Dementia - causes, types, symptoms and treatment. Dementia. Causes, symptoms and signs, treatment, prevention of pathology Severe dementia treatment

Dementia is a clinical syndrome characterized by memory loss , as well as other functions of thinking. This phenomenon occurs in the case of chronic degenerative lesions of the brain of a progressive nature. However, dementia is characterized not only by a change in thought processes, but also by the manifestation of behavioral disorders, as well as changes in a person’s personality.

It is important to understand that from mental retardation or congenital Dementia is distinguished primarily by the fact that it occurs as a result of a disease or damage to the brain. Typically, dementia is a condition that occurs in older people. Due to natural aging in the body, failures in the operation of various systems begin to occur. The neuropsychic sphere is characterized by cognitive , behavioral , emotional violations. Dementia is a type of cognitive impairment. However, if we consider this condition, guided by its external manifestations, then patients with dementia also have emotional disorders (state , ), behavioral disorders (too frequent awakenings at night, lost hygiene skills). In general, a person with dementia gradually degrades as a person.

Dementia is a severe and, as a rule, irreversible disorder that has a very noticeable effect on a person's normal life, destroying his social activity. Due to the fact that dementia is inherent in elderly patients, it is also called dementia or senility . According to specialist studies, approximately 5% of people who are already 65 years old suffer from certain manifestations of this condition. The state of dementia in elderly patients is considered to be not a consequence of aging, which cannot be avoided, but age-related diseases, a certain part of which (about 15%) can be treated.

Symptoms of dementia

Dementia is characterized by its manifestation simultaneously from many sides: changes occur in speeches , memory , thinking , attention sick. These, as well as other functions of the body, are disturbed relatively evenly. Even the initial stage of dementia is characterized by very significant disorders, which will certainly affect a person as an individual and a professional. In a state of dementia, a person not only loses the ability to exercise previously acquired skills, but also loses the opportunity to acquire new skills. Another important feature of dementia is the relatively stable manifestation of these disorders. All violations are manifested regardless of the state of consciousness of a person.

The very first manifestations of this condition may not be particularly noticeable: even doctors with experience are not always able to determine the onset of the development of the disease. As a rule, first of all, various manifestations of changes in a person's behavior begin to alert his relatives and friends. At the initial stage, these may be certain difficulties with resourcefulness, signs of irritability and forgetfulness, indifference to things that were previously interesting to a person, and the inability to work at full strength. Over time, the changes become even more noticeable. The patient shows absent-mindedness, becomes inattentive, cannot think and understand as easily as before. Memory disorders are also noted: it is most difficult for the patient to remember current events. Changes in mood are very pronounced, moreover, most often a person becomes apathetic, sometimes crying. Being in society, a person may exhibit deviations from the general norms of behavior. Not alien to patients with dementia and either delusional ideas, in some cases they may suffer from manifestation. With all the changes described, the person himself cannot adequately assess the changes that have occurred to him, he does not notice that he behaves differently than before. However, in some cases, at the very first manifestations of dementia, a person fixes changes in his own abilities and general condition, and this greatly worries him.

In the case of progression of the described changes, patients eventually lose almost all mental abilities. In most cases, there are speech disorders - it is very difficult for a person to choose words in a conversation, he begins to make mistakes when pronouncing them, does not understand the speech with which others address him. After a certain period of time, these symptoms are added dysfunction of the pelvic organs , the patient's reactivity decreases. If at the first stage of the disease the patient may have an increased, then later his need for food decreases significantly, and as a result, a state occurs cachexia . Movements of an arbitrary nature are poorly coordinated. If the patient has a concomitant illness, which is accompanied by febrile condition, or a disorder cause confusion. As a result, there may be stupor or coma . The described degradation process can last from several months to several years.

Such violations of human behavior are the result of damage to his nervous system. All other occurring disorders arise as a reaction to the onset of dementia. Thus, in order to hide disturbances in memory, the patient may be too pedantic. His dissatisfaction in response to the need for restrictions in life is expressed by irritability and bad mood.

Due to degenerative diseases, a person can be in a state of complete decortication - not to understand what is happening around, not to speak, not to show interest in food, although at the same time swallow the food put into his mouth. In a person in this state, the muscles of the limbs and face will be tense, tendon reflexes, grasping and sucking reflexes will be increased.

Forms of dementia

It is customary to distinguish the state of dementia according to the severity of the development of the disease. As the main criterion for such a distinction, the degree of dependence of a person on the care of others is taken into account.

Capable of mild dementia cognitive impairments are manifested by a deterioration in a person's professional abilities and a decrease in his social activity. As a result, the patient's interest in the outside world as a whole is weakened. However, in this state, a person serves himself independently and maintains a clear orientation in his own home.

At moderate dementia the next stage of cognitive disorders appears. The patient already needs periodic care, because he cannot cope with most household appliances, it is difficult for him to open the lock with a key. The people around him are constantly forced to prompt him certain actions, but still the patient can serve himself independently and retains the ability to carry out personal hygiene.

At severe dementia a person is completely maladapted to the environment and directly depends on the help of other people, and needs it when performing the simplest actions (eating, dressing, hygiene).

