Dementia Nursing Diagnosis and Nursing Care Plan

Dementia is a complex neurocognitive condition affecting one’s memory, thought process, and social skills.

The decline in these functions may affect the person’s ability to complete activities of daily living.

Dementia can also change feelings and behavior. It is often related to memory loss; however, memory loss alone does not signify the presence of the disease.

Dementia is most common in people aged 65 years and above.

This is referred to as late-onset dementia. On the other hand, early onset dementia occurs in people below the age of 65 years.

The majority of cases are late-onsets which accounts to about 97% of recorded incidents.

Dementia is an umbrella term referring to the decline in neurocognitive function.

Signs and Symptoms of Dementia

Cognitive symptoms include the following:
Short-term memory loss
Aphasia or difficulty in using words
Reduced visual and spatial abilities
Problem reasoning or problem solving
Difficulty handling complex tasks
Problem planning and organizing
Problems with coordination and motor functions
Confusion and disorientation
Psychological symptoms include the following:
Changes in personality
Depression
Anxiety
Inappropriate behavior
Paranoia
Agitation
hallucination

Causes and Types of Dementia

In general, dementia is caused by damage to brain cells which interferes with the normal function of the brain to communicate normally with each other. The following are the types of dementia and their etiology.

Alzheimer’s Dementia. Alzheimer’s dementia or Alzheimer’s disease is the most common of all dementia types with prevalence of about 50-70% of reported cases. Alzheimer’s disease is a progressive degenerative brain disorder caused by complex brain changes due to cell damage. Symptoms usually start to appear years before diagnosis, but they may be too subtle to be noted.
Vascular Dementia. Vascular dementia refers to the decline in neurocognitive functions due to conditions resulting to reduced blood flow to various parts of the brain.
Creutzfeldt-Jakob Disease. This type of dementia is a form of prion disease. Prion disease refers to the abnormal change in shapes of prion proteins which are found throughout the human body. The shape changes also occur in the prion proteins in the brain causing dementia.
Lewy Body Dementia (LBD). LBD is a type of dementia that occurs due to abnormal deposits of Lewy bodies containing alpha-synuclein protein in brain cells. These Lewy bodies are also found in other types of dementia and Dementia.
Frontotemporal Dementia. As the name suggests, frontotemporal dementia refers to neurocognitive decline due to nerve cell loss in the frontal or temporal lobe of the brain.
Huntington’s Disease (HD). This type of dementia is caused by a defective mutation on a gene, resulting to changes in the central brain area affecting movement, mood, and thinking skills.
Mixed Dementia. Mixed dementia refers to the presence of two or more forms of dementia occurring simultaneously.
Normal Pressure Hydrocephalus. This form of dementia occurs as a result of the accumulation of cerebrospinal fluid in the brain’s ventricles. This accumulation causes damage to the nearby brain cells.
Posterior Cortical Atrophy (PCA). PCA is a type of dementia that refers to the gradual and progressive degeneration of the brain cortex.
Parkinson’s Dementia. Parkinson’s dementia is a type of dementia that occurs as a result of Dementia.
Korsakoff Syndrome. Korsakoff syndrome refers to memory disorder which occurs due to severe deficiency in Vitamin B1 or thiamine.

Complications of Dementia

Dementia affects the person’s ability to function. It may lead to serious medical conditions and other related complications.

Malnutrition. Nutrition is a concern in people with dementia. The disease can make the individual stop eating or have reduced food intake. Dementia can also affect their ability to chew and swallow food.
Pneumonia. The effects dementia has on swallowing predisposes individuals to choke on food and cause pneumonia.
Inability to perform self-care activities. Depending on the type, progress of the disease, and symptoms present, individuals with dementia may require care assistance as the disease may affect their ability to perform self-care.
Issues with personal safety. The safety of people with dementia may become a challenge as the disease progresses. Short-term memory loss, confusion, and the other symptoms of the disease can all pose danger to the person with the disease.
Death. Death may occur as a result of infection from dementia. The disease itself predisposes individuals to secondary infections and medical conditions.

