What%20is%20dementia?

1
Dementia The Basics

• What is dementia?
• What are the types of dementia?
• What are the stages?
• Treatment?

2
Normal Agingor Symptoms of Mental Illness or
an Age-Related Disease Process?

• There are widespread misconceptions about what
  happens to us cognitively as we age.
• We have all heard that forgetfulness is an
  inevitable consequence of aging but the facts do
  not support this, and this myth exerts a powerful
  bias on the views of lay people as well as those
  of us in health care.
• Memory function as measured by delayed recall of
  newly learned information is not substantially
  decreased for most people as they age. Older
  persons do experience a decline in processing
  speed and rote memory. However, in regard to
  information that they are allowed sufficient time
  to acquire, older persons experience no more
  memory loss over time of newly learned material
  than do young people. Numerous studies document
  that aging in and of itself does not degrade
  memory disease does.

3
Normal Agingor Symptoms of Mental Illness or
an Age-Related Disease Process?

• It is true that memory function fails in
  everyone, of every age, every day. Because memory
  failures are so common, it is easy for observers
  to overlook genuine memory lapses in developing
  dementia.
• Conversely normal memory failures can mislead
  persons with normal brain function into thinking
  that they are developing a dementia such as
  Alzheimer s disease.
• Additionally, other problems such as depression
  and anxiety which are common in elders can also
  cause memory and other cognitive deficits
  mimicking dementia, and often incorrectly
  diagnosed as Alzheimers dementia.

4
Dementia vs Delirium vs Depression vs Mild
Cognitive Impairment

• Other problems such as depression and anxiety
  which are common in elders can also cause memory
  and other cognitive deficits mimicking dementia,
  and often incorrectly diagnosed as Alzheimers
  dementia.
• Physical changes, acute medical illness such as
  urinary infection can result in cognitive changes
  that mimic dementia but may be better understood
  and need to be evaluated for delirium.
• Mild cognitive impairments are sometimes present
  and do not necessarily indicate presence of
  dementia process.

5
Dementia Defined

• Dementia is a permanent and progressive loss in
  the ability to make new memories and general
  cognitive decline ultimately resulting in death.
  There are many types of dementia with varying
  causes such as Alzheimers disease, HIV,
  cardio-vascular disease, Parkinsons disease, to
  name just a few.
•  Diagnosis of Dementia requires a significant
  memory impairment and a significant impairment in
  another cognitive domain.
• Cognitive Domains
• Inability to learn, retain, and retrieve newly
  acquired information (memory)
• Inability to comprehend and express verbal
  information (language)
• Inability to manipulate and synthesize nonverbal,
  geographic, or graphic information / or inability
  to carry out motor activities despite intact
  motor functioning (psycho-motor functioning)
• Inability to perform abstract reasoning, solve
  problems, plan for future events, mentally
  manipulate more than one idea at a time, maintain
  mental focus in the face of distraction, or shift
  mental effort easily (executive functioning)

6
Delirium

• Delirium is an acute decline in mental status
  that can be resolved and is primarily a
  disturbance of consciousness, with change in
  cognition (memory deficit, disorientation,
  language disturbance) or perceptual disturbance
  that is the direct physiological consequence of a
  medical condition. Delirium should be considered
  any time there is an acute change in mental
  status.
• Abrupt onset (hours to days)
• Fluctuating level of consciousness (altered
  sleep/wake cycle)
• Perceptual disturbances (hallucinations, sensory
  misinterpretations)
• Disordered thoughts
• Disorientation, memory impairment, inattention,
  decreased concentration and attention
• Changes in psychomotor activity
•  

7
Delirium continued

• Delirium is a medical emergency which may
  indicate a serious medical illness.
• Treatment of delirium consists of correcting the
  underlying cause and treatment of symptoms. Risk
  factors for delirium include increasing age,
  pre-existing cognitive impairment and
  polypharmacy (especially Rx with a high
  anti-cholinergic load).
• Suspect delirium if psychosis is suddenly present
  in a resident who previously did not have
  psychotic symptoms.

8
Mild Cognitive Impairment

• MCI is a decline in at least 1 cognitive domain
  that is noticeable, but not significant enough to
  warrant a diagnosis of dementia.
• People with MCI typically function independently
  in their daily affairs.
• The most frequently encountered MCI is the
  amnesic type defined as subjective and objective
  memory impairment with the other cognitive
  functions and activities of daily living
  preserved.
• While in many instances people with MCI
  demonstrate progressive decline ultimately being
  diagnosed with dementia, many do not progress to
  such severity.

