GOOD MORNING STUDENTS

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HISTORY OF
DEMENTIA
• Dementia was first described in a book about mental illness in 183 ,. In 1894 , Dr
Alois
• Alzheimer’s a German neuropathologist who has a particular interest in ‘’nervous
disorders ‘’
described changes in the brain caused by vascular disease (now known as vascular
dementia )
DEFINITION
Dementia is a syndrome due to the disease of the
brain usually chronic and progressive in which
there is disturbance in multiple higher cortical
functions , including memory , thinking ,
orientation , comprehension , calculation ,
language , learning ability and judgement .
ICD- 10 BY WHO
 But without
impairment of
consciousness
CLASSIFICATION
• (F00-f09) organic including symptomatic mental disorders .
• (F00) Dementia in Alzheimer’s disease
• (F01) Vascular dementia
• (F02)Dementia in other diseases classified elsewhere
• (F03) unspecified dementia
• (F04) organic amnestic syndrome , not induce by alcohol and other psychoactive
substances .
• (F05) delirium not induced by alcohol and other psychoactive substances
• (F06)other mental disorders due to brain damage and dysfunction and to physical disease
• (F07) personality and behavioral disorders due to brain disease , damage and
dysfunction .
• (F09) unspecified organic or symptomatic mental disorder .
 INCIDENCE
•Dementia occurs more
commonly in the elderly than
in the middle aged .
TYPES OF
DEMENTIA
TYPES - CORTICAL DEMENTIA
•Dementia where the brain damage
primarily affects the brain’s cortex, or
outer layer . Cortical dementias tend to
cause problems with memory , language ,
thinking , and social behavior .
 SUBCORTICAL DEMENTIA
•Dementia that affects part of the brain
below the cortex . Sub – cortical dementia
tends to cause changes in emotions and
movement in addition to problems with
memory .
PROGRESSIVE DEMENTIA
•Dementia that gets worse over time
, gradually interfering with more
and more cognitive abilities.
PRIMARY DIMENTIA
•Dementia such as Alzheimer’s
disease that does not result
from any other disease .
SECONDARY DEMENTIA

•Dementia that occurs as a

result of a physical disease
or injury .
ETIOLOGY
 ETIOLOGY
 Significantly loss of neurons .
 Neurofibrillary tangles (twisted nerve cell fiber that are the damaged
remains of microtubules ).
 Build up of amyloid – accumulation of beta amyloid a(an Insoluble
protein , which forms sticky patches surrounded by debris of dying
neurons).
 Environmental factors -infection , metals and toxins .
 Deficiencies of vitamin B6 , B12 , and folate – possible risk factors due
to increased levels of homocysteine(amino acid that may interfere with
nerve cell repair ).
 Serious head injury .
Educational level – increase risk in those who remain mentally active
STAGES
STAGE 1-Early stage (2-4years)
Forgetfulness
Declining interest in environment
Hesistancy in initiating actions
Poor performance at work .
 
STAGE – 2 -Middle stage (2-12 years)
 Progressive memory loss .
 Hesitates in response to questions .
 Has difficulty in following simple instructions .
 Irritable , anxious .
 Neglects personal hygiene .
 Social isolation .
STAGE -3 – Final stage (up to a year )
 Marked loss of weight because of inadequate
intake of food .
 Unable to communicate .
 Does not recognize .
 Incontinence of urine and feces.
 Loses the ability to stand and walk .

 
CLINICAL FEATURES
 PERSONALITY CHANGES
 MEMORY IMPAIRMENT
 BEHAVIORAL IMPAIRMENT
 SUNDOWNER SYNDROME
 Personality changes
Lack of interest in day-to- day
activities .
Easy mental fatigability .
Self -centered .
Withdrawn.
 Decreased self -care .
 Memory impairment
 Recent memory is prominently affected .
Affective impairment
 Irritableness , depression .
Behavioral impairment
 Alteration in sexual drives and activities , neurotic /
psychotic behavior .
Neurological impairment
 Aphasia , apraxia ,, seizures , headache .
 
