Dementia

11 Key excerpts on "Dementia"

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  White Matter Dementia

  • Christopher M. Filley(Author)
  • 2016(Publication Date)
  • Cambridge University Press

    (Publisher)

  Chapter 4 A neuroanatomic overview of Dementia The word Dementia literally means “down from the mind” (from the Latin de and mens), and this broad concept implicates a long and continually expanding list of disorders that diminish intellect to a level lower than expected. The syndrome of Dementia can result from many diseases within the brain, or from many others originating elsewhere in the body that exert secondary effects on the brain. The acquired loss of cognitive competence meant by the term Dementia implies that brain function is compromised to the extent that multiple cognitive domains are affected and neither normal cognition nor customary social and occupational function can be maintained (McKhann et al., 1984; Mendez and Cummings, 2003). The recently updated Diagnostic and Statistical Manual of Mental Disorders (DSM-V) proposes the entity of “major neurocognitive disorder” to designate what is essentially the same syndrome (American Psychiatric Association, 2013). The term Dementia is widely used and has served well as a descriptor of clinically significant cognitive dysfunction, and both clinicians and researchers have derived benefit from the organizing framework this notion implies. In the clinic, establishing the presence of Dementia impels a critical search for reversible causes of the syndrome, correction of which can lead to a cure. The regrettably far more common scenario of finding an irreversible cause can still prove helpful with respect to the provision of information on prognosis, avoidance or mitiga- tion of medical problems that can worsen the Dementia, use of carefully selected medications for behavioral problems that may arise, and counseling as the disease progresses to its end. For researchers, the concept of Dementia means the persistent if not permanent failure of brain systems devoted to normal cognition, and detailed investigation of the basis for this failure can proceed.

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  Guide to the Psychiatry of Old Age

  • David Ames, Damien Gallagher, Samantha Loi, Tom Russ(Authors)
  • 2022(Publication Date)
  • Cambridge University Press

    (Publisher)

  Chapter 4 The Dementias Dementia Defined Definitions of Dementia have been getting longer and more complex, and recently the term itself has come under challenge. Seventy years ago, a leading psychiatric textbook defined Dementia in one short sentence. Current diagnostic manuals devote pages to its definition. Tables 4.1 and 4.2 give summaries of the diagnostic criteria used by the World Health Organisation’s ICD-11 and the American Psychiatric Association’s DSM- 5 systems, which are the criteria that will be most used in clinical practice and research during the lifetime of this edition. Because ICD-11 will retain the term ‘Dementia’, and it is an international classification rather than a purely American one, and because the new DSM-5 appellation of Major Cognitive Disorder has not gained universal accept- ance, we continue to use the term ‘Dementia’ in this edition. Strict application of the different criteria will yield different rates of Dementia in any population assessed because the criteria differ in the levels of impairment required to diagnose it. However, all definitions of Dementia include certain core features. First, Dementia is a syndrome (a collection of symptoms and signs) with multiple causes. Second, demen- tia is an acquired condition and represents a decline from a previous level of function no matter how exalted or limited that level of function used to be. Third, the diagnosis can be made only in an alert patient because one important differential diagnosis is delirium, which is characterised by both cognitive impairment and an impaired level of consciousness. Fourth, while memory impairment is usually present, Dementia affects not only memory but multiple higher mental functions such as intellect and personality. Last, Dementia is not a diagnosis based solely on the patient’s performance in an unfamiliar testing setting but must be rooted in real-world problems: namely, impair- ment of social or occupational functioning.