Diagnosis of Dementia

Diagnosing dementia may be tricky. Its symptoms often coincide or is mask by an overlying medical condition. The following are often performed to diagnose dementia:

Detailed medical history. History taking is performed to ascertain the presence of symptoms in patients. If short-term memory loss is present, history may be taken from family members or carers.
Physical examination. A thorough physical examination is performed to provide baseline information. It is also a chance to check for the presence of another medical condition and to rule out other neurocognitive problems.
Cognitive and neuropsychological tests. These include memory tests and other tests that will measure the person’s reasoning, judgment, and language skills.
Neurological evaluation. This assessment checks for the person’s neurological skills such as memory, balance, and reflexes.
Imaging of the brain. Brain imaging through CT scans and MRI may be performed to check for evidence of brain damage and possible causes such as stroke. A PET scan can also help doctors to assess brain activity patterns and the presence of amyloid protein that may suggest Alzheimer’s disease.
Laboratory tests. Lab tests may include testing of the cerebrospinal fluid and the level of thiamine.

Treatment of Dementia

Most types of dementia are irreversible. However, treatment methods are available to help manage the symptoms.

Medications. Certain drugs can be used to temporarily alleviate symptoms of dementia.
- Cholinesterase inhibitors. These drugs work by improving the levels of a neurotransmitter called acetylcholine. Acetylcholine is a neurotransmitter related to memory and judgement.
- NMDA receptor antagonists. NMDA receptor antagonists are often given with a cholinesterase inhibitor. These drugs work by regulating the activities of glutamate – a chemical messenger involved in memory and learning.
- Other drugs. Other medications can also be used to treat specific symptoms.
Therapies. Several behavioral therapies are also used to improve the symptoms of dementia.
- Occupational therapy. This kind of therapy is focused on enhancing the patient’s independence with essential day to day activities. It allows the patient to arrange a safe environment and to prepare for the possible progression of their disease.
- Modifying the environment. Major changes with function will occur as the disease progresses. Modification of the environment will greatly help assist a person with dementia to maintain safety. It may also assist them to remember certain things in the environment.
- Simplifying tasks. Building of a structure and routine is found helpful in people with dementia.

Nursing Care Plans for Dementia

Nursing Care Plan for Dementia 1

Nursing Diagnosis: Disturbed Thought Process related to cognitive impairment secondary to dementia as evidenced by problems with coordination and motor functions, difficulty handling complex tasks, confusion and disorientation, inability to do activities of daily living (ADLs) as normal

Desired Outcome: The patient will be able to maintain appropriate mental and physical functioning as long as possible.

Nursing Interventions for Dementia	Rationales
Assess the patient’s level of confusion.	To monitor effectiveness of treatment and therapy.
Assist the patient performing activities of daily living. Consider one-to-one nursing.	To maintain a good quality of life and promote dignity by allowing the patient to perform their ADLs while maintaining safety.
Simplify tasks for the patients by using simple words and instructions. Label the drawers with simple words and big letters, and use written notes when necessary.	Dementia patients may have difficulty handling complex tasks.
Provide opportunities for the patient to have meaningful social interaction, but never force any interaction.	To prevent feelings of isolation. However, forced interaction can make the patient agitated or hostile due to confusion.
Allow the patient to wander and hoard within acceptable limits and while maintaining patient safety.	To prevent agitation and increase the sense of security while allowing the patient to perform activities that are difficult to stop for him/her.

Nursing Care Plan for Dementia 2

Nursing Diagnosis: Impaired Physical Mobility related to disease process of dementia as evidenced by problems with coordination and motor functions, difficulty handling complex tasks, confusion and disorientation, inability to do activities of daily living (ADLs) as normal

Desired Outcome: The patient will be able to perform activities of daily living within the limits of the disease.

