Download A study was conducted on status of risk factors for vascular dementia

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
01
NAME OF THE
MRS. GLORY L.P.
CANDIDATE AND
1ST YEAR M.SC NURSING
ADDRESS
RAJEEV COLLEGE OF NURSING
K.R.PURAM,HASSAN,KARNATAKA.
02
NAME OF THE INSTITUTE RAJEEV COLLEGE OF NURSING
K.R.PURAM,HASSAN,KARNATAKA
03
COURSE OF THE STUDY
MASTER IN NURSING
PSYCHAITRIC NURSING
04
DATE OF ADMISSION TO 15-07-2013
THE COURSE
05
TITLE OF THE STUDY
STRUCTURED TEACHING PROGRAMME ON
KNOWLEDGE REGARDING RISK FACTORS
AND PREVENTION OF VASCULAR
DEMENTIA AMONG III YEAR B.SC NURSING
STUDENTS OF SELECTED COLLEGES OF
HASSAN.
06
STATEMENT OF THE
A STUDY TO ASSESS THE EFFECTIVENESS
PROBLEM
OF STRUCTURED TEACHING PROGRAMME
ON KNOWLEDGE REGARDING RISK
FACTORS AND PREVENTION OF VASCULAR
DEMENTIA AMONG III YEAR B.SC NURSING
STUDENTS OF SELECTED COLLEGES OF
HASSAN.
1
6. BRIEF RESUME OF INTENDED WORK
“To keep heart unwrinkled to be hopeful, kindly, cheerful, and reverent –
Triumph over Old age.”
Thomas Bailey.
6.1 INTRODUCTION
Vascular dementia refers to a subtle, progressive decline in memory and cognitive
functioning. It occurs when the blood supply carrying oxygen and nutrients to the brain is
interrupted by a blocked or diseased vascular system. If blood supply is blocked for
longer than a few seconds, brain cells can die, causing damage to the cortex of the
brain—the area associated with learning, memory, and language. Depending on the
person, and the severity of the stroke or strokes, vascular dementia may come on
gradually or suddenly.1
Vascular dementia is the second most common form of dementia, accounting for
up to 40 percent of dementia cases in older adults. The damage in vascular dementia can
add up over time, leading to memory loss, confusion, and other signs of dementia. The
cause of vascular dementia is directly related to interruption of blood flow to the brain.
Symptoms result from death of nerve cells in regions nourished by diseased vessels.
Various diseases and conditions that interfere with blood circulation have also been
implicated.1
Vascular Dementia is also known as multi infarct dementia because of the under
lying cause – disruption in the cerebral blood flow. And there are also various other
causes which can interrupt the blood flow to the brain they are hemorrhage,
hypoperfusion, vaculities from auto immune infectious disease,
post surgical
complications. The various conditions causing Vascular Dementia are atherosclerosis,
arterial hypertension, cerebral emboli, and cerebral thrombosis.2
Vascular Dementia mainly causes Cognitive impairment and
their symptoms
shown by the patients include loss of motor function, loss of speech, Behavioral changes
like Paranoid, delusions, Hallucination, inattention to hygiene, belligerence etc.3
2
Vascular dementia affects different people in different ways and the speed of the
progression varies from person to person. Some symptoms may be similar to those of
other types of dementia and usually reflect increasing difficulty to perform everyday
activities like eating, dressing, or shopping.1
There are several other causes for vascular dementia which includes hypertension,
smoking, age, stroke small vessel diseases, Cholesterol and alcoholism, which can cause
cognitive, mental, emotional, Physical and as well as Behavioral impairment among the
elderly clients.4
Although there is no specific treatment for vascular Dementia, the prevention of
possible risk factors plays a very important role in prevention of occurrence of vascular
dementia. In order to achieve this prevention, Knowledge of the health care professionals
on risk factors and prevention of Dementia is very essential.1
Managing the symptoms of vascular dementia means learning practical ways to
manage memory loss, while staying as optimistic and realistic as possible. Although you
may not be able to bring back what’s lost, you can still find ways to make a challenging
situation easier.1
6.2 NEED FOR THE STUDY
Vascular Dementia or "multi-infarct dementia" is dementia caused by problems in
supply of blood to the brain, typically by a series of minor strokes. This type of dementia
was previously referred to as "multi-infarct dementia", and also hardening of the arteries.4
Vascular dementia is the second most common form of dementia in older adults. Multiinfarct dementia (MID) is thought to be an irreversible form of dementia, and its onset is
caused by a number of small strokes or sometimes, one large stroke preceded or followed
by other smaller strokes. The term refers to a group of syndromes caused by different
mechanisms all resulting in vascular lesions in the brain. Early detection and accurate
diagnosis are important, as vascular dementia is at least partially preventable.4
Vascular dementia is the second most common type of dementia in the United
States and Europe in the elderly, but it is the most common form in some parts of Asia.
