DEMENTIA

a chronic or persistent disorder of the mental processes caused by brain disease or injury and
marked by memory disorders, personality changes, and impaired reasoning.
neurodegenerative diseases
Progressive dementias

Alzheimer's disease. In people age 65 and older, Alzheimer's disease is the most
common cause of dementia. People generally may develop symptoms after age 60,
but some people may have early-onset forms of the disease, often as the result of a
defective gene.
Although in most cases the exact cause of Alzheimer's disease isn't known, plaques
and tangles are often found in the brains of people with Alzheimer's. Plaques are
clumps of a protein called beta-amyloid, and tangles are fibrous tangles made up of
tau protein.
Certain genetic factors also may make it more likely that people will develop
Alzheimer's.
Alzheimer's disease usually progresses slowly over about eight to 10 years. Your
cognitive abilities slowly decline. Eventually, the affected areas of your brain don't
work properly, including parts of your brain that control memory, language, judgment
and spatial abilities.

Vascular dementia. Vascular dementia, the second most common type of dementia,
occurs as a result of brain damage due to reduced or blocked blood flow in blood
vessels leading to your brain.
Blood vessel problems may be caused by stroke, infection of a heart valve
(endocarditis) or other blood vessel (vascular) conditions.
Symptoms usually start suddenly and often occur in people with high blood pressure
or people who have had strokes or heart attacks in the past.
Several different types of vascular dementia exist, and the types have different
causes and symptoms. Alzheimer's disease and other dementias also may be present
at the same time as this dementia.

Lewy body dementia. Lewy body dementia affects approximately 10 percent of

people with dementia, making it one of the most common types of dementia. Lewy
body dementia becomes more common with age.
Lewy bodies are abnormal clumps of protein that have been found in the brains of
people with Lewy body dementia, Alzheimer's disease and Parkinson's disease.
Lewy body dementia symptoms are similar to symptoms of Alzheimer's disease. Its
unique features include fluctuations between confusion and clear thinking (lucidity),
visual hallucinations, and tremor and rigidity (parkinsonism).

People with Lewy body dementia often have a condition called rapid eye movement
(REM) sleep behavior disorder that involves acting out dreams.

Frontotemporal dementia. This type of dementia tends to occur at a younger age

than does Alzheimer's disease, generally between the ages of 50 and 70.
This is a group of diseases characterized by the breakdown (degeneration) of nerve
cells in the frontal and temporal lobes of the brain, the areas generally associated with
personality, behavior and language.
Signs and symptoms of frontotemporal dementia can include inappropriate behaviors,
language problems, difficulty with thinking and concentration, and movement
problems.
As with other dementias, the cause isn't known, although in some cases this dementia
is related to certain genetic mutations.
symptoms of dementia can vary greatly, at least two of the following core mental functions must be
significantly impaired to be considered dementia:

Memory

Communication and language

Ability to focus and pay attention

Reasoning and judgment

Visual perception

Dementia treatment and care

Treatment of dementia depends on its cause. In the case of most progressive dementias,
including Alzheimer's disease, there is no cure and no treatment that slows or stops its
progression. But there are drug treatments that may temporarily improve symptoms. The
same medications used to treat Alzheimer's are among the drugs sometimes prescribed to help
with symptoms of other types of dementias. Non-drug therapies can also alleviate some
symptoms of dementia.

Coping strategies:
Consider keeping a journal to write down, express, and work through your feelings.
Find an early-stage dementia support group where you can connect with others who have been
diagnosed and learn more about the disease. See the web resources listed at the end of this
discussion for information on support groups.
If you are depressed and find that other methods of coping are not helping, seek mental health
treatment with a professional who has expertise in issues affecting older adults and who has
experience treating people with dementia.
Keep the lines of communication open with family and friends. Although you may feel
embarrassed or want to withdraw, continue to share your feelings with them.

 Make sure your belongings are organized in such a way that things are easy to find. Putting labels
on drawers and doors can be a helpful way of keeping track of things.
Remember that a diagnosis of dementia does not mean that life is over. It means that
there will be challenges ahead, and thinking about those challenges now will better
prepare your whole family for them and benefit all of you in the long run.
BEHAVIORAL MANAGEMENT Using the A-B-C Behavior Chain
The first step in using an A-B-C Behavior Chain is to collect as much information as possible about
difficult behaviors in order to detect patterns about why they occur, or what function they serve
for the person with dementia. Caregivers should use a simple chart to record antecedents,
behaviors, and consequences for each behavior. The sample chart below can be used to track
behaviors (each challenging behavior should be recorded on a different sheet). Caregivers should
fill out the chart as soon as possible after the behavior occurs.

After a behavior has been recorded for one week, the chart can be reviewed for patterns among
antecedents and consequences. Start by examining the circumstances that precede problematic
behavior to come up with reasonable "guesses" about triggers for the behavior. Identifying the
triggers is important because you can then work to eliminate them from the environment, or at
least try to decrease their impact.

For example, does the person always become aggressive after interacting with a particular family
member or service provider? In this case, a specific person may be a source of stress, so the
solution may be to limit that individual's contact with the person with dementia.

Alzhiemers
a. characterized by irreversible, progressive cerebral dysfunction
b. Alzheimer's disease - most common cause of dementia
I.

characterized by brain atrophy

II.

development of senile plaques and neurofibrillary

tangles in the cerebral hemispheres

etiology unknown
Findings:
a. initially characterized by decreased intellectual functioning
b. Alzheimer's disease has three stages
I.

early stage
I.

memory loss

II.

III.

II.

subtle personality changes

III.

difficulty with abstract thinking

middle stage
I.

impaired judgment

II.

impaired language

III.

difficulty with motor activity and object recognition

IV.

wandering

V.

inability to carry out ADL

final stage
I.

complete loss of language function

II.

loss of bowel and bladder control

c. prognosis - poor, incurable

Management:
1. Management - expected outcome: maintenance of functional capacity
2. Nursing interventions
a. meet client's physical needs
b. promote client's independence
c. promote contact with reality
d. assist client/family to establish a routine
e. provide emotional support or caregiver support with appropriate
referrals