● Orientation: Ask for the current location, “Ma’am asa ta

karun?”
CARE OF OLDER ADULTS ● Memory: Who was the previous president, “Sino ba
president before President Bongbong?”
● Attention: Numbers that ends in 7 from 1 to 100; Count
OUTLINE the days of the week backwards
● Praxis: Drawing a watch
I. COGNITIVE DISORDERS
● COGNITIVE PARAMETERS
II. DELIRIUM
● ETIOLOGY DELIRIUM
● SYMPTOMS
● MEDICAL MANAGEMENT ● Delirium is a sudden, fluctuating, and usually reversible
● NON PHARMACOLOGICAL PROTOCOL cognitive disorder characterized by disorientation, the
● MEDICAL MANAGEMENT (based on the inability to pay attention, the inability to think clearly, and
ppt, twice lumabas ang medical mgt) a change in LOC (Level of Consciousness)
● NURSING INTERVENTION ● An abnormal mental state, not a disease
III. DEMENTIA
● CLASSIFICATION OF DEMENTIA
● WHAT CONDITIONS RESULT IN Additional notes:
DEMENTIA ● Delirium is a syndrome (a group of symptoms). It
● TYPES OF DEMENTIA involves disturbance in the level of consciousness and
● 4A’S IN DEMENTIA accompanied by the change of cognition.
● DIAGNOSTIC TESTS ● Usually it is developed in a short period of time,
● ASSESSMENT sometimes fluctuating; mood changes occurs; it can be
● NURSING DIAGNOSIS throughout the course a nagka sakit siya
● NURSING INTERVENTIONS
IV. ALZHEIMER’S DISEASE
● PROGRESSION OF ALZHEIMER’S ETIOLOGY
● TEN WARNING SIGNS
● 5 A’S IN ALZHEIMER’S
● Development or worsening of almost any disorder
● DIAGNOSTIC TESTS
● Relatively minor illness, such as retention of urine or
● MEDICAL MANAGEMENT
feces
● Sensory deprivation (prolonged lack of sleep)
● Common after surgery
● Most common reversible cause is drugs
● Abnormal electrolytes level (Ca, Na, Mg) interfere with
COGNITIVE DISORDERS the metabolic activity of nerve
● Hypothyroidism and Hyperthyroidism
● Cognition - is the ability of your brain to think, to
process and store information & to solve problems Additional notes:
● Neurogerintology more specifically deals with the ● According to Sheila Videbeck's (psychiatric nursing
aging nervous system book reference) she categorized etiology into three:
● Cognitive disorders are necessarily brain disorders, physiologic, metabolic and drug related.
and these are increasingly common after middle age
SYMPTOMS
Additional notes:
● Cognitive - we talk of our brain; mental status of the
patient; mental problems ● The hallmark is the inability to pay attention
● Cognition - cognitive abilities includes reasoning, ● Lacks concentration
judgment, how we pay attention, how we comprehend, ● Sudden confusion about time and place. Thinking is
and memory confused and sometimes becomes coherent
● Cognitive disorders - Impairment in higher form or ● If delirium is severe, people may not know who they are
higher level of function in the brain; has a devastating ● The level of consciousness may fluctuate between
effect especially on the elderlies increased wakefulness and drowsiness
● Sundowning phenomenon
● Symptoms often change within minutes and tend to
worsen late in the day
COGNITIVE PARAMETERS ● Ofen sleep restlessly or reverse sleep-wake cycle
● Frightened by bizarre visual hallucinations
● Orientation: person, place, time ● Paranoia or have delusions
● Memory: ability to register, retain, recall information ● Personality and mood may change
● Attention: ability to attend and concentrate on stimuli ● If not quickly identified and treated
● Thinking: ability to organize and communicate ideas ○ Person may become increasingly drowsy and
● Language: ability to receive and express a message unresponsive, requiring vigorous simulation to
● Praxis: ability to direct and coordinate movements be aroused (stupor)
● Executive function: ability to abstract, plan, sequence, ○ Stupor may lead to coma or death
and use feedback to guide performance ● Delirium is often the first sign of another, sometimes
serious disorder especially in older people
Additional notes:

