of somatic symptoms
and their meaning may vary across cultures.

ALGO, APOSTOL
 COGNITIVE DISORDERS
17 NCM 117: Psychiatric Nursing
Dr. SOCCORO SALVACION-GASCO • JUNE 24, 2021

•1 The presence of a host of somatic symptoms • Educate client in relaxation techniques:

can also be associated with other diagnoses.
Zhao and colleagues (2018) found that patients
in China diagnosed with major depression
sought treatment in various medical settings.
They reported experiencing insomnia, weight
loss, low appetite, circulatory system
complaints, headache, hyposexuality, GI
complaints, and respiratory system problems.
TREATMENT
• There are 3 antidepressant drugs that are used
to treat somatoform disorder.
• For many clients, depression and anxiety may
accompany or result from somatic symptom
illnesses. Thus, antidepressants help in some
cases (Strohle, Gensichen, & Domschke, 2018).
Selective serotonin reuptake inhibitors such as
fluoxetine (Prozac), sertraline (Zoloft), and
paroxetine (Paxil) are most commonly used
(Table 21.2).
• For clients with pain disorder, referral to a
chronic pain clinic may be useful. Clients learn
methods of pain management, such as visual
imaging and relaxation.
• Services such as physical therapy to maintain
and build muscle tone help improve functional
abilities.
• Providers should avoid prescribing and
administering narcotic analgesics to these
clients because of the risk for dependence or
abuse.
• Clients can use nonsteroidal anti-inflammatory
agents to help reduce pain.
progressive relaxation, deep breathing, guided
imagery, and distraction such as music or other
activities.
• Educate client by role-playing social situations
and interactions.
• Encourage family to provide attention and
encouragement when client has fewer
complaints.
• Encourage family to decrease special attention
when client is in “sick” role.
NURSING INTERVENTIONS
For Somatic Symptom Illnesses (take note)
• Health teaching
o Establish a daily routine.
o Promote adequate nutrition and
sleep.
• Expression of emotional feelings
o Recognize relationship between
stress/coping and physical
symptoms.
o Keep a journal.
o Limit time spent on physical
complaints.
o Limit primary and secondary gains.
• Coping strategies
o Emotion-focused coping strategies
such as relaxation techniques, deep
breathing, guided imagery, and
distraction.
o Problem-focused coping strategies
such as problem-solving strategies
and role-playing.

CLIENT AND FAMILY EDUCATION

For Somatic Symptom Illnesses (take note)

• Establish daily health routine, including

adequate rest, exercise, and nutrition.
• Teach about relationship of stress and physical
symptoms and mind– body relationship.
• Educate about proper nutrition, rest, and
exercise.

ALGO, APOSTOL
 COGNITIVE DISORDERS
17 NCM 117: Psychiatric Nursing
Dr. SOCCORO SALVACION-GASCO • JUNE 24, 2021

