Dementia Flashcards
What is dementia?
- A syndrome due to disease of the brain, usually chronic (over 6 months in duration) and progressive
- disturbance of memory and one or more other higher cortical functions (thinking, orientation, compression, calculation, learning, language and judgment
Symptoms of Dementia?
Cognitive or intellectual impairment - “Four As”:
- Amnesia (short-term and long-term),
- Aphasia (expressive and receptive),
- Apraxia (preprogrammed motor task and ADL),
- Agnosia (5 senses including internal/visceral information)
- Psychiatric symptoms – personality changes, depression, hallucination and delusions
12 modifiable risk factors for dementia?
potentially prevent or delay the onset up to 40% of dementia; Less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and infrequent social contact, excessive alcohol consumption, head injury and air pollution
Causes of dementia?
- Alzheimer’s disease
- Front-temporal lobar degeneration
- Lewy body disease
- HIV infection
- Vascular disease
- Substance medication use
Types of dementia?
Alzheimers disease
Vascular dementia
Front-temporal dementia
Lewy Body dementia
What is Alzheimers disease?
- Amyloid (protein fragments) plaques accumulate between neurons.
- destroyer memory and other important mental functions
What is vascular demetia?
- Atherosclerotic disease causes interruption to blood supply to the brain and consequent death of brain tissue. Damage is small and gradually declining
What is front-temporal?
= uncommon brain disorders that affect the frontal and temporal lobes of the brain
Impacts
- Behaviour
- Language
- personality
What is Lewy body dementia?
= abnormal deposits of protein
- Fluctuating cognition, variations in attention and alertness. Recurrent visual hallucinations, detailed and well formed
Non pharmacological interventions for dementia?
Psychosocial approaches are indicated as first-line approaches to all emotional and behavioral disturbances in people with dementia
• Psychosocial interventions work best when they are tailored to people’s backgrounds, interests, and capacity
• Family and professional caregivers are key collaborators. It is important to provide them with necessary information and education, and to support them as they test and refine their responses to challenging symptoms
• The physical environment can help prevent or minimize BPSD by reducing distress, encouraging meaningful activity, maximizing independence, and promoting safety
Pharmacological interventions of demetia?
- Antipsychotics (Risperidone, Olanzapine, Quetiapine)
- Antidepressants (SSRI, Tricyclics, MAO inhibitors)
- Anticonvulsants (Sodium Valproate, Carbamazepine, Divalproex sodium)
- Symptomatic Tx: Cholinesterase Inhibitors (Donepezil, Galantamine, Rivastigmine); Blocking Glutamate (Memantine)
Principles of dementia medication
- Start low and go slow 2
- Ensure appropriate consent procedures followed
- Use with caution and care – consider other interventions first
- Review prescriptions regularly (≥ 3 monthly) and try gradual withdrawal after 3-6 months
- Be aware of and monitor adverse effects
Need for carers and the knowledge they need for a dementia patient.
Impact on family carer:
- Health and wellbeing (depression, anxiety, stress, physical impacts and sleep distribution)
- Socio-economic consequences (reduced labour participation and social activities
Carer needs:
- Access to flexible support, information and respite services
- Workplace and community understanding
Effective interventions for the carer:
- Comprehensive, multidimensional dementia specific education and training
- Increasing ‘time for self’ and respite
- counselling