1

MEDICAL MANAGEMENT
● Delirium is usually caused by other medication
conditions, treat those conditions in order to treat
delirium. Carefully review the patient's medical history,
lab results, drug use, including over the counter, illicit
drugs and alcohol
● Nonpharmacologic interventions
Therapeutic environment
● Frequent reality orientation
● Clear communication
● Decrease stimuli - noise reduction
● Provide daily routine
● Ensure adequate fluid intake
● Ensure elimination need is met
● Avoid physical restraint
NON PHARMACOLOGICAL PROTOCOL
Orientation
● Provide visual and hearing aids
● Encourage communication and reorient patient
repetitively
● Have familiar objects from patient’s home in the room
● Attempt consistency in nursing staff
● Allow television during day with daily news
● Non-verbal music
Environment
● Sleep hygiene- lights off at night, on during the day;
sleep aids (zolpidem, mirtazapine)
● Control excess noise (staff, equipment, visitors) at night
● Ambulate or mobilize patient early and often
Clinical parameters
● Maintain systolic blood pressure > 90 mmHg
● Maintain oxygen saturation > 90%
● Treat underlying metabolic derangements and
infections
MEDICAL MANAGEMENT
- Allow adequate time for client to comprehend
and respond
- Allow client to make decisions
- Provide orienting verbal cues
- Use supportive touch if appropriate
● Controlling environment To reduce sensory
overload
- provide a quiet environment
- Monitor clients response to visitors
- validate clients anxiety and fears but do not
reinforce misperceptions
● Promoting sleep and proper nutrition
- Monitor sleep and elimination patterns
- Monitor food and fluid intake
- discouraged daytime napping
- encourage exercise during day
NURSING INTERVENTION
● Promote clients safety
- Offer unobtrusive assistance with or
supervision of activities
- Identify environmental triggers to help client
avoid them
● Promote adequate sleep and proper nutrition,
hygiene and activity
- Sit with client while eating
- Monitor bowel elimination pattern
- Remind client to urinate
- Encourage mild physical activities
● Structure the environment and routine
- Encourage client to follow regular routines and
habits
- Monitor environmental stimulation, and adjust
when needed
● Provide emotional support
- Be kind, respectful, calm, and reassuring, pay
attention to client
- Use supportive touch when necessary

● Hypoactive delirium - no specific pharmacologic ● Promote interaction and involvement

treatment - Plan activities according to clients interest and
● Sedatives - to prevent inadvertent self-injury but abilities
sedatives and benzodiazepines are avoided - this may - Allow the client to have familiar objects around
worsen delirium him/her
- Exemption to this is delirium induced by - Reminisce with client about the past
alcohol withdrawal. - Be alert to nonverbal cues
● Haloperidol 0.5-1 mg to decrease agitation - Employ techniques of distraction
● Supportive medical measures ● Provide a list of community resources, support
groups
Nursing Diagnosis
● Risk for injury DEMENTIA
● Acute confusion
● Disturbed sensory perception
● Disturbed thought processes ● dementia is a label of a cluster of symptoms
● Disturbed sleep pattern involving deterioration in behavior such as memory
● Risk for deficient fluid volume language and reasoning. The deterioration results
● Risk for imbalanced nutrition: less than body from a disease process in the brain.
requirement
Nursing Interventions
CLASSIFICATION OF DEMENTIA
● Ensure client’s safety
- Administer medications judiciously as ordered ● Dementia is classified as cortical or subcortical
- Teach client to request assistance for activities depending on the area of the brain affected.
- Close supervision must be rendered
● Managing client’s confusion Cortical Dementia
- Speak in a calm manner in a clear low voice Subcortical Dementia
 - AIDS dementia complex (ADC)
Additional Notes: - A complicated syndrome made up of different
nervous system and mental symptoms
Cortical Dementia: ● Parkinson’s Disease
- Characteristic feature: gait, involuntary
- Cerebral cortex is the largest site of the neural movement, pin-rolling
integration; play a role in the attention, perception, ● Dementia caused by head trauma
memory, thought, language and consciousness
- May nangyayare sa cerebral cortex Additional Notes:
- Causes problems in memory, thinking, language
- E.g. ALZHEIMER’s DISEASE A.D.
- Irreversible; progressive brain disorder that slowly
Subcortical Dementia: destroys your memory and your thinking skills and
- Destruction of subcortical region, deep part of the brain. eventually ability to carry out simple tasks
Inc. diencephalon, pituitary gland, limbic structure, - Reason for AD: senile plaque in the brain, enlargement
and basal ganglia - responsible for the activities such of the 3rd and 4th ventricle of the brain
as emotion, extremes of mood, release hormones, - Risk for AD: more advanced the age, the more at risk
neurotransmitters, responsible for pleasure for AD, onset 8-10 years
- Affects the subcortical layer or below the cortex:
therefore there will be problems in the motor movement, Vascular Dementia
difficulty retrieving information, alteration of mood - Vasculo - “blood vessel”
- Hardening of the arteries: atherosclerosis/
arteriosclerosis
WHAT CONDITIONS RESULT IN DEMENTIA?
Pick’s Disease
● Alzheimer’s disease - Strong genetic component because it runs in the family
- Accounts for 50% of all cases
● Vascular Dementia Creutzfeldt-Jakob Disease
- Repeated damage to the brain caused by - Prion disease - it can trigger the normal protein to fold
blockages in the blood vessels abnormally
- CJD is a type of TSE meaning there is an infectious
particle that entered the brain that is resistant in boiling
TYPES OF DEMENTIA
AT CONDITIONS RESULT IN DEMENTIA?
● Alzheimer’s Disease 4 A’S IN DEMENTIA
● Vascular Dementia
● Pick’s Disease
- Pick’s Disease is the result of a build-up of ● Amnesia
protein in the frontal and temporal lobes of the -memory impairment; disturbance in the executive
brain. functioning
- The accumulation of abnormal brain cells, ● Aphasia
known as Pick’s bodies, eventually leads to -language disturbance
changes in character, socially inappropriate ● Apraxia
behavior, and poor decision making, -unable to perform motor activities
progressing to a severe impairment intellect, ● Agnosia
memory and speech. Difficulty in identifying objects

