Dementia Type Symptoms Causes Diagnosis Treatment Nursing Consideration T

 

Nurses Note

Nursing Education • Neurocognitive Disorders

Dementia – Detailed Nursing Website Post

A structured, exam-ready note covering definition, types, causes, symptoms, diagnosis, treatment, complications, prevention, nursing diagnoses, and interventions.

Core goal

Safety + dignity + QoL

Approach

Person-centered care

Key risk

Falls, aspiration, delirium

Contents

Definition Types Causes & Risk Factors Symptoms & Stages Diagnosis Treatment Complications Prevention Nursing Diagnoses Nursing Interventions Patient & Caregiver Education

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1 Definition

Dementia is a chronic, progressive neurocognitive syndrome marked by decline in one or more cognitive domains (memory, language, executive function, visuospatial skills, social cognition) that is severe enough to interfere with independence and daily functioning. It is not a normal part of aging.

Differentiate:

• Delirium: acute onset, fluctuating, impaired attention; often reversible (infection, drugs).
• Depression (pseudodementia): low mood, poor effort; cognition improves with treatment.

2 Types

Alzheimer’s disease (AD)

• Most common (≈60–70%).
• Gradual memory impairment → global decline.
• Pathology: amyloid plaques + neurofibrillary tangles.

Vascular dementia

• Due to cerebrovascular disease (strokes, small vessel disease).
• Often stepwise deterioration.
• Risk: HTN, DM, hyperlipidemia, smoking.

Lewy body dementia

• Fluctuating cognition.
• Visual hallucinations.
• Parkinsonism (rigidity, bradykinesia).

Frontotemporal dementia

• Early personality/behavior change or language disorder.
• Often earlier onset (40–65).

Mixed dementia is common (e.g., Alzheimer’s + vascular). Always evaluate for potentially reversible contributors (B12 deficiency, hypothyroidism, medication effects, depression).

3 Causes & Risk Factors

Primary (irreversible) causes

• Neurodegenerative: Alzheimer’s, Lewy body, frontotemporal.
• Vascular brain injury (multi-infarct, small vessel disease).

Secondary (potentially reversible) causes

• Vitamin B12/folate deficiency, hypothyroidism.
• Normal pressure hydrocephalus (triad: gait, urinary, cognition).
• Medication effects (anticholinergics, sedatives), alcohol misuse.
• CNS infection/tumor, subdural hematoma.

Non-modifiable risks

Age • Genetics • Family history

Modifiable risks

HTN • DM • Smoking • Inactivity • Hearing loss

4 Symptoms & Stages

Early stage

• Mild forgetfulness, misplacing items.
• Word-finding difficulty.
• Reduced judgment, subtle personality change.

Moderate stage

• Disorientation (time/place), confusion.
• Needs help with ADLs.
• Wandering, agitation, sleep disturbance.

Late stage

• Severe cognitive impairment.
• Dysphagia, incontinence, immobility.
• Total dependence; high infection risk.

Behavioral & Psychological Symptoms of Dementia (BPSD): agitation, aggression, hallucinations, delusions, anxiety, depression, apathy, sundowning.
Nursing priority: identify triggers → use non-pharmacological strategies first.

5 Diagnosis

Assessment

• History (patient + caregiver), onset, progression, ADL function.
• Medication review (anticholinergics/sedatives), alcohol, comorbidities.
• Neuro exam, mood assessment (depression), delirium screen if acute change.

Cognitive testing

• MMSE / MoCA (more sensitive early).
• Clock drawing, verbal fluency, executive tasks.

Labs (to rule out reversible causes)

• CBC, U&E, LFT, glucose, calcium
• TSH
• Vitamin B12 ± folate

Imaging

• CT/MRI brain to assess stroke, tumor, hydrocephalus, atrophy.
• Further tests based on specialist guidance (as indicated).

6 Treatment

There is no definitive cure for most dementias. Treatment aims to slow symptom progression (where possible), manage behavioral symptoms, reduce complications, and support caregivers.

Pharmacological (specialist/doctor-led)

• Cholinesterase inhibitors: donepezil, rivastigmine, galantamine (often mild–moderate AD).
• NMDA antagonist: memantine (often moderate–severe AD).
• BPSD: use meds cautiously; prioritize non-pharm strategies first.

Non-pharmacological

• Structured routine, cognitive stimulation, reminiscence therapy.
• OT for function + home safety, PT for strength/balance.
• Sleep hygiene; reduce noise/clutter; meaningful activities.

Safety note: If antipsychotics are considered for severe distress/risk, monitor closely for side effects and reassess regularly. Use lowest effective dose and shortest duration under medical advice.

7 Complications

Physical complications

• Falls, fractures
• Malnutrition, dehydration
• Aspiration pneumonia, choking
• Pressure ulcers, contractures
• UTIs and recurrent infections

Psychosocial complications

• Depression, anxiety, social isolation
• Caregiver strain/burnout
• Safeguarding issues, wandering risk

8 Prevention

Primary prevention (risk reduction)

• Control BP, diabetes, cholesterol.
• Stop smoking; limit alcohol.
• Regular exercise (aerobic + strength + balance).
• Mediterranean-style diet; healthy weight.
• Hearing/vision support; manage sleep apnea.

Secondary/tertiary prevention

• Early recognition + assessment.
• Medication review (reduce anticholinergic burden).
• Prevent falls, infections, malnutrition.
• Caregiver education + respite support.

9 Nursing Diagnoses

• Chronic confusion related to neurodegeneration.
• Impaired memory related to cognitive decline.
• Impaired verbal communication related to aphasia/cognitive impairment.
• Risk for injury related to impaired judgment, wandering, falls.
• Self-care deficit (bathing, dressing, feeding, toileting) related to functional decline.
• Disturbed sleep pattern related to sundowning, anxiety, altered circadian rhythm.
• Imbalanced nutrition: less than body requirements related to dysphagia/poor intake.
• Caregiver role strain related to prolonged care demands.

10 Nursing Interventions (Practical)

Communication & orientation

• Use short, simple sentences; one step at a time.
• Allow extra time; avoid arguing; validate feelings.
• Use cues: clocks, calendars, labels, photo boards.
• Maintain routine; consistent caregivers when possible.

Safety & fall prevention

• Remove hazards; good lighting; non-slip footwear.
• Supervise wandering risk; ID band; door alarms if used.
• Review meds that increase falls (per prescriber).
• Frequent toileting schedule; call bell within reach.

ADLs & dignity

• Encourage independence with assistance as needed.
• Break tasks into steps; offer choices (2 options).
• Maintain privacy; explain before touch/care.

Nutrition, hydration & swallowing

• Small frequent meals; finger foods if helpful.
• Monitor weight, intake, hydration; mouth care.
• Assess dysphagia; upright feeding; aspiration precautions.

BPSD (agitation, sundowning)

• Look for triggers: pain, hunger, constipation, infection, noise.
• Use calm environment; redirection; meaningful activities.
• De-escalation: low voice, space, reassurance.

Skin, mobility & infection prevention

• Reposition 2-hourly if immobile; pressure-relief surfaces.
• ROM exercises; encourage safe mobilization.
• Monitor for UTI, chest infection, dehydration signs.

Golden nursing principle: Address reversible causes of worsening confusion first (pain, constipation, dehydration, infection, medication effects).

11 Patient & Caregiver Education

Home & routine

• Keep environment familiar; reduce clutter.
• Use reminders/labels; simplify choices.
• Plan advanced care early (legal, financial, future care).

Caregiver support

• Teach coping skills; encourage respite care.
• Support groups; community resources.
• Recognize burnout signs and seek help early.

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