Day 3 Types of Dementia PDF

Types of Dementia How is Dementia Identified Secondary Primary dementias: dementias: Which do not result Which occur as a from any other result of a physical...

Types of Dementia How is Dementia Identified Secondary Primary dementias: dementias: Which do not result Which occur as a from any other result of a physical disease disease or injury Primary dementia is a general term for a disease or condition in which dementia is the main illness Alzheimer's Disease Related Dementias (ADRD)  The most common form of dementia, Alzheimer’s disease and related dementias (ADRD), accounts for over 64% of all dementias in Canadians  Depending on the extent, ADRD can be categorized as either a minor or major neurocognitive disorder  Dr. Alois Alzheimer first identified Alzheimer’s disease in 1906. The two distinguishing characteristics he found were plaques and tangles  Currently, ADRD has no cure, but there are some medications that can slow its progress  The cause of ADRD is unknown, but a family history of ADRD is a known risk factor.  The progression can be described as a series of three stages  Memory loss affecting day-to-day abilities—forgetting things often or struggling to retain new information  Difficulty performing familiar tasks—forgetting how to do something one has been doing one’s whole life, such as preparing a meal or getting dressed  Difficulties with language—forgetting words or substituting words that do not fit the context  Disorientation in time and space—not knowing what day of the week it is or getting lost in a familiar place Warning Signs  Impaired judgement—not recognizing a medical condition that needs attention or wearing light clothing on a cold day  Problems with abstract thinking—not understanding what numbers signify on a calculator, for example, or how they are used  Misplacing things—putting things in strange places, like an iron in the freezer or a wristwatch in the sugar bowl  Changes in mood and behaviour—for example, going from being easy-going to quick-tempered  Changes in personality—behaving out of character, such as feeling paranoid or threatened  Loss of initiative—losing interest in friends, family, and favourite activities Tips from the Alzheimer’s Society of Canada  Knowing more about the person with dementia can help community support workers and staff in long-term care facilities build relationships and provide personalized care.  Like all people, people who are diagnosed with dementia are whole people with their own values, preferences, and personal life stories.  Examples:  Shadow Boxes  “All About Me”  Scrapbooks  Personalized Rooms  Causes  Genetic Factors  Older age  Lifestyle and environmental factors  Brain changes  Plaques  Tangles  Chronic brain inflammation Signs Initially forgetting recent events, Trouble handling conversations, or routine activities names Increased agitation, Trouble finding the wandering, or right words or inappropriate social forming sentences behavior Symptoms Impaired judgment Difficulty learning Repeated and decision- new information or questioning making. skills. Sundowning Changes in sleep Loss of coordination (increased confusion patterns, such as and mobility in later and agitation in the insomnia or stages. evening) excessive sleeping Specific Word-Finding Difficulties Comprehension Issues Repetition Communication Challenges Agitation Triggered Non-Verbal Progressive Decline by Dependence Miscommunication  Simple, clear language, and short sentences Supporting the Client Eye contact with ADRD Non-verbal cues Key Takeaways  Alzheimer’s disease primarily affects memory, cognition, and behavior, with progression leading to significant dependency on care.  Early recognition of signs and symptoms allows for more effective management of care routines.  Effective communication is foundational in maintaining dignity and reducing agitation.  Person-centered care is crucial: acknowledge the patient’s preferences, history, and emotional state.  HCAs should foster a safe environment by minimizing hazards (e.g., locks on doors, clear pathways) to prevent accidents or wandering.  Vascular Dementia  Vascular dementia, sometimes known as multi-infarct dementia, is one of the most common forms of dementia, second only to Alzheimer’s disease in older persons.  