Living with Dementia

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DEMENTIA- Progressive chronic disease that primarily effects the brain

and will sometimes cause secondary diseases exhibited elsewhere in the body.

- Affects 8% of older Canadians of which, 16% exhibit mild cognitive impairment

- 1 in 3 individuals 85 years or older are diagnosed with a form of Dementia

- Women are at more of a risk of being diagnosed with Dementia than men.

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Causes of Dementia- Research is still being conducted to understand the causes

of Dementia, however, most research has indicated that the following play an important role in causing Dementia:

- Vascular Disease, such as:- Arteriosclerosis, chronic hypertension, high cholesterol, diabetes, etc.

- Infections, such as:- AIDS, meningitis, encephalitis, and syphilis

- Toxins, such as:- Alcohol, heavy medals, drugs,

- Genetic Disorders

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TYPES OF DEMENTIA

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Alzheimer’s Dementia

- Alzheimer’s dementia is a progressive loss of intellectual functioning that causes: personality changes, impairments with judgement, decreased psycho-social functioning and problem solving.

- Affects approximately 10% of the human population over the age of 65 and 25% of the human population over the age of 85

- Women are affected more than menDon’t Despair – Become Aware

Alzheimer’s Dementia

- The cause of Alzheimer’s is still unknown.

- Research has associated that 4 sets of different genes on different chromosomes have some link to causing Alzheimer’s Dementia.

- Onset differs with each case

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Alzheimer’s DementiaSigns and Symptoms

Early Stage of Alzheimer’s- Gradual loss of memory appears- Lack of concentration - Ability to learn new information and to reason is

impaired- Irritability, hostility, and mood swings- Cognitive functioning will be affected, such as:

- Memory, language skills, problem solving, and managing activities of daily living

- Wandering in familiar and unfamiliar places

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Alzheimer’s DementiaSigns and Symptoms

Late Stage of Alzheimer’s- Individual does not recognize familiar people, such

as family, friends or coworkers.- Lack of awareness or interest in the environment- Incontinence

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Alzheimer’s Dementia

TESTING FOR ALZHEIMER’SPhysicians will often;- Conduct memory tests - Perform blood tests- Perform brain scans such as computerized

tomography (CT) and magnetic resonance imaging (MRI)

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Alzheimer’s Dementia

TREATMENT- There is no cure for Alzheimer’s Disease- Anticholinesterase medications such as: Aricept,

Galantamine, Rivastigmine, and tacrine are used to temporarily improve cognitive functioning.

- Daily routine and exercise programs help moderately stimulate the brain and prevent further cognitive impairment

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Alzheimer’s Dementia

MORBIDITY- Alzheimer’s Dementia can last up to 20 years in

individuals, however can cause death within 7 years of onset.

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Vascular Dementia

- Caused by cardiovascular disease- Usually a result from multiple small brain

infarctions- Occurs in persons 70 years or older and who

have hypertension- Onset is gradual and will differ with each case- Often will coincide with other neurological

impairments

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Vascular DementiaSigns and Symptoms- Hallucinations or Delirium- Memory problems- Slowed thinking- Mood changes- Apathy- Confusion- Inability to manage daily routines- Slurred speech- Dizziness or tremors- Incontinence

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Vascular Dementia

TESTING FOR VASCULAR DEMENTIAPhysicians will often;- Have patients perform hand-eye coordinated

tasks- Review past medical history for cardiovascular

diseases- Perform brain scans such as CT and MRI

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Vascular DementiaTREATMENT- No known cure to date- Treat risk factors, such as:

- Managing your blood pressure- Avoid smoking and drinking- Improve your high cholesterol- Control your diabetes- Include exercise in your lifestyle- Avoid salty foods

- There are no medications developed for the specific treatment of Vascular Dementia, however, some of the Anticholinesterase medications used for Alzheimer’s Dementia have some effect on temporarily improving Vascular Dementia

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Vascular Dementia

MORBIDITY• Death can occur within 1 year of diagnosis or

up to 20 years after diagnosis

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Creutzfeldt-Jakob Dementia

- Rare form of Dementia- Caused by infection by a prion (altered

infectious protein particle) that attacks nervous tissues

- Often the origin of the infection is not identified

- Common in older individuals

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Creutzfeldt-Jakob Dementia

SIGNS AND SYMPTOMS- Memory loss such as:

- Inability to recall past and recent events- Inability to recognize family or friends

- Rapid behaviour changes- Motor dysfunctions such as:

