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Questions and Answers
Which of the following symptoms are common in Stage 7 of dementia?
Which of the following symptoms are common in Stage 7 of dementia?
What is a characteristic clinical presentation of vascular dementia?
What is a characteristic clinical presentation of vascular dementia?
What is one key feature of vascular dementia that differentiates it from other types of dementia?
What is one key feature of vascular dementia that differentiates it from other types of dementia?
Which of the following is NOT a typical management strategy for vascular dementia?
Which of the following is NOT a typical management strategy for vascular dementia?
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What cognitive deficits are typically seen in vascular dementia?
What cognitive deficits are typically seen in vascular dementia?
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What characterizes dementia as a clinical condition?
What characterizes dementia as a clinical condition?
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Which of the following is NOT a risk factor for dementia?
Which of the following is NOT a risk factor for dementia?
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What is the estimated number of elderly individuals (60 years and older) in the Philippines by 2040?
What is the estimated number of elderly individuals (60 years and older) in the Philippines by 2040?
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Which of the following best differentiates delirium from dementia?
Which of the following best differentiates delirium from dementia?
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What was the percentage of total deaths attributed to Alzheimer's and dementia in the Philippines according to WHO data published in 2020?
What was the percentage of total deaths attributed to Alzheimer's and dementia in the Philippines according to WHO data published in 2020?
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Which of the following are common signs of dementia?
Which of the following are common signs of dementia?
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What impact does dementia have on daily life?
What impact does dementia have on daily life?
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What is a key emotional aspect associated with coping with dementia?
What is a key emotional aspect associated with coping with dementia?
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What role do laboratory studies play in cognitive assessments?
What role do laboratory studies play in cognitive assessments?
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What imaging techniques are mentioned as useful in detecting brain changes?
What imaging techniques are mentioned as useful in detecting brain changes?
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Which of the following symptoms is NOT associated with the early stages of Alzheimer’s?
Which of the following symptoms is NOT associated with the early stages of Alzheimer’s?
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During the preclinical stage of Alzheimer's, what might imaging studies reveal?
During the preclinical stage of Alzheimer's, what might imaging studies reveal?
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What describes the symptoms present in the mild cognitive impairment stage?
What describes the symptoms present in the mild cognitive impairment stage?
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What common behavior might occur due to memory loss in Alzheimer’s patients?
What common behavior might occur due to memory loss in Alzheimer’s patients?
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At what stage of Alzheimer’s do activities of daily living (ADLs) remain unimpaired?
At what stage of Alzheimer’s do activities of daily living (ADLs) remain unimpaired?
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What might characterize the early symptoms of Alzheimer's?
What might characterize the early symptoms of Alzheimer's?
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Which symptom is associated with the mild stage of Alzheimer’s Disease?
Which symptom is associated with the mild stage of Alzheimer’s Disease?
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What are the four A's of Alzheimer's disease?
What are the four A's of Alzheimer's disease?
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Which hallmark is NOT consistent with the neuropathology of Alzheimer’s Disease?
Which hallmark is NOT consistent with the neuropathology of Alzheimer’s Disease?
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What might a severe stage Alzheimer's patient demonstrate?
What might a severe stage Alzheimer's patient demonstrate?
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Which of the following is a common normal lapse that differs from dementia?
Which of the following is a common normal lapse that differs from dementia?
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What is one method used in the diagnosis of Alzheimer's Disease?
What is one method used in the diagnosis of Alzheimer's Disease?
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Which of the following is an example of apraxia associated with Alzheimer's Disease?
Which of the following is an example of apraxia associated with Alzheimer's Disease?
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What type of behavioral change might occur in the moderate stage of Alzheimer’s Disease?
What type of behavioral change might occur in the moderate stage of Alzheimer’s Disease?
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What is an important focus for therapy in the later stages of Parkinson's?
What is an important focus for therapy in the later stages of Parkinson's?
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Which of the following is considered a non-motor symptom of Parkinson's?
Which of the following is considered a non-motor symptom of Parkinson's?
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What should be assessed regularly for individuals with Parkinson's?
What should be assessed regularly for individuals with Parkinson's?
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Which treatment approach can help manage freezing episodes in Parkinson's patients?
Which treatment approach can help manage freezing episodes in Parkinson's patients?
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What is a common complication that should be checked for in those with Parkinson's?
What is a common complication that should be checked for in those with Parkinson's?
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What symptom may limit a Parkinson's patient's ability to communicate effectively in a group setting?
