CHAPTER II

BASIC CONCEPTS
A. Definition
Behavioural and Psychological Symptoms of Dementia / Dementia (or in
English is said to dementia) is a condition where a person experiences a
decline in memory and thinking and the ability kemampun interfere with the
function of everyday life.
Dementia is a syndrome due to disease or brain disorders are usually chronic,
progressive, where there Gannguan noble function of cortical including:
memory, thinking, orientation, comprehension (comprehension), arithmetic,
kemampun learning, language and power value judgment, generally
accompanied, and sometimes preceded by degeneration (deterioration) in
emotional control, social behavior, or motivation to live.
Dementia is a syndrome that indicates deterioration of intelligence.
Dementia is a disorder of intellectual functions without interruption vegetative
functions or awake. Memory, general knowledge, abstract thinking, judgment,
and interpretation of written and oral communication can be interrupted.
(Elizabeth J. Corwin, 2009)

B. Cause
Dementia is caused by:
a. Acute condition untreated or not curable, if an acute condition that causes
delirium or can not be treated, there is a possibility that this condition will
become chronic and can therefore be considered as dementia.

b. Vascular disease, such as hypertension, arteriosclerosis, and atherosclerosis

can cause a stroke.
c. Parkinson's disease: dementia attacked 40% of these patients.
d. Prion diseases (protein contained in the infection process Creutzfeldt-Jakob
disease).
e. Infection of human immuno deficiency virus (HIV) can attack the central
nervous system, causing encephalopathy komlek HIV or AIDS dementia.
f. Disruption of brain tissue structure, such as normal pressure hydrocephalus
and injuries from head trauma.

C. Range Response

D. Process of Problems
There are some typical biochemical changes and neuropathology are common
in dementia. Fibers neuron tangles (tangles period neuron are not functioning)
and senile plaques or neuritis (pritein beta-amyloid deposits, part of a large
protein, precusor amyloid protein (APP)). Damage occurred in primary neurons
of the cerebral cortex and cause damage to brain size. Similar changes are
also seen in normal brain tissue of small bumps elderly. The main cells affected
by the disease is using the neurotransmitter acetylcholine. In biochemical,

asetilkolion affecting production decreased activity. Acetylcholine is mainly

engaged in the process of memory.
Cerebral Damage occurs when the blood supply keotak disrupted. Infarction,
brain tissue death, occurs at an incredible speed. Cerebral infarction small
multiple-infarction.
Dizziness, headache and decreased physical and mental strength are the early
signs of the disease. In more than half the cases, the disease appears as a
sudden confusion. Then diikuuti sudden memory loss. Then followed a gradual
memory loss. Patients may experience hallucinations and showed signs of
delirium, speech disorders can occur.

E. Signs and Symptoms

a. Loss of memory (the early stages of a new memory loss like forgetting was
cooking food on the stove, the next stage of memory loss to forget the past as
children's names, work).
b. The decline in the function of language (forget the name common objects
such as chairs or tables, palilalia [repeating sound], and repeat the words
heard [echolalia]).
c. Loss of the ability to think abstractly and to plan, initiate, sequence, monitor
and stop complex behavior (loss of executive function): the client loses the
ability to perform self-care activities.

F. Type / Various Kinds of Dementia

1. By age:
a) Senile dementia is dementia that occurs in those aged> 65 years.

b) Dementia prasenilis namely dementia that occurs at age <65 years.

2. According to the course of the disease:
a) Reversible (improved)
b) Irreversible (normal pressure hydrocephalus, subdural hematoma, vitamin B
deficiency, hypothyroidism, intoxication PB). In this type dementia there is an
enlargement vertrikel with increased cerebrospinal fluid, it led to:
Disturbance of gait (unstable, dragging).
Urinary incontinence.
3. According to the structure of the brain damage:
a) Dementia Alzheimer's type
Alzheimer's is a decrease in the concentration of acetylcholine and choline
acetyl transferase in the brain and is a degenerative disease due to the death
of brain cells and generally cause a deterioration of intellectual or cognitive
functions, which include deterioration of remembering and thinking process.
behavior experienced by dementia are forgetfulness or dementia. Although
pennyebab dementia Alzheimer's type is not known for sure, some studies
have suggested that as many as 40% of patients have a family history of
dementia Alzheimer's type so highly regarded genetic factors play a role in the
development of disorders in at least some cases.
b) Vascular dementia
The primary cause of vascular dementia is the cerebral vascular disease that
causes a pattern of multiple symptoms of dementia, which usually also called
multi-infarct dementia. Vascular dementia is common in men, especially in
those with pre-existing hypertension or other cardiovascular risk factors.

G. Phase / Stage
Phases / stages of dementia are:
1. Early Stages: In the initial condition, dementia has an insidious onset of
symptoms, the condition is vascular dementia occurs with changes in cognition
that sudden. At this stage, the client can show the pattern of poor judgment,
especially if it is in a new situation or cause stress, personality changes occur.
Clients started to show an explosion of emotion and become anxious and
agitated, there was confusion between the orientation of time and distance.
The specific symptoms:
a. Changes in mood or personality.
b. Impaired judgment and problem resolution.
c. Confusion about time and place.
d. Difficulties with numbers, money and bills.
e. Withdraw or depression.
2. Middle Stages: In this condition, the memory of the client at this time and
the past deteriorated and the lack of judgment led to concerns about safety is
reduced. This stage is the stage that greatly affect the daily life of the client.
The specific symptoms shown at this stage:
a. Memory impairment present and past.
b. Impaired judgment and problem solving severe.
c. Perceptual disorders.
d. Loss of impulse control.
e. Anxiety, restlessness.
3. Final Stages: In the final stages of dementia, the client becomes muscle
rigidity, and reflexes primitife also appeared. The symptoms are:

a. Severe disruption on all cognitive abilities.

b. The inability to recognize family and friends.
c. Severe communication disorders (may grumble, complain or mumble).
d. At least self-care capacity.
e. Probable hiperoral and have an active hand.
f. Decreased appetite, dispasia, and the risk of aspiration.
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