PART OF HEALTH PSYCHOLOGY-DEMENTIA-ALZHEIMER'S SHAAKERA SUBJEE SHAREEKA ANGAMIA PSYCHOLOGY

6. Dementia
IS NOT a
specific
disease.
Dementia is a
GROUP OF SYMPTOMS
affecting intellectual and
social abilities severely
enough to interfere with
daily functioning.
Memory loss generally
occurs in dementia, but
memory loss alone
does not imply you
have dementia.
DEMENTIA
Alzheimer's disease is
the most common
cause of a progressive
dementia.
There are many
causes of dementia
symptoms.

7. PROGRESSSIVE BRAIN
DETERIORATION
Dementia
Normal
Aging
Mild
Cognitive
Decline
(MCD)

8. Normal
cognitive decline
associated with
age:
*Structural
changes –size,
weight and
neurons
*Varying
degrees of
cortical atrophy
*Memory and
speed of
processing
decline
Normal
Cognitive
Decline
Dementia
Mild
Cognitive
Decline
(MCD)

9. Transitional Phase-increased
probability of developing dementia
AGE-INCREASES PROBABILITY!
Amnestic type: memory impairment
(without the generalized deficits)
Non-amnestic: other domain is
affected
Dementia
Normal
Aging
Mild
Cognitive
Decline
(MCD)

10. Dementia
Normal
Cognitive
Decline
Mild
Cognitive
Decline
(MCD)
Behavioural Syndrome
with cognitive and
emotional symptoms
that affect everyday
life.
Memory impairment +
Other cognitive
impairments
More than 50 known
causes
Generally Progressive

11. Develops due to brain disease
Chronic and progressive in nature
Consciousness remaining intact
Deterioration of higher order cognitive functioning
Disturbances in social behaviour, emotional control and
motivation

12. The essential feature of any dementia is the development of multiple cognitive deficits that
include:
• memory impairment
and at least one of the following cognitive disturbances:
•
•
•
•
aphasia (language disturbance),
apraxia (impaired ability to carry out motor activities despite intact motor function),
agnosia (failure to recognize or identify objects despite intact sensory function), and
executive dysfunction (difficulty in planning, organizing, sequencing, abstracting).
The deficits must also be sufficiently severe and must represent a decline from a previously higher level of
functioning.
The diagnosis of dementia may be accompanied by subtypes and specifiers such as
• Early (before the age of 65) or Late Onset (after 65)
• With Behavioral Disturbance (e.g., wandering, striking out during care);
• With Delirium (if delirium is superimposed on dementia);
• With Delusions (if delusions are most prominent feature);
• With Depressed Mood (if depressed mood is most prominent feature); and
• Uncomplicated (if none of the aforementioned predominates the clinical presentation).

15. Changes in
mood and
personality
Withdrawal
from work or
social activities
Decreased or
poor judgment
Memory loss
that disrupts
daily
functioning
Challenges in
planning or
solving
problems
WARNING
SIGNS
Misplacing
things and
losing the
ability to
retrace steps
New problems
with words in
speaking or
writing
Difficulty
completing
familiar tasks
at home, at
work or at
leisure
Confusion with
time or place
Trouble
understanding
visual images
and spatial
relationships

16. CLINICAL DEMENTIA RATING SCALE
NONE
(O)
QUESTIONNABLE (0.5)
MILD
(1)
MODERATE (2)
SEVERE (3)
MEMORY
OK
CONSISTENT
FORGETFULNES
S
MEMORY LOSS
FOR RECENT
EVENTS
ONLY HIGH
LEARNING
MATERIAL
RETAINED
ONLY
FRAGMENTS
REMAIN
ORIENTATI-ON
FULLY
DIFFICULTY
WITH TIME
GEOGRAPHIC
TIME AND
PLACE
ONLY PERSON
JUDGEME-NT
AND PROBLEM
SOLVING
GOOD
SLIGHT
IMPAIRMENT
SOCIAL
JUDGMENT
OK,
DIFFICULTIES
WITH
SIMILARITIES
AND
DIFFERENCES
ISSUES WITH
SOCIAL
JUDGEMENT
SEVERELY
IMPAIRED
PROBLEM
SOLVING
UNABLE TO
MAKE
JUDGEMENTS

17. NONE
0
QUESTIONABLE
0.5
MILD
1
MODERA-TE
2
SEVERE
3
COMMUNITY
AFFAIRS
Independent to
work, shop
and have
social life
Slight
impairment
Unable to be
independent
but still
engaged
Well at home
but not outside
No
responsibilities
in or out the
home
HOME &
HOBBIES
Maintained
Slight
impairment
Complicated
hobbies or
chores
abandoned
Only simple
chores
maintained.
Low interest
No function
PERSONAL
CARE
Fully capable
Fully capable
Needs
prompting
Need
assistance
Help with
personal care
& incontinence

