The nature of agnosia in organic dementia is determined. Organic Dementia - Signs and Treatment. What is mixed dementia? Does it always lead to disability? How to treat mixed dementia

Senile dementia is a common disease.

It is characterized by the collapse of personality and leads to complete maladjustment of the patient.

Changes in the brain are organic in nature and therefore irreversible. Accepted by doctors various classifications illness.

Dementia is an organic lesion of the brain (organic dementia), leading to the loss of all previously acquired skills, knowledge, abilities and the inability to acquire new ones.

According to ICD 10, the disease is coded F00-F03.

The classification of pathology is based on the following characteristics:

cause of occurrence;
localization of the lesion;
nature of manifestations.

Functional and anatomical forms

Depending on which part of the brain the changes occur, there are several types of dementia. Dementia is divided into:

According to the degree of intellectual impairment, the following types of senile insanity are distinguished:

Lacunar dementia. Changes occur in memory and attention. A patient with lacunar dementia often gets tired and cannot concentrate on anything. But criticism of one’s actions remains.
The disease is a consequence of atherosclerosis (atherosclerotic dementia), cerebellar tumors, and the initial stage of Alzheimer's disease.
Partial dementia. Shallow changes occur due to contusion, encephalitis, meningitis. A person is aware of his condition and tries to compensate for shortcomings.
Total dementia (diffuse, global). Total dementia develops in the late stages of Alzheimer's disease, Pick's disease, and brain tumors.

The patient experiences a complete breakdown of personality, loss of all skills, and lacks a critical attitude towards himself.

Etiopathogenetic varieties

Dementia occurs for many reasons. Depending on the condition that caused the collapse of the personality, dementia is divided into the following types:

Vascular. (F01). Develops secondarily as a complication of the disorder cerebral circulation. The main provoking factors are atherosclerosis and hypertension, which cause minor cerebral hemorrhage.
The first symptoms are nervous and mental disorders (depression), then memory and thinking deteriorate.

Alzheimer's type dementia. (G30-39). With this disease, the death of brain neurons occurs, and the cerebral cortex atrophies.
The first sign of the disease is memory impairment. As it progresses, complete maladjustment of the patient develops.
Idiopathic dementia (dementia unspecified type). (G30.9). The causes have not been established. The symptoms are no different from the Alzheimer's type: memory impairment, movement, loss of all cognitive functions.
Presenile dementia. It is a variant of Alzheimer's dementia. Develops in the 5th year of illness. The main symptom is speech impairment. The patient confuses the names of objects, his speech is meaningless.
Pick's disease. (G31.0). With this disease, the frontotemporal cerebral lobes, which are responsible for human behavior and self-control, atrophy. At the initial stage, memory remains unchanged, but behavioral skills are lost, speech and thinking are impaired.
Consequence of Parkinson's disease. (G20). Characterized by impaired movement and loss of coordination. In later stages, the ability to walk and perform simple physical activities is lost.
. Occurs due to the destructive effects of large doses of alcohol. Violations occur in the departments responsible for memory, thinking, perception, and coordination of movement. At a later stage, the personality completely degrades.
Traumatic dementia. Development depends on repeated trauma. With a single injury it does not progress.
Another type of traumatic dementia is boxer's dementia. It occurs as a result of repeated traumatic brain injuries, leading to atrophy of brain cells.

Symptoms depend on the location of the lesion. Speech disturbances, decreased intelligence, and mental disorders are observed.
Toxic (drug-induced) dementia. Arises due to long-term use medications in large doses. Drugs such as blood pressure lowerers, antidepressants, antipsychotics, and heart medications can provoke disorders in the brain. This species has a reversible course.
(a consequence of epilepsy). However, the cause is not the disease itself, but injuries from falls, brain hypoxia, and treatment with phenobarbital. The emotional-volitional sphere is affected. The patient becomes aggressive, vindictive, perception and thinking are disrupted.

Dementia resulting from multiple sclerosis. In multiple sclerosis, the myelin sheath of the nerves is destroyed.
If the disease is not treated, at a later stage the changes will affect the brain. Memory, thinking, and self-criticism suffer.
Dementia due to mixed diseases. It is a consequence of a combination of diseases that provoke the destruction of neurons.
For example, a patient may have epilepsy and schizophrenia, Alzheimer's disease and multiple sclerosis. In this case, all the signs inherent in existing diseases are present.
. Develops against the background of schizophrenia. Characterized by a psychopathic course. Depression and manic pursuit begin, then orientation in space and coordination of movement are lost.
The peculiarity of this type is that the symptoms can weaken, sometimes disappear completely, then return with renewed vigor.
Hypothermic. Some doctors classify this type of dementia as a separate group. Considered a consequence metabolic disorders in the vessels of the brain, which arise under the influence of high or low temperatures(long stay in the cold).
Senile(). It is the result of natural aging of the body. Neuron death occurs due to hormonal imbalance, the volume and weight of the brain decreases. Diagnosed at a late age.

Other types of disease and their brief characteristics

In medicine, there are types of dementia that are not so widespread. According to the ICD, this type of disease is designated by code F02.8.

Each type of senile insanity is characterized by its own cognitive impairment. Only in some cases is there a combination of multiple symptoms. The doctor's task is to determine the source of progressive dementia.

Therapy is prescribed in accordance with the disease that triggered the process of brain cell degradation. The classification of the disease is adopted to identify the root cause of the pathology and prescribe adequate treatment.

– acquired dementia caused by organic brain damage. It may be a consequence of one disease or be of a polyetiological nature (senile or senile dementia). Develops with vascular diseases, Alzheimer's disease, trauma, brain tumors, alcoholism, drug addiction, central nervous system infections and some other diseases. Persistent intellectual disorders, affective disorders and decreased volitional qualities are observed. The diagnosis is established based on clinical criteria and instrumental studies (CT, MRI of the brain). Treatment is carried out taking into account the etiological form of dementia.

General information

Dementia is a persistent disorder of higher nervous activity, accompanied by a loss of acquired knowledge and skills and a decrease in learning ability. There are currently more than 35 million people suffering from dementia worldwide. The prevalence of the disease increases with age. According to statistics, severe dementia is detected in 5%, mild – in 16% of people over 65 years of age. Doctors assume that the number of patients will increase in the future. This is due to an increase in life expectancy and an improvement in the quality of medical care, which makes it possible to prevent death even in cases of severe injuries and diseases of the brain.

In most cases, acquired dementia is irreversible, so the most important task of doctors is timely diagnosis and treatment of diseases that can cause dementia, as well as stabilization pathological process in patients with existing acquired dementia. Treatment of dementia is carried out by specialists in the field of psychiatry in collaboration with neurologists, cardiologists and doctors of other specialties.

Causes of dementia

Dementia occurs when there is organic damage to the brain as a result of injury or disease. Currently, there are more than 200 pathological conditions that can provoke the development of dementia. The most common cause of acquired dementia is Alzheimer's disease, accounting for 60-70% of total number cases of dementia. In second place (about 20%) are vascular dementias caused by hypertension, atherosclerosis and other similar diseases. In patients suffering from senile dementia, several diseases that provoke acquired dementia are often detected at once.