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  Dementia

  Current Perspectives in Research and Treatment

  • Gary Christopher(Author)
  • 2023(Publication Date)
  • Routledge

    (Publisher)

  The final section will examine what is being done to overcome people’s misconceptions around Dementia. Defining Dementia Dementia is a term much used in all walks of life today. Its adoption into ordinary parlance means it suffers the same fate as other readily accepted terms such as migraine or depression. Each refers to a severe clinical condition, yet the way it is used in everyday language to a greater extent strips it of this severity. Much in the same way people complain of a migraine when they are merely experiencing a mild headache or the fact that they say they feel depressed when they are experiencing a slightly lowered mood, people talk of Dementia when referring to normal everyday lapses of memory. The term Dementia has a specific meaning. As stated earlier, Dementia is not a disease but rather relates to symptoms of the underlying disease process. Symptoms are severe and progressive, with cognitive decline the main symptom. Importantly, we need to be reminded that each individual is affected uniquely, depending on the location and extent of brain tissue damage. In Chapter 3, we shall explore the various diagnoses in detail. For the time being, to more fully expand what we mean by Dementia in general, one of the main overriding symptoms is difficulties with everyday memory, particularly remembering information or events that happened in the recent past. It is not just issues with memory, however. Global cognitive problems occur, with individuals experiencing difficulty concentrating, making plans, solving problems, and making decisions. Planned, sequential activity, such as cooking, becomes problematic. Visual and spatial processes are impaired, which has several significant knock-on effects in terms of being able to lead an everyday life, particularly issues around safety, especially where one considers problems judging changes in depth or distance, and general lack of orientation

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  Dementia

  An Attachment Approach

  • Kate White, Angela Cotter, Hazel Leventhal, Kate White, Angela Cotter, Hazel Leventhal(Authors)
  • 2018(Publication Date)
  • Routledge

    (Publisher)

  There is increasing research across all aspects of Dementia. Much of this focuses on finding and measuring “biomarkers” of progression, for example, changes in cerebrospinal fluid, brain imaging or cognitive tests, with a view to moving to clinical trials of compounds that might slow down or stop the various different pathologies (see Andrieu et al., 2015 for a recent review of clinical trials in Alzheimer’s Disease). However there is also an interest in documenting the psychosocial effects of Dementia on both patient, carer and families, and from that, developing psychosocial interventions to improve quality of life (e.g., Jensen et al., 2015).

  Summary

  Dementia is an umbrella term for a set of progressive, neurodegenerative diseases that can affect various cognitive domains, from mid-life onwards. The most common form of Dementia is non-inherited, late-onset Alzheimer’s Disease, which typically affects memory before other cognitive domains and for which symptoms are usually noticed late in life. Other, rarer forms of Dementia include the fronto-temporal Dementias, Posterior Cortical Atrophy, Vascular Dementia, and Lewy Body Dementia, many of which may be of young onset (prior to age 65) and some of which are inherited in an autosomal dominant pattern. There are clear guidelines for diagnosing the different Dementias, and for what help, support, and symptomatic treatment should be offered to both people with Dementia and their families, although in practice such help is not always sought or provided. Lack of awareness in the public and professionals, as well as limited resources, remain barriers to good practice. There is an increasing drive to increase awareness, and to pursue research into both drugs that might cure Dementia, as well as other interventions to improve symptoms and quality of life for people diagnosed with Dementia, and their families.

  References

  Alzheimer’s Society. (2014). Dementia 2014: Opportunity for Change. https://www.alzheimers.org.uk/downloads/download/1484/Dementia_2014_opportunity_for_change . Accessed 16 January 2018.

  Andrieu, S., Coley, N., Lovestone, S., Aisen, P. S., & Vellas, B. (2015). Prevention of sporadic Alzheimer’s disease: lessons learned from clinical trials and future directions. The Lancet Neurology , 4422 (15), 70–72. http://doi.org/10.1016/S1474-4422(15)00153-2

  Balfour, A. (2015). Living Together with Dementia: A Relationship Intervention for Couples Living with Dementia https://tavistockrelationships.org/images/TCCR_summary_of_the_LTwD_approach_Nov_2015_-_FINAL.pdf

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  Dementia Care Nursing

  Promoting Well-being in People with Dementia and their Families

  • Trevor Adams(Author)
  • 2017(Publication Date)
  • Red Globe Press

    (Publisher)