What symptom may limit a Parkinson's patient's ability to communicate effectively in a group setting?
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Which of the following is crucial for maintaining dignity in advanced Parkinson's care?
Which of the following is crucial for maintaining dignity in advanced Parkinson's care?
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What is a key aspect of supporting carers of individuals with Parkinson's?
What is a key aspect of supporting carers of individuals with Parkinson's?
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What is the primary purpose of melatonin during night time care?
What is the primary purpose of melatonin during night time care?
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Which factor is NOT mentioned as a consideration for night time care?
Which factor is NOT mentioned as a consideration for night time care?
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What should caregivers do to help manage chronic pain in individuals with dementia?
What should caregivers do to help manage chronic pain in individuals with dementia?
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Which of the following is a nonpharmacologic approach to treating psychosis in dementia?
Which of the following is a nonpharmacologic approach to treating psychosis in dementia?
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What is a recommended strategy for minimizing noise during night time care?
What is a recommended strategy for minimizing noise during night time care?
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Which of the following medications is considered an atypical antipsychotic?
Which of the following medications is considered an atypical antipsychotic?
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What is a common symptom that may accompany disorientation in individuals with dementia at night?
What is a common symptom that may accompany disorientation in individuals with dementia at night?
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Why should caregivers avoid arguing with individuals with dementia?
Why should caregivers avoid arguing with individuals with dementia?
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Study Notes
Virtual Classroom Information
- Dr. J.S. Espiritu is an Associate Professor
- The virtual classroom is for Gerontology, Older Adults, Geriatric NSG, and Advocates.
- Virtual meeting tools include Meet, FlipGrid, and a video-conferencing platform.
Prayer
- The prayer thanks Heavenly Father for the gift of education, and hopes students will be confident, guided by grace, and have hope for their future.
- The prayer expresses a desire for students to see needs of others, love well, and face each day with positivity.
NCM 114 Care of the Older Adult
- This is a course topic
- The course focuses on care for the elderly.
Learning Outcomes: Care of Older Adults with Dementia
- Define dementia
- Differentiate delirium and dementia
- Differentiate depression and dementia
- Causes of dementia
- Management of dementia
Couch Potato
- An image of a potato in a chair with chips
- The image is meant as a commentary on the lifestyles of some elderly people.
- Getting old is associated with a lack of purposeful activities.
Dementia: Symptoms, Cause, and Treatment
- Pictures of the brain and different brain areas are shown.
- The presentation covers symptoms, causes, and treatments.
Dementia as a Syndrome
- Dementia is an acquired syndrome of progressive cognitive decline.
- Memory, thinking, behavior, and daily activities are affected.
- Cognitive decline impacts daily life.
Types of Dementia
- Alzheimer's (50%-75%)
- Vascular (20%-30%)
- Lewy Body (10%-25%)
- Frontotemporal (10%-15%)
- Mixed dementia comes from more than one cause.
Dementia as a Complex Syndrome
- Dementia is characterized by cognitive, behavioral, and functional impairments.
- Cognitive impairments include amnesia, aphasia, agnosia, and apraxia.
- Behavioral impairments include behavioral disturbances and psychological/psychiatric symptoms.
- Functional impairments include instrumental ADLs and personal ADLs.
Risk Factors for Dementia
- Age
- Family history
- Head injury
- Fewer years of education are risk factors.
Philippines Dementia Prevalence and Statistics
- The estimated number of older adults in the Philippines (60 years or older) will double from 9.5 million in 2020 to 19.7 million in 2040.
- In 2020, Alzheimer's & Dementia deaths reached 2,010 (0.30% of total deaths) in the Philippines.
- The age-adjusted death rate is 3.10 per 100,000, and ranks Philippines #172 in the world.
- Globally, over 60% of dementia cases reside in low/middle income countries.
Healthy and Pathological Aging
- Various risk factors across the lifespan are associated with abnormal aging.
- Exposure to factors such as unhealthy diet, smoking, alcohol misuse, depression and diabetes are risk factors.
- These can contribute to neuronal damage, vascular insults, and dementia risk.
- AD risk impacts neuron viability, inflammation, oxidative stress, glucose metabolism, and tau and amyloid removal.
Impact of COVID-19 in People with Dementia
- People with dementia (65+) are at higher risk of COVID-19.
- 2020 witnessed a 16% increase in dementia-related deaths.
- Underlying health problems exacerbate COVID-19 complications in people with dementia,
COVID-19 and the Brain
- Studies suggest COVID-19 can enter the brain.
