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Living with Dementia

Living with Dementia. 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

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Living with Dementia

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  1. Living with Dementia Don’t Despair – Become Aware

  2. 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. Don’t Despair – Become Aware

  3. 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 Don’t Despair – Become Aware

  4. Types of Dementia Don’t Despair – Become Aware

  5. 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 men Don’t Despair – Become Aware

  6. 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 Don’t Despair – Become Aware

  7. 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 Don’t Despair – Become Aware

  8. 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 Don’t Despair – Become Aware

  9. Alzheimer’s Dementia TESTING FOR ALZHEIMER’S Physicians will often; • Conduct memory tests • Perform blood tests • Perform brain scans such as computerized tomography (CT) and magnetic resonance imaging (MRI) Don’t Despair – Become Aware

  10. 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 Don’t Despair – Become Aware

  11. Alzheimer’s Dementia MORBIDITY - Alzheimer’s Dementia can last up to 20 years in individuals, however can cause death within 7 years of onset. Don’t Despair – Become Aware

  12. 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 Don’t Despair – Become Aware

  13. Vascular Dementia Signs and Symptoms • Hallucinations or Delirium • Memory problems • Slowed thinking • Mood changes • Apathy • Confusion • Inability to manage daily routines • Slurred speech • Dizziness or tremors • Incontinence Don’t Despair – Become Aware

  14. Vascular Dementia TESTING FOR VASCULAR DEMENTIA Physicians will often; • Have patients perform hand-eye coordinated tasks • Review past medical history for cardiovascular diseases • Perform brain scans such as CT and MRI Don’t Despair – Become Aware

  15. Vascular Dementia TREATMENT • 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 Don’t Despair – Become Aware

  16. Vascular Dementia MORBIDITY • Death can occur within 1 year of diagnosis or up to 20 years after diagnosis Don’t Despair – Become Aware

  17. 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 Don’t Despair – Become Aware

  18. 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 Don’t Despair – Become Aware

  19. Creutzfeldt-Jakob Dementia TESTING FOR CREUTZFELDT-JAKOB DEMENTIA Physicians 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) Don’t Despair – Become Aware

  20. Creutzfeldt-Jakob Dementia TREATMENT • Currently there is no treatment for Creutzfeldt-Jakob Dementia • Manage and treat symptoms as they appear Don’t Despair – Become Aware

  21. Creutzfeldt-Jakob Dementia MORBIDITY - Long incubation period after infection occurs in brain; however, the disease on average causes death within 6 -12 months Don’t Despair – Become Aware

  22. 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 Don’t Despair – Become Aware

  23. Lewy Body Dementia SIGNS 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. Don’t Despair – Become Aware

  24. Lewy Body Dementia TESTING FOR LEWY BODY DEMENTIA Physicians 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 Don’t Despair – Become Aware

  25. Lewy Body Dementia TREATMENT • 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 Don’t Despair – Become Aware

  26. 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. Don’t Despair – Become Aware

  27. 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 Don’t Despair – Become Aware

  28. Frontotemporal Dementia SIGNS 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 Don’t Despair – Become Aware

  29. Frontotemporal Dementia TESTING FOR FRONTOTEMPORAL DEMENTIA Physicians will often, • Send individuals for brain imaging, such as: • MRI • CT scan • Perform a physical examination • Obtain full health history Don’t Despair – Become Aware

  30. 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 Don’t Despair – Become Aware

  31. Frontotemporal Dementia MORBIDITY - The course of the disease is (on average) 2 – 10 years, resulting in death. Don’t Despair – Become Aware

  32. Ways to Prevent Dementia Don’t Despair – Become Aware

  33. Preventing Dementia EXERCISE CONSISTENTLY • Work your heart by: • Swimming • Walking • Running • Gardening • Cleaning • Doing laundry • Build muscle by: • Moderate weight lifting and resistance Don’t Despair – Become Aware

  34. 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 Don’t Despair – Become Aware

  35. 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 Don’t Despair – Become Aware

  36. 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 Don’t Despair – Become Aware

  37. 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 Don’t Despair – Become Aware

  38. 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 Don’t Despair – Become Aware

  39. Caring for someone with Dementia Don’t Despair – Become Aware

  40. 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. Don’t Despair – Become Aware

  41. 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. Don’t Despair – Become Aware

  42. 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 Don’t Despair – Become Aware

  43. 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 Don’t Despair – Become Aware

  44. 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 Don’t Despair – Become Aware

  45. REFERENCES Alzheimer’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. Don’t Despair – Become Aware

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