Causes of dementia

The reasons for the development of senile dementia are varied. Thus, pathological disorders that negatively affect cells sometimes occur directly in the brain. As a rule, neurons die due to the presence of deposits that are detrimental to their functioning, or due to their poor nutrition due to poor blood circulation. In this case, the disease is organic character (primary dementia). This condition occurs in about 90% of cases.

Due to the deterioration of the functioning of the brain, a number of other diseases can manifest themselves - malignant tumors , infections , deterioration metabolism . The course of such diseases negatively affects the functioning of the nervous system and, as a result, secondary dementia appears. This condition occurs in about 10% of cases.

Diagnosis of dementia

To correctly diagnose, it is important, first of all, to correctly determine the nature of dementia. This directly affects the appointment of a method of treating the disease. The most common causes of primary dementia are neurodegenerative changes (for example, ) and vascular nature (for example, hemorrhagic ,cerebral infarction ).

The occurrence of secondary dementia is mainly provoked by cardiovascular diseases , excessive addiction to alcohol , violations metabolism . In this case, dementia may disappear after the cause of its occurrence is cured.

When making a diagnosis, the doctor first of all conducts a detailed conversation with the patient in order to find out whether the patient really has reduced intellectual performance and personality changes. In the process of clinical and psychological assessment of the patient's condition, the doctor conducts a study aimed at determining the condition gnostic function , memory , intellect , substantive actions , speeches , attention . At the same time, it is important to take into account in the process of research the stories of the patient's close people who have constant contact with him. Such information contributes to an objective assessment.

In order to fully ascertain the presence of symptoms of dementia, a long examination is required. There are also specially developed scales for assessing dementia.

It is important to distinguish dementia from a number of mental disorders. So, if among the symptoms inherent in the patient, nervousness, sleep disturbances are observed, then, assuming no changes in mental activity, the doctor may assume the presence of a mental illness. In this case, it is important to consider that mental disorders in middle-aged and elderly people are the consequences of either organic brain damage or depressive psychosis.

When making a diagnosis, the doctor takes into account that patients with dementia very rarely can adequately assess their condition and are not inclined to note the degradation of their own mind. The only exceptions are patients with dementia in the early stages. Consequently, the patient's own assessment of his condition cannot become decisive for a specialist.

After diagnosing a patient with dementia, the doctor prescribes a number of other examinations in order to identify signs of neurological or therapeutic diseases, which makes it possible to correctly classify dementia. The study includes computed tomography, EEG, MRI,. Also toxic products of an exchange are investigated. In some cases, to make a diagnosis, it is necessary to observe the patient for a certain time.

Dementia treatment

There is an opinion about the ineffectiveness of the treatment of dementia due to the irreversibility of age-related changes. However, this statement is only partially true, because not all types of dementia are irreversible. The most important point is the exclusion of self-treatment attempts and the appointment of therapy only after a thorough examination and diagnosis.

To date, in the process of treating dementia, drug therapy is used by prescribing drugs to the patient that improve connections between neurons and stimulate the process blood circulation in the brain . It is important to constantly monitor blood pressure, reduce mental and physical stress (early stage of the disease), provide nutrition with foods rich in natural antioxidants. For behavioral disorders, use antidepressants And antipsychotics .

With the right approach to the treatment of vascular factors in the elderly, it is possible to noticeably stop the progression of the disease.

The doctors

Medications

Prevention of dementia

To prevent the onset of dementia, measures are taken to reduce the risk of this disease to some extent. It is important to monitor the state of the level cholesterol and - it should not be high. development should not be allowed . An important factor in the prevention of dementia is an active social life, regular intellectual activity, an active lifestyle. Measures to prevent vascular dementia include avoiding smoking, excessive consumption of alcohol, salt and fatty foods. It is important to control blood sugar levels and avoid head injuries.

Diet, nutrition for dementia

List of sources

• Damulin I.V. Alzheimer's disease and vascular dementia / Ed. Yah-no N.N. M., 2002.
• Damulin I.V., Parfenov V.A., Skoromets A.A. et al. Circulatory disorders in the brain and spinal cord. Diseases of the nervous system: A guide for physicians. T.1. Ed. N.N. Yakhno. 4th ed., revised. and additional Moscow: OAO Publishing House Medicine, 2005;
• Levin O.S. Modern approaches to the diagnosis and treatment of dementia // Handbook of a polyclinic doctor. - 2007. - No. 1
• Damulin I.V. Cognitive disorders: modern aspects of diagnosis and treatment. - M., 2005.

What is dementia, what are the manifestations of this disease and how to treat it? Another name for this disease is dementia, which covers a large group of symptoms. These manifestations affect the intellectual and social abilities of patients, seriously affecting their everyday life. Today we will find out what the symptoms are, the treatment of this disease. We will also help you figure out how to behave with such a person, how you can help him and what it is desirable to protect him from.

Symptoms depending on the stage of the disease

To understand what dementia is, you need to find out what are the manifestations of this disease. Depending on the period of development of the disease, the symptoms are of the following nature:

At stage 1, the signs of the disease are:

Absent-mindedness.

Loss of track of time.

Loss of orientation in a familiar place.

In stage 2, the symptoms of dementia are:

Behavior appears that is unusual for an ordinary elderly person (aggressiveness, fits of rage, nervousness).

