The American Psychiatric Association is in charge of publishing the Diagnostic and Statistical Manual of Mental Disorders (DSM -5) to guide healthcare professionals in diagnosing mental conditions. The general class of these mental conditions is mood disorders, cognitive disorders, and developmental disorders. Developmental disorders refer to chronic disabilities, resulting in substantial functional limitations in three or more major life activities such as dementia. Dementia is a term for conditions that impact the brain’s normal functioning, causing a decline in memory and thinking skills severe enough to impact the ability to carry out daily activities and communications skills. Alzheimer’s disease is the most prevalent form of dementia, with a share of 60 % of cases. The other major forms of dementia include; Vascular dementia, Lewy bodies dementia, and Frontotemporal dementia.
Symptoms of Dementia
The earliest cognitive symptom of the disease is memory loss regarding past events, time, and place. The affected have a hard time remembering relatives’ names, where they are at a specific time, and misplacing personal belongings. The disease progresses steadily, where the process is unique to each person suffering from the disease. The psychological changes in dementia patients include being introverted, losing interest in people around them, and becoming paranoid and suspicious of the people who care for them (Alzheimer’s Association, 2018). The patients have difficulty handling complex tasks and coordinating motor functions, thus become withdrawn, leading to depression. In the later stages of the disease, the person loses the capacity of communication, thinking, reasoning, and visual perceptions leading to hallucinations.
Causes of Dementia
The cause of Alzheimer’s disease occurs when neurons within the brain develop abnormally, leading to their entanglement, preventing communication, and eventually leading to the cells’ death (Alzheimer’s Association,2018). Factors influencing a person’s risk to contract Alzheimer’s disease include; age, genetic disposition, early life events, culture, lifestyle, and down syndrome. Although dementia is not associated with old age, the risk of contracting the disease at old age is higher, especially after 65 years. A family history of dementia puts the descendants at a greater risk of contracting the disease through specific gene mutations. Down syndrome causes cognitive developmental problems; thus, patients with the condition develop early onset of Alzheimer’s disease. Vascular dementia is caused by brain cell damage as a result of a cerebrovascular disease such as stroke. Lewy bodies dementia is linked to abnormal structures in the brain involving alpha-synuclein protein. Frontotemporal dementia results from the shrinking of frontal and temporal lobes caused by abnormal protein forming inside brain cells.
Methods of Diagnosis
There is no single test that can accurately diagnose dementia. The diagnosis involves examining medical history, neuropsychological and cognitive tests, laboratory tests, brain scans, and psychiatric evaluation. Examination of medical history shows whether dementia runs in the family. Neuropsychological and cognitive tests are used to test mental functioning by assessing reasoning, memory, language skills, and problem-solving. Laboratory tests are used to test a patient’s blood and fluids to determine levels of various vitamins and hormones to find or role out causes of symptoms. Brain scans are done through neuroimaging to identify changes in the brain structure. The most common tools include; Computerized Tomography (CT), Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PET). In a Psychiatric evaluation interview, the physician enquires about mood and sense of well-being to determine if a mental condition such as depression contributes to dementia symptoms. The physician analyses the results of the diagnosis to identify the causes and prognosis of dementia.
Financial and Emotional Impact on Caregivers
Dementia patients lack confidence in performing tasks such as their hobbies, leading to withdrawal from social activities, impacting their self-esteem. Family members are vital in terms of support as they help them continue their social interactions, often focusing on the patient’s strengths to boost their morale and self-confidence (Schols and Kardol, 2017). The caring of people with dementia can be psychological, emotionally, and financially draining; hence the caretakers need to be patient to empower their loved ones and show support at all times.
Familiarity is vital to a person who has dementia. It helps to maintain a simple routine that the person can follow; thus, family and friends are charged with being caregivers. Family and friends act as unpaid caregivers, thus impacting them through; change in the relationship between them, negative impact on psychological health, increase in financial cost, and social isolation of caregivers. The change in a relationship happens when family members take on responsibilities when a relative is diagnosed with dementia, such as children taking care of sick parents and wives taking care of sick husbands. Levels of emotional distress are high in caregivers. They try to adjust their lives to suit the role, such as sacrificing leisure time, reducing social interactions, and waiving employment opportunities to devote more time to caregiving, thus socially isolating from the community. Caregiving may lead to depletion of finances due to high costs in treatment and disruptions in employment.
