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DEMENTIA       Dementia is not a disease, but rather is a symptom of a number of different disorder People with dementia have significantly impaired intellectual functioning that interferes with the normal activities and relationship They also lose their ability to solve problems and maintain emotional control They may experience personality changes and behavioral problems (agitation, delusion and hallucination) Memory loss is common symptoms but it does not mean that a person has dementia if he has memory loss Dementia are more likely to develop alzheimer’s disease (if the client have a mild cognitive impairment or MCI)

Etiology and Pathophysiology      Multiple “ministrokes” (multi-infarct dementia or vascular dementia) is common cause of dementia Chronic alcoholism, neurological infection, head injuries and many medications can cause changes in mental status leading to dementia Aging is associated with more frequent dementia diagnosis, dementia is not a normal part of aging In general, thinking is affected by changes in the brain that result from reduced blood flow or from structural changes related to disease states Some studies indicate that patient who have more education, have higher socioeconomic status and engage in stimulating intellectual activities are less likely to develop dementia because they develop a sort of “cognitive reserve” that keep them functioning in a high level

Signs and Symptoms      Most people have occasional memory lapses Recent memories are usually affected first Patient may easily recall an event or a phone number from childhood Later in the course of dementia even remote memory may be lost Patient may develop aphasia

Diagnostic Tests   Diagnosis of dementia is twofold: 1. Dementia must be identified 2. Then the focus moves to finding the cause of the mental status change Neuropsychological testing can determine the degree of memory, personality, and behaviour changes

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Patient should also be tested for depression since it can cause mental status change A review of medication may reveal to contribute to mental changes:  Anticholinergic agents (atropine, some antihistamine)  Analgesics (meperidine, morphine)  Cimetidine (tagamet)  CNS depressant ( sleeping pills, tranquilizers, alcohol)  Steroids (cortisone, prednisone) MRI, CT scan, PET, blood test help diagnose underlying cause

Therapeutic Interventions  Medication maybe used to delay some types of dementia:  Cholinesterase inhibitors – inhibits cholinesterase to improve function of acetylcholine in CNS (eg. Donepezil (Aricept), Tacrine (Cognex)  NMDA Antagonists – reduces binding of glutamate, an excitatory neurotransmitter (eg. Menantine (namenda)  If medical treatment cannot the course of the disease, the focus will shift to delaying progression of symptoms and maintaining patient safety  Excellent nursing care are essential for both patient and family

Carandang, Renz Bryan H. BSN IV-2 Group 6

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