  What is Dementia? The World Health Organisation (2003) has recently defined ‘Dementia’ as A syndrome due to disease of the brain, usually of a chronic or progres-sive nature, in which there is disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, cal-culation, learning capacity, language and judgement. Consciousness is not clouded. The impairments of cognitive function are commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour or motivation. This syndrome occurs in Alzheimer’s disease, in cerebrovascular disease, and in other conditions primarily or secondarily affecting the brain. This chapter examines the neurological changes that occur in Dementia and highlights the implications they have for people with Dementia and their nursing care. It is hoped that these insights will help nurses enhance the well-being of people with Dementia and make a positive contribution towards their care. The WHO defin-ition identifies the core feature of Dementia as the ‘disturbance of [the] multiple higher cortical functions’ of the brain. The word ‘cortical’ makes reference to the cortex, a vast sheet of nerve cells that covers the whole surface of the brain. The cortex is an important control centre between sensory information coming into the brain and motor commands leaving the brain. Complex networks of cells within the cortex are dedicated to processing sensory information to a very high level, resulting in high-level cognitive skills such as conscious perception, thought, language, memory, planning and decision-making. The emergence of these complex functions depends upon cooperation between different areas of the cortex that have become specialised for different purposes. Within the cortex there is a hierarchy of primary, secondary and association areas (see Figure 4.1; the primary and secondary areas are shaded and the association areas are unshaded).

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  The Importance of Food and Mealtimes in Dementia Care

  The Table is Set

  • Grethe Berg(Author)
  • 2006(Publication Date)
  • Jessica Kingsley Publishers

    (Publisher)

  CHAPTER 2 Dementia

  Dementia is a common term for a series of organic diseases characterized by chronic and irreversible intellectual and mental deterioration. A Dementia disease also affects the emotional and voluntary functions (Engedal and Haugen 1996). Dementia causes serious loss of self-care skills and makes the affected person unable to control his or her own life. People who suffer from a Dementia illness are likely to become largely dependent on other people for support and care. Investigations have shown that more than 70 per cent of residents in Norwegian nursing homes suffer from a Dementia illness and that only 14 per cent of the nursing home places are adapted for people with Dementia (Eek and Nygård 1999). This provides great challenges for the staff who are responsible for the daily treatment and care of nursing home residents. Managers who have responsibility for planning and organizing the caring service in the municipality have an obligation to consider the consequences of a Dementia disease. The organizing of staff and residents and the provision of the proper physical surroundings and facilities are important. This will provide good care and effective arrangements in order to maintain the remaining skills and resources of residents suffering from Dementia.

  The following is a definition of Dementia in old age:

  Dementia is an acquired organic brain disease affecting an elderly person. The disease affects the brain by loss of mental capacity and leads to weakness in the psychological processes such as speech, learning, memory and thinking. The disease is chronic, incurable, and deteriorates over time. (Engedal and Haugen 1996)

  Loss of function and practical consequences for persons with a Dementia illness

  A Dementia illness leads to serious loss of the ability to take care of oneself, generally speaking. Here we will consider some of the most common skills that are affected and the possible consequences for those who are affected.

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  Dementia

  • Mario Maj, Norman Sartorius, Mario Maj, Norman Sartorius(Authors)
  • 2003(Publication Date)
  • Wiley

    (Publisher)

  It is well recognized that psychological and psychiatric diseases are more feared than some physical afflictions, and Dementia is the archetypal example of this, because the symptoms lead to loss of independence and the inability of a person to be in control. Henderson and Jorm provide an unrivalled summary of the salient points in current thinking around demen- tia in terms of disease definition and epidemiology. There are seven aspects of the disorder which this commentator would like to emphasize. The symptoms of Dementia present a continuum between normal ageing and disease [1]. This fact has led people to believe that the syndrome is therefore the inevitable consequence of normal ageing and so nothing can or should be done to mitigate its effects. As a result, therapeutic nihilism has held back clinical innovations for decades, but now this is being slowly reversed. The classic pathological investigations in the early 1970s from Newcastle, with subsequent observations by others, demonstrating that the pathological changes seen in the brain at post-mortem correlate with the severity of the clinical picture, confirmed the close relationship between clinical and morphological findings. The contemporaneous neurochemical studies emphasized the importance of the cholinergic deficit, which formed the basis for current treatments [2]. The consideration of Dementia is a two-stage process. First, the syndrome of Dementia needs to be distinguished from normal ageing, the effects of drugs on cognitive function, learning disability, impoverished educa- tion or environment, delirium and depression. Second, the aetiology of the Dementia needs to be established—Alzheimer’s disease (AD), vascular Dementia, Dementia of frontal lobe type and Lewy body Dementia being the commonest. Dementia is still regarded by some as a diagnosis in its own 1 University Department of Psychiatry, Withington Hospital, West Didsbury, Manchester M20 8LR, UK 62 Dementia

