Cognitive Impairment, Alzheimer’s Disease, and Dementia Chapter 17 Cognitive Impairment, Alzheimer’s Disease, and Dementia Copyright © 2013 by Elsevier Inc. All rights reserved.

Confusion Has Many Faces (p. 190) Cognition refers to the higher brain functions: Intelligence Learning Judgment Reasoning Knowledge Understanding Memory Cognitive impairment is a disruption in higher brain functions that results in confusion. Cognition also includes language skills and reading and writing abilities. Being able to abstract is another part of cognition. Example: the proper use and understanding of proverbs. What does the proverb “People who live in glass houses shouldn’t throw stones” mean? (Abstract answer: Don’t criticize others for faults that you have yourself.) Someone with impaired cognition might give a concrete answer, such as, “If you throw stones in a house, you could break a window and shatter the glass.”

Confusion Has Many Faces cont’d. (p. 191) Normal changes in cognition The most significant losses include slower response times and impaired short-term memory. More time is needed to process, store, and retrieve information. Confusion is not normal. Confusion demands investigation. The five D’s of confusion Damage; Delirium; Dementia; Depression; Deprivation List and describe normal age-related changes in cognition. List and describe the main categories of confusion.

Confusion Has Many Faces cont’d. (p. 191) Medications in older adults Many medications and drugs cause confusion, especially in older adults. Confusion is often the first sign of a drug reaction. Why does medication use lead to confusion in the older adult? Which medications may cause confusion in the older adult? (Medications used to treat allergies, arthritis, high blood pressure, irritable bowel syndrome, migraine headache, pain, or Parkinson’s disease; antipsychotic agents, sedatives, hypnotics; over-the-counter [OTC] drugs, including those used to treat cold and flu, diarrhea, hay fever, and insomnia)

Clients with Delirium (p. 191) Delirium is a change in consciousness that occurs quickly (sudden/acute onset) May result in delusions or hallucinations Reversible if treated early Full recovery of mental functions occurs if cause is found and treated in such cases as taking certain medications-DRUG ALERT- such as pain, allergy, OTC cold and flu It is important for health care providers to recognize the signs of delirium. Delirium is a reversible syndrome that comes on suddenly, usually as a result of a metabolic, nutritional, or toxic disorder. Examples: hypoxia, hepatic or renal disease, postoperative states, psychoactive substances, chemical or alcohol intoxication or withdrawal Ask the class to give examples of head injuries. Copyright © 2013 by Elsevier Inc. All rights reserved.

Clients with Dementia (p. 193) Dementia- slow onset Loss of multiple abilities Memory-poor short term or remote Poor Judgement Language; Personality Changes Ability to abstract thinking and understand Causes Primary (Alzheimer’s disease) Secondary as a result of disease (such as human immunodeficiency virus [HIV]) Types Vascular dementia-happens because loss of oxygenated blood to the brain Alzheimer’s disease Dementia is an insidious process having an almost imperceptible start. It comes on slowly. It is chronic and usually irreversible. It can be primary: Alzheimer’s disease, multi-infarct dementia (resulting from many small strokes) It can be secondary: Parkinson’s disease, heart disease, multiple sclerosis, AIDS, hypothyroidism In some situations, care providers can be so focused on their clients’ primary medical diseases that they overlook a coexisting dementia.

Clients with Dementia (p. 194) Vascular Dementia Course of dementia may be characterized by ups and downs of behavior Dementia in general could possibly be reversed in some instances

Alzheimer’s Disease (AD) (p. 194) Sundown Syndrome Characterized by confusion, agitation, and disruptive actions late in afternoon or evening Cause unknown; associated with dementia Onset of nighttime become more confused, irritable, and agitated ***Box 17-3***What to assess for and Therapeutic Interventions Describe the signs and symptoms seen during the progression of Alzheimer’s disease.

Alzheimer’s Disease (AD) (p. 195) Progressive, degenerative disorder that affects brain cells and results in impaired-5% from 65 to 74; 50% of those over 85% have AD Memory Thinking Behavior Divided into two categories: Early onset Before 65 years of age- Late onset- 5% from 65 to 74 Not a normal part of aging Involves the gradual, progressive death of one’s brain and its functions Describe the signs and symptoms seen during the progression of Alzheimer’s disease.

Alzheimer’s Disease (AD) (p. 195) Diagnosis done by ruling out any other possible causes Slowly robs a person of their being-they lose things little by little Losses of AD Affective loss-personality side Conative Loss-will not be able to carry out the simplest of tasks Loss of ability to withstand stress Describe the signs and symptoms seen during the progression of Alzheimer’s disease.

Alzheimer’s Disease cont’d. (p. 196) Stages of Alzheimer’s disease Early stage Loss of recent memory Inability to learn, process information, and retain information- for instance things they have done for years Language problems Intermediate stage Develop aphasia-speaking, apraxia-not able to perform ADLs, and visual agnosia-not recognizing of family members, friends Inability to recall any recent events or process new information Will start to wander, become agitated, and become physical aggressive Personality traits start change List the mental health care goals for clients with Alzheimer’s disease.

Alzheimer’s Disease cont’d. (p. 196) Stages of Alzheimer’s disease Severe stage Inability to do anything End stage Coma and death can occur. A person with AD can live 2 to 20 years, but the average number of years is 8. List the mental health care goals for clients with Alzheimer’s disease.

Therapeutic Interventions (p. 197) Therapeutic care for clients with AD has three major goals: To provide for clients’ safety and well-being To manage clients’ behaviors therapeutically To provide support for family, relatives, and caregivers When behaving inappropriately, clients are gently redirected to less stressful activities. What can the care provider do to ensure safety for a client with Alzheimer’s? Describe the need-driven dementia-compromised behavior model.

Therapeutic Interventions (p. 198) Assessment Functional Assessment Daily Function; Cognitive Function; Medical; Behavioral; Psychological; Psychosocial Interventions Early-medications do not cure Cholinesterase Inhibitors to help preserve cognitive functions-Such as Aricept—Drug Alert Frequent orientation to time, place, & person-signs as markers on doors Communication-simple-***Box 17-6*** Therapeutic Interventions-Validation, Music; Audio presence; Life review Living quarters and routine keep simple Simple physical exercise & activites What can the care provider do to ensure safety for a client with Alzheimer’s? Describe the need-driven dementia-compromised behavior model.

Therapeutic Interventions (p. 198) Middle and Late Stages All sense of time and place is lost in middle stages Becomes agitated; hostile; aggressive; uncooperative-Do not take personal Wandering and pacing-walk with patient Alzheimer’s Asso.-60% will wander & become lost Established Safe Return Program Progress to late stage where they do not remember how to eat, walk, care for themselves and eventually in final stage slip in coma and die What can the care provider do to ensure safety for a client with Alzheimer’s? Describe the need-driven dementia-compromised behavior model.

Caregiver Support (p. 200) Caring for a loved one with AD is probably the most difficult of all care giving experiences. Most individuals with AD are cared for in the home by family, friends, and home care agencies. Informal support groups Family members, friends, people at work, social groups, and faith communities Formal support groups Home care agencies, elder care centers, and hospices Identify types of support groups available for the caregivers of clients with Alzheimer’s disease.