DEMENTIA

ANASTACIO, APOSTOL, BACUNAWA,

BALINGBING, & BAÑAGA - 3NU01 GROUP 1
DEMENTIA
Disease process marked by progressive
cognitive impairment with no change in the
level of consciousness.
ONSET & CLINICAL COURSE
MILD: Hallmark: FORGETFULNESS --> may experience anxiety.
Occupational and social settings are less enjoyable and the person may avoid them.
Most people remain in the community during this stage.

MODERATE: CONFUSION and PROGRESSIVE MEMORY LOSS --> loses ability to live independently.
Oriented to person and place, disoriented to time.
Remains in the community if adequate caregiver support is available.

SEVERE: PERSONALITY and EMOTIONAL CHANGES.

Delusional, may wander at night, forget the names of SO, and requires assistance with ADLs.
Most people live in nursing facilities, unless extraordinary community support is available.
SIGNS & SYMPTOMS
It involves multiple cognitive deficits, initially, memory impairment, and later, the following cognitive
disturbances may be see (Black and Adreasen, 2021):

DISTURBANCE
APHASIA APRAXIA AGNOSIA
IN EXECUTIVE
Deterioration of Impaired ability to Inability to recognize or FUNCTIONINIG
language function. execute motor function name objects despite
Inability to think
Echolalia (echoing despite intact motor intact sensory abilities.
abstractly and to plan,
what is heard) or abilities.
initiate, sequence,
palilalia (repeating
monitor, and stop
words or sounds over
complex behavior.
and over).
 ETIOLOGY
Though the clinical picture is similar for most dementias, the
causes may vary. Until a postmorten examination is finished, a
conclusive diagnosis may not always be possible.

Ref: Videbeck, L. (2020). Psychiatric-Mental Health Nursing (Eighth Edition). Wolters Kluwer.
 PREVALENCE
LOCAL INTERNATIONAL

In a 2020 study conducted in the According to World Health

Philippines, Dominguez et. al.
stated that in 1,367 participants,
dementia prevalence was found
to be 10.6% with the breakdown
85.5% AD and 2.7% other
dementias.
Organization, currently more than
55 million people have dementia
worldwide, over 60% of whom
live in low-and middle-income
countries. Every year, there are
nearly 10 million new cases.

Ref:
https://www.who.int/news-room/fact-sheets/detail/dementia#:~:text=Key%20facts,injuries%20that%20affect%20the%20brain.
Dominguez, Jacqueline et al. ‘Prevalence of Dementia and Associated Risk Factors: A Population-Based Study in the Philippines’. 1
Jan. 2018 : 1065 – 1073. https://content.iospress.com/articles/journal-of-alzheimers-disease/jad180095
PSYCHOPHARMACY

01 02 03
Cholinesterase Antidepressants Antipsychotics
Inhibitors
01
Cholinesterase Inhibitors
01
Cholinesterase Inhibitors

Tacrine (Cognex) is also a cholinesterase inhibitor; however, it elevates liver

enzymes in about 50% of clients using it.

Memantine (Namenda) is an NMDA receptor antagonist that can slow the

progression of Alzheimer in the moderate or severe stages.
02
Antidepressants

Antidepressants are effective for significant depressive

symptoms; however, they can cause delirium.

Selective serotonin reuptake inhibitor antidepressants are

used because they have fewer side effects.
03 Commonly Used Drugs

Haloperidol (Haldol), Olanzapine (Zyprexa),

Antipsychotics Risperidone (Risperdal), and Quetiapine (Seroquel)

Used to manage psychotic symptoms of delusions, hallucinations, or

paranoia, and other behaviors, such as agitation or aggression.

The potential benefit of antipsychotics must be weighed with the risks.

The U.S. Food and Drug Administration (FDA) has not approved
antipsychotics for dementia treatment, and there is a black box warning
issued.
Lithium carbonate, carbamazepine (Tegretol), and valproic acid (Depakote)
help stabilize affective lability and diminish aggressive outbursts.

Benzodiazepines are used cautiously because they may cause delirium

and can worsen already compromised cognitive abilities.
 NURSING MANAGEMENT
History
May be unable to provide accurate and thorough history of onset of
problems.

General Appearance and Motor Behavior

Display aphasia when they cannot name familiar name or object
Repetitive conversations due to idea perseveration.
Slurred speech
Total loss of intelligible language.
Apraxia- loss of ability to perform familiar tasks
NURSING MANAGEMENT
Mood and Affect
Anxiety and fear (initial memory loss)
Mood swings
Verbal or physical aggression

Thought Process and Content

Cannot think abstractly.
Delusions of persecution

Sensorium and Intellectual Processes

Lose intellectual function
Memory gaps
NURSING MANAGEMENT
Judgement and Insight
Poor judgement
"losing my mind"

Self-Concept
Angry or frustrated for losing objects and forgetting

Roles and Relationships

Inability to participate in meaningful conversastions.

Physiological and Self-Care Considerations

Disturbed sleep-wake cycle
Self-care deficits
NURSING MANAGEMENT
Nursing Diagnosis:
Impared memory
Impared socil interaction
Chronic confusion
Self-care deficits
Risk for ineffective relationship
Risk for adult falls
Risk for physical trauma
NURSING MANAGEMENT
Nursing Interventions:
Promote client's safety
Promote adequate sleep, and proper nutrition
Promote hygiene practices
Encourage interaction and involvement on activities
Structuring environment and routine.
Providing emotional support
NURSING MANAGEMENT

RE-FRAMING
Offering alternative points
of view to explain events.
NURSING MANAGEMENT
REMINISCENCE THERAPY
Thinking about or relating
personally significant past
experiences.

Example:
Handing a family photo to
the client and asking
questions about it.