NSG 371: Dementia

True or False: Dementia is a normal part of aging.

False

Normal Pressure Hydrocephalus (NPH)

Triad of dementia, ataxia, and urinary incontinence that results from obstruction of the arachnoid granulations that drain CSF, compressing the brain. This type of dementia is reversible

True or False: All Alzheimer's disease is dementia, but not all dementia is Alzheimer's disease.

True - Dementia is an "umbrella" term for cognitive impairment; Alzheimer's disease is a type of dementia

Wernicke's encephalopathy

A form of dementia caused by thiamine deficiency and characterized by visual disturbances, ataxia, somnolence, stupor, and death (without thiamine replacement)

Korsakoff's syndrome

A type of dementia related to alcohol marked by extreme confusion, memory impairment, and other neurological symptoms

An elderly woman who has just been diagnosed with dementia is sitting with her daughter, who asks the nurse "What is the prognosis of my mother's disease?" Which responses are true regarding the prognosis of dementia? Select all that apply. a) "Dementia shortens the life span, especially in early-onset dementia." b) "Patients with co-morbidities, such as diabetes, heart failure, vascular disease, and gait disturbances, will experience a faster decline and shorter life-span than someone without any pre-existing conditions." c) "Your mother's condition in non-discriminatory: it occurs in people of all ages, sexes, and social classes." d) "Your mother's early behavioral changes will likely shorten her life." e) "Because your mother's condition was so advanced when she was diagnosed, she will likely experience a shortened prognosis." f) "Women with dementia are more likely to live longer than men."

ALL are true except (d) - the only behavior change in dementia that could shorten a person's life is wandering; all other behavioral changes do not shorten the life-span.

This type of dementia has a slow, gradual onset, and memory loss is the most prominent symptom.

Alzheimer's disease

This type of dementia is the most common and accounts for 55-75% of people with dementia. It is a neurodegenerative disease, meaning that a person's nerve cells (neurons) in their brain deteriorate, which leads to a decline in normal functioning.

Alzheimer's disease

Dementia is an acquired global impairment of intellect, memory and personality, without impairment of consciousness. What changes in personality occur in patients with dementia?

Behavioral changes: - Heightened fight or flight response - As the disease progresses, they become more and more withdrawn and irritable - A lot of stimulation in their environment confuses them - NO hallucinations

The diagnosis of Alzheimer's disease requires what two criteria to be met?

Both 1) cognitive impairment, and 2) loss of independence in ADLs

Dementia is an acquired global impairment of intellect, memory and personality, without impairment of consciousness. What changes in memory occur in patients with dementia?

Forgetfulness: - More recent memories are lost first; childhood and early life is best preserved (anterograde amnesia)

This area of the brain is one of the last areas to develop in normal development, and one of the first to deteriorate in dementia.

Frontal Lobe (controls judgment, decision making, personality, etc.)

Dementia is an acquired global impairment of intellect, memory and personality, without impairment of consciousness. What changes in intellect occur in patients with dementia?

Impairments of Cognition: - Disorientation - Visual-spatial problems - Dyspraxia: difficulties with coordination, balance, spatial awareness, etc. - Anomia: a form of aphasia in which the patient is unable to recall the names of everyday objects. - Executive problems: poor judgment, trouble maintaining attention, setting goals and planning, responding to change

This type of dementia is often associated with depression, REM sleep behavior disorder, repeated falls and syncope, and transient unexplained loss of consciousness.

Lewy Body dementia

This type of dementia is the third most common (15%) and individuals often experience fluctuating cognitive impairment, dyspraxia, and the inability to perform executive functions. They may also experience abnormalities in their LOC, including falling asleep suddenly, difficulty waking, and clouding of their consciousness.

Lewy Body dementia

This type of dementia often causes individuals to experience psychosis, including visual hallucinations, paranoid auditory hallucinations, and paranoid delusions. They may exhibit behaviors of Parkinsonism, such as tremors, slow movement, impaired speech, and muscle stiffness.

Lewy Body dementia

A patient with dementia is experiencing forgetfulness that interferes with his everyday activities, but does not preclude independent living. He is having trouble learning new things, and has difficulty taking in, retaining, and recalling information. According to the ICD-10 Criteria for Dementia, what stage of memory decline is this patient experiencing?

Mild

A patient with dementia is experiencing progressive memory loss that has become a serious handicap. He is only able to retain familiar information, and new information is retained only briefly. He cannot recall names or places. According to the ICD-10 Criteria for Dementia, what stage of memory decline is this patient experiencing?

Moderate

It is suspected that in Alzheimer's disease, plaques and tangles are what cause a person's neurodegeneration. What are plaques and tangles?

Plaques are abnormal protein fragments that form between neurons in the brain, which makes it harder for them to communicate. Tangles are found inside the neurons and consist of tau protein, which damage these nerve cells.

A patient with dementia is experiencing a complete inability to learn new information, and only fragments of previous information are remaining. He can't even recognize his own relatives. According to the ICD-10 Criteria for Dementia, what stage of memory decline is this patient experiencing?

Severe

Symptoms of cognitive changes in dementia

Short-term memory loss Trouble communicating Confusion Moodiness Inability to understand Inability to perform simple tasks Repetition Loss of interest Falling Coping problems

Space occupying lesions

Specific deficits depend on location; can cause increased ICP, seizures, and neurological deficits, including memory impairment

Multi-Infarct Dementia

Sporadic and progressive loss of intellectual functioning caused by repeated CVA's (strokes) Aka Vascular dementia (VaD)

Anterograde amnesia

The inability to form new memories, but memories that were formed before the brain injury occurred are still intact

Retrograde amnesia

The inability to retrieve information from the past, but new memories can still be formed

This type of dementia is characterized by a general slowness of thinking and movement, and proceeds in a step-wise deterioration. These patients have more insight into their problems, which make them more aware of and distressed by their losses. They often have a history of HTN, IHD (ischemic heart disease), PVD, or stroke.

Vascular dementia (VaD)

This type of dementia is the second most common type (20%) and often presents alongside AD (Alzheimer's disease). It is commonly due to: 1) A history of one or more strokes (Multi-Infarct Dementia) which causes an abrupt onset, or 2) Small cerebral blood vessel damage, which causes a more subtle onset.

Vascular dementia (VaD)

Dementia is an acquired global impairment of what three things?

intellect, memory, and personality

Dementia is an acquired global impairment of ________, memory and ________ but without impairment of consciousness. It is almost always of long duration, usually progressive and ________.

intellect, personality irreversible

The onset and progression of dementia is usually ________.

slow (happens over years)