Dementia

Mr. HARI KRISHNA G L

Scope of the session
 What is dementia?
 Causes, risk factors and types of dementia
 Symptoms of dementia
 Care of dementia patient’s
Dementia
 Syndrome due to disease of the brain
 Chronic or progressive in nature, irreversible
 Disturbances of multiple higher cortical functions
 Consciousness is not clouded/impaired
 Occasionally deterioration in emotional control,
social behavior
Epidemiology
 Prevalence rate: 3-5%
 Prevalence increases with age
 1% under the age 60 years
 15-20% by the age of 80 years
 10% of all persons aged 65 yrs & above
 35-50% exhibit clinical signs
 Women form majority than men due to ???

www.alz.co.uk, www.alzheimerindia.org
Types
Reversible types:
 Depressive pseudo dementia

 Due to hypothyroidism

 Due to brain tumor

Irreversible types:
 Alzheimer’s disease

 Multi infarct dementia

 AIDS dementia complex

Risk factors

Non modifiable risk factors Modifiable risk factors

 Age  Vascular Disease

 Hypertension
 Family history +  Diabetes
 Female sex  Dyslipidaemia
 Depression  Nutritional deficiency (Vit B)
 Smoking
 Head trauma  Alcohol
 Mutation on  Obesity
1,14,21chromosome  Diet

THE DEMENTIA INDIA REPORT 2010

Investigations
 Blood studies ( Hb, LFT, Vitamin assays,
electrolytes)
 ECG, EEG
 CSF analysis
 Radiology
 X ray
 CT Scan, MRI ( vascular dementia)
Clinical picture
 Personality changes:
 Decreased drive, lack of interest, mental fatigability,
withdrawal from environment
 Memory impairment:
 Cognitive impairment:
 Difficulty in naming objects, aphasia, circumstantiality
Stages of dementia (Alzheimer's association, 2005)

 Stage 1: No apparent symptoms/decline in memory

 Stage 2: Forgetfulness
 Names of people, short term memory loss, aware of
intellectual decline, maintains schedule
 Stage 3: Mild cognitive decline
 Interference in work, concentration, recalling names
 Stage 4: Mild to moderate – Confusion
 Forgets major events, managing finance, confabulate
Stages contd…
 Stage 5: Moderate cognitive decline - Early
dementia
 Little compromise in ADL, disorientation but intact
knowledge about self

 Stage 6: Moderate to severe – Middle dementia

 ADL compromise, incontinence, sun downing, sleep
disturbance, may require institutional care
Contd..
 Stage 7: Severe cognitive decline
 End stage of Alzheimer’s disease
 Chair/bed bound
 ADL completely compromised
 Immobility
 Risk for infections
 Speech and language impairment
 Socially withdrawn
CARE OF DEMENTIA
Care for dementia patients
 Establish daily routine
 Make things simple
 Promote independence
 Improve self esteem
 Humor sense
 Safety concerns
 Quality of life
Communication
 Trust, security, care and support through verbal and
non verbal communication.
 Tone of communication should be calm and relaxed
 Simple words and short sentences
 Distraction at times
 Non verbal communication…
Physical interventions
 Physical health
 Daily hygiene and grooming- self esteem
Nutritional interventions
 On going nutrition
 Problems occur during feeding include refusing to
open the mouth, pocketting food in their cheeks,
refusing to swallow, coughing, chocking etc
 Having meals at the same place at same time each
day
 Small, frequent meals and snacks
Mental interventions
 Reality orientation
 Written messages may become meaningless but
picture evoke a response.
 Use of clock, calendars in their environment
 Daily orientation to care givers and daily tasks.
Behavioral interventions
 Behaviors are a form of communication and it may
be the dementia clients primary method of
communicating needs.
 Recognize behaviors
 Disruptive behaviors are a result of disease; not a
deliberate action.
Behavioral problems
 Personal hygiene
 Dressing and grooming
 Incontinence
 Repeated questioning
 Dependence
 Violence
 Wandering
 Weakness, depressed, sleeplessness
Wandering
 Reduce excessive stimulation
 Provide familiar objects, signs, pictures
 Provide safe area to move around
 Monitor medication
 Institute toileting schedule- place signs or pictures
in bathroom
 Exit signs/provide identification
Difficulty with personal care tasks
 Divide task into simple steps
 Be patient, allow ample time, try again later
 Demonstrate action/task
 State instructions 1 step at a time
Suspiciousness/ paranoia
 Do not argue/do not take personally
 Distract
 Introduce self and role routinely
 Reassure, set routine
 provide familiar social opportunities
 Medical evaluation
Incontinence
 Provide for privacy
 Simplify clothing, use elastic waist bands
 Contrast colours on toilet and floor
 Step by step routine
 independence
Sleep disturbance
 Medical evaluation
 Prescribe antidepressant (bed time)
 Plan more day time exercise
 Provide night time snack
 Ensure clear well lit pathway to toilet
Implementations
 Client safety
 Reality orientation
 Simple explanations
 Addressing ADL
 Activity scheduling
 Self care needs
 Nutrition
 Supporting the care givers
 Medications
THANK YOU