- Mechanisms of impact can be direct or indirect, relating to: blood-brain barrier, inflammation/immune response, or vascular connections.
Cognitive Disorders: Dementia
- Dementia is a clinical condition / syndrome involving a loss of cognitive function.
- Cognitive loss affects normal activities and social relationships.
- Common signs include memory impairment, cognitive disturbances and executive functioning.
Dementia: General Details
- Progressive and disabling
- Not an inherent aspect of aging
- Different from normal cognitive lapses
Types of Dementia
- Vascular dementia
- Alzheimer's disease
- Dementia with Lewy bodies
- Frontotemporal dementia (Pick's disease)
- Dementia from Parkinson's disease
- Creutzfeldt-Jakob disease
The Big Four Types of Dementia
- Lewy Body Dementia effects entire brain, widely diverse in symptoms.
- Alzheimer's Disease affects hippocampus at cortex base.
- Vascular Dementia affects entirety of brain, symptoms widely diverse.
- Frontotemporal Dementia affects frontal and temporal lobes.
Signs and Symptoms of Dementia: Recognizing Warning Signs
- Memory loss is a common early symptom of dementia.
- Difficulty with everyday activities (e.g., cooking, dressing, personal hygiene) is a sign.
- Language problems and communication difficulties
- Changes in mood and behavior
Stages of Dementia
- Stage 1 involves a lack of noticeable cognitive changes.
- Stage 2: mild cognitive changes
- Stage 3: mild but noticeable cognitive changes
- Stage 4: mild dementia
- Stage 5: moderate to severe dementia
- Stage 6: severe dementia
- Stage 7: very severe dementia.
Dementia: Symptoms (Stage 4)
- Choking, difficult swallowing, aspiration, excessive drooling
- Life-disrupting forgetfulness
- Difficulty performing daily activities
- High risk of falls
- Tremors
- Increased daytime sleep but few hallucinations
- High risk of potential health problems
- Increased need for supervision
Stage-Specific Symptoms of Dementia
- Stage 5: moderate to severe dementia, ability to recognize family and friends but recalling past events challenging. Requires assistance in daily tasks.
- Stage 6: severe dementia; major memory loss, incontinence is common. Difficulty recognizing family, communication problems, personality/mood changes and wandering are typical.
- Stage 7: the final stage of dementia, lasting approximately 1.5-2.5 years. Complete dependence on care, inability to speak, eat, or swallow, incontinence, lack of muscle control, constant disorientation.
Stage 7 Symptoms
- Inability to speak, eat, or swallow
- Loss of bladder/bowel control
- Assistance needed for every task
- No muscle control
- Constant disorientation
- Patient is bedridden
Vascular Dementia
- Development of cognitive deficits from both impaired memory, aphasia, apraxia, agnosia to disturbed abilities.
- Significant impairment in social and occupational functioning.
- Focal neurological symptoms and signs or evidence of cerebrovascular disease. Deficits occur in absence of delirium.
Vascular Dementia: Clinical Presentation
- Abrupt onset, step-wise deterioration
- Somatic complaints and emotional incontinence
- Hypertension and cerebrovascular history of disease/stroke are present
- Focal neurological symptoms/signs are found
Management of Vascular Dementia
- Risk assessment: age, hypertension, smoking, diabetes and history of stroke.
- Risk of further damage is reduced through management of stroke and risk factors.
- Secondary conditions (e.g., depression, anxiety, agitation) are treated.
- Dementia symptoms (cognition, global function, daily activities), are addressed in treatment.
Alzheimer's Disease
- A brain condition causing a progressive decline in memory, thinking, learning, and organizing skills.
- Eventually affects ability to carry out basic daily activities.
- Most common cause of dementia.
Alzheimer's Disease and Stages
- Signs vary in severity from Mild to Severe
- Symptoms include: Memory loss, Language problems, Mood swings, Personality changes, and Judgement
- Progression is categorized as Mild, Moderate, and Severe Stages
Normal Lapses vs. Dementia
- Normal Lapses: forgetting a name, leaving a kettle on, struggling for a word, or forgetting a date.
Normal Lapses Vs Dementia
- Dementia signs include problems remembering numbers, putting iron in the freezer, rapid mood swings for no reason and sudden changes in personality.
Four A's of Alzheimer's Disease
- Amnesia: loss of memory, the most common symptom of Alzheimer's disease.
- Aphasia: difficulty with language.
- Apraxia: difficulty with movement
- Agnosia: difficulty recognizing objects or people.