9
Depression (Pseudo-Dementia)

• Pseudo-dementia is not a discreet diagnostic
  category rather it represents a constellation of
  symptoms that mimic the cognitive impairment
  normally associated with dementia (especially
  memory and executive functioning deficits).
• Some reports suggest that as many as 20-50 of
  elderly patients are misdiagnosed with
  degenerative dementia when they are instead
  experiencing cognitive decline associate with
  another psychiatric disorder usually depression.
• The highest rates of depression are found among
  nursing home populations. Symptoms of depression
  can be found in 44-68 of nursing home
  residents. Rate of Major Depression among nursing
  home residents is 9-38. Depressed patients have
  higher risks of morbidity and mortality.

10
Types of Dementia

• Alzheimers Dementia Alzheimer's disease is the
  underlying cause of -- of all dementia cases.
  Research indicates that the disease is associated
  with plaques and tangles in the brain.
  Alzheimers dementia tends to be slow and is
  always progressive, although some cases are more
  aggressive.
• Vascular Dementia The second most common form of
  dementia, vascular dementia is caused by poor
  blood flow to the brain, which deprives brain
  cells of the nutrients and oxygen they need to
  function normally. One of the ten dementia types,
  vascular dementia can result from any number of
  conditions which narrow the blood vessels,
  including stroke, diabetes and hypertension.
• Mixed Dementia Sometimes dementia is caused by
  more than one medical condition. This is called
  mixed dementia. The most common form of mixed
  dementia is caused by both Alzheimer's and
  vascular disease.

11
Types of Dementia continued

• Dementia with Lewy Bodies Parkinsons Disease
  can lead to is one type of dementia with Lewy
  Body involvement. Sometimes referred to as Lewy
  Body Disease, this type of dementia is
  characterized by abnormal protein deposits called
  Lewy bodies, which appear in nerve cells in the
  brain stem. These deposits disrupt the brain's
  normal functioning, impairing cognition and
  behavior and can also cause tremors.
• Frontotemporal Dementia Picks Disease is one
  type of frontal lobe dementia., it is a rare
  disorder which causes damage to brain cells in
  the frontal and temporal lobes. Pick's disease
  affects the individual's personality
  significantly, usually resulting in a decline in
  social skills, coupled with emotional apathy.
  Unlike other types of dementia, Pick's disease
  typically results in behavior and personality
  changes manifesting before memory loss and speech
  problems.
• Creutzfeldt-Jacob Dementia CJD is a degenerative
  neurological disorder, which is also known as mad
  cow disease. The incidence is very low, occurring
  in about one in one million people. There is no
  cure. Caused by viruses that interfere with the
  brain's normal functioning, dementia due to CJD
  progresses rapidly, usually over a period of
  several months. Symptoms include memory loss,
  speech impairment, confusion, muscle stiffness
  and twitching, and general lack of coordination,
  making the individual susceptible to falls.
  Occasionally, blurred vision and hallucinations
  are also associated with the condition.

12
Types of Dementia continued

• Wernicke-Korsakoff Syndrome Wernicke-Korsakoff
  syndrome is caused by a deficiency in thiamine
  (Vitamin B1) and often occurs in alcoholics,
  although it can also result from malnutrition,
  cancer which have spread in the body, abnormally
  high thyroid hormone levels, long-term dialysis
  and long-term diuretic therapy (used to treat
  congestive heart failure). The symptoms of
  dementia caused by Wernicke-Korsakoff syndrome
  include confusion, permanent gaps in memory, and
  impaired short-term memory. Hallucinations may
  also occur.
• Huntington's Disease Huntington's disease is an
  inherited progressive dementia that affects the
  individual's cognition, behavior and movement.
  The cognitive and behavioral symptoms of dementia
  due to Huntington's include memory problems,
  impaired judgment, mood swings, depression and
  speech problems (especially slurred speech).
  Delusions and hallucinations may occur. In
  addition, the individual may experience
  difficulty ambulating, and uncontrollable jerking
  movements of the face and body.
• Others There are other types of dementia but
  those noted above are some of the most well
  known. Comprehensive evaluation is often needed
  for proper differential diagnosis of cognitive
  decline.

