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Melody Boonsompornkul

on 4 December 2014

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Transcript of Dementia

Early Dementia
While the pathophysiology of the most common forms of dementia [Alzheimer’s disease, vascular dementia, and dementia with Lewy bodies] is poorly understood, it is known that these forms are complicated by comorbidities. According to the Hartford Institute for Geriatric Nursing, dementia affects approximately 5% of individuals ages 65 and older. While four to five million Americans are afflicted with this disease, the global prevalence is approximately 24.3 million. As if this number were not terrifying enough, studies predict that by the year 2040, fourteen million people in the United States alone will have Alzheimer’s disease.
Staging Claudine's Progression (cont.)

Claudine is experiencing the third stage of cognitive decline at this point, also known as “mild cognitive decline.”
Some signs and symptoms specific to this stage that family members of Claudine have noticed include the following:
losing or misplacing objects with greater frequency
increasing trouble planning and organizing
noticeably greater difficulty performing tasks
trouble remembering answers to recently asked questions
Staging Claudine's Progression

According to the Alzheimer’s Foundation Web Site found at http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp, what stage of cognitive decline is Claudine experiencing at this point?
Case Study

Claudine is a 78 year old female who lives at home with her husband of 59 years. Her husband has noticed (but kept to himself) that Claudine increasingly asked him questions about things she previously had no trouble remembering and that she was misplacing things with greater frequency. At a family meal one Thanksgiving season, Claudine was having an unusual amount of difficulty organizing the meal and getting it ready to serve. She required recipes to follow for side dishes she had made from memory for decades.
Alzheimer's Disease

Without the ability to store, retain, and subsequently recall information and past experiences, who are we? How do we ever learn? Form new relationships and know when to retire old ones? Without memory we become a stunted being. The idea is a scary one but it is one that plagues nearly 5 million Americans every day.
Dementia Defined

Discuss the definition of dementia using the Hartford Institute for Geriatric Nursing Evidence Based Practice Web site at
http://consultgerirn.org/topics/dementia/want_to_know_more (Fletcher 2008)
What is the prevalence?
Dementia Defined (cont.)

Dementia is a cognitive disorder that results in memory impairment and disturbance in at least one other area, leading to possible development of the following disorders, among others:
Aphasia [inability to comprehend or express language]
Apraxia [inability to perform tasks or movement despite understanding the command]
Agnosia [inability to process sensory information]
Dementia Defined (cont.)

While the pathophysiology of the most common forms of dementia [Alzheimer’s disease, vascular dementia, and dementia with Lewy bodies] is poorly understood, it is known that these forms are complicated by comorbidities.
According to the Hartford Institute for Geriatric Nursing, dementia affects approximately 5% of individuals ages 65 and older. While four to five million Americans are afflicted with this disease, the global prevalence is approximately 24.3 million.
As if this number were not terrifying enough, studies predict that by the year 2040, fourteen million people in the United States alone will have Alzheimer’s disease.
Useful Websites for Alzheimer's Disease

After conducting an internet search, identify three reputable Web sites where Claudine’s family can obtain information about Alzheimer’s disease.
Useful Websites for Alzheimer's Disease (cont.)

Three reputable web sites where Claudine’s family can obtain information about Alzheimer’s disease include the following:
The Warning Signs

What warning signs (behaviors) for Alzheimer’s disease does the family find on the Alzheimer’s Association Web site at www.alz.org/10signs?
The Warning Signs (cont.)

The first 3 warning signs, “memory loss that disrupts daily life,” “challenges in planning or solving problems,” and, “difficulty completing familiar tasks at home, at work or at leisure” are all signs that apply to Claudine’s everyday life.
For the first warning sign, Claudine admits that her memory isn’t great. Also, her husband has noticed a decrease in her ability to recall certain information over the course of a year or more.
The second warning sign is evident by her inability to plan to set the table with traditional decorations.
The third warning sign is reflected in Claudine’s inability to create a meal using the same recipe that she has used for decades.
Diagnosing Alzheimer's

According to the Alzheimer’s Association at http://alz.org/alzheimers_disease_steps_to_diagnose.asp what kind of practitioner should Claudine visit?
Diagnosing Alzheimer's Disease

Claudine should visit a neurologist, who specializes in diseases of the brain and nervous system. Also, she should visit a psychologist, who will be able to test her memory and other mental functions.

Diagnosing Alzheimer's Disease (cont.)

According to Journal of Nuclear Medicine (JNM), we may be one step closer to diagnosing preclinical Alzheimer’s. Currently, there are FDA approved PET tracing agents that are able to bind to the nonspecific white matter in the brain, but none are approved to detect diffuse Beta-Amyloid plaques.
Plaques form when chemically sticky protein pieces called Beta-Amyloid clump together. This creation of plaques in the brains of Alzheimer’s patients blocks cell-to-cell synapses, thereby accounting for the causation of many of the distinctive signs in Alzheimer’s disease.
The JNM has published an article stating that they have discovered “a small fluorescent molecule that shows characteristics of translatable imaging agents, while also binding to the diffuse plaques in confirmed AD tissues.” This molecule binds to and “labels the parenchymal [functional tissue]βBeta-Amyloid plaques in the brains of transgenic mice within minutes of post-intravenous injection.” If approved by the FDA for further testing, this molecule could be key in developing an optimized Beta-Amyloid-targeted probe, which can be used to diagnose preclinical AD.
Recommended Treatments

What kinds of recommended treatments might Claudine’s family anticipate to slow the progression of Claudine’s disease? Find some of these at http://www.alz.org/alzheimers_disease_standard_prescriptions.asp
Recommended Treatments (cont.)