Pathology of Alzheimer's Disease (AD)
- Three key pathological hallmarks are present: Amyloid-rich senile plaques, Neurofibrillary tangles, Neuronal degeneration.
- Changes begin before symptoms emerge.
Alzheimer's Dementia: Brain Changes
- Healthy brain size and a shrunken brain due to Alzheimer's disease.
- Dying neurons showing tangles
Alzheimer's Disease - Symptoms
- Memory problems
- Trouble with decision making
- Sleep difficulties
- Inability to recognize people or things
- Communication difficulties
- Difficulty completing tasks
- Behavior changes
- Social withdrawal
- Forgetfulness
- Agressiveness.
Diagnosis and Management of Alzheimer's Disease
- Medical history & physical examination
- Review of current and past illnesses, medications and symptoms helps.
- Medical tests (laboratory studies & hormonal/vitamin deficiencies) help rule out other conditions.
- Brain imaging (e.g., CT, MRI) detects brain shrinkage, structural abnormalities.
- Neuropsychological tests assess memory and cognitive abilities to identify affected brain regions.
Cognitive, Psychiatric / Behavioral, and Physical Aspects of Dementia
- Cognitive impairments (non-amnestic, fluctuations)
- Psychiatric/behavioral symptoms (REM sleep behavior disorder, hallucinations, depression, delirium)
- Physical symptoms (Parkinsonism, hyposmia, constipation, orthostatic hypotension)
Stages of Alzheimer's Disease
- Stage 1: Preclinical Alzheimer's (no symptoms, brain changes)
- Stage 2: Mild Cognitive Impairment (more memory problems, daily function still maintained.)
- Stage 3: Mild Dementia (symptoms interfere with daily activities, noticeable cognitive decline).
- Middle Stage has noticeable cognitive changes
- Late Stage has worsening visual or spatial problems plus mental & behavioral problems.
Alzheimer's Treatment
- No cure, but treating aspects of disease
Sundowning
- Increased confusion, anxiety/agitation, sleep difficulties, pacing/wandering, disorientation are common issues for Alzheimer's/dementia patients that occur during evening hours.
Lewy Body Dementia (LBD)
- A brain disease with abnormal protein deposits (alpha-synuclein).
- Affects chemicals leading to problems with thinking, movement, behavior, and mood.
- Caused by abnormal protein deposits disrupting brain function and dopamine levels.
Dementia 7 Stages: Lewy Bodies
- Stage 1 - no noticeable cognitive changes are found
- Stage 2 - mild cognitive changes
- Stage 3 - noticeable cognitive changes
- Stage 4 - early signs of dementia
- Stage 5 - moderate to severe dementia
- Stage 6 - severe dementia
- Stage 7 - late or final stage dementia
frontotemporal dementia (FTD)
- Degeneration of frontal and temporal lobes
- Associated with Pick's bodies (tau protein) and Chr17 abnormality.
- Common Symptoms include: behavioral changes:
- (loss of job, compulsive, impulsive, difficulties interacting, hygiene, repetitive behaviors, withdrawal)
- Initial neurological symptoms (problems walking, slurred speech, numbness, dizziness, vision probs, hallucinations)).
Creutzfeldt-Jakob Disease (CJD)
- A rare brain disease affecting people (typically >60 years of age)
- Rapid progression, can cause dementia.
- Three types: sporadic, hereditary, acquired.
- Symptoms involve behavioral changes, memory issues, personality changes, vision problems, and muscle coordination problems.
Parkinson's Disease
- A neurological syndrome caused by low dopamine levels in the brain.
- Incurable, degenerative disease that affects movement and other areas of daily life.
- Symptoms include bradykinesia (slowness), rigidity (stiffness) tremor (shaking) and postural instability.
- A lack of dopamine leads to problems with movement and related tasks like walking and speech, among others.
Parkinson's Disease: Diagnosis & Treatment Stages Early/Maintenance
- Early diagnosis and management.
- Educate the person and caregivers.
- Reducing symptoms and distress
- Maintaining normal activities, function, & self-care. Assess carer needs for symptom reduction and treatment compliance.
Parkinson's Disease: Later Stages-Management
- Adaptations to promote self-care, optimize symptom control.
- Assess for complications and treatment fluctuations.
- Minimise disability through MDT input, carer support, and annual reviews.
- Palliative care with symptom relief, distress reduction and dignity.
Effects of Parkinson's Disease
- Motor symptoms affecting physical capability
- Nonmotor symptoms affect everything governed by muscles and fluctuate throughout the day.
