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b 13 4 6a 150x150 Nursing Care Plan Relocation Stress SyndromeNursing-CarePlan.com,Nursing Care Plan Relocation Stress Syndrome, Dementia is a general term used to describe a global cognitive impairment is progressive and usually affects the social and occupational activities were also normal daily life activities (AKS). (Mickey Stanley, 2006) dementia syndrome can be defined as the deterioration of intellectual capacity can result in brain pnyakit. This syndrome is characterized if cognitive impairment, emotional, and psychomotor. (Lumbantobing, 2006) alzhimer type Dementia is a degenerative process occurs primarily on the cell located in the basal forebrain that send information to the cerebral cortex and hippocampus. Cells that are affected first lose their ability to secrete acetylcholine and degeneration occurs. If the degeneration is underway, today there is no action that can be done to revive or replace cells. (Kushariyadi, 2010) Dementia is a decline in mental ability that usually develops slowly, with an interruption of memory, thought, judgment and the ability to focus, and personality deterioration can occur.

 Epidemiology

Report of the Department of Health in 1998, the elderly population above 60 years is 7.2% (elderly population approximately 15 million). The increase in the incidence of dementia cases is directly proportional to the increasing life expectancy of a population. Approximately 5% of age 65-70 years suffer from dementia and doubling every 5 years to reach 45% at the age above 85 years. In industrialized countries 0.5 -1.0% of cases of dementia in the United States and the number of dementia in the elderly 10-15% or about 3-4 million people. Dementia is divided into two Dementia Alzheimer’s and Vascular Dementia. Alzheimer’s dementia is dementia cases in the developed U.S. and Europe around 50-70%. Vascular dementia is the second leading cause about 15-20% of the remaining 15-35% are due to other dementias. In Japan and China vascular dementia 50-60% and 30-40% of dementia due to Alzheimer’s disease.

Etiology

Mentioned in the literature that the diseases can cause dementia symptoms there are a number of seventy-five. Some diseases can be cured while the vast majority can not be cured (Mace, NL & Rabins, PV 2006). Most researchers in the research agreed that the primary cause of the symptoms of dementia are Alzheimer’s disease, vascular (blood vessel), Lewy body dementia, frontotemporal dementia, and ten percent of them are caused by disease lain.Tiap diseases involving the brain can lead to dementia, such as: impaired blood circulation in the brain, inflammatory, neoplastic, metabolic disorders, degenerative diseases. All these things must be traced. Symptoms or abnormalities that accompany our dementia care. Often the diagnosis – etiology can be established by or with the help of accompanying disorders, such as: hemiparese, sensibility disorders, aphasia, apraxia, rigidity, tremor. (Lumbantobing, 2006) Fifty to sixty percent of the cause of dementia is Alzheimer’s disease. Alzhaimer is a condition in which nerve cells in the brain die making signals from the brain can not be transmitted properly (Grayson, C. 2004). People with Alzheimer’s experience memory impairment, the ability to make decisions and also decreased the thinking process.

Classification

Dementia of Alzheimer’s Type
Of all patients with dementia, 50-60% have this type of dementia. The man who first defined Alois Alzheimer’s disease is around 1910. Dementia is characterized by symptoms:

  • Decline in cognitive function with gradual onset and progressive,
  • Memory impaired, is found: aphasia, apraxia, agnosia, impaired executive function,
  • Not being able to learn / remember new information,
  • Changes in personality (depression, obsesitive, suspicion),
  • Loss of initiative.
    Dementia in Alzheimer’s disease is not known for certain causes, although neuropathology and biochemical examination post mortem has found selective cholinergic neurons lose the structure and function also changes shape.

