Download Progressive Symptoms of AD - Arrowhead Area Agency on Aging

Interventions to Minimize Behavioral
Symptoms of Dementia:
Moving Beyond Redirection
Part I
Margaret Hoberg MSN, GNP-BC
Siobhan McMahon MSN MPH GNP-BC
Objectives
Learning Objectives
1.
Explain the effects of dementia on thinking, emotions and
communication
2.
Use a theory to help explain behavioral and communication changes
associated with dementia and to guide interventions
3.
Respond to behavioral changes with a calm, validating approach
4.
Comprehensively assess verbal and nonverbal messages, including those
that are associated with stress
5.
Develop a plan whose non-pharmacological interventions reflect an
understanding of and respect for the person and their preferences.
Clara
 91-year-old woman
 AD (recent MMSE score 12)
 “Severe agitation” per LPN who is passing meds A few hours
ago she hit another resident.
 CNA adds she has been irritable and pacing.
 The night CNA also notes she has been having trouble sleeping
and has expressed feelings that others
 She has heart disease and mild COPD. She has a history of
recurrent UTIs .
 Clara cooperates at times, but when left in her room, she
wanders the hall, seeming confused. When “redirected” to her
room, she insists that she had to go home and would refuses
assistance with care.
What is the most appropriate next step in
the care of Clara?
(A) Administer prn lorazepam .5mg-1 mg intramuscularly,
sublingual or po
(B) Administer haloperidol 1 mg intramuscularly or po
(C) Ask family member, nurse or CNA to spend one-on-one
time with her; begin a thorough assessment for acute
illness and unmet physical need.
(D ) Restrain Clara to obtain a blood and urine work-up
What is the most appropriate next step in the care
of Clara?
(A) Administer lorazepam 1 mg intramuscularly,
sublingual or po
(B) Administer haloperidol 1 mg intramuscularly
or po
(C) Ask family member, nurse or CNA to spend
one-on-one time with her; begin a thorough
assessment for acute illness and unmet physical
emotional or social needs.
(D) Restrain the patient to obtain a blood and
urine work-up
Dementia Statistics
5.3 million
7th leading cause of death
Risk >65:



9.1 % men/
17.2% women


Risk: Over age 85

12.1% men
20.3% women



Long term care


AL 45-67 % with some dementia
41 % with moderate to severe
cognitive impairment
Memory / Cognitive Changes
• Normal aging
• Mild cognitive impairment
• Delirium (e.g. acute infection)
• Other medical / health causes (B12 deficiency;
•
•
•
•
•
thyroid dysfunction)
Depression
Alzheimer’s disease
Vascular (multi-infarct) dementia
Dementia associated with Lewy bodies
Other (alcohol, frontotemporal dementia,
Parkinson’s Disease, Neurosyphilis)
Dementia
PERSISTENT AND PROGRESSIVE
Alzheimer’s disease
 Alzheimer’s disease (AD) is an irreversible,
progressive brain disease that slowly destroys
memory and thinking skills and the ability to carry
out the simplest tasks of daily living. In most
people with AD, symptoms first appear after age
60.
 AD is the most common cause of dementia among
older people, but it is not a normal part of aging.
Cause of Alzheimer’s Dementia
 Amyloid plaques and neurofibrillary tangles
which start in area of brain affecting memory
and spread to other areas
 Gradual loss of connections between nerve cells
(neurons) in the brain. This loss leads to
diminished cell function and cell death.
 Read more about Alzheimer’s Disease by
connecting to this link:
 Alzheimer's
Association Web Page with
Description of Alzheimer's Dementia
Causes of Vascular Dementia
 Complete blockage of blood vessels in the brain. The complete
blockage of an artery in the brain usually causes a stroke, but some
blockages don't produce stroke. These "silent brain infarctions"
increase a person's risk of vascular dementia. The risk increases with
the number of infarctions experienced over time. One variety of
vascular dementia is called multi-infarct dementia. Heart disease and
irregular heart rhythms, such as atrial fibrillation, can increase your
risk of stroke.
 Narrowing of the blood vessels in the brain. Vascular dementia also
can occur without a complete blockage of an artery. Portions of the
brain can be starved for oxygen and food by reduced blood flow from
arteries narrowed by vascular disease.
 Vascular dementia can also be caused by: very low blood pressure,
bleeding brain, blood vessel damage from such disorders as lupus
erythematosus or temporal arteritis
Other conditions that cause memory loss or
dementia
 medication side effects
 chronic alcoholism
 certain tumors and infections in the brain
 blood clots in the brain
 vitamin B12 deficiency
 dehydration
 high fever
 some thyroid, kidney, or liver disorders
Dementia symptoms
 Memory impairment- getting lost in familiar settings,
forgetting previous conversations, names, faces
 Language impairment- difficulty finding words or
following conversation, inability to communicate needs and preferences
through verbal means
 Apraxia-unable to perform previously learned tasks such as not
knowing how to drink from a cup even though person may have sensory
and physical ability intact
 Agnosia-unable to recognize objects or other sensory stimuli
 Impaired executive function- poor planning and
judgement, difficulty solving problems
Progressive Symptoms of AD
Mild
Moderate
 Memory problems
 Getting lost
 Difficulty handling
 Increased memory loss
 Problems recognizing




money or medications
Taking a longer time
than usual completing a
task
Poor judgment
Losing things
Mood changes





family and friends
Inability to learn new
things
Difficulty carrying out
routine multi-step tasks
Problems coping with new
situations
Impulsive
Delusions and paranoia
Progressive Symptoms of AD
Severe
 Difficulty recognizing
 Difficulty swallowing
one self or family
 Inability to verbally
communicate
 Weight loss
 Seizures
 Groaning
 Moaning
 Increased sleeping
 Loss of bladder and
bowel control