Vascular dementia is caused by chronic, reduced blood flow to the brain—usually as the result of a stroke or series of strokes. In many cases, the strokes are so small that symptoms may not be noticeable. These strokes are known as “silent strokes” or transient ischemic attacks (TIAs). Over time, the damage adds up, leading to memory loss, disorientation, and other signs of dementia.  Vascular dementia results in a subtle, progressive decline in memory and cognitive functioning. It is caused when the blood supply carrying oxygen and nutrients to the brain is interrupted by a blocked or diseased vascular system.  Depending on each client’s health condition and the severity of the stroke or strokes, vascular dementia may come on gradually or suddenly.  Currently, there is no known cure, but the good news is that making certain lifestyle changes and using practical strategies may help prevent strokes, compensate for cognitive losses, and slow the disease’s development.  Vascular dementia typically progresses in a stepwise fashion, where lapses in memory and reasoning abilities are followed by periods of stability, only to give way to further decline. Causes  Stroke  Small vessel disease  TIA’s  Chronic CVC  Atherosclerosis  Slowed thinking and Weakness or paralysis difficulty with on one side of the body problem-solving. (post-stroke). Difficulty walking or Frequent mood swings, Signs balancing. irritability, or apathy. Cognitive and physical abilities may seem to worsen suddenly after a stroke or TIA and stabilize later.  Memory loss, Sudden confusion, though typically especially following less severe than in a stroke or TIA. Alzheimer’s. Personality Trouble changes, such as Symptoms communicating increased agitation or apathy. Trouble with Severe mobility spatial awareness issues, including or judgment, inability to walk leading to falls  Aphasia Word-Finding Issues Specific Communication Emotional Reactivity Challenges Inconsistent Abilities Supporting Clients with Vascular Dementia Use closed-ended Be Patient: Allow extra questions that require time for responses a simple yes or no without interrupting. answer. Use visual aids and non- Avoid Rushing: Speak verbal cues to reinforce clearly, slowly, and with understanding. a reassuring tone. Acknowledge Efforts: Validate and encourage attempts to communicate. Key Takeaways  Vascular dementia results from brain damage due to impaired blood flow, often linked to strokes or cardiovascular conditions.  Symptoms often fluctuate, with sudden declines after vascular events like strokes or TIAs.  Effective communication strategies tailored to the patient’s cognitive and physical capabilities are essential for maintaining dignity and reducing frustration.  HCAs should be vigilant about monitoring for signs of new strokes or cardiovascular issues. Promote a heart-healthy lifestyle within the patient’s capacity (e.g., proper diet, light exercise). Foster a safe environment to prevent falls and accidents, given mobility and judgment impairments.  Dementia with Lewy Bodies  Dementia with Lewy bodies (DLB) is one of the most common types of progressive dementia.  The central feature of DLB is progressive cognitive decline, combined with three additional defining features: 1) Severe fluctuations in alertness and attention— for example, sleep disturbances, frequent drowsiness, lethargy, lengthy periods spent staring into space, or disorganized speech; 2) Recurrent visual hallucinations; and 3) Parkinson’s disease–like motor symptoms such as rigidity and the loss of spontaneous movement.  The symptoms of DLB are caused by a buildup of Lewy bodies—accumulated bits of protein—inside in areas of the brain that regulate aspects of memory and motor control.  The similarity of symptoms between DLB and Parkinson’s disease and between DLB and Alzheimer’s disease can often make a definitive diagnosis difficult for the physician to make. As well, Lewy bodies are often found in the brains of people with Parkinson’s disease and in those with ADRD, a finding that suggests either that DLB is related to these other causes of dementia or that an individual can have both DLB and one of these other diseases at the same time  DLB usually occurs sporadically in people with no known family history of the disease. Causes  Lewy Bodies  Genetic link/family history of dementia or Parkinson’s disease Signs Fluctuating levels of alertness or awareness Early, recurrent, and detailed hallucinations of people or animals Parkinsonism: Slowed movement, muscle rigidity, tremors and shuffling gait Symptoms SUBTLE