In young and middle age, dementia can occur with alcoholism, drug addiction, traumatic brain injury, benign or malignant neoplasms. In some patients, acquired dementia is detected due to infectious diseases: AIDS, neurosyphilis, chronic meningitis or viral encephalitis. Sometimes dementia develops due to severe diseases of the internal organs, endocrine pathology and autoimmune diseases.

Classification of dementia

Taking into account the predominant damage to certain areas of the brain, four types of dementia are distinguished:

Cortical dementia. The cerebral cortex is predominantly affected. It is observed in alcoholism, Alzheimer's disease and Pick's disease (frontotemporal dementia).
Subcortical dementia. Subcortical structures suffer. Accompanied by neurological disorders (trembling limbs, muscle stiffness, gait disorders, etc.). Occurs in Parkinson's disease, Huntington's disease and white matter hemorrhages.
Cortical-subcortical dementia. Both the cortex and subcortical structures are affected. Observed in vascular pathology.
Multifocal dementia. Multiple areas of necrosis and degeneration form in various parts of the central nervous system. Neurological disorders are very diverse and depend on the location of the lesions.

Depending on the extent of the lesion, two forms of dementia are distinguished: total and lacunar. In lacunar dementia, the structures responsible for certain types intellectual activity. Short-term memory disorders usually play a leading role in the clinical picture. Patients forget where they are, what they planned to do, what they agreed on just a few minutes ago. Criticism of one’s condition is preserved, emotional and volitional disturbances are weakly expressed. Signs of asthenia may be detected: tearfulness, emotional instability. Lacunar dementia is observed in many diseases, including in the early stages of Alzheimer's disease.

With total dementia, there is a gradual disintegration of the personality. Intelligence decreases, learning abilities are lost, and the emotional-volitional sphere suffers. The circle of interests narrows, shame disappears, and previous moral and moral norms become insignificant. Total dementia develops with space-occupying formations and circulatory disorders in the frontal lobes.

The high prevalence of dementia in the elderly led to the creation of a classification of senile dementias:

Atrophic (Alzheimer's) type– provoked by primary degeneration of brain neurons.
Vascular type– defeat nerve cells occurs secondarily due to impaired blood supply to the brain due to vascular pathology.
Mixed type– mixed dementia - is a combination of atrophic and vascular dementia.

Symptoms of dementia

The clinical manifestations of dementia are determined by the cause of acquired dementia and the size and location of the affected area. Taking into account the severity of symptoms and the patient’s ability to socially adapt, three stages of dementia are distinguished. For dementia mild degree the patient remains critical of what is happening and of his own condition. He retains the ability to self-service (can do laundry, cook, clean, wash dishes).

With moderate dementia, criticism of one's condition is partially impaired. When communicating with the patient, a clear decrease in intelligence is noticeable. The patient has difficulty caring for himself, has difficulty using household appliances and mechanisms: cannot answer the phone call, open or close the door. Care and supervision required. Severe dementia is accompanied by a complete collapse of personality. The patient cannot dress, wash, eat, or go to the toilet. Constant monitoring is required.

Clinical variants of dementia

Alzheimer's type dementia

Alzheimer's disease was described in 1906 by the German psychiatrist Alois Alzheimer. Until 1977, this diagnosis was made only in cases of dementia praecox (aged 45-65 years), and when symptoms appeared after the age of 65 years, senile dementia was diagnosed. It was then found that the pathogenesis and clinical manifestations of the disease are the same regardless of age. Currently, the diagnosis of Alzheimer's disease is made regardless of the time of appearance of the first clinical signs of acquired dementia. Risk factors include age, the presence of relatives suffering from this disease, atherosclerosis, hypertension, excess weight, diabetes mellitus, low motor activity, chronic hypoxia, traumatic brain injury and lack of mental activity throughout life. Women get sick more often than men.

The first symptom is a pronounced impairment of short-term memory while maintaining criticism of one’s own condition. Subsequently, memory disorders worsen, and a “movement back in time” is observed - the patient first forgets recent events, then what happened in the past. The patient ceases to recognize his children, mistakes them for long-dead relatives, does not know what he did this morning, but can talk in detail about the events of his childhood, as if they had happened quite recently. Confabulations may occur in place of lost memories. Criticism of one's condition decreases.

In the advanced stage of Alzheimer's disease, the clinical picture is complemented by emotional and volitional disorders. Patients become grouchy and quarrelsome, often demonstrate dissatisfaction with the words and actions of others, and become irritated by every little thing. Subsequently, delirium of damage may occur. Patients claim that loved ones deliberately leave them in dangerous situations, they add poison to food in order to poison them and take over the apartment, they say nasty things about them in order to ruin their reputation and leave them without public protection, etc. Not only family members are involved in the delusional system, but also neighbors, social workers and other people interacting with the sick. Other behavioral disorders may also be detected: vagrancy, intemperance and indiscriminateness in food and sex, senseless disorderly actions (for example, shifting objects from place to place). Speech becomes simplified and impoverished, paraphasia occurs (the use of other words instead of forgotten ones).

At the final stage of Alzheimer's disease, delusions and behavioral disorders are leveled out due to a pronounced decrease in intelligence. Patients become passive and inactive. The need to take fluids and food disappears. Speech is almost completely lost. As the disease worsens, the ability to chew food and walk independently is gradually lost. Due to complete helplessness, patients require constant professional care. Death occurs as a result of typical complications (pneumonia, bedsores, etc.) or the progression of concomitant somatic pathology.

The diagnosis of Alzheimer's disease is made based on clinical symptoms. Treatment is symptomatic. There are currently no drugs or non-drug treatments that can cure patients with Alzheimer's disease. Dementia progresses steadily and ends in complete collapse mental functions. The average life expectancy after diagnosis is less than 7 years. The earlier the first symptoms appear, the faster the dementia worsens.

Vascular dementia

There are two types of vascular dementia - those that arose after a stroke and those that developed as a result of chronic insufficiency of blood supply to the brain. In post-stroke acquired dementia, the clinical picture is usually dominated by focal disorders (speech disorders, paresis and paralysis). The nature of neurological disorders depends on the location and size of the hemorrhage or area with impaired blood supply, the quality of treatment in the first hours after a stroke and some other factors. In chronic circulatory disorders, symptoms of dementia predominate, and neurological symptoms are quite monotonous and less pronounced.

Most often, vascular dementia occurs with atherosclerosis and hypertension, less often with severe diabetes mellitus and some rheumatic diseases, even less often - with embolism and thrombosis due to skeletal injuries, increased blood clotting and diseases of peripheral veins. The likelihood of developing acquired dementia increases with diseases of the cardiovascular system, smoking and excess weight.

The first sign of the disease is difficulty trying to concentrate, absentmindedness, fast fatiguability, some mental rigidity, difficulty planning and decreased ability to analyze. Memory disorders are less severe than in Alzheimer's disease. Some forgetfulness is noted, but when given a “push” in the form of a leading question or offered several answer options, the patient easily recalls the necessary information. Many patients exhibit emotional instability, low mood, depression and subdepression are possible.

