DEMENTIA DEFINITION: Group of symptoms that can be caused by

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DEMENTIA

• DEFINITION
• Group of symptoms that can be caused by over
  60-70 disorders.
• Syndrome which refers to progressive decline in
  intellectual functioning severe enough to
  interfere with persons normal daily activities
  and social relationships. (National Institute on
  Aging-1995 No. 95-3782)

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Dementia

• Marked by progressive, irreversible declines in
• memory.
• visual-spatial relationships
• performance of routine tasks
• language and communication skills
• abstract thinking
• ability to learn and carry out mathematical
  calculations.

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Dementia

• Two Types
• Reversible
• Irreversible
• Individuals must have intensive medical physical
  to rule out reversible types of dementia.

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Dementia

• Reversible
• D Drugs, Delirium
• E Emotions (such as depression) and
  Endocrine Disorders
• M Metabolic Disturbances
• E Eye and Ear Impairments
• N Nutritional Disorders
• T Tumors, Toxicity, Trauma to Head
• I Infectious Disorders
• A Alcohol, Arteriosclerosis (Dick-Mulheke-
  Overview of Alzheimer's Disease)

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Dementia

• Irreversible
• Alzheimers
• Lewy Body Dementia
• Picks Disease (Frontotemperal Dementia)
• Parkinsons
• Heady Injury
• Huntingtons Disease
• Jacob-Cruzefeldt Disease

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Dementia

• Irreversible
• Alzheimer's most common type of irreversible
  dementia
• Multi-Infarct dementia second most common type of
  irreversible dementia
• Death of cerebral cells
• Blockages of larger cerebral vessels, arteries
• More abrupt in onset
• Associated with previous strokes, hypertension
• Can be traced through diagnostic procedures

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Dementia

• Lewy Body Dementia
• Episodic confusion with intervals of lucidity
  with at least one of the following
• 1. Visual or auditory hallucinations
• 2. Mild extrapyramidal symptoms (muscle rigidity,
  slow movements
• Repeated unexplained falls
• Progresses to severe dementiafound at autopsy.

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Dementia

• Diagnosis of Frontemporal Dementia (Picks
  Disease)
• Picks bodies in cells.
• Personality changes
• Behavioral dis-inhibition.
• Loss of social or personal awareness.
• Disengagement with apathy
• Maintain ability to draw and calculate well into
  later stages

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Alzheimer's Disease

• Estimated that 4,000,000 people in U.S. have
  Alzheimer's disease.
• Estimated that 25-35 of people over age 85 have
  some time of dementia.
• After age 65 the percentage of affected people,
  doubles with every decade of life.
• Caring for patient with Alzheimer's disease can
  cost 47,000 per year (NIH).

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Changes Caused by Alzheimer's

• Diminished blood flow
• Neurofibrillary Tangles
• Neuritic Plaques
• Degeneration of hippocampus, cerebral cortex,
  hypothalamus, and brain stem

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Theories Regarding Causes of Alzheimer's

• Changes in Neurotransmitters
• Acetycholine is decreased--necessary for
  cognitive functioning.
• Changes in Protein Synthesis
• Beta amyloid--may be responsible for forming
  plaques.
• Tau--major component of neurofibrillary tangles.
• Genetic Theories
• ApoE4 on chromosone 19 linked to late-onset
  Alzheimers Disease.

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Theories Regarding Causes of Alzheimer's

• Genetic Theories
• Chromosome 21 --Responsible for early-onset
  Alzheimers Disease.
• Metabolic Theories
• Glucose metabolism declines dramatically in
  Alzheimers patients.
• Calcium Theories
• Too much calcium can kill cells. Suspect that it
  may reason why neurons die in Alzheimer's
  patients.

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Theories Regarding Causes of Alzheimer's

• Environmental
• Aluminum--Traces of metal found in brain.
• Zinc--found in brains on autopsies.
• Food borne poisons--amino acids found in legumes
  in Africa and India my cause neurological damage.
• Viral
• May be hidden in body and attack brain cells
  years later. (NIH-1995)

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Theories Regarding Causes of Alzheimer's

• Head Trauma
• Head trauma increase the concentration of
  B-amyloid protein
• Low Level of Education
• Individuals with low level of education less able
  to compensate for cognitive deficits
• Estrogen Deficiency
• Early Life Experience---have lost parent before
  age 16

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Diagnosis of Dementia Due to Alzheimers

• Memory Impairment
• Multiple cognitive deficits with at least one
  disturbance in the following areas
• Aphasialoss of the ability to use symbols to
  communicate orally or in writing
• Two Types
• Expressiveinability to form words
• Receptivedecreased ability to understand spoken
  or written language
• Apraxiainability to initiate complex learned
  motor movement or unable to perform activity on
  command
• Agnosia---inability to recognize familiar objects
  by sight, touch, taste, smell or sound

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Diagnostic Tests

• Neurological Exam
• Brain Imagingshrinkage, atrophy of brain (CT or
  MRI)
• Blood Work

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Stages of Alzheimers Disease

• Mild Stage
• Memory Loss
• Symptoms
• Confusion About Place
• Loss of Spontaneity
• Loss of Initiative
• Mood/Personality Changes
• Poor Judgment
• Takes Longer to Perform Routine chores
• Trouble Handling Money, Paying Bills

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Stages of Alzheimers Disease

• Moderate Stage
• Impairments in
• language
• motor ability
• object recognition
• increasing memory loss and confusion

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Stages of Alzheimers Disease

• Moderate Stage
• Symptoms
• Problems recognizing family members, close
  friends.
• Repetitive statements and/or movements.
• Restless, especially in late afternoon and at
  night.
• Occasional muscle twitches or jerking.
• Perceptual motor problems.
• Problems organizing thoughts, thinking logically.
• Cant find right words, makes up stories.
• Problems reading and writing.
• May be suspicious, irritable, fidgety, teary or
  silly.

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Stages of Alzheimers Disease

• Severe Stage
• Symptoms
• Loses weight even with good diet.
• Little capacity for self-care.
• Cant communicate with words.
• May put everything in mouth or touch everything.
• Cant control bladder or bowel.
• May have difficult with seizures, swallowing,
  skin breakdown, infections.

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Stages of Alzheimers Disease

• Terminal Stage
• Symptoms
• Loss of ability to ambulate.
• Loss of ability to sit.
• Loss of ability to smile.
• Loss of ability to hold up head.
• Loss of ability to swallow.

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Stages of Alzheimers Disease

• Stage IV--Terminal Stage
• Symptoms
• Loss of ability to ambulate.
• Loss of ability to sit.
• Loss of ability to smile.
• Loss of ability to hold up head.
• Loss of ability to swallow.
• Management of Challenging Behaviors in
  DementiaMahoney, Volicer, Hurley. Health
  Professionals Press2000. Baltimore, Md.