Dementia and Alzheimer's Disease - Term Paper Example

Dementia and Alzheimer Disease Student’s Name Institutional Affiliation Dementia and Alzheimer Disease Dementia can be described as a syndrome since its presenting features are multiple such as disturbances in comprehension, memory, judgement, language, learning capacity, orientation and thinking (Grand, Caspar & MacDonald, 2011). It often presents in elderly individuals as advanced age is a significant risk factor (Montine, 2014). Dementia syndromes can be grouped into four that include vascular dementia and Alzheimer’s disease (AD) that cumulatively account for about 80% of reported cases of dementia, and frontotemporal dementia and dementia with Lewy body that account for the remaining 20% of dementia cases (Montine, 2014). In dementia, the patients maintain their consciousness and the cognitive function impairment are often accompanied by adverse changes in motivation, social behaviour and emotional control (Duthey, 2013). Occasionally, such negative changes may preceded cognitive impairment. In the following discussion, prevalence and incidence of AD in Australia shall be examined including a critical discussion of the three forms of dementia and implication to interprofessional practice and nursing practice. Prevalence and Incidence of Alzheimer in Australia AD accounting for about 70% of dementia cases has its prevalence increasing in Australia (Alzheimer’s Australia NSW [AANSW], 2013; Australian Bureau of Statistics [ABS], 2012). As of 2011, 298 000 Australians had dementia as a symptom of Alzheimer’s disease with 62% of those affected been women (Australian Institute of Health and Welfare [AIHW], 2012). This number is higher than the previously estimated number in 2007 report. In the same year, 1.3 percent of Australians had dementia. Those aged above 65 years had a dementia prevalence of 1 in 11 (AIHW, 2012; ABS, 2012). With the regard to age group, the prevalence of AD was 33% in 75 to 84-year-old individuals, and 41% of Australians aged above 85 years in 2011 (AIHW, 2012). AD presenting in younger individuals aged less than 65 years can be referred to as younger onset dementia. In 2011, it was estimated that about 23 900 Australians presented with younger onset dementia. This was about 8% of Australians with dementia (AIHW, 2012). As of 2013, at least 321 000 Australians were reported to be symptomatic of Alzheimer’s presenting with dementia (AANSW, 2013). It is also reported that the number of new cases reported due to dementia is estimated to be 1700 every week which loosely translates to about a person for every six minutes (AANSW, 2013). It is also reported that one out of four older persons aged above 85 years has dementia in Australia (AANSW, 2013). The States and Territorial estimates of dementia varied from about 1000 residents of Northern Territory to about 101,800 individuals in New South Wales (AIHW, 2012). In terms of changes in projection in coming years up to 2050, Northern Territory would have experienced the greatest increase in number of dementia cases at 51% while South Australia would have experienced the smallest increase at 27% (AIHW, 2012). In terms of the incidence of dementia as in Australia, 37 100 incident cases were reported in 2003, 63% of the incident cases been accounted for by women (AIHW, 2012). Both men and women had dementia incidences increasing with age, but the incidence decreased with age for those aged above 85 years (AIHW, 2012). Dementia Types Alzheimer ’s disease It is an incurable disease that and has a progressive cycle that can be very long (Anderson, 2015). It is characterised by the development of plaques in the memory encoding structure in the brain called the hippocampus in addition to the development of plaques in other areas of the brain such as the cerebral cortex responsible for thoughts and decision making in the human body (Anderson, 2015; Yadav, 2012). The cause of AD is not known though genetic and environmental risk factors have been implicated. Risk factors include advanced age, a risk factor also present in Antonia, family history of AD, obesity, hypertension, dyslipidaemia, head trauma, and APOE 4 genotype (Anderson, 2015). The disease progresses in four stages that include pre-dementia or pre-clinical Alzheimer disease, early or mild Alzheimer, moderate Alzheimer and advanced Alzheimer (Anderson, 2015; Dubois et al., 2010). In the preclinical Alzheimer, patients may be very normal even after testing their mental status or after a physical examination. Mild AD signs include loss of memory – a sign exhibited by Antonio, confusion with regard to familiar places’ location, trouble paying bills and handling money, spontaneity loss, increased anxiety and compromised judgement (Anderson, 2015; Linda & Bludau, 2011). Moderate AD presents with symptoms such as confusion and more incidences of memory losses, problem recognising family members and friends – symptoms also exhibited by Antonio, difficulty thinking properly, reading and language problems, inability to learn and cope with new things, and brief attention span (Linda & Bludau, 2011). Severe AD presents with weight loss, loss of bladder control and patients are completely reliant on others for activities of daily living (ADL). Such patients, also, cannot communicate with anyone, and cannot even recognise close persons such as friends and relatives (Linda & Bludau, 2011). Vascular Dementia It is a preventable form of dementia commonly caused by cerebrovascular dysfunctions such as those leading to stroke. Impaired brain perfusion may result in damage to brain cells involved in memory processing especially if the impaired blood vessels supply such areas of the brain. Its risk factors include stroke, transient ischaemic attacks, diabetes mellitus and hypertension (Grand, Caspar & MacDonald, 2011). This type of dementia may progress in three phases that include early phase, middle and late forms of the disease but it may also be abrupt depending on the aetiology (Alagiakrishnan, 2015). Multiple infarcts are responsible for the progression of the disease to severe forms of dementia of subcortical type (Alagiakrishnan, 2015). Dementia with Lewy Bodies (DLB) It’s a form of degenerative dementia common in older adults that is