Demensia

Main ideas, concepts, and lessons

1) What dementia is (definition and key features)

• Dementia is a term for several diseases that affect:
  • Memory
  • Thinking/cognition
  • Ability to perform daily activities
• Dementia is not caused by a single cause; rather, it is a syndrome/clinical pattern seen in multiple types of diseases.
• Core cognitive domains commonly affected include:
  • Memory
  • Language skills
  • Problem solving
  • Focus/attention
  • Other cognitive abilities that support daily functioning
• Cognitive changes can also affect social functioning.

2) Classification and diagnostic framing

• DSM-5 categorizes dementia under major neurocognitive disorder for diagnosis.

3) Prevalence and global burden (WHO data)

• Every 3 seconds, someone in the world develops dementia.
• 2020: >55 million people living with dementia
• 2030: 78 million (noted as “5 years away” in the lecture timeline)
• 2050: 139 million
• The largest increases are expected in developing countries.
• 60% of sufferers live in low- and middle-income countries.
• Key lesson: dementia is a major challenge—especially in developing settings—due to scale and resource needs.

Dementia presents a growing global burden, with the steepest impact expected where healthcare resources are most limited.

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Causes and types of dementia (detailed list)

A) Causes of dementia (Kaplan and Sadock referenced)

1. Degenerative dementia
   • Examples mentioned:
     • Alzheimer’s disease
     • “Fick’s” disease (as transcribed—likely an alternate name/term)
     • Parkinson’s disease
     • Progressive supranuclear palsy
     • Wilson’s disease
2. Drug/toxicology-triggered dementia
   • Examples mentioned:
     • Alcohol
     • Heavy metals
     • Carbon monoxide poisoning
     • Drugs/substances
     • Radiation
3. Tumor-related dementia
   • Especially primary brain tumors
4. Trauma-related dementia
   • Examples mentioned:
     • Traffic accidents
     • Head injuries
5. Physiologic/medical conditions
   • Examples mentioned:
     • Epilepsy
     • Hydrosvalus (likely hydrocephalus based on transcription context)
     • Increased pressure beyond normal conditions
6. Chronic infection-related
   • Examples mentioned:
     • Vitamin deficiencies
     • Chronic metabolic disorders
     • Chronic anoxia
     • Chronic endocrinopathy
7. Congenital causes
   • Examples mentioned:
     • Huntington’s disease
     • Metachromatic leukodystrophy

B) Types based on cause (Thonsen/Thonson referenced)

• Primary dementia
  • Dementia is the main sign of an organic brain disease.
  • Not directly related to other organic diseases.
  • Example: dementia due to Alzheimer’s.
• Secondary dementia
  • Dementia caused by other diseases.
  • Examples: HIV, brain trauma.

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Major dementia examples discussed (symptoms and mechanisms)

1) Alzheimer’s dementia

• Most common type of dementia.
• Proportion stated:
  • Around 2/3 of cases among elderly aged 65+.
• Described as:
  • Neurodegenerative
  • Progressive and “dangerous” decline in brain/nerve function
• Affected functions:
  • Memory
  • Understanding
  • Language
  • Attention
  • Reasoning
  • Judgment
• Teaching point:
  • Examination images compare Alzheimer-affected organs/brain vs normal.

2) Vascular dementia

• Dementia resulting from problems with blood flow in the brain.
• Examples mentioned:
  • Cerebrovascular disease (CVD)
  • Stroke
• Symptom logic:
  • If part of the brain is not vascularized properly, that region cannot function → dementia-like symptoms.
• Examples of symptoms linked to vascular damage:
  • Weakness
  • Difficulty speaking (including aphasia)
• Imaging example:
  • Hemorrhagic CVD (ruptured blood vessel → increased intracranial pressure → impacts cognitive areas).

3) Dementia due to HIV

• Key concept: HIV can lead to dementia symptoms when it attacks the brain and nervous system.
• Teaching point:
  • Symptoms depend on which system is attacked.

4) Dementia due to head injury

• Repeated head injuries often lead to dementia.
• Example given:
  • Boxers
• Early symptoms:
  • Emotional changes
  • Speech/language problems (including dysarthria)
  • Ataxia
  • Increased impulsivity

5) Dementia related to Lewy body disease

• More specific symptoms beyond memory/cognition:
  • Fluctuating cognitive problems
  • Hallucinations (especially visual hallucinations)
  • Parkinson’s symptoms
  • Sleep problems
  • Autonomic dysfunction
• Reference cited:
  • Andresen and Black (2006): Lewy bodies visible in cerebral cortex and brainstem.

6) Dementia due to Parkinson’s disease

• Parkinson’s described as loss of nerve cells in the substantia (transcription appears incomplete; context suggests substantia nigra/basal ganglia region).
• Symptoms described as similar to Alzheimer’s (similar sign/symptom pattern).
• Teaching point:
  • Neuroanatomy differences (missing region) shown in lecture images.

