Dementia is an umbrella term for an array of symptoms reflecting progressive diminishing cerebral function. It affects memory, language, movement, orientation, and ultimately an individuals behaviour. These alterations to brain functioning interfere with the individuals ability to participate in work, social activities and activities of daily living.

Dementia is being recognized as a terminal illness and not just a mental condition that is associated with advancing age. It is the fourth leading cause of death in people over 65 years old within New Zealand, with over 41,000 people living with this condition. The World Health organisation has predicted that by 2050 the prevalence of dementia will triple, therefore, it is recognized as a health priority (Dyall, 2014).

There are many different conditions, over 100, that lead to dementia. The common causes of dementia include Alzheimer’s disease, vascular dementia and dementia with Lewy bodies.

 

Pathophysiology

Alzheimers disease (precursor to dementia):

Alzheimer is associated with two main anomalies within the brain,  the formation of senile plaques and the presence of neurofibrillary tangles within neurons. These changes are present for up to 15 years before the onset of Alzheimer symptoms.  Senile plaque is formed when there is a dysfunction in the regulation of amyloid beta protein. Excess amyloid beta protein binds together to form senile plaques, which are insoluable. The orginate in the cortex before spreading to the hippocampus and the rest of the brain. Neurofibrillary  tangles are formed when the tau protein, found wihtin microtubules of neurons, become defective and detach from the microtubule. The tau protein binds together to form filaments (tangles) which cause the neuron to degenerate, losing the ability to communicate with surrounding neurons. The neurofibrillary tangles eventually cause the death of the neuron (Hampel & Lista, 2013). The degeneration associated with neurofibrillary tangles starts in the hippocampus and causes regions of brain atrophy and hypoperfusion (Johnston & Gaye Elder, 2015)

 

There are seven stages of Alzeimer’s disease:

  • Stage 1: No Impairment.
  • Stage 2: Very Mild Decline
  • Stage 3: Mild Decline
  • Stage 4: Moderate Decline
  • Stage 5: Moderately Severe Decline
  • Stage 6: Severe Decline
  • Stages 7: Very Severe Decline

For detailed information of each stage, refer to this site:  http://www.alzheimers.net/stages-of-alzheimers-disease/

 

Retrieved from https://www.youtube.com/watch?v=dj3GGDuu15I

 

Here’s another video with helpful explanations of the disease process:  https://www.youtube.com/watch?v=v5gdH_Hydes

 

 

Risk factors

Sporadic Alzheimer’s: accounts for 90-95% of all cases: Late onset 

  • Genetic factors: APOEe4
  • Age: >65 by 85 risk increases to 50%

Familial alzheimer’s: accounts for 5-10% of all cases:  Early onset 

  • Dominant gene mutations: PSEN -1 & PSEN- 2
  • Trisomy 21: extra chromosome 21: down syndrome. Onset usually 40yo

 

 

Signs and Symptoms

  • short term memory loss
  • difficulty concentrating and completing familiar tasks
  • apraxia: loss of motor control
  • confusion with time, place, person
  • agnosia: failure to recognize objects
  • dysphasia: decreased ability to comprehend or produce language
  • withdrawal from social activities
  • change in mood and behaviour

Symptoms worsen as the diseases progresses from an accumulation of plaques and tangles

 

 

Nursing Management

Nursing management for caring for patients with Alzheimer’s and dementia are targeted towards promoting independence and maintaining function for as long as possible. Other important considerations is developing strategies to enhance communication, reducing anxiety and agitation, and providing education and support to the family.  There will be a time when the individual is no longer able to recognize their family members so it is important to discuss the progression of the disease to prepare the family for this eventuality.

 

Resources:

Here’s a quiz to test your new knowledge http://empowern.com/2015/08/alzheimers/

Here’s a cheat sheet for the stages of the disease and patient care

Here you can find nursing care plans

Here’s a link with treatment options to manage the symptoms of the disease

Here’s a link to a pdf which outlines New Zealand’s framework for delivering care to dementia patients

 

References

Alzheimer’s Association. (2017). 10 early signs and symptoms of Alzheimer’s.  Retrieved February 7, 2017, from http://www.alz.org/10-signs-symptoms-alzheimers-dementia.asp

Dyall, L. (2014). Dementia: Continuation of health and ethnic inequalities in New Zealand. The New Zealand Medical Journal (Online), 127(1389), 68–80. Retrieved from https://www.nzma.org.nz/journal

Hampel, H., & Lista, S. (2013). Use of biomarkers and imaging to assess pathophysiology, mechanisms of action and target engagement. The Journal of Nutrition, Health & Aging, 17(1), 54–63. doi: 10.1007/s12603-013-0003-1

Johnston, A., & Gaye Elder, E. (2015). Concepts of neurological dysfunction. In J. Craft & C. Gordon (Eds.), Understanding pathophysiology (2nd ed., pp. 155–184). Sydney, Australia: Mosby Elsevier.

Advertisements