MEMORY ISSUES FREQUENT VISUAL WORSENING MOTOR SUDDEN DEPRESSION, ANXIETY (LESS SEVERE THAN HALLUCINATIONS SYMPTOMS RESEMBLING DISORIENTATION AND APATHY ALZHEIMER'S INITIALLY) PARKINSON’S DISEASE MOOD SWINGS DELUSIONS  Fluctuating Awareness Difficulty with Speech Specific Communication Challenges Hallucinations Delusions  Be Flexible: Adapt communication style to the patient’s fluctuating Be abilities. Supporting Acknowledge Acknowledge Hallucinations Calmly: Avoid dismissing hallucinations but gently redirect focus. the Client Simplify Instructions: Use short sentences and give one-step with Simplify instructions when assisting with tasks. Dementia Use Use Non-Verbal Cues: Gestures and visual aids can enhance understanding. with Lewy Be Be Reassuring: Maintain a calm tone and validate the patient’s emotions to reduce agitation. Bodies Monitor Triggers: Recognize environmental factors that may Monitor exacerbate confusion or distress. Key Takeaways  Dementia with Lewy bodies is characterized by a combination of cognitive, motor, and psychiatric symptoms, often overlapping with Alzheimer’s and Parkinson’s diseases.  Early and recurrent visual hallucinations are a hallmark symptom, alongside motor difficulties.  Fluctuations in alertness and cognitive function require HCAs to adapt care approaches daily.  Effective communication strategies are essential to reduce anxiety and enhance cooperation.  Care Priorities for HCAs: Promote safety by minimizing fall risks due to motor impairments. Monitor for side effects of medications, particularly antipsychotics, which can worsen symptoms in DLB – rigidity and orthostatic hypotension. Frontotemporal Dementia Characterized  Dharacterized by dramatic changes in personality, behaviour, and thought processes.  Changes in personal and social conduct occur in the early stages of the disease and include loss of inhibition, apathy, social withdrawal, mouthing of objects, and ritualistic compulsive behaviours.  In ADRD, the initial symptoms tend to be memory impairment, but in FTD, since the frontal lobes of the brain are affected, the first symptoms occur in emotional and social functioning. The mood changes, often leaning toward euphoria, lack of inhibitions, and deterioration in social skills, are clearly noticeable.  A client with FTD may become excessively extroverted, withdrawn, rude, impatient, or aggressive and may make inappropriate remarks in public. The person may exhibit altered sexual behaviour, with a markedly increased interest in sex, which can be linked to loss of inhibition.  Difficulties with language can occur in the early stages of FTD but are not as striking as those in the early stages of ADRD. Difficulty finding words and naming objects occurs initially, and as the disease progresses, memory and apraxia (to move your lips or tongue the right way to say sounds) become more marked. Causes  Protein buildup damaging brain cells  Genetic links  Onset in younger individuals Signs Loss of social filters, leading Apathy and lack of interest in to inappropriate actions or personal care or activities. comments. Difficulty finding words and Compulsive or repetitive naming objects occurs behaviors (e.g., tapping, initially, and as the disease pacing, overeating). progresses, memory and apraxia become more marked Lack of empathy or Poor judgment and decision- understanding of others’ making feelings. Symptoms PROMINENT CHANGES IN RISK-TAKING AND LACK EMOTIONAL FLATNESS SYMPTOMS SIMILAR TO MOTOR NEURON DISEASE PERSONALITY AND OF INHIBITION. OR REDUCED EMPATHY. PARKINSON’S DISEASE, SYMPTOMS (E.G., BEHAVIOR. SUCH AS TREMORS OR MUSCLE WEAKNESS). RIGIDITY. Specific Communication Challenges Language deficits Behavioral Barriers Lack of insight  Supporting the Clients with Frontotemporal Dementia  Adapt to Language Loss: Use visual aids or gestures to aid understanding. Simplify communication with short, clear sentences. Avoid overwhelming with complex instructions.  Handle Behavioral Issues: Stay calm and nonjudgmental, even when faced with inappropriate behavior. Redirect conversations or actions gently without escalating frustration.  Engage in Routine: Establish consistent routines to minimize confusion and agitation. Use familiar words or phrases to create comfort Key Takeaways  FTD primarily affects younger individuals, targeting behavior, personality, and language rather than memory in early stages.  