7) Other diseases/conditions that can cause dementia

• Mentioned contributors/associations:
  • Hypoglycemia
  • Hypothyroidism
  • Lung disease
  • Liver failure
  • Kidney failure
  • Cardiopulmonary insufficiency
  • Fluid/electrolyte imbalance
  • Nutritional deficiencies
  • Frontal and temporal lobe lesions
  • Central nervous system infections
  • Uncontrolled epilepsy
  • Multiple sclerosis

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Symptoms and behavioral changes of dementia (as taught)

Primary/major signs and symptoms

• Memory disorders
  • Unable to recall new or old memories
  • Example:
    • Forgetting names/terms (e.g., forgetting what food is called while still recalling appearance/taste)
• Difficulty with abstract thinking, judgment, and impulse control
  • Example: cause-and-effect reasoning (e.g., when it’s cloudy, bring an umbrella)
• Language disorders
  • Difficulty naming objects
  • Difficulty speaking
• Personality changes
  • Can shift from extrovert ↔ introvert
• Apraxia
  • Inability to perform movements even though motor ability remains relatively intact
• Disorientation
  • Confusion about time, place, or people
  • May lead to wandering and getting lost
• Delusions of persecution
  • Example logic:
    • Not remembering identity/origin → fear/anxiety increases

Behavioral changes (examples listed)

• Easily irritated
• Easily worried
• Easily angry
• Loss of interest in previously enjoyed activities
• Loss of care/concern for other people
• Suspiciousness or excessive fear
• Progression described as:
  • Anger → wandering → irritability/paranoia → aggression
• Changes in sexual behavior
• Sleep disturbances at night
• Hiding objects / paranoid accusations (e.g., accusing others of hiding things)
• Wandering and restlessness

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Nursing focus: assessment, nursing diagnosis, and interventions (methodology/instructions)

A) Nursing approach and assessment priorities

• Because dementia is linked to organic brain/organ disorders, nurses should do:
  • Comprehensive assessment
  • Mental/psychosocial nursing care
• Assess both:
  1. Physical condition
     • Use Gordon’s 11 patterns (mentioned explicitly)
  2. Psychological/psychosocial side
     • Evaluate cognitive and psychosocial aspects using assessment tools

B) Cognitive assessment instruments (tools named)

• RUDAS (Universal Dementia Assessment Scale, as transcribed)
• MMSE (Mini Mental State Examination)
• These assess:
  • Memory
  • Speech
  • Language
  • Decision-making
  • Attention/focus
  • Other cognition-related domains

C) Psychosocial assessment targets

• Determine whether the illness impacts:
  • Feelings
  • Emotions
  • Thinking
• Assess:
  • What the patient feels
  • How coping is used (e.g., responses when anxious/forgetful; emotional instability)
• Identify methods used to reduce anxiety:
  • What helps the patient when anxious or confused
• Assess self-concept:
  • Changes due to reduced social function
  • Personality shifts
• Assess relevant physical aspects too, because dementia may be caused by other diseases (hence the comprehensive assessment).

D) Nursing problems / nursing diagnosis mentioned

Potential nursing diagnosis/problems listed:

• Risk of trauma
• Self-care deficits
• Sensory perception disorders, especially hallucinations
• Low self-esteem

E) Caregiver considerations (lesson/instruction)

• Dementia is often experienced by the elderly → requires a caregiver.
• Care is long-term, so caregivers need sufficient abilities/competence.

F) Behavioral change management strategies for caregivers (step-by-step)

• Be patient
  • Avoid showing frustration when the person forgets repeatedly.
• Avoid arguments
  • Arguments can trigger emotional escalation.
• Identify triggers
  • Check whether routine disruptions occurred (e.g., delayed meals → behavioral change → confusion).
  • Reason given: memory decline can cause confusion when routines shift.
• Use distraction techniques
  • Redirect attention to a new object/activity, such as:
    • Listening to music
    • Reading a book
    • Going for a walk
• Reframe negative behavior
  • Treat behavior as communication:
    • Anger may signal pain, confusion, or fear.
  • Caregiver mindset affects care quality.
• Prevent caregiver burnout
  • Encourage discussion with family members.
  • Recommend support groups for dementia caregivers so they can share successful strategies and reduce isolated burden.
• Emphasized risk:
  • If a caregiver “gives up quickly,” patient care may worsen and caregiver burden may increase (mental, physical, emotional, etc.).

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Sources / speakers identified

• Mrs. Ayu (primary speaker/lecturer)
• DSM-5 (diagnostic framing)
• WHO (prevalence statistics)
• Kaplan and Sadok (causes of dementia)
• Thonsen/Thonson (primary vs secondary dementia types)
• Andresen and Black (2006) (Lewy body disease description)