Is this Dementia?
The purpose of making as accurate a diagnosis as possible of the cause of dementia is twofold, first to provide information to the client/family/caregivers, and second, to rule out any potentially treatable or reversible factors.
Confirm whether dementia is present
- Assessment of impaired mental status (video
clip 1, video clip 2) and function in older adults is defined by loss with functional decline.
- normal mental status with normal function - no dementia
- impaired mental status with normal function - may have some type of mental illness
- normal mental status with impaired function - rule out physical causes
- impaired mental status with impaired function - probable dementia; proceed with dementia evaluation
(Adapted from AHCPR: Early Identification of Alzheimer's Disease and Related Dementias: coa.kumc.edu)
More Information: http://www.americangeriatrics.org/products/positionpapers/aan_dementiaPF.shtml
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Is this Just "Old Age"?
Early signs of dementia
- memory and concentration
- normal : periodic minor memory lapses or forgetfulness, occasional lapses in attention or concentration
- dementia : misplacement of important items, confusion with performance of simple tasks, difficulty making routine decisions, confusion about month or season
- mood and behavior
- normal : temporary sadness or anxiety based on appropriate or specific cause, changing interests, increasingly cautious behavior
- dementia : unpredictable mood changes, increasing loss of outside interests, depression/anger/confusion in response to change, denial of symptoms
Later signs of dementia
- language and speech
- normal : unimpaired language skills
- dementia : difficulty completing sentences or finding the right words, inability to understand the meaning of words, reduced and/or irrelevant conversation
- movement and coordination
- normal : increasing caution in movement, slower reaction times
- dementia : visibly impaired movement or coordination, including slowing of movements, halting gait, and reduced sense of balance
- other symptoms
- normal : normal sense of smell, no abnormal weight changes in men or women
- dementia : impaired sense of smell, severe weight loss (particularly in females)
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Stages of Dementia are classified according to the level of functional impairment and the subsequent ability to perform specific functions .
- Questionable - borderline functioning in several areas but definite impairment in none
- Mild - likely to have difficulties with balancing a checkbook, preparing a complex meal, or managing a difficult medication schedule
- Moderate - difficulties with simpler food preparation, household cleanup, and yard work; may require assistance with some aspects of self-care (e.g., reminders to use the bathroom, help with fasteners or shaving)
- Severe - considerable assistance with personal care, including feeding, grooming, and toileting
- Profound - largely oblivious to their surroundings and almost totally dependent on caregivers
- Terminal - generally bed bound, require constant care, and are susceptible to accidents and infectious diseases, which often prove fatal
Disease Process
The development of multiple cognitive deficits manifested by both:
- Memory impairment - impaired ability to learn new information or to recall previously learned information
- One (or more) of the following cognitive disturbances:
- Amnesia - loss of memory; repeats questions often; misplaces objects; may be described by caregiver as frustrating or paranoid.
- Aphasia - language disturbances; inability to speak or understand; cannot follow directions; won't engage in conversation; described by caregiver as uncooperative or withdrawn
- Apraxia - impaired ability to carry out motor activities despite intact motor function; loss of ability to coordinate learned movements; cannot use utensils or toilet, cannot dress; may be described by caregiver as incontinent, uncooperative, won't eat
- Agnosia - failure to recognize or identify objects despite intact sensory function; inability to recognize what is seen; cannot recognize faces, home. or familiar objects; may be described by caregiver as frightened, combative, wandering, paranoid
- Disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)
(Source: Alzheimer's Association. Key Elements of Dementia Care. Chicago, IL: Alzheimer's Disease and Related Disorders Association, Inc. 1997; coa.kumc.edu)
Manifestation of disease
The cognitive deficits noted each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning
- Gradual withdrawal from activities (due to forgetfulness regarding activity performance)
- Increased tendency to misplace things
- Narrowed interests and loss of initiative
- Decreased tolerance of new ideas or changes in routine (often due to increased confusion and decreased ability to perform)
- Self-centered thoughts
- Increased restlessness or apathy
- Deterioration of language and abstract thought processing
- Inconsistent performance of tasks of daily living
(Source: Medscape Nursing, 2001)
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Probable Causes of Dementia
- Alzheimer's Disease
- Progressive supranuclear palsy
- Lewy Body Disease
- Multi-infarct (vascular) dementia
- Drug, alcohol, or anoxic encephalopathy/dementia
- Pick's Disease
- Huntington's Disease
- Senile dementia
- Parkinson's Disease
- Pseudodementia
- Organic brain syndrome
- Senile memory loss
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Differential Diagnosis: Conditions that can be reversed or improved
- Depression
- Delirium
- medications
- medical illness
- hypothyroidism
- B12 deficiency
- syphilis
- metabolic disorders
- Comorbid Diseases
- Hypertension
- Stroke
- Parkinson's Disease
- Treatable dementia causes
- Normal pressure hydrocephalus
- Intoxication
- CNS infections
- Nutritional disorders
- Vascular diseases
- Space-occupying lesions
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Risk Factors
- Higher Prevalence
- advanced age
- family history
- lower educational level
- high cholesterol
- female gender (studies inconsistent)
- hypertention (studies inconsistent)
- Lower Prevalence due to potential protective relationship
- hormone replacement therapy
- anti-inflammatory use
- moderate alcohol consumption
- Other
- environmental factors - infections, metals, industrial, or other toxins
- infectious organisms - slow infectious viruses, infections with powerful inflammatory effects in blood vessels
- electromagnetic fields
- head injury
Factors which at the time of diagnosis indicate a higher risk for a more rapid decline:
- Older age
- Male gender
- Presence of hypertension
- Signs of motor control/coordination loss
- Tremor
- Social withdrawal
- Anorexia with severe weight loss
- Sensory problems: hearing loss, decline in reading ability
- General physical debility
More Information:
http://www.ethnicelderscare.net/ethnicity&dementia.htm
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