CONFUSION DEMENTIA CHAPTER 35 COGNITION Some changes in

CONFUSION & DEMENTIA CHAPTER 35

COGNITION Some 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: n Memory n Thinking n Reasoning n Understanding n Judgment n Behaviour

CONFUSION Confusion is a mental state where the person is disoriented to person, place and time. Signs and symptoms include: n Memory loss n Poor judgment n Behavioural changes n Anger n Anxiety n Depression n Irritability n Delusions n Hallucinations

CONFUSION Confusion can occur suddenly and be temporary. This is called delirium. Delirium can be caused by: q q q n n 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.

DEMENTIA 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: n Memory n Thinking n Reasoning n Judgment n Language n Behaviour n Mood n Personality SEE PG. 806 FOR SIGNS/SYMPTOMS OF DEMENTIA

DEMENTIA FORMS & CAUSES OF DEMENTIA There are many forms and causes of dementia. Some dementias can be treated and reversed. They include: q Brain injury q Brain tumor q Alcohol q Thyroid deficiency Forms of dementia that cannot be reversed include: q *Alzheimer’s disease* q Vascular dementia (Multi-Infarct) q Lewy body dementia q Fronto – Temporal Dementia (Pick’s Disease) q Creutzfeldt-Jakob disease q Korsakoff’s Syndrome

ALZHEIMER’S DISEASE n n 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 n n n n 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. n depression, n psychoses and behavioral disturbances n anxiety n sleep disturbances n decreased memory and cognition Tx n n 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.

DEMENTIA Some health conditions can cause dementia, they include: n AIDS n Huntington’s n MS n Parkinson’s n Syphilis STAGES OF DEMENTIA n Stage 1: Mild (Early stage) n Stage 2: Moderate (Middle stage) n Stage 3: Severe (Late stage)

DEMENTIA People with dementia often display challenging behaviours. They include: n n n n n Wandering Sundowning Hallucinations Delusions Catastrophic reactions Agitation/Restlessness Aggression/combativeness Screaming Abnormal sexual behaviour Repetitive behaviours

DEMENTIA THE A’S OF DEMENTIA Anosognosia – no knowledge of illness Amnesia – loss of memory Aphasia – loss of language Agnosia – loss of recognition Apraxia – loss of purposeful movement Altered perceptions Attentional deficits Apathy

DEMENTIA It is important that PSW’s meet the needs of those with dementia, including: n n n Safety Hygiene, grooming, dressing Elimination Nutrition/fluids Exercise