Transcript
Dementia & DeliriumDementia & Delirium
Hena JawaidInstructorPsychiatry
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• Dementia is a chronic progressive mental disorder that adversely affects higher
• cortical functions including memory, thinking, orientation, comprehension,
• calculation, learning capacity, language and judgement
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• Alzheimer's disease is the most common form of dementia.
• Degenerative cerebral disease with characteristic neuro-pathological and neuro-chemical features.
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Incidence
• UK incidence of Alzheimer's disease in people over the age of 65 years is estimated to be 4.9 per 1000 person-years.
• Between 50 and 64% of people with Alzheimer's disease are estimated to have mild to moderately severe disease, and approximately 50% have moderately severe to severe disease.
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Onset
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• Alzheimer's disease is usually insidious in onset and develops slowly but steadily over several years.
• It predominantly affects older people.
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• The median survival for people with Alzheimer's disease from onset has been estimated at 7 years
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• Progression is characterized by deterioration in cognition (for example, thinking, conceiving and reasoning)
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• functional ability (for example, activities of daily living such as dressing, personal hygiene and handling money)
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• behavior (for example, agitation, wandering and uncharacteristic aggression)
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• and non-cognitive symptoms including depression, delusions and hallucinations.
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• People with Alzheimer's disease might find it increasingly difficult to do everyday activities, such as shopping, socializing and recognizing people and places. Communication may become a problem as people find it more difficult to find words and remember names
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• In later stages of disease, physical problems can include problems with eating, swallowing, incontinence, and unsettled and unsettling behavior.
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• Alzheimer's disease may also be associated with loss of confidence and feelings of fear, confusion, apathy, stigma and depression. The effects of Alzheimer's disease are heterogeneous and vary from patient to patient.
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• Carers (including friends and family) are affected by the progressive deterioration in cognition, function and behaviour of a person with Alzheimer's disease. Behavioural symptoms can have a particular impact on carers, and are often the reason cited for a person with Alzheimer's disease going into full-time residential care.
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severity of Alzheimer's disease
• mild Alzheimer's disease: MMSE 21–26• moderate Alzheimer's disease: MMSE 10–20• moderately severe Alzheimer's disease: MMSE
10–14• severe Alzheimer's disease: MMSE less than
10.
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There is no cure no cure for Alzheimer's disease!!!
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• Current management involves the treatment of cognitive, non-cognitive and behavioral symptoms.
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Aims of Treatment
• to promote independence, maintain function and treat symptoms including cognitive, non-cognitive (hallucinations, delusions, anxiety, marked agitation and associated aggressive behavior), behavioral and psychological symptoms.
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• AChE inhibitors (donepezil, galantamine and rivastigmine) and memantine are the pharmacological treatments available specifically for Alzheimer's disease.
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• social support, increasing assistance with day-to-day activities
• information and education • carer support groups• community dementia teams• home nursing and personal care • Community services such as meals-on-wheels,
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Snoezelen Therapy
• Snoezelen (“snoozelen”) is a multisensory stimulation approach used to provide opportunities for multi-sensory experiences in the cognitively impaired.
• Snoezelen therapy can be used as both a stimulating and calming technique.
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• Textures, smells, unusual lighting, contrasts, nature sounds are all examples of snoezelen stimulation.
• An entire room dedicated to Snoezelen therapy may be hard to come by in most settings, but a box filled with items that provide tactile, visual, or hearing stimulation can be a cost effective investment in multi-sensory therapy
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• ICU beeping• Constant lights• Constant noise• Nurses shift overs• Lack of human touch• Artificial environment• Family turnover
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