Disease recognition

When the first symptoms of impaired memory, attention, behavior appear, you should quickly contact a specialist who will give you a referral for a series of tests to exclude a disease called dementia. Diagnosis of the disease consists in performing procedures such as:

CT scan.

Radioisotope brain check.

An electroencephalogram is a method for studying the electrical activity of the brain.

Checking blood vessels.

Bacteriological study of cerebrospinal fluid - a fluid circulating in the ventricles of the brain.

Biopsy of the medulla.

General analysis of blood and urine.

Examination by a neurologist, psychiatrist, ophthalmologist.

Types and types of disease

There are two forms of dementia:

1. Total.
2. Partial.

The second point is characterized by serious deviations in the process of short-term memory, at the same time, emotional changes are not particularly pronounced. There is only tearfulness and excessive sensitivity.

Total dementia is characterized by complete personal degradation. A person's intellectual, cognitive, emotional sphere of life is disturbed, his feelings and emotions change radically. For example, the patient loses a sense of shame, duty, vital interests and spiritual values ​​disappear.

An ailment of an atrophic type (these are Alzheimer's and Pick's diseases). It occurs against the background of primary degeneration reactions occurring in the cells of the central nervous system.

It develops due to improper blood circulation in the vascular system of the brain.

A mixed disease is a combination of the first two types of the disease.

Causes

The problems of dementia have been studied for a long time, but still some people do not know that this disease is not at all an effect of evil spirits on a person (as some individuals believe). Also, people do not understand the risk factors for this disease, saying that it is just old age. However, this is not the case at all. Dementia develops as a result of certain circumstances. The reasons for the appearance of this disease are as follows:

Heredity.

The presence of pathologies that lead to the death or degeneration of brain cells.

Skull trauma.

Tumor in the brain.

Alcoholism.

Multiple sclerosis.

Viral encephalitis.

Chronic meningitis.

Neurosyphilis.

Pick's disease

Another name for the disease - frontal dementia suggests the presence of degenerative abnormalities that affected the temporal and frontal parts of the brain. In 50% of cases, Pick's disease appears due to a genetic factor. The onset of the disease is characterized by such changes as:

Passivity and isolation from society;

Silence;

apathy;

Ignoring the norms of decency;

Sexual immorality;

Urinary incontinence;

Bulimia is a mental disorder associated with eating. This disease is characterized by a sharp increase in appetite, which begins with excruciating hunger.

People who are struck by this disease live no more than 10 years. They die from immobility or the development of a genitourinary, pulmonary infection.

Alcoholic dementia: features

This type of dementia occurs as a result of prolonged exposure to alcohol on the brain (for 15-20 years). The state of alcoholic dementia may worsen after the patient completely refuses strong drinks. This type of dementia occurs in older people who drink alcohol regularly. The amount of consumption usually increases from four glasses of wine per week to an unlimited amount per day. With alcoholic dementia, the patient has various mental disorders, including psychosis, depression, anxiety, apathy. There is also a lack of sleep, nocturnal confusion, irritability, anxiety. If a person is not stopped in time and treatment is not started, then he may have a stroke. Therefore, it is necessary in this case not to start the disease and not to ignore the patient.

Treatment of the disease

To date, scientists have not created that miracle pill that could cure the disease. What is dementia, know firsthand 35 million families around the world. This is how many patients were counted by the World Health Organization. But still, you can improve the condition of the affected person by knowing and strictly following the following points:

1. Providing care, maintaining safety in relation to this category of persons.
2. Identification and timely treatment of concomitant diseases.
3. Not belated detection and correction of mental disorders and sleep disorders.
4. Drug therapy.

Treatment with medications for Alzheimer's disease, for example, includes pills such as Amiridin, Memantine, Seleginil. And for the treatment of vascular dementia, solutions such as Galantamine, Nicergoline are used.

To prevent stroke, as a possible cause of dementia, a doctor may prescribe anti-thrombotic drugs that lower blood pressure and lower cholesterol levels. Also, the specialist prescribes medications so that the patient sleeps better. And for behavioral disorders, the doctor may prescribe sedatives, antidepressants, etc.
Treatment of dementia, therefore, is aimed at eliminating the symptoms of the disease, improving memory, mental abilities, and motor functions.

Prevention

What is dementia, found out, now is the time to learn about measures to prevent the development of this disease:

1. Maintaining a healthy lifestyle, without drinking alcohol.
2. It is necessary to carry out mental exercises daily (solving crossword puzzles, puzzles, reading a book and further discussing it, etc.)
3. Normal recovery after a stroke, encephalitis and other diseases, after which dementia may develop.
4. Timely therapy of ailments of internal organs in the elderly.
5. Mandatory control of blood glucose levels.
6. Prevention of the appearance of atherosclerosis (good nutrition and annual determination of the lipid profile - a study of venous blood).
7. Work in non-toxic production conditions.
8. Control of blood cholesterol levels.
9. To give up smoking.

However, it is erroneous to believe that by fulfilling all the above points, this disease will not begin. Dementia has a hereditary factor to a large extent, because many diseases can be passed from generation to generation and they can cause dementia. Therefore, it is necessary to know how to behave towards the affected person and what to pay attention to.