Neurological disorders include dysarthria, dysphonia, gait changes (shuffling, decreased step length, “sticking” of the soles to the surface), slowing of movements, impoverishment of gestures and facial expressions. The diagnosis is made based on clinical picture, USDG and MRA of cerebral vessels and other studies. To assess the severity of the underlying pathology and draw up a diagram pathogenetic therapy patients are referred for consultations to appropriate specialists: therapist, endocrinologist, cardiologist, phlebologist. Treatment - symptomatic therapy, therapy of the underlying disease. The rate of development of dementia is determined by the characteristics of the leading pathology.

Alcoholic dementia

The cause of alcoholic dementia is long-term (over 15 years or more) abuse of alcoholic beverages. Along with the direct destructive effect of alcohol on brain cells, the development of dementia is caused by impaired activity various organs and systems, gross metabolic disorders and vascular pathology. Alcoholic dementia is characterized by typical personality changes (coarsening, loss of moral values, social degradation) combined with a total decrease in mental abilities (distracted attention, decreased ability to analyze, plan and abstract thinking, memory disorders).

After complete refusal Partial recovery from alcohol and alcoholism treatment is possible, however, such cases are very rare. Due to a pronounced pathological craving for alcoholic beverages, decreased volitional qualities and lack of motivation, most patients are unable to stop taking ethanol-containing liquids. The prognosis is unfavorable; the cause of death is usually somatic diseases caused by alcohol consumption. Often such patients die as a result of criminal incidents or accidents.

Diagnosis of dementia

The diagnosis of dementia is made if five mandatory signs are present. The first is memory impairment, which is identified based on a conversation with the patient, special research and interviewing relatives. The second is at least one symptom indicating organic brain damage. These symptoms include the “three A” syndrome: aphasia (speech disorders), apraxia (loss of the ability to perform purposeful actions while maintaining the ability to perform elementary motor acts), agnosia (perceptual disorders, loss of the ability to recognize words, people and objects while maintaining the sense of touch , hearing and vision); reducing criticism of one’s own condition and the surrounding reality; personality disorders (unreasonable aggressiveness, rudeness, lack of shame).

The third diagnostic sign of dementia is a violation of family and social adaptation. The fourth is the absence of symptoms characteristic of delirium (loss of orientation in place and time, visual hallucinations and delirium). Fifth – the presence of an organic defect, confirmed by instrumental studies (CT and MRI of the brain). A diagnosis of dementia is made only if all of the above symptoms are present for six months or more.

Dementia most often has to be differentiated from depressive pseudodementia and functional pseudodementia resulting from vitamin deficiency. If you suspect depressive disorder the psychiatrist takes into account the severity and nature of affective disorders, the presence or absence of daily mood swings and the feeling of “painful insensibility”. If vitamin deficiency is suspected, the doctor examines the medical history (malnutrition, severe intestinal damage with prolonged diarrhea) and excludes symptoms characteristic of a deficiency of certain vitamins (anemia due to deficiency folic acid, polyneuritis due to a lack of thiamine, etc.).

Prognosis for dementia

The prognosis for dementia is determined by the underlying disease. In cases of acquired dementia resulting from traumatic brain injury or volumetric processes(, hematoma), the process does not progress. Often there is a partial, less often a complete reduction of symptoms due to the compensatory capabilities of the brain. In the acute period, it is very difficult to predict the degree of recovery; the outcome of extensive damage can be good compensation with preservation of ability to work, and the outcome of minor damage can be severe dementia leading to disability and vice versa.

In dementia caused by progressive diseases, there is a steady worsening of symptoms. Doctors can only slow down the process by providing adequate treatment of the underlying pathology. The main goals of therapy in such cases are maintaining self-care skills and adaptability, prolonging life, providing proper care and eliminating unpleasant manifestations of the disease. Death occurs as a result of a serious violation vital functions associated with the patient’s immobility, his inability to perform basic self-care and the development of complications characteristic of bedridden patients.

Alzheimer's disease(dementia of the Alzheimer's type) is the cause of almost half of cases of dementia.

Alzheimer's disease is a neurodegenerative disease based on the progressive death of neurons, primarily the hippocampus and temporoparietal cortex. The leading role in the pathogenesis of memory impairment and other higher mental functions in Alzheimer's disease is given to changes in neurotransmitter systems, especially acetylcholinergic.

Clinical picture (symptoms and course) is characterized by a gradual onset over the age of 40-50 years (usually after 65 years), the predominance of progressive forgetfulness in the early stages of the disease, followed by the addition of aphasia, apraxia and agnosia, acalculia, and the absence of focal neurological symptoms. Speech impairment is characterized by acoustic-mnestic aphasia with difficulties in selecting words and inaccurate word use (paraphasia), but intact repetition. Visual-spatial agnosia is manifested by a violation of the ability to draw or copy a picture, a disorder of spatial orientation. At the same time, behavioral stereotypes and motor functions at the early stage of the disease remain relatively intact. Actually focal neurological symptoms up to late stages the disease is quite sparse - patients may exhibit positive axial reflexes and extrapyramidal disorders. The course of the disease may be complicated by the occurrence of emotional, affective and other mental disorders.

Clinical manifestations of Alzheimer's disease conditionally divided into three stages.

Stage 1 Alzheimer's disease(initial) manifests itself as an isolated deterioration of RAM or memory for current events, names, prices, names of objects, etc.

There is a narrowing of the range of interests, slowing down of thinking, lack of initiative, absent-mindedness, and inattention. A feature of this stage is the absence of complaints about memory impairment due to impaired adequate self-esteem. In 50% of all cases, low mood (depression) or emotional instability is observed. Household and professional skills are often preserved at this stage of the disease.

Stage 2 Alzheimer's disease(developed) is manifested by the ongoing deterioration of short-term memory, which leads to difficulties in everyday and work activities due to the addition of the following disorders:

speech becomes poor, difficulties arise in selecting individual words;
violation of purposeful activity (praxis) consists of difficulties in choosing and putting on clothes, performing hygiene procedures(brushing teeth, shaving), handling correspondence, using household equipment; interest in hobbies disappears, orientation in unfamiliar surroundings becomes difficult, and the ability to drive vehicles is lost;
violations of optical-spatial activity: it becomes impossible to draw any elementary object (cube, pillar, clock dial);
thinking disorder (impossibility of generalizing several words, interpreting proverbs, sayings);
violation of voluntary attention and calculation;
affective disorders (delusions, especially delusions of jealousy, hallucinations, anxiety, fear).

Stage 3 Alzheimer's disease(final) occurs 5-10 years after the onset of the disease, when any forms become impossible mental activity, the ability to self-care is lost, speech remains at the level of verbal emboli.

At this stage, weight loss, increased muscle tone in the limbs, walking disorder, epileptic seizures.

An early sign of Alzheimer's disease may be atrophy of the medial parts of the temporal lobes, primarily the hippocampus according to CT or MRI (single small vascular lesions in the periventricular region and projections of the subcortical nodes or limited periventricular leukoaraiosis do not exclude the diagnosis).

MRI parameters characteristic of changes in Alzheimer's disease:

Increase (compared to the age norm) of the interhook distance.
Widening of the perihippocampal fissures.
Reduction in hippocampal volume.

There may be no changes on MRI. Reduced perfusion of the temporoparietal region, detected with single-photon emission computed tomography, can confirm the clinical diagnosis of Alzheimer's disease, and hypoperfusion of the medial temporal lobe may be the earliest manifestation of Alzheimer's disease.

