DEMENTIA

Dr VRKV –MPT-Ortho
 DEMENTIA
Dementia is a syndrome in which there is deterioration in memory,
thinking, behaviour and the ability to perform everyday activities.
Although dementia mainly affects older people, it is not a normal
part of ageing.
Worldwide, around 50 million people have dementia, and there are
nearly 10 million new cases every year.
Alzheimer's disease is the most common form of dementia and
may contribute to 60–70% of cases.
Dementia is one of the major causes of disability and dependency
among older people worldwide.
Dementia has a physical, psychological, social, and economic
impact, not only on people with dementia, but also on their carers,
families and society at large.
Dementia is a syndrome – usually of a chronic or

progressive nature – in which there is deterioration in

cognitive function (i.e. the ability to process thought)
beyond what might be expected from normal ageing.
It affects memory, thinking, orientation, comprehension,

calculation, learning capacity, language, and judgement.

Consciousness is not affected.

The impairment in cognitive function is commonly

accompanied, and occasionally preceded, by deterioration

in emotional control, social behaviour, or motivation.
 Classification of Dementia:
Types and causes of dementia include:
Alzheimer’s disease

Vascular dementia

Lewy body dementia, which may occur with Parkinson’s

disease
Frontotemporal dementia

Mixed dementia
Dementia symptoms
memory problems
asking the same question repeatedly
difficulty finding or understanding words
feeling confused in an unfamiliar environment
problems dealing with money and numbers
anxiety and withdrawal
difficulty planning and carrying out tasks
mood changes
personality and behavioral changes
sleep disturbances
changes in social awareness, such as making
inappropriate jokes
obsessive tendencies
Dementia stages
The World Health Organization (WHO) divides
dementia into roughly three stages:
 Early,
 Middle,
 Late. 
Early stage
 become more forgetful
lose track of time
feel lost in familiar locations
Middle stage
At this stage, the symptoms become more noticeable and
include:
forgetting names and recent events
feeling lost when at home
difficulty communicating
behavioral changes
repeatedly asking questions
needing help with personal care
Late stage
At this stage, a person needs full-time assistance, as
the impact of the symptoms typically becomes
more severe. The person may:
be unaware of where they are
be unaware of time
have difficulty recognizing loved ones
find it hard to walk
experience behavioral changes, which may include
aggression
 Dementia causes
The progressive death of brain cells and neurons. It develops
and worsens over time.
However, dementia can also result from head injuries, stroke
, brain tumors, and other causes.
Some types of traumatic brain injury — particularly if
repetitive, which can happen in some sports — may increase
 the risk of certain types of dementia later in life.
Some other factors include:
 the use of some drugs
 some infections, such as HIV or neurosyphilis
 depression
 vitamin B12 or E deficiency
 thyroid problems
 Dementia treatment
There is currently no cure for most types of dementia, as it is not
yet possible to reverse brain cell death.
Some medications may help reduce the symptoms of Alzheimer’s
disease. Three drugsTrusted Source, known as cholinesterase
inhibitors, They are:
 donepezil (Aricept)
 galantamine (Reminyl)
 rivastigmine (Exelon)
Cholinesterase inhibitors can also help manage behavioral
symptoms of Parkinson’s disease.
A person may also use memantine (Namenda), which is an NMDA
receptor antagonist, either alone or with a cholinesterase inhibitor.
If the symptoms result from an injury, medication use, or a vitamin
deficiency, it may be possible to prevent further damage.
Other forms of care
Some lifestyle strategiesTrusted Source that may
help manage dementia include making sure the
person:
healthy diet
gets regular exercise
attends all medical appointments
takes their medication as prescribed
has regular sleep habits
has a safe living space
has support from family members and caregivers, as
needed
Preventing dementia
In most cases, it is not possible to prevent dementia.
However, the WHOTrusted Source suggests that the
following habits may lower the risk:
exercising regularly
avoiding smoking
limiting alcohol consumption
maintaining a moderate weight
eating a healthy diet
seeking treatment for conditions such as high blood
pressure, high cholesterol levels, and high blood sugar levels
Wearing protective headgear during contact sports may also
lower the risk of sustaining repeated head injuries, which
could be a risk factor for dementia.
AUTISM

Dr VRKV, MPT-Ortho
A Alaways

U Unique

T Totally

I Interesting

S Sometimes

M Mysterious
AUTISM
Autism spectrum disorder (ASD) is a broad term used
to describe a group of neurodevelopmental disorders.
These disorders are characterized by problems with
communication and social interaction.
People with ASD often demonstrate restricted,
repetitive, and stereotyped interests or patterns of
behavior.
Autism does occur more often in boys than in girls,
with a 4 to 1 male-to-female ratio.
People with autism have trouble with communication.
They have trouble understanding what other people
think and feel.
This makes it hard for them to express themselves, either
with words or through gestures, facial expressions, and
touch.
People with autism might have problems with learning.
Their skills might develop unevenly. For example, they
could have trouble communicating but be unusually good
at art, music, math, or memory.
 Classification of AUTISM:
The DSM-5(Diagnostic and Statistical Manual of Mental
Disorders) currently recognizes five different ASD
subtypes. They are:
1) with or without accompanying intellectual impairment
2) with or without accompanying language impairment
3) associated with a known medical or genetic condition
or environmental factor
4) associated with another neuro developmental, mental,
or behavioral disorder
5) with catatonia(abnormality of movement and
behaviour arising from a disturbed mental state )
 Symptoms of Autism:
Autism symptoms typically become clearly evident
between 12 and 24 months of age. However, symptoms
may also appear earlier or later.
Early symptoms may include a marked delay in language
 or social development.
The DSM-5 divides symptoms of autism into two
categories:
Problems with communication and social interaction,
Restricted or repetitive patterns of behavior or activities.
Problems with communication and social interaction include:
issues with communication, including :
difficulties sharing emotions,
sharing interests, or
maintaining a back-and-forth conversation
issues with nonverbal communication, such as :
trouble maintaining eye contact or
reading body language
difficulties developing and maintaining relationships
Restricted or repetitive patterns of behavior or
activities include:
repetitive movements, motions, or speech patterns

