GERIATRIC SYNDROMES: DEMENTIAS

This topic is very extensive, so I have decided to focus on Alzheimer's disease.

ALZHEIMER'S DISEASE is the most common form of dementia in the elderly. It is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and eventually even the ability to carry out the simplest tasks.

I have found this explanatory video of National Institutes of Health which explains the pathophysiology of Alzheimer's disease.

CLIK TO WATCH VIDEO: INSIDE THE BRAIN: UNRAVELING THE MYSTERY OF ALZHEIMER'S DISEASE

Nowadays, scientist don't know the causes of Alzheimer's disease. It's believe that there are genetic, chemical, viral, environmental and lifestyle factors involved in Alzheimer's development. However, it's known that the age is the main risk factor but other factor such as the presence of the apolipoprotein E gene appear to indicate an increased risk for development of the disease.

To assess the cognitive deterioration there are some scales:

• GLOBAL DETERIORATION SCALE OF REISBERG
• MINI-EXAM COGNITIVE OF LOBO
• CLOCK TEST

ALZHEIMER'S DISEASE EVOLUTION

Alzheimer's development usually begins after age 60 years and the type and severity of symptoms as well as the order of their appearance, differ from person to person. It's characterized by a memory problems, intellectual impairment and personality changes.

I consider that It's important don't overlook the first symptoms and don't consider them as "THINGS OF THE ELDERLY", as sometimes happens.

There are three phases:

Alzheimer's disease begins slowly. Memory problems are the first warning signs of cognitive loss. There are other signs that indicate Alzheimer's disease is beginning, such as  word-finding, vision/spatial issues and impaired reasoning or judgement.

      1. INITIAL PHASE

It's clear that as the Alzheimer  progresses, symptoms worsen. For example, memory and communication problems are more frecuently  Appear other problems such as getting lost, trouble handling money and paying, repeating questions, taking more time to complete normal daily tasks and having some mood and personality changes. 

      2. MIDDLE PHASE

Memory problems and confusion grow worse, and people begin to have problems recognizing family and friends. In addition, they can't be able to learn new things, difficultly doing tasks that involve a lot of things at the same time (getting dressed). They may have hallucinations, delusions, paranoia and behave impulsive.

      3. FINAL PHASE

In this phase, the person can't be able to communicate and is completely dependent on others for their care. In addition, the person may be in bed most or all the time.

NURSING CARE

I think that to be patient with these persons is the most important, because they aren't aware of many things.

An important nursing intervention with this type of patients is ensuring the communication with them. The nurse should use the following resources:

• Ask yes/no questions whenever possible
• Observe nonverbal communication
• Use touch to communicate empathy
• Speak slowly using short, simple sentences
• Repeat, rephrase, and restate messages
• Decrease environmental distractions
• The patient may have problems to understand the facial expressions, for this reason, nurses should approach the patient always with a smile.
• Establish eye contact before starting communication
• As trying to capture the attention of the patient, nurses should avoid scare them. For this reason, the best form to capture de attention of the patient is touching gently his hand or arm
• Provide visual cues whenever possible
• Use pictures of familiar items
• Allow ample time for responses
• Explain basic communication techniques to family
• Consult with speech therapist regarding other communication techniques.

Nursing should recommend some changes in the patient's home:

• Smoke and carbon monoxide detectors in or near the kitchen and in all bedrooms
• Emergency phone numbers and the person’s address near all phones
• Lock up or remove these potentially dangerous items from the home such as medicines, alcohol, cleaning and household products, poisonous plants, guns and other weapons, scissors,knives, power tools, machinery...
• Check all rooms for adequate lighting. Use nightlights in bathrooms, bedrooms, and hallways
• Put a glass-ceramic, use plastic plates, cup and cutlery.
• Install secure locks on all outside windows and doors, especially if the person is prone to wandering. Remove the locks on bathroom doors or dangerous rooms to prevent the person from accidentally locking himself or herself in.
• Keep the house free from clutter. Remove scatter rugs and anything else that might contribute to a fall.
• Each room must be marked with a easy picture or word.
• Paint the front door of the same color as the wall and always closed.
• Put a shower and anti-slip floor in the bathroom.
• Remove mirrors of bathroom or bedroom.
• Close the dangerous rooms (kitchen or bathroom).

Nowadays, there isn't cure for Alzheimer's disease, but the Alzheimer's disease development can be prevented with these brain-healthy lifestyles.

• Regular exercise
• Healthy diet
• Mental stimulation
• Quality sleep
• Stress management
• An active social life

I consider that mental stimulation is the most effective strategie for decrease Alzheimer's development, because they provide a great mental workout and they can help to build our capacity to form and retain cognitive associations. 

FOR EXAMPLE:

• Learn something new, study a foreign language, learn sign language, practice a musical instrument, read newspaper or a good book. 
• Practice memorization
• Enjoy strategy games, puzzles, riddles or sudokus
• Follow the road less traveled because it's help to vary our habits regularly to create new brain pathways.

Bibliografia

• NATIONAL INSTITUTES OF HEALTH
• ALZHEIMER'S & DEMENTIA PREVENTION