nursing care of older adult module 10

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Dementia

By Hilda Nyemah

Definition

Dementia is a is a group of symptoms, not an illness lasting more than six months and affecting aspects of mental function. Cognitive dysfunction, psychiatric and behavioral problems, and difficulties with activities of daily living.

People with dementia have significantly impaired intellectual functioning that interferes with normal activities and relationships.

Cognitive dysfunction, resulting in problems with memory, language, attention, thinking, orientation, calculation, and problem solving. Psychiatric and behavioral problems, such as changes in personality, emotional control, social behavior, depression, agitation, hallucinations, and delusions. Difficulties with activities of daily living, such as driving, shopping, eating, and dressing.

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Common causes of dementia

Vascular dementia, Alzheimer’s disease, Lewy body dementia

Dementia is caused by damage to brain cells. This damage interferes with the ability of brain cells to communicate with each other. When brain cells cannot communicate normally, thinking, behavior and feelings can be affected.

Vascular Dementia is caused by a series of small strokes. Multi-infarct Dementia (MID) is the second most common cause of dementia after Alzheimer disease in people over age 65. MID usually affects people between ages 55 and 75. More men than women have MID.

Alzheimer's disease (AD) is the most common form of Dementia. AD begins slowly. It first involves the parts of the brain that control thought, memory and language. People with AD may have trouble remembering things that happened recently or names of people they know. Usually begins after age 60.

Lewy body dementia (LBD) is a type of progressive dementia that leads to a decline in thinking, reasoning and independent function because of abnormal microscopic deposits that damage brain cells over time. Most experts estimate that Lewy body dementia is the third most common cause of dementia after Alzheimer’s disease and Vascular dementia accounting for 5 to 10 percent of cases. (Alzheimer Association)

Lewy Body Dementia. (n.d.). Retrieved December 13, 2020, from https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/lewy-body-dementia?utm_source=google

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Risk Factors

Age

Genetics

Smoker

atherosclerosis

Diabetes

Some risk factors for dementia, such as age and genetics cannot be changed. Alzheimer’s Association suggests that adopting multiple healthy lifestyle choices, including healthy diet, not smoking, regular exercise and cognitive stimulation, may decrease the risk of cognitive decline and dementia.

Age the risk of Alzheimer's disease, vascular dementia, and several other dementias goes up significantly with advancing age.

Genetics/family history Although people with a family history of Alzheimer's disease are generally considered to be at a heightened risk of developing the disease themselves, many people who have relatives with Alzheimer's disease never develop the disease, and many without a family history of the disease do get it.

Smoking and alcohol use significantly increases the risk of mental decline and dementia. People who smoke have a higher risk of atherosclerosis and other types of vascular disease, which may be the underlying causes for the increased dementia risk.

Atherosclerosis is a significant risk factor for vascular dementia, because it interferes with the delivery of blood to the brain and can lead to stroke.

Diabetes is a risk factor for both Alzheimer's disease and vascular dementia. It is also a known risk factor for atherosclerosis and stroke, both of which contribute to vascular dementia.

Mild cognitive impairment 40% of people with mild cognitive impairment over the age 65 get diagnose with dementia.

Risk Factors. (2017, September 11). Retrieved December 14, 2020, from https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/dementia/risk-factors.html

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Diagnostic testing

PET scans

CT

MRI

Neurological assessment

No single test can diagnose dementia, so doctors are likely to run a number of tests that can help pinpoint the problem. Doctors will evaluate your thinking (cognitive) function. A number of tests measure thinking skills, such as memory, orientation, reasoning and judgment, language skills, and attention. Doctors evaluate your memory, language, visual perception, attention, problem-solving, movement, senses, balance, reflexes and other areas. CT OR MRI. These scans can check for evidence of stroke or bleeding or tumor or hydrocephalus. PET scans. These can show patterns of brain activity and whether the amyloid protein, has been deposited in the brain.

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Sign and symptoms

Trouble remembering things that happened recently or names of people they know. decline in thinking, reasoning and independent function

confusion in the evening hours

Irritability

Anxiety

Depression unsteady walking

Cognitive: mental decline, confusion in the evening hours, disorientation, inability to speak or understand language, making things up, mental confusion, or inability to recognize common things

Behavioral: irritability, personality changes, restlessness, lack of restraint, or wandering and getting lost

Mood: anxiety, loneliness, mood swings, or nervousness

Psychological: depression, hallucination, or paranoia

Muscular: inability to combine muscle movements or unsteady walking

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Treatments

No cure exists, but medications and management strategies may temporarily improve symptoms.

Donepezil (Aricept), Galantamine (razadyne) and Rivastigmine (exelon).

Rehabilitation and occupational therapy improve daily living and skills of patients.

According to (Mayo clinic), current approaches focus on helping people maintain mental function, manage behavioral symptoms, slow down disease progression. Several prescription drugs are currently approved by the U.S. Food and Drug Administration (FDA) to treat people who have been diagnosed. Treating the symptoms of the disease can provide people with comfort, dignity, and independence for a longer period of time.

Cholinesterase inhibitors. These medications including donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) work by boosting levels of a chemical messenger involved in memory and judgment (mayo clinic).

Memantine. Memantine (Namenda) works by regulating the activity of glutamate, another chemical messenger involved in brain functions, such as learning and memory. In some cases, memantine is prescribed with a cholinesterase inhibitor. (mayo clinic).

Other medications. conditions, such as depression, sleep disturbances, hallucinations, parkinsonism or agitation. (mayo clinic).

Occupational therapy. Teach coping behaviors. The purpose is to prevent accidents, such as falls; manage behavior; and prepare patient and family for the dementia progression.

Dementia. (2019, April 19). Retrieved December 13, 2020, from https://www.mayoclinic.org/diseases-conditions/dementia/diagnosis-treatment/drc-20352019

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Modifiable lifestyle

Exercise

Enhance communication

Engage in activity

Establish a night time routine

Keep a calendar

Enhance communication. When talking with your loved one, maintain eye contact. Speak slowly in simple sentences, and don't rush the response. Present one idea or instruction at a time. Use gestures and cues, such as pointing to objects.

Encourage exercise. The main benefits of exercise in people with dementia include improved strength, balance and cardiovascular health. Exercise may also be helpful in managing symptoms such as restlessness.

Plan activity. Plan activities the person with dementia enjoys and can do. Dancing, painting, gardening, cooking, singing and other activities can be fun, can help you connect with your loved one, and can help your loved one focus on what he or she can still do.

Establish a nighttime ritual. Behavior is often worse at night. Try to establish going-to-bed rituals that are calming and away from the noise of television, meal cleanup and active family members. Leave night lights on in the bedroom, hall and bathroom to prevent disorientation.

Keep a calendar. A calendar might help your loved one remember upcoming events, daily activities and medication schedules. Consider sharing a calendar with your loved one.

Dementia. (2019, April 19). Retrieved December 13, 2020, from https://www.mayoclinic.org/diseases-conditions/dementia/diagnosis-treatment/drc-20352019

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References

Dementia. (2019, April 19). Retrieved December 13, 2020, from https://www.mayoclinic.org/diseases-conditions/dementia/diagnosis-treatment/drc-20352019

Lewy Body Dementia. (n.d.). Retrieved December 13, 2020, from https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/lewy-body-dementia?utm_source=google

Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D., & Cooper, C. (2017). Dementia prevention, intervention, and care. The Lancet, 390(10113), 2673-2734.

Risk Factors. (2017, September 11). Retrieved December 14, 2020, from https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/dementia/risk-factors.html

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