1 COGNITIVE DISORDERS ETIOLOGY

• Cognition is the brain’s ability to process, • Delirium almost always results from an
retain, and use information. identifiable physiological, metabolic, or
• These cognitive abilities are essential for many cerebral disturbance or disease or from drug
important tasks, including making decisions, intoxication or withdrawal.
solving problems, interpreting the environment, • Often, delirium results from multiple causes
and learning new information. and requires a careful and thorough
• Cognitive abilities include: physical examination and laboratory tests
o Reasoning for identification.
o Judgment
DSM-IV-TR DIAGNOSTIC CRITERIA:
o Perception
o Attention • Difficulty with attention
o Comprehension • Easily distractible
o Memory • Disoriented
• May have sensory disturbances such as
illusions, misinterpretations, or
COGNITIVE DISORDER hallucinations.
• Can have sleep-wake cycle disturbances
• Cognitive disorder is a disruption or impairment
• Changes in psychomotor activity
in these higher-level functions of the brain.
• May experience anxiety, fear, irritability,
• Cognitive disorders can have devastating
euphoria, or apathy.
effects on the ability to function in daily life.
They can cause people to forget the names of COMMON CAUSES OF DELERIUM
immediate family members, be unable to
1. Physiological or metabolic
perform daily household tasks, and neglect
• Hypoxemia; electrolyte
personal hygiene.
disturbances; renal or hepatic
• The primary categories of cognitive disorders
failure; hypoglycemia or
are delirium, dementia, and amnestic disorders.
hyperglycemia; dehydration; sleep
All involve in impairment of cognition, and effect
deprivation; thyroid or
on clients and family members or caregivers.
glucocorticoid disturbances;
DELERIUM thiamine or vitamin B12 deficiency;
vitamin C, niacin, or protein
• Delirium is a syndrome that involves a
deficiency; cardiovascular shock;
disturbance of consciousness accompanied by a
brain tumor; head injury; and
change in cognition.
exposure to gasoline, paint solvents,
• Delirium usually develops over a short period,
insecticides, and related substances.
sometimes a matter of hours, and fluctuates, or
2. Infections as Causes
changes, throughout the course of the day.
• Systemic:
• Clients with delirium have difficulty paying
o Sepsis
attention, are easily distracted and disoriented,
o Urinary Tract Infection
and may have sensory disturbances such as
o Pneumonia
illusions, misinterpretations, or hallucinations.
• Cerebral:
An electrical cord on the floor may appear to
o Meningitis,
them as a snake (illusion).
o Encephalitis
• They may mistake the banging of a laundry cart
o HIV
in the hallway for a gunshot
o Syphilis
(misinterpretation).
3. Drug Related
• They may see “angels” hovering above when
• Intoxication: Anticholinergics,
nothing is there (hallucination).
lithium, alcohol, sedatives, and
• At times, they also experience disturbances in
hypnotics
the sleep–wake cycle, changes in psychomotor
• Withdrawal: Alcohol, sedatives, and
activity, and emotional problems such as
hypnotics
anxiety, fear, irritability, euphoria, or apathy.
• Reactions to anesthesia, prescription
medication, or illicit (street) drugs.

