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 is a term used to describe severe change in the brain that cause memory loss. These changes also make it diffcult for people to perform basic daily activities. In most people , dementia causes changes in behavior and personality. Dementia affect three area of the brain .

Language , memory , decision making .

Type of dementia:

1. Alzheimer''s disease is the most common type of dementia early signs of alzeimer's disease include depression, forrgetting name and recent events and depressed mood.

2. Parkinson's disease : many people with advanced parkinson's disease will develop dementia . Early signs of this type of demintia are problem with reasoning and judgement .

3. Vascular dementia is a general term describing problems with reasoning, planning, judgment, memory and other thought processes caused by brain damage from impaired blood flow to your brain. You can develop vascular dementia after a stroke blocks an artery in your brain, but strokes don't always cause vascular

Vascular dementia is damage in the brain that occurs due to reduced blood flow. People most often develop vascular dementia following a stroke, but there are several other potential causes and risk factors.

Causes and risk factors

The cause of vascular dementia is a lack of blood flow in the brain. There are several different conditions that may cause this restriction, either gradually or straight away:

Stroke : A stroke occurs when a blood vessel leading to the brain bursts or becomes blocked by a clot. Stroke can have many effects on the body, one of which is the development of vascular dementia.

Damaged or narrowed blood vessels : Damaged or narrowed blood vessels leading to the brain may also cause vascular dementia. Because of this, conditions that damage the blood vessels over time or cause them to narrow may also increase the risk of vascular dementia.

Other risk factors : The risk of vascular dementia tends to increase as a person gets older. In fact, the National Heart, Lung, and Blood Institute state that the condition affects almost one-third of people over the age of 70.

Also, a number of other factors and conditions may increase the risk of damaged blood vessels and vascular dementia, including:

smoking ,obesity, abnormal heart rhythms , high cholesterol ,high blood pressure, atherosclerosis, diabetes, a history of heart attack or stroke

Symptoms may be most obvious after a major stroke. These may include:

Confusion.

Disorientation.

Trouble speaking or understanding speech.

4. Dementia with Lewy bodies : Dementia with Lewy bodies, also known as Lewy body dementia, is caused by protein deposits in nerve cells. This interrupts chemical messages in the brain and causes memory loss and disorientation.

People with this type of dementia also experience visual hallucinations and have trouble falling asleep at night or fall asleep unexpectedly during the day. They also might faint or become lost or disoriented.

Dementia with Lewy bodies shares many symptoms with Parkinson and Alzheimer diseases. For example, many people develop trembling in their hands, have trouble walking, and feel weak.

Lewy body dementia causes a progressive decline in mental abilities. People with Lewy body dementia may experience visual hallucinations and changes in alertness and attention. Other effects include Parkinson's disease-like signs and symptoms such as rigid muscles, slow movement and tremors.

Lewy body dementia signs and symptoms may include:

Visual hallucinations. Hallucinations may be one of the first symptoms, and they often recur. They may include seeing shapes, animals or people that aren't there.

Movement disorders. Signs of Parkinson's disease (parkinsonian signs), such as slowed movement, rigid muscles, tremor or a shuffling walk may occur.

Poor regulation of body functions (autonomic nervous system). Blood pressure, pulse, sweating and the digestive process are regulated by a part of the nervous system that is often affected by Lewy body dementia. This can result in dizziness, falls and bowel issues such as constipation.

Cognitive problems. You may experience thinking (cognitive) problems similar to those of Alzheimer's disease, such as confusion, poor attention, visual-spatial problems and memory loss.

Sleep difficulties. You may have rapid eye movement (REM) sleep behavior disorder, which can cause you to physically act out your dreams while you're asleep.

Fluctuating attention. Episodes of drowsiness, long periods of staring into space, long naps during the day or disorganized speech are possible.

Depression. You may experience depression sometime during the course of your illness.

Apathy. You may have loss of motivation.

Risk factors : A few factors seem to increase the risk of developing Lewy body dementia, including:

Age. People older than 60 are at greater risk.

Sex. Lewy body dementia affects more men than women.

Family history. Those who have a family member with Lewy body dementia or Parkinson's disease are at greater risk.

Complications

Lewy body dementia is progressive. Signs and symptoms worsen, causing:

Severe dementia

Aggressive behavior

Depression

Increased risk of falling and injury

Worsening of parkinsonian signs and symptoms, such as tremors

Death, on average about eight years after symptoms start.