13
Course Progression

• The various types of dementia have varying rates
  of progression and course. For example, the rate
  of progression for vascular dementia is highly
  variable depending on re-occurring
  cerebral-vascular events, and the progression is
  step-wise.
• Alzheimers type dementia tends to have a slow
  and progressive course and the stages tend to be
  demarcated by a regular constellations of
  symptoms. However, even though the stages in
  Alzheimers dementia tend to follow a fairly
  regular course the effect on each individual is
  idiosyncratic and while many patients with
  Alzheimers will show significant problems with
  mental calculations by the middle stages, many
  will not especially if math was always a strength
  for them. Thus, testing is required for accurate
  differential diagnosis.

14
Stages of Alzheimers Dementia

• Early Stages mild cognitive decline
• The person may feel as if he or she is having
  memory lapses such as forgetting familiar words
  or the location of everyday objects.
  Alternatively, they may have no awareness of
  changes, but friends, family or co-workers begin
  to notice difficulties. During a detailed medical
  interview, doctors may be able to detect problems
  in memory or concentration.
• Common difficulties include
• Noticeable problems coming up with the right
  word or name
• Trouble remembering names when introduced to new
  people
• Having noticeably greater difficulty performing
  tasks in social or work settings Forgetting
  material that one has just read
• Losing or misplacing a valuable object
• Increasing trouble with planning or organizing
• May demonstrate some spatial disorientation

15
Stages of Alzheimers Dementia

• Middle Stages moderate cognitive decline
• At this point, cognitive changes are more overt.,
  and at times personality changes may also become
  evident. Individuals in the middle stages will
  begin needing help with activities of daily
  living.
• Common difficulties include
• Impaired ability to perform challenging mental
  arithmetic for example, counting backward from
  100 by 7s
• Greater difficulty performing complex tasks, such
  as planning dinner for guests, paying bills or
  managing finances
• Memory impairments become more obvious, and some
  forgetfulness about one's own personal history
  may be observed
• Becoming moody or withdrawn, especially in
  socially or mentally challenging situations
• Confusion about where they are or what day it is
• Hygiene and personal grooming may decline
• Important autobiographical memories are generally
  still intact. Need help handling details of
  toileting (for example, flushing the toilet,
  wiping or disposing of tissue properly)

16
Stages of Alzheimers Dementia

• Late Stages severe cognitive decline
• Memory continues to worsen, personality changes
  may take place or worsen, individuals need
  extensive help with daily activities.
• Difficulties Include
• Lose awareness of recent experiences as well as
  of their surroundings
• Remember their own name, but have difficulty
  remembering their personal history
• Distinguish familiar and unfamiliar faces but
  have trouble remembering the name of a spouse or
  caregiver
• Need help dressing properly and may, without
  supervision, make mistakes such as putting
  pajamas over daytime clothes or shoes on the
  wrong feet
• Experience major changes in sleep patterns
  sleeping during the day and becoming restless at
  night
• Have increasingly frequent trouble controlling
  their bladder or bowels
• Experience major personality and behavioral
  changes, including suspiciousness and delusions
  (such as believing that their caregiver is an
  impostor)or compulsive, repetitive behavior like
  hand-wringing or tissue shredding

17
Stages of Alzheimers Dementia

• In the final stage of this disease, individuals
  lose the ability to respond to their environment,
  to carry on a conversation and, eventually, to
  control movement. They may still say words or
  phrases. At this stage, individuals need help
  with much of their daily personal care, including
  eating or using the toilet. They may also lose
  the ability to smile, to sit without support and
  to hold their heads up. Reflexes become abnormal.
  Muscles grow rigid. Swallowing can be impaired.

18
Treatment

• Effective treatment for dementia, regardless of
  the type, is dependent on proper diagnosis, good
  understanding of cognitive and adaptive
  functioning, and management of physical health.
• Research is clear that the best treatment for
  patients with dementia includes a combination of
  psychotherapy, medical management, occupational
  and physical therapy, and recreation.
• The specific type of psychotherapy should be
  determined by idiosyncratic needs and functioning
  of each patient but can include, talk therapy,
  cognitive-behavioral treatment, behavioral
  treatment aimed at assessing and managing
  environmental factors, narrative therapy,
  supportive treatment, and family therapy.
• Medical management includes managing physical and
  health related issues as well as
  psychopharmacological management of psychiatric
  symptoms associated with dementia.