Normal Aging vs

Dementia
 Slow  Slow
 Accurate recall  Inaccurate recall
 Remedied by cues  Reminders fail eventually
recall poor despite cueing
Eg. appointment, calendars
& list
 Progressive decline
 Stable
 Does not interfere with
 Interferes with function
function
 Minimal Forgetfulness
 Poor memory
 No change in other  Decline in other cognitive
cognitive domains domains
 Intact ADL’s  Impaired ADL’s
 Abnormal N/P result.
Clinical Criteria
- Memory impairment
- Impairment of language
(Aphasia)
- Impairment of recognition
(Agnesia)
- Impairment in execution of task
(Apraxia)
- Impairment in executive
 Cognition

Demen
tia
Functio Behavi
n or
Filipinos Aged 60 &
Above
3.7 M 8.7 M
22 M
5.5 % 8.8 %
17 %
68 M 99 M
126 M
1995 2015
2040
Types of Dementia
-Alzheimer 15%
-Vascular & Alzheimer Disease 10%
-Prone Temporarily Dementia 5%
-Infectious 3%
-Toxic Metabolic 4%
- Psychiatric 4%
-Delubitant
Alzheimer’s
Disease
-Most common cause of dementia in the
elderly.
-Average duration is 8-11 years old
-Prevalence doubles every 5 years from 6-8% @ 65
years old.
-Risk Factors: age, genetic influence, apoE status,
female gender, lack of education, head trauma,
myocardial infarction.
 Dementia's Clinical Diagnosis
•Assessing presenting problem
• Taking a informant base history
• Physical – neurogical status
• Evaluation of cognitive, behavior
and functional status.
Signs of
Dementia
• Memory Loss
• Difficulty performing family task
• Problems with language
• Disorientation in place & time
• Poor or Decreased judgment
• Problems with complex task and abstract
thinking.
• Misplacing things
• Change in mood & behavior (Delusions)
 Physical
Examination
-Hypertension & signs of vascular disease
-Signs of Cardiac Disease particularly
features that increase risk for cerebral
embolism
-Signs of gait & balance, neurologic
abnormal
-Tremors & brain disorder
Cognitive & Functional
Evaluation Tools
-MMSE (Minimal Sense
Examination)
-Verbal Fluency
-Cancellation Test
-4 item ADL
-4 points Geriatric
Depression Scale (GDS)
 AncillIary Test
-When diagnosis is
unclear.
-Referral to NP for formal
cognitive resting.
-Structural Imaging
-Depression always
screen
Non-Drug therapy for Persons
with Dementia
Intervention for Cognitive Decline:
-Advice relative of the patient to have
daily calendar, it helps patient to
keep track of date.
- Digital Clock – consider switching
time.
- Provide a simple list for the day.
- Establish medication routine
through label pill box.
-Avoid moving things around in the
Improving Communication
-Maintain eye contact.
- Always face the person.
-Speak slowly, clearly & warmly.
-Keep sentence short
-Use hand gestures & facial
expressions.
-Use physical prompts.
-Assist calmly when client struggle with
words.
5 Steps Approach to
Assessment & Management
BPSD’s
-Describe the behavior.
-Prescribe trigger &
consequences, depression,
anxiety & alinging.
-Give more love & support to
the person.
-Don’t expect the person to
snap out of the depression
 Losing
Things
-Discover if the person has
favorite hiding place.
-Keep replacement of
important items.
-Respond to person accusation
gently defensively.
-Agree with the person that
item is lost.
 Wandering
-Make sure that the person carries
some form of identification.
-Secure your home and make sure
he/she can’t leave without.
-Provide 24 hours supervision.
-If the person wandered and was found
avoid showing anger.
-Keep recent photos of the person.
 Delusion &
Hallucination
-Do not argue with
person regarding
validity of what heard.
-Give comfort when she
is frightened.
-Distract by drawing
attention to something
 Violence &
Aggression
-Keep calm
-Draw
attention
Inappropriate
Sexual Behavior
-Allow privacy
-Distract person to
another activity
-Keep some productive
activity.
 Repetitive
Behavior
-Distract the
person
-Write down the
repeat behavior
Intervention of
activity
participation
-Breakdown activity in
smaller.
-Choosing activities
through the diff stage
-Promoting motility