DEMENTIA

Dementia IS NOT a specific disease.

Dementia is a GROUP OF SYMPTOMS

affecting intellectual and social abilities severely

enough to interfere with daily functioning.

There are many causes of dementia

symptoms.

Alzheimer's disease is the most common

cause of a progressive dementia.

Memory loss generally occurs in dementia, but memory loss alone does not imply you have dementia.

Normal Aging

Mild Cognitive Decline (MCD)

Dementia

PROGRESSSIVE BRAIN DETERIORATION

Normal

Cognitive Decline

Mild Cognitive Decline (MCD)

Dementia

Normal cognitive decline associated with age:*Structural changes –size, weight and neurons*Varying degrees of cortical atrophy *Memory and speed of processing decline

Normal Aging

Mild Cognitive Decline (MCD)

Dementia

Transitional Phase-increased probability of developing dementia AGE-INCREASES PROBABILITY!Amnestic type: memory impairment (without the generalized deficits) Non-amnestic: other domain is affected

Normal Cognitive Decline

Mild Cognitive Decline (MCD)

DementiaBehavioural Syndrome with cognitive and emotional symptoms that affect everyday life.Memory impairment + Other cognitive impairments More than 50 known causesGenerally Progressive

Develops due to brain disease

Chronic and progressive in nature

Consciousness remaining intact

Deterioration of higher order cognitive functioning

Disturbances in social behaviour, emotional control and motivation

The essential feature of any dementia is the development of multiple cognitive deficits that include: • memory impairment

and at least one of the following cognitive disturbances:

• aphasia (language disturbance), • apraxia (impaired ability to carry out motor activities despite intact motor function), • agnosia (failure to recognize or identify objects despite intact sensory function), and• executive dysfunction (difficulty in planning, organizing, sequencing, abstracting).

The deficits must also be sufficiently severe and must represent a decline from a previously higher level of functioning.

The diagnosis of dementia may be accompanied by subtypes and specifiers such as• Early (before the age of 65) or Late Onset (after 65)• With Behavioral Disturbance (e.g., wandering, striking out during care); • With Delirium (if delirium is superimposed on dementia); • With Delusions (if delusions are most prominent feature); • With Depressed Mood (if depressed mood is most prominent feature); and • Uncomplicated (if none of the aforementioned predominates the clinical presentation).

WARNING SIGNS

Memory loss that disrupts

daily functioning

Challenges in planning or

solving problems

Difficulty completing

familiar tasks at home, at work or at

leisure

Confusion with time or place

Trouble understanding visual images

and spatial relationships

New problems with words in

speaking or writing

Misplacing things and losing the ability to

retrace steps

Decreased or poor judgment

Withdrawal from work or

social activities

Changes in mood and

personality

CLINICAL DEMENTIA RATING SCALENONE

(O)QUESTIO-NNABLE (0.5)

MILD(1)

MODERATE (2) SEVERE (3)

MEMORY OK CONSISTENTFORGETFULNESS

MEMORY LOSS FOR RECENT EVENTS

ONLY HIGH LEARNINGMATERIAL RETAINED

ONLY FRAGMENTSREMAIN

ORIENTATI-ON FULLY DIFFICULTYWITH TIME

GEOGRAPHIC TIME AND PLACE

ONLY PERSON

JUDGEME-NTAND PROBLEM SOLVING

GOOD SLIGHT IMPAIRMENT

SOCIAL JUDGMENT OK, DIFFICULTIES WITH SIMILARITIES AND DIFFERENCES

ISSUES WITH SOCIAL JUDGEMENTSEVERELY IMPAIRED PROBLEM SOLVING

UNABLE TO MAKE JUDGEMENTS

NONE 0

QUESTIONA-BLE 0.5

MILD 1

MODERA-TE 2

SEVERE 3

COMMUNITY AFFAIRS

Independent to work, shop and have social life

Slight impairment

Unable to be independent but still engaged

Well at home but not outside

No responsibilities in or out the home

HOME & HOBBIES

Maintained Slight impairment

Complicated hobbies or chores abandoned

Only simple chores maintained. Low interest

No function

PERSONAL CARE

Fully capable Fully capable Needs prompting

Need assistance

Help with personal care & incontinence

CORTICAL

• ALZHEIMER’S DISEASE

• Genetic hypothesis: chromosomes 1, 14, 21

• Neuropathology: cortical atrophy, amyloid plaques and neurofibrillary tangles

• General cognitive decline with severe memory impairment

SUBCORTICAL

• Huntington’s Disease

• Genetic: ITI5 on chromosome 4. Abnormal repetitions

• Neuropathology: deterioration of the caudate nucleus, globuspallidus, putamen and striatum