Cholinesterase inhibitors like Donepezil (Aricept), Rivastigmine (Exelon), and Galantamine (Razadyne) are approved to treat mild to moderate Alzheimer’s.
Cholinesterase inhibitors prevent the breakdown of acetylcholine, which is a chemical messenger that is essential for learning and memory function.
The medications will delay the worsening of symptoms for 6 to 12 months for roughly half of the people that take them.
Respite Care (cont.)

What could you tell the family about potential respite services for them?
Respite Care (cont.)

The different types of respite care include in-home care services, adult day centers and residential facilities.
A myriad of in-home care services are available. These services can be provided overnight or can last for several days. Some of these services include:
Companion services, which allows the patient an opportunity to interact with others.
Help with activities of daily living (ADLs) such as bathing, dressing, toileting, and meal preparations.
Skilled care service that provides medical aid.
Respite Care (cont.)

Adult day care centers can offer a safe environment for persons diagnosed with Alzheimer's Disease. Within these centers clients can participate in staff-planned activities, such as arts and crafts, music programs, and board games. Transportation and meals are often provided.
Residential facilities are able to accommodate the clients for a prolonged period of time. This allows the patient to be in safe environment away from the home while caregivers are away. The downside to this option is that it is usually not covered by insurance or Medicare, so families will need to find other ways to obtain the funds for these facilities.
Recommended Respite Care for Early Dementia

What are some reasons for which the nurse might recommend an adult day care center as a potential option for Mr. Everett to pursue?
Recommended Respite Care for Early Dementia (cont.)

Because Claudine is in the early stages of dementia, she is not yet socially withdrawn. She could benefit greatly from being in an adult day care setting. The activities, along with a safe environment and staff interaction, would be a perfect fit for her.

What are three questions you would advise the family to consider as they grapple with this issue?
Considerations (cont.)

Does Claudine know how to use the telephone in an emergency?
Does she show signs of agitation, depression, or withdrawal when left alone for any period of time?
Does she wander or become disoriented?
What are two actions Claudine’s family could take to promote safety in the home’s entryway?
Safety (cont.)

According to Home Safety for People with Alzheimer’s Disease, two actions could be to:
remove scattered rugs
use textured strips or nonskid wax on hardwood and tile floors to prevent slipping
Confronting the patient

What are your thoughts on how to best handle this situation in relation to Claudine knowing the truth?
Confronting the patient (cont.)

Everyone deserves to know the truth. According to the International Psychogeriatrics journal, “People with dementia typically experience progressive impairment in the acquisition and retention of new information or events, referred to as a deficit in episodic memory.” This should not stop the family from disclosing any information to Claudine - especially during the early stages of dementia. Claudine should be treated like any other patient when it comes to this matter. It is her right to know what is happening. Anything short of this is considered unethical.
Words Cited

Fletcher, K. (2008). Nursing standard of practice protocol:
Recognition and management of dementia. Hartford Institute of Geriatric Nursing. Retrieved from http://consultgerirn.org/topics/dementia/want_to_know_more
Home safety for people with Alzheimer’s disease (2010). National
Institute on Aging. (NIH Publication No. 02-5179). Retrieved from http://nia.nih.gov/Alzheimers/Publications/homesafety.htm#safe
Respite care. (2007). Alzheimer’s Association. Retrieved from http://
Stages of Alzheimer’s (2010). Alzheimer’s Association. Retrieved from
Standard treatments. (2010) Alzheimer’s Association. Retrieved from
Steps to diagnosis. (2010) Alzheimer’s Association. Retrieved from
Works Cited (cont.)

Fargo, K., & Bleiler, L. (2014). 2014 Alzheimer's disease facts and figures.
Alzheimer's and Dementia: The Journal of the Alzheimer's Association, 10(2), 47-92. Retrieved December 1, 2014, from Alzheimer's and Dementia.
Guruswami, S., Cairns, N., Moo Lee, J., & Sharma, V. (2014). Design and synthesis
of a novel PET probe for early detection of Alzheimer's disease -- Guruswami et al. 55 (1001): 137 -- Society of Nuclear Medicine Annual Meeting Abstracts. Retrieved December 1, 2014, from http://jnumedmtg.snmjournals.org/cgi/content/meeting_abstract/55/1_MeetingAbstracts/137
Home safety for people with Alzheimer's Disease. (2010) (1st ed., p. 11). Retrieved
from http://www.nia.nih.gov/sites/default/files/home_safety_for_people_with_alzheimers_disease_2.pdf
Smith, E. R., Broughton, M., Baker, R., Pachana, N. A., Angwin, A. J., Humphreys,
M. S., . . . Chenery, H. J. (2011). Memory and communication support in dementia: Research-based strategies for caregivers. International Psychogeriatrics, 23(2), 256-63. doi:http://dx.doi.org/10.1017/S1041610210001845
Maayan N, Soares-Weiser K, Lee H. Respite care for people with dementia and
their carers. Cochrane Database of Systematic Reviews 2014, Issue 1.
Erica Varela
Max Mitchell
Monica Leconte
Mel Boonsompornkul

Respite Care

Respite care is the temporary provision of care for a person with dementia. Care may be provided by trained and untrained staff or volunteers.
The care provided may also differ in duration, ranging from a couple of hours to a number of weeks. Respite care may be planned or unplanned and may involve overnight care or daytime-only care.
Ideally the patient and caregiver should be able to choose the type of respite care that suits them.
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