REPORT INTRODUCTION DEMENTIA

A. DEFINITIONS
Dementia is a syndrome characterized by a variety of disorders of cognitive
function without disturbance of consciousness. Impaired cognitive function
among others in intelligence, learning and memory, language, problem solving,
orientation, perception, attention and concentration, adjustment, and the ability to
socialize. (Arif Mansjoer, 1999)
Dementia is a disorder of intellectual functions without interruption vegetative
functions or circumstances. Memory, general knowledge, abstract thinking,
judgment, and interpretation of written and oral communication can be
interrupted. (Elizabeth J. Corwin, 2009)
Dementia is a decline in intellectual function that causes the loss of social
independence. (William F. Ganong 2010)
So Dementia is a decline in mental ability that usually develops slowly, where
there is impaired memory, mind, judgment and ability to focus, and personality
deterioration can occur.
B. ETIOLOGY
The main cause of dementia is Alzheimer's disease, whose cause had not yet
known for certain, but suspected Alzheimer's disease is caused by abnormalities
of genetic factors or certain gene abnormalities.
Other causes of dementia that is, a stroke that row. Single stroke small size
and causes mild weakness or weaknesses that arise slowly. This small strokes
gradually cause damage to the brain tissue, the brain region that suffered damage
due to blockage of blood flow, called infarction. Dementia is caused by small
strokes called multi-infarct dementia. The majority of sufferers have high blood
pressure or diabetes, both of which cause damage to blood vessels in the brain.
Causes of dementia according to Nugroho (2008) can be classified into
three major categories:
a. Syndrome of dementia diseases are essentially unknown etiology disorder
that is: there are at subcellular level or biochemically in enzyme systems, or
on the metabolism
b. Dementia syndrome with unknown etiology but not yet curable, the main
culprit in this group include:
1. Spino-cerebellar degeneration diseases.
 2. Leuko-encephalitis subacute sclerotic van Bogaert
3. Khorea Huntington
c. Sindoma dementia etiology of the disease that can be treated, in this class
include
1. Cerebro disease kardiofaskuler
2. metabolic diseases
3. nutritional disorders
4. As a result of chronic intoxication

