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

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• 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

Normal Changes in CognitionNormal Changes in Cognition

• 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 ConfusionThe 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…)

(…Cont’d)

• 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

DeliriumDelirium

Finding the Cause Pain Constipation High or low body temp (extreme) Alcohol use Lack of oxygen to brain malnutrition

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

• 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

DementiaDementia

Causes- More than 60

Metabolic problems Hormonal Infections Brain trauma Tumors Pain Sensory deprivation Chemical Anemia Drug interactions

Dementia

Dementia Slow gradual onset Attempt to hide impairments Most common early symptom is declining

memory

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

• 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…)

Alzheimer’s DiseaseAlzheimer’s Disease

Left- normalRight – Alzheimer’s

(…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

Alzheimer’s DiseaseAlzheimer’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.

Stages of Alzheimer’s DiseaseStages of Alzheimer’s Disease

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

• 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 Disease 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

Health Care Goals for Clients with Alzheimer’s DiseaseHealth Care Goals for Clients with Alzheimer’s Disease

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 Early-

Cholinesterase inhibitors P 175 top Cognitive training Orientation Monitor personal hygiene Daily routine Home eval for safety

Middle/Late StageBehavior 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

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

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

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