Senile dementia, the signs of which pass from one stage to another, thus progressing, should be adequately perceived by the relatives of the sick person. And for this it is necessary to help your affected relative, improve his quality of life, as well as safety. In this case, you can use the following tips:

1. Prepare a plan for patient care. Such a task must be carried out and for oneself to understand what are the goals of supervision of the elderly. Doctors, lawyers, and other family members should be consulted to create such a plan. Here are the main points to which the relative must answer:

What is the treatment prognosis? What to expect from such therapy?

Does a person necessarily require care for him or can he live alone?

Which family member will be the main person responsible for the patient?

Is there a need to help a person eat, drink medicine, take a bath?

Is it necessary to install security devices in the patient's home (for example, put soft devices on the corners of furniture, buy a special bed, make locks on the windows, install CCTV cameras, etc.)?

Do you need from driving a car?

What are the wishes of the patient himself regarding his treatment and care?

2. Get a special calendar for every day.

In such a diary, it will be necessary to note everything about which the affected person can forget, up to brushing his teeth. And in front of each item you will need to put a tick that has been completed. Close people will thus be able to check everything that the patient does on the calendar, and he, in turn, will be better oriented in everyday affairs and worries.

3. Keep order and immutability of the domestic circle of people.

A constant, quiet and familiar environment will eliminate feelings of anxiety, excitement, confusion. But new situations, things and orders will only interfere with dementia patients, and then they will learn poorly and remember things new to them.

4. Put the affected person to bed on time.

The actions and deeds of the elderly may worsen in the evening due to fatigue or, for example, due to anxiety, anxiety caused by a decrease in light. Therefore, people caring for the sick need to introduce a clear procedure for timely night rest. This requires taking the patient away from the TV or active family members. It is forbidden to give coffee to an elderly person, especially in the afternoon.

The sad experience of people in relation to nursing

People who have personally encountered a problem, seen and cared for a sick family member, quite often share their experiences and spiritual impulses on the Internet. After all, it is unusual and very scary to see how an adult, successful person turns into a child who is not responsible for either his words or actions. Therefore, many people support each other, share their experience in the treatment and prevention of such a disease as dementia. Reviews of people who had to be near a feeble-minded person on the forums say that it is very difficult to control oneself when there is a loved one nearby, but at the same time a stranger. Some pour out their souls, they cry and sob because their beloved grandfather, grandmother, mother, father was overtaken by this illness. However, they still look after their beloved relatives and do not lose hope that they will get better. And this is a completely normal reaction, because everyone wants their loved ones to be healthy and happy. But there are also negative reviews, downright impartial and abusive. People simply cannot stand such a fate of their relative, they are already waiting and will not wait for his death in order to remove such a burden from themselves.

But this is fundamentally wrong. After all, the patient is not to blame for becoming a victim of such an ailment as dementia. Therefore, the task of close people is to treat such mental changes with understanding, one cannot argue and scold a weak-minded person, it is also important to control his behavior. It must be remembered that he is not aware of his actions and words, so he does not need to prove anything, to assure him of something, and even more so to be offended. Also, relatives at the first symptoms of the disease must show their affected family member to the doctors. And experts will help you choose drugs that would improve metabolic processes in the brain, and due to this, the disease will not worsen.

I would like to wish relatives and friends who have such patients in their arms, patience, calmness and understanding. It is necessary to communicate more often with a weak-minded person, because he needs to be well, if the whole family will support the one who provides full-fledged care for the sick, as well as who is actually affected, and will also help and control his behavior.

Now you know what is senile dementia, symptoms, treatment of dementia in the elderly. It was determined that if a person has primary signs of the disease, then a visit to specialists should not be shelved, otherwise the disease will only progress. And at the first stage of illness, doctors will be able to help the patient as much as possible by prescribing medications that improve memory and metabolic processes in the brain. It is also important to take proper care of such a family member, because he obviously will not help himself in this situation.

Dementia defines an acquired form of dementia, in which patients experience a loss of previously acquired practical skills and acquired knowledge (which can occur in 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, are manifested 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 is not excluded.

general description

Dementia develops as a result of damage to the brain, against which the marked disintegration of mental functions occurs, which generally makes it possible to distinguish this disease from mental retardation, congenital or acquired forms of dementia. Mental retardation (it is also oligophrenia or dementia) implies a stop in the development of the personality, 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 intellect of a person, an adult physically, does not reach normal levels corresponding to his age. 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, and when considering dementia, and when considering mental retardation, there is a 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 (it is this pathology that is usually defined as senile insanity). However, dementia also appears in youth, often as a result of addictive behavior. Addiction implies 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 or personal problems that exist for him.

Often, addiction is used in connection with such phenomena as drug addiction and drug dependence, but more recently, another type of addiction has been identified 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 intoxicating substances).

