Ns.Eirene E.M.Gaghauna, S.

Kep
Latin demens (without mind),
Sindrom klinis o/k ggn organik
karakteristik onset lambat
Pe fs. kognitif
Disfs. ADL
10% > 65
th
,
> 50 % > 85th


Non-Reversible Types of Dementia




Alzheimers disease
Vascular Dementia
Dementia with Lewy bodies
Fronto-Temporal Dementia
Others:
Parkinsons Disease
Huntingtons Disease
Creutzfeldt Jakob
Disease
Progressive
Supranuclear Palsy
Korsakoffs
Syndrome
Infection-Related
Dementia (HIV,
Syphilis)
5
Reversible Dementia
Malnutrisi
Dehidrasi
Disfungsi Metabolik
Defisiensi Vitamin B12
Depresi
Delirium
6
Perubahan Otak
Saat lahir, otak > 100 trilliun sel syaraf/neurons
Dementia neurons pd bbrp bagian mati o/k
peny.ttt
Massa otak dpt ber< s.d 50%

Beberapa tipe:
Alzheimers (~55%),
vascular dementia (~20%), dementia with Lewy
bodies
(~15%), and frontotemporal dementia (~5%).
Parkinsons with dementia, Creutzfeldt-Jakob and
Huntingtons disease.



Dementia- defined
Memory problems AND at least one
additional cognitive deficit:
Aphasia
Apraxia
Agnosia
Problems with executive functioning
Details, Details: Aphasia
Aphasia is a drop off in language function
that shows up in a variety of ways

Apraxia
impaired ability to pantomime the use of
known objects or to execute known motor
acts
Agnosia
Trouble recognizing or identifying things
despite intact sensations (ex. You can see
fine, but you cant recognize a stop sign)
May include difficulty recognizing family
members or even themselves in the mirror
Disturbances in Executive
Functioning
Abstract thinking
Planning, initiating, sequencing, and
stopping behaviors
May manifest as trouble with novel tasks or
new situations
Masalah psikiatri
Agitation
Wandering
Insomnia
Catastrophic
reactions

Psychosis
Depression
Anxiety
Agnosia
Aphasia
Apraxia
Deficits in abstract
thinking
Psychometric tests
Mini-Mental State Examination
Sensitif thd kultur dan sosial
dpt berubah, harus dikaji lg

Brain-imaging
Structural imaging (CT and MRI scans)
functional imaging (PET and SPET scans)

Cairan tubuh
CSF

TREATMENT Agitasi
Perilaku
Lingk. Nyaman dan
aman
Stimulus fs. kognitif
Music
Terapi cahaya
Siang hari exercise,
<i istirahat siang
Medications
Typical antipsychotics
(Haldol)
Atypical antipsychotics
(Risperdal)
Antidepressants -- watch
for agitated depression,
harus dikaji
benzodiazepines


Intervensi
Demensia
Orientasi
Tujuan membantu klien berfungsi di lingk
Tulis nama petugas pd kamar klien yg jelas,
besar dan terbaca
Orientasikan barang pribadi, waktu, tempat,
orang
Penerangan di malam hari
Jam besar, kalender harian
Kontak personal dan fisik
Aktifitas kelompok
Komunikasi
Komunikasi verbal: jelas, ringkas, tdk buru2
Topik percakapan dipilih klien
Pertanyaan tertutup
Pelan dan diplomatis dlm menghadapi persepsi yg
salah
Empati, hangat, perhatian
Penguatan koping
Kaji sumber kecemasan, koping masa lalu
Kurangi agitasi
Beri penjelasan, pilihan
Jadual harian
Penyaluran energi
Saat agitasi: senyum, sikap bersahabat
Keluarga dan Masyarakat
Siapkan kelg dan fasilitas di masy
Perlu bantuan dlm merawat 24 jam di rumah
Home care

CHARACTERISTICS DEMENTIA DELIRIUM DEPRESSION
Onset Tdk terlihat, lambat
dan tdk dikenali
Tiba2, mendadak Baru2 ini, b.d perub.
hidup
Course over 24 hours Cukup stabil, berubah
jika ada stres
Fluctuasi, gelisah
malam hari
Cukup stabil, mgkn
buruk saat pagi hari
Consciousness Sadar berkurang kesadaran sadar
Alertness Normal Meningkat, menurun,
variasi
Normal
Psychomotor activity Normal, apraxia Meningkat, menurun,
kombinasi
Variasi, agitasi/
retardasi
Duration Berbulan2 s.d
bertahun2
Ebrjam2 s.d
berminggu2
Variasi (min 6 mgg),
dpt berbulan2 s.d
bertahun2
Attention umumnya normal Berubah, fluktuasi Sedikit ggn, mudah
terdistraksi
Orientation Sering ggn (answer
may be close to
right)
Biasanya terganggu,
variasi
biasanya normal,
jawaban saya tdk
tahu
Speech Sulit mencari kata Sering incoherent,
slow or rapid
Mungkin lambat
Affect Labile Variable Flat
Pseudo Dementia
( Depression )
Dementia
More acute onset Insidious onset
Emphasizes failure Delights in accomplishments
Uncommon Sun downing Common
(increase confusion at night)
Often answer Dont Know Guess at answer
( confabulate )
Pt is aware of problem Pt unaware of problem
24