The value of single-photon emission computed tomography in differentiating Alzheimer's disease from vascular dementia is limited. In patients with illness. Alzheimer's computed tomography, and especially magnetic resonance imaging, can reveal abnormalities in the white matter or basal ganglia that give rise to Additional information about concomitant vascular damage that can affect the course of the disease.

Kushnir G.M. - Doctor of Medical Sciences, Professor, Savchuk E.A. - Ph.D., Samokhvalova V.V. - Ph.D.

“Degenerative dementia, Alzheimer’s disease as a cause of dementia, manifestations, stages”- article from the section

The term “dementia” in medicine usually refers to acquired dementia, characterized by a violation of the basic mental functions of a person: thinking, intelligence, attention, memory and others. The disease usually progresses slowly, but in some cases it occurs very quickly. The rapid development of pathology is observed, as a rule, with traumatic brain injury or intoxication, in which brain cells die in a short period of time.

With dementia, a person loses the ability to understand the world, loses previously acquired skills, does not show emotions, forgets events that happened recently, while the patient is not aware of what is happening to him. Violations are usually so severe that a person cannot carry out his or her professional activity and experiences serious difficulties in everyday life. Many people whose relatives have encountered this pathology wonder how many years patients with dementia live. It is very difficult to give a definite answer, as everything depends on many factors. If a person receives the necessary care and supportive treatment, they can live for many years. You should also take into account how quickly dementia develops and what causes it was caused.

According to statistics, dementia is most often diagnosed in older people over the age of sixty. In patients over eighty years of age, the disease is diagnosed in approximately 80% of cases.

Causes of the disease

Dementia develops due to severe damage to the central nervous system organic character, therefore, the triggering moment for its beginning can be any pathological conditions, leading to degenerative changes and death of cellular structures of the cerebral cortex. Considering the most likely reasons for this, it is necessary to first identify those specific types of acquired dementia in which destruction of the cerebral cortex acts as an independent mechanism of pathology. In this case we are talking about Alzheimer's disease, Pick's disease, etc. Such pathologies are most often diagnosed in patients over the age of sixty-five years.

In other cases, dementia occurs due to secondary damage to the human brain. Often this pathology acts as a complication of injury, infectious lesions, vascular diseases that occur in a chronic form, and exposure to various toxic substances. Most often, secondary organic brain damage occurs due to vascular pathologies, such as atherosclerosis, hypertension, etc.

It is possible that dementia can develop due to alcohol and drug abuse and tumor growths in the brain. Quite rarely, the development of the disease is facilitated by infections: meningitis, viral encephalitis, AIDS, neurosyphilis and others.

It is extremely difficult to say how many reasons there are that contribute to one degree or another to the development of acquired dementia. In some cases, dementia becomes a complication of hemodialysis, severe hepatic or renal failure, certain endocrinological and autoimmune diseases. In most cases, the disease occurs due to the influence of several provoking factors at once. A typical example A similar disorder may be the so-called senile (senile) dementia.

It is worth noting that the risk of developing acquired dementia increases with age. If we rely on medical statistics, then among people under sixty years of age the percentage of patients with dementia is extremely small, while among older people over seventy to eighty years of age this figure reaches 75-80%.

Classification

In modern clinical practice, dementia is divided into the following functional and anatomical forms:

Dementia can occur in lacunar or total form. In the first case, the patient experiences localized lesions of those structures that are responsible for the function of the intellect. In this case, it is usually observed serious violations short-term memory, minor asthenic manifestations may also occur.

If there is complete destruction of the core of the personality, we are talking about total dementia. Such patients experience not only deterioration of memory and intelligence, but also serious disorders of the emotional-volitional sphere. If the disease develops over several years, the patient may completely lose his previously characteristic interests and spiritual values. The person becomes completely socially maladapted.

Type of dementia	Examples
Cortical (primary neurodegenerative)	Alzheimer's disease, dementia with an Altheimer's component, frontotemporal acquired dementia
Vascular	Multifactorial dementia, lacunar disease
Dementia caused by intoxication	Dementia associated with alcohol or chemical intoxication
Dementia due to infection	Dementia associated with fungal or viral infection, as well as spirochete infection (HIV, syphilis, etc.)
Associated with Lewy bodies	Progressive paralysis, diffuse Lewy body disease, Parkinson's disease, corticobasal degeneration
Dementia due to structural damage to the brain	Hydrocephalus, brain tumors, chronic subdural hematoma
Dementia associated with prion contamination	Creutzfeldt-Jakob disease

Clinical picture

Depending on the stage of dementia, symptoms can be quite variable. This disease is characterized by a violation of all human cognitive functions. Behavioral and personality disorders can develop at any stage of the disease, as well as motor dysfunctions and other deficit syndromes.

Vascular dementia is usually characterized by the most rapid development, while, for example, in Alzheimer's disease, the pathology progresses at a slow pace. As temporary clinical manifestations, many patients experience various psychoses, characterized by manic, depressive, and paranoid states.

Early stage dementia may present with memory impairment. The patient is unable to remember and understand new information, and speech disorders may occur due to difficulties in finding words. Personality disorders and mood swings are also quite common early in the development of acquired dementia. Quite often, patients experience progressive difficulties in performing usual daily activities. It becomes difficult for them to find their way home, remember where they live, etc. Loss of independence often leads to outbursts of aggression and depressive disorders.

Other symptoms that characterize incipient dementia include apraxia, agnosia, and aphasia. Often, early signs of the disease are noticed by loved ones of a sick person, complaining about his strange behavior and emotional instability.

At the intermediate stage of development of the pathology, patients are almost completely deprived of the ability to learn. Their memory does not disappear completely, but it is significantly reduced, especially for those events that happened relatively long ago, for example, a couple of years ago. It becomes increasingly difficult for patients to take care of themselves: dressing, washing, etc. At the same time, personal changes also progress: irritability appears, sometimes accompanied by outbursts of aggression, or complete passivity occurs with a lack of emotional manifestations and signs of depression.

Dementia at this stage of its development often leads to the patient losing an adequate sense of space and time. A person finds it difficult to answer basic questions, for example, how old is he, can get lost in his own apartment, and confuse day with night. Such disorders can eventually transform into psychosis, accompanied by hallucinations, mania and depression.

In the severe stage of the disease, patients lose the ability to move independently. Often the disease at this stage is accompanied by urinary incontinence and a complete lack of memory. The patient may forget how to eat and drink independently. These patients are at very high risk of developing bedsores and pneumonia. Patients are often placed in specialized medical facilities to ensure proper care.

Diagnostics

In case of cognitive impairment and suspicion of dementia, a comprehensive examination of the patient is necessary. As a rule, at the very beginning of the development of the disease, few people pay attention to minor changes, and therefore dementia is often diagnosed at a fairly advanced stage. Relatives need to be careful and consult a doctor if close person for some reason he began to confuse words, forget recent events, became uncommunicative and irritable.

To identify the disease, specialists use special psychometric tests. An examination by a neurologist and an ophthalmologist is required. In order to exclude infectious and metabolic diseases, a number of laboratory tests are prescribed. This usually includes a blood test for sugar levels, hormonal analysis of blood serum and other studies.

