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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CHAPTER 17 Cognitive Impairment, Alzheimer’s Disease, and Dementia

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Chapter 17 cognitive impairment alzheimer s disease and dementia

CHAPTER 17Cognitive Impairment, Alzheimer’s Disease, and Dementia


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

        (Cont’d…)


The five ds of confusion1

The Five “Ds” of Confusion

(…Cont’d)

  • Deprivation – variable onset

    • Causes

      • Sensory impairment

      • Social interaction

  • Depression – subacute onset

    • Causes

      • Loss

      • Metabolic imbalances

      • Drugs

      • Inner sadness

        (Cont’d…)


The five ds of confusion2

The Five “Ds” of Confusion

(…Cont’d)

  • Dementia – slow onset

    • Causes

      • Cardiovascular disease

      • Metabolic problems

      • Alzheimer’s disease

      • HIV


Delirium

Delirium

  • 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


Treatment

Treatment

  • Depends on cause

  • Treat the source

  • Supportive Care

    • Low stimuli environment

    • Have them wear hearing aids/glasses

    • Clocks and calendars

    • Ambulate often if allowed


Dementia

Dementia

  • 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


Dementia1

Dementia

  • Causes-

  • More than 60

    • Metabolic problems

    • Hormonal

    • Infections

    • Brain trauma

    • Tumors

    • Pain

    • Sensory deprivation

    • Chemical

    • Anemia

    • Drug interactions


Dementia2

Dementia

  • Slow gradual onset

  • Attempt to hide impairments

  • Most common early symptom is declining memory


Sundowners

Sundowners

  • 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

    (Cont’d…)


Chapter 17 cognitive impairment alzheimer s disease and dementia

Left- normal

Right – Alzheimer’s


Alzheimer s disease1

Alzheimer’s Disease

(…Cont’d)

  • 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.

      (Cont’d…)


Health care goals for clients with alzheimer s disease1

Health Care Goals for Clients with Alzheimer’s Disease

(…Cont’d)

  • 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


Chapter 17 cognitive impairment alzheimer s disease and dementia

  • As late stage progresses

    • High risk for : malnutrition, pneumonia and pressure related wounds


Caregivers

Caregivers

  • 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


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