• Motor functioning and frontal functioning affected

&NeurofibrillaryTangles

AMYLOID PLAQUES

NEUROANATOMY OF ALZHEIMER’S DISEASE…

NEUROANATOMY OF HUNTINGTON’S DISEASE…

STATIC

• Heavy Metal Poisoning

• The whole system is affected, including the brain

• Cognitive decline and behavioural changes that can be stopped by ending the exposure or with detox treatment

PROGRESSIVE

• Vascular Dementia

• Blood supply is affected (multi-infarcts)

• Damage to multiple areas of the brain

• Cognitive decline + hallucinations/delusions , personality changes

REVERSIBLE

• Severe Anemia

• Memory loss (holes).

• Cognitive decline similar to AD

• Lack of vitamin B12 that can be reverted with treatment

IRREVERSIBLE

• Parkinson’s Dementia

• Motor symptoms of tremor, rigidity, and slowness of movement.

• Loss of dopamine from the substantia nigra

memory

language

thoughtnavigation

behavior

personality / mood

PSYCHOLOGICAL AND BEHAVIOURAL DISTURBANCES

Depression

• Reaction to early cognitive decline

• Less prevalent in severe dementia due to impaired awareness

• Vascular dementia more susceptible

• Early Onset-Dementia as a predictor of severity

Psychotic

Disturbances

• Approximately 50% will display disturbances

• DELUSIONS- 1/3 will display persecutory delusions not attributed to memory impairment

• Moderate Level

• HALLUCINATIONS- less frequent

• More significant relationship with cognitive decline

• Associated with a rapid decline at a more severe stage

Behavioural Problems

• Agitation, irritability, fatigue, tiredness, apathy, psychomotor behaviours, anxiety and sadness.

• AD patients with co-morbid psychotic symptoms more likely to display severe aggression and behaviour problems

• Pre-morbid communication emulated

• RISK FACTORS:

• Genetics, personality variables, location of deterioration

• Social implications on self and caregiver

Shultz (2004) defines the role of

caregiving as:

“… the provision of extraordinary care,

exceeding the bounds

of what is normative or usual in family

relationships. Caregiving

typically involves a significant

expenditure of time, energy, and

money over potentially long periods of

time; it involves tasks that

may be unpleasant and uncomfortable

and are psychologically

stressful and physically exhausting”

(259).

“Stigma is an attribute, behaviour, or reputation which is socially

discrediting in a particular way: it causes an individual to be

mentally classified by others in an undesirable, rejected

stereotype rather than in an accepted , normal one” (Goffman,

1963, as cited in Batsch, & Mittelman, 2012).

COMBATING STIGMA

CAREGIVER & PATIENT

COUNSELLING FOR ACCEPTANCE

RAISE AWARENESS –CAMPAIGNS, EDUCATIONAL

PROGRAMS

INVOLVE MEDIA, GOVERNMENT,O

THER STRUCTURAL

SERVICES

-2011, 5.5 million individuals living with HIV in S.A

Risk Factors: lower CD4 count, older age, lower

levels of education, depression, substance

abuse .

Prevalence: 25.4% of adults living with HIV met

the criteria for HAD.

Consequences: In addition to HIV,

cognitive impairments such as poor concentration,

attention and executive functioning

Challenges when screening for

HAD:language, culture, inadequate resources.,

inappropriate tools, untrained staff.

-International HIV Dementia Scale

(IHDS)

Sample of 65 non-adherent HIV

patients

8O% screened positive for HAD

FREQUENTLY ENGAGE IN MENTALLY STIMULATING ACTIVITIES

REGULAR PHYSICAL ACTIVITY

NUTRITIONAL DIETS, MODERATE-LOW ALCOHOL INTAKE

ENGAGE IN SOCIAL ACTIVITIES

TAKING CARE OF MENTAL

HEALTH

• Nerve growth factor (NGF)

• No fewer than 10 drugs

• Cognitive training

• Reality orientation

• Reminiscence therapy

• Cognitive rehabilitation

• Psychodynamic Therapy

• Support groups

•Public education

•Training professionals

•Developing programs

•Integrating services