Dementia is a broad category of brain diseases that cause a long-term and often gradual decline in the ability to think and remember in a way that affects the subject's daily life. Other common symptoms include emotional problems, speech problems, and decreased motivation. The subject's consciousness is not affected. For a diagnosis to be made, there must be changes in the subject's normal mental functioning and significant deviations from those expected in connection with aging. These diseases also have a significant effect on the caregiver of the sick. The most common type of dementia is Alzheimer's disease, which accounts for 50% to 70% of cases. Other common types include vascular dementia (25%), diffuse Lewy body disease (15%), and frontotemporal dementia. Less common cases include normotensive hydrocephalus, syphilis, and Creutzfeldt-Jakob disease, among others. One person may have more than one type of dementia. A small proportion of cases involve families. In the Diagnostic and Statistical Manual of Mental Disorders-5, dementia was reclassified as a neurocognitive disorder of varying severity. Diagnosis is usually based on medical history and cognitive testing, with diagnostic imaging and blood tests used to rule out other possible causes. The Brief Mental Status Scale is the most widely used cognitive test. Dementia prevention measures include efforts to reduce risk factors such as high blood pressure, smoking, diabetes and obesity. Mass screening of the general population for the disease is not recommended. There is no cure for dementia. Cholinesterase inhibitors such as donepezil are widely used and may be useful in low to moderate disease severity. The overall benefit may, however, be negligible. For people with dementia and their caregivers, many indicators can improve their lives. Cognitive and behavioral interventions may be appropriate. Learning and providing emotional support for being active in daily life has the potential to improve outcomes. Treatment of behavioral problems or psychosis associated with dementia with antipsychotic drugs is widespread but generally not recommended because they often have little benefit and increase the risk of death. Globally, 36 million people suffer from dementia. About 10% of people develop the disease at some point in their lives. It becomes more common with age. About 3% of people aged 65–74 have dementia, 19% between the ages of 75 and 84, and about half of people over the age of 85. In 2013. dementia has caused about 1.7 million deaths, up from 0.8 million in 1990. As more people live longer, dementia is becoming more common in the general population. It is the most common cause of disability among older people. It leads to economic costs of USD 604 billion per year.
Signs and symptoms
Dementia affects the brain's ability to think, reason, and remember clearly. The most commonly affected regions include memory, visual-spatial thinking, speech, attention, and executive function (problem solving). Most types of dementia are slow and gradual. By the time a person shows signs of illness, the process in the brain can continue for a long time. This is possible for patients who suffer from two types of dementia at the same time. About 10% of people with dementia have what is called mixed dementia, which is usually a combination of Alzheimer's and another type of dementia such as frontotemporal dementia or vascular dementia. Additional physiological and behavioral problems that are common in people with dementia include:
Difficulty speaking and language
Problem with eating or swallowing
Delusional ideas (believers are often susceptible to them) or hallucinations
Memory distortions (the certainty that a memory has already occurred, although in reality it has not, the certainty that an old memory is a new one, combining two memories, or confusing people in a memory)
Wandering or restlessness
Disinhibition and impulsivity
Depression and / or anxiety
Anxiety
Imbalance
When people with dementia are exposed to circumstances beyond their capacity, mood swings to tears or anger (“catastrophic reactions”) can occur. Depression affects 20–30% of people with dementia, with approximately 20% suffering from anxiety. Psychosis (often delusional ideas of persecution) and anxiety / aggression also often accompany dementia. Each of these subjects should be evaluated and treated regardless of the underlying dementia.
In the early stages of dementia, the signs and symptoms of the disease may be subtle. The earliest stage of dementia is called mild cognitive impairment (MCI). 70% of diagnosed MCIs develop dementia at some point in time. In MCI, the changes in the subject's brain did not last for a long time, but the symptoms of the disease are already beginning to appear. These problems, however, are not yet severe enough to have an impact on a person's daily life. If they affect daily life, it is indicative of dementia. A person with MCI scores up to 27 and 30 on the Abbreviated Mental Status Evaluation (MMSE) scale, which are normal. They may have some memory and word problems, but they can solve everyday problems and lead their own lives reasonably well.
Early stage
In the early stages of dementia, a person begins to show symptoms that are noticeable to others. In addition, the symptoms begin to affect daily life. A person usually has scores ranging from 20 to 25 on the MMSE. Symptoms depend on the type of dementia. The person may begin to face difficulties with more difficult household chores and chores. The person can usually continue to take care of themselves, but may forget things like taking pills or doing laundry and may need prompts or reminders. Symptoms of early dementia usually include memory-related difficulties, but can also include problems with finding words (amnestic aphasia) and problems with planning and organizational skills (executive function). One reasonably good way to determine a person's impairment is to ask whether they are capable of independently managing their financial resources. This is often one of the first things that gets problematic. Other signs may include disappearing in new places, repetition of actions, personality changes, social exclusion and difficulties in work. When evaluating a person with dementia, it is important to consider how the person was able to function five or ten years earlier. It is also important to take into account the educational level of the subject when assessing the loss of functioning. For example, an accountant who can no longer pay off a checkbook will be more of a concern than someone who has never graduated from high school or who has never managed his finances. The predominant symptom of Alzheimer's dementia is memory impairment. Other symptoms include trouble finding words and disorientation. In other types of dementia, such as Lewy body dementia and frontotemporal dementia, personality changes and difficulty organizing and planning may be early signs.
Intermediate stage
As dementia progresses, symptoms first discovered in the early stages of dementia tend to get worse. The degree of deterioration is different for each person. A person with moderate dementia has an MMSE score of 6-17. For example, if a person suffers from Alzheimer's dementia, in the intermediate stages, almost all new information will be quickly forgotten. A person may exhibit serious impairments in problem solving, and their social judgment is usually impaired as well. Usually, the subject cannot perform functions outside his own home and, as a rule, should not be left alone. The subject may be able to do simple household chores, but no more, and requires assistance with personal care and hygiene beyond simple reminders.
Late stage
People with advanced dementia tend to become more withdrawn and require help with most or all of their self-care activities. People with advanced dementia typically require 24-hour follow-up for personal safety and to ensure that basic needs are met. Left unattended, a person with advanced dementia may wander off and fall, may not be aware of the usual dangers around them, such as a hot stove, may not fulfill a need to take a bath, or become unable to control their bladder or bowels (incontinence). Changes in meal frequency have been observed, and people with advanced dementia may require mashed foods, thickened fluids, and assistance with eating. Appetite can drop to such a level that a person will not want to eat at all. The subject may be reluctant to get out of bed, or may require absolute assistance in doing so. People can no longer recognize familiar people. They may show changes in sleep habits or have trouble sleeping.
Causes
Reversible causes
There are four main causes of easily reversible dementia: hypothyroidism, deficiency, Lyme disease, and neurosyphilis. All people with memory difficulties should be tested for hypothyroidism and vitamin B12 deficiency. For Lyme disease and neurosyphilis, testing should be done if a person has risk factors for these diseases.
Alzheimer's disease
Alzheimer's disease is the most common form of dementia. The most common symptoms are short-term memory loss and difficulty finding words. People with Alzheimer's also have problems with visuospatial areas (for example, they can get lost often), reasoning, the ability to connect words, and understanding. Understanding refers to whether a person can be aware or not that they have memory problems. Common early symptoms of Alzheimer's include recurrence, disappearance, difficulty keeping track of finances, trouble preparing meals, especially new or difficult meals, forgetting to take medications, and trouble finding words. The region of the brain most affected by Alzheimer's is the hippocampus. Other regions of the brain that show atrophy include the temporal and parietal lobes. Although this pattern is indicative of Alzheimer's disease, brain damage in Alzheimer's is quite variable, and brain scans cannot actually aid diagnosis.
Vascular dementia
Vascular dementia covers at least 20% of dementia cases, representing the second most common cause of dementia. It is the result of a disease or injury to the blood vessels that damage the brain, including strokes. The symptoms of this type of dementia depend on where in the brain the stroke occurs and whether the vessels are large or small. Multiple injuries can be the cause of long-term progressive dementia, while a single injury located in an area critical for cognitive function (i.e. hippocampus, thalamus) can lead to a sharp decline in cognitive function. Brains of people with vascular dementia can show multiple, single strokes of varying sizes. These people have risk factors for arterial disease, such as tobacco smoking, high blood pressure, atrial fibrillation, high cholesterol or diabetes, or other signs of blood vessel disease such as a previous heart attack or sore throat.
Lewy body dementia
Lewy body dementia (DLB) is dementia whose primary symptoms are visual hallucinations and "parkinsonism." Parkinsonism is a term that describes a subject with the characteristic features of Parkinson's disease. These include tremors, stiff muscles, and an emotionless face. Visual hallucinations in DLB are generally quite vivid visions of humans and / or animals that often appear when the subject falls asleep or wakes up. Other prominent symptoms include problems with attention, organization, difficulty solving problems and planning (executive function), and impaired visuospatial function. Again, imaging studies may not necessarily reveal the presence of DLB, but some features are particularly common. A person with DLB often exhibits occipital underperfusion on a gamma imaging image or occipital hypometabolism on a PET image. As a rule, the diagnosis of DLB is straightforward and, if it is not complicated, a brain scan is not necessary.
