Question

Scenario

You are the nurse working triage in the emergency department (ED). This afternoon a woman brings in her father, ALI, a 72-year-old who is a retired doctor. The daughter reports that over the past several months she has noticed her father has progressively had problems with his mental capacity. These changes have developed gradually but seem to be getting worse. At times he is alert, and at other times he seems disoriented, depressed, and tearful. He is forgetting things and doing things out of the ordinary, such as placing the milk in the cupboard and sugar in the refrigerator. He had difficulty finding objects in the kitchen and at times forgets where his room is.

This morning he thought it was nighttime and wondered what his daughter was doing at his house. He could not pour his coffee, and he seems to be getting more agitated. ALI reports that he has been having memory problems for the past year and at times has difficulty remembering the names of family members and friends.

A review of his past medical history (PMH) is significant for hypercholesterolemia and coronary artery disease (CAD). He had a myocardial infarction (MI) 5 years ago. ALI’s vital signs (VS) today are all within normal limits (WNL).

Q:You know that there are four main types of dementia that result in cognitive changes. List two types.

Answer 1

DEMENTIA

dementia specifically is a persistent disorder in the mental processes of Human beings that is caused by brain injury or disease in the individual that will lead to memory disorder ,personality changes and impaired reasoning on the individual

Types of dementia

1.Alzheimer's disease which mainly occur in old age

2.Vascular or multi infarct dementia which is frequently seen in individual

3.Lewy body dementia which is the third type

4.Frototemporal dementia which is the fourth type

Alzheimer's dementia:-

It is one of the most common etiology of dementia ,a general term which represents memory loss as well as other cognitive abilities seriously interferes the daily activity of the individual . This accounts for about Sixty to eighty % of dementia cases all over and is frequent

Age is  a specific non modifiable risk factor and it usually affects above 65 years of age.one in every six people over 80 years of age have this disease.

There are 7 stages in this process

Stage 1 is the Normal stage which ...Stage2 is specifically the Normal aged forgetfulness.. Stage 3 is know as Mild cognitive impairment.. Stage 4 is specifically Mild alzheimer,s disease..Stage 5 in this process is Moderate alzheimer'sdisease...Stage 6 in this process is Moderately severe Alzheimer's disease...Stage 7 is the final stage in the prognosis know as Severe Alzheimer's disease.

Clinical features includes

the early stage forgotting the specific recent events as well as conversations of the individual. As the disease prognosis occur memory impairment that is severe will occur as well as lose of ability to carry out every day task. Memory loss may be

• Repeating the statements as well as the questions over and over
• Forgotting the conversions ,appointments or events that the patient was involved in
• Routinely misplacement of specific possessions of the individual often putting them in illogical locations.
• Getting lost in places that are familiar to the person .
• Eventually forgetting the names of family members as well as every day objects.
• Trouble to find out right words to identify the objects .

Management

The medications may help to temporarily slow the prognosis of the condition .. Eg...Medication known as Cholnesterase inhibitors is used for mild to moderate disease condition.it will help to reduce the symptoms as well as help in the control of Some behavioural symptoms which occur in the individual.There is no specific treatment that cures Azheimer's disease process in the brain.

To a certain extent it can be prevented by cessation of smoking,keep alcohol intake at minimum,eating healthy balanced diet and adequate exercise so on .

VASCULAR DEMENTIA

It is the specific problems associated with reasoning, planning, judgements and , memory of the individual and other thought process that are caused by brain damage. It usually occurs after a stroke or any blocks in the arteries to the brain.

Symptoms include specific confusion,trouble in attention and concentration of the individual and problems with memory restlessness as well as agitation,unsteady gait,sudden or frequent urge to urinate or inability to control passing urine,depression in the individual . These are the main sympoms

Risk factors of the condition include increasing age of the individual ,history of heart attacks in the person,strokes abnormal ageing of blood vessels,high cholesterol which not in control,high blood pressure,diabetes, smoking, obesity ,atrial fibrillations all these are main risk .

Management

prevention of new strokes with the help of administering anti platelet drugs , control risk factors.asprin will specifically helps for it. It can be prevented by leading healthy life style practises and proper medical check ups and follwups.

The above scenario showing that all most all symptoms typically correlated with alzheimer,s disease.