Alzheimer & Dementia & Delirium PDF

Alzheimer & Dementia&Delirium  TABLE OF CONTENTS 01 02 03 Definition of dementia Causes INTRODUCTION and Alzheimer’s disease,Delirium 04 05...

Alzheimer & Dementia&Delirium  TABLE OF CONTENTS 01 02 03 Definition of dementia Causes INTRODUCTION and Alzheimer’s disease,Delirium 04 05 06 07 Risk Factors Signs & Symptoms Complications Diagnostic tests 08 09 10 Pharmacologic & Nursing Roles Nonpharmacologic Preventions  01 INTRODUCTION!  INTRODUCTION Alzheimer's disease (AD) is the commonest progressive, dementing neurodegenerative disease in elderly, which affects innumerable. people each year, and these numbers are likely to further increase as the population ages. In addition to the financial burden of AD on health care system, the disease has powerful emotional impact on caregivers and families of those afflicted.  02 Definition of dementia and Alzheimer’s disease,Delirium  What is Alzheimer’s Disease? Alzheimer’s disease (AD) is a progressive and irreversible, degenerative, fatal disease and is the most common form of dementia among older people. What is Dementia? Dementia is a brain disorder that seriously affects a person’s ability to carry out daily activities.  What is Delirium? Delirium is a rapid, acute change in mental status marked by confusion, disorientation, and impaired attention. It can develop within hours to days due to various medical conditions, medications, or environmental factors. While usually reversible, if not promptly addressed, it can result in serious complications like prolonged hospitalization, cognitive decline, and increased mortality.  Stages of Alzheimer's Disease 1. Preclinical Stage No noticeable symptoms, but changes in the brain may be occurring. Biomarkers may indicate the presence of Alzheimer's. 2. Mild Cognitive Impairment (MCI) due to Alzheimer's Noticeable memory problems, but not severe enough to interfere significantly with daily life. Individuals may still function independently. 3. Mild Alzheimer's Disease Memory loss and confusion become more apparent. Difficulty with tasks such as managing finances or remembering recent events. Changes in mood and personality may occur.  Stages of Alzheimer's Disease 4. Moderate Alzheimer's Disease Increased memory loss and confusion. Difficulty recognizing friends and family. Assistance is often needed for daily activities. 5. Severe Alzheimer's Disease Loss of ability to communicate or respond to the environment. Requires full-time assistance with personal care. Physical abilities may decline, leading to immobility.  03 Causes- Alzheimer's disease Alzheimer's disease is thought to be caused by the abnormal build-up of proteins in and around brain cells.  Causes-Alzheimer's disease As brain cells become affected, One of the proteins involved is there's also a decrease in chemical called amyloid, deposits of which messengers (called form plaques around brain cells. neurotransmitters) involved in sending messages, or signals, between brain cells. The other protein is called tau, deposits of which form tangles Levels of one neurotransmitter, within brain cells. acetylcholine, are particularly low in the brains of people with Alzheimer's disease. Although it's not known exactly Over time, different areas of the what causes this process to begin, brain shrink. The first areas scientists now know that it begins usually affected are responsible many years before symptoms for memories. appear.  04 Signs & Symptoms  Signs & Symptoms Signs Symptoms Memory loss Problems with abstract thinking Difficulty to performing familiar tasks Loss of initiative Problems with language Confusion Disorientation to time and place Having a hard time concentrating Poor or decreased judgment Disturbed sleep Misplacing things Changes in personality Ask questions repetitively Changes in mood or behavior  05 Risk Factors  Risk Factors - ALZHEIMER’S DISEASE Gender. Head injuries. Smoking and Drinking 1 2 3 4 5 5 Age Health conditions Family History.  Age Gender Age is the biggest risk factor for Alzheimer’s, as women over the age of 80 still have a it is for most types of dementia. This means that slightly higher risk of getting Alzheimer’s a person is more likely to get Alzheimer’s as than men their age. We don’t know the they get older. Above the age of 65, a person’s exact reasons for this. risk of developing Alzheimer’s doubles about every five years. Health conditions There are lots of health conditions that increase a person’s risk of developing Alzheimer’s disease (as well as vascular dementia). These include: 1. diabetes, stroke and heart problems 2. risk factors for heart and blood vessel disease, such as high blood pressure, high cholesterol and obesity in mid-life 3. age-related hearing loss 4. depression.  