Frontotemporal dementia
Frontotemporal dementia (FTD) is dementia characterized by radical personality changes and difficulty speaking. In general, people with FTD exhibit relatively early social withdrawal and an early lack of understanding of the disease. Memory problems are not the main feature of this type of disease. There are three main types of FTD. The main symptoms of the first are in the field of personality and behavior. It is called the behavioral form of FTD (bv-FTD) and is the most common. In bv-FTD, the individual exhibits changes in personal hygiene, becomes inflexible in thought, rarely realizes that there is a problem, is socially alienated, and often exhibits a sharp increase in appetite. The subject may also be socially inadequate. For example, the subject may make inappropriate comments of a sexual nature, or may openly use pornography that they have not done before. One of the most common signs is apathy or lack of anxiety about something. Apathy, however, is a common symptom in various types of dementia. The other two types of FTD include speech problems as the main symptom. The second type is called semantic dementia, or temporary dementia (TV-FTD). The main characteristic of this type is the loss of the meaning of words. It can start with complex names for things. A person can at times also forget the meanings of objects equally. For example, when drawing a bird, a dog, and an airplane, an FTD subject can depict them in much the same way. In classic testing, the patient is shown an image of a pyramid, and after that an image of a palm tree and a pine tree. Subject is asked which tree is best suited to the pyramid. A person with TV-FTD is not able to answer the question. The last type of FTD is called progressive immobile aphasia (PNFA). It is mainly a problem of speaking. Sufferers have trouble finding the right words, but mostly they find it difficult to coordinate the muscles needed for pronunciation. Ultimately, people with PNFA may only use monosyllabic words or may become completely dumb. Behavioral symptoms can be observed with both TV-FTD and PNFA, but are weaker and later than with bv-FTD. Imaging studies show compression of the frontal and temporal lobes of the brain.
Progressive supranuclear palsy
Supranuclear palsy (PSP) is a form of dementia characterized by problems with eye movement. In general, problems begin with difficulty moving the eyes up and / or down (vertical gaze paralysis). Since the difficulty of moving the eyes upward can sometimes occur with natural aging, problems with moving the eyes downward are key to the PSP. Other key symptoms of PSP include falling backwards, balance problems, slow movements, stiff muscles, irritability, apathy, social withdrawal, and depression. A person may also have certain “frontal lobe signs” such as perseveration, grasping reflex and user behavior (the need to use an object as soon as you see it). People with PSP often show progressive difficulty in eating and swallowing, and ultimately being able to speak equally. Due to the numbness and sluggishness of movement, PSP is sometimes mistaken for Parkinson's disease. In brain images, the midbrain of people with PSP is usually compressed (atrophied), without other common brain abnormalities seen in the image.
Corticobasal degeneration
Corticobasal degeneration is a rare form of dementia that is characterized by many different types of neurological problems that worsen over time. The reason for this is that the disease affects the brain not only in many regions, but also to varying degrees. One of the characteristic features is the difficulty of using only one limb. A symptom that is rare enough in any condition other than corticobasal degeneration is called a foreign limb. An alien limb is a subject's limb, which acts on its own, it moves without succumbing to the control of the patient's brain. Other common symptoms include jerking of one or more limbs (myoclonus), with symptoms that are different for different limbs (asymmetric), difficulty speaking, which is associated with an inability to move the muscles of the mouth in concert, numbness and tingling of the limbs, and ignorance of one side of vision or perception. When ignored, the person does not take into account the opposite side of the body other than the one that presents the problem. For example, a person may not feel pain on one side, or may only paint half a picture. In addition, the subject's exposed limbs may be immobile or produce muscle contractions, causing strange, repetitive movements (dystonia). The area of the brain most frequently affected by corticobasal degeneration is the posterior frontal lobe and the parietal lobe. Yet other regions of the brain may be affected as well.
Rapidly progressive dementia
Creutzfeldt-Jakob disease usually causes dementia, which worsens over weeks to months, caused by prions. Causes of slowly progressive dementia in some cases are also represented in rapidly progressive disease: Alzheimer's disease, Lewy body dementia, frontotemporal lobar degeneration (including corticobasal degeneration and progressive supranuclear palsy). On the other hand, encephalopathy or delirium can develop relatively slowly and resemble dementia. Possible causes include brain infection (viral encephalitis, subacute sclerosing leukoencephalitis, Whipple syndrome) or inflammation (limbic encephalitis, Hashimoto's encephalopathy, cerebral vasculitis); tumors such as lymphoma or glioma; drug toxicity (eg, anticonvulsants); metabolic causes such as liver failure or renal failure; chronic subdural hematoma.
Other conditions
There are many other medical and neurological conditions in which dementia occurs exclusively at the end of the illness. For example, the proportion of patients with dementia developed from Parkinson's disease, despite the rather variable numbers, belongs to this group. When dementia develops from Parkinson's disease, the underlying cause may be Lewy body dementia or Alzheimer's disease, or both. Cognitive impairment is also observed in accessory Parkinson's syndromes, progressive supranuclear palsy and corticobasal degeneration (while the same underlying pathology can cause clinical syndromes of frontotemporal lobar degeneration). Chronic inflammatory diseases of the brain can have long-term effects on cognitive function, including Behcet's disease, multiple sclerosis, sarcoidosis, Sjogren's syndrome, and systemic erythematous lupus. Although acute porphyria can cause episodes of confusion and psychiatric distress, dementia is a rare feature of these rare conditions.
In addition to those mentioned above, hereditary conditions that can cause dementia (along with other symptoms) include:
Alexander's disease
Canavan's disease
Cerebrotendinous xanthomatosis
Dentato-rubro-pallido-Lewis atrophy
Fatal familial insomnia
Unstable X-linked tremor / ataxia syndrome
Glutaraciduria type 1
Krabbe-Beneke disease
Maple syrup-smelling urine disease
Niemann-Pick disease type C
Neuronal ceroid lipofuscinosis
Neuroacanthocytosis
Organic acidemia
Pelizaeus-Merzbacher disease
Disruptions to the urine cycle
Sanfilippo syndrome type B
Spinal cerebellar ataxia type 2
Moderate cognitive impairment
Moderate cognitive impairment (MCI) mainly means that a person has difficulty with memory and thinking, but they are not severe enough to be diagnosed. Subjects have scores in the range of 25-30 on the MMSE. Approximately 70% of people with MCI go on to develop some form of dementia. MCIs mainly fall into two categories. The first mainly includes primarily memory (amnestic MCI). The second category is represented by disorders that do not cover memory loss (non-amnestic MCI). In people with predominantly memory problems, the impairment develops into Alzheimer's disease. In people with a different type of MCI, the disorder can develop into other forms of dementia. Diagnosing MCI is often difficult because cognitive test results may be normal. More in-depth neurophysiological testing is often required to make a diagnosis. The most commonly used criteria are called the Peterson criteria and include:
Memory or other (thought-processing) complaints of a person or subject who knows the patient well.
The person must have memory problems or other cognitive impairments compared to someone of the same age and educational level.
The violation should not be serious enough to affect the person's daily life.
A person should not have dementia.
Persistent cognitive impairment
Various types of brain damage can cause irreversible cognitive impairment that does not worsen over time. Traumatic brain injury can cause generalized damage to the white matter of the brain (diffuse axonal injury), or more localized damage (similar to neurosurgery). A temporary decrease in the supply of blood or oxygen to the brain can lead to hypoxic-ischemic injury. Stroke (ischemic stroke or intracerebral, subarachnoid, subdural, or extradural blood loss) or infections (meningitis and / or encephalitis) affect the brain, prolonged epileptic seizures and acute hydrocephalus can also have long-term effects on cognitive function. Excessive alcohol consumption can cause alcohol dementia, Wernicke's encephalopathy, and / or Korsakoff syndrome.