- Inability to pick up objects,- Difficulty walking

- Progressive Dementia

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Creutzfeldt-Jakob Dementia

TESTING FOR CREUTZFELDT-JAKOB DEMENTIAPhysicians will often,

- Send the individual for an electroencephalogram (EEG) or a magnetic resonance imaging (MRI) to test for brain activity and functioning

- Obtain blood samples to check for infection- Perform cognitive functioning testing (such as

MMSE or MOCA tests)

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Creutzfeldt-Jakob Dementia

TREATMENT- Currently there is no treatment for

Creutzfeldt-Jakob Dementia- Manage and treat symptoms as they appear

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Creutzfeldt-Jakob Dementia

MORBIDITY- Long incubation period after infection occurs in

brain; however, the disease on average causes death within 6 -12 months

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Lewy Body Dementia

- Lewy Body Dementia refers to dementia with Lewy Bodies as well as Parkinson’s Disease Dementia

- Affects multi-systems within the body- Lewy bodies are deposits of protein called

alpha-synuclein that form inside the brain’s nerve cells.

- Accounts for 5 – 15% of all dementias

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Lewy Body DementiaSIGNS AND SYMPTOMS- Progressive dementia - Fluctuating cognition - Visual hallucinations- Features of Parkinson’s disease- Insomnia- Repeated falls and syncope (fainting)- Loss of consciousness- Visual disturbances- Autonomic dysfunctions such as:

- Blood pressure fluctuations, heart rate variability, sexual impotence, bowel and bladder impairments, etc.

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Lewy Body DementiaTESTING FOR LEWY BODY DEMENTIAPhysicians will often,- Perform physical and neurological examinations- Mental status test- Individual’s functional abilities- Brain imagining such as:

- CT scans- MRI scans

- Blood tests- The final diagnosis of Lewy Body Dementia can only be

conducted and obtained from a post-mortem autopsy

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Lewy Body DementiaTREATMENT- There is no cure for Lewy Body Dementia- Medications are used to treat all the symptoms of Lewy Body Dementia.

Often physicians will prescribe anticholinesterase medications for cognitive deficits. If symptoms of Parkinson’s Disease are present, they may prescribe anti-Parkinson’s medications.

- Physical therapy to assist with strengthening, flexibility and increasing cardiovascular output

- Speech therapy to improve and strengthen swallowing difficulties and speech deficits

- Occupational therapy to promote and maintain independence- Psychotherapy to assist with emotional and behavioural symptoms both

at an individual and family level

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Lewy Body Dementia

MORBIDITY- The course of the disease is from 2 – 20 years

depending on health of the individual, however, on average the disease duration lasts from 5 – 7 years.

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Frontotemporal Dementia- Frontotemporal Dementia encompasses many names

of dementia such as:- Semantic Dementia- Frontal Lobe Dementia- Primary Progressive Aphasia- Corticobasal Degeneration- Pick’s Complex

- 2 – 5% of Dementia are Frontotemporal Dementia- Affects the frontal and temporal lobes, which are

generally associated with personality and behaviour

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Frontotemporal DementiaSIGNS AND SYMPTOMS- Changes in behaviours, such as:

- Withdrawn- Lose interest in personal hygiene- Become easily distracted- Repeat the same action repeatedly

- Incontinence- Problems with speech- Sexual inappropriateness- In later stages, memory and cognition will become affected,

however, the individual will preserve memory in early stages

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Frontotemporal Dementia

TESTING FOR FRONTOTEMPORAL DEMENTIAPhysicians will often,- Send individuals for brain imaging, such as:

- MRI- CT scan

- Perform a physical examination- Obtain full health history

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Frontotemporal Dementia

TREATMENT- There is no cure for Frontotemporal Dementia- There is no effective way to slow its

progression- There is no set medication used to treat

Frontotemporal Dementia, instead managing the symptoms is the best treatment

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Frontotemporal Dementia

MORBIDITY- The course of the disease is (on average) 2 – 10

years, resulting in death.