Head injury Family History Another strong risk factor for Alzheimer's is Head injuries are most commonly caused by family history. According to research, those car, motorcycle, and bicycle accidents; military who have a parent, brother or sister with exposures; boxing, football, hockey and other Alzheimer’s are more likely to develop the sports; firearms and violent assaults; and falls. disease. The risk increases if more than one Policymakers should use public health and other family member has the illness. policy measures to reduce head injuries. Smoking and Drinking Smoking greatly increases your risk of developing dementia. You’re also increasing your risk of other conditions, including type 2 diabetes, stroke, and lung and other cancers. It’s never too late – stopping smoking later in life also reduces the risk of dementia Alcohol misuse and drinking more than 21 units weekly increase the risk of dementia. The harmful use of alcohol is a causal factor in more than 200 disease and injury conditions.  06 Comparison between Delirium and Dementia  07 Complications  Physical Complications  Falls and injuries: Impaired judgment, balance, and coordination increase the risk of falls.  Swallowing difficulties (dysphagia): This can lead to choking, pneumonia, and malnutrition.  Incontinence: Loss of bladder and bowel control is common and no longer recognize the sensation of needing to use the bathroom. They may also be unable to respond quickly to urges.  Skin breakdown: Bedsores (pressure ulcers) can develop due to immobility.  Nutritional deficiencies: Difficulty eating or loss of appetite can lead to malnutrition.   Agitation and aggression: These behaviors can become Mental and challenging for caregivers.  Wandering: Individuals with Alzheimer's may wander away Behavioral from home, posing a safety risk.  Depression: The disease can lead to feelings of sadness, Complications hopelessness, and withdrawal.  Psychosis: Hallucinations and delusions can occur in some individuals.  Sleep disturbances: Sleep patterns can become disrupted, leading to fatigue and irritability.  Increased risk of infections: Weakened immune systems make individuals more susceptible to infections like pneumonia and Other urinary tract infections.  Cardiovascular disease: Alzheimer's is Complications often linked to heart disease and stroke.  Diabetes: There is a higher incidence of diabetes among people with Alzheimer's.  08 Diagnostic tests To diagnose Alzheimer's dementia, you might see your healthcare professional. Or you might see a doctor trained in brain conditions, known as a neurologist, or a doctor trained to treat older adults, known as a geriatrician. The doctor or other healthcare professional reviews your symptoms, medical history and medicine history. Diagnostic tests A Psychiatric assessments. B Mental status examination and neuro psychological assessment. C Laboratory tests. D Brain imaging.  CT scan  MRI E CSF Examination  PET  SPECT F Electro-encephalogram (EEG)  1. Psychiatric Assessments Psychiatric assessments are critical for diagnosing mental health conditions and formulating treatment plans. They typically involve a comprehensive evaluation of the patient's mental state, cognitive abilities, and overall functioning.  2. Mental Status Examination (MSE) and Neuropsychological Assessment 1.Mental Status Examination (MSE) The MSE is a structured way of observing and describing a patient's current state of mind. Key components include: 1.Appearance: Physical characteristics, grooming, and attire. 2.Behavior: Level of cooperation, agitation, or psychomotor activity. 3,Speech: Rate, volume, coherence, and spontaneity. 4.Mood: Patient’s self-reported emotional state (e.g., depressed, anxious). 5.Affect: Observed emotional expression (e.g., flat, appropriate). 6.Thought Process: Organization and flow of thought (e.g., logical vs. disorganized). 7.Thought Content: Presence of delusions, obsessions, or suicidal ideation. 8.Perception: Hallucinations or other perceptual disturbances.  