Slide 1Learning OutcomesSlide 3North Carolina Counties Percent 65+ Years Old in 2000North Carolina Counties Percent 65+ Years Old in 2030Facts About NC Older AdultsDementia??????Types of DementiaCostsSlide 10Functions of the brainVascular DementiaParkinson’s DementiaTemporal LobeFrontotemporal DementiaHIV/AIDS related dementiaNeurosyphilisHuntington’s diseaseCreutzfeldt-Jakob diseaseNeurotransmittersPrevalence of Alzheimer’sPlaques & Tangles in ADSlide 23Risk factors for ADProtective factors against ADSymptoms of ADCont.DiagnosisDementia MnemonicGlobal deterioration scaleCont.TreatmentsPrescribed treatmentsDrug interactionsPrognosisComplicationsReferencesDementiaFall 2013 Dr. Tamatha Arms, DNP, NP-CLearning Outcomes Discuss concepts related to cognition and memory in later life.Discuss the different types of dementia and appropriate diagnosis.Discuss common concerns in care of persons with dementia and nursing responses.Discuss strategies to enhance quality of life for caregivers of persons with dementia.North Carolina Counties Percent 65+ Years Old in 2000North Carolina Counties Percent 65+ Years Old in 2030Facts About NC Older AdultsIn 2000, 41.6% did not have a high school diploma. By 2005, this decreased to 32.8%.About 19% are minorities. Women age 75+ are twice as likely to be poor as men the same age.Five leading causes of death (2007) ◦Heart disease◦Cancer◦Stroke◦Chronic respiratory disease◦Alzheimer's Disease.Dementia?????? “Dementia is a general term that describes a group of symptoms-such as loss of memory, judgment, language, complex motor skills, and other intellectual function-caused by the permanent damage or death of the brain's nerve cells, or neurons.” Alzheimer’s Foundation of America Permanent & progressiveMild Cognitive Impairment (MCI) is earliest signsTypes of DementiaAlzheimer’s Disease (50-70%)Vascular (multi infarct) Parkinson’s Disease DementiaDementia with Lewy BodiesFrontotemporal Dementia (Pick’s Dz)Creutzfeldt-Jakob disease AIDS Dementia Complex (ADC)Tertiary Syphilis (Neurosyphillis)Korsakoff’s syndromeNormal Pressure HydrocephalusHuntington’s diseaseCostsHealthy People 2020 goal of reducing morbidity & costs associated and enhancing QOL with Dementia2010 worldwide cost of dementia was $604 billion.It costs $56,800 a year to care for a person with Alzheimer’s DiseaseFunctions of the brainVascular DementiaUsually follows a CVAMultiple vascular lesions in the cortex and subcortical areasDecline is a stair step fashion◦“good days” & “bad days” ◦Patients and families delay treatmentParkinson’s DementiaUsually a late onset Person has been diagnosed with Parkinson’s Disease for at least a year prior to dementia symptomsCommonly seen with Lewy Bodies Dementia◦Deposits of lewy bodies (a protein) in neurons in frontal & temporal cortex◦Visual hallucinationsTemporal Lobe Limbic System: Hippocampus & Amygdala – regulate emotion and memoryFrontotemporal DementiaAtrophy of frontal and temporal brainPeople are younger (40-70 yrs old) Significant changes in personality, behavior and languagePick’s Disease (most common type)◦Pick’s bodies build up in the brain Antidepressants (Trazodone & SSRIs)Antipsychotics for severe behaviorsHIV/AIDS related dementiaAlso called AIDS Dementia Complex (ADC)Damage is related to proinflammatory toxins and NOT direct effects of HIVIn persons with advanced stages of AIDS◦ADC is presentation of HIV in 4-15% of patients with HIVPerson with HIV / AIDS presents with apathy, cognitive and motor problemsOften misdiagnosed as Major Depressive Disorder Early & aggressive treatment can reduce risk of ADC by 50%!NeurosyphilisAlso called Tertiary Syphilis Occurs ~20 yrs after a person has been affected by Syphilis and did not receive treatment◦Can happen up to 50 yrs later!!RPR & VDRL are blood test for syphilisSymptoms are slow & progressiveTreated by IV PCN◦Dementia symptoms can be reverse to a certain extentHuntington’s diseaseCaused by Autosomal dominant gene on Chromosome 4Risk for children is 50%Onset between ages 30 – 50Clinical presentation: ◦Insidious onset ◦Disruption of attention◦Choreiform movementsCreutzfeldt-Jakob diseaseInfecting agent known as a prion causes spongiform encephalopathy Bovine Spongiform Encephalopathy (BSE) – “mad cow disease”Transmissible by blood & body fluidsVery rapid course with death usually within 1 year*personality changes are 1st symptomGenetic component in 10-15% of casesNeurotransmittersDementia is related to a decline in the brain’s level of Acetylcholine (Ach) which is essential to learning & memory.◦Cholinesterase inhibitorsGlutamate overactivity ◦Causes neurodegeneration and atrophy of the brain◦NamendaPrevalence of Alzheimer’s5.4 million people ≥65 yrs old AND 200,000 < 65 yrs old have Alzheimer’s Disease just in the United States!!!!!!This is projected to Quadruple by 2050 (about 20% of the population)Risk doubles every 5 years >65 yrs oldNC has >170,000 adults with dementia◦By 2030 this is projected to be >300,000◦70% are cared for at homePlaques & Tangles in ADPlaques are “clumps of protein” called beta-amyloid. Tangles are caused by tau (a protein) that twists upon itself and cause failure of the brain to transport essential nutrients & materials◦Both of these cause death of brain cellsRisk factors for ADIncreasing ageGenetic predispositionApolipoprotein e4 (APOE e4) gene has the strongest linkWomen > menPast head trauma Same modifiable risk factors as heart diseaseProtective factors against ADLiving a healthy lifestyleLife long learning◦Higher levels of formal education◦Mentally challenging leisure activities such as learning to play a musical instrumentSocial engagementSymptoms of ADProgressive and increased forgetfulnessMild confusionDifficulty concentrating & organizing thoughts & sequencing◦Difficulty with IADLsRepeating statements / questionsSimple tasks become overwhelmingly difficulty & challengingChanges in personality & behavior◦Social withdrawal, paranoia (distrust), irritability, wandering, loss of