However, if we consider this type of addiction at a deeper level, this phenomenon also occurs in the everyday mental activity that a person encounters (hobbies, hobbies), which, thereby, determines the subject of this activity as an intoxicating substance, as a result of which he, in in turn, is considered as a source-substitute, causing certain missing emotions. This includes shopaholism, Internet addiction, fanaticism, psychogenic overeating, gambling addiction, etc. At the same time, addiction is also considered as a way of adaptation, through which a person adapts to conditions that are difficult for him. Under the elementary agents of addiction are considered drugs, alcohol, cigarettes, which create an imaginary and short-term atmosphere of "pleasant" conditions. A similar effect is achieved when performing relaxation exercises, when resting, as well as during actions and things that cause 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 “leave” in such ways, as a result of which addictive behavior is seen as a rather complex problem of internal conflict, based on the need to escape from specific conditions, against which background and there is a risk of developing mental illness.

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

With dementia, patients are not able to realize 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 as part of cognitive-mnestic disorders (intellectual-mnestic disorders) - that is, with mental performance disorders, a decrease in perception, speech and memory. In any case, dementia not only determines the outcome for the patient in the form of problems of an intellectual scale, but also problems in which many human personality traits are lost. The severe stage of dementia determines for patients dependence on others, maladjustment, they lose the ability to perform the simplest actions related to hygiene and food intake.

Causes of dementia

The main causes of dementia are the presence of Alzheimer's disease in patients, which is defined, respectively, as dementia of the Alzheimer's type, as well as with actual vascular lesions to which the brain is exposed - the disease is defined in this case as vascular dementia. Less often, any neoplasms that develop directly in the brain act as causes of dementia, and this also includes craniocerebral 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, systemic circulatory disorders, lesions of the main vessels against the background of atherosclerosis, arrhythmias, hereditary angiopathy, repeated disorders relevant to cerebral circulation. (vascular dementia).

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

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

In about 20% of cases, dementia develops against the background of alcoholism, the appearance of 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 is determined for the development of dementia against the background of current diabetes mellitus, HIV, infectious diseases of the brain (meningitis, syphilis) , thyroid dysfunction, diseases of internal organs (renal or liver failure).

Dementia in the elderly by the nature of the process is irreversible, even if the possible factors that provoked it (for example, taking medications and canceling them) are eliminated.

Dementia: classification

Actually, on the basis of a number of listed features, types of dementia are determined, namely senile dementia And vascular dementia . Depending on the degree of social adaptation relevant to the patient, as well as the need for supervision and receiving third-party assistance, in combination with his ability to self-service, the corresponding forms of dementia are distinguished. So, in the general variant of the 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 professional skills, in addition to this, his social activity is also reduced. Social activity in particular means a reduction in the time spent for everyday communication, thereby spreading to the immediate environment (colleagues, friends, relatives). In addition, in a state of mild dementia, patients also lose 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, from hobbies. Mild dementia is accompanied by the preservation of existing self-care skills, in addition, patients are adequately oriented within the limits of their home.

moderate dementia leads to a state in which patients can no longer be alone with themselves for a long period of time, which is caused by the loss of skills to use the equipment and devices that surround them (remote control, telephone, stove, etc.), even difficulties are not excluded using door locks. Requires constant monitoring and assistance from others. As part of this form of the disease, patients retain the skills to self-care and perform activities related to personal hygiene. All this, accordingly, complicates the life and environment of patients.

With regard to such a form of the disease as severe dementia, here we are already talking about the absolute maladjustment of patients to what surrounds them, while at the same time the need to provide constant assistance and control, which is necessary even for performing the simplest actions (eating, dressing, hygiene measures, etc.).

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

• cortical dementia - the lesion predominantly affects the cerebral cortex (which occurs against the background of conditions such 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 paralysis, 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 appropriate variant of its course. In particular, this may be lacunar dementia , which implies a predominant memory lesion, manifested in the form of a progressive and fixative form of amnesia. Compensation for such a defect by patients is possible due to important notes on paper, etc. In this case, the emotional-personal sphere 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. Alzheimer's disease is an example of this type of disorder.

Dementia of the Alzheimer's type , the symptoms of which appear after the age of 65, within the initial (initial) stage, proceeds in combination with cognitive-mnestic disorders with an increase in disorders in the form of orientation in place and time, delusional disorders, the appearance of neuropsychological disorders, subdepressive reactions in relation to one's own insolvency . At the initial stage, patients are able to critically assess their condition and take measures to correct it. Moderate dementia within the framework of this condition is characterized by the progression of the listed symptoms with a particularly gross violation of the inherent functions of the intellect (difficulties in conducting analytical and synthetic activities, a reduced level of judgment), the loss of opportunities to perform professional duties, and the need for care and support. All this is accompanied by the preservation of basic personality traits, a sense of one's own inferiority with an adequate response to an existing disease. In the severe stage of this form of dementia, the breakdown of memory occurs in full, support and care are needed in everything and constantly.

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

This pathology is diagnosed less frequently than Alzheimer's disease, mainly among women. Among the main characteristics, actual changes are noted within the emotional-personal sphere and the cognitive sphere. In the first case, the condition implies gross forms of personality disorder, a complete lack of criticism, spontaneous, passive and impulsive behavior; relevant hypersexuality, foul language and rudeness; assessment of the situation is disturbed, there are disorders of drives and will. In the second, with cognitive disorders, there are gross forms of impaired thinking, automated skills persist 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 generally atrophic dementias, while there is also a variant of a mixed form of the disease. (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 consider in a generalized form those signs (symptoms) that characterize dementia. As the most characteristic of them, disorders associated with cognitive functions are considered, and such disorders are the most pronounced in their 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, which occurs 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 a sick person or sexual disinhibition. In the case of personality changes or changes in the behavior of the patient, the question is raised about the relevance of dementia for him, which is especially important if he is over 40 years old and if he does not have a mental illness.