ALGO, APOSTOL
 COGNITIVE DISORDERS
17 NCM 117: Psychiatric Nursing
Dr. SOCCORO SALVACION-GASCO • JUNE 24, 2021
1 APPEARANCE & MOTOR BEHAVIOR
GENERAL
• Clients with delirium often have a disturbance
of psychomotor behavior.
• They may be restless and hyperactive,
frequently picking at bed clothes or making
sudden, uncoordinated attempts to get out of
bed.
• Clients may have slowed motor behavior,
appearing sluggish and lethargic with little
movement.
• Speech may also be affected, becoming less
coherent and more difficult to understand as
delirium worsens. Clients may perseverate on a
single topic or detail, may be rambling and
difficult to follow, or may have pressured
speech that is rapid, forced, and usually louder
than normal. At times, clients may call out or
scream, especially at night.
MOOD AND AFFECT
• Clients with delirium often have rapid and
unpredictable mood shifts.
• A wide range of emotional responses is
possible, such as anxiety, fear, irritability,
anger, euphoria, and apathy.
• These mood shifts and emotions usually have
nothing to do with the client’s environment.
• When clients are particularly fearful and feel
threatened, they may become combative to
defend themselves from perceived harm.
THOUGHT PROCESS AND CONTENT
• Although clients with delirium have changes in
cognition, it is difficult for the nurse to assess
these changes accurately and thoroughly.
Marked inability to sustain attention makes it
difficult to assess thought process and content.
• Thought content in delirium is often unrelated
to the situation, or speech is illogical and
difficult to understand.
• The nurse may ask how clients are feeling, and
they will mumble about the weather.
• Thought processes are often disorganized and
make no sense.
• Thoughts also may be fragmented (disjointed
and incomplete). Clients may exhibit delusions,
believing that their altered sensory perceptions
are real.
SENSORIUM AND INTELLECTUAL PROCESS
• The primary and often initial sign of delirium is
an altered level of consciousness that is seldom
stable and usually fluctuates throughout the
day.
ALGO, APOSTOL
• Clients are usually oriented to people but
frequently disoriented to time and place.
• They demonstrate decreased awareness of the
environment or situation and instead may focus
on irrelevant stimuli such as the color of the
bedspread or the room.
• Noises, people, or sensory misperceptions
easily distract them.
• Clients cannot focus, sustain, or shift attention
effectively, and there is impaired recent and
immediate memory. This means the nurse may
have to ask questions or provide directions
repeatedly. Even then, clients may be unable to
do what is requested. Clients frequently
experience misinterpretations, illusions, and
hallucinations. Both misperceptions and
illusions are based on some actual stimuli in the
environment; clients may hear a door slam and
interpret it as a gunshot or see the nurse reach
for an IV bag and believe the nurse is about to
strike them. Examples of common illusions
include clients believing that IV tubing or an
electrical cord is a snake and mistaking the
nurse for a family member. Hallucinations are
most often visual; clients “see” things for which
there is no stimulus in reality. When more lucid,
some clients are aware that they are
experiencing sensory misperceptions. Others,
however, actually believe their
misinterpretations are correct and cannot be
convinced otherwise.
JUDGEMENT AND INSIGHT
• Judgment is impaired.
• Clients often cannot perceive potentially
harmful situations or act in their own best
interests. For example, they may try repeatedly
to pull out IV tubing or urinary catheters; this
causes pain and interferes with necessary
treatment.
• Insight depends on the severity of the delirium.
Clients with mild delirium may recognize that
they are confused, are receiving treatment, and
will likely improve. Those with severe delirium
may have no insight into the situation.
SELF-CONCEPT
• Although delirium has no direct effect on self-
concept, clients often are frightened or feel
threatened.
• Those with some awareness of the situation
may feel helpless or powerless to do anything
to change it.
• If delirium has resulted from alcohol, illicit drug
use, or overuse of prescribed medications,
 COGNITIVE DISORDERS
17 NCM 117: Psychiatric Nursing
Dr. SOCCORO SALVACION-GASCO • JUNE 24, 2021
1 clients may feel guilt, shame, and humiliation,
or think, “I’m a bad person; I did this to myself.”