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  Evidence-Based Practice in Dementia for Nurses and Nursing Students

  • Karen Harrison Harrison Dening(Author)
  • 0(Publication Date)
  • Jessica Kingsley Publishers

    (Publisher)

  Chapter 1 What is Dementia? Malarvizhi Babu Sandilyan and Tom Dening Learning objectives By the end of this chapter you will:

  • Be aware of the common causes of Dementia.

  • Have an understanding of some of the brain changes in Dementia.

  • Have an awareness of the risk factors for Dementia.

  • Know the cognitive symptoms of Dementia.

  • Know the non-cognitive symptoms of Dementia.

  Introduction

  Dementia is an increasingly common condition among the older pop-ulation. It is characterised by multiple cognitive deficits leading to decline from premorbid level of functioning. The ICD-10 Classification of Mental and Behavioural Disorders (World Health Organization 1992) describes Dementia as a syndrome occurring as a result of brain disease, which is usually chronic or progressive in nature. Several higher cortical functions including memory, thinking, comprehension, calculation, learning, language and judgement are impaired. These impairments often accompany changes in emotional control, social behaviour or motivation. Alzheimer’s disease (AD), vascular Dementia (VaD) and Dementia with Lewy bodies (DLB) remain the main underlying causes.

  Dementia – a global health burden

  The number of people with Dementia worldwide is estimated at 44 million and it is projected that it will almost double every 20 years until at least 2050 (Alzheimer’s Disease International 2014). The number of new cases of Dementia each year worldwide is almost 7.7 million. Dementia predominantly affects older people, with global prevalence rates over the age of 60 years ranging between 5 per cent and 7 per cent (Prince et al. 2013), increasing exponentially with age; around 20 per cent of people over 85 years have Dementia. It is projected there will be more than 2 million people with Dementia by 2051 (Alzheimer’s Society 2014). Most people with Dementia live in low- and middle-income countries, where numbers of people living into old age has grown dramatically (Alzheimer’s Disease International 2017). Dementia is not just a disorder of older people. Earlier data suggested that there were at least 18,000 people younger than 65 years with Dementia in the UK (see Chapter 4

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  Dementia and Memory

  A Handbook for Students and Professionals

  • Simon B. N. Thompson(Author)
  • 2017(Publication Date)
  • Routledge

    (Publisher)

  PART I Defining Dementia and Memory Passage contains an image

  Chapter 1 Introduction to Dementia

  Background

  Increasing longevity, especially of people with learning disabilities (Jancar, 1984; Wolf & Wright, 1987; Eyman et al., 1987), has brought with it a seemingly ever-increasing demand on health and social services. In particular, clinical psychology services have seen an increasing number of referrals to assess older clients who have poor cognitive functioning and to provide advice for carers about clients who have declining memory ability (Thompson, 1994a). Supportive consultation with staff and clients alike is also important, and has increased the demands on all services as the size of the older population has grown.

  Identifying signs of declining memory and general cognitive functioning early on clearly has many advantages (see Huppert & Tym, 1986), including the planning and provision of specialist care for these people. Researchers and clinicians have been interested in the effects of ageing on the normal population for some considerable time (for example, Holden, 1989), and have compared common impairments, such as short-term memory (McDade & Adler, 1980), age-related memory decline (Young & Kramer, 1991), and psychophysiological differences, such as auditory event-related potentials (Muir, Squire & Blackwood, 1988). The difficulties of a differential diagnosis between depression and Dementia have also been examined (Warren, Holroyd & Folstein, 1989), but the stumbling block for researchers has often been the transferability of measures to different client groups (Rosen, Mohs & Davis, 1984). Often, standardised assessments are too difficult or are culturally dependent; testing some clients results in floor or ceiling effects, and other tests are simply too demanding on a subject’s attention or concentration.