The prevalence of the illness is 1.5% in Western countries and approximately 2.2% in
3
Japan. It accounts for 50% of all dementias in Japan, 20% to 40% in Europe and 15% in
Latin America.4
Vascular dementia accounts for up to 40 percent of dementia cases in older adults.1
And it is the most common cause of dementia in the elderly, second only to Alzheimer’s
disease (AD). Between 1% and 4% of people of 65 years of age suffer from VaD and the
prevalence appears to double every 5–10 years after the age of 65.55 The 5-year survival
rate is 39% for patients with vascular dementia.4
A Study was conducted on Prevalence and Pattern of cognitive impairement in
rural and urban populations from northern Portugal. The study identified 31 cases of
Dementia and equal proportion of Vascular Dementia and Alzheimer’s disease. Both
Vascular Dementia and Alzheimer’s disease were more prevalent in rural settings (R:U =
3.0 and 1.8, respectively), but Vascular Dementia was more prevalent in men than in
female with the ratio of (F:M = 0.3) and patients had a median age of 70.4years.6
A study was conducted on incidence and risk factors of Vascular Dementia and
Alzheimer’s disease in a defined elderly Japanese population. They observed 828 non
demented residents of Hisayama Town, Kyushu, Japan, aged 65 years or older for 7 years
in order to determine the type specific incidence of Dementia, vascular Dementia, and
Alzheimer’s disease.
The incidence of Vascular Dementia and Alzheimer’s disease
increased with age for both sexes. The age-adjusted total incidences (per 1,000 personyears) for Vascular Dementia were 12.2 for men and 9.0 for women, and for AD, 5.1 for
men and 10.9 for women. Among the Vascular Dementia subjects whose brain
morphology we examined, the most frequent type of stroke was multiple lacunar infarcts
(42%), but half these subjects lacked a stroke episode in their histories. Multivariate
analysis showed that age, prior stroke episodes, systolic blood pressure, and alcohol
consumption were significant independent risk factors for the occurrence of Vascular
Dementia. Findings of the study suggests that asymptomatic stroke is an important factor
in the development of Vascular Dementia, with age, prior stroke episodes, systolic blood
pressure, and alcohol consumption being independent risk factors for its occurrence.7
4
A study was conducted on the incidence of dementia, with an objective of carrying
out a meta-analysis of the age-specific incidence of all dementias, including vascular
dementia. The study results showed that incidence rates for vascular dementia varied
greatly from study to study, but the trend was also for an exponential rise with age. It was
found that men tended to have a higher incidence of vascular dementia at younger ages.8
A 7-year prospective study was conducted among 181 neurologically normal
elderly volunteers (mean age, 70.6 years) revealed an incidence of 3.3%, or 0.47% new
cases per year, for Alzheimer's disease (SDAT) and 5.5%, or 0.78% new cases per year,
for multi-infarct dementia (MID). The unusually high incidence of MID considered on
reflection for preselection of a large percentage of volunteers (48.6%) with risk factors for
(but without symptoms of) atherothrombotic stroke. Of 88 volunteers at risk of stroke,
11.4% developed MID within 7 years. In MID patients, cerebral blood flow (CBF) values
began to decline around 2 years before onset of symptoms.9
A study was conducted to examine temporal changes in the prevalence of
vascular dementia and associated factors. All publications on the epidemiology of
Vascular dementia were identified using a Medline search for the years 1966–1999.The
study Results showed that Alzheimer’s disease (AD) has become nearly twice as
prevalent as vascular dementia (VaD) in Korea, Japan, and China since transition in early
1990s. Prior to this, in the 1980s, VaD was more prevalent than AD in these countries.10
Managing the symptoms of vascular dementia requires practical learning. As
health care professionals though we are not able to provide a complete cure to Vascular
Dementia the only management is prevention. There are certain measures which can be
undertaken in prevention and as well as managing Vascular Dementia. They are
prevention of risk factors, promoting the clients safety, Promoting adequate sleep, proper
nutrition, hygiene and activity, structuring the environment, providing emotional support,
promoting interaction and involvement, and help in coping with memory loss and
confusion.11
Since the student nurses are found to have inadequate knowledge regarding risk
factors and Prevention of vascular Dementia hence the investigator feels that imparting
5
knowledge on risk factors and Prevention of Vascular Dementia would give rise to a
better management of the clients with Vascular Dementia and its Prevention.