This would indicate possible long-term
problems with self-concept.
NURSING DIAGNOSES
• Risk for Injury
• Acute Confusion
• Disturbed Sensory Perception
• Disturbed Thought Process
• Disturbed Sleep Pattern
• Risk for Deficient Fluid Volume
• Risk for Imbalanced Nutrition: Less Than Body
Requirements
DEMENTIA
NURSING INTERVENTIONS
1. Promoting Client’s Safety
• Teach client to request assistance for activities.
• Provide close supervision to ensure safety
during these activities.
• Promptly respond to client’s call for assistance.
2. Managing Client’s Confusion
• Speak to client in a calm manner in a clear low
voice; use simple sentences.
• Allow adequate time for client to comprehend
and respond.
• Allow client to make decision as much as
possible.
• Provide orienting verbal cues when talking with
client.
• Use supportive touch if appropriate.
3. Controlling Environment to Reduce Sensory
Overload
• Keep environmental noise to minimum
• Monitor client’s response to visitors; explain to
family and friends that client may need to visit
quietly one on one
• Validate client’s anxiety and fears, but do not
reinforce misperception
4. Promoting Sleep and Proper Nutrition
• Monitor sleep and elimination patterns.
• Monitor food and fluid intake; provide prompts
or assistance to eat and drink adequate
amounts of food and fluid.
• Provide periodic assistance to bathroom if client
does not make requests.
• Discourage daytime napping to help sleep at
night.
• Encourage some exercise during day like sitting,
walking, or other activities client can manage.
INTERVENTIONS
• Do not allow the client to assume responsibility
for decisions or actions if they are unsafe.
ALGO, APOSTOL
• If limits on the client’s actions are necessary,
explain limits and reasons clearly, within the
client’s ability to understand.
• Involve the client in making plans or decisions
as much as he or she is able to participate.
• Assess the client daily or more often if needed
for his or her level of functioning.
• Allow the client to make decisions as much as
he or she is able.
• Assist the client to establish a daily routine,
including hygiene, activities, and so-forth.
• Teach the client about underlying causes of
confusion and delirium.
• Mental disorder that involves multiple cognitive
deficits, primarily memory impairment, and at
least one of the following cognitive
disturbances:
• APHASIA which is deterioration of language
function. Diri na nakakayakan.
• APRAXIA which is impaired ability to excuse
motor functions despite intact motor abilities. Di
nakakalakat, di nakakasuklay.
• AGNOSIA which is inability to recognize or
name objects despite intact sensory abilities.
Ex: Diri maaram na saging iton, sige la tudlok.
• DISTURBANCE IN EXECUTIVE
FUNCTIONING which is the ability to think
abstractly and to plan, initiate, sequence,
monitor, and stop complex behavior. Diri na
nakakaplano, mayda difficulty in choosing kung
ano gagawin.
• Memory impairment is the prominent early sign
of dementia. Clients have difficulty learning new
material and forget previously learned material.
• Initially, recent memory is impaired – for
example, forgetting where certain objects were
placed or that food is cooking on the stove.
• Aphasia usually begins with the inability to
name familiar objects or people and then
progresses to speech that becomes vague or
empty with excessive use of terms such as it or
thing.
• Clients may exhibit ECHOLALIA (echoing what
is heard) or PALILALIA (repeating words or
sounds over and over).
DSM-IV-TR DIAGNOSTIC CRITERIA:
• LOSS OF MEMORY
o Initial stages, recent memory loss
such as forgetting food cooking on
the stove.
 COGNITIVE DISORDERS
17 NCM 117: Psychiatric Nursing
Dr. SOCCORO SALVACION-GASCO • JUNE 24, 2021
1 Later stages, remote memory loss
o ✓ Most people live in nursing facilities when
such as forgetting names of
children, occupation.
• DETERIORATION OF LANGUAGE
ETIOLOGY
FUNCTION
o Forgetting name of common objects
or PALILALIA, echoing sounds,
and echoing words that are heard or
ECHOLALIA.
• LOSS OF ABILITY TO THINK
ABSTRACTLY
o And to plan, initiate sequence,
monitor or stop complex behaviors
(Loss of Executive Function): the
client loses the ability to perform
self-care activities.
ONSET AND CLINICAL COURSE
• MILD
✓ Forgetfulness is the hallmark of beginning,
mild dementia.
✓ It exceeds the normal, occasional
forgetfulness experienced as part of the
aging process.
✓ The person has difficulty finding words,