rigid adherence to specific routines or behaviors

an increase or decrease in sensitivity to specific

sensory information from their surroundings, such as
a negative reaction to a specific sound
fixated interests or preoccupations
 Causes of Autism:
The exact cause of ASD is unknown.
Some of the suspected risk factors for autism include:
genetic mutations
fragile X syndrome and other genetic disorders
being born to older parents
low birth weight
metabolic imbalances
exposure to heavy metals and environmental toxins
a history of viral infections
fetal exposure to the medications valproic acid (Depakene) or
thalidomide (Thalomid)
According to the 
National Institute of Neurological Disorders and Stroke (NINDS) , both
genetics and environment may determine whether a person develops
autism.
 Diagnosis of autism
An ASD diagnosis involves several different screenings,
genetic tests, and evaluations.
Developmental screenings
The American Academy of Pediatrics (AAP) recommends
 that all children undergo screening for ASD at the ages of
18 and 24 months.
Screening can help with early identification of children
who could have ASD. These children may benefit from
early diagnosis and intervention.
The 
Modified Checklist for Autism in Toddlers (M-CHAT)
 is a common screening tool used by many pediatric
offices.
This 23-question survey is filled out by parents.
Pediatricians can then use the responses provided to
identify children that may be at risk of having ASD.
Other screenings and tests:Your child’s physician may
recommend a combination of tests for autism,
including:
DNA testing for genetic diseases
behavioral evaluation
visual and audio tests to rule out any issues with vision
and hearing that aren’t related to autism
occupational therapy screening
developmental questionnaires, such as the 
Autism Diagnostic Observation Schedule (ADOS)
Diagnoses are typically made by a team of specialists.
This team may include child psychologists, occupational
therapists, or speech and language pathologists.
Autism treatment
There are no “cures” for autism, but therapies and other
treatment considerations can help people feel better or
alleviate their symptoms.
Many treatment approaches involve therapies such as:
behavioral therapy
play therapy
occupational therapy
physical therapy
speech therapy
Massages,  and meditation techniques may also induce
relaxing effects. However, treatment results will vary.
Some people on the spectrum may respond well to certain
approaches, while others may not.
Alternative treatments
Alternative treatments for managing autism may
include:
high-dose vitamins
chelation therapy, which involves flushing metals
from the body
hyperbaric oxygen therapy
melatonin to address sleep issues
Teaching strategies for children with autism
Reduce noise level and distraction in the classroom
The teacher or caregiver should be aware of any aversion
that the child might have.
Children with autism need a schedule or routine to follow.
Use cue cards to make them aware of what is expected next.
When teaching a concept , give fewer choice to choose from.
Do not give more than three choices.
Use very clear and precise language
Give the child some “wait time” to process information
Give immediate feedback
 THE MANAGEMENT OF BEHAVIOR DISORDERS
Drug Therapy: Drugs have to be prescribed by a
psychiatrist. Combinations of the following may be
used:
• Antipsychotic drugs
• Antianxiety drugs
• Antidepressant drugs.
Group Therapy:
• When the patient is in a group he gets to interact with
others like him.
• This visual feedback gives him information of what others
are going through.
• He sees that there are others worse off than him, and
decides that life is worth living after all.
Family Therapy:
• Sometimes the family members in all good intention

end up by doing more harm.

They discourage rehabilitation -appropriate behavior by

doing all functions for the patient, or by giving them

unwanted sympathy.
Giving a concrete job to the patient and family member

can prevent day dreaming and negative attitudes.

Behavior Therapy:

Whenever called up on to correct a deviant behavior,

psychologists use behavior therapy which lays emphasis
on current individual behavior rather than the historical
origins of its problems.
First, the behavior to increase or decrease is identified.
 It is also noted how often this behavior occurs and
reinforcers are identified.
Reinforcers are nothing but stimuli that increase or
decrease the frequency of a behavior.
Positive reinforcers (carrot) increase the frequency while
negative reinforcers (stick) decrease its frequency.
For example:
 a child not co-operating to therapy can be offered a sweet, or the
therapy can be converted into a game.
An adult can be given the option of listening to music while doing
therapy. It is not enough to reduce unwanted behavior it is equally
important to provide alternate behavior.
 For complicated tasks which do not find approval Or cooperation
 with the patient, the tasks are broken down into smaller steps and
the patient is instructed on what he can do .
 Encouragement increases performance Leisure and prevocational
activities have to be given.
 We must remember that the patient has a lot of time on his
hands.
 An idle mind isthe devils workshop. Hence he must have some
thing to occupy his mind throughout his tenure.
Behavioral modification techniques are
classified as:
Techniques for reducing anxiety including relaxation

training
Graded exposure treatment involves exposing the

subject to the feared stimulus one step at a time.

Aversion therapy aims to reduce maladaptive behavior

by associating it with an unpleasant experience, such as

pain or a noxious smell.
Rewards: The child will learn best when they are caught
Techniques to Increase Desired Behavior

doing the desirable behaviour and rewarded immediately.

The desired behaviour will increase if the rewards are
predictable and consistent.
Behavioral contracts—written agreements between
people who desire a change in behavior
Shaping—gradual development of complex pieces of
behaviour by reinforcement of the constituent parts. This
technique is used to develop basic skills (such as eating
and dressing) in cases of mental retardation.
Psychological treatment—hypnosis