Slowly progressive dementia
Dementia, which begins gradually and worsens progressively over several years, is usually caused by a neurodegenerative disease - which, through conditions affecting only or primarily the neurons in the brain, causes a gradual but irreversible loss of function of these cells. Less commonly, a non-degenerative condition can have side effects on brain cells that can be reversible or irreversible by treating the condition. The causes of dementia depend on the age at which symptoms began to appear. In the elderly population (usually over 65 years of age in this context), the vast majority of cases of dementia are caused by Alzheimer's disease, vascular dementia, or both. Lewy body dementia is another commonly observed form that, again, can occur with one or both of the other conditions. Hypothyroidism in some cases causes slowly progressive cognitive impairment as the main symptom, which can be completely reversible with treatment. Normotensive hydrocephalus, although relatively rare, is important to identify because treatment can prevent progression and worsening of other symptoms of the condition. However, significant cognitive improvement is not typical. Dementia is significantly less common before the age of 65. Alzheimer's disease is still the most common case, but asymptomatic forms of the disease cover the majority of cases in this age group. Frontotemporal lobar degeneration and Huntington's disease cover the majority of the remaining cases. Vascular dementia also occurs, but in turn may be associated with underlying medical conditions (including antiphospholipid syndrome, cerebral autosomal dominant arteriopathy with subcortical infarction and leukoencephalopathy, MELAS, homocystinuria, moyamoya, and Binswanger's disease). People with frequent head injuries, such as boxers or soccer players, are at risk for chronic traumatic encephalopathy (also called boxer dementia). Young adults (under the age of 40) who previously had normal mental abilities rarely develop dementia without other features of a neurological disorder, or without signs of illness in another part of the body. Most cases of progressive cognitive impairment in this age group are caused by psychiatric illness, alcohol or other drugs, or metabolic disorders. However, certain genetic disorders can cause true neurodegenerative dementia at this age. These include familial Alzheimer's disease, SCA17 (dominant inheritance); adrenoleukodystrophy (linked to the X chromosome); Gaucher syndrome type 3, metachromatic leukodystrophy, Niemann-Pick type C disease, pantothenate kinase-associated neurodegeneration, Tay-Sachs disease, and Wilson-Konovalov disease (all recessive). Wilson-Konovalov disease is especially important because cognitive function can be improved through treatment. At any age, a significant proportion of patients who complain of memory impairment or other cognitive symptoms are more likely to suffer from depression than neurodegenerative disease. Vitamin deficiencies and chronic infections can also occur at any age; they usually cause other types of degenerative dementia. These include vitamin B12, folate or niacin deficiencies, and infections including cryptococcal meningitis, HIV, Lyme disease, progressive multifocal leukoencephalopathy, subacute sclerosing leukoencephalitis, syphilis, and Whipple syndrome.
Diagnostics
As you can see above, there are many specific types and causes of dementia, often showing slightly different symptoms. However, the symptoms are quite similar and it is usually difficult to diagnose a type of dementia based on symptoms alone. Brain scanning techniques can assist in the diagnosis. In many cases, the diagnosis cannot be absolutely firm, with the exception of a brain biopsy, but it is rarely recommended (although it can be performed at autopsy). In older subjects, general assessment of cognitive impairment using cognitive testing or early diagnosis of dementia does not improve outcomes. However, screening tests have been found to be beneficial for people over 65 with memory complaints. Typically, symptoms must appear for at least six months for a diagnosis to be validated. Cognitive dysfunction of shorter duration is called delirium. Delirium is easily confused with dementia due to similar symptoms. Delirium is characterized by sudden onset, variable course, short duration (often hours to weeks), and is primarily associated with a physical (or medical) disorder. In comparison, dementia has a long duration, a gradual onset (except in cases of stroke or injury), a gradual decline in mental capacity, and a longer duration (from months to years). Several mental disorders, including depression and psychosis, can exhibit symptoms that must be differentiated from delirium and dementia. Therefore, the definition of dementia should include surveys for depression, such as the neuropsychiatric questionnaire or the Geriatric Depression Inventory. This is used because of the assumption that anyone who comes in with memory complaints is depressed but not dementia (since it is assumed that dementia patients are generally unaware of their memory problems). This phenomenon is called psvdodementia. However, in recent years it has been found that many elderly people with memory complaints actually suffer from mild cognitive impairment, an early stage of dementia. However, depression is still a significant contributor to the list of options for older adults with memory problems.
Cognitive testing
There are several short tests (5-15 minutes) that are reliable enough to screen for dementia. While many tests have been investigated, the Summary Mental Status Evaluation (MMSE) scale is currently the most well researched and widely used, although some may prove to be a better alternative. Other examples include Abbreviated Mental Performance Scale (AMTS), Modified Short Mental Status Scale (3MS), Cognitive Ability Test Device (CASI), Route Guidance Test, and Drawing Clock Test. The MOCA (Montreal Cognitive Assessment Scale) is a fairly reliable test and is available free of charge on the Internet in 35 languages. MOCA is also somewhat better at detecting mild cognitive impairment than MMSE. Another means of determining dementia is to ask the informant (relative or other family member) to complete a questionnaire about the person's daily cognitive functioning. Informant questionnaires provide comprehensive information for short cognitive tests. Perhaps the best known questionnaire of this type is provided by the Informant's Questionnaire on Cognitive Impairment in the Elderly (IQCODE). The Alzheimer's caregiver questionnaire is another tool. It is approximately 90% accurate for Alzheimer's and can be done online or in the office by a caregiver. On the other hand, the General Practitioner Cognitive Assessment combines both the patient examination and the interview of the informant. It has been specially designed for use in a first aid environment. Clinical neuropsychologists provide diagnostic counseling following a full range of cognitive testing, often lasting several hours, to identify functional patterns of abnormality associated with different types of dementia. Tests of memory, executive function, information processing speed, attention and speech skills, as well as tests of emotional and psychological adaptation, are appropriate. These tests help rule out other etiologies and determine comparative cognitive decline over time or based on previous cognitive abilities.
Laboratory tests
Regular blood tests are also usually done to rule out treatable cases. These tests include vitamin B12, folic acid, thyroid-stimulating hormone (TSH), C-reactive protein, CBC, electrolytes, calcium, kidney function, and liver enzymes. Abnormalities may indicate vitamin deficiencies, infections, or other problems that often cause confusion or disorientation in older people. The problem is compounded by the fact that it most commonly causes confusion in people with early dementia, so the “relief” of such problems can ultimately only be temporary. Testing for alcohol and other dementia-inducing drugs can produce results.
Visualization
CT scans or magnetic resonance imaging (MRI scans) are widely used, although these tests do not cover diffuse metabolic changes associated with dementia in people who do not show significant neurological problems (such as paralysis or weakness) on neurologic examination. CT or MRI scans may indicate normotensive hydrocephalus, a potentially reversible case of dementia, and may provide information relevant to other types of dementia, such as heart attack (stroke), that indicates vascular dementia. Functional neuroimaging gamma imaging and PET are more useful in identifying long-term cognitive dysfunction because they have the same ability to diagnose dementia as clinical examination or cognitive testing. The ability of gamma imaging to distinguish a vascular event (i.e., multi-infarction dementia) from Alzheimer's dementia is superior to differentiation by clinical examination. A recent study has established the value of PET imaging using carbon-11 Pittsburgh composition B as a radioactive tracer (PIB-PET) in the predictive diagnosis of various types of dementia, in particular Alzheimer's disease. A study in Australia found that PIB-PET has an 86% accuracy in predicting which patients with mild cognitive impairment will develop Alzheimer's disease within two years. In another study, conducted on 66 patients at the University of Michigan, PET studies used either PIB or another radioactive tracer, carbon-11 dihydrotetrabenazine (DTBZ), and a more accurate diagnosis was obtained in more than one quarter of patients with mild cognitive impairment or moderate dementia. ...
Prevention
Main article: Prevention of dementia Many preventive measures have been proposed, including lifestyle changes and medications, although none have proven to be effective. Among otherwise healthy older people, computerized cognitive training can improve memory; however, it is not known whether it prevents the development of dementia.
Control
Except for the treatable types listed above, dementia cannot be cured. Cholinesterase inhibitors are often used early in the course of the disease; however, the benefits are generally negligible. Cognitive and behavioral interventions may be appropriate. Educating and providing emotional support for caregivers is equally important. Training programs are helpful in relation to daily activities and potentially relieve dementia.
Psychotherapy
Psychotherapy, which is seen as a treatment for dementia, includes music therapy with implicit evidence, conditional evidence for reminiscence therapy, somewhat helpful cognitive rethinking for caregivers, vague evidence for recognition therapy, and conditional evidence for mental exercise. Adult day care centers as well as special care units in nursing homes often provide specialized care for patients with dementia. Adult day care centers offer observation, recreation, food and limited medical care to patients, and provide rest for caregivers. In addition, home care can provide personalized support and care at home, allowing for the more personalized attention that is needed as the disease progresses. Mental health nurses can make a significant contribution to the mental health of patients. Because dementia interferes with normal ability to communicate due to changes in receptive and expressive speech, as well as the ability to plan and solve problems, restless behavior is often a form of communication for a person with dementia, while actively looking for a potential cause such as pain, physical illness, or excessive irritation can be helpful in reducing anxiety. In addition, the use of ABC Behavior Analysis can be a useful tool for understanding the behavior of people with dementia. It includes the study of past life (A), behavior (B) and consequences (C) associated with the complication in order to identify the problem and prevent further episodes, which may worsen if the person is not understood.
Medications
To date, no medication can prevent or cure dementia. Drugs can be used to treat behavioral and cognitive symptoms, but do not affect the underlying disease process. Acetylcholinesterase inhibitors such as donepezil may be useful for Alzheimer's and dementia in Parkinson's disease, Lewy body dementia, or vascular dementia. However, the quality of the evidence is low and the beneficial effect is negligible. There is no difference between agents in this family of drugs. In a minority of people, side effects include bradycardia and syncope. Determination of the underlying cause of the behavior is necessary before prescribing antipsychotic drugs for dementia symptoms. Antipsychotic drugs should only be used to treat dementia if drug-free therapy has been ineffective and the patient's actions are dangerous to himself or others. Aggressive behavior in some cases is a consequence of other solvable problems that can make medication unnecessary. Because people with dementia can be aggressive, resistant to treatment, and otherwise disruptive, antipsychotic drugs are considered therapy in some situations. These drugs have dangerous side effects, including an increased risk of stroke and patient death. In general, stopping antipsychotic drugs in people with dementia does not cause problems, even if the medication has been taken for a long time. N-methyl-D-aspartate (NMDA) receptor blockers such as memantine may be helpful, but the evidence is less clear than for acetylcholinesterase inhibitors. Due to their different mechanisms of action, memantine and acetylcholinesterase inhibitors can be used in combination, but, nevertheless, the beneficial effect is not significant. Antidepressants: Depression is often associated with dementia and tends to worsen the degree of cognitive and behavioral impairment. Antidepressants are effective in treating the cognitive and behavioral symptoms of depression in Alzheimer's patients, but the evidence for their use in other types of dementia is unreliable. It is recommended to avoid the use of benzodiazepines such as diazepam in dementia due to the risks of increased cognitive impairment and falls. There is little evidence of effectiveness for this group of people. There is no reliable evidence that folate or vitamin B12 improves outcomes in patients with cognitive problems.
