Dementia Assessment and Management of Challenging Behavior - Essay Example

Name xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Institution xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Lecturer xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Date Dementia is characterized by the impairment of the cognitive and intellectual functions in normal life activities as well as relationships. This condition makes the affected individuals to also lose their ability to be able to solve problems as well as maintaining emotional control and hence have problems with regard to decision making and emotional control respectively. The affected patients will also experience changes in personality as well as behavior. It would take a long duration of loss of the cognitive functions for one to be termed as having dementia. Dementia can be static which mainly results from global head injury or progressive which is mainly due to long term decline that gives rise to long term decline due to damage or an ongoing pathology in the body. Dementia is more common in the elderly although it also occurs in the young it is referred to as early onset dementia. Dementia is classified basing on the affected part of the brain and also whether it is progressive. Cortical dementia is a type of dementia that affects the brain cortex and results in problems with thinking, language, memory and alterations in the normal social behavior of an individual. Sub cortical dementia affects the parts of the brain below the cortex and this type of dementia causes changes in emotions, movements as well as memory problems. Progressive dementia on the other hand would tend to get worse as time goes by from the onset and it will gradually result in the interference of more and more of the cognitive abilities of the individual affected. When dementia is classified basing on the causative agent, Primary dementia does not result form any on going pathology such as in the case of Alzheimer’s disease whereas secondary dementia would come as a result of having an ongoing pathology or disease process or even injury. Dementia can easily be confused with other mental disorders and hence for the diagnosis of dementia to be made, taking of a comprehensive history and physical examination, neurocognitive evaluations and neuropsychological testing, imaging tests such as computed tomography or magnetic resonance imaging all have to be carried out. Mental status examination will also have to be done (Brewer et al 2007). Before the onset of dementia in the patient, the patient was always outgoing on a number of occasion’s .In this case the patient was elderly and was admitted to hospital because of having increasingly odd behavior. A collaborative history that was taken revealed that the patient had problems with memory which was characterized by being disoriented in time, place and person. The patient could not tell where he is and the reason why he thinks he was brought to hospital. Cognitive skills such as calculating and abstract thinking were both impaired. The patient was also reported to have had memory problems which were accompanied by strong feeling of jealousy. The patient already had become disoriented for instance he could get lost while driving the routes he was familiar with. On examination the patient could not be able to read and understand clearly what he read and could stress the words in a very unusual way. Agitations as well as hallucinations were also common to the patient. Recent events as well as past event such as date of birth could not be recalled by the patient when asked .The patient was also reported to have been working previously as a shop keeper and had been good at managing the finances until when he started to give customers extra change. Lost money could sometimes be found in his pockets after search was conducted .the patient could also go ahead and forget the price list which he could sue while selling his products in the shop. Restocking of the shop also became a great problem since the patient could forget names of some of the products he was stocking and also the various points he could collect. Daily chores seemed to take longer times than before for the patient and when the patient woke up and was asked which day it was, he could not recall the day and sometimes also time became a challenge to keep. It is evident that the patient had memory impairment as well as being disoriented in some cases on time place and person. The patient also had a change in the personality since previously before the illness the patient was very social and liked the company of other but of late he has been solitary and was totally withdrawn from social activities or contact (Killick & Allan 2001). In some instances, the patient could not even recognize some of the family members whom he had previously been spending most of the times with. There was loss of interest in activities that were pleasant to the patient and other things he used to enjoy during leisure times such as hanging out with friends for a drink. Patient’s performance of the daily activities such as dressing also started to be a problem with sometimes the patient putting on garments inside out. Sleep patterns were also altered with the patient reported often to be waking up in the nights and having unusual sleeping patterns. Activities which the patient could perform with ease long ago such as serving the customer fast enough were slowed down and hence he could take a long time to be able to exactly meet the needs of the client (Killick & Allan 2001). Dementia is caused though various ways. Primary dementia is characterized by dementia that results from an on going pathology such as Alzheimer’s disease, Huntington’s disease, and lewwy body dementia, multiple sclerosis, Parkinson’s disease or picks disease. Secondary dementia on the other hand will not result from an ongoing pathology and the causes would include alcohol or substance abuse, tumors of the brain, diseases of the cardiovascular system, electrolyte imbalance, human immunodeficiency virus infection, normal pressure hydrocephalus, nutritional deficiencies such as in vitamin B12 deficiencies and stroke among other causes. Various risk factors are associated with dementia. The risk factors will include genetics, social habits such as smoking or use of alcohol, high cholesterol, atherosclerosis, diabetes, hypertension and a family history of the existence of dementia. Some of the progressive disease like in the case of Alzheimer’s disease cannot be prevented however risks of having dementia can be reduced especially in the case of dementia associated with stroke or disease of the cardiovascular system. Lowering of the risks of dementia in this case could be done by lowering the blood sugars as well as blood pressures, being able to eat a healthy and well balanced diet that is low in fat, regular exercises and cessation of smoking (Killick & Allan 2001). One of the greatest challenges that dementia posses to the patients as well as the society is the stigma that dementia is associated with. Most people in the society do not understand dementia as a mental illness and they would go ahead to stigmatize and discriminate the affected patients. The discrimination affects the patients with dementia since it makes them to be thrown a step back in the acceptance of the condition as well as the adherence to the management of dementia. This is so because of the discrimination makes them to be hopeless and hence find no value in continuing coping with dementia. Better out comes of dementia could be realized only if the society is able to have a different view about dementia and that it is an illness like any other and the society should be ready to offer help where necessary. Acceptance of the condition exists and understanding of the illness by the society about the illness will thus enhance better outcomes (Lipinska 2009). Dementia affects the cognitive as well as the intellectual capabilities of an individual and as a result, this will tend to affect the personality of the affected patients due to the changes in the mood as well as behaviors of the patients. Patients with dementia will also have problems with communication due to loss of the capabilities to be able to make decisions as well as good judgment hence this will greatly affected their daily activities and will render them to be totally dependent on others. Urinary incontinence will also be characteristic in patients with dementia and hence they will have the inability to control their urination. While feeding, dementia patients will exhibit swallowing problems due to the impaired swallow reflex and this will readily predispose the patients to aspiration pneumonia which will involve the food particles finding their way into the respiratory system (Killick & Allan 2001). Challenges will also be present in the management of the behavioral changes I effects of dementia due to the effect of the drugs. Medications will be vital in the management of some of the behavioral changes exhibited in dementia. For instance stimulants such as methylphenidate (methylin, Ritalin) will be sued to improve on cases that have sleep disorders or even flat moods. Antidepressants such as citalopram and fluoxetin will be used in stabilization of the mood of the patients while antipsychotics such as haloperidol, olanzapine will be used in the in patients with severe behavioral issues. These medications in general will alter the moods of the patients and they may be perceived by the society negatively as a result of the effects of the drugs due to the bipolar properties the drugs have on the patients (Farlow & Cummings 2007). References Brewer JB, Gabrieli JDE, Preston AR, Vaidya CJ, Rosen AC. Memory. In: Goetz CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier, chap 5. Killick, J, & , Allan, K, (2001), Communication and the care of people with dementia, Buckingham: Open University Press Farlow, MR, Cummings, JL, (2007), Effective pharmacologic management of Alzheimer's disease, Am J Med, 120:388-397. Lipinska, D, (2009), Person-centered counseling for people with dementia, London: Jessica Kingsley Publishers. Read More