Types of Dementia
Alzheimer disease (60-70%): progressive memory loss, executive dysfunction, behavioral changes. Vascular dementia: stepwise decline, vascular risk factors. Lewy body dementia: fluctuating cognition, visual hallucinations, parkinsonism. Frontotemporal dementia: personality/behavior changes, language. Mixed: combination of types. Severity: mild (independent with cuing), moderate (needs assistance with ADLs), severe (dependent, bedbound).
Assessment
Cognitive screening: Mini-Mental State Exam (MMSE, 0-30, <24 abnormal), Montreal Cognitive Assessment (MoCA, <26 abnormal), Mini-Cog (3-item recall, clock draw). Functional: ADLs, IADLs. Behavioral: agitation, aggression, wandering, sundowning, sleep disorders. Staging: Global Deterioration Scale, FAST. Rule out reversible causes: delirium, depression (pseudodementia), hypothyroidism, B12 deficiency, normal pressure hydrocephalus, medications.
Nursing Management
Person-centered care: know the person, their history, preferences, routines. Communication: simple, one topic at a time, yes/no questions, patience, non-verbal. Safety: fall prevention, wandering (secure unit, door alarms, bracelet), cooking safety, driving cessation. Behavioral: identify triggers, non-pharmacological first (redirect, distract, validate), avoid antipsychotics for behavioral symptoms unless severe danger. Nutrition: assistance, swallow assessment, finger foods. Activities: meaningful, appropriate level. Family: education, support, respite, advance care planning. Late stage: hospice, comfort care, pressure injury prevention, aspiration precautions.
Important Notes
- Antipsychotics (haloperidol, risperidone) for dementia behavioral symptoms are associated with increased mortality — use only for severe agitation with safety risk, lowest dose, shortest time.
- Rule out reversible causes of cognitive decline: delirium, depression (pseudodementia), hypothyroidism, B12 deficiency, normal pressure hydrocephalus.
Clinical Tips
- Person-centered care (know the person history, preferences, routines) improves outcomes and reduces behavioral symptoms.
- Wandering is a safety risk — secure unit, door alarms, identification bracelet, and Safe Return program for community patients.
Summary
Dementia management requires recognizing the type, cognitive screening, person-centered care, safety (falls, wandering), non-pharmacological behavioral management, and family support.
