Dementia

Define dementia

An acquired syndrome consisting of a decline in memory and other cognitive functions. Dementia is used as an umbrella term to group all diseases in which there is some form of memory loss. DEMENTIA IS NOT A DISEASE.

Aphasia: characterized initially by fluent aphasia

-- Able to initiate and maintain a conversation -- Impaired comprehension -- Intact grammar and syntax however the speech is vague with paraphasias, circumlocutions, tangential and frequent use of nonspecific phrases ("the thing") -- Later language can be severely impaired with mutism, echolalia. (Using "that's for sure" over and over again in conversation)

Progressive and Irreversible Dementias:

-- Alzheimer's Disease -- Creutzfeld-Jakob Disease -- Huntington's -- Multiple Sclerosis -- Parkinson's Dementia Complex -- Pick's Disease -- AIDS

Types/Causes of Dementia

-- Alzheimer's disease (approximately 70%) -- Dementia with Lewy Bodies -- Vascular dementia - (Strokes and TIA's) -- Parkinson's disease -- Frontotemporal dementia (FTD) [have language symptoms first, primary progressive aphasia] -- Normal-Pressure hydrocephalus (NPH) -- Delirium/Depression -- Other, less common causes

More Behavior disturbances

-- Delusions resulting in suspiciousness of care provider, calling the police, bizarre acts: redirect them -- Disturbed sleep-wake cycle -- Incontinence- Can not control bowel and or bladder *** Often the straw that breaks the camels back

Other treatable and reversible dementias:

-- Hypothyroidism- medication -- Vitamin B1 (thiamine) deficiency -- Vitamin B12, Vitamin A deficiency -- Depressive pseudodementia (note: dementia and depression can coexist in many patients and can be difficult to differentiate.) -- Normal pressure hydrocephalus -- Tumor

Examples of functional impairments: Marked loss of memory for recent event

-- Losing items (in the freezer, microwave) -- Getting lost -- Missing appointments -- Trouble with coking, paying bills, driving -- Inability to understand books, movies or new items

Symptoms of Dementia

-- Memory loss -- Difficulty communicating -- Inability to learn or remember new information -- Difficulty with planning and organizing -- Difficulty with coordination and motor functions -- Personality changes -- Inability to reason -- Inappropriate behavior -- Paranoia -- Agitation -- Hallucinations

Treatable and Reversible Dementias:

-- Multi-infarct dementia- comes from mini strokes in the brain, we treat it with the blood thinners -- Alcohol dementia- stop drinking

Behavior Disturbances

-- Wandering, especially at night - sleepy all day and up all night -- Physical combativeness- need to recognize signs of frustration -- Argumentative with care provider -- Refusing medications- deny their health issues -- Dangerous memory lapses such as: Leaving stove on, forgetting to turn off faucets, getting lost

Examples of functional impairments:

-- Word finding difficulty ("Where is the thing for sweeping?" for 'broom') -- Misidentifying people (Confusing sister with [deceased] mother) -- Use of empty phrases ("You know", "That thing" "particular item in the cook room" ) -- Difficulty inhibiting behavior

What is the most common cause of progressive dementia?

Alzheimer's disease

Dementia can be due to a variety of etiologies including:

Alzheimer's, Pick's disease, parkinson's disease, Huntington disease, AIDS Dentia Complex, Vascular Dementia, and Creutzfeldt-Jakob's Disease

Parkinson's Disease

Basal ganglia system depleted in dopamine: Movements become smaller, cognitive decline in some cases

Creutzfeldt-Jakob's Disease

Caused by virus, causes progressive vacolation (empty spaces, brain looks like sponge, spongiform encephalopathy) Mad cow disease- get this and dead in a few weeks

AIDS Dementia Complex

Changes in white matter and subcortical structures

Apraxia: Inability to carry out motor activities despite intact motor function

Contributes to loss of ADLs. ADL = Activities of Daily Living (self care, grooming, eating, ability to dress themselves)

Diagnosis of Dementia

Memory impairment impaired ability to learn new information or to recall old information AND at least one of the following: Aphasia, apraxia, agnosia, or abstract thinking/executive function impairments. Cognitive deficits result in impairment in social and/or occupational function. Symptoms not explainable by another disorder (delirium or psychiatric condition)

Vascular Dementia

Multi Infarct: Loss of brain tissue in many sites

Impaired Executive Functions: Difficulty with planning, initiating, sequencing, monitoring or stopping complex behaviors.

Occurs early to midcourse. Contributes to loss of instrumental activities of daily living -DLs such as shopping, meal preparation, driving and managing finances

Agnosia: The inability to recognize or identify objects despite intact sensory function

Typically occurs later in the course of illness. Can be visual or tactile. Examples include: Loss of ability to identify eating utensils, personal care items for grooming, clothing

Dementia is not

a specific disease or part of normal againg

Dementia describes a group of symptoms

affecting intellectual and social abilities severely enough to interfere with daily functioning. Many causes of dementia symptoms exist

Pick's Disease

cause unknown, rare: Lobar atrophy (mainly frontal & temporal). Neuronal loss, increase glia. Pick bodies form in nucleus of cortical cells

Alzheimer's disease

chromosomal mutation (genetic), but there is also non-familial Alzheimer's: Neurofibrillary tangles and plaques and brain atrophy

Huntington's Disease

genetic: Involuntary chorea (uncontrolled movements) and cognitive decline

Etiology of Dementia

impaired functioning of multiple brain systems in both cortical and sub-cortical areas associated with short-term memory (i.e. learning) and other higher cognitive functions. (Hippocampus- this is where Alzheimer's starts). Generally this is due to structural brain damage that is often progressive and relatively irreversible

Abstract thinking/executive function impairments

impairments (disturbance in executive functioning -impaired ability, plan, organize, sequence, abstract)

Aphasia

language impairments (language disturbances)

Apraxia

motor impairments (impaired ability to carry out motor activities despite intact motor action)

Agnosia

sensory impairments (failure to recognize or identify objects despite intact sensory function)

Symptoms of dementia emerge slowly,

worsen over time and restrict ability to function. Because depression can sometimes affect memory and cognition, it is often difficult to clearly differentiate it from dementia.