 Sundowner syndrome
 Drowsiness , confusion , ataxia : accidental falls
may occur at night when external stimuli , such as
light and interpersonal orienting cues are
diminished .
 
DIAGNOSTIC EVALUATION
DIAGNOSTIC EVALUATION
 Psychiatric history taking
 Mental status examination
 Functional dementia scale (indicate degree of
dementia)
 MRI (Magnetic resonance imaging)
 Spinal fluid analysis (Shows increased beta
amyloid deposits).
 
TREATMENT
TREATMENT
Pharmacotherapy
 Antipsychotic medications such as risperidone ,
haloperidol may be used to decrease verbal and
physical aggressiveness to alleviate
hallucination and delusions .
 Benzodiazepines for insomnia and anxiety .
 Antidepressants for depression .
 Anticonvulsants to control seizures .
NURSING MANAGEMENT
1. Nursing assessment.
2. Daily routine.
-Maintain daily routine
-Orient the patient in reality
-Clock with large faces
-Use calendar
-Provide newspaper
3.Nutrition and body weight .
-Balanced diet
-allow plenty of time for meals
4.Personal hygiene
- compliment
Check the nails and cut if client is unable to do so .
5. Toilet habbits and incontinence .
6. Constipation .
7.Fluid management .
8. Mood and emotions .
9.Disturbed sleep .
10. Interpersonal relationship .
 Nursing assessment
o Assessment data for the patient with dementia should include a past
health and medication history
 Nursing intervention
o Daily routine
o Maintaining daily routine
o Drawing up a fixed time table for the patient for wake up in the morning ,
toilet , exercise , and meals .
o This gives the patient a sense of security .
o Orient the patient to reality in order to decrease confusion .
o Clock with large faces aid in orientation to time .
o Use calendar with large writing sand a separate page for each day .
o Provide newspaper with stimulate interest in current events .
 
  
oOrientation of place , person and time should be
given before approaching the patient.
Nutrition and body weight
oPatient should be provided a well balanced diet ,
rich in protein , high in fiber with adequate amount
of calories .
oAllow plenty of time or meals .
oFood served should neither be too hot nor too cold.
Personal hygiene
oPatient’s personal hygiene should be taken care
oIncluding brushing of teeth , bathing , keeping the
skin clean and dry such as armpit and groin.
oRemember to check finger and toe nails
regularly, cut them if the person cannot do it by
himself .
oCompliment the patient if he/she looks good .
Toilet habbits and incontinence
oToilet habbits should be established as soon as
possible.
oPatient should be taken to urinate at fixed interval.
oWhen the first sign of incontinence appear should
check for an underlying cause such as urinary
infection .
Constipation
oFrequent cause of the discomfort of the patient .
oThe quantity of feces passed each morning should be
checked .
o Great care should be taken to avoid accidents.
o Reason for falling include loose and poorly fitted
footwear and wrinkled carpets .
o Patient should be made to wear soft slip- on shoes with
straps .
o Make sure that the lights are bright enough
o Do not allow the patient to take medicines .
Fluid management
o Patient requires fluid as much as normal people.
o Sufficient fluid should be given only during the day .
o Only essential amount of fluid after 6pm .
o Proper fluid management will reduce bed wetting .
Mood and emotions
oMood changes are best controlled by
keeping a calm environment with fixed
daily routine .
oDisturbed sleep
oSleep pattern must be maintained .
oNapping during the day should be avoided.
oSleeping pills are best avoided .
 Interpersonal relationship
oVerbal communication should be clear and
unhurried .
oReinforce socially acceptable skills .
oGive necessary information repeatedly
oFocus on things the person does well rather than
on mistakes or failures .
oTry to make sure that each day has something
interest of the patient .
 
 ASSIGNMENT
Prepare a nursing care plan related to dementia
Thank you