The nurse has provided teaching to the family members of a client with dementia. Which family member statement indicates that additional education is required?

Dementia is a neurological condition, caused by structural changes in the brain, and characterized by a progressive decline in mental functions, including memory, thinking, language, behavior, mood, and personality.

There are several types of dementia and Alzheimer disease is by far the most common type, followed by vascular dementia, frontotemporal dementia, and Lewy body dementia.

Let’s start by looking at the anatomy and physiology of the brain, which has three main parts, called the cerebrum, which consists of the two cerebral hemispheres, the cerebellum, which sits down at the base of the skull, and the brainstem, which is located right in front of the cerebellum. Each of the cerebral hemispheres is made of the frontal lobe, parietal lobe, temporal lobe, and occipital lobe.

Zooming in, the cells that make up our brain are called neurons. They’re composed of a cell body, which contains all the cell’s organelles, and nerve fibers that extend out from the neuron cell body. These nerve fibers are either dendrites that receive signals from other neurons or axons that send signals along to other neurons. Neurons communicate with each other through neurotransmitters, such as glutamate, GABA, and dopamine.

Now, the brain is responsible for various mental functions, including memory, language, personality, visuospatial function, concentration, executive function, and praxis, which is the ability to carry out complex motor activities.

Okay, now, causes of dementia can be classified into reversible and irreversible ones. Reversible causes can be controlled and possibly cured with the right treatment. Some common examples of this include infectious conditions, like syphilis and HIV; dietary deficiencies, especially vitamin B12 deficiency; and hormone imbalances, such as thyroid problems. Irreversible causes cannot be cured and include Alzheimer disease, which is by far the most common cause of dementia; vascular dementia, which is the second most common cause; frontotemporal dementia; and Lewy body dementia. Finally, some dementia secondary to other conditions are also irreversible like Parkinson disease and Creutzfeldt-Jakob disease.

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There are several types of dementia and Alzheimer disease is by far the most common type, followed by vascular dementia, frontotemporal dementia, and Lewy body dementia.

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DEMENTIA
	KEY POINTS	NOTES
DEFINITION	Neurological condition Progressive decline in mental functions Most common type: Alzheimer disease
PHYSIOLOGY	Brain Responsible for mental functions Memory Language Personality Visuospatial function Concentration Executive function Praxis Structures Cerebrum Cerebral hemispheres Cerebellum Brainstem Neurons Cell body Nerve fibers Dendrites Axons Communicate via neurotransmitters
CAUSES AND RISK FACTORS	Causes Reversible Infectious conditions Dietary deficiencies Hormone imbalances Irreversible Alzheimer disease Abnormal protein deposits b/n neurons and inside the cells Impaired neuron-to-neuron signaling Neurons that don’t function properly Undergo programmed cell death Vascular dementia Progressive loss of function d/t poor blood flow over time Results from cerebral atherosclerosis Frontotemporal dementia Atrophy of frontal lobes Progresses to temporal lobes Sparing of parietal and occipital lobes Lewy body dementia Caused by aggregation of abnormal proteins (Lewy bodies) inside of neurons Neuronal death Secondary to other conditions Risk factors Advanced age Genetic predisposition Family history Alzheimer disease Down syndrome Cardiovascular risk factors Hypertension Diabetes Abnormal lipid profile
PATHOPHYSIOLOGY	As neurons die, brain atrophies Functions are impaired
SIGNS AND SYMPTOMS	Gradual onset, worsens over time Repeating conversations or actions Misplacing belongings Wandering, getting lost Agnosia Impaired executive functioning Aphasia Apraxia Restlessness Rummaging, hiding things Agitation Anger, verbal or physical aggression Worried, distressed Embarrassment Sundowning Inappropriate sexual behavior Depression Lewy body dementia Delusions Hallucinations Abnormal motor behavior Complications Dependent on others Decreased mobility Limited communication Trouble with activities of daily life Urinary/fecal incontinence Infections
DIAGNOSIS	History Physical assessment Screening test MOCA MMSE Rule out delirium
TREATMENT	Reversible Treat underlying cause Irreversible Slow progression Cholinesterase inhibitors NMDA-receptor antagonists Supportive care Promote healthy lifestyle Treat emotional disturbances
MANAGEMENT OF CARE	Goals of care Maintain patient safety Provide supportive care Prevent falls Monitor for sundowning If agitation occurs Move closer to nursing station Reduce stimulation Administer prescribed medications Encourage reminiscence and social interaction Ensure familiar objects are around Engage patient in activities Assist in using relaxation techniques Help with activities of daily living (ADLs) Collaborate with physical and occupational therapy Promote a stable bedtime routine
PATIENT AND FAMILY TEACHING	Explain condition, plan of care, and safe medication administration Explain interventions to promote safety and reduce anxiety Encourage family to visit loved one

Dementia: Nursing

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