Neurological examination of patients with dementia reveals slowing of psychomotor functions. The patient may expend a lot of effort, but not give correct answers. As one of the most informative tests for identifying acquired dementia, doctors often ask patients to evaluate their short-term memory. If you put three or four objects in front of the patient, and then remove them and ask them to name them after a few minutes, the person with dementia will not be able to do this.

In addition to identifying a memory disorder, when diagnosing acquired dementia, it is necessary to confirm the presence of aphasia, agnosia, apraxia and other characteristic signs of the disease in the patient. In addition to this, the patient's mental status is assessed.

Electrocardiography, vascular Dopplerography, magnetic resonance and computed tomography are required. Vascular dementia and Alzheimer's disease are detected using the Khachinsky ischemic scale. The verdict about the disease and its stage is made based on the patient’s score.

Differential diagnosis

In clinical practice, organic dementia must be differentiated from so-called depressive pseudodementia during the examination of the patient. Often severe depression accompanied by severe intellectual impairment, which can be taken as signs of dementia. Severe psychological trauma and stress can also cause pseudodementia as a kind of defensive reaction.

In some cases, intellectual impairment occurs due to metabolic disorders, for example, a lack of vitamin B12, folic acid or other substances necessary for the human body. In such cases, all symptoms of dementia disappear after proper correction of the disorders.

It is important to emphasize that differentiating pseudodementia from organic dementia can be very difficult even for experienced specialists. Most often, making a correct diagnosis is only possible with constant and long-term monitoring of the patient’s condition. In addition, dementia must be differentiated from memory impairment, which is often found in older people, and cognitive disorders that occur against the background of depression.

Unfortunately, with organic dementia, treatment can almost always only be supportive. Therapy is prescribed to compensate for deficits in cognitive functions and improve cerebral circulation. To do this, the doctor prescribes the appropriate medications, individually setting their dosage for each specific patient. Speaking about how long such treatment should last, it should be emphasized that maintenance therapy is necessary throughout life. Can be prescribed as symptomatic treatment sedatives and antidepressants. It is worth noting that dementia occurring against the background of depression does not disappear even when the latter is eliminated.

Dementia defines an acquired form of dementia, in which patients experience a loss of previously acquired practical skills and acquired knowledge (which can occur to varying degrees of intensity of manifestation), while at the same time a persistent decrease in their cognitive activity. Dementia, the symptoms of which, in other words, manifest themselves in the form of a breakdown of mental functions, is most often diagnosed in old age, but the possibility of its development at a young age cannot be ruled out.

general description

Dementia develops as a result of brain damage, against which a marked decline in mental functions occurs, which generally makes it possible to distinguish this disease from mental retardation, congenital or acquired forms of dementia. Mental retardation (also known as oligophrenia or dementia) implies a stop in personality development, which also occurs with brain damage as a result of certain pathologies, but predominantly manifests itself in the form of damage to the mind, which corresponds to its name. At the same time, mental retardation differs from dementia in that with it the intelligence of a person, physically adult, is up to normal indicators, corresponding to his age, never arrives. In addition, mental retardation is not a progressive process, but is the result of a disease suffered by a sick person. However, in both cases, both when considering dementia and when considering mental retardation, there is the development of a disorder of motor skills, speech and emotions.

As we have already noted, dementia overwhelmingly affects people in old age, which determines its type as senile dementia (this pathology is usually defined as senile insanity). However, dementia also appears in youth, often as a result of addictive behavior. Addiction means nothing more than addictions or addictions - a pathological attraction in which there is a need to perform certain actions. Any type of pathological attraction increases the risk of a person developing mental illness, and often this attraction is directly related to social problems or personal problems that exist for him.

Addiction is often used in connection with such phenomena as drug addiction and drug dependence, but more recently another type of addiction has been defined for it - non-chemical addictions. Non-chemical addictions, in turn, define psychological addiction, which itself acts as an ambiguous term in psychology. The fact is that predominantly in the psychological literature this kind of dependence is considered in a single form - in the form of dependence on narcotic substances (or intoxicants).

However, if we consider this type of addiction at a deeper level, this phenomenon also arises in the everyday mental activity that a person encounters (hobbies, interests), which, thereby, defines the subject of this activity as an intoxicating substance, as a result of which he, in in turn, is considered as a substitute source that causes certain missing emotions. These include shopaholism, Internet addiction, fanaticism, psychogenic overeating, gambling addiction, etc. At the same time, addiction is also considered as a method of adaptation, through which a person adapts to conditions that are difficult for himself. The elementary agents of addiction are drugs, alcohol, and cigarettes, which create an imaginary and short-term atmosphere of “pleasant” conditions. A similar effect is achieved when performing relaxation exercises, while resting, as well as through actions and things that bring short-term joy. In any of these options, after their completion, a person has to return to reality and conditions from which he managed to “escape” in such ways, as a result of which addictive behavior is considered as a rather complex problem of internal conflict, based on the need to escape from specific conditions, against the background of which and there is a risk of developing mental illness.

Returning to dementia, we can highlight the current data provided by WHO, based on which it is known that global incidence rates number about 35.5 million people with this diagnosis. Moreover, it is expected that by 2030 this figure will reach 65.7 million, and by 2050 it will be 115.4 million.

With dementia, patients are not capable of realizing what is happening to them; the disease literally “erases” everything from their memory that accumulated in it during the previous years of life. Some patients experience the course of such a process at an accelerated pace, which is why they quickly develop total dementia, while other patients can linger for a long time at the stage of the disease within the framework of cognitive-mnestic disorders (intellectual-mnestic disorders) - that is, with disorders mental performance, decreased perception, speech and memory. In any case, dementia not only determines the result for the patient in the form of problems of an intellectual scale, but also problems in which he loses many human personality traits. The severe stage of dementia determines for patients dependence on others, maladaptation, they lose the ability to perform simple actions related to hygiene and eating.

Causes of dementia

The main causes of dementia are the presence of Alzheimer's disease in patients, which is defined, respectively, as Alzheimer's type dementia, as well as with actual vascular lesions to which the brain is exposed - the disease in this case is defined as vascular dementia. Less commonly, the causes of dementia are any neoplasms that develop directly in the brain; this also includes traumatic brain injuries ( non-progressive dementia ), diseases of the nervous system, etc.

The etiological significance in considering the causes leading to dementia is assigned to arterial hypertension, disorders of the systemic circulation, lesions great vessels against the background of atherosclerosis, arrhythmias, hereditary angiopathy, repeated disorders relevant to cerebral circulation (vascular dementia).

The etiopathogenetic variants leading to the development of vascular dementia include its microangiopathic variant, macroangiopathic variant and mixed variant. This is accompanied by multi-infarct changes occurring in the brain substance and numerous lacunar lesions. In the macroangiopathic variant of the development of dementia, pathologies such as thrombosis, atherosclerosis and embolism are distinguished, against the background of which occlusion develops in a large artery of the brain (a process in which narrowing of the lumen and blockage of the vessel occurs). As a result of this course, a stroke develops with symptoms corresponding to the affected pool. As a result, vascular dementia subsequently develops.