Nursing Interventions for Dementia	Rationales
Assess the patient’s level of functional mobility and ability to perform ADLs.	To assist in creating an accurate diagnosis and monitor effectiveness of treatment and therapy.
Assist the patient during exercises and when performing activities of daily living. Consider one-to-one nursing.	To encourage the patient to perform muscle-strengthening exercises and promote dignity by allowing the patient to perform their ADLs while maintaining safety.
Simplify tasks for the patients by using simple words and instructions.	Dementia patients may have difficulty handling complex tasks.
Ensure the safety of the environment. Check that the call bell is within reach, the bed rails are up when the patient is on the bed, the bed is in the lowest level, the room is well-lit, the floor is not slippery, and that important things like phone and eyeglasses are easy to reach.	To maintain patient safety and reduce the risk of falls.
Encourage the patient to perform range of motion (ROM) exercises in all extremities.	To improve venous return, muscle strength, and stamina while preventing stiffness and contracture deformation.
Refer to the physiotherapy and occupational therapy team.	To provide a specialized care for the patient to gain physical and mental support in performing ADLs and mobilizing.

Nursing Care Plan for Dementia 3

Nursing Diagnosis: Fatigue related to disease process of dementia as evidenced by generalized weakness, tremors, muscular rigidity, and verbalization of overwhelming tiredness

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

Nursing Interventions for Dementia	Rationales
Assess the patient’s degree of fatigability by asking to rate his/her fatigue level (mild, moderate, or severe). Explore activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.	To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance.
Encourage activity through self-care and exercise as tolerated Alternate periods of physical activity with rest and sleep. Encourage enough rest and sleep, and provide comfort measures.	To help the patient balance his/her physical activity and rest periods. To reserve energy levels and provide optimal comfort and relaxation.
Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.	To allow the patient to relax while at rest. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.	To provide a more specialized care for the patient in terms of helping him/her build confidence in balancing daily physical activity and rest periods.

Nursing Care Plan for Dementia 4

Impaired Verbal Communication

Nursing Diagnosis: Impaired Verbal Communication related to dementia as evidenced by confusion, restlessness, and marked disorientation to person, place, and time.

Desired Outcome: The patient will be able to have effective speech and communication, or be able to use other forms of communication to make his needs known.

Nursing Interventions for Dementia	Rationale
Evaluate the patient’s communication skills, including any language deficits, cognitive or sensory issues, presence of aphasia, dysarthria, dyslalia or apraxia. Evaluate for the presence of neurologic disorders that may affect speech.	Assessing for the patient’s baseline data and care needs can help in formulating effective and efficient plans of care.
Assess the effects of communication issues on the patient.	Communication skills of a patient diminish continuously as dementia becomes more progressive.
Observe how the patient utilizes nonverbal communication cues such as facial reactions (e.g., smiling or crying), pointing mannerisms, hand gestures, etc. Motivate the patient in using speech when possible, along with nonverbal skills.	Observing how the patient utilizes nonverbal communication cues may indicate that the patient can express their feelings or needs despite speech impediment. Nonverbal communication abilities, such as excessive mumbling, etc., may only be the method by which a patient with dementia can express discomfort. Recognizing these cues can help the healthcare team assist the patient with his needs.
Evaluate the patient for hearing issues, allowing for the use of assistive devices when needed. Ensure that the patient’s room is free from glare. Be sure to speak in a normal tone and clear voice, and to use short but precise words.	Ensuring if the patient has hearing deficits will help the healthcare team address his or her communication difficulties. If the patient is using hearing devices, ensure proper functionality. Unnecessary glare can hinder the patient’s ability to read the provider’s lips. Shouting phrases to a patient already with hearing issues will not help with their difficulties.
Ensure to face the patient when talking, to maintain eye contact, and to speak clearly and slowly.	Practicing clarity and brevity when interacting with the patient will promote communication success for the patient by allowing him to process the information received.
Make sure to provide a calm environment, free from distractions, and in an unhurried manner when interacting with the patient.	Unhurried interaction with the patient will provide more time for him to process the information presented. In addition, reduced distractions will allow the patient ample time to process and react to the conveyed information.
Refrain from rushing the patient to express himself, especially during episodes of struggling to communicate or to remember.	Patients with communication issues can cause feelings of isolation and despair. Showing compassion, by taking time when interacting with the patient, will foster a healthy patient-nurse relationship that is crucial for reaching health goals.
Utilize simple, direct queries that would only need one-word responses. Repeat and reword the questions as needed to clarify the information relayed.	Simple and clear sentences promote improved understanding of the relayed information for patients with impaired verbal communication. This is because patients with communication challenges will either forget the significance of words or would have difficulties forming or conveying thoughts.
Use writing tools, such as pencil and paper, to write sentences and information.	Writing tools will serve as alternative ways of communication for patients with no problems with their fine motor skills
Be patient and tenacious in decoding the patient’s message.	The healthcare provider should not pretend to understand the patient’s message if it is vague and ambiguous. Allowing for ample time in understanding the message will ensure that the information is clearly relayed so that the appropriate interventions are given.
Expect to address patient needs.	The healthcare provider is expected to stay focused and render useful responses to patient concerns in order to prevent unnecessary frustrations that may hinder progress on care.
Utilize the therapeutic touch as appropriate. Tactile stimulation may also be used if permitted.	Tactile stimuli, such as hugs and hand-holding with the patient’s consent, are useful in rendering a calming effect to anxious patients with communication issues. Doing so can be perceived as signs of affection, care, and security that are needed for patients with problems in relaying their concerns.
Have the patient gradually participate in more social activities.	Social activities will help reduce the patient’s anxiety and feelings of isolation that may lead to depression. Gradually involving the patient to more social interactions will promote a sense of belongingness and improve self-perception.