2. Mental Status Examination (MSE) and Neuropsychological Assessment Neuropsychological assessments evaluate cognitive functions to identify deficits related to neurological or psychiatric conditions. Components include: Cognitive Domains: 1.Attention 2.Memory (both short-term and long-term) 3.Language skills (expressive and receptive) 4.Executive functions (planning, reasoning) 5.Visuospatial skills  3. Laboratory Tests Laboratory tests can help identify underlying medical conditions that may present with psychiatric symptoms.  4.CSF Examination Cerebrospinal fluid (CSF) analysis is often performed when there are concerns about infections or neurological disorders: Indications for CSF Examination: 1.Suspected infections (e.g., meningitis or encephalitis). 2.Autoimmune conditions affecting the CNS. 3.Neurodegenerative diseases.  Electroencephalogram (EEG) Pharmacological: 1. Cholinesterase Inhibitors: Donepezil, Rivastigmine, Galantamine – Improve cognitive function by increasing acetylcholine levels. 2. NMDA Receptor Antagonist: Memantine – Regulates glutamate activity for moderate to severe cases. Non-Pharmacological: 1. Cognitive Stimulation Therapy: Engaging activities to enhance cognitive function. 2. Environmental Modifications: Creating a structured, calm environment to reduce confusion.  09 Pharmacologic & Nonpharmacologic Pharmacologic Treatment CHOLINESTERASE COMBINATION INHIBITORS THERAPY MEMANTINE VITAMIN E Galantamine  Pharmacologic Treatment MEMANTINE CHOLINESTERASE INHIBITORS Memantine is a medication primarily used to treat moderate to severe Alzheimer's disease. It works as an NMDA (N-methyl-D- aspartate) receptor antagonist, which helps to regulate the 1.Donepezil (Aricept) is approved to treat all activity of glutamate, a neurotransmitter involved in learning stages of Alzheimer's disease. It's taken and memory. By blocking excessive stimulation of these once a day as a pill. receptors, memantine may help to improve or stabilize 2.Galantamine (Razadyne) is approved to treat cognitive function in some patients with Alzheimer's disease. mild to moderate Alzheimer's disease. It's taken as a pill once a day or as an extended- release capsule twice a day. COMBINATION THERAPY Combination therapy refers to the use of two or more medications or treatment modalities to Galantamine manage a condition. In the context of Alzheimer's disease and dementia, Galantamine is a medication used primarily for the combination therapy may involve using treatment of mild to moderate Alzheimer's disease and galantamine alongside other drugs to enhance other types of dementia. It belongs to a class of drugs known as cholinesterase inhibitors, which work by therapeutic effects, improve cognitive increasing levels of acetylcholine, a neurotransmitter function, and manage symptoms more that is important for memory and learning. effectively.  Non Pharmacologic Treatment Cognitive stimulation Exercise therapy Validation Therapy Occupational Therapy  Non Pharmacologic Treatment Validation Therapy Cognitive stimulation therapy Validation Therapy is a therapeutic approach designed to communicate with and support individuals, particularly those Cognitive Stimulation Therapy (CST) is a structured with dementia or cognitive impairments, by validating their program designed to improve cognitive feelings and experiences. Developed by Naomi Feil in the function and quality of life for individuals with 1960s, Validation Therapy aims to enhance the emotional well- mild to moderate dementia, including being of individuals who may struggle to communicate Alzheimer's disease. CST involves engaging effectively due to cognitive decline. participants in a variety of activities and exercises that stimulate thinking, memory, and social interaction. Occupational Therapy Occupational Therapy (OT) is a client-centered health profession that focuses on promoting health and well-being through engagement in meaningful activities or occupations. Occupational therapists work with individuals of all ages to help them develop, recover, or maintain the daily living and work skills they need to lead fulfilling lives.  10 Prevention!  Healthy Lifestyle Habits 1 2 Heart-healthy diet: Consuming fruits, Regular exercise: Engaging in physical vegetables, whole grains, lean activity helps improve blood flow to proteins, and healthy fats can benefit the brain and overall cognitive both heart and brain health. The function. Mediterranean diet is often recommended. 3 4 Weight management: Maintaining a Quit smoking: Smoking increases the healthy weight can reduce the risk risk of various health conditions, of heart disease and diabetes, including Alzheimer's. both linked to Alzheimer's.  