6.3 STATEMENT OF THE PROBLEM
A Study to assess the effectiveness of structured teaching program on knowledge
regarding risk factors and prevention of Vascular Dementia among III year B.Sc nursing
Students of selected Colleges of Hassan.
6.4 OBJECTIVES
1. To assess the level of knowledge regarding risk factors and Prevention of
Vascular Dementia.
2. To implement the structured teaching programme on risk factors and
Prevention of Vascular Dementia.
3. To analyze the effectiveness of structured teaching programme on risk factors and
Prevention of Vascular dementia.
4. To associate the level of knowledge with the selected demographic variables.
6.5 HYPOTHESIS
H1: There is a significant increase in the knowledge score after administration of
Structured teaching Programme.
6.6 OPERATIONAL DEFINITION
1. Assess - It is the organized, systemic and continuous process of collecting data.
2. Effectiveness - Acquire knowledge about risk factors and Prevention of Vascular
Dementia.
3. Structured teaching program – It refers to the systematically planned teaching
Programme designed to provide information regarding risk factors and Prevention
of vascular Dementia.
4. Knowledge - It refers to awareness of risk factors and Prevention of Vascular
Dementia among IIIrd year B.Sc nursing Students.
6
5. Risk factors - The factors likely to cause vascular Dementia.
6. Prevention - The strategies adopted for avoiding the occurrence of Vascular
Dementia.
7. Vascular dementia - Vascular dementia refers to a subtle, progressive decline in
Memory and cognitive functioning. It occurs when the blood supply carrying
Oxygen and nutrients to the brain is interrupted by a blocked or diseased vascular
System. If blood supply is blocked for longer than a few seconds, brain cells can
die, causing damage to the cortex of the brain and the area associated with
Learning, memory, and language.
8. III year B.Sc nursing Students- students undergoing training for 4 years.
6.7 CONCEPTUAL FRAMEWORK
The Conceptual framework os based on “General System theory”.
6.8 DELIMITATIONS
The study is delimited to

6 weeks

III year B.Sc nursing Students of selected Colleges of Hassan.

60 Samples only.
6.9 REVIEW OF LITERATURE
Studies related to Incidence of Vascular Dementia.
A study was conducted on Incidence and Risk Factors in the Canadian Study of
Health and Aging where the incidence rates of VaD were determined and risk factors
analyzed. The risk factors were examined with a nested prospective case-control study.
Exposure was determined by means of a risk factor questionnaire administered to the
subject. For the risk factors study, 105 incident cases of VaD according to the NINCDSAIREN criteria were compared with 802 control subjects. Significant risk factors were:
7
age (OR=1.05), residing in a rural area (2.03), living in an institution (2.33), diabetes
(2.15), depression (2.41), apolipoprotein E ε4 (2.34), hypertension for women (2.05),
heart problems for men (2.52), taking aspirin (2.33), and occupational exposure to
pesticides or fertilizers (2.05). Protective factors were eating shellfish (0.46) and regular
exercise for women (0.46). There was no relation with sex, education, or alcohol. The
study confirmed some previously reported risk factors but also suggested new ones for
the development of vascular dementia.12
A cohort study was conducted to estimate the incidence of dementia, Alzheimer's
disease (AD), and vascular dementia (VaD) in older Italians and evaluate the relationship
of age, gender, and education to developing dementia. The dementia-free cohort was
examined in 1995 to identify incident cases. The Mini-Mental State Examination (cutoff
23 / 24) was employed to screen for dementia, Dementia cases were identified before the
follow-up examination, 127 new dementia cases were identified. Average incidence rates
per 1,000 person-years were 12.47 (95% confidence interval (CI) = 10.23–14.72) for
dementia, 6.55 (95% CI = 4.92–8.17) for AD, and 3.30 (95% CI = 2.14–4.45) for VaD.
