MODULE 3

Topic:
Management of
Dementia
 OBJECTIVES:
• Differentiate dementia, depression and delirium.

• Describe procedures for diagnosing dementia.

• Recognize common causes of delirium.

• Recognize role of adult day services in the care of persons

with dementia
 DEMENTIA
• Is a general term that refers to progressive, degenerative
brain dysfunction. It includes deterioration in :
• Memory
• Concentration
• Language skills
• Visuospatial skills
• Reasoning
; which interferes with a person’s functioning.
• The most common type of dementia is Alzheimer’s
Disease (AD) named after Dr. Alois Alzheimer – described
the condition 100 years ago.
• Pathological Hallmarks of AD are:
• 1. Beta-amyloid plaques – dense deposits around neurons.

• 2. Neurofibrillary tangles. – builds up around the nerve

cells.

• Together, both interfere with normal cell function and lead

to neuronal death.
• Alzheimer’s Dementia (most common type) accounts for
50-70% cases of dementia of all cases.
• Vascular Dementia (second most common type) general
term describing problems with reasoning, planning,
judgment, memory and other thought processes caused by
brain damage from impaired blood flow to your brain.
• Combinations of Alzheimer’s and Vascular Dementia are
called mixed dementia.
• Parkinson’s disease (PD) a chronic neurodegenerative
disease characterized by motor symptoms in early stages,
cognitive symptoms and dementia may develop in the later
stages of PD.
 Other types:
• Frontotemporal dementia or Frontal Lobe Dementia (FLD)

• Affects frontal and temporal lobes of the brain and is often

characterized by early deficiencies in executive functioning.
• Affected functions: Planning and Decision Making
• Memory may initially remain intact.

• Normal Pressure Hydrocephalus (NPH)

• A rare type of dementia, symptoms are related to accumulation of

CSF and are clinically distinguishable from other dementias by
triad of symptoms: 1. Slowed cognitive process 2. Gait
disturbances 3. Urinary Incontinence
• Memory may remain intact
 Other less common types:
• Huntington’s Disease – Hereditary, causes the
progressive breakdown of nerve cells in the brain. It
deteriorates a person's physical and mental abilities
usually during their prime working years and has no cure.

• Wernicke - Korsakoff’s Syndrome – caused by chronic

alcoholism and deficiency of Thiamine (Vitamin B-1)

• Creutzfeldt – Jakob Disease – Rare, rapidly progressing

dementia related to “Mad Cow Disease”
 RISK FACTORS:
• AGE (Main risk factor)

• FAMILY HISTORY

• Presence of Apolipoprotein E-e4 (APOE-e4)

• HISTORY OF HEAD INJURY

• VASCULAR DISEASES
 MEDICAL DIAGNOSIS OF AD/DEMENTIA
• If one family member is suspected with memory problems,
the first step is to visit a primary care provider.

• Stages of Alzheimer’s Disease (3 Stages)

• 1. Mild
• 2. Moderate
• 3. Severe

But it is further identified and subdivided into 7 stages by

Reisberg and Colleagues in 2002
 7 Stages of Alzheimer's Disease?
• What Are the 7 Stages of Alzheimer's Disease?
• Stage 1: No Impairment. During this stage, Alzheimer's is
not detectable and no memory problems or other
symptoms of dementia are evident.
• Stage 2: Very Mild Decline
• Stage 3: Mild Decline
• Stage 4: Moderate Decline
• Stage 5: Moderately Severe Decline
• Stage 6: Severe Decline
• Stages 7: Very Severe Decline

• Acetylcholine is a neurotransmitter in the brain known to

be important for memory.
 PHARMACOLOGICAL INTERVENTIONS
• CHOLINESTERASE INHIBITORS (CEIs)

• Chemicals that prevent the breakdown of the

neurotransmitter acetylcholine or butyrylcholine.
• donepezil
• galantamine (Razadyne)
• rivastigmine (Exelon)
• N-METHYL-D-ASPARTATE (NMDA) receptors
antagonists
• dextromethorphan/quinidine.
• esketamine intranasal.
• memantine.
• memantine/donepezil.
DELIRIUM
• A syndrome, that occurs relatively acutely often called acute
confusion, unlike dementia, which is characterized by chronic
confusion.

DEPRESSION
Risk for depression increases in older adults with chronic illness
including dementia.
Older adults may deny depression due to stigma that this
cohort often attaches to mental illness.
 Caring for person with Dementia
• Theories of dementia care
• 1. Progressively Lowered Stress Threshold (PLST)
• 2. Enablement Model
• 3. Need-driven Dementia-Compromised Behavior (NDB)
model.

• Behavior and Physiological Symptoms of Dementia (BPSD)

• Includes symptoms of disturbed perceptions, thought content,
mood or behavior.
• Psychosis of Alzheimer’s disease may be made if patient’s
dementia displays disturbing hallucinations, delusions, and
or paranoia. This is treated with Antipsychotic medication.
Non-Pharmacologic Treatment
• General interventions
• Environmental interventions
• Physical comfort interventions
• Activity interventions
• Communication interventions
• Interventions for particular behaviors
• Activities of daily living