Kriteria Diagnostik DSM-IV
5 > gejala yg berlangsung >2 mgg, terjadi
perubahan:
Depressed mood dan atau kehilangan
perhatian/ketertarikan
<< tidur, << energi, tdk nafsu makan/BB <<,
rasa tidak berdaya/bersalah, perubahan
psikomotor, << konsentrasi dan fokus, pikiran
bunuh diri
SIG E CAPS
Sleep
Interest
Guilt (Are you a burden to others?)
Energy
Concentration
Appetite
Psychomotor changes
Suicidality (Do you wish you could die?)
Epidemiology
Men: 5-12%
Women: 10-25%
Prevalence 1-2% in elderly
6-10% in Primary Care setting
12-20% in Nursing home setting
11-45% in Inpatient setting
>40% of outpt. Psychiatry clinic and inpt.
psychiatry
28
Diagnosis is Difficult
Coexistence of many
other problems
medical
physical
social
economic
normal aging
May mask
depression
29
TRUE FALSE
30
Suicide in Older Adults
Represent 13% of the
population
Account for 1/5 (20%) of
all reported suicides
Lowest rate of ATTEMPTS
Highest rate of COMPLETED SUICIDE

31
Indirect Suicide
Starvation, refusing
to eat
Refusing needed
medications
Mixing medications
Alcohol abuse
Loss of will to live
32
Poor Outcomes
Comorbid Conditions
Anxiety
Medical problems
Cognitive impairment
Concurrent Problems & Issues
Psychotic depression
Impaired social support
Stressful life events
Multiple previous episodes
33
Major Depression
Depressed mood most of the day,
everyday
OR
Loss of interest or pleasure nearly every
day

and at least 4 additional symptoms . . .
34
Major Depression, cont.
Significant weight loss
or gain
Insomnia or
hypersomnia
Psychomotor
agitation or
retardation
Fatigue or loss of
energy
Feelings of
worthlessness,
inappropriate guilt
Loss of ability to think,
concentrate, make
decisions
Recurrent thoughts of
death, suicidal
ideation
FOUR ADDITIONAL SYMPTOMS
35
MINOR Depression
Also known as
subsyndromal
depression
subclinical
depression
mild depression
2 - 4 times more
common than major
depression
Associated with:
subsequent major
depression
greater use of health
services
reduced physical,
social functioning
loss of quality of life
Responds to same
treatments!
36
Common Causes of Depression
CHAIN OF EVENTS
Stress & loss
Biological depression
Physical illness and
its treatment interact
with depression in older adults
37
Biological Depression
Genetic cause vs. reaction to stress
seems to come out of nowhere
family, personal history more common
increased risk of severity, reoccurrence

Effects of environment and physical
illness are still important to
address!!
38
Physical Illness & Depression
Physical illness directly cause
symptoms of depression
metabolic
endocrine
neurologic
pulmonary
cardiovascular
musculoskeletal
others: cancer, anemia

1
39
Physical Illness & Depression
Physical illness can cause a reaction of
depression by causing
chronic pain,
fear of pain
disability, loss of
function
loss of self esteem
increased dependence
fear of death
2
40
Physical Illness & Depression
Depressed elderly may present with
somatic (physical) complaints
aches, pains
appetite, weight
fatigue, loss of energy
constipation
tachycardia
insomnia
3
41
Physical Illness & Depression
Medications can cause symptoms of
depression
antihypertensives
psychotropics
analgesics
cardiovacscular
antimicrobials
steroids
others
4
42
Physical Illness & Depression
Environment in which physical illnesses
are treated may
contribute to
depression . . .
Isolation
Sensory deprivation
Enforced dependency
5
43
Assessment
Depression symptoms
Suicidal thoughts
Psychiatric history
personal
family
Physical health/illness
Medications
Recent loss/stress
Resources/abilities
44
Geriatric Depression Scale
Score 0 or 1
Add up points (0-30)
Further assessment if
> 10
Remember!
Screening tool;
assess symptoms
further!!
45
Suicide Assessment
Always ASK!!!
Have you thought that life isnt worth living?
If YES, then . . .
Have you thought about harming yourself?
If YES, then . . .
Do you have a plan?
If YES, examine lethality. . .
Is the plan viable? Can they execute it?
Are means deadly, available?
46
Resources & Abilities
___ family support?
___ community support?
___ social network?
___ physical abilities?
___ functional abilities?
___ cognitive abilities?
___ financial resources?
___ personality traits? personal history?
___ experiences, beliefs, convictions?
47
Person-Centered
Appreciate the older persons
perspective and experience:
control, power loss
unwanted dependency
meaning of functional
losses, relationship
to activity, meaning
and purpose in living
Facility,
Staff
48
Interventions
Depression is highly
treatable
Depression is
sometimes called A
reason for hope
Many treatments
Talking therapy
Medications
Daily contacts
49
Depression
A
REASON
FOR
HOPE