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DEMENTIA DEMENTIA •WHAT IS IT •HOW COMMON IS

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DEMENTIA DEMENTIA •WHAT IS IT •HOW COMMON IS Powered By Docstoc
					           DEMENTIA
•WHAT IS IT?

•HOW COMMON IS IT ?

•WHAT ARE ITS CAUSES?

•WHAT DOES IT DO TO THE INDIVIDUAL?

•WHAT ARE ITS LEGAL, FINANCIAL, SOCIAL
IMPLICATIONS
            WHAT IS DEMENTIA?


IN ITS SIMPLEST DEFINITION ONE CAN SEE IT AS

              "BRAIN FAILURE"


      HOWEVER IT IS DEFINED AS GLOBAL

      IMPAIRMENT OF INTELLECT, MEMORY

  AND PERSONALITY IN CLEAR CONSCIOUSNESS.
                 MEMORY

•SELECTIVE IMPAIRMENT OF MEMORY INITIALLY

 FOR RECENT EVENTS THEN MOVING ON TO

            THE DISTANT PAST.

• CAN RECALL EVENTS OF A LONG TIME AGO, BUT
         CAN'T RECALL YESTERDAY!

OR WHAT I HAD FOR BREAKFAST THIS MORNING
     OR WHETHER I HAD IT AT ALL!
               INTELLECT

ABSTRACT THINKING IS PARTICULARLY VULNERABLE.
       ONE IS UNABLE TO GRASP NEW IDEAS.

 MISINTERPRETATION CAN LEAD TO SUSPICION
      AND EVEN TO DELUSIONAL IDEAS.


 THINKING IS FRAGMENTED AND THE THINKING
   PROCESSES ARE CONFUSED AND MUDDLED


     IDEAS ARE REDUCED TO PLATITUDES AND
 PERSEVERATION IS COMMON. THE LATTER IMPLIES
        THAT SAME IDEAS ARE REPEATED
             OVER AND OVER AGAIN.
         PERSONALITY

 DUE TO THE CHANGES IN THE BRAIN
  THERE MAY BE AN EXAGGERATION
OF THE NORMAL PERSONALITY TRAITS.
  MAY EVEN BE A CARICATURE OF ITS
         WORST FEATURES.

  EMOTIONAL LABILITY IS COMMON,
 SO TOO MAY BE THE EXPLOSIVENESS.


   THERE IS A TENDENCY TOWARDS
INTROVERSION & SOCIAL WITHDRAWL.
     CORTICAL FUNCTIONS


DYSPHASIA DISORDER OF LANGUAGE
DUE TO BRAIN DYSFUNCTION

DYSPRAXIA INABILITY TO CARRY OUT
MOTOR FUNCTIONS DESPITE INTACT
COMPREHENSION

AGNOSIA INABILITY TO RECOGNISE OR
IDENTIFY OBJECTS DESPITE INTACT
SENSORY FUNCTION
      PATHOLOGY

LOSS OF NERVE CELLS

NEUROFIBRILLARY TANGLES

PLAQUES


AMYLOID DEPOSIT

CEREBRAL ATROPHY
        TYPES OF DEMENTIA
•SENILE DEMENTIA OF ALZHEIMER TYPE

•LEWY BODY DEMENTIA

•MULTI-INFARCT DEMENTIA

•PICK’S DISEASE

•HUNTINGTON’S DISEASE

•PRION DISESES ( C.J.D )
       THREE STAGES OF THE ILLNESS

STAGE ONE
[ 2 TO 4 YRS ] MEMORY LOSS LACK OF SPONTANEITY,
DISORIENTATION, PERPLEXITY, AGITATION.

STAGE TWO
[2 TO 4 YRS] MORE RAPID DETERIORATION OF INTELLECT
& PERSONALITY. FOCAL FEATURES DEVELOP:-
dysphasia, dyspraxia, agnosia, dyscalculia.