Vascular Dementia

The disease is caused by the same cognitive deficits of Alzheimer’s but there are symptoms / focal neurological signs such as:

  • Increased deep tendon reflexes,
  • Respontar eksensor,
  • pseudobulbar palsy,
  • gait abnormalities,
  • Weakness of limbs.
    Vascular dementia is the second most common dementia in the elderly, so it is necessary to distinguish the dimensions Alzheimer.Pencegahan in dementia can be done by reducing risk factors such as hypertension, diabetes, smoking, arrhythmia. Dementia can be enforced also by MRI and blood flow sentral.Pedoman diagnostic vascular dementia:
  • There are symptoms of dementia
  • Hendaya cognitive function usually uneven
  • sudden onset with symptoms of focal neurologic

Signs and Symptoms
In general, signs and symptoms of dementia are as follows;

  • Decreased memory that continues to happen. In patients with dementia, “forgot” to be part of daily life that can not be separated.
  • Impaired orientation to time and place, for example: forget the day, week, month, year, where people with dementia are
  • The decline and inability crafting a proper sentence, using words that are not appropriate for a condition, repeating the same word or story many times
  • Excessive expression, such as excessive crying when she saw a television drama, was furious at the little mistakes of others, fear and nervousness unwarranted. People with dementia often do not understand why these feelings arise.
  • There is a change of behavior, such as indifference, withdrawn and anxious

Pathophysiology

Alzheimer’s disease resulted in at least two-thirds of dementia cases. The specific cause of Alzheimer’s disease is unknown, though genetics seems to play a role in that. Other theories are never popular, but currently lack support, among other toxic effects of aluminum, slowly evolving virus causing or immune response, or biochemical deficiency. Dr. Alois Alzheimer first described the two kinds of abnormal structures that are found in the brains of corpses that had Alzheimer’s disease: amyloid plaques and tangling neurofibril trdapat also drop certain neurotransmitters, particularly acetylcholine. Areas of the brain affected by Alzheimer’s disease are primarily the cerebral cortex and hippocampus, both of which are an important part of cognitive function and memori.Amiloid cause damage to brain tissue. Plaque amyloid-protein derived from the larger amyloid precursor protein (amyloid precursor protein [APP]). Families * with early onset Alzheimer’s disease appear sebagaisesuatu derived have undergone research, and some of them have mutations in the APP gene. GenAPP other mutations associated with late onset AD and cerebrovascular disease have also been identified. There is an increased risk of late onset Alzheimer’s disease by decreasing apo E4 allele on chromosome 19. Neurofibriler node is a collection of nerve cell fibers that spiral into each other, called the pair helical filaments. Specific role of the node on the disease being studied. Acetylcholine and neurotransmitters are chemicals needed to send messages through the nervous system. Neurotransmitter deficit caused solving complex communication process between cells in the nervous system. Dalah tau protein in fluid srebrospinal that number has increased even in the early stages of Alzheimer’s disease. The findings show that there can be Alzheimer’s disease begins at the cellular level, with or be a molecular marker in cells tersebut.Demensia multi-infarct dementia is the second most cause a lot going on. Patients suffering from cerebrovascular disease as the name suggests, evolved into multiple infarcts in the brain. However, not everyone who suffers from multiple cerebral infarction dementia. In comparison with patients with Alzheimer’s disease, those with multi-infarct dementia experienced the onset of a sudden illness, more than just a linear deterioration in cognition and function, and may show some improvement in the serebrovaskular.Sebagian events of patients with Parkinson’s disease suffering from a long trip and severe penyakiy will experience dementia. In one study, patients were observed for 15 to 18 years after entering the program levodopa treatment, and 80% of them suffer from moderate dementia or [worse before it finally died. (Mickey Stanley, 2006)
Pathway (attached)

Diagnosis

Diagnosis is focused on the following matters:

  • The distinction between delirium and dementia
  • Parts of the brain affected
  • potentially reversible causes
  • Need distinction and depression (this can be treated relatively easily)
  • Check to remember 3 things that are called
  • Grouping objects, animals and tools with difficulty
  • laboratonium examination, inspection EEC
  • Brain imaging is important CT or MRI