NANDA Nursing Diagnosis
The North American Nursing Diagnosis Association (NANDA) standardizes nursing-based diagnoses meant to promote patient safety. Standardization enables nurses to intervene with the preconceptions of the outcome. The potential nursing diagnoses for dementia patients incorporate poor communications emphasized by having difficulty finding words during a conversation. Nursing management emphasizes speaking in a low and slow voice, calling the client by name, and face to face conversations (Lawrie and Lane, 2020). This increases the client’s possibility of understanding the message being conveyed while repeating the client’s name maintains a sense of self-identity.
Lack of hygiene self-care is demonstrated by the inability to complete activities of daily life. Caregivers should assist the client in maintaining a sense of dignity through activities such as bathing. The risk of injury related to wandering behavior management practice determines the specific reasons related to the wandering. Caregivers should closely observe them assess their needs, and provide assistance within a safe environment. The risk of violence, either self-inflicted or directed to other parties relating to suspicion and inability to recognize faces, is prevented by building trust with the patient. Dementia patients are delusional and often suspicious, thus fighting psychological reactions, leading to injuries to clients and caregivers. Caregivers should build rapport with the client through a supportive approach and cultivating real talks. Impaired social interaction management provides positive feedback to increase their self-esteem and desire to repeat interactions. The routines are structured to schedule social interactions between sleep sessions.
Implementation, Treatment, and Outcomes
There is no cure for dementia, with the treatment focusing on slowing the disease’s progression to help the affected live an average life. Treatment is both pharmacological and non-pharmacological. Pharmacological treatment addresses the symptoms of dementia by slowing down the progression of cognitive ability. There are two primary medicines; Acetylcholinesterase inhibitors and Memantine. Acetylcholinesterase inhibitors prevent Acetylcholine’s breakdown in the brain, responsible for facilitating communication between nerve cells in the brain. Alzheimer’s disease depletes the Acetylcholine; thus, the medicine boosts its levels. The three main inhibitors include; Donepezil, Rivastigmine, and Galantamine (Birks and Harvey, 2018). Memantine is prescribed to patients with moderate to severe dementia. It is used to treat Alzheimer’s disease by blocking glutamate produced excessively in damaged brain cells. Memantine improves the cognitive, functional, and behavioral symptoms in patients. The medication also helps reduce agitation and psychotic symptoms.
Non-Pharmacological interventions include; Cognitive Stimulation Therapy (CST), Reminiscence therapy, and reality orientation training. CST treats patients with mild dementia, where activities are designed to engage and stimulate memory, problem-solving skills, and language ability. Reminiscence therapy involves talking and reliving past events using props such as pictures and music. The therapy enables the patient to tap into long-term memory, thus encouraging social and recreational objectives. The reality orientation program helps dementia patients remember the present such as name, date, and time. The caregiver uses calendars, signposts, and notice boards to reinforce self-identity.
The latest research aims at developing better methods for accurate and earlier diagnosis to maximize the potential for treatment. Genetic precursors of dementia are also being developed to identify possible dementia preconditions instead of waiting for dementia to develop, thus initiating lifestyle prevention strategies. The research will identify biomarkers for Alzheimer’s disease in the cerebrospinal fluid through lumbar punctures of participants (Simrén, Ashton, Blennow, and Zetterberg, 2020). Detection of Alzheimer’s disease has also improved through Pittsburgh Compound-B(PIB) in collaboration with PET. PIB-PET can detect early signs of brain damage before symptoms become apparent.
Alzheimer’s Association. (, 2018). 2018 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 14(3), 367-429.
Birks, J. S., & Harvey, R. J. (2018). Donepezil for dementia due to Alzheimer’s disease. Cochrane Database of systematic reviews, (6).
Lawrie, H., & Lane, A. (2020). The Compounding Nature of Transitions in Dementia: Nursing Implications to Promote Dignity. International Journal of Nursing Student Scholarship, 7, 1-14.
Schols, J., & Kardol, T. (2017). Dementia Care in Nursing Homes Requires a Multidisciplinary Approach. In Dementia in Nursing Homes (pp. 203-217). Springer, Cham.
Simrén, J., Ashton, N. J., Blennow, K., & Zetterberg, H. (2020). An update on fluid biomarkers for neurodegenerative diseases: recent success and challenges ahead. Current Opinion in Neurobiology, 61, 29-39.
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