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

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Learning Objectives
Describe two normal age-related changes in cognition.
Identify five main categories of confusion.
Explain why medication use can lead to confusion in older adults.
Describe at least three signs or symptoms of delirium.
Identify five symptoms of dementia.
Copyright © 2013 by Elsevier Inc. All rights reserved.

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Learning Objectives
Describe the signs and symptoms seen during the progression of Alzheimer’s disease.
List three mental health care goals for clients with Alzheimer’s disease.
Describe the need-driven dementia-compromised behavior model.
Identify two types of support groups for the caregivers of clients with Alzheimer’s disease.
Copyright © 2013 by Elsevier Inc. All rights reserved.

4. 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.”
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5. Confusion Has Many Faces cont’d. (p. 190)
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.
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6. 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)
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7. Clients with Delirium (p. 191)
Delirium is a change in consciousness that occurs quickly.
May result in delusions or hallucinations
Reversible if treated early
Full recovery of mental functions occurs if cause is found and treated.
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.
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8. Clients with Dementia (p. 193)
Loss of multiple abilities
Memory
Language
Ability to think and understand
Causes
Primary (Alzheimer’s disease)
Secondary as a result of disease (such as human immunodeficiency virus [HIV])
Types
Vascular dementia
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.
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9. Alzheimer’s Disease (AD) (p. 194)
Progressive, degenerative disorder that affects brain cells and results in impaired
Memory
Thinking
Behavior
Divided into two categories:
Early onset
Before 65 years of age
Late onset
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.
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10. Alzheimer’s Disease cont’d. (p. 195)
Stages of Alzheimer’s disease
Early stage
Loss of recent memory
Inability to learn, process information, and retain information
Language problems
Intermediate stage
Inability to recall any recent events or process new information
Severe stage
Inability to do anything
End stage
Coma and death can occur.
List the mental health care goals for clients with Alzheimer’s disease.
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11. Therapeutic Interventions (p. 196)
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.
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Caregiver Support (p. 200)
Caring for a loved one with AD is probably the most difficult of all caregiving 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.
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Question 1
Which of the following words indicates a change in consciousness that occurs quickly?
Memory loss
Delirium
Delusion
Dementia
Correct Answer: 2
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Question 2
The nurse has a client who is being admitted with delirium. When treating the client with delirium, what is the nurse’s first priority?
Obtain as much history as possible from the client and family.
Administer medications.
Treat the source.
Be supportive of the client and family.
Correct Answer: 3
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Question 3
The client, who was diagnosed with delirium, has settled into her room. Around 6:00 pm, the nurse notices that the client is becoming more agitated, confused, and disruptive. The client’s behavior is known as:
Institution adjustment
Progression of the delirium
Sundown syndrome
Alzheimer’s disease
Correct Answer: 2
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Question 4
The nurse is caring for a client with Alzheimer’s disease (AD). The client has experienced loss of recent memory and has developed an inability to learn, process, and retain information. The client’s judgment and abstract thinking have declined as well. The client is in what stage of AD?
Early
Intermediate
Severe
End
Correct Answer: 1
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Question 5
People with Alzheimer’s disease (AD) may live for many years. What is the average length of time after diagnosis that the client lives with the disease?
5 years
8 years
10 years
12 years
Correct Answer: 2
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