As for the next, microangiopathic development option, here angiopathy and hypertension are considered as risk factors. The characteristics of the lesion in these pathologies lead in one case to demyelination of the white subcortical matter with the simultaneous development of leukoencephalopathy, in another case they provoke the development of lacunar lesion, against which Binswanger's disease develops, and because of which, in turn, dementia develops.

In about 20% of cases, dementia develops against the background of alcoholism, the appearance tumor formations and the previously mentioned traumatic brain injuries. 1% of the incidence is due to dementia due to Parkinson's disease, infectious diseases, degenerative diseases of the central nervous system, infectious and metabolic pathologies etc. Thus, a significant risk has been identified for the development of dementia against the background of current diabetes mellitus, HIV, infectious diseases of the brain (meningitis, syphilis), dysfunction of the thyroid gland, diseases of the internal organs (renal or liver failure).

Dementia in older people, by the nature of the process, is irreversible, even if the possible factors that provoked it are eliminated (for example, taking medications and their withdrawal).

Dementia: classification

Actually, based on a number of listed features, types of dementia are determined, namely senile dementia And vascular dementia . Depending on the degree of social adaptation that is relevant for the patient, as well as the need for supervision and receiving outside help in combination with his ability to self-care, corresponding forms of dementia are distinguished. So, in the general course, dementia can be mild, moderate or severe.

Mild dementia implies a condition in which a sick person is faced with degradation in terms of his existing professional skills; in addition, his social activity also decreases. Social activity in particular means a reduction in the time spent on everyday communication, thereby spreading to the immediate environment (colleagues, friends, relatives). In addition to this, in mild condition Dementia patients also have a weakened interest in the conditions of the outside world, as a result of which it is important to abandon their usual options for spending free time and hobbies. Mild dementia is accompanied by the preservation of existing self-care skills; in addition, patients adequately navigate within the confines of their home.

Moderate dementia leads to a condition in which patients can no longer remain alone with themselves for a long period of time, which is caused by the loss of skills in using the technology and devices surrounding them (remote control remote control, telephone, stove, etc.), difficulties cannot be excluded even with the use of door locks. Constant monitoring and assistance from others is required. As part of this form of the disease, patients retain the skills to self-care and perform actions related to personal hygiene. All this, accordingly, makes life more difficult for those around the patients.

As for such a form of the disease as severe dementia then here we are talking about the absolute disadaptation of patients to what surrounds them with the simultaneous need to provide constant assistance and control, which are necessary even for performing the simplest actions (eating, dressing, hygiene measures, etc.).

Depending on the location of the brain damage, the following types of dementia are distinguished:

cortical dementia - the lesion predominantly affects the cerebral cortex (which occurs against the background of such conditions as lobar (frontotemporal) degeneration, alcoholic encephalopathy, Alzheimer's disease);
subcortical dementia - in this case, subcortical structures are predominantly affected (multi-infarct dementia with white matter lesions, supranuclear progressive palsy, Parkinson's disease);
cortical-subcortical dementia (vascular dementia, cortical-basal form of degeneration);
multifocal dementia - many focal lesions are formed.

The classification of the disease we are considering also takes into account dementia syndromes that determine the corresponding variant of its course. In particular this could be lacunar dementia , which implies a predominant memory loss, manifested in the form of a progressive and fixation form of amnesia. Compensation for such a defect by patients is possible due to important notes on paper, etc. The emotional-personal sphere in this case is slightly affected, because the core of the personality is not subject to damage. Meanwhile, the appearance of emotional lability (instability and changeability of moods), tearfulness and sentimentality in patients is not excluded. An example of this type of disorder is Alzheimer's disease.

Alzheimer's type dementia , the symptoms of which appear after the age of 65 years, in the initial (initial) stage occurs in combination with cognitive-mnestic disorders with increasing disturbances in the form of orientation in place and time, delusional disorders, the appearance of neuropsychological disorders, subdepressive reactions in relation to one’s own incompetence . At the initial stage, patients are capable of critically assessing their condition and taking measures to correct it. Moderate dementia within this condition is characterized by the progression of the listed symptoms with a particularly severe violation of the inherent functions of the intellect (difficulties in conducting analytical and synthetic activities, a reduced level of judgment), loss of ability to perform professional duties, and the emergence of a need for care and support. All this is accompanied by the preservation of basic personal characteristics, a feeling of one’s own inferiority while adequately responding to existing illness. In the severe stage of this form of dementia, memory decay occurs completely; support and care are needed in everything and at all times.

The next syndrome is considered total dementia. It means the appearance of gross forms of disorders of the cognitive sphere (impaired abstract thinking, memory, perception and attention), as well as personality (here we already distinguish moral disorders, in which such forms as modesty, correctness, politeness, sense of duty, etc.) disappear. . In the case of total dementia, as opposed to lacunar dementia, the destruction of the core of the personality becomes relevant. Vascular and atrophic forms of damage are considered as the causes leading to the condition in question. frontal lobes brain. An example of such a condition is Pick's disease .

This pathology is diagnosed less frequently than Alzheimer's disease, mainly among women. Among the main characteristics, current changes are noted within the emotional-personal sphere and the cognitive sphere. In the first case, the state implies rough forms personality disorder, complete lack of criticism, spontaneity, passivity and impulsiveness of behavior; hypersexuality, foul language and rudeness are relevant; the assessment of the situation is impaired, there are disorders of desires and will. In the second, with cognitive disorders, severe forms of thinking impairment are present, and automated skills are retained for a long time; Memory disorders are noted much later than personality changes; they are not as pronounced as in the case of Alzheimer's disease.

Both lacunar and total dementia are in general terms atrophic dementia, and there is also an option mixed form diseases (mixed dementia) , which implies a combination of primary degenerative disorders, which mainly manifests itself in the form of Alzheimer's disease, and a vascular type of brain damage.

Dementia: symptoms

In this section we will look at a generalized view of the signs (symptoms) that characterize dementia. The most characteristic of them are considered disorders associated with cognitive functions, and this kind of impairment is the most pronounced in its own manifestations. No less important clinical manifestations are emotional disorders in combination with behavioral disorders. The development of the disease occurs gradually (often), its detection most often occurs as part of an exacerbation of the patient’s condition, arising due to changes in the environment surrounding him, as well as during an exacerbation of a somatic disease that is relevant to him. In some cases, dementia can manifest itself in the form of aggressive behavior of the sick person or sexual disinhibition. In the event of personality changes or changes in the patient’s behavior, the question is raised about the relevance of dementia for him, which is especially important if he is over 40 years old and does not have a mental illness.

So, let’s take a closer look at the signs (symptoms) of the disease we are interested in.