Management

Some cases of dementia can be treated as a dysfunctional brain tissue can withstand potential for recovery if the treatment is done on time. A complete medical history, physical examination, and laboratory tests, including proper brain imaging, should be performed as soon as the diagnosis is suspected. If the patient is suffering from a treatable cause of dementia, therapy aimed at treating the basic disorder. Common treatment approaches in patients with dementia is to provide supportive medical care, emotional support to patients and their families, and pharmacological treatments for specific symptoms, including symptoms of disruptive behavior. Maintenance of the patient’s physical health, a supportive environment, and symptomatic pharmacological treatment is indicated in the treatment of most types of dementia. Symptomatic treatment including maintenance nutritional diet, proper exercise, recreational therapy and activities, attention to visual problems and audiotoris, and treatment of medical problems that accompany such as urinary tract infections, decubitus ulcers, and cardiopulmonary dysfunction. Special attention because it was given to the caregiver or family members dealing with frustration, sadness, and psychological issues as they care for patients during the time period lama.Jika vascular dementia diagnosis is made, the risk factors that contribute to cardiovascular disease must be identified and addressed therapeutically. These factors are hypertension, hyperlipidemia, obesity, heart disease, diabetes and alcohol dependence. Patients with smoking should be asked to quit, because smoking cessation is accompanied by improved cerebral perfusion and cognitive function.

Drugs For Dementia

Cholinergic-Enhancing Agents

For the treatment of Alzheimer’s type dementia, has done a lot of research. Giving cholinergic-enhancing agents show considerable results in some people, and yet as a whole does not show success at all. This is due to the fact that dementia alzheimerntidak solely caused by a deficiency of cholinergic; dementia is also caused by a deficiency of other neurotransmitters. Meanwhile, the combination of cholinergic and noradrenergic turns out to be complex; drug combination should be careful because it can interfere with the interaction of the cardiovascular system.

  • Lecithin Cholinedan

The deficit of acetylcholine in the cortex and hippocampus in Alzheimer’s dementia and hypotheses about cause and its relationship with memory prompted researchers to direct attention to the neurotransmitter. Giving precursor, cholinedan lecithin is one option and give passable results, however, do not show something special. Dengancholine there is a slight improvement, especially in the verbal and visual function. Denganlecith in the results tend to be negative, although with excessive dosage so that the levels in the serum of 120 percent and in cerebrospinal fluid rose to 58 percent.

  • Neuropeptide, vasopressin and ACTH

Giving neuropetida, vasopressin and ACTH need attention. Neuropeptides can improve memory semantics associated with information and words. In the elderly without psycho-organic disorders, ACTH administration can improve concentration and improve the general condition.

  • Nootropic agents

From the class of nootropic substances there are two types of drugs are commonly used in the treatment of dementia, ialahnicer goline and co-dergocrine mesylate. Both affect the catecholamines. Co-dergocrine mesylate improve cerebral perfusion by reducing vascular resistance and increase brain oxygen consumption. These drugs improve the behavior, activity, and reduce confusion and improve cognition. On the other hand, nicergoline seem beneficial for improving mood and behavior.

  • Dihydropyridine

In the elderly with microvascular changes and neuronal L-type calcium channels showed a strong influence. Lipophilic dihydropyridine useful to overcome the damage to the central nervous system in the elderly. Nimodipine useful to restore cognitive function decline in the elderly and Alzheimer’s type dementia. Nimodipine maintain endothelial cells / condition microvascular no hypotensive effect and thus highly recommended as an alternative therapy for the elderly, especially those suffering from essential hypertension

Prevention and Treatment

Things we can do to reduce the risk of dementia include memory acuity and maintain continuously optimize brain function, such as:

  • Prevent the introduction of substances that can damage brain cells and addictive substances such as alcohol excess
  • Read books that stimulate the brain to think should be done every day.
  • Perform activities that can make us healthy and mentally active
  • Spiritual activities and deepen their knowledge of religion.
  • Continued to interact with the environment, hanging with friends who have similar interests or hobbies
  • Reduce stress at work and trying to stay relaxed in their daily lives can make our brains healthy.