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Dementia: The Basics What is dementia? What are the types of dementia? What are the stages? Treatment? – PowerPoint PPT presentation

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Title: What%20is%20dementia?

Dementia The Basics
  • What is dementia?
  • What are the types of dementia?
  • What are the stages?
  • Treatment?

Normal Agingor Symptoms of Mental Illness or
an Age-Related Disease Process?
  • There are widespread misconceptions about what
    happens to us cognitively as we age.
  • We have all heard that forgetfulness is an
    inevitable consequence of aging but the facts do
    not support this, and this myth exerts a powerful
    bias on the views of lay people as well as those
    of us in health care.
  • Memory function as measured by delayed recall of
    newly learned information is not substantially
    decreased for most people as they age. Older
    persons do experience a decline in processing
    speed and rote memory. However, in regard to
    information that they are allowed sufficient time
    to acquire, older persons experience no more
    memory loss over time of newly learned material
    than do young people. Numerous studies document
    that aging in and of itself does not degrade
    memory disease does.

Normal Agingor Symptoms of Mental Illness or
an Age-Related Disease Process?
  • It is true that memory function fails in
    everyone, of every age, every day. Because memory
    failures are so common, it is easy for observers
    to overlook genuine memory lapses in developing
  • Conversely normal memory failures can mislead
    persons with normal brain function into thinking
    that they are developing a dementia such as
    Alzheimer s disease.
  • Additionally, other problems such as depression
    and anxiety which are common in elders can also
    cause memory and other cognitive deficits
    mimicking dementia, and often incorrectly
    diagnosed as Alzheimers dementia.

Dementia vs Delirium vs Depression vs Mild
Cognitive Impairment
  • Other problems such as depression and anxiety
    which are common in elders can also cause memory
    and other cognitive deficits mimicking dementia,
    and often incorrectly diagnosed as Alzheimers
  • Physical changes, acute medical illness such as
    urinary infection can result in cognitive changes
    that mimic dementia but may be better understood
    and need to be evaluated for delirium.
  • Mild cognitive impairments are sometimes present
    and do not necessarily indicate presence of
    dementia process.

Dementia Defined
  • Dementia is a permanent and progressive loss in
    the ability to make new memories and general
    cognitive decline ultimately resulting in death.
    There are many types of dementia with varying
    causes such as Alzheimers disease, HIV,
    cardio-vascular disease, Parkinsons disease, to
    name just a few.
  • ¬†Diagnosis of Dementia requires a significant
    memory impairment and a significant impairment in
    another cognitive domain.
  • Cognitive Domains
  • Inability to learn, retain, and retrieve newly
    acquired information (memory)
  • Inability to comprehend and express verbal
    information (language)
  • Inability to manipulate and synthesize nonverbal,
    geographic, or graphic information / or inability
    to carry out motor activities despite intact
    motor functioning (psycho-motor functioning)
  • Inability to perform abstract reasoning, solve
    problems, plan for future events, mentally
    manipulate more than one idea at a time, maintain
    mental focus in the face of distraction, or shift
    mental effort easily (executive functioning)

  • Delirium is an acute decline in mental status
    that can be resolved and is primarily a
    disturbance of consciousness, with change in
    cognition (memory deficit, disorientation,
    language disturbance) or perceptual disturbance
    that is the direct physiological consequence of a
    medical condition. Delirium should be considered
    any time there is an acute change in mental
  • Abrupt onset (hours to days)
  • Fluctuating level of consciousness (altered
    sleep/wake cycle)
  • Perceptual disturbances (hallucinations, sensory
  • Disordered thoughts
  • Disorientation, memory impairment, inattention,
    decreased concentration and attention
  • Changes in psychomotor activity
  • ¬†

Delirium continued
  • Delirium is a medical emergency which may
    indicate a serious medical illness.
  • Treatment of delirium consists of correcting the
    underlying cause and treatment of symptoms. Risk
    factors for delirium include increasing age,
    pre-existing cognitive impairment and
    polypharmacy (especially Rx with a high
    anti-cholinergic load).
  • Suspect delirium if psychosis is suddenly present
    in a resident who previously did not have
    psychotic symptoms.

Mild Cognitive Impairment
  • MCI is a decline in at least 1 cognitive domain
    that is noticeable, but not significant enough to
    warrant a diagnosis of dementia.
  • People with MCI typically function independently
    in their daily affairs.
  • The most frequently encountered MCI is the
    amnesic type defined as subjective and objective
    memory impairment with the other cognitive
    functions and activities of daily living
  • While in many instances people with MCI
    demonstrate progressive decline ultimately being
    diagnosed with dementia, many do not progress to
    such severity.

Depression (Pseudo-Dementia)
  • Pseudo-dementia is not a discreet diagnostic
    category rather it represents a constellation of
    symptoms that mimic the cognitive impairment
    normally associated with dementia (especially
    memory and executive functioning deficits).
  • Some reports suggest that as many as 20-50 of
    elderly patients are misdiagnosed with
    degenerative dementia when they are instead
    experiencing cognitive decline associate with
    another psychiatric disorder usually depression.
  • The highest rates of depression are found among
    nursing home populations. Symptoms of depression
    can be found in 44-68 of nursing home
    residents. Rate of Major Depression among nursing
    home residents is 9-38. Depressed patients have
    higher risks of morbidity and mortality.

Types of Dementia
  • Alzheimers Dementia Alzheimer's disease is the
    underlying cause of -- of all dementia cases.
    Research indicates that the disease is associated
    with plaques and tangles in the brain.
    Alzheimers dementia tends to be slow and is
    always progressive, although some cases are more
  • Vascular Dementia The second most common form of
    dementia, vascular dementia is caused by poor
    blood flow to the brain, which deprives brain
    cells of the nutrients and oxygen they need to
    function normally. One of the ten dementia types,
    vascular dementia can result from any number of
    conditions which narrow the blood vessels,
    including stroke, diabetes and hypertension.
  • Mixed Dementia Sometimes dementia is caused by
    more than one medical condition. This is called
    mixed dementia. The most common form of mixed
    dementia is caused by both Alzheimer's and
    vascular disease.

Types of Dementia continued
  • Dementia with Lewy Bodies Parkinsons Disease
    can lead to is one type of dementia with Lewy
    Body involvement. Sometimes referred to as Lewy
    Body Disease, this type of dementia is
    characterized by abnormal protein deposits called
    Lewy bodies, which appear in nerve cells in the
    brain stem. These deposits disrupt the brain's
    normal functioning, impairing cognition and
    behavior and can also cause tremors.
  • Frontotemporal Dementia Picks Disease is one
    type of frontal lobe dementia., it is a rare
    disorder which causes damage to brain cells in
    the frontal and temporal lobes. Pick's disease
    affects the individual's personality
    significantly, usually resulting in a decline in
    social skills, coupled with emotional apathy.
    Unlike other types of dementia, Pick's disease
    typically results in behavior and personality
    changes manifesting before memory loss and speech
  • Creutzfeldt-Jacob Dementia CJD is a degenerative
    neurological disorder, which is also known as mad
    cow disease. The incidence is very low, occurring
    in about one in one million people. There is no
    cure. Caused by viruses that interfere with the
    brain's normal functioning, dementia due to CJD
    progresses rapidly, usually over a period of
    several months. Symptoms include memory loss,
    speech impairment, confusion, muscle stiffness
    and twitching, and general lack of coordination,
    making the individual susceptible to falls.
    Occasionally, blurred vision and hallucinations
    are also associated with the condition.

Types of Dementia continued
  • Wernicke-Korsakoff Syndrome Wernicke-Korsakoff
    syndrome is caused by a deficiency in thiamine
    (Vitamin B1) and often occurs in alcoholics,
    although it can also result from malnutrition,
    cancer which have spread in the body, abnormally
    high thyroid hormone levels, long-term dialysis
    and long-term diuretic therapy (used to treat
    congestive heart failure). The symptoms of
    dementia caused by Wernicke-Korsakoff syndrome
    include confusion, permanent gaps in memory, and
    impaired short-term memory. Hallucinations may
    also occur.
  • Huntington's Disease Huntington's disease is an
    inherited progressive dementia that affects the
    individual's cognition, behavior and movement.
    The cognitive and behavioral symptoms of dementia
    due to Huntington's include memory problems,
    impaired judgment, mood swings, depression and
    speech problems (especially slurred speech).
    Delusions and hallucinations may occur. In
    addition, the individual may experience
    difficulty ambulating, and uncontrollable jerking
    movements of the face and body.
  • Others There are other types of dementia but
    those noted above are some of the most well
    known. Comprehensive evaluation is often needed
    for proper differential diagnosis of cognitive

Course Progression
  • The various types of dementia have varying rates
    of progression and course. For example, the rate
    of progression for vascular dementia is highly
    variable depending on re-occurring
    cerebral-vascular events, and the progression is
  • Alzheimers type dementia tends to have a slow
    and progressive course and the stages tend to be
    demarcated by a regular constellations of
    symptoms. However, even though the stages in
    Alzheimers dementia tend to follow a fairly
    regular course the effect on each individual is
    idiosyncratic and while many patients with
    Alzheimers will show significant problems with
    mental calculations by the middle stages, many
    will not especially if math was always a strength
    for them. Thus, testing is required for accurate
    differential diagnosis.

Stages of Alzheimers Dementia
  • Early Stages mild cognitive decline
  • The person may feel as if he or she is having
    memory lapses such as forgetting familiar words
    or the location of everyday objects.
    Alternatively, they may have no awareness of
    changes, but friends, family or co-workers begin
    to notice difficulties. During a detailed medical
    interview, doctors may be able to detect problems
    in memory or concentration.
  • Common difficulties include
  • Noticeable problems coming up with the right
    word or name
  • Trouble remembering names when introduced to new
  • Having noticeably greater difficulty performing
    tasks in social or work settings Forgetting
    material that one has just read
  • Losing or misplacing a valuable object
  • Increasing trouble with planning or organizing
  • May demonstrate some spatial disorientation

Stages of Alzheimers Dementia
  • Middle Stages moderate cognitive decline
  • At this point, cognitive changes are more overt.,
    and at times personality changes may also become
    evident. Individuals in the middle stages will
    begin needing help with activities of daily
  • Common difficulties include
  • Impaired ability to perform challenging mental
    arithmetic for example, counting backward from
    100 by 7s
  • Greater difficulty performing complex tasks, such
    as planning dinner for guests, paying bills or
    managing finances
  • Memory impairments become more obvious, and some
    forgetfulness about one's own personal history
    may be observed
  • Becoming moody or withdrawn, especially in
    socially or mentally challenging situations
  • Confusion about where they are or what day it is
  • Hygiene and personal grooming may decline
  • Important autobiographical memories are generally
    still intact. Need help handling details of
    toileting (for example, flushing the toilet,
    wiping or disposing of tissue properly)

Stages of Alzheimers Dementia
  • Late Stages severe cognitive decline
  • Memory continues to worsen, personality changes
    may take place or worsen, individuals need
    extensive help with daily activities.
  • Difficulties Include
  • Lose awareness of recent experiences as well as
    of their surroundings
  • Remember their own name, but have difficulty
    remembering their personal history
  • Distinguish familiar and unfamiliar faces but
    have trouble remembering the name of a spouse or
  • Need help dressing properly and may, without
    supervision, make mistakes such as putting
    pajamas over daytime clothes or shoes on the
    wrong feet
  • Experience major changes in sleep patterns
    sleeping during the day and becoming restless at
  • Have increasingly frequent trouble controlling
    their bladder or bowels
  • Experience major personality and behavioral
    changes, including suspiciousness and delusions
    (such as believing that their caregiver is an
    impostor)or compulsive, repetitive behavior like
    hand-wringing or tissue shredding

Stages of Alzheimers Dementia
  • In the final stage of this disease, individuals
    lose the ability to respond to their environment,
    to carry on a conversation and, eventually, to
    control movement. They may still say words or
    phrases. At this stage, individuals need help
    with much of their daily personal care, including
    eating or using the toilet. They may also lose
    the ability to smile, to sit without support and
    to hold their heads up. Reflexes become abnormal.
    Muscles grow rigid. Swallowing can be impaired.

  • Effective treatment for dementia, regardless of
    the type, is dependent on proper diagnosis, good
    understanding of cognitive and adaptive
    functioning, and management of physical health.
  • Research is clear that the best treatment for
    patients with dementia includes a combination of
    psychotherapy, medical management, occupational
    and physical therapy, and recreation.
  • The specific type of psychotherapy should be
    determined by idiosyncratic needs and functioning
    of each patient but can include, talk therapy,
    cognitive-behavioral treatment, behavioral
    treatment aimed at assessing and managing
    environmental factors, narrative therapy,
    supportive treatment, and family therapy.
  • Medical management includes managing physical and
    health related issues as well as
    psychopharmacological management of psychiatric
    symptoms associated with dementia.
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