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  Cracking the Dementia Code

  Creative Solutions to Cope with Changed Behaviours

  • Karen A Tyrell(Author)
  • 2016(Publication Date)
  • Personalized Dementia Solutions Inc.

    (Publisher)

  “Dementia is an umbrella term for a variety of brain disorders. Symptoms include loss of memory, judgment and reasoning, and changes in mood and behaviour. Brain function is affected enough to interfere with a person’s ability to function at work, in relationships or in everyday activities. Several conditions produce symptoms similar to Dementia. These can include depression, thyroid disease, infections or drug interactions. Early diagnosis is essential to make sure that people with these conditions get the right treatment. If the symptoms are caused by Dementia, an early diagnosis will mean early access to support, information, and medication should it be available.”

  Here is the definition of Dementia from the Alzheimer’s Association (USA):

  “Dementia is not a specific disease. It’s an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities. Alzheimer’s disease accounts for 60 to 80 percent of cases. Vascular Dementia, which occurs after a stroke, is the second most common Dementia type. But there are many other conditions that can cause symptoms of Dementia, including some that are reversible, such as thyroid problems and vitamin deficiencies.”

  Alzheimer’s Society (UK):

  “The term ‘Dementia’ describes a set of symptoms that include loss of memory, mood changes, and problems with communication and reasoning. There are many types of Dementia. The most common are Alzheimer’s disease and vascular Dementia. Dementia is progressive, which means the symptoms will gradually get worse.”

  Alzheimer Society of Australia states:

  “There are many different forms of Dementia and each has its own causes. The most common types of Dementia are; Alzheimer’s disease, Vascular Dementia, etc. There are a number of conditions that produce symptoms similar to Dementia. These include some vitamin and hormone deficiencies, depression, medication clashes or overmedication, infections and brain tumours. It is essential that a medical diagnosis is obtained at an early stage when symptoms first appear to ensure that a person who has a treatable condition is diagnosed and treated correctly. If the symptoms are caused by Dementia, an early diagnosis will mean early access to support, information, and medication should it be available.”

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  Handbook of Dementing Illnesses

  • John Morris, James E. Galvin, David M. Holtzman, John Morris, James E. Galvin, David M. Holtzman(Authors)
  • 2006(Publication Date)
  • CRC Press

    (Publisher)

  4 Neuropsychological Assessment of Dementia Kathleen A. Welsh-Bohmer and Stephanie Johnson Department of Psychiatry and Joseph & Kathleen Bryan Alzheimer’s Disease Research Center–Division of Neurology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, U.S.A. Neuropsychological assessment plays an important part in the differential diagnosis of dementing disorders, particularly in clinically ambiguous situations (e.g., suspected early Dementia) and in the context of confounding factors, such as the presence of a superimposed depression or advanced age (1,2). Within the medical evaluation of Dementia, the neuropsychological evaluation provides unique information in the form of a “behavioral sample” that can be used to determine in an objective, quantifiable manner the presence of cognitive symptoms and their functional significance. To accomplish these basic aims, the neuropsychological examination employs rigorous, standardized psychometric tests of memory and cognitive function and relies heavily on the application of normative standards and on a fundamental understanding of brain function. The examination results in metric values for discrete cognitive and behavioral capacities, which can then be used by the examining clinician to arrive at diagnostic inferences, to make judgments of functional abilities, and to establish a benchmark for monitoring future change and responsiveness to medical treatments and therapies. With advances in both public awareness of Dementia and greater availability of symptomatic treatments for Alzheimer’s disease (AD), there is an increasing tendency for patients to present to their primary care physicians with mild complaints of memory loss and cognitive disturbance (3,4). Disentangling what may be normal cognitive change from the pre-clinical stages of Dementia is a daunting task and one that is not easily remedied with a quick bedside examination of mental status (5).

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