Pain
As people age, they develop more and more health problems, and most of the problems are associated with the fact that aging carries a significant pain load; thus, 25% to 50% of older people suffer from persistent pain. Seniors with dementia show a similar incidence of pain-causing diseases as seniors without dementia. Pain is often overlooked on screening in older people and is often inadequately assessed, especially among patients with dementia, as they become unable to inform others that they are in pain. In addition to the problem of human concern, untreated pain carries functional complications. Persistent pain can lead to impaired mobility, depressed mood, sleep disturbances, impaired appetite and increased cognitive impairment, and pain-related interaction with activity is a factor contributing to the fall of older adults. Although persistent pain in people with dementia is difficult to transmit, diagnose and treat, neglecting persistent pain leads to functional, physiological and quality of life complications for this vulnerable population. Health care professionals often lack the skills and time to identify, accurately assess, and properly control pain in people with dementia. Family members and friends can make a significant contribution to caring for someone with dementia by learning how to identify and assess their pain. Educational resources (such as the Understanding Pain and Dementia Workshop) and experimental assessment tools are available.
Difficulty eating
People with dementia may have difficulty eating. Whenever possible, the recommended response to eating problems is to provide a caregiver with the goal of helping the patient eat. Another way to help people who cannot swallow food is to use a gastrostomy feeding tube as a way to get food. However, in terms of patient comfort and functional status, as well as reducing the risk of aspiration, pneumonia and death, oral nutritional support is almost equivalent to a feeding tube. Tube feeding has been associated with anxiety, increased use of physicochemical restraints, and worsening pressure ulcers. Feeding tubes can also cause hypervolemia, diarrhea, abdominal pain, local complications, less personal interaction, and may increase the risk of aspiration. No benefit has been observed with this procedure in people with advanced dementia. Risks of using a feeding tube include anxiety, the patient being able to remove the tube, or otherwise using physical or chemical immobilization to prevent it, or developing pressure ulcers. A mortality rate of 1% is directly related to the procedure, as well as a serious complication rate of 3%.
Alternative medicine
Other therapies that have been investigated for effectiveness include aromatherapy with inconsequential evidence and massage with inconclusive evidence.
Symptomatic therapy
If dementia is progressive or terminal in nature, symptomatic therapy can be beneficial for patients and carers by providing them with an understanding of what to expect, how to cope with the loss of physical and mental capacity, and plan for patients' desires and goals, including surrogate decision making and discussion of desires. benefit or against cardiopulmonary resuscitation and life support. Because the decline in ability can be transient, and because most people allow people with dementia to make their own decisions, it is recommended that symptomatic treatment be used until the advanced stages of dementia.
Epidemiology
The number of dementia cases worldwide in 2010 was 35.6 million. The incidence increases significantly with age, with dementia affecting 5% of the population over 65 and 20–40% of people over 85. About two thirds of people with dementia live in low- and middle-income countries, which are forecast to have a sharp increase in the incidence. The incidence is slightly higher in women than in men, aged 65 and over. In 2013, dementia caused an estimated 1.7 million deaths, up from 0.8 million in 1990.
History
Until the late 19th century, dementia was a broader clinical concept. It included mental disorder and any type of psychosocial disability, including conditions that could be cured. Dementia at the time simply referred to anyone who had lost the ability to think and extended equally to psychosis of mental disorder, "organic" diseases like syphilis that damage the brain, and dementia associated with old age, which was attributed to "arteriosclerosis." ... Dementia has been mentioned in medical texts since antiquity. One of the earliest mentions dates back to the 7th century BC. and belongs to the physicist and mathematician Pythagoras, who divided the life span of a person into six different phases, which are 0-6 (early childhood), 7-21 (adolescence), 22-49 (youth), 50-62 (middle age), 63 -79 (advanced age) and 80- (advanced age). The last two phases he described as "old age", a period of mental and physical decline, and the last phase occurs when "the reality of death is in close proximity after a long period of time, to which, fortunately, few individuals of the human race come when the mind is weakened to nonsense of early infancy. " In 550 BC. the Athenian statesman and poet Solon reasoned that a person's statements can be invalidated if he suffers from loss of reason due to old age. Chinese medical texts also mention the disease, and the characters for "dementia" literally translate to "feeble-minded old man." Aristotle and Plato talked about mental breakdown in old age, but clearly saw it as an inevitable process that affects all old people and cannot be prevented in any way. The latter argued that old people are unsuitable for any responsible positions, since “there is no sharpness of mind that was inherent in them in their youth, which was characterized by expression of opinion, imagination, power of thinking and memory. They gradually grow stupid as they age and can hardly fulfill their functions. " In comparison, the Roman statesman Cicero held the view that is most consistent with modern medical views that mental loss is not inevitable for the elderly and "only affects those elderly who were weak." He said that those who remain mentally active and willing to learn new things can delay dementia. However, Cicero's view of dementia, while progressive, was largely ignored in a world dominated by Aristotle's medical texts for centuries. The following doctors of the Roman Empire, such as Galen and Celsus, simply repeated Aristotle's claims, although they added a small number of new works to medical science. Byzantine doctors sometimes described dementia, and it was recorded that at least seven emperors, whose life expectancy exceeded 70 years, showed signs of cognitive decline. There were special hospitals and homes in Constantinople for those diagnosed with dementia or insanity, but this, of course, did not apply to emperors who were outlawed and whose state of health could not be publicly announced. In addition, there are few records of senile dementia in Western medical texts dating back to around 1700. One of the few references dates back to the 13th century and belongs to the monk Roger Bacon, who viewed old age as a punishment for original sin. While he reiterated Aristotle's existing claims that dementia is inevitable as a result of long life spans, he made the extremely progressive assertion that the brain is the center of memory and thinking rather than the heart. Poets, playwrights, and other writers have frequently mentioned the loss of mental faculties in old age. Shakespeare makes a pointed mention of it in some of his works, including Hamlet and King Lear. Dementia in the elderly was called senile dementia or senile marasmus, and was viewed more as a normal and somewhat inevitable feature of aging than caused by any specific disease. At the same time, in 1907, a specific organic dementia process with an early onset, called Alzheimer's disease, was described. It was associated with certain microscopic changes in the brain, but was considered a rare disease in middle age as the first patient diagnosed was a 50-year-old woman. Throughout the 19th century, physicians generally came to the conclusion that dementia in the elderly was the result of cerebral atherosclerosis, although opinions fluctuated between the idea that it was associated either with blockage of the main arteries that feed the brain or with minor strokes of the cerebral vessels. This view remained mainstream medical opinion throughout the first half of the 20th century, but in the 1960s, the link between neurodegenerative diseases was increasingly questioned and age-related cognitive impairment was identified. In the 1970s, the medical community supported the view that vascular dementia is less common than previously thought, and that Alzheimer's disease is responsible for the vast majority of mental disorders in old age. Later, however, it was argued that dementia is often a combination of two diseases. Like other diseases associated with aging, dementia was relatively rare until the 20th century due to the fact that it was most common among people over 80, and this life expectancy was not typical of pre-industrial times. On the contrary, syphilitic dementia was widespread in the developed world until it was largely eradicated with the use of penicillin after World War II. Due to the significant increase in life expectancy after World War II, the number of people over 65 in developed countries began to grow rapidly. While older people averaged 3-5% of the population prior to 1945, in 2010 10-14% of people over 65 years old were common to many countries, while in Germany and Japan this figure exceeded 20%. Public attention to Alzheimer's disease increased significantly in 1994 when former US President Ronald Reagan announced that he was suffering from the disease. For the period 1913-1920, schizophrenia was clearly expressed to some extent similar to our days, and the concept of premature dementia was used to describe the development of senile dementia at a young age. Ultimately, the two concepts merged in such a way that until 1952, doctors used the terms dementia (early dementia) and schizophrenia interchangeably. The concept of premature dementia for mental disorder suggests that a type of mental disorder such as schizophrenia (including paranoia and cognitive decline) may be expected for all seniors (see paraphrenia). After around 1920, the concept of dementia began to be used to refer to what is now understood as schizophrenia, with the concept of senile dementia helping to limit the meaning of the word to "permanent, irreversible mental disorder." This marked the beginning of a more distinctive use of the concept in our time. In 1976, the neurologist Robert Katzmann confirmed the link between senile dementia and Alzheimer's disease. Katzmann argued that the majority of cases of senile dementia (by definition) occur after age 65, that it is pathologically identical to Alzheimer's disease before age 65, and therefore should not be treated differently. He noted in relation to the fact that “senile dementia” was not considered a disease, but rather part of the aging process, that millions of aging patients show similarities to Alzheimer's disease, whereby senile dementia should be diagnosed as a disease rather than just a normal aging process. ... Katzmann, therefore, indicates