1. Elsevier items and derived items © 2005 by Mosby, Inc. 0 CHAPTER 17 Cognitive Impairment, Alzheimer’s Disease, and Dementia

2. Elsevier items and derived items © 2005 by Mosby, Inc. 1 Cognition comprises intelligence, learning, judgment, reasoning, knowledge, understanding and memory. Normal age-related changes in cognition  Slower response times  Loss of short-term memory Confusion not a normal part of aging Normal Changes in Cognition

3. Elsevier items and derived items © 2005 by Mosby, Inc. 2 Delirium – acute onset  Causes Metabolic disorder Infections Fever Dehydration Damage – acute onset  Causes Stroke Head injury Exposure to chemicals (Cont’d…) The Five “Ds” of Confusion

4. Elsevier items and derived items © 2005 by Mosby, Inc. 3 (…Cont’d) Deprivation – variable onset  Causes Sensory impairment Social interaction Depression – subacute onset  Causes Loss Metabolic imbalances Drugs Inner sadness (Cont’d…) The Five “Ds” of Confusion

5. Elsevier items and derived items © 2005 by Mosby, Inc. 4 (…Cont’d) Dementia – slow onset  Causes Cardiovascular disease Metabolic problems Alzheimer’s disease HIV The Five “Ds” of Confusion

6. Elsevier items and derived items © 2005 by Mosby, Inc. 5 A sudden change of consciousness that occurs rapidly Signs and symptoms  Disorganized thinking  Decreased attention span  Lowered or fluctuating level of consciousness  Disturbance in sleep-wake cycle  Disorientation  Changes in psychomotor activity  Sometimes, delusions or hallucinations  Usually, agitation and hyperactivity  Sometimes, hypoactive behavior such as lethargy and reduced activity Delirium

7. Elsevier items and derived items © 2005 by Mosby, Inc. 6 Finding the Cause Pain Constipation High or low body temp (extreme) Alcohol use Lack of oxygen to brain malnutrition

8. Elsevier items and derived items © 2005 by Mosby, Inc. 7 Treatment Depends on cause Treat the source Supportive Care Low stimuli environment Have them wear hearing aids/glasses Clocks and calendars Ambulate often if allowed

9. Elsevier items and derived items © 2005 by Mosby, Inc. 8 Classified as Alzheimer’s or non-Alzheimer’s In early stages is difficult to differentiate from age- associated memory impairment Decreasing ability to process new information and to retrieve and use the information accumulated throughout life Dementia

10. Elsevier items and derived items © 2005 by Mosby, Inc. 9 Causes- More than 60 Metabolic problems Hormonal Infections Brain trauma Tumors Pain Sensory deprivation Chemical Anemia Drug interactions Dementia

11. Elsevier items and derived items © 2005 by Mosby, Inc. 10 Dementia Slow gradual onset Attempt to hide impairments Most common early symptom is declining memory

12. Elsevier items and derived items © 2005 by Mosby, Inc. 11 Sundowners Group of behaviors characterized by confusion, agitation and disruptive actions that occur IN LATE AFTERNOON OR EVENING Cause is unknown Associated with dementia, physical or social stressors Box 16-3

13. Elsevier items and derived items © 2005 by Mosby, Inc. 12 A progressive, degenerative disorder that affects brain cells and results in impaired memory, thinking, and behavior Cause is unknown 50% of all cases of dementia have Alzheimer’s Disease. Some 250,000 new cases per year Post mortem the brain reveals shrunken and with abnormal tangles of nerve fibers (Cont’d…) Alzheimer’s Disease

14. Elsevier items and derived items © 2005 by Mosby, Inc. 13 Left- normal Right – Alzheimer’s

15. Elsevier items and derived items © 2005 by Mosby, Inc. 14

16. Elsevier items and derived items © 2005 by Mosby, Inc. 15

17. Elsevier items and derived items © 2005 by Mosby, Inc. 16 (…Cont’d) Signs and symptoms  Memory loss  Difficulty performing familiar tasks  Problems with language  Poor judgment  Problems with abstract thinking  Misplacing things  Disorientation to time and place  Loss of initiative  Changes in mood or behavior  Changes in personality Alzheimer’s Disease

18. Elsevier items and derived items © 2005 by Mosby, Inc. 17 Early stage  Begins with the loss of recent memory and progresses to strange behaviors and mood swings Intermediate stage  Clients cannot recall recent events or process new information and eventually lose all sense of time and place. They are still ambulatory but at high risk for falls and injury. Severe stage  Clients are unable to do anything and are entirely dependent on others. End stage  Clients slip into a coma. Stages of Alzheimer’s Disease

19. Elsevier items and derived items © 2005 by Mosby, Inc. 18 Losses of Alzheimer’s Robbed of “personhood” Affective loss- drain of one’s personality Conative loss- inability to carry out plans for the simplest activities Catastrophic reactions- minor anxiety cascade Confused Agitated fearful

20. Elsevier items and derived items © 2005 by Mosby, Inc. 19 Provide for clients’ safety and well-being  Bathing, grooming, eating, physical activity  Remember that clients have no sense of safety or danger. Manage clients’ behaviors therapeutically  Gently redirect clients who are behaving inappropriately to less stressful activities.  Music therapy, validation therapy, and exercise help reduce stress. (Cont’d…) Health Care Goals for Clients with Alzheimer’s Disease

21. Elsevier items and derived items © 2005 by Mosby, Inc. 20 (…Cont’d) Support for family, relatives, and caregivers  Important sources of information about clients  Should be included in planning care for clients  Provide respite care  Informal support groups–family members, friends, and people who knew the family member before AD  Formal support groups Offered by the Alzheimer’s Association, home care agencies, and elder care centers Health Care Goals for Clients with Alzheimer’s Disease

22. Elsevier items and derived items © 2005 by Mosby, Inc. 21 Therapeutic Interventions Provide for safety and well-being Manage behaviors therapeutically Proved support for family and caregivers Gentle redirection Music therapy, validation, sensory stim

23. Elsevier items and derived items © 2005 by Mosby, Inc. 22 Interventions by stage Early- Cholinesterase inhibitors P 175 top Cognitive training Orientation Monitor personal hygiene Daily routine Home eval for safety

24. Elsevier items and derived items © 2005 by Mosby, Inc. 23 Middle/Late Stage Behavior gradually becomes disorganized personal hygiene, eating and elimination neglected Wandering is most serious problem 60% will wander and become lost in commun. Offensive behaviors need to looked at as COMMUNICATION OF UNMET NEED

25. Elsevier items and derived items © 2005 by Mosby, Inc. 24 As late stage progresses High risk for : malnutrition, pneumonia and pressure related wounds

26. Elsevier items and derived items © 2005 by Mosby, Inc. 25 Caregivers Support 70% of alzheimer’s are cared for in the home by family, friends and home care staff Find a balance between personal needs and those of the loved one Informal support groups Formal support groups Education- Stress levels decrease with adequate training