Both AD and VaD showed age-dependent patterns. Education was protective against
dementia and AD. Women carried a significantly higher risk of developing AD (hazard
ratio = 1.67, 95% CI = 1.02–2.75), and men of developing VaD (hazard ratio = 2.23, 95%
CI = 1.06–4.71).The study concludes that burden of VaD, especially in men, offers
opportunities for prevention.13
Increased prevalence of vascular dementia in Japan
A door-to-door three-phase population survey was carried out on all persons aged
65 years and older residing at home on the prevalence day (January 1, 1997). The
ascertainment of cases was made between January 1997 and March 1998. The study
included
a
psychiatric
interview;
physical,
neurologic,
and
neuropsychologic
examinations; comprehensive laboratory tests; and cranial CT. A public health nurse also
interviewed a person close to each subject. The result of the study showed that of 1438
inhabitants, 1162 (81.0%) completed the protocol. The prevalence of dementia was 4.8%.
Of the 60 subjects with dementia, 35% had AD, 47% had VaD, and 17% had dementia
resulting from other causes. The prevalence of dementia was similar to previous reports,
8
but, contrary to results of virtually all studies conducted in developed countries and those
recently conducted in Japan, almost half of the cases in the present study appeared to have
VaD with neuroradiologic confirmation. 14
Studies related to risk factors of Vascular Dementia.
Hypertension and stroke are highly prevalent risk factors for cognitive
impairment and dementia. Alzheimer’s disease (AD) and vascular dementia (VaD) are the
most common forms of dementia, and both conditions are preceded by a stage of
cognitive impairment. Stroke is a major risk factor for the development of vascular
cognitive impairment (VCI) and VaD; Hypertension is a major risk factor for stroke, thus
linking hypertension to VCI and VaD, Reducing these two major, but modifiable, risk
factors—hypertension and stroke—could be a successful strategy for reducing the public
health burden of cognitive impairment and dementia. Intake of long-chain omega-3
polyunsaturated fatty acids (LC-n3-FA) and the manipulation of factors involved in the
renin–angiotensin system (e.g. angiotensin II or angiotensin-converting enzyme) have
been shown to reduce the risk of developing hypertension and stroke, thereby reducing
dementia and Vascular Dementia risk. This paper also reviewed the research conducted
on the relationship between hypertension, stroke, and dementia and also on the impact of
LC-n3-FA or antihypertensive treatments on risk factors for VCI, VaD, and AD.15
A population-based study was conducted with the purpose of examining if Type 2
diabetes mellitus is a risk factor for dementia in very old age, specifically for Alzheimer's
disease (AD) and vascular dementia (VaD).The study consisted of 702 individuals aged
80 years and older (mean age 83 years). A total of 187 persons received a dementia
diagnosis. Thirty-one individuals had a diabetes diagnosis prior to onset of the dementia.
Cox proportional hazard analyses, adjusted for age, gender, education, smoking habits,
and circulatory diseases, indicated an elevated risk to develop VaD (relative risk = 2.54,
95% confidence interval 1.354.78) in individuals with diabetes mellitus. No association
was found between diabetes and AD. Hence the study concludes that Type 2 diabetes is
selectively related to the different subtypes of dementia. There is no increased risk of AD
but more than a twofold risk of VaD in persons with diabetes.16
9
A prospective data was analyzed from a multiethnic population-based cohort of
21,123 members of a health care system who participated in a survey between 1978 and
1985. Diagnoses of dementia, AD, and VaD made in internal medicine, neurology, and
neuropsychology were collected from January 1, 1994, to July 31, 2008. Multivariate Cox
proportional hazards models were used to investigate the association between midlife
smoking and risk of dementia, AD, and VaD. A total of 5367 people (25.4%) were
diagnosed as having dementia (including 1136 cases of AD and 416 cases of VaD) during
a mean follow-up period of 23 years. Results were adjusted for age, sex, education, race,
marital status, hypertension, hyperlipidemia, body mass index, diabetes, heart disease,
stroke, and alcohol use. Compared with nonsmokers, those smoking more than 2 pack a
day had an elevated risk of dementia (adjusted hazard ratio [HR], 2.14; 95% CI, and 1.652.78), AD (adjusted HR, 2.57; 95% CI, 1.63-4.03) and VaD (adjusted HR, 2.72; 95% CI,
1.20-6.18). The result of the analysis showed that, in this large cohort, heavy smoking in
midlife was associated with a greater than 100% increase in risk of dementia, AD, and
VaD more than 2 decades later. These results suggest that the brain is not immune to
long-term consequences of heavy smoking.17
A prospective population-based Rotterdam Study was conducted. This Study
reported an association between plasma levels of inflammation markers and the risk of
vascular dementia. Both fibrinogen and C-reactive protein are considered inflammatory
markers. The researchers investigated the association of fibrinogen and C-reactive protein
with vascular dementia. The study based on the Fibrinogen was measured in a random
sample of 2835 persons. High-sensitivity C-reactive protein was measured in the total
cohort of 6713 persons. It was identified that 395 incident dementia cases during followup (mean, 5.7 years). Then estimation of the associations of fibrinogen and C-reactive
protein with dementia using Cox proportional hazard models was done. The results
showed that persons with higher levels of fibrinogen had an increased risk of dementia.