that Alzheimer's disease that occurs after 65 years of age is widespread, not rare, and is fatal in every 4th or 5th patient, even though it is rarely indicated in death certificates in 1976. This testimony initiated the view that dementia is never normal and is always the result of a specific disease process, and is not usually part of the aging process per se. As a result of subsequent discussions, which continued for a long time, a diagnosis of senile dementia of the Alzheimer's type (SDAT) was proposed for people over 65 years old, while the diagnosis of Alzheimer's disease was made for people under 65 years of age who had a similar pathology. Ultimately, however, it was agreed that the age limit was fictitious and that Alzheimer's disease was a viable concept for people with some of the brain pathology seen in this disease, regardless of the age of the person diagnosed. A helpful finding was that although the incidence of Alzheimer's disease increases with age (from 5-10% at 75 to 40-50% at 90), there is no age at which everyone develops it, so , it is not an inevitable consequence of the aging process, regardless of the age at which the disease occurs. Evidence for this is provided by many publicly documented centenarians (people living to 110+) who did not show significant cognitive impairment. There is some evidence that dementia is most likely to develop between the ages of 80 and 84, and that subjects who have passed that point in time without developing the disease have a lower risk of developing the disease. Women have a higher incidence of dementia than men, although this may be due to their longer life expectancy and greater chances of reaching the age at which the disease usually develops. In addition, after 1952, mental disorders such as schizophrenia were excluded from the category of organic brain syndromes and thus (by definition) excluded from the possible causes of "dementia diseases" (dementia). At the same time, however, the traditional cause of senile dementia - "arteriosclerosis" - has now returned to the group of dementia caused by a vascular cause (minor strokes). Today it is denoted by the concept of multi-infarction dementia, or vascular dementia. In the 21st century, several other types of dementia have been separated from Alzheimer's and vascular dementia (these two are the most common types). This differentiation is based on pathological examination of brain tissue, symptomatology, and various patterns of brain metabolic activity in radioisotope medical imaging, such as gamma tomography and PET scans of the brain. Different forms of dementia have different prognoses (the expected outcome of the disease), and also differ in a complex of epidemiological risk factors. The causal etiology of many of these, including Alzheimer's disease, remains unclear, although there are many theories such as accumulation of protein plaques as part of the normal aging process, inflammation (either from bacterial pathogens or toxic chemicals), abnormal sugar levels in the blood and traumatic brain injury.
Senile (senile) dementia is a persistent violation of higher nervous activity that develops in elderly people and is accompanied by a loss of acquired skills and knowledge, as well as a decrease in the ability to learn.
Source: mozgvtonuse.com
Higher nervous activity includes processes that occur in the higher parts of the human central nervous system (conditioned and unconditioned reflexes, higher mental functions). The improvement of the mental processes of higher nervous activity occurs theoretically (in the learning process) and empirical (when gaining direct experience, testing the theoretical knowledge gained in practice) ways. Higher nervous activity is associated with neurophysiological processes occurring in the cerebral cortex and subcortex.
Timely adequate treatment can slow down the progression of the pathological process, improve social adaptation, maintain self-care skills and prolong life.
Senile dementia is most often seen in the age group over 65. According to statistics, severe dementia is diagnosed in 5%, and mild - in 16% of people in this age group. According to the information provided by the World Health Organization, a significant increase in the number of patients with senile dementia is expected in the coming decades, which is primarily associated with an increase in life expectancy, accessibility and improvement in the quality of medical care, which allows avoiding death even in the case of severe brain damage. ...
Causes and risk factors
The main cause of primary senile dementia is organic brain damage. Secondary senile dementia can develop against the background of any disease or have a polyetiological nature. At the same time, the primary form of the disease accounts for 90% of all cases, secondary senile dementia occurs in 10% of patients, respectively.
Risk factors for developing senile dementia include:
- genetic predisposition;
- systemic circulatory disorders;
- infectious diseases of the central nervous system;
- neoplasms of the brain;
- metabolic disorders;
- endocrine diseases;
- the presence of bad habits;
- poisoning with heavy metals (in particular, zinc, copper, aluminum);
- irrational use of drugs (especially anticholinergics, antipsychotics, barbiturates);
- vitamin deficiency (in particular, lack of vitamin B 12);
- overweight.
Forms of the disease
Senile dementia is classified into primary and secondary dementia.
Memory disorders are the main symptom of atrophic senile dementia.
Depending on the degree of brain damage, the disease proceeds in the following forms:
- mild senile dementia(decrease in social activity, preservation of the ability to self-service);
- moderate senile dementia(loss of skills in using equipment and devices, inability to endure loneliness for a long time, preservation of the ability to self-service);
- severe senile dementia(complete maladjustment of the patient, loss of the ability to self-service).
Depending on the etiological factor, the following forms of senile dementia are distinguished:
- atrophic(primary damage to the neurons of the brain);
- vascular(secondary damage to nerve cells against the background of a violation of the blood supply to the brain);
- mixed.
The clinical manifestations of senile dementia range from a slight decrease in social activity to an almost complete dependence of the patient on other people. The prevalence of certain signs of senile dementia depends on its form.
Source: feedmed.ru
Atrophic senile dementia
Memory disorders are the main symptom of atrophic senile dementia. Mild forms of the disease are manifested by loss of short-term memory. In severe cases of the disease, there are also violations of long-term memory, disorientation in time and space. In some cases, patients' speech is impaired (it is simplified and impoverished, artificially created words can be used instead of forgotten words), the ability to respond to several stimuli at the same time and keep attention in one lesson is lost. With continued self-criticism, patients may try to hide their illness.
Drug therapy, first of all, is indicated for insomnia, depression, hallucinations, delirium, aggression towards others.
With the course of the pathological process, personality changes and behavioral disorders occur, hypersexuality appears in combination with incontinence, the patient grows irritability, egocentrism, excessive suspicion, a tendency to edification and resentment. There is a decrease in the critical attitude to the surrounding reality and its state, sloppiness and negligence appear or increase. The pace of mental activity in patients slows down, the ability to think logically is lost, the formation of delusional ideas, the emergence of hallucinations, illusions is possible. Any people can be involved in the delusional system, but more often they are relatives, neighbors, social workers and other persons who interact with the patient. Patients with senile dementia often develop depressive states, tearfulness, anxiety, anger, and indifference to others. In the case of the presence of psychopathic features before the onset of the disease, their exacerbation is noted with the progression of the pathological process. Interest in past hobbies, the ability to self-service, to communicate with other people are gradually lost. In some patients, there is a tendency to meaningless and disorderly actions (for example, shifting objects from place to place).
In the later stages of the disease, behavioral disorders and delusions are leveled due to a pronounced decrease in mental abilities, patients become inactive and indifferent, they may not recognize themselves when looking at the reflection in the mirror.
It is recommended to use the services of a professional nurse to care for patients with severe senile dementia.
With the further progression of the pathological process, the ability to move independently, to chew food is lost, which causes the need for constant professional care. Some patients may have single seizures similar to epileptic seizures or fainting.
Senile dementia in atrophic form is steadily progressing and leads to the complete disintegration of mental functions. After the diagnosis is made, the average life expectancy of the patient is about 7 years. Death often occurs as a result of the progression of concomitant somatic diseases or the development of complications.
Source: imgsmail.ru
Vascular senile dementia
The first signs of vascular senile dementia are difficulties that the patient experiences when trying to concentrate, inattention. Then there is rapid fatigue, emotional instability, a tendency to depression, headaches and sleep disorders. Sleep duration can be 2-4 hours or, conversely, reach 20 hours a day.
Memory disorders in this form of the disease are less pronounced than in patients with atrophic dementia. In post-stroke vascular dementia, the clinical picture is dominated by focal disorders (paresis, paralysis, speech disorders). Clinical manifestations depend on the size and location of the hemorrhage or the area with impaired blood supply.
A patient with senile dementia is recommended to be placed in psychiatric clinics only in severe forms of the disease, in all other cases it is not necessary.
In the case of the development of a pathological process against the background of a chronic disturbance of blood supply, signs of dementia prevail, at the same time, neurological symptoms are less pronounced and are usually represented by changes in gait (decrease in stride length, shuffling), slowing down of movements, impoverishment of facial expressions, and impaired vocal function.
Diagnostics
The diagnosis of senile dementia is based on the characteristic features of the disease. Memory impairments are determined during a conversation with a patient, interviewing relatives and conducting additional research. If senile dementia is suspected, the presence of symptoms indicating organic brain damage (agnosia, aphasia, apraxia, personality disorders, etc.), impaired social and family adaptation, as well as the absence of signs of delirium is determined. The presence of organic brain lesions is confirmed by computed tomography or magnetic resonance imaging. The diagnosis of senile dementia is confirmed by the presence of the listed signs for six months or more.