So, let us dwell in more detail on the signs (symptoms) of the disease of interest to us.

• Cognitive disorders. In this case, disorders of memory, attention and higher functions are considered.
  • Memory disorders. Memory disorders in dementia consist in the defeat of both short-term memory and long-term memory, in addition, confabulations are not excluded. Confabulation specifically refers to false memories. Facts from them that occur earlier in reality or facts that occur earlier, but have undergone a certain modification, are transferred by the patient to another time (often in the near future) with their possible combination with events completely fictional by them. A mild form of dementia is accompanied by moderate memory impairment, they are mainly associated with events that occur in the recent past (forgetting conversations, phone numbers, events that occurred within a certain day). Cases of a more severe course of dementia are accompanied by the retention of only previously memorized material in memory with a quick forgetting of newly received information. The last stages of the disease 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 of interest to us, this disorder implies the loss of the ability to respond to several relevant stimuli at once, as well as the 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 in the patient's ability to perform targeted actions. In this case, the skills previously acquired by the patient are lost, and those skills that have been formed over the years (speech, everyday, motor, professional).
    • agnosia determines a violation of various types of perception in a patient (tactile, auditory, visual) while maintaining consciousness and sensitivity.
• orientation disorder. This type of violation occurs in time, and mainly - within the initial stage of the development of the disease. In addition, disorientation in temporal space precedes disorientation on the scale of orientation in place, as well as within the framework of one's own personality (here, the symptom differs in dementia from delirium, 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 a familiar environment.
• Behavioral disorders, personality changes. The onset of these manifestations is gradual. The main features inherent in the personality gradually increase, transforming to the states inherent in this disease as a whole. So, energetic and cheerful people become restless and fussy, and people who are thrifty and tidy, respectively, become greedy. Similarly, transformations inherent in other features are considered. In addition, there is an increase in egoism in patients, the disappearance of responsiveness and sensitivity to the environment, they become suspicious, conflicting and touchy. Sexual disinhibition is also determined, 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. Untidiness 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 the unwillingness of self-service (hygiene, etc.), with uncleanliness and, in general, a lack of reaction to the presence of people next to them.
• Thinking disorders. There is a slowdown in the pace of thinking, as well as a decrease in the ability to think logically and abstract. Patients lose the ability to generalize and solve problems. Their speech is detailed and stereotyped, its scarcity is noted, and with the progression of the disease, it is completely absent. Dementia is also characterized by the possible appearance of delusional ideas in patients, often with ridiculous 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 from her, and this action may go beyond her environment (ie, family or friends). The essence of the nonsense in such an idea lies in the fact that she never had a mink coat at all. Dementia in men within the framework of this disorder often develops according to the scenario of delirium based on jealousy and infidelity of the spouse.
• Reducing the 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 preserve their own intellectual defect, which may look like a sharp change in the topic of conversation, turning the conversation into a joking form, or otherwise distracting from it.
• Emotional disorders. In this case, it is possible to determine the diversity of such disorders and their general 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.
• Perceptual disorders. In this case, the states of the appearance of illusions and hallucinations in patients are considered. For example, with dementia, the patient is sure that he hears the screams of children being killed in it in the next room.

Senile dementia: symptoms

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

Senile dementia, being among the mental illnesses, is the disease most common among the elderly. Senile dementia is almost three times more common 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 the form of presbyophrenia and in the 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 by constitutional and genetic factors.

simple form characterized by low visibility, flowing in the form of disorders generally inherent in aging. With an acute onset, there is reason to believe that pre-existing mental disorders have been aggravated due to 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 (it implies a violation of the ability to concentrate and switch attention, its volume narrows; the ability to generalize and analyze, to abstract and, in general, weakens the imagination is disturbed; the ability for ingenuity and resourcefulness is lost in the framework of solving problems that arise in everyday life).

Increasingly, a sick person adheres to conservatism in terms of their own judgments, worldview and actions. What is happening in the present tense is considered as something insignificant and not worthy of attention, and often is completely rejected. Returning to the past, the patient primarily perceives it as a positive and worthy model in certain life situations. A characteristic feature is a tendency to edification, intractability bordering on stubbornness and increased irritability arising from contradictions or disagreement on the part of the opponent. Pre-existing interests are narrowed to a great extent, especially if they are in one way or another connected with general issues. Increasingly, patients are focusing their own attention on their physical condition, especially physiological functions (ie, bowel movements, urination).