Disorders related to cognitive functions. In this case, disorders of memory, attention and higher functions are considered.
- Memory disorders. Memory disorders in dementia involve damage to both short-term memory and long-term memory; in addition, confabulations are not excluded. Confabulations in particular involve false memories. Facts from them that occurred earlier in reality or facts that previously occurred but underwent a certain modification are transferred to the patient at another time (often in the near future) with their possible combination with events that were completely fictitious by them. Light form dementia is accompanied moderate impairments memory, they are mainly associated with events occurring in the recent past (forgetting conversations, phone numbers, events that occurred within a certain day). Cases of more severe dementia are accompanied by retention in memory of only previously learned material while quickly forgetting newly received information. Final stages diseases may be accompanied by forgetting the names of relatives, one’s own occupation and name, this manifests itself in the form of personal disorientation.
- Attention disorder. In the case of the disease we are interested in, this disorder implies a loss of the ability to respond to several relevant stimuli at once, as well as a loss of the ability to switch attention from one topic to another.
- Disorders associated with higher functions. In this case, the manifestations of the disease are reduced to aphasia, apraxia and agnosia.
  - Aphasia implies a speech disorder in which the ability to use phrases and words as a means of expressing one’s own thoughts is lost, which is caused by actual damage to the brain in certain areas of its cortex.
  - Apraxia indicates a violation of the patient's ability to perform purposeful actions. In this case, the skills previously acquired by the patient are lost, and those skills that have been developed over many years (speech, household, motor, professional).
  - Agnosia determines a violation of various types of perception in the patient (tactile, auditory, visual) with the simultaneous preservation of consciousness and sensitivity.
Disorientation. This type of disorder occurs over time, and mainly within the initial stage of development of the disease. In addition, disruption of orientation in temporal space precedes disruption of orientation on the scale of orientation in place, as well as within the framework of one’s own personality (here the difference between a symptom in dementia and delirium is manifested, the features of which determine the preservation of orientation within the framework of considering one’s own personality). The progressive form of the disease with advanced dementia and pronounced manifestations of disorientation on the scale of the surrounding space determines for the patient the likelihood that he can freely get lost even in an environment that is familiar to him.
Behavioral disorders, personality changes. The onset of these manifestations is gradual. The main features characteristic of the individual gradually intensify, transforming into conditions inherent to this disease as a whole. Thus, energetic and cheerful people become restless and fussy, and people who are thrifty and neat, accordingly, become greedy. Transformations inherent in other traits are considered similarly. In addition, there is an increase in selfishness in patients, a disappearance of responsiveness and sensitivity to the environment, they become suspicious, conflictual and touchy. Sexual disinhibition is also detected; sometimes patients begin to wander and collect various rubbish. It also happens that patients, on the contrary, become extremely passive, they lose interest in communication. Untidyness is a symptom of dementia that occurs in accordance with the progression of the general picture of the course of this disease; it is combined with a reluctance to self-care (hygiene, etc.), with uncleanliness and a general lack of reaction to the presence of people next to you.
Thinking disorders. There is a slowness in the pace of thinking, as well as a decrease in the ability to logical thinking and abstraction. Patients lose the ability to generalize and solve problems. Their speech is detailed and stereotypical in nature, its scarcity is noted, and as the disease progresses, it is completely absent. Dementia is also characterized possible appearance crazy ideas in patients, often with absurd and primitive content. So, for example, a woman with dementia with a thought disorder before the appearance of delusional ideas may claim that her mink coat was stolen, and such an action may go beyond her environment (i.e., family or friends). The crux of the nonsense in this idea is that she never had a mink coat at all. Dementia in men within this disorder often develops according to a scenario of delusion based on the jealousy and infidelity of the spouse.
Decreased critical attitude. We are talking about the attitude of patients both to themselves and to the world around them. Stressful situations often lead to the appearance of acute forms of anxiety-depressive disorders (defined as a “catastrophic reaction”), in which there is a subjective awareness of intellectual inferiority. Partially preserved criticism in patients determines the possibility for them to maintain their own intellectual defect, which may look like a sharp change in the topic of conversation, turning the conversation into a humorous form, or distracting from it in other ways.
Emotional disorders. In this case, it is possible to determine the diversity of such disorders and their overall variability. Often these are depressive states in patients combined with irritability and anxiety, anger, aggression, tearfulness or, conversely, a complete lack of emotions in relation to everything that surrounds them. Rare cases determine the possibility of developing manic states in combination with a monotonous form of carelessness, with gaiety.
Perception disorders. In this case, the conditions of the appearance of illusions and hallucinations in patients are considered. For example, with dementia, a patient is sure that he hears the screams of children being killed in the next room.

Senile dementia: symptoms

In this case, a similar definition of the state of senile dementia is the previously mentioned senile dementia, senile insanity or senile dementia, the symptoms of which arise against the background of age-related changes occurring in the structure of the brain. Such changes occur within neurons; they arise as a result of insufficient blood supply to the brain, the impact on it caused by acute infections, chronic diseases and other pathologies discussed by us in the corresponding section of our article. Let us also repeat that senile dementia is an irreversible disorder that affects each of the areas of the cognitive psyche (attention, memory, speech, thinking). As the disease progresses, all skills and abilities are lost; It is extremely difficult, if not impossible, to acquire new knowledge during senile dementia.

Senile dementia, being among the mental illnesses, is the most common disease among older people. Senile dementia occurs almost three times more often in women than in men. In most cases, the age of patients is 65-75 years, on average, in women the disease develops at 75 years, in men - at 74 years.
Senile dementia manifests itself in several varieties of forms, manifesting itself in a simple form, in a presbyophrenic form and in a psychotic form. The specific form is determined by the current rate of atrophic processes in the brain, somatic diseases associated with dementia, as well as factors of a constitutional-genetic scale.

Simple form characterized by inconspicuousness, occurring in the form of disorders generally inherent in aging. At acute onset there is reason to believe that pre-existing mental disorders have been aggravated by one or another somatic disease. There is a decrease in mental activity in patients, which is manifested in a slowdown in the pace of mental activity, in its quantitative and qualitative deterioration (implying a violation of the ability to concentrate attention and switch it, its volume is narrowed; the ability to generalize and analyze, to abstract and in general weakens imagination is impaired; the ability to be inventive and resourceful in solving issues that arise in everyday life is lost).

To an increasing extent, a sick person adheres to conservatism in terms of his own judgments, worldview and actions. What happens in the present tense is seen as unimportant and not worth a look, and is often completely rejected. Returning to the past, the patient primarily perceives it as a positive and worthy example in certain ways. life situations. Characteristic feature there becomes a tendency to edify, intractability bordering on stubbornness and increased irritability that arise when there are contradictions or disagreement on the part of the opponent. Interests that previously existed are significantly narrowed, especially if they are in one way or another connected with general questions. Increasingly, patients focus their own attention on their physical condition, in particular this applies to physiological functions (i.e. bowel movements, urination).

Patients also have a decrease in affective resonance, which is manifested in an increase in complete indifference to what does not directly affect them. In addition, attachments weaken (this even applies to relatives), and in general, understanding of the essence of relationships between people is lost. Many people lose their modesty and sense of tact, and the range of shades of mood is also subject to narrowing. Some patients may show carelessness and general complacency, sticking to monotonous jokes and a general tendency to joke, while other patients are dominated by dissatisfaction, pickiness, capriciousness and pettiness. In any case, the patient’s past characterological traits become scarce, and awareness of the personality changes that have arisen either disappears early or does not occur at all.

