CONFUSION & DEMENTIA

CHAPTER 35

COGNITIONSome changes in the brain and nervous system

occur normally with aging. Some diseases also affect the brain and can affect cognitive function.

Cognitive relates to knowledge and involves: Memory Thinking Reasoning Understanding Judgment Behaviour

CONFUSIONCONFUSION

Confusion is a mental state where the person is disoriented to person, place and time.

Signs and symptoms include: Memory loss Poor judgment Behavioural changes Anger Anxiety Depression Irritability Delusions Hallucinations

CONFUSIONConfusion can occur suddenly and be temporary. This is

called delirium. Delirium can be caused by:

Medications Infection Dehydration Poor nutrition Emotional trauma

Delirium is an emergency and is often a sign of something more serious.

Confusion is permanent when it is caused by physical changes to the structure if the brain.

DEMENTIADEMENTIA

Dementia is the term that describes the progressive loss of cognitive and social functions. It is a symptom of changes in the brain, which starts slowly and progresses gradually. Dementia is not a normal part of aging, however, it is more common in those over 65. Functions affected include:

Memory Thinking Reasoning Judgment Language Behaviour Mood PersonalitySEE PG. 806 FOR SIGNS/SYMPTOMS OF DEMENTIA

DEMENTIAFORMS & CAUSES OF DEMENTIAThere are many forms and causes of dementia. Some dementias can be treated and reversed. They include:

Brain injury Brain tumor Alcohol Thyroid deficiency

Forms of dementia that cannot be reversed include: *Alzheimer’s disease* Vascular dementia (Multi-Infarct) Lewy body dementia Fronto – Temporal Dementia (Pick’s Disease) Creutzfeldt-Jakob disease Korsakoff’s Syndrome

ALZHEIMER’S DISEASE Alzheimer’s disease is a type of dementia

that is characterized by progressive deterioration in memory and other aspects of cognition.

It is recognized as one of the major health problems in people over 65 yrs of age and accounts for more than half of the cases of dementia.

The cause of Alzheimer’s is still unclear, although age is the most important risk factor for developing it.

There is data to suggest that estrogen protects against the development of Alzheimer’s and that it may also slow the progression of the disease for those who have it.

ALZHEIMER’S DISEASE The initial sign of Alzheimer’s disease is a subtle

deterioration in memory. This deterioration progresses and interferes with the

pt.’s ability to function. Recent events and new information can not be recalled.

Some pt.’s develop psychotic symptoms. Personal hygiene deteriorates, as does the ability to

maintain attention. As the disease progresses, long term memory can not be

recalled and pt.’s lose the ability to recognize family members.

Eventually the ability to communicate and to perform ADL’s is lost.

Death eventually occurs.

ALZHEIMER’S DISEASE

The care of Alzheimer’s disease is aimed at improving or controlling the decline in cognition and controlling the symptoms that the pt. may exhibit.

depression, psychoses and behavioral disturbances anxiety sleep disturbances decreased memory and cognition

Tx Donepezil (Aricept) – can mildly improve or stabilize

cognitive decline. Used in early and middle stages of Alzheimer’s.

There is no cure for Alzheimer’s, we can only try to slow the progression of the symptoms and control them.

DEMENTIASome health conditions can cause dementia, they

include: AIDS Huntington’s MS Parkinson’s Syphilis

STAGES OF DEMENTIA Stage 1: Mild (Early stage) Stage 2: Moderate (Middle stage) Stage 3: Severe (Late stage)

DEMENTIAPeople with dementia often display challenging behaviours.

They include: Wandering Sundowning Hallucinations Delusions Catastrophic reactions Agitation/Restlessness Aggression/combativeness Screaming Abnormal sexual behaviour Repetitive behaviours

DEMENTIATHE A’S OF DEMENTIAAnosognosia – no knowledge of illnessAmnesia – loss of memoryAphasia – loss of languageAgnosia – loss of recognitionApraxia – loss of purposeful movementAltered perceptions Attentional deficitsApathy

DEMENTIAIt is important that PSW’s meet the needs

of those with dementia, including:

Safety Hygiene, grooming, dressing Elimination Nutrition/fluids Exercise