In the presence of concomitant diseases, additional studies are shown, the volume of which depends on the existing clinical manifestations.
Differential diagnosis is carried out with functional and depressive pseudodementia.
Treatment of senile dementia
Treatment of senile dementia consists of psychosocial and drug therapy aimed at slowing the progression of the disease and correcting existing disorders.
With continued self-criticism, patients may try to hide their illness.
Drug therapy, first of all, is indicated for insomnia, depression, hallucinations, delirium, aggression towards others. The administration of drugs that improve cerebral circulation, neurometabolic stimulants, vitamin complexes is shown. In case of anxiety, tranquilizers can be used. If a depressive condition develops, antidepressants are prescribed. In the vascular form of senile dementia, antihypertensive drugs are used, as well as drugs that help lower blood cholesterol levels.
In addition to drug therapy, psychotherapeutic methods are used, the purpose of which is to return the patient to acceptable behavioral reactions in society. A patient with mild forms of senile dementia is advised to lead an active social life.
The rejection of bad habits, as well as the therapy of concomitant diseases, is of no small importance. So, when dementia develops against the background of a stroke, it is recommended to take a number of measures to reduce the risk of recurrent stroke (adjust excess weight, control blood pressure, perform therapeutic exercises). With concomitant hypothyroidism, adequate hormonal therapy is indicated. If brain tumors are detected, the neoplasms are removed in order to reduce the pressure on the brain. In the presence of concomitant diabetes mellitus, it is necessary to monitor the blood glucose level.
When caring for a patient with senile dementia at home, it is recommended to get rid of objects that can be dangerous, as well as unnecessary things that obstruct the patient's movement around the house, equip the bathroom with handrails, etc.
According to information provided by the World Health Organization, a significant increase in the number of patients with senile dementia is expected in the coming decades.
It is recommended to use the services of a professional nurse to care for patients with severe senile dementia. If it is impossible to create comfortable conditions for the patient at home, he should be placed in a boarding house specializing in caring for patients of this kind. A patient with senile dementia is recommended to be placed in psychiatric clinics only in severe forms of the disease, in all other cases it is not necessary, moreover, it can increase the progression of the pathological process.
Possible complications and consequences
The main complication of senile dementia is social maladjustment. Due to problems with thinking and memory, the patient loses the ability to contact with people around him. In the case of a combination of pathology with laminar necrosis, in which neuronal death and proliferation of glial tissues are observed, vascular occlusion and cardiac arrest are possible.
Forecast
The prognosis for senile dementia depends on the timeliness of diagnosis and initiation of treatment, the presence of concomitant diseases. Timely adequate treatment can slow down the progression of the pathological process, improve social adaptation, maintain self-care skills and prolong life.
Prevention
In order to prevent the development of senile dementia, it is recommended:
- adequate physical and intellectual activity;
- socialization of elderly people, their involvement in feasible work, communication with other people, vigorous activity;
- adequate treatment of existing diseases;
- strengthening the body's defenses: balanced nutrition, rejection of bad habits, regular walks in the fresh air.
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Dementia is an acquired form of dementia. In this condition, there is a pronounced violation of mental functions. Patients have a loss of everyday and social skills in parallel with a persistent decline in cognitive abilities and memory. Most often, dementia develops in old age; very common, but far from the only reason is.
Important:memory impairment does not mean that dementia has begun to develop. The decrease in the ability to remember can be due to many reasons. However, in such cases, it is imperative to consult a doctor - neurologist or psychiatrist.
Effective measures for the treatment of this pathology have not yet been developed.... Patients are prescribed symptomatic therapy to achieve a certain improvement.
Causes of dementia and classification of pathology
The immediate cause of dementia is damage to the nerve cells of certain areas of the brain, due to various diseases and pathological conditions.
It is customary to distinguish between progressive dementia, characterized by an irreversible course of the process, and conditions that resemble them, but amenable to treatment (encephalopathy).
Progressive dementia includes:
- vascular;
- frontotemporal;
- mixed;
- dementia with Lewy bodies.
Note:the development of dementia often becomes a consequence of repeated brain injuries (for example, in professional boxers).
Alzheimer's disease develops more often in elderly and senile people. The exact cause of the pathology has not yet been identified. Genetic predisposition is believed to play a role. In the brain of patients, in most cases, pathological deposits of a protein (beta-amyloid) and neurofibrillatory tangles are found.
Vascular dementia develop against the background of pathological changes in the blood vessels of the brain, and these, in turn, appear as a result of strokes and a number of other diseases.
Some people with progressive dementia have abnormal protein compounds in the brain - the so-called. Lewy body... They are found in patients diagnosed with Parkinson's and Alzheimer's.
Frontotemporal dementia- this is a whole group of serious disorders of higher nervous activity, which are caused by atrophic changes in the frontal and temporal lobes. It is these areas of the human brain that are responsible for speech perception, personality and behavioral characteristics.
At mixed dementia several factors that cause disturbances in the central nervous system are revealed at once. In particular, vascular pathologies and Lewy bodies may be present in parallel.
Diseases accompanied by progressive dementia:
- Huntington's disease;
- Creutzfeldt-Jakob disease.
Parkinson's disease due to the gradual death of neurons; it is accompanied by dementia often, but not in 100% of cases.
Huntington's disease belongs to the hereditary diseases. A genetic mutation leads to atrophic changes in the cells of certain structures of the central nervous system. Pronounced thought disorders in most cases appear after 30 years.
The reason Creutzfeldt-Jakob disease the presence in the body of pathological protein compounds - prions is considered. Their presence can be hereditary. The disease is incurable and, on average, leads to the death of patients by the age of 60.
Treatable encephalopathies can be caused by:
- pathology of infectious and autoimmune genesis;
- reactions to pharmacological drugs;
- (acute and chronic);
- metabolic disorders;
- endocrine pathologies;
- deficiency conditions;
- subdural hematomas;
- hydrocephalus (with normal intracranial pressure);
- hypoxia (anoxia).
Signs of dementia may appear against the background of a severe course infectious and inflammatory diseases... The symptoms of dementia also often make themselves felt when the immune system attacks its own nerve cells, perceiving them as foreign. A striking example of autoimmune pathology is considered, for example,.
Personality changes and cognitive impairment are able to develop against the background of pathologies of the endocrine glands (for example, the thyroid gland). The activity of the central nervous system is negatively affected by low sugar levels, deficiency or excess of calcium and sodium, and impaired absorption.
Symptoms characteristic of dementia are detected with hypovitaminosis (especially for), dehydration (dehydration), taking certain medications, using drugs and alcohol. Extremely serious consequences for the nervous system are caused by ... With adequate treatment of intoxication and deficiency conditions, in many cases it is possible to achieve a significant improvement in the condition or complete recovery.
Hypoxia- This is oxygen starvation of nerve cells. It can be caused by CO (carbon monoxide) poisoning, myocardial infarction and severe asthmatic attack.
Clinical manifestations
The symptoms of dementia and their combinations can vary depending on the underlying cause of the disorder.
All manifestations of pathology can be divided into two large groups - cognitive disorders and mental disorders.
Common cognitive disorders include:
Psychological disorders:
- , depressed state;
- unmotivated feeling of anxiety or fear;
- personality changes;
- behavior that is unacceptable in society (constant or episodic);
- pathological excitement;
- paranoid delusions (experiences);
- hallucinations (visual, auditory, etc.).
As dementia progresses, it causes the loss of important skills and leads to disorders of several organs and systems.
The consequences of dementia:
- eating disorders (in severe disorder, patients lose the ability to chew and swallow food);
- (pneumonia is the result of aspiration of food particles);
- inability to serve oneself;
- security threat;
- death (often - against the background of severe infectious complications).
Diagnostics
Higher mental functions include thinking, speech, memory and the ability to adequately perceive. If at least two of them are affected so that it directly affects the patient's life, a diagnosis of dementia can be made.
At the first stage of the examination, the neurologist collects an anamnesis, talking with the patient himself and his relatives.
A variety of neuropsychological tests are used to assess cognitive function. With their help, you can identify changes in the ability to memorize, logical reasoning and concentration. Particular attention is paid to the patient's speech.
Neurological examination reveals abnormalities in motor functions, visual perception and sensitivity. The patient's reflexes are assessed and their ability to maintain balance is examined.
Blood tests can help identify some of the possible causes of dementia.... Signs of an infectious and inflammatory process and specific markers of some degenerative pathologies of the nervous system can be found in the cerebrospinal fluid.
To verify the diagnosis, a number of additional (neuroimaging) studies are required - various types of tomography:
- positron emission.
CT and MRI can detect neoplasms, hematomas, hydrocephalus, as well as signs of circulatory disorders (including hemorrhagic or ischemic).
With the help of positron emission tomography, the metabolic rate in the central nervous system is determined and the deposits of abnormal protein are detected. The method makes it possible to clarify or deny the presence of Alzheimer's disease.
Note:psychiatric consultation is required for the differential diagnosis of dementia with individual mental disorders and mental retardation.
Dementia treatment
Currently, most types of dementia are considered incurable. Nevertheless, therapeutic techniques have been developed to control a significant part of the manifestations of this disorder.
