Behavioral and Psychological Symptoms of Dementia - Essay Example

Dementia Vicky Brown UCLA Senile dementia Patient initials: M.T Age: 80 years Sex: Male Subjective Data: History of present illness: The patient has been brought by the daughter to the clinic because he has become more forgetful. The daughter further reports that the problem has persisted for almost four years, and currently the patient cannot recognise his grandson. Mr M.T is not able to take care of his home and household and is sometimes slow to answer questions. Past medical history: peptic ulcer disease (PUD) which last occurred three years ago. Social and family history: He is a retired sanitation worker fifteen years ago, lives with daughter after the death of his wife five years ago. He quit cigarette smoking fifteen years ago and denies the use of ethyl alcohol and intravenous drug abuse (IVDA). Family history: The patients father died in combat in Korea, and the mother died at the age of ninety-two years. Current medication Prevacid 30mg po q day ASA EC 81mg po q day Mylanta 30 cc po p.r.n when having GI upset Tylenol 325mg po p.r.n HA Physical examination General: Thin, pleasant; working memory (WM) in no acute distress Vital signs: BP: 145/78 mmHg; HR: 80; RR: 17; WT: 70kg; Ht: 62 Head, eyes, ears, nose, and throat (HEENT): Pupils equal, round, reactive to light and accommodation (PERRLA), ears packed with cerumen Neck: No bruits, (-) JVD Cardiovascular: Respiration, rate, and rhythm (RRR), normal S1, S2, no S3 or S4 Abdominal: (+) BS; not tender, not distended (NTND) External: Normal, no clubbing, cyanosis, or edema Neuro: A&O x1; oriented only to person; CNI-XII intact; reflexes normal Laboratory: Tests Observed Values Albumin (Alb) 3.6g/dl Alkaline Phosphate (Alk Phos) 41 units/L Aspartate aminotransferase (AST) 25 units/L Blood urea nitrogen (BUN) 11 mg/dl Serum creatinine (SCr) 0.7 mg/dl Sodium (Na) 136 mEq/L Chloride (Cl) 103 mEq/L Bicarbonate (CO2) 24 mEq/L Glucose 101mg/dl Calcium (Ca) 8.5 mg/dl Magnesium (Mg) 1.9 mg/dl Phosphate 3.3 mg/dl Cholesterol 160 mg/dl Total protein 6.8 g/dl Alanine aminotransferase (ALT) 21 units/L Bilirubin (Bili) 0.3 mg/dl Hemoglobin (Hb) 13.5 g/dl Hematocrit(Hct) 39 percent Platelets (Plt) 300,000/mm2 White blood cells (WBC) 8,700/mm2 Erythrocyte sedimentation rate 17mm/hr B12 452 pg/ml Folate 6.4 ng/ml Free thyroxine index (FTI) 6.3 Triodothyronine (T3) 101 ng/dl Total serum thyroxine (T4) 6.1 mcg/dl Thyroid stimulating hormone (TSH) 2.0 microunits/ml Rapid plasma reagin (RPR) Nonreactive CT scan impression Mild cortical atrophy The disease process Dementia Dementia is a clinical syndrome that causes long-term and occasional gradual decrease in the intellectual function of an individual in the absence of impairment of arousal. There are several potential causes of dementia, however; Alzheimer’s disease and diffuse vascular disease have been noted to be the most common cause. When a client presents with disturbances of personality and memory loss, the primary step is to rule out focal lesion by establishing that there is cognitive disturbance in several areas. Careful history is taken from both the patient and family member to help in giving a clue to the diagnosis. In addition, simple bedside examination and tests like the mini-mental state examination (MMSE) are imperative in assessing the cognitive deficit and general examination may give clues of the cause. Dementia is divided into two; namely, cortical and sub-cortical type based upon the clinical features (Bewernitz et al., 2009). Sign and symptoms of dementia Dementia generally affects the brain function; thus it impairs reasoning, memory and thinking ability of an individual. Several types of dementia are gradual and progressive, in that by the time an individual shows the sign and symptoms of dementia, the process has been happening for a long time in the brain. Most people who have dementia will show the following signs and symptoms: impulsivity, depression, agitation, tremor, memory loss, difficulty in speech and language, tremors, restlessness and language or speech difficulty. Progression of the disease can be divided into three stages that include early stage, middle stage and late stage. In early stage, the individual shall begin to show signs and symptoms that are noticeable to people. Moreover, the sign and symptoms start to interfere with his/her daily activities. At this stage, the person usually scores 20 to 25 on the MMSE. The middle stage is characterised by worsening of the sign and symptoms present in the early stage, for example, the patient loses almost all-new information very fast. At this stage, the patient usually has a score of 6 to 17 on MMSE. In the late stage dementia, the symptoms are very severe, and the patient often requires assistance in almost all his/her personal needs. In essence, these individuals need a close