NEUROLOGICAL DISORDERS:
DEMENTIA
CHO module on MNS disorders – Chapter 7 (Pages 61 to 63)
Staff Nurse module on MNS disorders – Chapter 7 (Pages 56 to 58)
LEARNING OBJECTIVES
At the end of the session, participants should be able to-
1. Define dementia
2. List the risk factors of dementia
3. Describe the stages and clinical features of dementia
4. Describe the role of CHO in management of dementia
5. Identify red flags for referral to specialist
DEFINITION
Dementia is a syndrome – usually of a chronic or progressive nature – in
which there is deterioration in cognitive function (i.e. the ability to process
thought) beyond what might be expected from normal ageing (WHO).
It affects-
Memory
Thinking
Orientation
Comprehension
Calculation
Learning capacity
Language Consciousness is not affected.
Judgement and social interaction
INTRODUCTION
Worldwide, around 50 million people have dementia, and there are nearly 10
million new cases every year.
53 Lakhs people are estimated to have dementia in India in 2020.
The number of Persons With dementia (PWD) is expected to increase to 76
Lakhs by 2030
Although dementia mainly affects older people, it is not a normal part of
ageing.
Alzheimer's disease is the most common form of dementia and may contribute
to 60–70% of cases.
Dementia is one of the major causes of disability and dependency among older
people worldwide.
Dementia has a physical, psychological, social, and economic impact, not only
on people with dementia, but also on their carers, families and society at large.
(who.int dementia 2020)
RISK FACTORS
Potentially Non- Modifiable Factors:
• Age
• Genetic factors
Modifiable Factors:
• Illiteracy
• Hearing Loss
• Diabetes
• Hypertension
• Obesity
• Smoking
• Depression
• Physical Inactivity
• Social Isolation
• Stroke
CLINICAL FEATURES
Signs and symptoms depend on the stage and type of dementia
Dementia may mimic depression & also may co-exist with
depression.
Clinical stage Progression of disease
Early stage/ Mild Dementia The early stage of dementia is often overlooked, because
the onset is gradual.
Middle stage/ Moderate Dementia As dementia, progresses to the middle stage, the signs and
symptoms become clearer and more restricting.
Late stage/ Severe Dementia The late stage of dementia is one of near total dependence
and inactivity. Memory disturbances are serious and the
physical signs and symptoms become more obvious.
CLINICAL FEATURES
Early stage
forgetfulness
losing track of the time
becoming lost in familiar places
Independent for basic activities of daily living (ADL)
Middle stage
becoming forgetful of recent events and people's names
becoming lost at home
having increasing difficulty with communication
needing help with personal care( dependent on ADL)
experiencing behaviour changes, including wandering and
repeated questioning.
CLINICAL FEATURES
Late stage
becoming unaware of the time and place
having difficulty recognizing relatives and friends
having an increasing need for assisted self-care
having difficulty walking
experiencing behaviour changes that may escalate including
aggression( severity of Behavioural and Psychological Symptoms of
Dementia- (BPSD) increases).
ASSESSMENT OF DEMENTIA AT SHC-HWC
Cognitive assessment is done to assess dementia since patients with
dementia are characterized by cognitive impairment.
Brief cognitive assessment using standard tools such as Hindi Mental
Status Examination (MMSE)
HMSE is a modified tool derived from MMSE and can be used
specially in the sociocultural context in the Indian scenario.
Everyday Abilities Scale for India (EASI) – specific tool to screen for
impairment of functioning.
HINDI MENTAL
STATUS
EXAMINATION
Developed
considering the
sociocultural
context of Indian
population from
MMSE
Total score is out of
31.
EVERYDAY ABILITIES SCALE FOR INDIA
MANAGEMENT OF DEMENTIA AT SHC-HWC
There is no curative therapy for dementia, and hence, the focus is on
treatment of symptoms and associated comorbidities, including
psychiatric concerns.
Management at the SHC-HWC includes:
Continuation of Medications ( AchE-I) as prescribed by the MO.
