Elder Care In Hospital

Alzheimer’s Disease

  • Most common type of dementia (60 %)
  • Slow progression (Avg ~ 10 yrs but may be 20)

  • Short term memory problems
  • Word finding problems
  • Visuospatial problems
  • Changes in IADLs
  • Decrease in awareness of deficits
  • Occasional irritability
  • Personality and social behaviour not affected here
  • Depressive symptoms (not necessarily depression)

  • Apraxia
  • Indifference and apathy
  • Some irritability
  • Pacing and restless
  • Hyperactivity
  • Delusions
  • Sleep disturbances

  • Disinhibited
  • Wandering and pacing
  • Gait problems
  • Weight loss
  • Possible verbal and/or physical aggression
  • Long term memory affected
  • Incontinent
  • 24 hr care needed
  • No longer recognizes family
  • Seizures (17%)

Dementia With Lewy Bodies

  • 2nd or 3rd most common cause of dementia
  • Most DLB patients are male
  • Survival time is ~ 7 yrs  (+/- 3 yrs)

  • Visual hallucinations (people or animals)
  • Parkinsonism (Gait disturbances, prone to falls)
  • Fluctuation of alertness, attention, and functioning
  • Milder or same memory deficits as AD

  • Have severe problems with visuospatial tasks
  • Decreased frontal executive function
  • Decreased verbal fluency
  • Sensitive to antipsychotics so try to avoid use

Frontotemporal Dementia & Frontal Lobe Dysfunction

Frontotemporal Dementia (FTD) is an umbrella term under which there are a variety of different types. This is not another name for Alzheimer’s disease. These types of dementia affect the frontal and/or temporal lobes of the brain. Some of the different clinical forms of FTD are:

  • Behaviour Variant FTD
  • Primary Progressive Aphasia – non-fluent type (speaks hesitantly and labored)
  • Primary Progressive Aphasia – semantic type (unable to understand/formulate words into a sentence)
  • Motor Movement Disorders

 

True FTD typically begins when someone is in their fifties or sixties, although some cases have been as young as 21 or as old as 85 years. It is important to remember that unlike patients with Alzheimer’s disease (AD), patients with FTD may not have as significant memory problems.

For detailed differentiation of forms of FTD please consult the below resources:

The type of FTD is determined based on:

  • Inappropriate social conduct (dis-inhibition)
  • Apathy (which may be labeled by staff or family as depression)
  • Ritualistic/repetitive behaviour (perseveration)
  • Loss of attention to personal hygiene
  • Difficulties with language
  • Executive dysfunctioning (inability to set goals or easily follow a plan of action; poor insight and judgement)
  • Weakness/motor neuron diseases (limb weakness, prone to falls)
  • Hyperorality (mouthing of objects, particularly sweets)

The following key points are recommended for working on a care plan for a FTD/FD patient:

  1. Structured routine and individual care
  2. Recognition of common behaviours 
  3. Identify triggers for angry outbursts and disinhibition
  4. Practice clear communication techniques
  5. Learn about what works and share with other care providers

Find practical tips about the above care plan elements in this handout:

Vascular Dementia

  • May or may not co-exist with AD
  • Abrupt onset and stepwise progression
  • Have “vascular history” (Eg. stroke, diabetes, MI, hypertension, high cholesterol)
  • MRI scan may be helpful to diagnose
  • Usually a shorter lifespan than those with AD

  • Better overall Short Term Memory than in AD
  • Depression
  • Mood swings
  • Neurological signs (gait affected or physical problems)
  • Fronto/executive decline
  • Hallucinations
  • Delirium event
  • Tend to be worse on visuospatial tasks than FTLD

  • Are usually better in social skills, awareness, verbal fluency and abstract thinking than FTLD

Helpful Resources

References:
Mendez, M. F., & Cummings, J. L. (2003). Dementia: a clinical approach. Butterworth-Heinemann.
Weiner, M. F., & Lipton, A. M. (Eds.). (2008). The dementias: diagnosis, treatment, and research. American Psychiatric Pub.