said to account for about 10-20% of cases during autopsy (Crystal, 2014). Initial symptoms may be cognitive resembling those of vascular dementia or AD in their early stages. However, most individuals also present with movement disorders roughly the same time that the symptoms of dementia begin manifesting (Montine, 2014). The dementia symptoms may sometimes precede movement disorders similar to those experienced in Parkinson's' disease (Montine, 2014). Known precipitant of DLB is exposure to organophosphates pesticides with advanced age been a risk factor too. It's characterised by a fluctuating type of progressive cognitive impairment in over 50% of cases, parkinsonism, and visual hallucination (Grand, Caspar & MacDonald, 2011). Other symptoms include depression and REM sleep behaviour disorder (Crystal, 2014). Implications for Nursing and Interprofessional Practice The diagnosis of AD makes patients with dementia such as Antonio occasionally or constantly need assistance in performing some or most of their ADL depending on the stage of the disease. For an AD’s patient to be successfully managed such as Antonio, it requires the development of a timely, appropriate and individualised care plan that shall have to undergo re-evaluation at regular intervals (Grand, Caspar & MacDonald, 2011). In the management of Antonio, the interprofessional team is paramount. This team may consist of the nursing team, caregivers, physician, geriatric social workers, clergy and psychologists and their input at various stages of the disease is indispensable (Brody & Galvin, 2014). For nursing care, the major goals include the provision of information and enabling the availability of resources to aid the patient and the family in identifying a specific path that would work best for them (Rose & Lopez, 2012). This is after a nursing assessment of the patient’s mental status, ability to undertake ADLs, environmental risks such as his gardening job, support group, and caregiver’s capability of undertaking care tasks and mechanisms of coping, to come up with specific and appropriate nursing diagnosis. In the early AD stages such as in Antonio’s case, possible nursing and other management interventions target the environment, education, behaviour and verbal communication (Rose & Lopez, 2012). The environment needs to be safe for the patient and other members around him. While undertaking his gardening job, Antonio may have to be watched so that he may not hurt himself. Medications, sharp objects, and other potential harmful objects should be kept out of the patient’s reach. The nurse shall be expected to educate the patient and the family members on the disease, its symptoms, progress and prognosis and encourage the family members to offer relevant support such as tolerating his indifference towards them and frequently encouraging him to engage in activities or hobbies he is interested in to alleviate his depressed mood, and tolerate the changes the patient may have undergone. Regarding verbal interventions, the nurse may advise that the patient may need reminding of usual activities such as when to visit the garden, be allowed sufficient time for activities, and be given simple step-by-step cues (Kapusta, 2011). Behavioural interventions may include maintenance of routine activities due to the patient's forgetfulness and providing safe walking areas in the house to avoid hurting himself. These are some of the possible interventions for Antonio. As the disease progresses to intermediate stage, the patient shall require more support such as availing basic requisite things such as food and clothing where the patient can easily see, fencing the compound to avoid wandering and getting lost, and providing a secure environment (Kapusta, 2011). The patient should be talked to in a calm voice. Caregivers are instrumental in this stage of the disease as the patient is unable to perform most tasks. Pharmacological interventions may be necessary to prevent rapid deterioration of cognitive function. Physicians and even pharmacists are significant in deciding the best pharmacological therapy for the patient and in the pharmacological management of comorbidities (Rose & Lopez, 2012; Kapusta, 2011). Caregivers will aid in fostering adherence and compliance to medication when Antonio reaches such as stage. Conclusion The progressive loss of memory function and other neurological dysfunctions accompanying patients such as Antonio makes them require monitoring and support as the disease progresses. Even though the disease cannot be cured, its progress can be delayed through the help of health professionals, care givers and family members. Support institutions such as adult day care services and nursing homes may be necessary in the late stages of the disease. (For any consultation you can give me your contacts). References Alagiakrishnan, K. (2015). Vascular dementia. Retrieved from http://emedicine.medscape.com/article/292105-overview#a5 Alzheimer's Australia NSW. (2013). Key facts and statistics 2013. Retrieved from http://givetoalzheimers.org.au/events/downloads/0000/7215/Key-facts-National_January-2013.pdf Anderson, H.S. (2015). Alzheimer Disease. Retrieved from http://emedicine.medscape.com/article/1134817-overview Australian Bureau of Statistics. (2012). Australian social trends, Dec 2012. Retrieved from http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features50Dec+2012 Australian Institute of Health and Welfare. (2012). Dementia in Australia. Canberra: AIHW. Crystal, H.A. (2014). Dementia with lewy bodies. Retrieved from http://emedicine.medscape.com/article/1135041-overview#a5 Brody, A.A. & Galvin, J.E. (2013). A review of interprofessional dissemination and education interventions for recognizing and managing dementia. Gerontology Geriatrics Education, 34(3), 225-256. Dubois, B., Feldman, H.H., Jacova, C., Cummings, J.L., Dekosky, S.T., Barberger-Geteau, P., ... Scheltens, P. (2010). Revising the definition of Alzheimer's disease: A new lexicon. Lancet Neurology, 9(11), 1118-27. Duthey, B. (2013). Alzheimer disease and other dementia. Retrieved from http://www.who.int/medicines/areas/priority_medicines/BP6_11Alzheimer.pdf Grand, J.H., Caspar, S. & MacDonald, S. (2011). 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