In patients, affective resonance also decreases, which is manifested in the growth of complete indifference to what does not directly concern them. In addition, attachments are also weakening (this applies even to relatives), in general, understanding of the essence of relations between people is lost. Many 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, while adhering to monotonous jokes and a general tendency to jokes, while in other patients discontent, captiousness, capriciousness and pettiness prevail. In any case, the past characterological traits inherent in patients become scarce, and the awareness of 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 applies to authority, greed, categoricalness, etc.) leads to their exacerbation in manifestation at the initial stage of the disease, often to a caricature form (which is defined as senile psychopathization ). Patients become stingy, begin to accumulate rubbish, on their part, various reproaches against the immediate environment are increasingly heard, in particular, this concerns the irrationality, in their opinion, of expenses. Also, morals that have developed in public life are subject to censure on their part, especially in relation to marital relations, intimate life, etc.
The initial psychological shifts, combined with the personality changes that occur with them, are accompanied by a deterioration in memory, in particular, this applies to current events. Surrounding patients, they are noticed, as a rule, later than the changes that have occurred in their character. The reason for this is to revive the memories of the past, which is perceived by the environment as a good memory. Its decay actually corresponds to the patterns that are relevant for a progressive form of amnesia.

So, first, the memory associated with differentiated and abstract topics (terminology, dates, titles, names, etc.) comes under attack, then the fixative form of amnesia is added here, manifesting itself in the form of an inability to remember current events. Amnestic disorientation with respect to time also develops (i.e. patients are not able to indicate a specific date and month, day of the week), chronological disorientation also develops (the impossibility of determining important dates and events with their binding to a specific date, regardless of whether such dates concern private life or public life). On top of this, spatial disorientation develops (it manifests itself, for example, in a situation where, when leaving the house, patients cannot return, etc.).

The development of total dementia leads to a violation of self-recognition (for example, when considering oneself in reflection). Forgetting the events of the present is replaced by the revival of memories relating to the past, often this can relate to youth or even childhood. Often, such a time substitution leads to the fact that patients begin to "live in the past", considering themselves young or children, depending on the time at which such memories fall. 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, habitual performance. Physical insanity is noted already within the framework of a far-reaching disease (complete disintegration of behavior patterns, mental functions, speech skills, often with relative preservation of somatic functions skills).

With a pronounced form of dementia, the states of apraxia, aphasia and agnosia considered by us earlier are noted. Sometimes these disorders manifest themselves in a sharp form, which may resemble the picture of the course of Alzheimer's disease. Few and single epileptic seizures similar to fainting are possible. Sleep disturbances appear in which patients fall asleep and get up at an indefinite time, and the duration of their sleep is on the order of 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 pronounced form of exhaustion sets in, in which there is a sharp weight loss and weakness, reduced activity in terms of physiological processes with concomitant changes in the psyche. In this case, the adoption of the fetal position is characteristic when the patients are in a drowsy state, there is no reaction to surrounding events, sometimes muttering is possible.

Vascular dementia: symptoms

Vascular dementia develops against the background of the previously mentioned disorders that are relevant for cerebral circulation. In addition, as a result of the study of brain structures in patients after their death, it was revealed that vascular dementia often develops after a heart attack. More precisely, the point is not so much in the transfer of the specified 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 affected, but by the total volume of the cerebral arteries that have undergone necrosis.

Vascular dementia is accompanied by a decrease in indicators that are 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) is allowed.

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, acts as a symptom of certain diseases in children, which can be oligophrenia, schizophrenia, and other types of mental disorders. This disease develops in children with a decrease in mental abilities characteristic of it, this manifests itself in a violation of memorization, and in severe cases of the course, 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 in them within the framework of time and space. Dementia in young children manifests itself in the form of a loss of skills previously acquired by them and in the form of a speech disorder (up to its complete loss). The final stage, similar to the general course, is accompanied by the fact that patients cease to follow 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 related to an 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 considered on a phylo- and ontogenetic scale), they are identified as underdeveloped, which makes it possible to attach the disease to oligophrenia.

Intellectual deficiency of a persistent type, which develops in children over the age of 2-3 years against the background of injuries and infections, is defined as organic dementia, the symptoms of which are manifested due to the decay of relatively formed 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;
• a pronounced type of memory and attention impairment;
• emotional disturbances in a more pronounced form, not correlating (i.e., not associated) with the degree of decrease in intellectual abilities that is relevant for the patient;
• frequent development of violations relating to instincts (perverted or increased forms of attraction, performance of actions under the influence of increased impulsivity, weakening of existing instincts (self-preservation instinct, lack of fear, etc.) is not excluded;
• often the behavior of a sick child does not adequately correspond to a specific situation, which also occurs if a pronounced form of intellectual deficiency is irrelevant for him;
• in many cases, the differentiation of emotions is also subject to weakening, there is no attachment to loved ones, and the child is completely indifferent.

Diagnosis and treatment of dementia

Diagnosis of the condition of patients is based on a comparison of their actual symptoms, as well as on the recognition of atrophic processes in the brain, which is achieved through computed tomography (CT).

As far as the treatment of dementia is concerned, there is currently no effective treatment, especially when considering cases of senile dementia, which, as we have 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 considers the need to treat concomitant diseases (with vascular dementia in particular), such as atherosclerosis, arterial hypertension, etc.

Treatment of dementia is recommended within the framework of a home environment, placement in a hospital or a psychiatric department is relevant for a severe degree of development of the disease. It is also recommended to create a daily regimen so that it includes a maximum of vigorous activity with periodic household chores (with an acceptable form of load). The appointment of psychotropic drugs is made only in the case of hallucinations and insomnia, in the early stages it is advisable to use nootropic drugs, then - nootropic drugs in combination with tranquilizers.