C. CLINICAL
Signs and Symptoms of Dementia Disease, among others:
1. Damage to the whole range of cognitive functions.
2. Initially short-term memory loss.
3. Personality disorders and behavior (mood swings).
4. And focal neurological deficits.
5. Irritable, hostile, agitation and seizures.
6. Psychotic disorders: hallucinations, illusions, delusions, and paranoia.
7. Limitations in ADL (Activities of Daily Living)
8. Regulate the use of financial difficulties.
9. Can not go home when traveling.
10. Forgot to put important stuff.
11. Difficult bathing, eating, dressing and toileting.
12. Easily fall and poor balance.
13. Orientation disorder of time and place, for example: forget the day, week,
month, year, place of people with dementia are
D. CLASSIFICATION OF DEMENTIA
1. According to Structural Damage Brain
a. Alzheimer's type
Dementia is characterized by symptoms:
1. The decline in cognitive function with gradual onset and progressive,
2. Impaired memory, it was found: aphasia, apraxia, agnosia, impaired
executive function,
3. Not being able to learn / remember new information,
4. Personality changes (depression, obsesitive, suspicion),
5. Loss of initiative.
b. Vascular dementia
Types of vascular dementia caused by impaired blood circulation in the
brain and any causes or risk factors for stroke can cause dementia.
Depression can be caused by certain lesions in the brain due to blood
circulation disorders of the brain, so that depression can be presumed as
vascular dementia
Focal neurological signs such as:
 1. Increased deep tendon reflexes
2. Gait abnormalities
3. Limb weakness
2. According Age:
a. Senile dementia (age> 65tahun)
b. Dementia prasenilis (age <65tahun)
3. According to the course of the disease:
a. Reversible (improved)
b. Irreversible (Normal pressure hydrocephalus, subdural hematoma, vit.B,
Deficiency, Hipotiroidisma, intoxikasi Pb)
In this type dementia there is an enlargement vertrikel with increased
cerebrospinal fluid, it led to:
1. Gait disturbance (unstable, dragging).
2. Urinary incontinence.
3. Dementia.
4. According to the clinical nature
a. dementia proprius
b. Pseudo-dementia
C. Pathophysiology
The interesting thing about the symptoms of dementia patients (age> 65
years) is a change in personality and behavior that affect the day-to-day activities.
Elderly people with dementia do not show a prominent symptom in the early
stages, they are as the elderly generally suffer from aging and degenerative
processes. Initial awkwardness felt by the patient themselves, they are hard to
remember and often forget when putting an item. They often cover up the matter
and assured that it was a regular thing at their age. Similar confusion being felt by
people nearby to stay with them, they are concerned about memory loss is
increasingly becoming, but once again the family feel that the fatigue and the
elderly may need more rest.
The next dementia symptoms appear usually in the form of depression in the
elderly, they keep a distance with the environment and more sensitive. Conditions
such as these can only be followed by the emergence of other diseases and usually
will aggravate the condition of the Elderly. At this time might be the elderly
became very frightened even to hallucinate. This is where the family took Elderly
people with dementia to the hospital where dementia is not the main thing to
focus inspection. Often dementia escape scrutiny and not terkaji by the health
team. Not all health workers have the ability to be able to assess ddan recognize
the symptoms of dementia.
D. SUPPORTING INVESTIGATION
Supporting investigation : (Alzheimer's Association of Indonesia, 2003)
1. Routine laboratory examination
Laboratory tests are only carried out once the clinical diagnosis of
dementia is made to help search for the etiology of dementia, especially in
dementia reversible, although 50% of people with dementia is Alzheimer's
dementia with normal laboratory results, routine laboratory tests should be
performed. Laboratory tests are routinely done include: complete blood
count, urinalysis, serum electrolytes, blood calcium, urea, liver function,
thyroid hormone, levels of folic acid
2. imaging
computed Tomography (CT) scan and MRI (Magnetic Resonance
Imaging) has become a routine examination in the examination of dementia
although the results are still questionable.
3. An EEG
electroencephalogram (EEG) did not give a specific description, and in
most EEG was normal. In the advanced stages of Alzheimer's can illustrate
diffuse and complex periodic slowdown.
4. Examination of brain fluid
Lumbar puncture is indicated when clinically encountered acute onset
dementia, persons with immunosuppressants, meninges and heat stimuli
encountered, dementia atypical presentation, normotensive hydrocephalus,
syphilis test (+), meningeal penyengatan on CT scans.
5. genetic screening
Apolipoprotein E (APOE) is a polymorphic lipid carrier protein
that has three alleles are epsilon 2, epsilon 3 and epsilon 4 allele encodes any
form of APOE different. The increased frequency of epsilon 4 among persons
with Alzheimer-type dementia onset or type of sporadic causes APOE epsilon
4 genotype usage as markers increased.
 6. As an initial esesmen Mini Mental status examination (MMSE) is the most
widely used test. (Indonesia Alzheimer's Association, 2003; Boustani, 2003;
Houx, 2002; Kliegel et al, 2004) but sensitive to detect mild memory
impairment. (Tang-Wei, 2003)
Folstein MMSE mental status examination is a test most commonly used
today, the assessment with a maximum value of 30 is quite good at detecting
impaired cognition, establish baseline data and monitor cognitive decline
within a certain time. Values below 27 are considered abnormal and indicates
significant cognitive decline in people with a tertiary education. (Indonesia
Alzheimer's Association, 2003).
E. MANAGEMENT
1. pharmacotherapy
Most cases of dementia can not be cured. Used to treat dementia of
Alzheimer's drugs - drugs such antikoliesterasedonepezil, rivastigmine ,
Galantamine , memantine
Vascular dementia requiring drugs of anti platelet drugs such as Aspirin ,
ticlopidine , clopidogrel for blood flow to the brain thereby improving
cognitive impairment.
Dementia due to stroke in a row can not be cured, but its development can
be slowed or even stopped to treat high blood pressure or diabetes-related
stroke.
If they are due to depression memory loss, given anti-depressants such as
sertraline and citalopram,
F. PREVENTION AND TREATMENT WITH DEMENTIA
Things we can do to reduce the risk of dementia include memory acuity
maintain and continually optimize brain function, as :
1. Preventing the introduction of substances that can damage brain cells
addictive substances such as alcohol and excessive.
2. Read books that stimulate the brain to think should be done every day.
3. Doing activities that make the mind healthy and active:
4. Reducing stress in work and trying to stay relaxed in everyday life can
make us healthy brain.
Nursing Diagnosis DEMENTIA
1. Relocation stress syndrome associated with changes in activities of daily life is
marked by confusion, concern, anxiety, looking anxious, irritable, defensive
behavior, mental disorder, suspicious behavior, and aggressive behavior.
2. Thought process changes associated with physiological changes (irreversible
neuronal degeneration) is characterized by loss of memory or a memory, lost
konsentrsi, unable to interpret the stimulation and assess reality accurately.
3. Changes in sensory perception associated with changes in perception,
transmission or sensory integration (neurological disease, unable to communicate,
sleep disorders, pain) is characterized by anxiety, apathy, anxiety, hallucinations.
4. Changes in sleep patterns associated with environmental changes marked by a
verbal complaint about difficulty sleeping, constantly awake, unable to determine
the needs / bedtime.
5. The risk to injury associated with difficulty with balance, weakness, muscle
uncoordinated, seizure activity.