The hazard ratio for dementia per SD increase of fibrinogen was 1.26 (95% CI, 1.11 to
1.44), adjusted for age and gender, and 1.30 (95% CI, 1.13 to 1.50) after additional
adjustment for cardiovascular factors and stroke. For Alzheimer disease, the adjusted
hazard ratio was 1.25 (95% CI, 1.04 to 1.49), and for vascular dementia it was 1.76 (95%
10
CI, 1.34 to 2.30). Therefore study concluded that High fibrinogen levels were associated
with an increased risk of both Alzheimer disease and vascular dementia.18
A systematic review and meta-analysis was conducted to evaluate the risk of
incident all-cause dementia, Alzheimer’s disease and vascular dementia in individuals
with late-life depression in population-based prospective studies. A total of 23 studies
were included in the meta-analysis. Generic inverse variance method with a randomeffects model was used to calculate the pooled risk of dementia, Alzheimer’s disease and
vascular dementia in older adults with late-life depression. Late-life depression was
associated with a significant risk of all-cause dementia (1.85, 95% CI 1.672.04, P<0.001), Alzheimer’s disease (1.65, 95% CI 1.42-1.92, P<0.001) and vascular
dementia (2.52, 95% CI 1.77-3.59, P<0.001). Subgroup analysis, based on five studies,
showed that the risk of vascular dementia was significantly higher than for Alzheimer’s
disease (P = 0.03). Hence it was concluded that late-life depression is associated with an
increased risk for all-cause dementia, vascular dementia and Alzheimer’s disease.
Studies related to Prevention of Vascular Dementia
A study was conducted on Vascular Dementia Prevention: A Risk Factor
Analysis The study explained that brain injury from ischemic or hemorrhagic
cerebrovascular disease (CVD) produces decline in cognitive functions and vascular
dementia (VaD). Likewise, CVD may cause VaD from hypoperfusion of susceptible
brain areas. CVD may also worsen degenerative dementias such as Alzheimer’s disease.
Significant advances have been made in the identification and control of risk factors for
stroke and cardiovascular disease. The main risk factors for VaD include age,
hypertension and absence of antihypertensive medication, diabetes, cigarette smoking,
history of cardiovascular disease (coronary heart disease, congestive heart failure,
peripheral
vascular
disease),
hyperhomocysteinemia,
atrial
orthostatic
fibrillation,
left
hypotension,
ventricular
cardiac
hypertrophy,
arrhythmias,
hyperfibrinogenemia, and sleep apnea. Recently identified risk factors include chronic
infection and elevation of C-reactive protein, particularly in patients with diabetes.