monitor throughout the day to ensure their safety since they may wander and fall into unrecognised dangers around them (Cerejeira, Lagarto, & Mukaetova-Ladinska, 2012). Diagnosis of dementia Diagnosis of dementia is very critical as it helps to discover some treatable causes if present and give an idea of the disease prognosis. Brain scanning and imaging is very vital since it exclude potential curable structural lesions like cerebral tumours, subdural hematomas as well as hydrocephalus. Some of the scanning and imaging techniques used include CT-scan, magnetic resonance and imaging (MRI) and single photon emission computed tomography (SPECT). If the test fails to yield any substantial result, then cerebral biopsy can be resorted to, even though it is rarely advocated . Cognitive testing can also be done by the use of mini-mental status examination (MMSE) tool. Other test that can be done include full blood tests, thyroid function test, EEG, HIV serology, UECs, LFT, C-reactive protein, calcium level and thyroid function test (Holmes, 2012). Management Management is usually focused on removing the correctable causes and providing support for the patient. Psychological therapies have shown some had better result for example music therapy. Adult’s day care centres also provide an excellent improvement of the cognitive function because they provide recreational facilities, meals and other healthcare services (Lawlor, 2002). Except for the treatable causes of dementia, there is no cure for dementia. However, some drugs like the anticholinesterase such as galantamine, rivastigmine and donepezil have shown some improvement in the cognitive function of the patients. Antipsychotic drugs should only be used when other therapies have failed to be effective, and the patient’s actions are threat to their lives. Health education to the caregivers is very imperative since it equips them with the necessary information on what to expect and handle the patient in relation to the loss of mental and physical abilities (Gitlin, Kales, & Lyketsos, 2012). Prevention Even though some of the risk factors like genetics and age cannot be changed, some of the risk factors of dementia can be modified and they include: regulating blood sugar levels within normal levels, avoid smoking and reduce cholesterol intake since they damage blood vessels supplying the brain. Physical exercise is good since it improves blood oxygen flow to the brain. Eating healthy diet that, include vegetables, nuts, fruits and reducing intake of red meat (Gitlin, 2012). Specific management for Mr M.T Orders: Medication Donezapil 5mg OD for six weeks Memantine 5mg OD for one week Sertraline 50mg OD for one week Vitamin B12 tabs 25mg OD for two weeks Continued medication Prevacid 30mg po q day ASA EC 81mg po q day Mylanta 30 cc po p.r.n when having GI upset Tylenol 325mg po p.r.n HA Consult/Referral For psychiatric review Dietician for proper diet prescription Education Teach the caregivers on assisting the patient to meet daily activities Family to monitor patient behaviours closely The family to give positive compliments regarding patient activities To come back to the clinic on the stated date Mode of action of the drugs Donepezil drug is a cholinesterase inhibitor that inhibit the breakdown of neurotransmitters in the brain. Memantine works by regulating glutamate activity in the brain. Glutamate is neurotransmitter that is involved in memory. Sertraline is an antidepressant that acts by selectively inhibiting the uptake of serotonin. Conclusion Dementia is a degenerative disease that occurs slowly but gradually over a long period. Advance in age is a major risk factor; however, other risk factors like lack of exercise, unhealthy eating habits can be improved to reduce its occurrence. There is no definite treatment, however; cholinesterase inhibitors have shown better results. Those patients suffering from dementia should be closely monitored because they are prone to injury. Reference Bewernitz, M. W., Mann, W. C., Dasler, P., & Belchior, P. (2009). Feasibility of machine-based prompting to assist persons with dementia. Assistive Technology : The Official Journal of RESNA, 21, 196–207. Cerejeira, J., Lagarto, L., & Mukaetova-Ladinska, E. B. (2012). Behavioral and psychological symptoms of dementia. Frontiers in Neurology, MAY. Gitlin, L. N. (2012). Good news for dementia care: Caregiver interventions reduce behavioral symptoms in people with dementia and family distress. American Journal of Psychiatry, 169, 894–897. Gitlin, L. N., Kales, H. C., & Lyketsos, C. G. (2012). Nonpharmacologic management of behavioral symptoms in dementia. JAMA : The Journal of the American Medical Association, 308, 2020–9. Holmes, C. (2012). Dementia. Medicine. Lawlor, B. (2002). Managing behavioural and psychological symptoms in dementia. British Journal of Psychiatry, 181, 463–465. Read More