LTC Resources - Dementia

Dementia is associated with a progressive decline in memory and other cognitive skills severe enough to reduce a person's ability to function in which reversible and remedial factors have been excluded.

Why is it important?

  • Present in over 50% of admissions to LTC
  • New illness in presence of dementia is often associated with delirium, change in  function and/or behavioural changes
  • Care is challenging and time consuming for family & formal care providers (4)
  • Outcomes and prognosis of illness is worsened in presence of dementia.
  • Family caregivers who live apart from the resident with dementia may exhibit significant guilt and psychological burden (2)

Common Causes

Alzheimer's disease accounts for about 60% of cases of dementia, almost half of whom have co-existing cerebrovascular disease (mixed dementia). Vascular dementia accounts for 10-20% of dementia. Less common but important causes to consider are Lewy Body Dementia, Normal Pressure Hydrocephalus, Frontotemporal Dementia, and Dementia associated with Extrapyramidal syndromes such as Parkinson’s Disease.

Key Considerations

  • Take a careful a history and explore the changes in thinking, day-to-day function and behavior.
  • Care should be based on the individual’s previous levels of function, their current retained abilities, and modification of the environment to compensate for the individual’s competency (4)
  • 90% of individuals with dementia will experience behavioural symptoms at some time. Important to review any change in behaviour (P.I.E.C.E.S.TM framework and 3 question template)
  • Ensure Power of Attorney for Finances/Personal Care are in place and  discuss Advance Health Directives early on
  • Consult appropriate referrals: Geriatric Psychiatry or Psychogeriatric Social Worker, Neurologists, Geriatricians
  • Treatment with nonpharmacologic management should always be considered first before resorting to pharmacological strategies
  • There is good evidence to indicate that individualized exercise programs have an effect on functional performance in those with mild to moderate dementia (3)

References

1.  Alzheimer Society of Canada.  (2011). About Dementia.  Retrieved Feb. 2014 from: 
     http://www.alzheimer.ca/en/About-dementia

2.  Dupuis, S., Epp, T., & Smale, B. (2004) Caregivers of Persons with dementia: Roles, Experiences, Supports
     and  Coping, A Literature Review. 
Retrieved Feb. 2014 from University of Waterloo, Murray Alzheimer
     Research & Education Program (MAREP) Web site: 
     https://uwaterloo.ca/murray-alzheimer-research-and-education-program/news

3.  Feldman, S., Frank, C., & Schulz, M. (2011) Resources for people with dementia: The Alzheimer Society and
     beyond
.  Canadian Family Physician (CFP), Vol. 57.  December 2011.  Retrieved Feb. 2014 from:  
     http://www.cfp.ca/content/57/12/1387.full

4.   RNAO. (2010).  Nursing Best Practice Guideline, Caregiving Strategies for Older Adults with Delirium,
      Dementia and Depression. 
Retrieved March 2014 from:    
     
http://rnao.ca/bpg/guidelines/caregiving-strategies-older-adults-delirium-dementia-and-depression

Recommended Readings / Guidelines

1.   American Academy of Neurology .  DETECTION, DIAGNOSIS AND MANAGEMENT OF DEMENTIA
      Retrieved March 2014 from:   
      http://tools.aan.com/professionals/practice/pdfs/dementia_guideline.pdf

2.   Chertkow, H., Gauthier, S., Gordon, M., Herrmann, N., Patterson, C., Rockwood, K., Rosa-Neto, P. &  Soucy, J.P. 
      (2012)  Recommendations of the 4th Canadian Consensus Conference on the Diagnosis and Treatment of
      Dementia
(CCCDTD4). Can Geriatr J. Dec 2012; 15(4): 120–126.  Retrieved March 2014 from:
      http://www.alzheimer.ca/~/media/Files/national/For-HCP/for_hcp_recos_CCCDTD4_en.ashx

3.   Galvin, J.E. & Sadowsky, C.H. (2012)  Practical guidelines for the recognition and diagnosis of dementia.;
      NINCDS-ADRDA.  J Am Board Fam. Med. 2012 May-Jun;25(3):367-82.  Retrieved March 2014 from: 
      http://www.ncbi.nlm.nih.gov/pubmed/22570400

4.   Government of British Columbia.  (2012)  Dementia Guidelines.  Retrieved March 2014 from: 
      http://www2.gov.bc.ca/gov/topic.page?id=DABFEA5A7EAA45D7A22B815D830EC194

5.   National Institute for Health and Clinical Excellence.  (2006) Dementia: Supporting people with dementia and
      their carers in health and social care
. Clinical Guideline CG42 NICE Nov 2006.  Retrieved March 2014 from:   
      http://www.nice.org.uk/CG42

6.   Registered Nurses’ Association of Ontario.  (2004). Caregiving Strategies for Older Adults with Delirium,
      Dementia and Depression
.  Retrieved March 2014 from: 
      http://rnao.ca/bpg/guidelines/caregiving-strategies-older-adults-delirium-dementia-and-depression

7.   Registered Nurses’ Association of Ontario.  (2003).  Screening for Delirium, Dementia and Depression in the
      Older Adult
.  Retrieved March 2014 from: 
      http://rnao.ca/bpg/guidelines/screening-delirium-dementia-and-depression-older-adult