Nursing Care Plan for Dementia 5

Disturbed Sensory Perception

Nursing Diagnosis: Disturbed Sensory Perception related to dementia as evidenced by several changes in sensory acuity, behavior, and altered patterns of communication.

Desired Outcomes:

The patient will be able to properly identify sounds and objects presented.
The patient will be able to maintain remaining sensory function and control the effects of deficits in relation to the limits of their condition.
The family will be amenable to adjustments in the patient’s environment to prevent untoward incidents.

Nursing Interventions for Dementia	Rationale
Evaluate the patient’s neurologic status focusing on the confusion state, level of disorientation, behavioral changes, deterioration in mental acuities, and responses.	Cognitive behavior is proportionate to the sensory acuity of a person. Changes caused by physiologic, psychological or environmental factors to a person’s sensory faculties will cause dysfunction in his cognitive behavior.
Evaluate the patient’s senses for any deviations from the standard. Vision – Check for the patient’s acuity, issues, and their effects; any presence of eye conditions such as cataracts, and state of the remaining vision. Hearing – Check for the patient’s acuity, characteristics of cerumen, response to noise, quality of loss and its effect, and issues in discerning location or identification of sounds. Taste and smell – Check for the patient’s loss of taste or smell, including eating patterns, and the quality of loss and its effect. Touch – Check for the presence of tingling or numbness, loss of sensation, pain, or pressure. Kinesthetic perception – Check for the patient’s perception, disposition, and awareness of movement.	Having visual issues can cause challenges on the patient’s mobility and social lifestyle. Hearing loss can result to inadequate or inaccurate interpretation of words that would promote poor communication and isolation. A deteriorating sense of taste or smell can cause the patient to lose interest in eating. Diminishing tactile perception is common in the elderly therefore increasing injury risk. An aging body can cause cognitive deficits that can affect awareness and control of muscles thereby increasing fall risk.
Address eye issues through the following interventions: Administer eye drops as ordered. Promote the use of corrective glasses or contact lenses. Offer the use of magnifying glass or brighter lights. Offer reading materials with larger fonts in a contrasting color. Advise on the use of sunglasses or visor.	Mydriatics are a type of medication utilized to improve cataracts. Miotics, on the other hand, facilitate the better flow of the eye’s aqueous humor. A corrective appliance renders improvement on the visual deficit. The use of a magnifying glass or brighter lights can stimulate a patient’s visual acuity. This type of visual aid will promote patient independence. Glare can be debilitating to a patient with an already compromised vision. The use of sunglasses or visor will promote better vision.
Address ear issues through the following interventions: Administer proper ear medications as prescribed or recommended. Promote the use of hearing aids.Provide telephone amplifiers, the use of flashing lights on phones, loudspeakers for TV, etc. as needed.Remove background noise as much as possible.	This type of medication softens cerumen, thereby allowing for easier removal and improvement of hearing. A corrective appliance renders improvement on the auditory deficit. The use of these auditory aids will promote better perception and improved acuity. Unnecessary noise can affect negatively the patient’s hearing and perception of auditory cues.
Address taste and smell issues through the following interventions: Check the availability of salt and sweet substitutes. Encourage social interactions during mealtimes.Ensure that smoke detectors and safety alarms have audible alarms or flashing lights	This ensures satiety to food without compromising the diet of an aging patient with taste issues. In addition, it prevents excessive use of salt or sugar that may compromise the patient’s diet and recommended dietary intake. Social interactions can help improve patients interest to eat better. These types of alarm systems reduce injury risk for patients with reduced olfactory perception.
Address tactile and kinesthetic issues through the following interventions: Ensure that the patient avoids exposure to temperature or pressure extremes. Help the patient in performing activities of daily living.	This reduces burn risk and injuries associated with deviations in tactile sensations. This reduces fall and injury risks for the patient with compromised visual or kinesthetic faculties.
Encourage the family or significant others to participate in the patient’s care through the following interventions: -Educate the family and carers on the application of eye or ear medications. -Educate the family and/ or carers on the use of assistive devices, cleaning, and troubleshooting. -Educate the family and/or carers on the necessity of routine vision and hearing exams. -Educate the family on rendering modifications that are important in enhancing the patient’s weakened senses as appropriate.	Medication compliance involving the patient’s family and/ or carers will preserve acuity and prevent further loss of function. Involving the family in the upkeep of assistive devices ensures the proper functioning of the devices and the desired enhancement of compromised senses. Routine exams will ensure that assistive devices are adjusted according to the current needs of the patient. Involving the family in environmental modifications promotes patient safety and the prevention of debilitating injuries.