Evidence from controlled clinical trials strongly suggests that control of vascular risk
11
factors, in particular hypertension, could prevent the development of vascular
dementia.20
A study was conducted on Vascular dementia. Advances in nosology, diagnosis,
treatment and prevention.Which explains that Ischemic or hemorrhagic cerebrovascular
disease (CVD) produces injury of brain regions important for executive function,
behavior, and memory leading to decline in cognitive functions and vascular dementia
(VaD). Cardiovascular disease may cause VaD from hypoperfusion of susceptible brain
areas. CVD may worsen degenerative dementias such as Alzheimer disease (AD). Risk
factors for VaD include age, hypertension, diabetes, smoking, cardiovascular disease
(coronary heart disease, congestive heart failure, peripheral vascular disease), atrial
fibrillation, left ventricular hypertrophy, hyperhomocysteinemia, orthostatic hypotension,
cardiac arrhythmias, hyperfibrinogenemia, sleep apnea, infection, and high C-reactive
protein. Research on biomarkers revealed increased CSF levels in VaD, Studies states that
vascular dementia responds to acetylcholinesterase inhibitors. Hence the evidence
strongly suggests that control of vascular risk factors, in particular hypertension, could
prevent VaD.21
A study was to conducted with a aim of conducting a meta-analysis of
epidemiological and case control studies to determine whether arterial hypertension is
specifically associated with an increased risk of vascular dementia (VaD).the study
included eleven studies recruiting either volunteers or clinical patients, or which were
population-based, examined a total of 768 people with VaD and 9857 control cases. A
meta-analysis of the six longitudinal studies showed that hypertension was significantly
associated with increased risk of incident VaD (odds ratio, OR: 1.59, CI: 1.29-1.95,
p < 0.0001). A similar association between hypertension and the risk of prevalent VaD
was found in the five cross-sectional studies (OR: 4.84, CI: 3.52-6.67, p < 0.00001). The
study concluded that hypertension significantly increases the risk of vascular dementia.
The current meta-analysis highlights the potential importance of rigorous treatment of
hypertension as a key measure to help prevent the development of VaD.22
12
Hypertension is a leading risk factor for vascular dementia. With the increasing
burden of dementia, prevention and delay of cognitive decline are becoming a priority.
Recent clinical trials have demonstrated that patients taking antihypertensive medications
have a reduced incidence of dementia and cognitive impairment. Calcium channel
blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers
appear to offer significant neuroprotection, even beyond blood pressure reduction.
Evidence is emerging that the angiotensin receptor blockers offer superior
neuroprotection Therefore the study conclded that use of angiotensin receptor blockers as
first-line therapy for hypertension and cognitive protection in the elderly should be
strongly considered23
Studies related to knowledge on risk factors and Prevention of Vascular Demention
A study was conducted on status of risk factors for vascular dementia the study
explains the two most common causes of vascular dementia (VAD) are dementia
evolving in connection with multiple small or large strokes and dementia related to
ischemic white-matter lesions (WMLs) of the brain. The knowledge about risk factors
for these disorders is still scarce. Besides sharing risk factors with stroke, dementia with
multiple small or large brain infarcts is also associated with non-vascular risk factors
such as high alcohol consumption, psychological stress in early life, lower formal
education, blue collar occupation, and occupational exposures. The main risk factors for
ischemic WMLs are hypertension or increased blood pressure, but WMLs have also been
associated with a number of other vascular risk factors. AD and cerebrovascular disease
may for instance share similar risk factors or etiologic pathways. The pathogenetic
implications for the association between AD and vascular factors need to be further
explored and the knowledge needs to be increased. There is also a need for more studies
on risk factors for VAD and risk factors for dementia in stroke samples, as well as
studies on non-vascular risk factors for ischemic WMLs.24
A randomised controlled trial was conducted which states that Early diagnosis of
dementia vascular dementia benefits both patient and caregiver. Nevertheless, dementia
and VaD in primary care is currently under-diagnosed. Some educational interventions
developed to improve dementia VaD diagnosis and management were successful in
13
increasing the number of dementia VaD diagnoses and in changing attitudes and
knowledge of health care staff. An an EASYcare-based Dementia Training Program
(DTP) was developed aimed at stimulating collaboration in dementia and Vad primary
care. We expect this program to increase the number of cognitive assessments and
dementia diagnoses and to improve attitudes and knowledge of nurses.in addition to this a
multifaceted dementia training programme was also developed. Novelties in this
programme are the training in fixed collaborative duos and the inclusion of an individual
coaching program. The intervention is designed according to international guidelines and
educational standards. Exploratory analysis will reveal its successful elements. Selection
bias and contamination may be threats to the reliability of future results of this trial.
Nevertheless, the results of this trial may provide useful information for policy makers
and developers of continuing medical education on dementia and VaD.25
7. MATERIALS AND METHOD OF STUDY
7.1 SIGNIFICANCE OF THE STUDY
The Purpose of the Study is to Improve Knowledge level of IIIrd year B.Sc
nusing students regarding risk factors and Prevention of Vascular Dementia.
