Dementia

Normal Aging vs Dementia Slow  Accurate recall  Remedied by cues Eg. appointment, calendars & list  Stable  Does not interfere with function  Minimal Forgetfulness  No change in other cognitive domains  Intact ADL’s 

  

Slow Inaccurate recall Reminders fail eventually recall poor despite cueing



Progressive decline



Interferes with function



Poor memory Decline in other cognitive domains Impaired ADL’s Abnormal N/P result.

  

Clinical Criteria - Memory impairment - Impairment of language (Aphasia) - Impairment of recognition (Agnesia) - Impairment in execution of task (Apraxia) - Impairment in executive

Cognition

Demen tia Functio n

Behavi or

Filipinos Aged 60 & Above 3.7 M

8.7 M 22 M

5.5 %

8.8 % 17 %

68 M

99 M 126 M

1995

2015 2040

Types of Dementia -Alzheimer 15% -Vascular & Alzheimer Disease 10% -Prone Temporarily Dementia 5% -Infectious 3% -Toxic Metabolic 4% - Psychiatric 4% -Delubitant

Alzheimer’s Disease -Most common cause of dementia in the elderly. -Average duration is 8-11 years old -Prevalence doubles every 5 years from 6-8% @ 65 years old. -Risk Factors: age, genetic influence, apoE status, female gender, lack of education, head trauma, myocardial infarction.

Dementia's Clinical Diagnosis •Assessing presenting problem • Taking a informant base history • Physical – neurogical status • Evaluation of cognitive, behavior and functional status.

Signs of Dementia •

Memory Loss

• Difficulty performing family task • Problems with language • Disorientation in place & time • Poor or Decreased judgment • Problems with complex task and abstract thinking. • Misplacing things • Change in mood & behavior (Delusions)

Physical Examination -Hypertension & signs of vascular disease -Signs of Cardiac Disease particularly features that increase risk for cerebral embolism -Signs of gait & balance, neurologic abnormal -Tremors & brain disorder

Cognitive & Functional Evaluation Tools -MMSE (Minimal Sense Examination) -Verbal Fluency -Cancellation Test -4 item ADL -4 points Geriatric Depression Scale (GDS)

AncillIary Test -When diagnosis is unclear. -Referral to NP for formal cognitive resting. -Structural Imaging -Depression always screen

Non-Drug therapy for Persons with Dementia Intervention for Cognitive Decline: -Advice relative of the patient to have daily calendar, it helps patient to keep track of date. - Digital Clock – consider switching time. - Provide a simple list for the day. - Establish medication routine through label pill box. -Avoid moving things around in the

Improving Communication -Maintain eye contact. - Always face the person. -Speak slowly, clearly & warmly. -Keep sentence short -Use hand gestures & facial expressions. -Use physical prompts. -Assist calmly when client struggle with words.

5 Steps Approach to Assessment & Management BPSD’s -Describe the behavior. -Prescribe trigger & consequences, depression, anxiety & alinging. -Give more love & support to the person. -Don’t expect the person to snap out of the depression

Losing Things -Discover if the person has favorite hiding place. -Keep replacement of important items. -Respond to person accusation gently defensively. -Agree with the person that item is lost.

Wandering -Make sure that the person carries some form of identification. -Secure your home and make sure he/she can’t leave without. -Provide 24 hours supervision. -If the person wandered and was found avoid showing anger. -Keep recent photos of the person.

Delusion & Hallucination

-Do not argue with person regarding validity of what heard.

-Give comfort when she is frightened. -Distract by drawing attention to something

Violence & Aggression

-Keep calm -Draw attention

Inappropriate Sexual Behavior -Allow privacy -Distract person to another activity -Keep some productive activity.

Repetitive Behavior

-Distract the person

-Write down the repeat behavior

Intervention of activity participation -Breakdown activity in smaller. -Choosing activities through the diff stage -Promoting motility