Regular follow ups and monitoring
Non-pharmacological intervention
Referring to specialist (in c/o red flags)
NON-PHARMACOLOGICAL INTERVENTION
Environmental modification
Memory training
Adequate sensory cueing
Simplification of tasks
Dementia support groups
Other therapies – music therapy, aroma therapy, art therapy, light
exercises
Interventions for caregivers
Disability benefits/ welfare measures including legal implications
RED FLAGS IN DEMENTIA (when to refer)
Young onset
Rapidly progressive cognitive dysfunction
Worsening impairment in activities of daily living
Headache and vomiting
Fever
Involuntary weight loss and loss of appetite
Incontinence of bowel or bladder
Self-injury or injury to a caregiver
Recent history of head trauma
Presence of focal neurological deficits such as hemiparalysis
Associated seizures
GROUP ACTIVITY
A 70-years old male, a retired teacher, presented with complaints of forgetfulness in day-
to-day activities. He had noticed these symptoms around three years ago, and the
complaints had been progressive since. This had led to problems such as forgetting where
he placed his spectacles or car keys, and also forgetting to lock the house after him. Of
late he has also not been able to manage his finances. He felt bothered by these issues
and his wife reported that he seemed worried and withdrawn. His wife also reported that
he sometimes got confused about the routes while driving and couldn’t find his way
home, a problem that he never had before. On examination, he was alert and oriented to
time, place and person. His general knowledge was intact. He had no other significant
past medical or family history. He had no history of substance use or the use of any
regular medications.
GROUP ACTIVITY
GROUP 1: What is the possible diagnosis? What are the clinical features
that made you think of this diagnosis?
GROUP 2: Assess the case using Everyday Abilities Scale for India.
GROUP 3: What is the role of CHO in management of this case at the
SHC-HWC?
Discussion – 6 minutes
Presentation – 3 minutes per group
EVALUATION
State whether the following are true or false
1. Complete dependence and near total inactivity is seen in early stage of
dementia.
2. A patient of dementia with worsening impairment in activities of daily
living should be referred to a specialist.
3. Dementia is characterized by loss of consciousness.
4. CHO can initiate pharmacological treatment in patients with dementia.
5. Setting reminders and alarms on the phone is an example of sensory
cueing in patients with dementia.
EVALUATION
State whether the following are true or false
1. Complete dependence and near total inactivity is seen in early stage of
dementia. FALSE
2. A patient of dementia with worsening impairment in activities of daily
living should be referred to a specialist. TRUE
3. Dementia is characterized by loss of consciousness. FALSE
4. CHO can initiate pharmacological treatment in patients with dementia.
FALSE
5. Setting reminders and alarms on the phone is an example of sensory
cueing in patients with dementia. FALSE
EVALUATION
Fill in the blanks
1. While filling the EASI, a cut off score of ____ warrants further
evaluation.
2. The clinical stage of dementia which is often overlooked is _____.
3. MMSE/HMSE is used to assess _____.
4. Dementia might sometimes mimic _____.
EVALUATION
Fill in the blanks
1. While filling the EASI, a cut off score of >4 warrants further evaluation.
2. The clinical stage of dementia which is often overlooked is early stage/
mild dementia.
3. MMSE/HMSE is used to assess cognitive function.
4. Dementia might sometimes mimic depression.
Further readings and resources
https://www.dementiauk.org/
https://dementiacarenotes.in/
https://www.who.int/news-room/fact-sheets/detail/dementia
Shaji KS, Sivakumar PT, Rao GP, Paul N. Clinical practice guidelines for
management of dementia. Indian journal of psychiatry. 2018
Feb;60(Suppl 3):S312.
https://www.mhinnovation.net/sites/default/files/downloads/innovation/r
eports/Dementia-India-Report.pdf
https://www.alzint.org/resource/world-alzheimer-report-2020/
VAYOMANASA SANJEEVANI (outreach initiative)
https://www.youtube.com/channel/UCndmTxMQq9AOjj2WRBCzmOQ
THANK YOU
