Posted: June 21st, 2021
Manifestations of Dementia Melinda Godfrey GNUR543 St. John Fisher College Mrs. Yowell is a 90-year-old woman who is a resident of a long-term care facility. She was alert and mentally quite capable until about a year ago when she began to manifest signs and symptoms of dementia. A review of her medical records failed to document a thorough analysis of her dementia, but a diagnosis of “probable Alzheimer disease” was recorded. What are the common manifestations of dementia? The definition of Dementia is “a general term for loss of memory and other mental abilities severe enough to interfere with daily life.
It is caused by physical changes in the brain. ” (Common Types of Dementia, 2012). The first manifestations of Dementia usually are: * Loss of memory – generally the patient doesn’t notice the loss of memory but a loved one will. This is generally the entree into the physician’s office leading to a diagnosis. * Trouble focusing and following conversations – the patient is unable to handle more than one task at a time and will not be able to perform a task and listen to or follow a conversation easily. * Impaired judgment and reasoning – patients become confused and are unable to cope as well when unexpected events come up.
Other symptoms could include: mood changes, personality and behavior changes. As noted, dementia is not a disease itself but a cluster of cognitive changes. The onset symptom of dementia can vary depending on the disease or syndrome that is associated (Common Types of Dementia, 2012). The major dementia diseases or syndromes are: 1. Alzheimer Disease (AD) – AD accounts for 60 – 80% of the cases of dementia (Shadlen & Larson, 2012). 2. Dementia with Lewy Bodies (DLB) – DLB starts with progressive cognitive decline and usually the patient also has hallucinations, periods of lucidity and some rigidity.
DLB has abnormal accumulations of protein structures in the patient’s brain (Dementia With Lewy Bodies Information Page, 2011). 3. Frontotemporal Dementia (FT) – FT is associated with the shrinking of the frontal and temporal anterior lobes of the brain (Frontotemporal Dementia Information Page, 2011). Generally the patient will have trouble with speech and behavior. 4. Vascular Dementia – This form of dementia results from many strokes. When a patient has a stroke, the blood flow is interrupted to the brain and the result is brain tissue damage (Types of Dementia, 2011).
These patients normally lose their cognitive ability before their memory. 5. Parkinson Disease with Dementia – Approximately 40% of patients with Parkinson’s disease will have dementia (Parkinson’s disease, 2011). The nerve cells in the brain that make dopamine are slowly destroyed leaving no way for the brain to send messages. What other potentially treatable factors might have led to Mrs. Yowell’s deteriorating mental function? There are many reasons that Mrs. Yowell may have impaired mental functioning (see Table 1). The first and easiest reason to rule out would be a urinary tract infection (UTI).
A urine sample can show if there are white blood cells (indicating infection) present in the urine. The increased levels of bacteria in an elderly person’s body can cause toxicity which leads to the altered mental status (Midthun, 2004). Most noted changes are confusion, agitation and lethargy. Table 1| | (Shadlen & Larson, 2012)| Secondly, Mrs. Yowell could have vitamin deficiencies. For example, if a patient has low levels of thiamine they can develop Wernicke’s encephalopathy. This can cause damage in the brain to the thalamus and the hypothalamus.
These patients will exhibit signs of confusion, loss of memory and hallucinations (Dugdale, 2010). If left untreated it can cause permanent damage but, it is usually corrected by injections of thiamine. Another cause of confusion/delirium in elderly patients is an adverse drug reaction or interactions with another drug. Mrs. Yowell could have been given a new medication that is directly affecting her mental status. Nearly 70% of residents in long term facilities take nine or more medications (Gillick, 2012). Elderly patients have slower clearance rates of drugs through their liver and kidney thus leading to drug accumulation (Gillick, 2012).
There should be a regular review of medications in order to anticipate and keep on top of any potential changes. Discuss in detail the organic brain/neuronal alterations that are typical of Alzheimer disease? The changes that occur in the brain with Alzheimer’s disease (AD) are threefold. The first is amyloid plaque, this is abnormal clumps of protein found outside of the nerve cells. The protein pieces are in the fatty membrane that is around the brains nerve cells. The amyloid is a protein that is snipped from a larger protein (amyloid precursor protein) during metabolism (Copstead, 2010).
These clumps form plaque and can block cell-to-cell signaling (Common Types of Dementia, 2012). In a healthy brain the fragments are broken down and eliminated before they turn into plaque. Without the ability to signal the brain may also activate the inflammatory response. At this point it is still not known whether the plaque causes or is created by AD. Secondly, inside the nerve cells there is a protein called tau. This protein is normally helps maintain the cell structure allowing proper nutrition and signaling. The tau protein in AD is changed into twisted strands, called tangles (Common Types of Dementia, 2012).
It is said that the changes are brought on by the phosphorylating enzymes which are activated by inflammatory changes, lipid abnormalities and aging (Copstead, 2010). Thirdly, the brain is losing connectivity between nerve cells and cells are dying which results in permanent brain damage. Other changes in the brain include shrinking of the hippocampus and cortex. AD also shows an increase in ventricles. The progression of the damage in the AD brain is predictable. According to the Alzheimer’s research center, the plaques and tangles spread through the cortex in a predictable fashion (Common Types of Dementia, 2012).
Summary Scientists believe that the cause of AD is multi-factorial. IT could be a combination of genetics, lifestyle and environmental factors. Specifically, it is believed that a person with diabetes, depression or heart disease is more likely to develop AD (Copstead, 2010). There is a link to a gene, APOe4 that is thought to be associated with late onset AD. However, studies have shown it is not present in some cases of AD and is present in cases with no AD (Common Types of Dementia, 2012). At this point the definitive diagnosis of AD can only be obtained after death (Common Types of Dementia, 012). This means that clinicians must ask the right questions to diagnose this disease. AD is still quite unknown as to the order of the changes that occur in the brain. As more research is conducted we will be able to identify the manifestations of the disease earlier and slow the progression of AD. References Common Types of Dementia. (2012). Retrieved March 14, 2012, from Alzheimer’s Association: http://www. alz. org Copstead, L. -E. C. (2010). Pathophysiology. St. Louis: Saunders. Dementia With Lewy Bodies Information Page. (2011, December 28).
Retrieved March 8, 2012, from National Institute of Neurological Disorders and Stroke: http://www. ninds. nih. gov Dugdale, I. M. (2010, February 6). Wernicke-Korsakoff Syndrome. Retrieved March 10, 2012, from Medline Plus: http://www. nlm. nih. gov/medlineplus Frontotemporal Dementia Information Page. (2011, December 28). Retrieved March 8, 2012, from National Institute of Neurological Disorders and Stroke: http://www. ninds. nih. gov Gillick, M. M. (2012, February 22). Medical Care of the Nursing Home Patient in the United States. Retrieved March 10, 2012, from UpToDate: http://www. uptodate. com Lexicomp. 2012). Retrieved February 5, 2012, from Lexicomp: https://online-lexi. com Midthun, M. R. (2004). Criteria for Urinary Tract Infections. Retrieved March 4, 2012, from Medscape: http://www. medscape. com Parkinson’s disease. (2011, September 26). Retrieved March 5, 2012, from PubMed Health: http://www. ncbi. nlm. nih. gov Shadlen, M. -F. M. , ; Larson, E. B. (2012, February 10). Evaluation of Cognitive Impairment and Dementia. Retrieved March 5, 2012, from UpToDate: http://www. uptodate. com Types of Dementia. (2011, June 23). Retrieved March 14, 2012, from Cleveland Clinic: http://my. clevelandclinic. org
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