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WAYS TO PREVENT DEMENTIA

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Preventing Dementia

EXERCISE CONSISTENTLY- Work your heart by:

- Swimming- Walking- Running- Gardening- Cleaning - Doing laundry

- Build muscle by:- Moderate weight lifting and resistance

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Preventing Dementia

EXERCISE CONSISTENTLY- Protect your head

- Always use proper head protection when riding a bicycle or playing in rough sports

- If falling, avoid hitting your head- Improve balance and coordination

- Practice activities such as yoga, tai-chi, use exercise balls to improve core balance

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Preventing Dementia

EAT A BRAIN HEALTHY DIET- Eat foods that improve memory and maintain

cognition, such as:- Cold water fish,- Eggs,- Walnuts

- Avoid Trans and Saturated Fats- Avoid alcohol, salts and caffeine's

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Preventing Dementia

CHALLENGE YOUR MIND- Keeping your mind active with different

activities helps promote and maintain constant brain synapses. Some activities include:- Crossword puzzles- Sudoku puzzles- Word search puzzles- Jigsaw puzzles- Reading a book

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Preventing Dementia

GET REGULAR AND RESTFUL SLEEP- Allow your brain to rest and regenerate- A restful sleep allows individuals to function at

optimal capacity- Constant sleep deprivation puts individuals at

risk for developing symptoms of Alzheimer’s

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Preventing Dementia

MINIMIZING STRESS- Constant stress eventually leads to decreased

nerve cell growth within the brain- Learn strategies to decrease levels of stress,

such as:- Breathing exercises- Relax daily with things you like to do- Meditate or pray

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Caring for someone with Dementia

Caring for someone with Dementia

DEVELOP DAILY ROUTINES• Sticking to daily routines can help assist the demented

with orientation to time or person• Always communicate what you are doing to the

demented either through words or actions. For example, pouring a cup of coffee can indicate breakfast, whereas a cup of tea can indicate the evening snack.

• Continue to involve the demented individual in all of the activities of daily living.

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Caring for someone with Dementia

SEXUAL RELATIONSHIPS• Dementia can inhibit sexual relationships. Some people

with dementia will have increased sexual behaviours, whereas others may have decreased sexual behaviours.

• To maintain a healthy sexual experience, individuals may need to seek counselling from a professional or support group.

• Physical demands on the individuals partner can potentially increase and the family may need separate support.

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Caring for someone with Dementia

COMMUNICATION• Continue to verbally communicate with the

demented individual. Always tell them what you’re doing and why it’s being done.

• Consider non-verbal cues as well, such as:– Touch – Smell– Visual stimulation through picture boards

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Caring for someone with Dementia

SAFETY• Creating a safe environment for someone with dementia

will decrease any risk for harm to the individual or family– Ensure medications and cleaning supplies are locked in a

cupboard or behind locked doors– Prevent an individual from slipping on the ground by

removing scatter mats or loose rugs– Ensure adequate lighting throughout the house– Ensure appliances that are unsafe for an individual are out of

sight or safety equipment is in place to prevent accidents with those appliances – ie flip switch on stove to turn it on

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Caring for someone with Dementia

PSYCHO-SOCIAL ACTIVITIES• Group Exercise classes will help stimulate the individual

with dementia and will help blood flow to the brain• Past recollection – Sit with the individual and reminisce

on the past via scrap books, pictures, or movies• Music – music will help sooth an agitated individual• Daily housework – making the individual feel like they

are contributing to simple tasks will help prevent depression

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REFERENCESAlzheimer’s Society. (2011). Retrieved from http://www.alzheimer.ca/english/index.php

Burke, K., Lemone, P. (2004). Nursing Care of Clients with Neurologic Disorders. In M. Connor, N. Anselment, K. Wyatt, & M. Merserve (Eds.), Medical-Surgical Nursing (3rd edition, pp. 1398-1406). Upper Saddle River, New Jersey: Pearson.

Day, R. A., Paul, P., Williams, B., Smeltzer, S. C., & Bare, B. (2010). Management of Patients with Oncologic or

Degenerative Neurologic Disorders. In H. Surrena & L. Scott (Eds.), Textbook of Canadian Medical-Surgical Nursing (2nd edition, pp. 2205-2207). Philadelphia, PA, USA: Lippincott-Raven.

Gould, B. E. (2006). Pathophysiology of the Systems. In M. Hutchinson, & M. K. Boyle (Eds.), Pathophysiology for the Health Professions (3rd edition, pp. 586 – 588). Philadelphia, PA: Elsevier.

Help Guide supported by the Rotary Club of Santa Monica. (2011). Retrieved from http://www.helpguide.org/elder/vascular_dementia.htm

Lewy Body Dementia Association, Inc. (2011). Retrieved from http://www.lbda.org/

Potter, P. A., Perry, A. G. (2006). Caring Through the Lifespan – Older Adult. In J. C. Ross-Kerr, & M. J. Wood (Eds.), Canadian Fundamentals of Nursing (3rd edition, pp. 422-427). Toronto, ON: Elsevier.

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