Irene and David are a married couple who have lived much of their adult lives in Hobart, Tasmania.  Irene describes progressive changes in David's cognition and function, including being not able to tell the time, increasing forgetfulness, and gradual loss of ability to carry out activities of daily living. She describes however that he still has moments of total clarity. 

David is currently in hospital following a fall at home. He is undergoing assessment as it is suspected he has probable major neurocognitive disorder due to Alzheimer's disease. He has had some cognitive screening tests carried out in the hospital ward and was very worried about his performance on these tests.

Question 1:

It is recommended in the Clinical Practice Guidelines and Principles of Care for People with Dementia (Guideline Adaptation Committee, 2016) that a diagnosis of dementia should only be made after a comprehensive assessment that includes, if possible, a collateral history from someone who knows the person well.  Briefly explain ONLY three (3) reasons why it is important for Irene to be consulted as a reliable informant (that is, someone who knows David well) when David is undergoing assessment for a diagnosis of dementia.

150 words +/-10%

Question 2:

Describe why dementia is regarded as a terminal condition, giving only two (2) reasons to support your answer.

You will need to provide in-text citations in your answer to Question 2, and the sources you use will need to be presented in the single reference list at the end of your work.

150 words +/-10%

Patient with Alzheimer disease and other dementia experiences loss of memory and disorientation. As a result, they may not be able to remember the symptoms experienced by them and cannot give proper information to the nurse or health care provider during the assessment (Feldman, et al., 2008).  Most of the patients with dementia who are 60 years old may experience asphyxia.  The presence of asphyxia impedes the patient's ability to communicate. Due to which the patient will not be able to speak and inform about his symptoms.  Also, the patient may experience apraxia, agnosia, depression and disturbance in executive functioning (Sampson, 2010). Therefore, a reliable informant such as a patient’s family member or friend is essential while taking history and assessing the patient with cognitive complaints. The information provided by the informant about the patient’s cognitive and behavioural status, comorbid conditions, functional status, intellectual capacities, personality, and behaviour will help the nurse to obtain accurate information and diagnosis the patient’s condition (Wilkins, Wilkins, Meisel, Depke, Williams, & Edwards, 2007).

Dementia is a common neurological disease that causes progressive loss of intellectual abilities. It is caused due to degenerative changes in the brain, which progress over time and affects the quality of life (Sampson, 2010). Despite several advancements in neuroscience and psychopharmacology, there is no treatment available to stop or reverse the disorders associated with dementia. As dementia progresses, it eventually affects the patient’s personality and functioning. Therefore, advanced dementia is considered a terminal condition and treatment aim to provide palliative care to provide comfort to the patient (Sampson, 2010). Certain types of dementia decrease the functioning of the brain and cause brain failure resulting in death. Pick’s disease is a type of dementia in which the patient’s life expectancy is as short as 1-2 years. Moreover, patients with advanced dementia have eating problems, pneumonia, and risk of falls, infections, pain and dyspnoea, which increases the risk of death (Brunnström, & Englund, 2009).

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