frequently loses objects, and begins to
experience anxiety about these losses.
✓ Occupational and social settings are less
enjoyable, and the person may avoid them.
✓ Most people remain in the community
during this stage.
• MODERATE
✓ Confusion is apparent, along with
progressive memory loss.
✓ The person no longer can perform complex
tasks but remain oriented to person and
place. He or she still recognizes familiar
people.
✓ Toward the end of this stage, the person
loses the ability to live independently and
requires assistance because of
disorientation to time and loss of
information.
✓ The person may remain in the community if
adequate caregiver support is available, but
some people move to supervised living
situations.
• SEVERE
✓ Personality and emotional changes occur.
✓ The person may be delusional, wander at
night, forget the names of his or her spouse
and children, and require assistance in
activities of daily living.
ALGO, APOSTOL
they reach this stage unless extraordinary
community support is available.
• Metabolic activity is decreased in the brains of
clients with dementia.
• A genetic component has been identified for
some dementias such as Huntington’s disease.
• An abnormal APOE gene is known to be linked
with Alzheimer’s disease.
• Other causes of dementia are related to
infections such as human immunodeficiency
virus (HIV) infection or Creutzfeldt-Jakob
disease.
(Salit para diri mag dementia or Alzheimer, teach
them Suduko, Scrabble, Chess para it utok
umandar, pabasahon hin newspaper. Diri kay mag
inukoy la ha rocking chair)
COMMON TYPES OF DEMENTIA AND ITS CAUSES
1. ALZHEIMER’S DISEASE
• A progressive brain disorder that has a
gradual onset.
• Causes an increasing decline in functioning,
including loss of speech, loss of motor
function, and profound personality and
behavioral changes.
• Evidenced by atrophy of cerebral neurons,
senile plaque deposits, and enlargement of
the third and fourth ventricles of the brain.
• Risk for Alzheimer’s disease increases with
age, and average duration from onset of
symptoms to death is 8 to 10 years.
Dementia of the Alzheimer’s Type,
especially with late onset (after 65 years of
age), may have genetic component.
2. VASCULAR DEMENTIA
• Symptoms similar to those of Alzheimer’s
disease.
• Onset is typically abrupt, followed by rapid
changes in functioning; a plateau, or
levelling-off period; more abrupt changes;
another levelling-off period; and so on.
• Computed tomography or magnetic
resonance imaging usually shows multiple
vascular lesions of the cerebral cortex and
subcortical structures resulting from the
decreased blood supply to the brain.
3. PICK’S DISEASE
• A degenerative brain disease that
particularly affects the frontal and temporal
lobes and results in a clinical picture similar
to that of Alzheimer’s disease.
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1• Early signs include personality changes, loss
of social skills and inhibitions, emotional
blunting, and language abnormalities
• Onset is most commonly 50 to 60 years of
age; death occurs in 2 to 5 years.
4. CREUTZFELDT-JACOB DISEASE
• A central nervous system disorder that
typically develops in adults 40 to 60 years of
age.
• It involves altered vision, loss of
coordination or abnormal movements, and
dementia that usually progresses.
• The cause of the encephalopathy is an
infectious particle resistant to boiling, some
disinfectants, and ultraviolet radiation.
Pressured autoclaving or bleach can
inactivate the particle.
5. HUMAN IMMUNODEFICIENCY VIRUS
• Lead to dementia and other neurologic
problems.
• These may result directly from invasion of
nervous tissue by HIV illnesses such as
toxoplasmosis and cytomegalovirus.
• This type of dementia can result in a wide
variety of symptoms ranging from mild
sensory impairment to gross memory and
cognitive deficits to severe muscle
dysfunction.
6. PARKINSON’S DISEASE
• Slowly progressive neurologic condition
characterized by tremor, rigidity,
bradykinesia, and postural instability.
• It results from loss of neurons of the basal
ganglia.
• Characterized by cognitive and motor
slowing, impaired memory, and impaired
executive functioning.
7. HUNTINGTON’S DISEASE
• An inherited, dominant gene disease that
primarily involves cerebral atrophy,
demyelination, and enlargement of the
brain ventricles. Initially, there are
choreiform movements that are continuous
during waking hours and involve facial
