Dementia

Key Points

• Dementia (major neurocognitive disorder) is progressive decline in cognition that impairs independence.
• Alzheimer disease is most common, but multiple etiologies and subtypes exist.
• Differential diagnosis from delirium is essential because onset and treatment pathways differ.
• Nursing care prioritizes safety, function support, caregiver education, and quality-of-life preservation.

Pathophysiology

Major neurocognitive disorders involve progressive neuronal dysfunction and loss, producing decline in memory, executive function, language, visuospatial ability, and social cognition. Course and symptom profile vary by etiology (for example Alzheimer, vascular, Lewy body, frontotemporal, Parkinson-associated).

As decline advances, functional dependence and safety risk increase, requiring staged care adaptation.

Classification

• Severity staging: Progressive levels from mild to very severe cognitive decline.
• Etiologic subtype: Alzheimer, vascular, Lewy body, frontotemporal, trauma/substance/medical-related, and mixed forms.
• Care context: Community support, assisted living, or skilled nursing based on function and safety.

Nursing Assessment

NCLEX Focus

Compare onset and fluctuation pattern to distinguish dementia from delirium.

• Assess baseline cognition, progression timeline, and ADL/IADL performance.
• Assess behavioral symptoms (agitation, wandering, sleep disruption, communication changes).
• Assess home environment hazards and supervision needs.
• Assess caregiver strain, coping, and resource gaps.
• Assess comorbid medical needs that may worsen cognitive decline.

Nursing Interventions

• Use calm, simple communication and consistent routines to reduce distress.
• Adapt environment for orientation and safety (lighting, cues, fall prevention, exit safety).
• Support person-centered care and avoid confrontational reorientation when harmful.
• Coordinate interdisciplinary planning for medications, function support, and placement needs.
• Provide caregiver coaching, respite-resource linkage, and anticipatory guidance.

One-Size-Fits-All Approach

Applying uniform interventions across dementia subtypes can worsen symptoms and caregiver burden.

Pharmacology

Medication may provide symptom support in selected subtypes (for example cognitive enhancers and targeted behavioral treatments), but nursing monitoring for effectiveness, adverse effects, and functional impact remains essential.

Clinical Judgment Application

Clinical Scenario

An older adult with gradual memory loss, getting lost in familiar places, and reduced medication self-management is brought by family after two recent near-falls.

Recognize Cues: Progressive cognitive and functional decline with immediate safety concerns. Analyze Cues: Pattern is consistent with major neurocognitive disorder rather than acute delirium. Prioritize Hypotheses: Priority is home safety stabilization and structured long-term care planning. Generate Solutions: Initiate dementia-focused assessment, caregiver support, and environment modifications. Take Action: Coordinate interdisciplinary plan and community-resource referrals. Evaluate Outcomes: Track safety events, caregiver burden, and function trajectory.

Related Concepts

• mild-neurocognitive-disorders - Clarifies early-stage cognitive decline before major impairment.
• delirium - Supports high-priority differential diagnosis in acute confusion.
• caring-for-clients-with-dementia - Expands practical dementia-care strategies.
• caregiver-role-strain - Addresses caregiver burden and support planning.
• community-support-systems - Connects long-term dementia care to local resources.