DEME By: Maria Sharina S.

Gonzalez
BSN Level 3
INTRODUCTION
Cognition is that operation of the mind
process by which we become aware of objects
of thought and perception, including all
aspects of perceiving, thinking and
remembering. Organic brain syndrome is
general term referring to many physical
disorders that cause impaired mental
function.
HISTORY OF DEMENTIA
Dementia was first described in a
book about mental illness in 1833.
In 1834, Dr. Alois Alzheimer, 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).
DEMENTIA
Dementia is an acquired global
impairment of intellect, memory
and personality but without
impairment of consciousness.
It is defined as a progressive
impairment of cognitive functions
occurring in clear consciousness. It
is often associated with language
difficulty, memory lapses,
disorientation, poor judgment and
INCIDENCE
Dementia occurs more commonly in
elderly than in the middle aged.
ETIOLOGY
Significant loss of neurons and volume in brain
regions devoted to memory and higher mental
functioning
Neurofibrillary angles (twisted nerve cell fibers that
are damaged remains of microtubules)
Environmental factors : infection, metals and toxins
Excessive amount of metal ions such as zinc and
copper in the brain
Deficiencies of vitamin B6, B12 and Folate
UNTREATABLE AND
IRREVERSIBLE CAUSE OF
DEMENTIA
Degenerating disorders of the CNS
Alzheimer’s Disease (common)
Pick’s disease
Huntington’s chorea
Parkinson’s disease
TREATABLE AND
REVERSIBLE CAUSES OF
DEMENTIA
Vascular multi infarct dementia
Intracranial space occupying lesions
Metabolic disorders ( hepatic failure, renal failure)
Endocrine disorders ( myxedema, Addison’s disease)
Infections (AIDS, Meningitis, Encephalitis)
Intoxication ( alcohol, heavy metals)
Anoxia ( anemia, post anesthesia, chronic respiratory
failure )
 TYPES OF
DEMENTIA
CORTICAL DEMENTIA
Dementia where the brain damage primarily affects
the brain’s cortex or outer layer. Tends to cause
problems with memory, language, thinking and
social behavior.
SUBCORTICAL DEMENTIA
Dementia that affects parts of the brain below
the cortex. 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 DEMENTIA
Dementia such as Alzheimer’s disease
that does not result from any other
disease
Alzheimer's is a type of dementia that
causes problems with memory, thinking
and behavior. Symptoms usually develop
slowly and get worse over time,
becoming severe enough to interfere
with daily tasks.
SECONDARY DEMENTIA
Dementia that occurs as a result of
physical disease or injury.
STAGES OF DEMENTIA
STAGE 1 : EARLY STAGE (2
TO 4 YEARS)
Forgetfulness
Declining interest in environment
Hesitancy in initiating actions
Poor performance at work
STAGE 2 : MIDDLE STAGE (2
TO 12 YEARS)
Progressive memory loss
Hesitates in response to questions
Has difficulty in following simple instructions
Irritable, anxious
Wandering
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 family
Incontinence of urine and feces
Loses the ability to stand and walk
Death is caused by aspiration pneumonia
WARNING SIGNS OF
ALZHEIMER’S DEMENTIA
Memory loss
Difficulty performing familiar tasks
Problems with language
Disorientation to time and place
Poor or decreased judgment
Problems with abstract thinking
Misplacing things
Changes in mood or behavior
DIAGNOSIS
Cognitive assessment evaluation- mini mental status
examination (MMSE) – shows cognitive impairment
Functional dementia scale ( to indicate the degree of
dementia )
Magnetic resonance imaging (MRI) the brain shows
structural and neurologic changes
Spinal fluid analysis shows increased beta amyloid
deposits
TREATMENT MODALITIES
Tacrine hydrochloride (cognex)
Donepezil hydrochloride (Aricept)
NMDA ANTAGONIST
Mematine
ANTIPSYCHOTIC AGENTS
Risperidone, quetiapine and olanzapine
ANTIDEPRESSANT AGENTS AND MOOD
STABILIZERS
Low doses of the selective serotonin reuptake
NURSING MANAGEMENT
Assessment data for the patient with
dementia should include a past
health and medication history
EATING
Ensure that the patient ate food
Provide well balanced diet
Cut down food into smaller pieces
Mix fool and give it to them
Encourage a soft and liquid diet and ensure
that patient drinks enough water
Diet supplements like calcium and vitamins
COMMUNICATION
Use simple sentences with simple words
Speak clearly and slowly
Stand in front of the client and look into his face and talk
Give the patient time to understand before continuing with
the next sentence
Observe clients verbal and non verbal responses
Don’t argue with the client
Use gestures such as pointing to an object or demonstrating
the action to be done
Avoid distractions while talking to client
WANDERING
Make sure that the person carries identity bracelet
with name address and telephone number
Relocate door locks to positions where the person
will not look for them
Install bells and buzzers that sounds when external
doors are opened
Make the door less visible by painting it the same
color or covering it with a curtain
Put a large stop sign on the door
BATHING
Never leave the patient alone
Encourage hygiene and avoid dependency on the
caregiver
Provide bath stools and grab rails inside the
bathroom
Keep bathroom clean and dry
Check the temperature of water before bath
Keep familiar soaps, hair oils shampoo to remind the
patient abouth bathing
TOILETING
Monitor for signs of constipation and dehydration
Assist the patient to toilet at scheduled intervals
Use signage or symbols leading to the toilet
Use nigh lights or grab rails in the toilet
Provide easily removable garments
Keep the toilet clean and dry
GROOMING
Assist with grooming, cutting and filing nails
Never cut nails closely to avoid injuries
Apply moisturizers and deodorants to avoid
body odor
Comb hair properly
FOR REALITY ORIENTATION
Place large clocks with numbers clearly
written
Place large calendar, date display so that the
patient can see the date, day and month or
year
Place reminder lists on sticky notes or white
boards
REDUCE CHANCES OF
CONFUSED INTERPRETATION
Remove mirrors if patient gets frighten
by reflection
Remove pictures, masks and decorations
which may haunt or frighten the patient
Avoid bright or dark paint inside the
room
GENERAL SAFETY
Replace door bolts and locks with simple
latches and hooks which can be opened from
the outside
Keep medicines, poisonous liquids, sharp
objects out of reach or locked
Keep all electrical outlets covered
Make sure all switches are safe
NURSING DIAGNOSIS
Self care deficit
Disturbed thought process
Wandering
Impaired verbal communication
Risk for injury
Compromised family coping
Social isolation
THANK