contortions, twisting, turning, and tongue
movements.
• Personality changes are initial psychosocial
manifestations, followed by memory loss,
decreased intellectual functioning, and
other signs of dementia.
• The disease begins in the late 30s or early
40s and may last 10 to 20 years or more
before death.
ALGO, APOSTOL
Dementia can be a direct pathophysiologic
consequence of head trauma. The degree and type of
cognitive impairment and behavioral disturbance
depend on the location and extent of the brain injury.
When it occurs as a single injury, the dementia is
usually stable rather than progressive. Repeated head
injury may lead to progressive dementia.
TREATMENT AND PROGNOSIS
• The prognosis for the progressive types of
dementia may vary, but all prognoses involve
progressive deterioration of physical and mental
abilities until death.
• Typically, in the later stages, clients have
minimal cognitive and motor function, are
totally dependent on caregivers, and are
unaware of their surroundings or people in the
environment. They may be totally
uncommunicative or make unintelligible sounds
or attempts to verbalize.
• For degenerative dementias, no direct therapies
have been found to reverse or retard the
fundamental pathophysiologic processes.
• Levels of numerous neurotransmitters such as
acetylcholine, dopamine, norepinephrine, and
serotonin are decreased in dementia. This has
led to attempts at replenishment therapy with
acetylcholine precursors, cholinergic agonists,
and cholinesterase inhibitors.
• Donepezil (Aricept), Rivastigmine (Exelon), and
Galantamine (Reminyl) are cholinesterase
inhibitors and have shown modest therapeutic
effects and temporarily slow the progress of
dementia.
• Tacrine (Cognex) is also a cholinesterase
inhibitor; however, it elevates liver enzymes in
about 50% of clients using it. Lab tests assess
liver function are necessary every 1 to 2 weeks;
therefore, tacrine is rarely prescribed.
• Memantine (Namenda) is an NMDA receptor
antagonist that can slow the progression of
Alzheimer’s in the moderate or severe stages.
• Antidepressants are effective for significant
depressive symptoms; however, they can cause
delirium. SSRI antidepressants are used since
the have fewer side effects.
• Antipsychotics, such as haloperidol (Haldol),
olanzapine (Zyprexa), risperidone (Risperdal),
and quetiapine (Seroquel), may be used to
manage psychotic symptoms. The potential
benefit of antipsychotics must be weighed with
risks, such as increased mortality rate, primarily
from cardiovascular complications. Due to this
increased risk, the FDA has not approved
antipsychotics for dementia treatment.
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•1 Lithium carbonate, carbamazepine (Tegretol),
and valproic acid (Depakote) help to stabilize
affective liability and to diminish aggressive
outbursts.
• Benzodiazepines are used cautiously because
they may cause delirium and can worsen
already compromised cognitive abilities.
GENERAL APPEARANCE AND BEHAVIOR
• Dementia progressively impairs the ability to
carry on meaningful conversation.
• Clients display aphasia and conversation
becomes repetitive because they often
perseverate on one idea. Eventually, speech
may become slurred, followed by a total loss of
PHYSIOLOGIC
language function.
CONSIDERATIONS
• The initial finding with regard to motor behavior
is apraxia.
• Clients cannot imitate the task when others
demonstrate it for them. In the severe stage,
clients may experience a gait disturbance that
makes unassisted ambulation unsafe, if not
impossible.
THOUGHT PROCESS AND CONTENT
• The ability to think abstractly is impaired,
resulting in loss of the ability to plan, sequence,
monitor, initiate, or stop complex behavior.
• The client loses the ability to solve problems or
to take action in new situations because he or
she cannot think about what to do.
• The ability to generalize knowledge from one
situation to another is lost because the client
NURSING DIAGNOSES
cannot recognize similarities or differences in
situations.
• As the dementia progresses, delusions of
persecution are common.
SENSORIUM AND INTELLECTUAL PROCESS
• Clients lose intellectual function, which
eventually involves the complete loss of their
abilities.
• Memory deficits are the initial and essential
feature of dementia.
• Dementia first affects recent and immediate
memory and then eventually impairs the ability
to recognize close family members and even
oneself.