19. CORTICAL
• ALZHEIMER’S DISEASE
• Genetic hypothesis: chromosomes 1, 14, 21
• Neuropathology: cortical atrophy, amyloid plaques and
neurofibrillary tangles
• General cognitive decline with severe memory impairment
SUBCORTICAL
• Huntington’s Disease
• Genetic: ITI5 on chromosome 4. Abnormal repetitions
• Neuropathology: deterioration of the caudate nucleus, globus
pallidus, putamen and striatum
• Motor functioning and frontal functioning affected

20. Neurofibrillary
&
Tangles
AMYLOID
PLAQUES

21. NEUROANATOMY OF ALZHEIMER’S
DISEASE…

22. NEUROANATOMY OF HUNTINGTON’S
DISEASE…

23. STATIC
• Heavy Metal Poisoning
• The whole system is affected, including the brain
• Cognitive decline and behavioural changes that can be stopped
by ending the exposure or with detox treatment
PROGRESSIVE
•
•
•
•
Vascular Dementia
Blood supply is affected (multi-infarcts)
Damage to multiple areas of the brain
Cognitive decline + hallucinations/delusions , personality
changes

24. REVERSIBLE
•
•
•
•
Severe Anemia
Memory loss (holes).
Cognitive decline similar to AD
Lack of vitamin B12 that can be reverted with treatment
IRREVERSIBLE
• Parkinson’s Dementia
• Motor symptoms of tremor, rigidity, and slowness of
movement.
• Loss of dopamine from the substantia nigra

26. personality
/ mood
behavior
navigation
memory
language
thought

27. PSYCHOLOGICAL AND BEHAVIOURAL DISTURBANCES
Depression
• Reaction to early cognitive
decline
• Less prevalent in severe
dementia due to impaired
awareness
• Vascular dementia more
susceptible
• Early Onset-Dementia as a
predictor of severity
Psychotic
Disturbances
• Approximately 50% will
display disturbances
• DELUSIONS- 1/3 will display
persecutory delusions not
attributed to memory
impairment
• Moderate Level
• HALLUCINATIONS- less
frequent
• More significant relationship
with cognitive decline
• Associated with a rapid
decline at a more severe
stage
Behavioural
Problems
• Agitation, irritability,
fatigue, tiredness, apathy,
psychomotor behaviours,
anxiety and sadness.
• AD patients with co-morbid
psychotic symptoms more
likely to display severe
aggression and behaviour
problems
• Pre-morbid communication
emulated
• RISK FACTORS:
• Genetics, personality
variables, location of
deterioration
• Social implications on self
and caregiver

32. Shultz (2004) defines the role of
caregiving as:
“… the provision of extraordinary care,
exceeding the bounds
of what is normative or usual in family
relationships. Caregiving
typically involves a significant
expenditure of time, energy, and
money over potentially long periods of
time; it involves tasks that
may be unpleasant and uncomfortable
and are psychologically
stressful and physically exhausting”
(259).

38. “Stigma is an attribute, behaviour, or reputation which is socially
discrediting in a particular way: it causes an individual to be
mentally classified by others in an undesirable, rejected
stereotype rather than in an accepted , normal one” (Goffman,
1963, as cited in Batsch, & Mittelman, 2012).

39. CAREGIVER &
PATIENT
COUNSELLING FOR
ACCEPTANCE
COMBATING
STIGMA
INVOLVE MEDIA,
GOVERNMENT,O
THER
STRUCTURAL
SERVICES
RAISE AWARENESS
–CAMPAIGNS,
EDUCATIONAL
PROGRAMS

41. -2011, 5.5 million
individuals living
with HIV in S.A
Challenges when
screening for
HAD:language, culture,
inadequate resources.,
inappropriate tools,
untrained staff.
Risk Factors: lower CD4
count, older age, lower
levels of education,
depression, substance
abuse .
Prevalence: 25.4% of
adults living with HIV met
the criteria for HAD.
-International HIV
Dementia Scale
(IHDS)
Consequences: In
addition to HIV,
cognitive
impairments such as
poor concentration,
attention and
executive functioning
Sample of 65 nonadherent HIV
patients
8O% screened
positive for HAD

42. FREQUENTLY
ENGAGE IN
MENTALLY
STIMULATING
ACTIVITIES
REGULAR
PHYSICAL
ACTIVITY
NUTRITION
AL DIETS,
MODERATELOW
ALCOHOL
INTAKE
ENGAGE IN
SOCIAL
ACTIVITIES
TAKING
CARE OF
MENTAL
HEALTH

43. • Nerve growth factor (NGF)
• No fewer than 10 drugs
• Cognitive training
• Reality orientation
• Reminiscence therapy
• Cognitive rehabilitation
• Psychodynamic Therapy
• Support groups
•Public education
•Training professionals
•Developing programs
•Integrating services