Dementia and

Confusion
GROUP NAME :
1. Dwi Olinda (181141008)
2. Faizatul Dwi M (181141011)
3. M. Lukman (181141021)
4. Roynaldi iqbal (181141032)
5. Serly Rosa (181141033)
6. Umul Azmiya (181141041)
7. Uswatun (181141042)
 BACKGROUND
● Dementia is a type of non-communicable disease, but has a detrimental effect on the cognitive function of the
elderly. Dementia is a condition when a person experiences a decrease in memory and other thinking power which
significantly interferes with the activities of daily life (Nugroho, 2008). The criteria for dementia are loss of
intellectual abilities, including memory that is quite heavy, so that it can interfere with social and work functions
(Santoso & Ismail, 2009).
● The prevalence of dementia has reached 35.6 million people in the world. This incidence rate is expected to double
every 20 years, namely 65.7 million in 2030 and 115.4 million in 2050 (Alzheimer's Disease International, 2009).
The increase in the prevalence of dementia follows the increase in the elderly population. Based on these data, it
can be seen that there is an increase in the prevalence of dementia every 20 years.
● Cognitive disorders are conditions or pathophysiological processes that can damage or change brain tissue to
interfere with cerebral function, regardless of physical causes, the typical symptoms are cognitive impairment,
behavioral dysfunction and personality changes (Copel, 2007). Cognitive disorders are closely related to brain
function, because the patient's ability to think will be influenced by the state of the brain. Cognitive disorders,
including delirium and dementia (Azizah, 2011)
 DEFINITION
Dementia is a syndrome characterized by various cognitive
impairments without impaired consciousness. Impaired
cognitive functions include intelligence, learning and
memory, language, problem solving, orientation,
perception, attention and concentration, adjustment,
and social skills. (Arif Mansjoer, 1999)
Dementia is a disorder of intellectual function without
impaired vegetative function or conditions that occur.
Memory, general knowledge, abstract thinking,
judgment, and interpretation of written and oral
communication can be impaired. (Elizabeth J. Corwin,
2009)
 ETIOLOGY
Dementia is caused by :
● Untreated or incurable acute condition, if it is an acute condition that causes delirium or cannot be treated, there is a
possibility that this condition will become chronic and therefore can be considered dementia.
● Vascular diseases, such as hypertension, arteriosclerosis, and atheroclerosis can cause strokes.
● Parkinson's disease: dementia affects 40% of these patients.
● Prion disease (protein contained in the infection process of Creutzfeldt-Jakob disease).
● Human immunodeficiency virus (HIV) infection can attack the central nervous system, causing HIV
encephalopathy or the AIDS dementia complex.
● Structural disorders of brain tissue, such as normal pressure hydrocephalus and head trauma injuries
 CLASSIFICATION
● According to age:

■ Senile dementia is dementia that occurs at> 65 years of age.

■ Presenilis dementia is dementia that occurs at <65 years of age.

● According to the course of the disease:
○ Reversible
○ Irreversible (normal pressure hydrocephalus, subdural hematoma, vitamin B deficiency,
hypothyroidism, PB intoxication).
 CLASSIFICATION
● According to brain structure damage:

○ Alzheimer's type dementia

Alzheimer's is a decrease in the concentration of acetylcholine and choline acetyl transferase in the brain and is a
degenerative disease due to the death of brain cells and generally causes deterioration of intellectual or cognitive function, which
includes deterioration of memory and thought processes. The behavior experienced by dementia is forgetfulness or senility.
Although the cause of the Alzheimer's type of dementia is not certain, several studies have stated that as many as 40% of
patients have a family history of Alzheimer's type dementia so that genetic factors are highly thought to play a role in the
development of the disorder in at least a few cases.

○ Vascular dementia
The main cause of vascular dementia is multiple cerebral vascular disease that causes a pattern of dementia
symptoms, which is also known as multi-infarct dementia. Vascular dementia is common in men, especially in those
with pre-existing hypertension or other cardiovascular risk factors.
 CLINIC MANIFESTATIONS
01 02 03
Memory loss that continues Time and place orientation Language disorders, inability to
disorders compose sentences

04 05 06
exaggerated expressions, e.g. changes in behavior such as Irritable, hostile
excessive crying when watching indifference, withdrawal,
dramas on TV restlessness
 SUPPORTING INVESTIGATION

