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Dementia Pathophysiology
Dementia is mainly characterized by irreversible, progressive brain damage. It’s a syndrome of a decline in cognitive abilities that interferes with daily functioning.
In end-stage dementia, too much brain damage makes it impossible for patients to understand reality. This causes more anxiety and aggression – so nursing interventions revolve around distraction.
Causes
- Alzheimer’s disease
- Infections
- Parkinson’s disease
- Traumatic brain injuries
- Severe head injury
- Huntington’s disease
- Leukoencephalopathies
- Creutzfeldt-Jakob disease
- Multiple-system atrophy
- Multiple sclerosis (MS)
- Amyotrophic lateral sclerosis (ALS)
Subjective Data (patient May Report)
- Difficulty remembering details of personal history
- Poor short-term memory
- Difficulty finding words during a conversation
Risk Factors
- Age
- Family history
- Smoking
- Alcohol use
- Atherosclerosis
- Cholesterol
- Plasma homocysteine
- Diabetes
Dementia Signs & Symptoms
- Taking longer to complete daily tasks
- Memory loss, poor judgment, and confusion
- Losing balance and problems with movement
- Difficulty speaking, understanding, and expressing thoughts
- Wandering and getting lost
- Repeating questions
- Using unusual words to refer to familiar objects
- Losing interest in normal daily activities or events
- Hallucinating or experiencing delusions or paranoia
- Acting impulsively
Nursing Assessment for Dementia
Assessments should include the patient’s memory, attention, language, and other cognitive abilities. Standardized cognitive tests such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA) can be used.
Cardiac Function
- Previous heart failure
- Abnormalities in the left atrial structure
Respiratory function
- Impaired lung function
Neurological & Sensory Functions
- Sensory deficit
- Impairment of nerve cells and their connections in the frontal and temporal lobes
Labs
- Blood glucose test
- Urinalysis
- Thyroid and thyroid-stimulating hormone level analysis
- Toxicology screen
- Cerebrospinal fluid analysis
- Complete blood count (CBC)
Nursing Interventions for Dementia
- Maintain a safe environment. Patients with dementia can be disoriented and may wander or have difficulty with mobility.
- Encourage a structured routine, which can include regular mealtimes, scheduled activities, and bedtime routines.
- Administer medication as prescribed to help manage symptoms – and monitor the patient for any side effects.
- Monitor behavioral and psychological symptoms. Patients with dementia may exhibit a range of behavioral and psychological symptoms, such as agitation, depression, and hallucinations. A comprehensive assessment of these symptoms is important to guide treatment and management.
- Provide support for their social network and living environment, and help with important information about their overall well-being and potential barriers to care.
NCLEX Questions
The daughter of a patient with advanced Alzheimer’s dementia confides in the nurse that she can no longer care for her parent’s needs without help. Which is the best response by the nurse?
A. “Taking care of a parent with dementia is very difficult, and I agree you need help.”
B. “I will let the practitioner know that your parent probably needs a medication change.”
C. “Let’s discuss your daily routine and any difficulties you encounter.”
D. “Maybe you should place your parent in a care facility for a few weeks.”
Answer: C
This statement allows the caregiver to open up and discuss the concerns around caregiving, further developing a therapeutic relationship.
The nurse provides care for an older adult patient diagnosed with dementia. The patient is frequently found pacing up and down the halls of the unit at night. Which statement from the nurse is best to address the patient’s behavior?
A. “I will help you get back to your room so you can rest.”
B. “If you continue to leave your room at night, I will have to restrain you.”
C. “You are prohibited from leaving your room after 10:00 PM without approval.”
D. “I don’t want you to get hurt, and walking in the dark is dangerous.”
Answer: A
This statement reorients the patient while avoiding escalation of other behaviors associated with the diagnosed dementia. Therefore, this is the best statement from the nurse based on the current data.
Sources
https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/dementia/causes.html
https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/dementia/risk-factors.html
