Discuss the deficits Mr. Lusk has presented with
Mental status exam revealed Mr. Lusk’s deficits in orientation what means that he can be easily lost even in the familiar places and it is hard for him to distinguish the place he is in, even if it is his own room, moreover it is difficult for him to find the right way to the appropriate place because locations are confused in his cognition). Memory loss is shown in constant forgetting the simple things and every day routing actions. Insight and judgment deficits block Mr. Lusk’s logic and his thoughts and conclusions are absurd and impractical. Language skills deficit is noticeable through multiple repeating of one statement, long pauses for remembering the needed every day used word.
All these deficits are the symptoms of dementia which may be caused by different aetiologies and should be properly treated to prevent the progressing of the illness and symptoms exacerbation.
What investigations would help to confirm a medical diagnosis of Dementia?
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To diagnose dementia the examination of a geriatric internist and psychiatrist, neurologist and neuropsychologist are required. Besides, there exist different simple tests for confirming dementia diagnosis. The AMTS test (Abbreviated Mental Test Score) was developed of the large Mental Test and consists of ten simple questions like persons name and address, the name of the current country’s president and indentify the level of cognitive impairment. The MMSE (Mini Mental State Exam ) is more complete test which provides not only questions but also different kinds of tasks, the patient should repeat few said before by the examiner words, do actions asked, redraw the picture and so on. The 3MS (The Modified Mini-Mental State Examination) is screening test for dementia. When the score range of the MMSE is 0-30, the 3MS allows 0-100, what helps to define even minor changes and is more effective. The best invention is CASI (Cognitive Abilities Screen Instrument). The examination takes 15-20 minutes and “provides quantitative assessments on attention, concentration, orientation, short-term memory, long-term memory, language abilities, visual construction, list-generating fluency, abstraction, and judgment” writes Teng (Teng, 2012).
The simplest AMTS test can be used even at home by relatives when the CASI requires special equipment and specialist’s job.
Christian Nordqvist in his article “What is Dementia? What Causes Dementia? Symptoms of Dementia” gives the definition of the phenomenon: “The word dementia comes from the Latin de meaning "apart" and mens from the genitive mentis meaning "mind"” (Nordqvist, 2009). Dementia is characterized by serious deterioration of the mental cognitive function what leads to slow and constantly ceased thinking and intelligence hindering.
Mostly older people suffer from dementia but in certain cases adults of any ages can be affected. By itself dementia is not a disease but in progress it may cause severe mental deficits and illnesses.
The scientists determine two categories of dementia: cortical and subcortical. The first affects the cerebral cortex which is vital for language and memory cognitive functions and in progress may cause Alzheimer’s disease. The second is often caused by Parkinson’s disease, AIDS and Huntington’s disease and is featured by changes in personality, bad concentration and slow thinking.
As a rule suffering from dementia patients can not remember the current date, identify the familiar place and close relatives, they can not do housework properly and sometimes care about themselves.
What are some of the common symptoms of Dementia?
Dementia is a kind of non-specific syndrome, it involves the higher mental functions of the person initially and at the beginning it can be hard to define the disorder. Melinda Smith represents the comparable table of normal age related memory changes and symptoms that may indicate dementia. The most describable examples of the last are “the difficulty performing simple tasks (paying bills, dressing appropriately), forgetting how to do things you have done many times before, gets lost or disoriented even in familiar places, repeating phrases and stories in the same conversation, behaving in socially inappropriate ways” (Smith, 2012). Ordinary people also can notice their memory lapses, recalling incidents of forgetfulness and pause to remember the direction, but it does not poison they life and has no impact at their working and social abilities.
Summarizing the foregoing three main symptoms of dementia may be listed: communicative difficulties, memory loss and moodiness followed with fear and anxiety.
What community/support services are available for Mrs. Lusk to utilize to/
assist with caring for her husband when discharged?
Few kinds of support services care about elderly people in the USA. The most known are personal care, home health care, adult day care, hospitalization, nursing homes. The best decision for Mrs. Lusk is to assist social home health care, which provides cognitive training. The mental health center providing care for people with psychiatric disorders and dementia can exist in their location too. If it is not hard to look after her husband and the illness does not progress it would be useful to request day care facilities for help as they provide cognitive and social home care few hours a day for several days of the week. Maintenance care will help Mr. Lusk to maintain his functional level as long as possible and is less expensive then day hospital programs while provide long-term care.
It the case of dementia exacerbation Mrs. Lusk would be hospitalized, but after the next discharging nursing homes can be the way out.
What information would you provide for Mrs. Lusk in relation to Mr. Lusk’
episodes of wandering?
Mr. Lusk suffers from such mental disorder as orientation deficit one of the dementia symptoms. Among 30% of dementia cases are treatable but the patient needs forbearing caregiver and rightly established causes of the disorder. People with dementia do not accept the world as ordinary people, they strongly believes that what they are seeing and feeling is real and one will hardly persuade then to change their opinions. That is why it is not easy to take care about dementia patients, because caregivers should assimilate to the patients’ reality.
In disorientation case the family support plays important role. The patient should constantly stay under someone’s control and should not be left alone even in the own yard. It is important to engage him in positive family conversations and activities. “Treatments for disorientation include individualized treatment, reality orientation group programs and the use of orientation aids such as calendars, clocks and photographs of places and familiar people” (Rehabait Society , 2012).
What are the possible aetiologies for this change in personality and behaviour?
The deficit of orientation, judgment and memory, language and social difficulties, constant fear feeling and irritation, inadmissible social behaviour are the symptoms of dementia which may be caused by many factors. Vee Prasher in his book “Alzheimer’s disease and dementia in down syndrome and intellectual disabilities” dedicated the second chapter to aetiology of dementia. Among the most common causes of dementia Prasher distinguishes: degeneration, which evidences in the cases of Alzheimer’s and Parkinson’s diseases, Huntington’s cholera etc. , vascular disease with multiple infarcts, physical brain damage, toxic substances (alcohol, drug toxicity, aluminium and carbon monoxide poisoning), endocrine disease, such infections as bacterial meningitis, viral encephalitis, neurosyphilis, nutritional vitamin B12 , folate, niacin deficiency and such immune diseases as multiple sclerosis and polyarteritis nodosa.
How can validation therapy assist Mr. Lusk?
Validation therapy was worked out between 1930 and 1980 by Naomi Feil. It is not the panacea in dementia treatment but in some cases it gives effects. Naomi distinguishes four stages of dementia: mal-orientation, time confusion, repetitive motion and vegetation. Mr. Lusk suffers from orientation deficit and may be regarded as mal-orientation patient according to Naomi Feil. His disorder is caused more because of age changes than serious mental disease so validation may assist.
The main principle of validation is caregiver living in the patient’s world to prevent irritation and sadness and use less medication to calm down. The caregiver should not argue or explain the truth; he should just ensure peace and harmony with the help of different psychological and logical tricks which are described in the book “The Validation Breakthrough” written by Naomi Feil.
What interventions could be incorporated in Mr. Lusk’s care to respond
to his challenging behaviour?
Psychological and pharmacological interventions are used in dementia treatment. Psychological intervention provides supporting care and encourages patient to maintain as much independent functions as possible. Mr. Lusk should participle in structured group cognitive stimulation. The psychological intervention is organized so that engages activities and cognitive processing development. Psychological intervention aims at the patient enjoyment and recovery.
Pharmacological intervention is used in severe cases, Mr. Lusk can use some medicines for memory improvement and nervous calming, but they should be carefully selected by the professional doctor and their effects on Mr. Lusk functioning and the adverse effects appearing should be monitoring by the nurses.
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