chapter 17 cognitive impairment alzheimer s disease and dementia
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CHAPTER 17 Cognitive Impairment, Alzheimer’s Disease, and Dementia

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CHAPTER 17 Cognitive Impairment, Alzheimer’s Disease, and Dementia. Normal Changes in Cognition. Cognition comprises intelligence, learning, judgment, reasoning, knowledge, understanding and memory. Normal age-related changes in cognition Slower response times Loss of short-term memory

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normal changes in cognition
Normal Changes in Cognition
  • Cognition comprises intelligence, learning, judgment, reasoning, knowledge, understanding and memory.
  • Normal age-related changes in cognition
    • Slower response times
    • Loss of short-term memory
  • Confusion not a normal part of aging
the five ds of confusion
The Five “Ds” of Confusion
  • Delirium– acute onset
    • Causes
      • Metabolic disorder
      • Infections
      • Fever
      • Dehydration
  • Damage – acute onset
    • Causes
      • Stroke
      • Head injury
      • Exposure to chemicals


the five ds of confusion1
The Five “Ds” of Confusion


  • Deprivation – variable onset
    • Causes
      • Sensory impairment
      • Social interaction
  • Depression – subacute onset
    • Causes
      • Loss
      • Metabolic imbalances
      • Drugs
      • Inner sadness


the five ds of confusion2
The Five “Ds” of Confusion


  • Dementia – slow onset
    • Causes
      • Cardiovascular disease
      • Metabolic problems
      • Alzheimer’s disease
      • HIV
  • A sudden change of consciousness that occurs rapidly
  • Signs and symptoms
    • Disorganized thinking
    • Decreased attention span
    • Lowered or fluctuating level of consciousness
    • Disturbance in sleep-wake cycle
    • Disorientation
    • Changes in psychomotor activity
    • Sometimes, delusions or hallucinations
    • Usually, agitation and hyperactivity
    • Sometimes, hypoactive behavior such as lethargy and reduced activity
finding the cause
Finding the Cause
  • Pain
  • Constipation
  • High or low body temp (extreme)
  • Alcohol use
  • Lack of oxygen to brain
  • malnutrition
  • Depends on cause
  • Treat the source
  • Supportive Care
    • Low stimuli environment
    • Have them wear hearing aids/glasses
    • Clocks and calendars
    • Ambulate often if allowed
  • Classified as Alzheimer’s or non-Alzheimer’s
  • In early stages is difficult to differentiate from age-associated memory impairment
  • Decreasing ability to process new information and to retrieve and use the information accumulated throughout life
  • Causes-
  • More than 60
    • Metabolic problems
    • Hormonal
    • Infections
    • Brain trauma
    • Tumors
    • Pain
    • Sensory deprivation
    • Chemical
    • Anemia
    • Drug interactions
  • Slow gradual onset
  • Attempt to hide impairments
  • Most common early symptom is declining memory
  • Group of behaviors characterized by confusion, agitation and disruptive actions that occur IN LATE AFTERNOON OR EVENING
  • Cause is unknown
  • Associated with dementia, physical or social stressors
  • Box 16-3
alzheimer s disease
Alzheimer’s Disease
  • A progressive, degenerative disorder that affects brain cells and results in impaired memory, thinking, and behavior
  • Cause is unknown
  • 50% of all cases of dementia have Alzheimer’s Disease.
  • Some 250,000 new cases per year
  • Post mortem the brain reveals shrunken and with abnormal tangles of nerve fibers



Left- normal

Right – Alzheimer’s

alzheimer s disease1
Alzheimer’s Disease


  • Signs and symptoms
    • Memory loss
    • Difficulty performing familiar tasks
    • Problems with language
    • Poor judgment
    • Problems with abstract thinking
    • Misplacing things
    • Disorientation to time and place
    • Loss of initiative
    • Changes in mood or behavior
    • Changes in personality
stages of alzheimer s disease
Stages of Alzheimer’s Disease
  • Early stage
    • Begins with the loss of recent memory and progresses to strange behaviors and mood swings
  • Intermediate stage
    • Clients cannot recall recent events or process new information and eventually lose all sense of time and place. They are still ambulatory but at high risk for falls and injury.
  • Severe stage
    • Clients are unable to do anything and are entirely dependent on others.
  • End stage
    • Clients slip into a coma.
losses of alzheimer s
Losses of Alzheimer’s
  • Robbed of “personhood”
  • Affective loss- drain of one’s personality
  • Conative loss- inability to carry out plans for the simplest activities
  • Catastrophic reactions- minor anxiety cascade
    • Confused
    • Agitated
    • fearful
health care goals for clients with alzheimer s disease
Health Care Goals for Clients with Alzheimer’s Disease
  • Provide for clients’ safety and well-being
    • Bathing, grooming, eating, physical activity
    • Remember that clients have no sense of safety or danger.
  • Manage clients’ behaviors therapeutically
    • Gently redirect clients who are behaving inappropriately to less stressful activities.
    • Music therapy, validation therapy, and exercise help reduce stress.


health care goals for clients with alzheimer s disease1
Health Care Goals for Clients with Alzheimer’s Disease


  • Support for family, relatives, and caregivers
    • Important sources of information about clients
    • Should be included in planning care for clients
    • Provide respite care
    • Informal support groups–family members, friends, and people who knew the family member before AD
    • Formal support groups
      • Offered by the Alzheimer’s Association, home care agencies, and elder care centers
therapeutic interventions
Therapeutic Interventions
  • Provide for safety and well-being
  • Manage behaviors therapeutically
  • Proved support for family and caregivers
  • Gentle redirection
  • Music therapy, validation, sensory stim
interventions by stage
Interventions by stage
  • Early-
    • Cholinesterase inhibitors
    • P 175 top
    • Cognitive training
    • Orientation
    • Monitor personal hygiene
    • Daily routine
    • Home eval for safety
middle late stage
Middle/Late Stage

Behavior gradually becomes disorganized

personal hygiene, eating and elimination neglected

Wandering is most serious problem

60% will wander and become lost in commun.

Offensive behaviors need to looked at as COMMUNICATION OF UNMET NEED

As late stage progresses
    • High risk for : malnutrition, pneumonia and pressure related wounds
  • Support
    • 70% of alzheimer’s are cared for in the home by family, friends and home care staff
    • Find a balance between personal needs and those of the loved one
    • Informal support groups
    • Formal support groups
  • Education-
    • Stress levels decrease with adequate training