Cognitive Stimulation Managing Health Conditions  Mental challenges: Engaging in  Blood pressure control: High blood activities that stimulate the mind, such pressure is a risk factor for Alzheimer's. as puzzles, learning new skills, or  Diabetes management: Keeping blood playing games, can help maintain sugar levels under control is important. cognitive function.  Cholesterol management: High cholesterol  Social interaction: Staying connected can contribute to heart disease and with friends and family can help increase Alzheimer's risk. prevent social isolation and cognitive decline. Hearing and Vision Care  Addressing hearing loss: Untreated hearing loss has been linked to cognitive decline  Regular eye exams: Maintaining good vision is essential for overall brain health.  11 Health education for family about how to deal with Al zahimar  Health education for family about how to deal with Al zahimar 1. Understand the Disease: Learn about Alzheimer’s symptoms, progression, and its impact on cognition and behavior. 2. Effective Communication: Use simple language, speak slowly, and maintain eye contact to enhance understanding. 3. Create a Safe Environment: Remove hazards and use labels to help the person navigate their surroundings safely. 4. Establish Routines: Develop a consistent daily schedule to provide structure and reduce anxiety. 5. Encourage Independence: Allow the person to do as much as they can on their own while providing support when needed.  Health education for family about how to deal with Al zahimar 6. Use Memory Aids: Utilize calendars, reminders, and notes to help with memory recall and daily tasks. 7. Stay Patient: Recognize that frustration is common; approach situations with empathy and patience. 8. Engage in Activities: Encourage participation in hobbies and activities they enjoy to promote mental stimulation. 9. Focus on Emotions: Validate feelings rather than correcting misconceptions to foster emotional connection. 10. Practice Self-Care: Caregivers should prioritize their own health and well- being to prevent burnout.  12 Nursing Roles  Nursing Roles Assessment and Care Planning: Nurses conduct comprehensive assessments to identify the patient's physical, cognitive, and emotional needs. Based on these assessments, they develop individualized care plans that address the patient's specific challenges. Medication Management: Nurses administer prescribed medications and monitor their effectiveness, while also educating patients and caregivers about medication side effects and importance of adherence. Safety and Environment: Creating a safe environment is crucial. Nurses implement strategies to prevent falls, wandering, and other accidents. Activities of Daily Living (ADLs): As the disease progresses, patients may require assistance with ADLs such as bathing, dressing, and eating. Nurses provide direct care or teach caregivers how to assist effectively. Behavior Management: Nurses employ various techniques to manage challenging behaviors, such as agitation, aggression, and wandering. Communication and Support: Effective communication is key. Nurses use clear and simple language, maintaining patience and empathy. They also provide emotional support to both patients and caregivers. Family and Caregiver Education: Nurses educate families about the disease, its progression, and available resources. They offer support and guidance on coping strategies. Collaboration: Nurses collaborate with other healthcare professionals, including physicians, social workers, and therapists, to provide comprehensive care. End-of-Life Care: As the disease progresses, nurses provide compassionate end- of-life care, addressing physical, emotional, and spiritual needs. Comprehensive Assessment: Conduct thorough assessments to evaluate cognitive function, mental status, and daily living activities. Care Plan Development: Create individualized care plans that reflect the unique needs and preferences of each patient. Family Support: Provide emotional support and resources to families and caregivers navigating the challenges of these conditions. Cognitive Stimulation: Engage patients in activities that stimulate cognitive function, such as puzzles, music therapy, or reminiscence therapy. Monitoring for Changes: Regularly monitor and document changes in cognitive status, behavior, and physical health. THANKS! CREDITS: This presentation template was created by Slidesgo, and includes icons by Flaticon, and infographics & images by Freepik Please keep this slide for attribution