● Creutzfeldt-Jakob Disease DIAGNOSTIC TESTS

- Prion Disease - which means that healthy
brain tissue deteriorates into an abnormal
protein that the body cannot break down. ● Psychological Tests
- CJD is a type of transmissible spongiform ● Neurologic Tests
encephalopathy (TSE) ○ EEG (electroencephalogram)
○ CAT (Computerized Axial Tomography
● Huntington’s Disease ○ Cerebral Blood Flow
- Destroying cells in the basal ganglia ○ Magnetic Resonance Imaging (MRI)
- Caused by a gene mutation that leads to a ● Mental Status Exam
toxic accumulation of protein in the brain ● Physical Status Exam
inherited from either one or both parents. ● Laboratory tests targeted at identifying general medical
- Symptoms in early stages: and substance related causes
Poor memory
Difficulty making decisions
ASSESSMENT
Mood changes such as increased depression,
anger, or irritability
Growing lack of coordination, twitching or other ● Level of consciousness- not affected
uncontrolled movements ● Thought processes is impaired
Difficulty walking, speaking, and/or swallowing.
● Mental Function is lost, relatively consistently for all
Choreiform gait. Dance sign
functions
● HIV Dementia ● Memory is lost, especially for recent events
 ● Use of language- sometimes has difficulty finding the
right word
● Mood is usually depressed and anxious in early stage,
labile mood, restless pacing, angry out-bursts in later
stage
● Self- concept is usually angry or frustrated
● Often experiences disturbed sleep- wake cycles
● Has at least one of the 4 A’s
NURSING DIAGNOSIS
● Risk for injury
● Disturbed sleep pattern
● Risk for deficient fluid volume
● Risk for imbalanced nutrition: less than body
requirements
● Chronic confusion
● Impaired environmental interpretation syndrome
● Impaired memory
● Impaired social interaction
● Impaired verbal communication
● Ineffective role performance
NURSING INTERVENTIONS
● Provide emotional support
○ Be kind, respectful, calm, and reassuring, pay
attention to client
○ Use supportive touch when necessary
● Promote interaction and involvement (Milieu
Management)
○ Plan activities according to client’s interest and
abilities
○ Allow the client to have familiar objects around
him/her
■ Reality orientation, self-worth, dignity
○ Reminisce with client about the past
○ Be alert to nonverbal cues
○ Employ techniques of distraction
● Provide a list of community resources, support groups,
… protein is cleaved by 2 enzymes.
● Presenting reality & attention to the emotional response
○ Dementia is a primary brain pathology.
○ It is a long term care
Additional Notes:
- Involvement in special activities help clients as well
- Activities to reminisce the past (e.g. going back to
school, wear uniform, bring bags)
- Reminiscing activities can stimulate recall basically of
people.
- Refer patients who have the same condition in a
community so that the patient will not feel alone and the
people around will understand them. Also,significant
others can learn in different ways to care for patient with
the same health condition.
ALZHEIMER’S DISEASE
● An irreversible form of senile dementia from a nerve cell
deterioration
● Most common & most important degenerative disease
of the brain
● Characterized by cortical atrophy and loss of
neurons, particularly in the parietal and temporal
lobes (starts at hippocampus) resulting to intellectual
deterioration
Additional Notes:
- Alzheimer’s Disease is one of Dementia.
- First described and Discovered by Dr Alois Alzheimer,
German Doctor in 1907. Through his autopsy, caring
about a patient who died who has manifestations like
plaques and tangles.
- Some Notes From the video:
https://www.youtube.com/watch?v=zTd0-A5yDZI
(incomplete notes from video since you can view the
video for clever understanding)
- Plaques are insoluble deposits of a peptide
called amyloid-β (Aβ). They are formed when a
- The oligomers come in several forms of
species. Results that weaken communication
could be what stops the brain from retrieving
and forming memories.
- Microglia can also get activated by triggering
the release of inflammatory cytokines that can
damage neurons.
- As synapses start to malfunction and neurons
die, abnormal patterns of activity emerge.
Eventually, the brain can't process and store
information properly.
- No current cure of Alzheimer’s exist.
 ● Stage 1: Preclinical Alzheimer’s Disease
- It begins near the hippocampus and the
affected region starts to shrink and in time
(10-20 years perhaps) lead to memory loss.