• In mild and moderate dementia, clients may
NURSING INTERVENTIONS
make up answers to fill in memory gaps
(confabulation). Confabulation is making up
stories, kunware para la sidngon na di ka
nagdedementia.
• Agnosia is another hallmark of dementia.
Clients lose visual spatial relations, which is
ALGO, APOSTOL
often evidenced by deterioration of the ability
to write or draw simple objects. Attention span
and ability to concentrate are increasingly
impaired until clients lose the ability to do
either.
JUDGEMENT AND INSIGHT
• Clients with dementia have poor judgement
in light of the cognitive impairment. They
underestimate risks and unrealistically
appraise their abilities, which result in a high
risk for injury. Clients cannot evaluate
situations for risks or danger.
• Insight is limited.
AND SELF-CARE
• Clients with dementia often experience
disturbed sleep-awake cycles; they nap during
the day and wander at night.
• Some clients ignore internal cues such as
hunger or thirst; others have little difficulty with
eating and drinking until dementia is severe. If
you will not feed them, they won’t eat. That’s
why malnutrition is present.
• Clients may experience bladder and even bowel
incontinence or have difficulty cleaning
themselves after elimination. They frequently
neglect bathing and grooming.
• Eventually, clients are likely to require complete
care from someone else to meet these basic
physiologic needs.
• Risk for injury (madudulas, mahuhulog)
• Disturbed sleep pattern
• Risk for deficient fluid volume (diri kasi nakaon
at nainom)
• Risk for imbalanced nutrition: less than body
requirements
• Chronic confusion (because of brain atrophy)
• Impaired environmental interpretation
syndrome
• Impaired memory
• Impaired social interaction
• Impaired verbal communication (they cannot
remember the names, etc.)
• Ineffective role performance
1. PROMOTING CLIENT’S SAFETY AND
PROTECTING FROM INJURY
• Offer unobstrusive assistance with or
supervision of cooking, bathing, or self-care
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1 acts. Identify environmental triggers to help such as aphasia, apraxia, agnosia, and impaired
client avoid them. executive functions.
2. PROMOTING ADEQUATE SLEEP, PROPER • Several medical conditions can cause brain
NUTRITION AND HYGIENE, AND ACTIVITY damage and result in an amnestic disorder—for
• Prepare desirable foods and foods client can example, stroke or other cerebrovascular
self-feed events, head injuries. and neurotoxic
• Monitor bowel elimination patters exposures, such as carbon monoxide poisoning.
• Remind the client to urinate; provide pads chronic alcohol ingestion. and vitamin 812 or
or diapers as needed thiamine deficiency.
• Encourage mild physical activity such as • Alcohol-Induced Amnestic Disorder results
walking from a chronic thiamine or vitamin B deficiency
3. STRUCTURING ENVIRONMENT AND ROUTINE and is called Korsakoff’s syndrome.
• Encourage client to follow regular routine
and habits of bathing and dressing. Monitor
environmental stimulation and adjust when
needed.
4. PROVIDING EMOTIONAL SUPPORT
• Be kind, respectful, calm, and reassuring
• Use supportive touch when necessary
5. PROMOTING INTERACTION AND
INVOLVEMENT
• Plan activities geared towards client’s
interests and abilities
• Reminisce with client about the past
• Employ techniques of distraction

REMINISCE THERAPY – effective intervention for

dementia and which involves thinking about or relating
personally significant past experiences.

DISTRACTION – involves shifting the client’s

attention and energy to a more neutral topic.

TIME AWAY – involves leaving the client for a short

period and then returning to them to re-engage in
interaction.

GOING ALONG – providing emotional reassurance to

clients without correcting their misperception or
delusion.

RELATED DISORDERS

• AMNESTIC DISORDERS are characterized by a

disturbance in memory that results directly from
the physiologic effects of a general medical
condition or the persisting effects of a
substance such as alcohol or other drugs.
• The memory disturbance is sufficiently severe
to cause marked impairment in social or
occupational functioning.
• Confusion, disorientation, and attentional
deficits are common.
• Clients with amnestic disorders are similar to
those with dementia in terms of memory
deficits, confusion, and problems with
attention. They do not, however, have the
multiple cognitive deficits seen in dementia,

ALGO, APOSTOL