Medical treatment for dementia
Pharmacotherapy contributes to the temporary improvement of the patient's condition..
To increase the level of neurotransmitters in the central nervous system that improve cognitive abilities and memory, patients are shown taking drugs from the group of cholinesterase inhibitors.
These drugs include:
- Galantamine (trade name - Razadin);
- Donepezil (Aricept);
- Rivastigmine (Exelon).
Alzheimer's and vascular dementia are also indications for their appointment. During therapy, undesirable effects are possible - dyspeptic disorders and intestinal dysfunction ().
The level of the neurotransmitter glutamate allows the drug Namenda (Memantine) to be increased.
According to the testimony of a patient suffering from dementia, drugs are prescribed to combat and increased excitability. In some cases, a course admission is necessary.
Important:all medications should be taken under the supervision of family and friends in order to avoid overdose or missed appointments due to forgetfulness. It is unacceptable to take medications without a doctor's prescription!
Drug-free treatment for dementia
To prevent accidents, it is necessary to make the home safer.
It is recommended to minimize the level of noise and other external stimuli that can interfere with concentration. Objects through which the patient is able to accidentally harm himself or others, it is advisable to hide.
Adherence to a specific daily routine will help to cope with disorientation in time and space. Relatively complex tasks should be divided into several consecutive simple ones.
Note:data were obtained indicating a slowdown in the development of Alzheimer's disease with regular intake of drugs. But there is an opinion that this biologically active compound increases mortality among people suffering from serious diseases of the heart and blood vessels.
The risk of developing dementia is greatly reduced by regular consumption, which, in particular, is abundant in sea fish. There is reason to believe that dietary adjustments can slow the progression of dementia.
Listening to calm music and communicating with pets (especially cats) can help reduce anxiety and improve the mood of patients.
Aromatherapy and general relaxing massage help to stabilize the psycho-emotional state.
The effectiveness of such a technique as art therapy has been proven. It can involve painting, sculpting and other types of creativity. In the course of classes, special attention is paid to the process, and not to the result, which positively affects the emotional state of the patient.
Plisov Vladimir, medical columnist
(dementia) is a condition (often progressive) in which a person has a persistent violation of thought processes.
This is expressed in the loss of memory, loss of basic skills, abilities and knowledge and, as a result, complete degradation.
The disease is not independent, but is considered only a symptom of certain neurological and mental pathologies. It occurs against the background of complete and irreversible destruction of the structure of the brain and cannot be completely cured.
Dementia does not necessarily manifest itself with age, and lately it has become more and more “younger”. The term "early dementia" means the onset of the disease in people over the age of 35, and sometimes a little younger.
Fortunately, the pathology is not very common: there are about 48 million patients registered in the world, and young people make up only 15-20% of this figure.Having completely given up smoking, alcohol, observing a competent diet, playing sports or any other physical activity, you can not only prolong your youth, but also insure yourself against many terrible diseases.
Regular brain training can help you overcome dementia.
It can be solving crosswords, memorizing poetry, intellectual and logic games, puzzles, etc.
It is important to keep track of your weight, blood pressure, cholesterol and glucose levels in your body.
If dementia is not hereditary, then these tips can help you avoid it:
- Refusal of bad habits, significantly reduces the risk of illness.
- Proper nutrition, exercise, dieting will not only prolong an active life, but also increase the body's defenses.
- Exercising the brain is just as important as the body.
- By regularly passing all the necessary tests, you can detect any disease in time.
Dementia (translated from Latin - "dementia") is a serious pathology of the nervous system. The main cause of the disease is organic brain damage, and the main feature is a sharp decrease in intelligence. Signs of pathology are due to the cause, severity of the lesion, its location and size. But all cases of dementia are characterized by persistent disorders of higher nervous activity up to the absolute disintegration of the personality.
- Viral encephalitis.
- Acquired immunodeficiency syndrome.
- Chronic meningitis.
- Neurosyphilis and others.
- 1. Cortical. It occurs as a result of damage to the cerebral cortex (Alzheimer's disease).
- 2. Subcortical. Differs in the pathology of subcortical structures (Parkinson's disease).
- 3. Cortical-subcortical. Typical for diseases based on vascular disorders.
- 4. Multifocal. Its feature is the defeat of all parts of the brain and a pronounced neurological clinical picture associated with it.
- violation of short-term memory;
- change of mood;
- tearfulness;
- aggravation of sensitivity
- violations of intellectual and cognitive activity;
- disappearance of spiritual values;
- loss of vital interests, feelings of shame and duty;
- absolute social maladjustment
- 1. Light degree. It is characterized by minor violations of intellectual activity and the preservation of an understanding of its own state. The presence of the disease has practically no effect on the patient's life.
- 2. Moderate. In this case, there is a decrease in intelligence and critical awareness of the disease. Patients can hardly use household appliances, telephone and need care from other people.
- 3. Severe degree. She is characterized by an absolute disintegration of the personality. Patients need constant care, as they are unable to perform the elementary actions necessary for life.
- 1. Atrophic, or Alzheimer's. It occurs during the primary degeneration of nerve cells.
- 2. Vascular. This is a secondary lesion, which is based on the pathology of the blood vessels of the brain.
- 3. Mixed. Includes primary and secondary brain damage.
- 1. Impaired cognitive (cognitive) function. These include:
- Memory disorders. Depending on the severity, both short-term and long-term can be impaired. Confabulation often occurs - false memories. A mild degree is characterized by moderate memory impairment and is accompanied by forgetting the events of the recent past. The severe form is accompanied by the rapid loss of new information up to the loss of the names of loved ones, their names and personal disorientation.
- Attention disorder. Loss of ability to switch from one topic to another or lack of interest in what is happening.
- Disorders of higher functions:
- Aphasia is a speech disorder.
- Apraxia is the inability to perform actions to achieve a specific goal.
- Agnosia is a disorder of perception (visual, auditory, tactile) with preserved consciousness.
- 2. Violation of temporal and spatial orientation.
- 3. Disorder of behavior and personality. The transformation of character is manifested by a gradual strengthening of the traits inherent in the individual, for example, energy turns into fussiness, frugality into greed. Responsiveness is lost, selfishness, conflict, suspicion, sexual revival develops.
- 4. Thinking disorder. A distinctive feature is his inhibition, a decrease in the ability to reason logically, solve problems and generalize. Poor speech and delusional ideas often occur.
- 5. Decrease in critical attitude. This determines the patient's perception of himself and the world around him. Perhaps the emergence of anxiety-depressive disorder against the background of awareness of their own intellectual disability.
- 6. Emotional disturbance. It is distinguished by great variety and variability. Often there are:
- Depression.
- Irritability.
- Aggression.
- Anxiety.
- Tearfulness.
- Malice.
- Insensitivity to everything.
- Manic states.
- Carelessness.
- Gaiety.
- 7. Perceptual disorder. It is expressed by the appearance of visual, auditory hallucinations and illusions.
- 1. Dementia in Alzheimer's disease.
- 2. Against the background of vascular pathology.
- 3. Senile dementia with Lewy bodies.
- 4. Alcoholic dementia.
- 5. Epileptic.
- 1. Age about 80 years.
- 2. Hereditary predisposition.
- 3. Hypertension.
- 4. Excess blood lipids.
- 5. Atherosclerosis.
- 6. Diabetes mellitus.
- 7. Sedentary lifestyle.
- 8. Obesity.
- 9. Chronic hypoxia of various etiology.
- 10. Traumatic brain injury.
- 11. Low degree of education.
- 12. Lack of intellectual pursuits throughout life.
- a sharp decline in memory of recent events;
- anxiety and distraction due to awareness of their condition
- the progression of memory loss, in which only significant events are saved;
- false memories;
- the patient's loss of criticism of his condition;
- emotional and volitional disorders in the form of egocentrism, suspicion, grumpiness and conflict;
- delusion of damage - accusation of the surrounding people of theft, the desire for his death, and so on;
- sexual liberation;
- tendency to gluttony;
- vagrancy;
- fussiness
- the collapse of the delusional system;
- the disappearance of behavioral disorders;
- complete apathy;
- lack of feeling of hunger and thirst;
- movement disorders with a tendency to completely immobilize
- 1. In the early stages:
- Ginkgo biloba extract (homeopathic remedy).
- Nootropic drugs (Cerebrolysin, Piracetam).
- Medicines that improve blood circulation in the brain (Nicergoline).
- Dopamine receptor stimulants (Piribedil).
- Actovegin.
- Phosphatidylcholine.
- 2. At the advanced stage, acetylcholinesterase inhibitors (Donepezil) are recommended, which improve the social adaptation of patients.
- 1. Concentration disorders.
- 2. The complexity of switching from one subject of activity to another.
- 3. Slowing down the work of the intellect.
- 4. Difficulties in organizing life, for example, making plans.
- 5. Problems in the analysis of information.
- 6. Emotional disorders, which are expressed in frequent mood changes or a decrease in mood up to depression.
- 7. Neurological symptoms:
- Pseudobulbar syndrome, including:
- Dysarthria is a violation of articulation.
- 8. Dysphonia - a change in vocal coloration.
- 9. Dysphagia - swallowing disorder.