7.2 SOURCE OF THE DATA
The data will be collected from IIIrd year B.Sc nursing Students.
7.3 RESEARCH DESIGN
Single group Pretest and post test desig
Group of 60 IIIrd
Pretest
Intervention
Post test
O1
X
O2
year B.Sc nursing
Students
E
14
Key;
E = Experimental group
O1= Pretest knowledge on risk factors and prevention of Vascular
Dementia.
X = Structured teaching Programme on risk factors and Prevention of
Vascular Dementia among IIIrd year B.Sc nursing Students.
O2=
Post
test
Knowledge
on
risk
factors
and
Prevention
of
Vascular Dementia
7.4 METHODS OF DATA COLLECTION
Questionnaire is selected as the suitable method to collect data .
7.5 SAMPLING PROCEDURE
7.5.1 INCLUSION CRITERIA AND EXCLUSION CRITERIA

Inclusion Criteria.
1. III year B.Sc nursing Students.
2. III year B.Sc nursing Students who are willing to Participate in the study
3. III year B.Sc nursing Students who are Present at the time of data
collection.

Exclusion critera.
1. III year B.Sc nursing students who are not willing to participate in the
study.
2.
Students who are not present at the time of data collection.
7.5.2 POPULATION
III year B.Sc nursing Students of selected colleges of Hassan.
15
7.5.3 SAMPLES
60 samples of IIIrd year B.Sc nursing Students who are fulfilling the
Inclusion criteria.
7.5.4 SAMPLE SIZE
Sample size is 60
7.5.5 SAMPLING TECHNIQUE
Non-Probability convenient sample will be used.
7.5.6 SETTING
The study will be conducted at selected Nursing colleges of Hassan.
7.5.7 PILOT STUDY
Pilot study is planned with 10% of the population
7.6 VARIABLES
- INDEPENDENT VARIABLE
Structured teaching Programme on risk factors and Prevention of
Vascular Dementia.
-DEPENDENT VARIABLE
Level of knowledge of III year B.Sc Nursing Student on risk factor
and Prevention of Vascular Dementia
7.7 PLAN FOR DATA ANALYSIS
Descriptive statistics: Demographic Variables, level of Knowledge on
Risk factors and prevention of Vascular Dementia will be given in
frequencies With their percentage. Risk factors and prevention of
Vascular Dementia Score will be given in mean and standard deviation.
16
Inferential statistics: pretest and post test differences on risk factors and
Prevention of Vascular Dementia knowledge score will be analyzed
using Student paired t- test, Mc Nemar Chi- square test. Association
between variables and level of knowledge on risk factors and prevention
Vascular Dementia among IIIrd year B.Sc nursing students will be
analysed using Pearson Chi- Square test.
7.8 ETHICAL CONSIDERATION
1. Does the study require any intervention or investigation to be conducted
On Patients or other human or animals?
Yes, intervention will be given to IIIrd year B.Sc nursing students, studying in
Selected colleges of Hassan.
2. Has ethical clearance being obtained from institution?
Yes, ethical Clearence has been obtained from the Principal.
3. Has the consent being obtained from the institution?
Yes, the consent has been obtained from the principal of nursing colleges of
Hassan.
4.
Has the consent being taken from the subjects?
Yes, Consent has been taken from the subjects.
17
8. LIST OF REFERENCES
1. www.helpguide.org/elder/vascular_dementia.htm.
2. Gail.w. Stuart, Michele T. Lararia. Principles of Psychaitric Nursing. 9th edition.
Published by Elsevier. P.no. 397.
3. Basavantappa .B.T. Psychaitric Mental Health Nursing. Jatpee brothers Publications
(P) Ltd. New Delhi. P. no. 581.
4. en.wikipedia.org/..Vascular dementia.
5. Catherine Mc Veigh, Peter Pass more. Clin interv Aging. 2006 September 1(3).229235.
6. Belina Nunes, Ricardo D Silva, Vitor T Cruz, Jose M Roriz,et.al, “Prevalence and
pattern of cognitive impairment in rural and urban populations from Northern
Portugal. BMC Neurol. 2010; 10: 42. Published online 2010 June 11.
7. T. Yoshitake, MD, Y. Kiyohara, MD, I. Kato MD, T. Ohmura, MD, H. Iwamoto,
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