Care for FTD patients requires a unique focus on managing behavioral changes and language impairments.  Behavioral Management:  Address disinhibition or compulsive actions by redirecting the patient without judgment.  Ensure safety by monitoring for risky or impulsive behaviors.  Communication Approaches:  Focus on non-verbal cues and visual aids for patients with severe language deficits.  Be patient, and allow extra time for responses.  Care Priorities for HCAs:  Maintain structure and routine to reduce behavioral triggers.  Provide opportunities for meaningful engagement to reduce apathy and foster connection. Secondary dementia results from the physical effects of a disease process, from ingestion of damaging substances, or from injury   Parkinson’s Disease Dementia (PDD) is a type of dementia that develops in people who have been living with Parkinson’s disease, a progressive neurological disorder that primarily affects movement. It typically occurs in Parkinson’s the later stages of Parkinson’s, after motor symptoms like tremors and Disease stiffness have been present for several years. PDD is caused by the Dementia accumulation of Lewy bodies.  Key difference between PDD and DLB: In PDD, motor symptoms occur first, followed by dementia; in DLB, cognitive symptoms appear earlier or at the same time as motor symptoms.   Creutzfeldt–Jakob Disease (CJD) is a rare, degenerative, and fatal brain disorder. It is caused by prions, which are abnormal proteins that can trigger normal proteins in the brain to fold abnormally. This leads to rapid brain damage, affecting cognitive and motor functions. CJD is usually rapidly fatal. In later stages, the client will have poor balance, muscle stiffness, spasms, involuntary jerking movements and pain, which will cause increasing problems Creutzfeldt- with stability and walking. Dementia becomes obvious, and it eventually leads to a mute, rigid state such as a comatose state. Jakob Disease Once the signs of CJD become apparent, the progress of the disease is very rapid, causing severe emotional distress to family and friends. About 90% of patients with CJD die within 1 year of the first symptoms  Creutzfeldt–Jakob Disease progresses rapidly, requiring HCAs to adapt quickly to the patient's changing needs. Emphasis should be placed on maintaining safety, providing comfort, and supporting both the patient and their family through this difficult condition   Substance-Induced Persisting Dementias refer to long-term cognitive Substance- impairments caused by chronic substance abuse or exposure to toxic Induced substances. These impairments remain even after the individual stops using Persisting the substance, leading to persistent deficits in memory, thinking, and Dementias behavior.   Wernicke–Korsakoff Syndrome (WKS) is a neurological disorder caused by a severe deficiency of thiamine (Vitamin B1). It is often associated with chronic alcohol abuse but can also occur due to poor nutrition.  WKS has two stages: 1) Wernicke’s Encephalopathy (Acute Phase): A sudden and potentially reversible condition affecting the brain and nervous system.  Confusion: Difficulty understanding or responding to questions.  Ataxia: Unsteady gait and difficulty walking  Eye problems: Double vision, drooping eyelids, or uncontrolled eye Wernicke-  movements When these symptoms become long term, they cause lasting brain Korsakoff and nerve cell damage. This causes severe memory loss and the inability to form new memories, leading to Korsakoff syndrome. 2) Korsakoff Syndrome (Chronic Phase): A long-term condition causing Syndrome persistent memory and cognitive problems.  Severe memory loss: Inability to form new memories (anterograde amnesia). And, fabrication of memories (confabulation) to fill gaps.  This can lead to confusion and miscommunication Patients may fabricate memories (confabulation) without realizing it  Untreated, Wernicke encephalopathy develops into Korsakoff syndrome. Early treatment of Wernicke’s encephalopathy can prevent progression to Korsakoff syndrome. Once Korsakoff syndrome develops, recovery is often partial or limited  Treatment involves thiamine replacement therapy by intravenous (IV) or intramuscular (IM) injection, together with proper nutrition and hydration. However, the amnesia and brain damage caused by the disease do not respond to thiamine replacement therapy. Other Causes of Secondary Acquired Immune Deficiency Syndrome (AIDS) Huntington’s Disease Multiple Sclerosis Dementia