The presence of pronounced forms of psychopathic traits before the disease (especially those that are sthenic, this concerns power, greed, categoricalness, etc.) leads to their aggravation in manifestation at the initial stage of the disease, often to a caricatured form (which is defined as senile psychopathization ). Patients become stingy, begin to accumulate rubbish, and they increasingly make various reproaches towards their immediate environment, especially regarding irrationality, in their opinion, of expenses. Also subject to censure on their part are the morals that have developed in public life, this especially applies to marital relationships, intimate life, etc.
Initial psychological changes, combined with the personal changes that occur with them, are accompanied by memory deterioration, in particular this applies to current events. They are usually noticed by those around the patients later than the changes that have occurred in their character. The reason for this is the revival of past memories, which is perceived by the environment as a good memory. Its decay actually corresponds to those patterns that are relevant for a progressive form of amnesia.

So, first, memory associated with differentiated and abstract topics (terminology, dates, titles, names, etc.) comes under attack, then a fixation form of amnesia is added here, manifesting itself in the form of an inability to remember current events. Amnestic disorientation regarding time also develops (i.e., patients are unable to indicate a specific date and month, day of the week), and chronological disorientation also develops (the inability to determine important dates and events linking them to a specific date, regardless of whether such dates relate to personal life or social life). To top it off, spatial disorientation develops (manifests itself, for example, in a situation where, when leaving home, patients cannot return back, etc.).

The development of total dementia leads to impairment of self-recognition (for example, when viewing oneself in reflection). Forgetting the events of the present is replaced by the revival of memories relating to the past, often this can concern youth or even childhood. Often, such a substitution of time leads to the fact that patients begin to “live in the past,” while considering themselves young or children, depending on the time in which such memories occur. Stories about the past in this case are reproduced as events relating to the present time, while it is not excluded that these memories are generally fiction.

The initial periods of the course of the disease can determine the mobility of patients, the accuracy and speed of performing certain actions, motivated by random necessity or, conversely, by habitual performance. Physical insanity is observed already within the framework of an advanced disease (complete collapse of behavior patterns, mental functions, speech skills, often with relative preservation of somatic function skills).

In severe forms of dementia, the previously discussed states of apraxia, aphasia and agnosia are noted. Sometimes these disorders manifest themselves in a sharp form, which may resemble the course of Alzheimer's disease. Few and isolated epileptic seizures, similar to fainting, are possible. Sleep disorders appear, in which patients fall asleep and get up at an unspecified time, and the duration of their sleep ranges from 2-4 hours, reaching an upper limit of about 20 hours. In parallel with this, periods of prolonged wakefulness may develop (regardless of the time of day).

The final stage of the disease determines for patients the achievement of a state of cachexia, in which an extreme form of exhaustion occurs, in which there is a sharp loss of weight and weakness, decreased activity in some areas. physiological processes with accompanying mental changes. In this case, the characteristic feature is the adoption of the fetal position when the patients are in a drowsy state, there is no reaction to surrounding events, and sometimes muttering is possible.

Vascular dementia: symptoms

Vascular dementia develops against the background of previously mentioned disorders that are relevant for cerebral circulation. In addition, as a result of studying the brain structures of patients after their death, it was revealed that vascular dementia often develops after a heart attack. To be more precise, the point is not so much in the transfer of this condition, but in the fact that because of it a cyst is formed, which determines the subsequent likelihood of developing dementia. This probability is determined, in turn, not by the size of the cerebral artery that has been damaged, but by the total volume of the cerebral arteries that have undergone necrosis.

Vascular dementia is accompanied by a decrease in indicators relevant for cerebral circulation in combination with metabolism, otherwise the symptoms correspond to the general course of dementia. When the disease is combined with a lesion in the form of laminar necrosis, in which glial tissue grows and neurons die, the possibility of developing serious complications(blockage of blood vessels (embolism), cardiac arrest).

As for the predominant category of people who develop the vascular form of dementia, in this case the data indicate that this predominantly includes people aged 60 to 75 years, and one and a half times more often these are men.

Dementia in children: symptoms

In this case, the disease, as a rule, appears as a symptom of certain diseases in children, which may include mental retardation, schizophrenia and other types of mental disorders. This disease develops in children with a characteristic decrease in mental abilities, which manifests itself in impaired memorization, and in severe cases, difficulties arise even with remembering one’s own name. The first symptoms of dementia in children are diagnosed early, in the form of loss of certain information from memory. Further, the course of the disease determines the appearance of disorientation within the framework of time and space. Dementia in children early age manifests itself in the form of loss of skills previously acquired by them and in the form of speech impairment (up to its complete loss). The final stage, similar to the general course, is accompanied by the fact that patients stop taking care of themselves; they also lack control over the processes of defecation and urination.

Within childhood dementia is inextricably linked with oligophrenia. Oligophrenia, or, as we previously defined it, mental retardation, is characterized by the relevance of two features relating to intellectual defect. One of them is that mental underdevelopment is total, that is, both the child’s thinking and his mental activity are subject to defeat. The second feature is that with general mental underdevelopment, the “young” functions of thinking are most affected (young - when considering them on a phylo- and ontogenetic scale); insufficient development is determined for them, which makes it possible to associate the disease with oligophrenia.

Persistent intellectual disability, which develops in children after 2-3 years of age against the background of trauma and infection, is defined as organic dementia, the symptoms of which appear due to the collapse of relatively mature intellectual functions. Such symptoms, due to which it is possible to differentiate this disease from oligophrenia, include:

lack of mental activity in its purposeful form, lack of criticism;
pronounced type of memory and attention impairment;
emotional disturbances in a more pronounced form, not correlating (i.e. not associated) with the actual degree of decline in intellectual abilities for the patient;
frequent development of disorders relating to instincts (perverted or increased forms of desire, performance of actions under the influence of increased impulsiveness, weakening of existing instincts (instinct of self-preservation, lack of fear, etc.) is not excluded);
Often the behavior of a sick child does not adequately correspond specific situation, which also happens if a pronounced form of intellectual disability is irrelevant for him;
in many cases, the differentiation of emotions is also subject to weakening, there is a lack of attachment in relation to close people, and the child’s complete indifference is noted.

Diagnosis and treatment of dementia

Diagnosis of the patient’s condition is based on a comparison of the symptoms that are relevant to them, as well as on the recognition of atrophic processes in the brain, which is achieved through computed tomography (CT).

Regarding the issue of treating dementia, there is currently no effective treatment, especially if cases of senile dementia are considered, which, as we noted, is irreversible. Meanwhile, proper care and the use of therapeutic measures aimed at suppressing symptoms can, in some cases, seriously alleviate the patient’s condition. It also discusses the need to treat concomitant diseases (with vascular dementia in particular), such as atherosclerosis, arterial hypertension etc.

Treatment for dementia is recommended as appropriate home environment, placement in a hospital or psychiatric department is important in severe cases of the disease. It is also recommended to create a daily routine so that it includes a maximum of vigorous activity while periodically performing household chores (with an acceptable form of load). Purpose psychotropic drugs performed only in case of hallucinations and insomnia, within early stages It is advisable to use nootropic drugs, then nootropic drugs in combination with tranquilizers.

Prevention of dementia (in its vascular or senile form), as well as effective treatment of this disease, is currently excluded due to the practical absence of appropriate measures. If symptoms indicating dementia appear, it is necessary to visit specialists such as a psychiatrist and a neurologist.