Nursing Care Plan for Dementia 6

Anxiety

Nursing Diagnosis: Anxiety related to the realization of diminishing abilities secondary to dementia as evidenced by apprehensiveness, irritability, and altered sleep patterns.

Desired Outcome: The patient will be able to demonstrate decreased anxiety levels and reduced restlessness.

Nursing Interventions for Dementia	Rationale
Observe for early clinical manifestations of fatigue and agitation.	Prompt problem identification can result in time intervention that will promote better health goals for the patient (i.e., removal of anxiety-inducing factors)
Take the patient away from anxiety-causing situations or factors.	Large groups and environments with excessive noise are some situations that can trigger or even increase the patient’s anxiety.
Observe for signs of catastrophic reactions.	Excessive stimulation has varied effects to a patient with anxiety. Because of the compromised state, an anxious patient is prone to overreact when faced with unnecessary stimulation. The patient may present by screaming, crying, or being abusive, which can be an indication of their inability to cope with overstimulation. Once these occur, the healthcare provider is expected to either remove the provoking factor or transfer the patient to familiar surroundings in order to calm the patient.
Ensure that the patient’s daily routine is kept consistent as much as possible.	Discrepancies to an anxious patient’s daily routine may cause undue stress to the patient that may trigger panic attacks. Ensuring that a schedule is maintained will enhance feelings of familiarity for the patient. Furthermore, it will aid the patient to be familiar with their environment. Ensure that areas for activities of daily living are kept noise-free, devoid of needless distraction and overstimulation.
Discuss activities of daily living with the patient and ensure that he/she gets adequate rest periods or downtimes for the patient throughout the day.	Adequate rest periods are essential in the maintenance of a person’s well-being, especially for anxious patients. Fatigue is known to contribute to a person’s anxiety levels, thereby reducing the threshold in tolerating stress. Activities such as reading books, guided meditation and listening to relaxing music should be promoted so as to calm the anxious patients, especially on periods of rest.
Discuss effective methods of problem-solving with the patient. Give attention to logical strategies that the patient can use during anxiety episodes.	Improving the patient’s problem identification and learning to address these problems efficiently promotes a sense of control and well-being. It also allows for evaluation of appropriate alternatives in order to resolve problems that will help with patient coping.
Reassure the patient on the use of positive self-talk with words such as “It’s going to be okay,” “I don’t have to be perfect,” etc.	Utilizing cognitive techniques such as positive self-talks focuses on behavioral changes by changing thoughts. Substitution of negative thoughts with positive statements assists in managing anxiety and reducing patient stress.

More Nursing Diagnosis for Dementia

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon