Chapter 93 Dementias and Related Disorders

Impairment of Mental Functioning Confusion Delirium Mild cognitive impairment (MCI) Amnestic MCI Nonamnestic MCI Dementia Progressive dementia Pseudodementia

Question Is the following statement true or false? A nurse needs to learn about the history of onset of cognitive dysfunction to decide if the client has confusion, delirium, or dementia.

Answer True When first meeting an individual who has a cognitive dysfunction, the nurse may find it difficult to determine if the disruption is owing to confusion, delirium, or dementia. Learning about the history of onset and observing the client’s level of consciousness and cognitive abilities can help differentiate the condition.

Types of Dementia Alzheimer’s disease Multi-infarct dementia Parkinson’s disease Wernicke-Korsakoff syndrome Frontotemporal temporal dementia (FTD), Pick’s disease Creutzfeldt-Jakob disease (infectious) Huntington’s disease (HD, hereditary) Dementia caused by AIDS

Types of Dementia (cont’d) Crack-related dementia; dementias caused by other illegal drugs Normal-pressure hydrocephalus Brain trauma Metabolic disorders (e.g., diabetes mellitus or end-stage renal disease) Drug overdose (toxic dementia) Dementia of tertiary syphilis (Bayle’s disease)

Dementia’s Common Terminology Agnosia Akinesia Aphagia Aphasia Apraxia Compulsions Confabulation Delusional Dysphagia Emotional liability Paranoid

Alzheimer’s Disease Theories of causes Risk factors Age, genetics, diet, environment Education and continual use of mental abilities Diseases that affect cerebral blood flow, such as stroke, heart disease, and hypertension Low levels of the vitamin folate

Alzheimer’s Disease (cont’d) Physiologic changes Major changes occur in the brain Cerebral cortex atrophy Loss of neurons Changes in brain cells

Alzheimer’s Disease (cont’d) Description Common symptoms Memory loss, inability to learn and retain new information Loss of judgment and planning skills Personality and mood changes Decreased reasoning and abstract thinking skills Loss of language skills Inability to care for self

Alzheimer’s Disease (cont’d) Pharmacologic treatment The goals To prevent the development of AD To slow the onset of symptoms To reduce the symptoms

Diagnosis of Dementia History Physical and neurologic examination Laboratory tests CT scan, MRI, PET scan, and EEG Psychometric testing Functional assessment

Question Is the following statement true or false? If a person with dementia who resides in a long-term care facility wants to go home, it is important for the nurse to convince this person that the facility is his or her home.

Answer False The person with dementia who resides in a long-term care facility may want to go home. The nurse should not try to convince the resident that this is his or her home. It is not the “home” the resident knows. The nurse can make statements, such as “You are staying here. You are safe here.” Distracting the person by initiating an activity may also help.

Nursing Process Data collection Physical assessment Psychological assessment Determination of abilities to perform functional ADLs Determination of abilities to perform complex or instrumental ADLs Determination of support systems

Nursing Process (cont’d) Planning and implementing Assisting with daily care Assisting with communication Assisting with behavior management Assisting caregivers Evaluation

Question Is the following statement true or false? When communicating with a person with dementia, a nurse should restrain the person.

Answer False Restraints should be used only as a last resort. Restraining a client with dementia often causes more aggression. If the client becomes combative or hostile, have a safe place or room the client can stay and be monitored but not physically restrained.

End of Presentation