- 10. Unnatural laughing and crying.
- Pseudobulbar syndrome, including:
- Gait disorders.
- Decreased motor activity, characterized by poor facial expressions and gestures, slow movements.
- 1. Small fluctuations - temporary inability to concentrate and complete the task.
- 2. Large fluctuations - violation of recognition of people, location, objects. Sometimes there is disorientation in space and confusion of consciousness.
- 3. Visual illusions and hallucinations.
- 4. Disorder of behavior during sleep (sudden movements, trauma).
- Vegetative disorders:
- Orthostatic hypotension is a sharp drop in blood pressure when the body position changes from horizontal to vertical.
- Arrhythmia.
- Fainting.
- Constipation.
- Retention of urine.
- 1. Acetylcholinesterase inhibitors - Donepezil.
- 2. Atypical antipsychotics - Clozapine.
- 3. Levodopa in small doses - used for symptoms of parkinsonism.
- 1. Decreased intelligence:
- 2. Deterioration of memory.
- 2. Decreased concentration of attention.
- 3. Loss of abstract thinking and others.
- 2. Degradation of personality:
- Emotional callousness.
- 3. The destruction of social ties.
- 4. Primitive thinking.
- 5. Loss of values in life.
- 1. Inhibition of thinking.
- 2. Deterioration of memory.
- 3. Scarcity of vocabulary.
- 4. Decrease in intelligence against the background of changes in individual personality traits:
- Selfishness.
- 5. Vindictiveness.
- 6. Malice.
- 7. Bigotry.
- 8. Suspiciousness.
- 9. Quarrelsomeness.
- 10. Pedantism.
- 1. Oligophrenia.
- 2. Schizophrenia.
- 3. Other mental disorders.
- 1. Decrease in mental abilities, manifested by impaired memorization, up to the impossibility of recovering one's own name.
- 2. Loss of some information from memory.
- 3. Spatial and temporal disorientation.
- 4. Loss of previously acquired skills.
- 5. Violation of speech or its complete loss.
- 6. Sloppiness.
- 7. Uncontrolled bowel movements and urination.
- lack of thinking and criticism;
- marked impairment of memory and attention;
- emotional disturbances;
- pathology of instincts (increased or perverted attraction, excessive impulsivity, lack of fear and weakening of the instinct for self-preservation;
- inconsistency of the child's behavior with a specific situation;
- lack of affection for family people;
- absolute indifference of the child.
- 1. Memory impairment (long-term and short-term).
- 2. The presence of one of the following pathologies:
- The gradual loss of abstract thinking.
- 3. Decrease in criticism of perception.
- 4. Aphasia.
- 5. Apraxia.
- 6. Agnosia.
- 7. Changes in personality traits (aggressiveness, rudeness, lack of shame).
- 3. Social maladjustment.
- 4. Absence of hallucinations, temporal, spatial and personal disorientation - as far as the patient's condition allows at the time of diagnosis.
- 5. The presence of organic lesions based on anamnesis and instrumental diagnostics.
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Causes
The main cause of dementia is the degeneration (regeneration) of brain cells or their death.
The factors provoking the development of the disease are also:
Rarely, the causes of dementia are infectious processes:
Sometimes a number of reasons contribute to the development of the disease at once. An example is mixed senile dementia.
Alzheimer's disease - symptoms, stages, causes and treatment methods
Classification
Depending on the site of the organic lesion, several types of dementia are distinguished:
Classification of the main forms of dementia:
| The form | Signs |
| Lacunar. This form of pathology is characterized by damage to the brain structures responsible for intelligence, as well as a slight violation of the emotional sphere. In this case, the patient is aware of his condition. It is inherent in the early stages of Alzheimer's disease. | |
| Total. It is characterized by a complete disintegration of the personality. The cause is damage to the frontal lobes of the brain, which lead to vascular and atrophic diseases, as well as tumors |
Depending on the severity, dementia is distinguished:
Common types of dementia of the elderly (presenile) and senile (senile) age:
Age has a huge impact on the onset of dementia. In the mature period, the incidence is no more than 1%, and after 80 years this figure reaches 20%.
General symptoms
The most common signs of dementia are cognitive impairment and emotional and behavioral disorders. Pathology develops gradually and reveals itself with an exacerbation of the underlying disease or when the situation changes.
The main signs of dementia are:
Clinical varieties
The manifestations and treatment of dementia can vary. It depends on the type of pathology.
Distinguish:
Dementia in Alzheimer's Disease
Alzheimer's dementia is a common type of senile dementia. It accounts for 35-60% of actual organic lesions. In this case, the disease occurs more often in women than in men.
Alzheimer's type dementia predisposing factors:
The signs of dementia differ depending on the stage of the disease:
| Stage | Symptoms |
| Initial (first signs) | |
| Deployed | |
| Heavy |
Diagnosis of this type of dementia is based on the clinical picture and suggests differentiation with vascular dementia. Often this can only be done after the death of the patient.
Treatment involves controlling symptoms and stabilizing the patient's condition. This is a complex process that includes mandatory therapy for the underlying disease. Depending on the stage of the pathology, various drugs are used:
Alzheimer's type dementia is a steadily progressive disease. The result is severe disability and death of the patient. On average, the disease develops over 10 years. The rate of progression of the pathology depends on the age at which it appeared - the less it is, the faster the disease intensifies.
Vascular dementia
Dementia of a vascular nature is in second place after dementia of the Alzheimer's type. It accounts for about 20% of all types of pathology.
Common Causes and Risk Factors for Vascular Dementia:
The clinical picture of dementia of a vascular nature includes:
Treatment for vascular dementia is aimed at restoring blood circulation to the brain. Pathogenetic therapy with Actovegin, Piracetam, Donepezil, Cerebrolysin is also recommended.
A separate place is occupied by dementia, which developed against the background of hemorrhagic and ischemic stroke. They are characterized by significant death of brain cells and pronounced focal symptoms, depending on the location of the lesion site. Post-stroke dementia is distinguished by a variety of clinical conditions and depends on the degree of damage to the vessel, the compensatory capabilities of the body, the area of blood supply to the brain, the quality and timeliness of medical care.
Senile dementia with Lewy bodies
Senile dementia (senile dementia) with Lewy bodies is an atrophic-degenerative process, a distinctive feature of which is the accumulation in the cerebral cortex and its subcortical structures of specific intracellular formations - Lewy bodies.
The causes and mechanism of the development of pathology are not fully known. It is inherited. This disease accounts for about 15–20% of all senile dementia. Very often, patients are mistakenly diagnosed with vascular dementia or Parkinson's disease.
Lewy body dementia symptoms:
Features of the symptomatology:
Lewy body treatments for senile dementia include:
Lewy body dementia - a rapidly progressive disease. Its development takes about 4–5 years.
Alcoholic dementia
It develops with prolonged exposure to alcohol on the brain. Sometimes the disease is preceded by more than 20 years of alcoholism.
The causes of organic pathology are also the indirect effects of endotoxins, liver damage, vascular disease, and others. Usually, all people suffering from the last stage of alcoholism develop atrophic processes in the brain.
Clinic of mental disorders in this type of dementia:
The prognosis is favorable. With a complete rejection of alcohol consumption during the year, dementia regresses and organic brain damage is smoothed out.
Epileptic dementia
This type of dementia develops against the background of a severe course of the underlying disease. It is also affected by prolonged use of antiepileptic drugs, trauma during seizures, hypoxia, and so on.
Symptoms of epileptic dementia:
Epileptic dementia is an invariably progressive disease. With a severe course, malice disappears, but obsequiousness and hypocrisy remain, and apathy and indifference to everything also arise.
Childhood Dementia Symptoms
Mostly dementia occurs in adults. In children, it acts as a symptom of certain pathologies:
Signs of dementia are:
Persistent intellectual disability that occurs in a child over the age of 2-3 years against the background of an injury or infection is considered organic dementia with its characteristic symptoms:
Diagnostics
The clear criteria for diagnosing dementia are:
For an accurate definition of the disease, the presence of all signs is necessary for six months. Otherwise, a conjectural conclusion is made.
Differential diagnosis is carried out in relation to depressive pseudodementia. This is a complex process that requires long-term observation of the patient.
Treatment
There is currently no effective treatment for dementia, especially senile dementia. The main therapy is aimed at caring for the patient, relieving symptoms, eliminating concomitant pathologies and adhering to the daily regimen with maximum activity.
Psychotropic drugs are prescribed only for insomnia and hallucinations. Their use is limited to nootropics and tranquilizers.
Forecast
The clinical picture and prognosis of dementia depend on the underlying cause contributing to the onset of organic damage to the central nervous system.
A relatively favorable outcome is observed if the underlying disease is not prone to development. In this case, with proper treatment, a significant improvement in the patient's condition is possible.
With common types of dementia (vascular and Alzheimer's type), there is a tendency to progress. Treatment can only slow down the process of personal and social maladjustment, prolong the patient's life, and relieve unpleasant symptoms.
In the case of a rapidly progressive underlying disease, an extremely poor prognosis is noted. The death of a patient occurs within several years or months after the first symptoms of pathology appear. The cause of death is concomitant diseases that develop as a result of a violation of the central regulation of organs and systems.
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