● Stage 2: Mild Alzheimer’s Disease

- Memory disturbances.
- Poor judgement and problem solving skills.
- Becomes careless.
- Confused and begins to get lost easily.
- Routine activities and daily tasks take longer.
- Irritable, suspicious and indifferent.

● Stage 3: Moderate Alzheimer’s Disease

- Decreased knowledge of recent occasions or
current event.
Plaque Formation - Spontaneous speech becomes empty
- plaques form when protein pieces called beta-amyloid. (echolalia apraxia).
- Beta-amyloid comes from a larger protein found in the - Impaired ability to perform challenging mental
fatty membrane surrounding nerve cells. arithmetic.
- Blocks cell-to-cell signaling at synapses and activities - Depression and irritability may worsen.
the immune system. - Decreased capacity to perform complex tasks.
- Delusions and psychosis may appear.
Tangles - Destroy a vital cell transport system made of proteins. - Reduced memory of personal history.
- Tau collapses into twisted strands. - May seem subdued and withdrawn.
- The tracks can no longer stay straight. They fall apart - Need help choosing proper clothing for the
and disintegrate. season or the occasion.
- Nutrients and other essential supplies can no longer - Retain substantial knowledge about
move through the cells, which eventually die. themselves and know their own name and the
names of their spouse or children.
- Usually require no assistance with eating or
using the toilet.
● Stage 4: Severe Alzheimer’s Disease
- Plaques and tangles are widespread
throughout the brain.
- Cannot recognize family or friends.
- Does not communicate in any way.
- Minimal voluntary movement.
- Limbs becomes rigid.
- Frequent urinary and fecal incontinence.
- Frequent aspiration and aspiration pneumonia.
- Loose most awareness recent experiences
and events as well as of their surroundings.
- Suspiciousness and delusions; hallucinations
or compulsive, repetitive behaviors, then to
wander and become lost.

Additional Notes: echolalia vs palilalia

● Echolalia - repeats/follows (echo) usually the last word
of a statement.
The course of the disease depends in part on age at diagnosis example: “ good morning ning ning ning…”
and whether a person has other health conditions. ● Palilalia - uttered word is being repeated.
example: “Palilalia is is is…”
Additional Notes:
- AD is like “Endless funeral”
- Once onset happens, the patient can only live up until TEN WARNING SIGNS
10 years. (according to ma’am)
1. Memory loss
PROGRESSION OF ALZHEIMER’S (STAGES) 2. Difficulty performing familiar tasks
3. Problems with language
4. Disorientation to time andplace
5. Poor or decreased judgement
6. Problems with abstract thinking
7. Misplacing things
8. Changes in mood or behavior
9. Changes in personality
10. Loss of initiative
 5 A’S IN ALZHEIMER’S

● Amnesia
● Apraxia
● Agnosia
● Aphasia
● Anomia

DIAGNOSTIC TESTS

● PET Scan (positron emission tomography)

● EEG (electroencephalogram)
● CT Scan (computerized tomography)
● MRI (magnetic resonance imaging)
● Autopsy (as the most reliable)

MEDICAL MANAGEMENT

● Tacrine hydrochloride (Cognex)

● Donepezil (Aricept)
● Rivastigmine (Exelon)

Common medications: Cognex and Exelon