Hospital 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?

  • Care is challenging and time consuming for family & health care providers (4)
  • Outcomes and prognosis is worsened in the presence of dementia. It is a common contributor to risk of ALC (longer length in stay)
  • Family caregivers who live apart from the resident with dementia have greater burden and diminished psychological burden (2)
  • Support for the family who provide at least 80% of the care is necessary to keep relatives out of institutions (3)

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.

Actual causes are unclear although risk factors include:

  • Family History:
      • 5-7% occur as a result of familial AD:  a person with a direct relative (parent or sibling) with Alzheimer's disease has a 3 times greater chance of developing the disease
      • 15 % will get AD at age 65 or older when both parents have the disease (1)
      • All individuals with Down syndrome over 40 or develop plaques and tangles that characterize the disease (1)
      • apoE4 is the associated genetic variant: 50% all people with two apoE4 genes will develop AD at age 65 or older (1)
  • Cognitive impairment;
      • Up to 85% of people with mild cognitive impairment in their 40-50’s develop AD within 10 years (1)
  • Vascular risk factors;
      • Type 2 ("Adult") diabetes is a known risk factor  (1)
  • People who sustain repeated concussions can development of Alzheimer's disease (1)

Key Considerations

  • Commonly complicated in hospital setting by delirium and/or behavioural symptoms
  • Delirium prevention strategies should be utilized
  • 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)
  • 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
  • Review driving status

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