COGNITIVE IMPAIRMENT AND DEMENTIA

Cognitive impairment and dementia are among the issues most important public health in developed countries.

Until recent years, mild cognitive impairment to be related to the aging process itself and was detected in advanced stages of disease. Today, it was determined that these patients be evaluated increasingly early stages and therefore achieves influence the course and the social environment of the patient and family.

Mild cognitive impairment is the physiological if functional impairment is dementia.

Since the middle of last century, Kral, proposed the clinical concept of benign neglect of the elderly as an isolated disturbance of memory, then other authors have developed various nomenclatures such as memory impairment associated with age. Finally, in the late nineties arises the concept of mild cognitive impairment defined by Petersen, outlining the various subclasses and is currently the most used.

The term "mild cognitive impairment" refers to a clinically apparent intellectual decline, but carries no apparent functional disability

COGNITIVE IMPAIRMENT ASSESSMENT. ROLE OF NURSING

For evidence of cognitive decline if there really is necessary to know the existing cognitive losses in normal aging ie baseline.

The lack of pathology changes in the healthy individual are:

-          Memory: affects working memory, episodic free recall, whereas iconic memory (short-term), recognition, cued recall, semantic memory, implicit and prospective remains preserved.

-          Language: deteriorates thnaming e and verbal fluency decreases, but retains the syntax and lexicon.

-          Reasoning, problem solving skills and speed of information processing decline with age.

-          Care is preserved.

ALZHEIMER

Is a progressive disorder of the brain, characterized by degenerative changes cellas cortical nerve and brain nerve endings. This process produces an irreversible deterioration of memory and intellectual functions destruction.

The background cause is unknown, the shuffled causes are autoimmune disease, a virus, genetic disease and neurotransmitter deficiency. The main risk factor is age, the eating is insidious, can affect individuals of up to 40 years, the disease progresses until the total disability.

It affects both men and women.

The occurrence and severity of signs and symptoms will vary between individuals, is characterized by loss of memory, intellectual impairment and personality change. It is classified into three stages: initial, medial and final phase. Initial indications are mild, but the main sign is the loss of short term memory, the diagnosis can take years and even diagnosed in the next stage of the disease.

In the middle stage the patient have trouble recognizing objects and things, for activities or to implement skills before or had to communicate.

In the final stage are absent memory and brainpower. In the final stage the patient is in a vegetative state

Guidelines to improve communication between nurses and patients with Alzheimer

1.      Use short words and simple sentences

2.      Repeat your statements

3.      Avoid unusual expressions

4.      From indications using fewer words

5.      Ask questions if and when patients have difficulty responding

6.      Make distracting noises disappear.

They can be both positive and negative

1.      A smile communicates happiness

2.      The frown communicates sadness or displeasure

3.      The folded arms can communicate displeasure

4.      Fast speed communicates impatience.

Be aware of facial expressions

1.      The patient may have trouble understanding facial expressions

2.      Be always aware of the expression on his face

3.      Always approach the patient with a smile.

Catching the eye of a patient

1.      You may need to grab the attention of a patient, but do not want to alarm

2.      Touch the patient gently on the arm or hand to get his attention

3.      Remember to be gentle or else his touch can alarm you

Look into the eyes

1.      The patient may feel uncomfortable when someone is standing above it or if the patient is lying

2.      Mireles in the eyes and make sure you live up to these when speaking with them

3.      Look at the patient's knees or sitting if you need them to be at their level

ASSESSMENT BY GORDON MARYORY FUNCTIONAL PATTERNS

Specific patterns are to be used for dementia. He assesses obtaining a comprehensive view of patient identifying health problems to establish appropriate care plan.

To conclude this article  se need to know that there is a need to ensure people with dementia have the best, compassionate care and support from all nurses and their teams. All nurses can make a contribution across the dementia pathway, irrespective of provider, whether it’s within the NHS, social, private, voluntary or prison sectors. 

This support starts right from keeping well, awareness raising and reducing social stigma, through to early identification, diagnosis, maintaining health and wellbeing and finally end of life care and bereavement support for carers and their families.

BIBLIOGRAPHY:

- Nursing Times; [quoted the 25/04/13]; http://www.nursingtimes.net/nursing-practice/clinical-zones/older-people/cognitive-assessment-of-older-adults-with-alzheimers-disease/201662.article

-Sonoma;[quotes the 25/04/13]; http://www.sonoma.edu/users/k/koshar/n340/N345_Gordon_FHP.html

- R.C.Petersen; Mild cognitive impairment as a diagnostic entity; Journal of Internal Medicine 2004; 256: 183–194, available in: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2004.01388.x/full