STAGE THREE
[4 YRS. ONWARDS} PROFOUND DEMENTIA, INCONTINENCE
BEDFAST, ACCELERATED AGING, EMACIATED, WEAKNESS,
NEEDING NURSING CARE.
      LEWY BODY DEMENTIA

HYALINE INCLUSION BODIES FIRST DESCRIBED IN 1912


EARLY FLUCTUATION IN COGNITIVE STATE
PARKINSONN SYMPTOMS
HALLUCINATIONS
DELUSIONS


FEWER CORTICAL SYMPTOMS

2ND. MOST COMMON OF DEMENTIAS

VERY SENSITIVE TO MAJOR TRANQUILIZERS
       MULTI -INFARCT DEMENTIA

REPEATED SMALL STROKES LEADING TO WIDESPREAD
LOSS OF FUNCTIONS

MORE LIKELY THAN AD TO HAVE HISTORY OF
STROKES, M.I., HYPERTENSION, SMOKING


STEP LADDER COURSE


TREAT WITH ASPIRIN
        DISCUSSION POINTS
         CONSENT   CAPACITY

FINACIAL ASPECTS
  MANAGING MONEY
  •ENDURING POWER OF ATTORNEY
  •COURT OF PROTECTION
  •CONTINUING POWER OF ATTORNEY
  •TESTAMENTARY CAPACITY


 •RIGHT TO SERVICES
 •RIGHTS TO ASSESSMENT/CARE/TREATMENT
 •CONTINUING CARE
 •ADVOCACY

 •DNR POLICIES
         CAPACITY

INTACT ABILITY TO RESPOND TO A PARTICULAR
SITUATION, WITH APPROPRIATE APPRECIATION
   AND TO ACT IN ONE’S OWN SELF-INTEREST



     IT IS A LEGAL CONCEPT

       CAPACITY    FOR WHAT?


      FOR DIFFERENT REASONS
   CAPACITY TO CONSENT TO TREATMENT

         TESTAMENTARY CAPACITY
           ( Capacity to make a will)


CAPACITY TO DEAL WITH FINACIAL AFFAIRS
  (power of attorney, both general and enduring
             and court of protection)

   CAPACITY TO CONSENT TO MARRIAGE,
 TO ENGAGE IN SEXUAL RELATIONSHIPS etc.

  CAPACITY TO ENTER INTO CONTRACTS
        ALZHEIMER’S -- MEMORY



STROKES -- INABILITY TO READ, UNDERSTAND


  FRONTAL LOBE DEMENTIA – JUDGEMENT


  DEPRESSION – FEELINGS OF HOPELESSNESS
 NOT “ WOULD A RATIONAL PERSON DECIDE
    WHAT THIS PERSON HAS DECIDED”

   NOT THE DECISION ITSELF BUT THE
 THOUGHT PROCESS BEHIND THE DECISION


PRESUMPTION THAT A PERSON HAS CAPACITY
       TILL PROVED OTHERWISE

  PEOPLE SHOULD BE ENCOURAGED TO TAKE
  FOR THEMSELVES THOSE DECISIONS WHICH
          THEY ARE ABLE TO TAKE
             (Law Commission)
  ASSESSING MENTAL STATE

 APPEARANCE, SPEECH, MOOD, THOUGHT,
    PERCEPTION, COGNITION, MEMORY,
  INTELLIGENCE, ORIENTATION, INSIGHT

LOCATION          TIMING

 COMMUNICATION     PRESENCE OF OTHERS



           OTHER CONDITIONS
      DNR [do not resuscitate ]
•PATIENTS KNOWN VIEWS
•NATURE OF CONDITION
•PROGNOSIS
•QUALITY OF LIFE
•WHAT IS PROPOSED PLAN OF MANAGEMENT
TO KEEP PATIENT ALIVE


               •CAPACITY
               •CONSENT
               •MEDICAL VIEW
               •NURSING/TEAM VIEW
               •NEXT OF KIN
               •SECOND OPINION
               •DOCUMENTATION

				
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posted:11/11/2011
language:English
pages:18