Supporting Parkinson's People & Caregivers
- Support people with Parkinson's and their close contacts.
- Educate home care workers
- Refer to specialists for issues such as speech, swallowing, dietary intake, and physiotherapy
- Use specific techniques like queuinging or marching during freezing periods to create rhythm.
Types of Troubleshooting for Parkinson's
- UTI, constipation, medication changes (doses, timing, etc.)
- These may contribute to functional impairment.
Dementia Care
- Responding with a calm & positive manner.
- Reassure the patient and validate their emotions
- Removing yourself temporarily is useful if needed and to regroup.
- Returning to assist when the situation has calmed.
Night-time care
- Night-time care may need to accommodate different cultures and experiences.
- Important to understand cues and address concerns.
- Provide a safe and comfortable sleep environment (minimise noise and light, establish routine, provide night-light if needed).
Night-time Experiences
- Experiences like fears, worries, misunderstood cues & disorientation.
Noise
- Quiet is important for good sleep, may cause disorientation/confusion/fear.
- Try reducing noise to minimise issues.
Light
- Darkness at night & bright light during the day helps regulate sleep-wake cycles.
- Melatonin secretion is influenced by light.
Night-Time Lighting Strategies
- Utilize light-blocking curtains, minimise light under doors, use night lights appropriately, minimise electronics, use automatic light activation, use dimmer switches, use torches carefully.
Nutrition
- Hunger & hydration are important considerations, especially if dinner to breakfast is over 12 hours.
Activities
- Engagement in activities can be beneficial but individuals may need assistance in initiating activities.
- Reviewing life stories can be significant.
Pain
- Increases with age, expressed differently in those with dementia and other complications and affects quality of life.
Sensory Experience
- Important to note sensory input.
symptom management
- Treat Psychoses (delusions & hallucinations)
- Manage sleep disturbances
- Address Aggression & Agitation
Non-Pharmacological Treatments for Dementia
- Cognitive enhancement, individual/group therapy, regular appointments, communication with family/caregivers, environmental modification, and attention to safety are important.
Pharmacological Treatments for Dementia
- Cholinesterase inhibitors (offer some improvement in cognition and activities of daily living) Example: donepezil, rivastigmine, galantamine
- Memantine (NMDA Antagonist).
Treatment: Alzheimer's Disease: Specific Drugs
- Tacrine
- Memantine/namenda
- Seligiline
Treating Psychoses with Dementia
- Higher potency antipsychotics (e.g., haloperidol) but can have side effects (extrapyramidal symptoms).
- Lower potency antipsychotics (e.g., thioridazine) but can have side effects (anticholinergic effects, sedation, hypotension, constipation, urinary retention).
- Atypical antipsychotics (e.g. clozapine, risperidone, olanzapine) are also used with caution due to new prescribing information.
Managing Sleep Disturbances with Dementia
- Consistent bedtime and comfortable setting.
- Providing daytime activities & avoidance of daytime sleeping.
- Bright light therapy.
- Treating associated conditions like depression and delusions
- Consider trazodone, nefazodone, or zolpidem (if above methods fail), but avoid benzodiazepines or antihistamines.
Managing Agitation with Dementia
- Behavioral interventions like distraction, supervision, routines and structure.
- Rewards programs can modify behaviors.
- Pharmacological methods such as antipsychotics, antidepressants, mood stabilizers and beta-blockers.
Five Rs of Dementia Care
- Remain calm.
- Respond to feelings.
- Reassure your loved one.
- Remove yourself (physically or psychologically) to regain composure.
- Return after calming down.
General Dementia Care Considerations
- Remember, you cannot separate the emotional connection from irrational behaviors but maintain best response manners.
AIDS & Dementia
- Approximately two-thirds of people with AIDS develop dementia (AIDS dementia complex).
- In some cases, HIV is found in CNS postmortem; others point to an unidentified pathogen or immune mechanism.
- Dementia is often subcortical.
- Treatment with AZT halts and reverses some neuropsychological deficits.
References
- Brunner & Suddarth Textbook of Medical-Surgical Nursing (Chapter 17).
- www.sharecare.com
- [URL for urinary incontinence] (Note: URL removed since it's not possible to verify this specific URL)
Quote
- Age wrinkles the body; quitting wrinkles the soul. - Douglas MacArthur
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Description
Test your knowledge on vascular dementia symptoms, clinical presentations, and management strategies. This quiz covers key features that set vascular dementia apart from other types. Challenge yourself to understand cognitive deficits associated with this condition.