The diagnosis of dementia is based on a comprehensive assessment, taking into account the patient's age, family
history, early symptoms and development of symptoms and the presence of other diseases (such as high blood
pressure or diabetes).
1. Standard blood chemistry tests were performed.
2. CT and MRI scans are intended to determine the presence of a tumor, hydrocephalus or stroke.
3. EEG examination.
4. EEG: may be normal or give no specific picture. In advanced alzeymers, diffuse retardation and periodic
complexes can be seen.
5. Brain fluid examination. Lumbar function is indicated if there is clinical onset of acute dementia,
stimulation of meninges and heat.
6. Brain scans, such as PET, BEAM, MRI: can show areas of the brain that have decreased metabolism
which is characteristic of DAT.
7. CT scan: can show the presence of dilated brain ventricles, cortical atrophy
8. CCS: the appearance of abnormal protein from brain cells in about 90% is an indication of DAT.
 MANAGEMENT
1. Pharmacotherapy
For the treatment of dementia in the Alzheimer's type, many studies have been conducted.
Administration of cholinergic-enhancing agents has shown moderate results in some patients;
however overall it did not show any success at all. This is due to the fact that Alzheimer's
dementia is not caused solely by cholinergic deficiency; dementia is also caused by deficiency
of other neurotransmitters. Meanwhile, the combination of cholinergic and noradrenergic turns
out to be complex; administration of this combination drug must be careful because there can be
interactions that interfere with the cardiovascular system.
 MANAGEMENT
2. Support or family roles.
- Maintain a familiar environment and modify the environment according to the needs of the elderly
- Helping the elderly in fulfilling their daily needs
- Scolding or punishing an elderly person will not help.
- Ask for help from organizations providing nursing social assistance.
3. Symptomatic therapy.
- In dementia sufferers, symptomatic therapy can be given including:
- Diet
- Appropriate physical exercise
- Recreational and activity therapy
- Handling of problems.
PREVENTION AND TREATMENT
What we can do to reduce the risk of dementia include maintaining memory acuity and optimizing brain function, such
as:
- Prevent the entry of substances that can damage brain cells such as alcohol and excessive addictive
substances
- Reading books that stimulate the brain to think should be done every day.
- Doing activities that can make us mentally healthy and active
○ Spiritual activities & deepening religious knowledge.
○ Keep interacting with the environment, hanging out with friends who have similar interests
or hobbies
- Reducing stress at work and trying to stay relaxed in everyday life can keep our brains healthy
 CONFUSION (DELIRIUM)
Delirium is an acute and transient global organic disorder of central nervous system function that causes impaired
awareness and attention (Allison et al., 2004). in Septian, 2015). The term delirium is synonymous with acute confused
state, strictly speaking, it describes a variety of separate acute confused states characterized by periods of restlessness,
heightened mental activity, easy awakening, clear unpreparedness in responding to certain stimuli (such as sudden noise.
suddenly), disturbing visual hallucinations, motor hyperactivity, and autonomic stimulation. Distraction of attention,
essential in acute confusion, occurs despite apparent confusion. Delirium agitation is typically fluctuating and can
change or progress into a dim confused state. The clinical picture is shown by the joyful hallucinations of delirium
tremens that accompany cessation of drinking. However, delirium may appear in acute confusion of any cause
(Isselbacher et al.in Aggraini, 2014).
 ETIOLOGY
When talking about the etiology of delirium, predisposing
factors are distinguished by precipitation factors. Predisposing ● Precipitation factor
factors make a person more susceptible to delirium, whereas
precipitation is a factor that causes somatic delirium.
Precipitation factor is a factor causing somatic
● Predisposing Factors delirium. Including environmental changes (room
Predisposing factors make a person more susceptible to
displacement), pneumonia, infection,
delirium. Predisposing factors for organic brain disorders: such
dehydration, hypoglycemia, immobilization,
as dementia, advanced age, brain accidents such as stroke,
Parkinson's disease, visual and hearing impairments,
malnutrition, and use of a bladder catheter. The

functional disabilities, living in institutions, alcohol
dependence, social isolation, depression, sensory and other
multiple disorders, and a history of delirium post-operative
before.
use of anesthesia also increases the risk of
delirium, especially in prolonged surgery.
Likewise, elderly patients who are admitted to
the ICU are at higher riskAggraini, (2014).
 ROLE OF THE PROAGING SES IN DELIRIUM
● Several main mechanisms are associated with increased risk the occurrence of delirium at late age:
- Loss of nerve cells, especially at the locus coereleus and substantia nigra.
- Changes in various neurotransmitter systems.
- Age-related decline in white matter integrity.
- Decreased cerebral blood flow, especially in the anterior cingulate gyrus, bilateral basal ganglia, left prefrontal
section, left lateral frontal and left superior temporal sections, and the insular cortex.
- Decreased oxygen metabolism in the brain.
- Decreased oxygen supply (eg hypoxia).
- Reduced brain oxidative metabolismRara, (2016).
THANK’
S