INTERVENTION
No Objectives and expected
Intervention Rational
Dx outcomes
1 After being given the
a. Establish mutually supportive
a) For membangan trust and a sense of
expected nursing actionsrelationship with the client. comfort.
b. Orient on the environment and
clients can adapt to changes
Reduce anxiety and feeling disturbed.
new routines.
in their daily activities and
c. Assess the level of stressor
c) To determine the client's perceptions
environments with KH:
(adjustment, development,
about the incidence and severity of
a. identify changes
family roles, due to changes
b. able to adapt to attacks.
in health status)
environmental changes and
d. Determine a reasonable
activities of daily life
schedule of activities and
c. anxiety and fear reduced Consistency reduce confusion and
d. making a positive statemententer into routine activities.
increase the sense of togetherness.
about the new environment.
e. Provide a pleasant explanation
e) Reduce tension, maintain mutual trust,
and information regarding the
and orientation.
activities / events.
2 After nursing actions
a. Develop a supportive
a. Reduce anxiety and emotional.
expected given the client isenvironment and nurse-client
able to recognize a changerelationship that is
in thinking by KH: therapeutic.
Noise is excessive increases sensory
b. Maintain a pleasant and quiet
Able to demonstrate the
neuron disorders.
environment.
cognitive ability to undergo
c. Face-to-face when talking to
Cause of concern, especially in clients
the consequences of
clients.
with perceptual disorders.
stressful events on the
The name is a form of identity and lead
emotions and thoughts of
d. Call the client by name. to the introduction of the reality and
suicide.
the client.
b. Able to develop strategies to
overcome negative self Enhance understanding. High Speech
e. Use a rather low voice and
assumption. and hard stressful confrontation and
speak slowly on the client.
Being able to recognize the
that sparked an angry response.
behavior and the causes.
3 After being awarded a. a Develop a supportive
a. Improve comfort and reduce anxiety on
nursing action is expected toenvironment and nurse-clientthe client.
change in sensoryrelationship that is
No Objectives and expected
Intervention Rational
Dx outcomes
perception client can betherapeutic. Improving coping and lower
b. Help clients to understand
reduced or controlled by hallucinations.
hallucinations.
KH:
c. Involvement of the brain shows the
Decreased hallucinations. c. Assess the degree of sensory
problem of asymmetric cause the
b. Developing strategies for
or perceptual disorder and
client to lose the ability on one side of
reducing psychosocial
how it affects clients
the body.
stress.
including loss of vision or
Demonstrating appropriate
hearing.
response stimulation. To reduce the need for hallucinations.
d. Teach strategies to reduce
stress. e. Picnics show the reality and provide
sensory stimulation that decrease
e. Invite a simple picnic, walk
suspicion and hallucinations caused a
around the hospital. Monitor
feeling of unfettered.
activity.
4 After nursing action is notDo not encourage clients napCircadian rhythm (sleep-wake rhythm)
expected to occur disruptionwhen resulting in negativesynchronized caused by a short nap.
of sleep patterns in clientseffects on sleep at night.
Deragement psychic occurs when there
b. Evaluation of the effect of
with KH:
is panggunaan corticosteroids,
client drug (steroids,
a. Understanding the causes of
including mood changes, insomnia.
diuretics) that interfere with
disruption of sleep patterns.
b. Being able to determine thesleep.
Changing the pattern already familiar
cause of inadequate sleep.
c. Report can get enough rest. from the client food intake in the
Determine habits and bedtime
d. Being able to create adequate
evening proved to disturb sleep.
routine with custom clients
sleep patterns.
(giving warm milk).
d. Providing a comfortableCortical inhibition in the reticular
environment to improve sleepformation is reduced during sleep,
(turn off the lights,increasing the automatic response,
ventilation is adequate space,hence the cardiovascular response to
suitable temperature, avoidincreased noise during sleep.
noise).
Create a regular sleep
No Objectives and expected
Intervention Rational
Dx outcomes
schedule. Tell the client that itStrengthening that time to sleep and
was time to sleep. maintain environmental stability.
5 After nursing actions are
a. Assess the degree of hearing
a. Identify risks in the environment and
expected risk of injury is notability, impulsive behaviorraising awareness of the dangers
the case with KH: and a decrease in visualnurse. Client behavior risk impulsion
a. Increasing the level ofperception. Help familiestrauma because less able to control
activity. identify the risk of hazardsbehavior. The decline in visual
b. Can adapt to the environment
that may arise. perception at risk of falling.
to reduce the risk of trauma /
injury.
c. Not injured.
Clients with cognitive impairment,
b. Eliminate sources of
impaired perception is due to the
environmental hazards.
initial trauma is not responsible for the
basic security needs.

Maintaining security by avoiding a

confrontation that increase the risk of
c. Divert attention when agitated
trauma.
behavior / hazardous
memenjat bed railing.
d. Clients who can not report signs /
symptoms of a drug may cause
d. Assess side effectsof
toxicity in the elderly. The size of the
medication, signs of
dose / drug changes needed to reduce
poisoning (extrapyramidal
interference.
signs, orthostatic
e. Endanger clients, increasing agitation
hypotension, visual
and raised the risk of fracture in the
disturbances, gastrointestinal
elderly client (associated with a
disorders).
decrease in bone calcium).
e. Avoid the use of restrain
constantly. Allow the family
lived with the client during
the period of acute agitation.
 BIBLIOGRAPHY

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source: http://stikeskabmalang.wordpress.com/2009/10/03/demensia-pada-lansia-3/