The New York State Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This course has been awarded 3.5 contact hours.

Dementia is a syndrome of progressive decline that relentlessly erodes intellectual abilities, causing cognitive and functional deterioration leading to impairment of social and occupational functioning. Because Alzheimer's disease is the most common dementing illness in the United States, it is used as a prototype for dementia in this course unless otherwise stated.

An estimated 5 to 10 percent of the U.S. adult population age 65 and older is affected by a dementing disorder, and incidence doubles every 5 years after age 65. Currently over 4.5 million Americans suffer from dementing illness. The older population in the United States is increasing dramatically. As of the year 2000, an estimated 35 million people were age 65 and older. Researchers estimate that by 2050, 70 million Americans will be age 65 or older, accounting for 1 in 5 Americans. More than 19 million Americans will be age 85 and older (ADEAR, 2005; NIA, NIH & DHHS, 2003).

Despite its prevalence, dementia is often unrecognized or misdiagnosed in its early stages. Many healthcare professionals, as well as patients, their families and friends, mistakenly view the early symptoms of dementia as inevitable consequences of aging. Failure to identify early stage dementia can result in inappropriate treatment, hazardous situations, and needless distress. Early recognition of dementia, however, not only can prevent problems but also can allow the patient and family to plan for the future and consider participation in trials of promising new therapies as they are developed.

A number of characteristics distinguish early-stage dementia from normal aging and from other syndromes that involve cognitive problems, including depression. Certain triggers (clues, symptoms) should prompt a clinician to conduct an initial assessment of mental and functional status to rule out dementia rather than attribute it to apparent signs of decline due to aging. Although the patient, family members, or others often bring their concerns about symptoms to the clinician's attention, clinicians also should be alert to such signs during office visits, hospitalization and any other contact with patients. In asymptomatic persons who have possible risk factors the clinician's judgment and knowledge of the patient's current condition, history, and social situation (living arrangements, support services, isolation) must guide the decision to initiate an assessment for dementia

All dementias are not Alzheimer's disease and differentiation of depression, delirium or reversible causes of dementia is essential. Early diagnosis is vital and may result in reversal of some conditions, lessening of symptoms in others or the opportunity to prepare one's self and family. The earlier that Alzheimer's Disease is recognized and diagnosed, the greater the gain in managing symptoms and developing a plan of care and treatment. An early, accurate diagnosis of AD is especially important to patients and their families because it helps them plan for the future and pursue care options while the patient can still take part in making decisions.

This course provides information to help nurses and other clinicians recognize those characteristics as symptoms suggestive of a dementing disorder to conduct an initial assessment of mental and functional status. The recommendations are intended for use by primary care clinicians, including but not limited to family physicians, internists, geriatricians, psychologists, psychiatrists, nurses, and nurse practitioners. Registered nurses need to know how to do a complete and thorough assessment of patients and identify dementia so that they can assist in treatment planning, care, and patient education.

© 2001, 2005 NYSNA All rights reserved.

Course Objectives

At the completion of this learning activity the learner will be able to:

• Describe the physiology of Alzheimer's Disease as it is understood today.

• Identify triggers that indicate the need for an assessment for dementia.

• Discuss risk factors for Alzheimer's disease.

• Explain components of a basic dementia assessment.

• List medications that can cause symptoms of dementia.

• Discuss the relationships/differences between and among dementia, delirium and depression.

• Identify assessment instruments that can be helpful in determining dementia.

• Explain the importance of early identification of Alzheimer's disease and the relationship to patient education.

• Discuss treatment options.

• Identify resources available for patients and families affected by Alzheimer's disease.