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LOSS OF MENTAL ABILITIES & MOST COMMONLY OCCURS LATE IN LIFE A BRAIN DISORDER THAT SERIOUSLY AFFECTS A PERSONS

ABILITY TO CARRY OUT DAILY ACTIVITIES

OVER AGE 65 OVER AGE 75 OVER AGE 85

58% 15 20 % 25 50 %

PROGRESSIVE WASTING OF BRAIN CELLS OR LOSS OF BRAIN FUNCTION DUE TO HARDENING OF ARTERIES ONSET IS SLOW, OVER YEARS RESULT OF A DISEASE OR AN ABNORMAL CONDITION

1.

Degenerative disorders that are progressive, irreversible & not due to any other condition. Specific disorders: Dementia of

Alzheimers type (DAT) & Vascular Dementia

2.

Occur as a result of another pathologic process CAUSES: infection-related; subcortical degenerative disorders; hydrocephalus; trauma; neoplasm; inflammatory conditions; toxic conditions; & metabolic disorders

ALTERATION IN MEMORY ALTERATION IN ABSTRACT THINKING ALTERATION IN JUDGMENT ALTERATION IN PERCEPTION: hallucination,

delusion, illusion

LOSS OF INTEREST IN ACTIVITIES HABITUAL BEHAVIORS BREAK DOWN INCREASED EMOTIONAL & PHYSICAL INSTABILITY WITH UNPREDICTABLE SWITCHES BETWEEN APATHY & AGGRESSION; SOCIAL INHIBITIONS SEXUAL INHIBITONS

Treatment is generally community focused. Goal: maintain the quality of life as long as possible despite the progressive nature of the disease.

Effective treatment is based on: diagnosis of primary illness & concurrent psychiatric disorders Assessment of auditory & visual impairment Measurement of the degree, nature & progression of cognitive deficits Assessment of functional capacity & ability for self-care Family & social system assessment

Environmental strategies: maintain

safety & functional abilities of the patient. Family education: family & treatment team collaborate in the delivery of care

Anticholinesterase (Donepezil) increases acetylcholine Agitation management: neuroleptic

agents

Psychosis: neuroleptic agents Depression: antidepressants Hypertension management for vascular dementia

DR. ALOIS ALZHEIMER first described the condition in 1907 An age related progressive disorder in the CNS characterized by chronic cognitive dysfunction.

Most common form of dementia in older people which involves part of the brain that controls thought, memory & language.

GROSS PATHOPHYSIOLOGIC CHANGES: cortical atrophy; enlarged ventricles; basal ganglia wasting MICROSCOPIC CHANGES: neurofibrillary tangles & neuritic plaques; granulovascular degeneration

BIOCHEMICAL: neurotransmitters are impaired Genetics & Female gender Viruses, environmental toxins, & previous head injury

Detailed patient history Noncontrast CT; MRI Neuropsychological evaluation Laboratory test: Syphilis; Urinalysis; serum B12; HIV Commercial assay for CSF Genetic testing

AMNESIA inability to learn new information or to recall previously learned information


AGNOSIA failure to recognize objects or identify objects despite intact sensory function

APHASIA language disturbance that can manifest in both understanding & expressing the spoken word
APRAXIA inability to carry out motor activities despite intact motor function

EARLY STAGE:

Short-term memory Language disturbance Visual-processing difficulty Inability to perform skilled motor activities Poor abstract reasoning & concentration Personality changes : irritability & suspiciousness; personal neglect of appearance; disorientation to time & space

MIDDLE STAGE:

Repetitive actions (perseveration) Nocturnal restlessness Apraxia Aphasia Agraphia Frontal lobe dysfunction: loss of social inhibitions & spontaneity; delusions; hallucinations; aggressions; wandering behavior

ADVANCED STAGE:

Urinary & fecal incontinence Emaciation Increased irritability Unresponsiveness or coma

Cognitive assessment: orientation, insight, abstract thinking, concentration, memory & verbal ability Assess for changes in behavior & ability to perform ADL. Evaluate nutrition & hydration; check weight, skin turgor & meal habits Assess motor ability, strength, muscle tone, & flexibility

ALTERED THOUGHT PROCESSES related to physiologic changes SLEEP PATTERN DISTURBANCE CAREGIVER ROLE STRAIN related to behavioral manifestations RISK FOR INJURY related to loss of cognitive abilities

IMPROVE COGNITIVE RESPONSE: Simplify the environment: decrease noise & social interaction to a level tolerable for the patient. Maintain a strict routine. Encourage participation in care & provide positive feedback for accomplished task. Provide rest periods between activities. Provide large calendar & clock in patients view & orient frequently to TPP. Use lists & written instructions as reminders to daily activities. Maintain consistency in instruction & introduce new person slowly.

PREVENT INJURY: Avoid restraints but maintain observation of the patient. Provide adequate lighting to avoid misinterpretation of the environment. Remove unneeded furniture & equipment from the room. Make sure patient has nonslip shoes or slippers that are easy to put on. Encourage use of assistive safety devices. Ensure physical activity & range-of-motion exercises to maintain mobility

ENSURE ADEQUATE REST: Administer antipsychotics to manage agitation. Provide periods of physical exercise to expend energy. Support normal sleep habits & bedtime ritual: keep regular bedtime; have patient change into pajamas; and allow desired bedtime activity. Maintain quiet relaxing environment to avoid confusion & agitation.

SUPPORT CAREGIVER: Encourage caregiver to discuss feelings. Encourage caregiver to maintain own health & emotional well-being. Stress the need for relaxation time . Assist in finding resources (community/church groups, social service programs, hospital-based support group). Assess caregivers stress and refer for counseling.

CHOLINESTERASE INHIBITORS improves cholinergic neurotransmission [e.g.:Tacrine (Cognex); Donepezil (Aricept)] ANTIDEPRESSANT therapy ANTIPSYCHOTICS Clozapine (Clozaril), Risperidone (Risperdal), & Onlazapine ( Zyprexa)

Reality Orientation Memory Retraining Reminiscence Therapy Art Therapy Recreational / Play Therapy

INCREASED SUSCEPTIBILITY TO INFECTIONS INJURY DUE TO LACK OF INSIGHT, HALLUCINATIONS & CONFUSION MALNUTRITION DUE TO INATTENTION TO MEALTIME & HUNGER OR LACK OF ABILITY TO PREPARE MEALS