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

- Acquired dementia due to organic brain damage. It may be the result of one disease or be polyetiological in nature (senile or senile dementia). It develops with vascular diseases, Alzheimer's disease, trauma, brain neoplasms, alcoholism, drug addiction, CNS infections and some other diseases. There are persistent disorders of the intellect, affective disorders and a decrease in volitional qualities. The diagnosis is established on the basis of 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 the loss of acquired knowledge and skills and a decrease in the ability to learn. Currently, there are more than 35 million patients with dementia in the world. 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 in the future the number of patients will increase. 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 with severe injuries and diseases of the brain.

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

Causes of dementia

Dementia occurs when 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. Alzheimer's disease is the most common cause of acquired dementia, accounting for 60-70% of all cases of dementia. In second place (about 20%) are vascular dementias due to hypertension, atherosclerosis and other similar diseases. In patients suffering from senile (senile) dementia, several diseases are often detected at once, provoking acquired dementia.

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

Classification of dementia

Taking into account the predominant lesion of certain parts of the brain, four types of dementia are distinguished:

• Cortical dementia. The cerebral cortex suffers predominantly. It is observed in alcoholism, Alzheimer's disease and Pick's disease (frontotemporal dementia).
• subcortical dementia. Subcortical structures suffer. Accompanied by neurological disorders (trembling of the limbs, muscle stiffness, gait disorders, etc.). Occurs in Parkinson's disease, Huntington's disease, and bleeding into the white matter.
• Cortical-subcortical dementia. Both the cortex and subcortical structures are affected. It is observed in vascular pathology.
• Multifocal dementia. In various parts of the CNS, multiple areas of necrosis and degeneration are formed. Neurological disorders are very diverse and depend on the localization of lesions.

Depending on the extent of the lesion, there are two forms of dementia: total and lacunar. With lacunar dementia, the structures responsible for certain types of intellectual activity suffer. Short-term memory disorders usually play a leading role in the clinical picture. Patients forget where they are, what they planned to do, what was agreed upon just a few minutes ago. Criticism of his condition is preserved, emotional-volitional disorders are weakly expressed. There may be signs of asthenia: tearfulness, emotional instability. Lacunar dementia is observed in many diseases, including at the initial stage of Alzheimer's disease.

With total dementia, a gradual disintegration of the personality is observed. Intelligence decreases, learning abilities are lost, the emotional-volitional sphere suffers. The range of interests narrows, shame disappears, the former moral and moral norms become insignificant. Total dementia develops with volumetric 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 the primary degeneration of brain neurons.
• Vascular type- damage to nerve cells occurs a second time, due to impaired blood supply to the brain in vascular pathology.
• mixed type- mixed dementia - is a combination of atrophic and vascular dementia.

Symptoms of dementia

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

In moderate dementia, criticism of one's condition is partially impaired. When communicating with the patient, a clear decrease in intelligence is noticeable. The patient hardly serves himself, has difficulty using household appliances and mechanisms: he cannot answer the phone, open or close the door. Needs care and supervision. Severe dementia is accompanied by complete disintegration of the personality. The patient is unable to dress, wash, eat or go to the toilet. Requires constant monitoring.

Clinical variants of dementia

Dementia of the Alzheimer's type

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 over the age of 65 years, senile dementia was diagnosed. Then it was 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, overweight, diabetes mellitus, low physical 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 state. Subsequently, memory disorders are aggravated, while there is a "movement back in time" - the patient first forgets recent events, then - what happened in the past. The patient ceases to recognize his children, takes them for long-dead relatives, does not know what he did this morning, but can tell in detail about the events of his childhood, as if they had happened quite recently. Confabulations can occur at the site of lost memories. Criticism of his condition is reduced.

In the advanced stage of Alzheimer's disease, the clinical picture is supplemented by emotional and volitional disorders. Patients become grouchy and quarrelsome, often show dissatisfaction with the words and actions of others, get annoyed by any little thing. In the future, delusions of damage may occur. Patients claim that relatives deliberately leave them in dangerous situations, put poison in 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 patients. Other behavioral disorders may also be detected: vagrancy, intemperance and promiscuity in food and sex, senseless erratic actions (for example, shifting objects from place to place). Speech is simplified and impoverished, paraphasias arise (the use of other words instead of forgotten ones).

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

Alzheimer's disease is diagnosed based on clinical symptoms. Treatment is symptomatic. Currently, there are no drugs and non-drug methods that can cure patients with Alzheimer's disease. Dementia is steadily progressing and ends with a complete breakdown of mental functions. 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 - which arose after a stroke and 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 the 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 uniform 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 being overweight.

The first sign of the disease is difficulty in trying to concentrate, distracted attention, fatigue, some rigidity of mental activity, planning difficulties and a decrease in the ability to analyze. Memory disorders are less pronounced than in Alzheimer's disease. Some forgetfulness is noted, but with a “push” in the form of a leading question or the proposal of several answers, the patient easily recalls the necessary information. In many patients, emotional instability is revealed, mood is reduced, depression and subdepression are possible.

Neurological disorders include dysarthria, dysphonia, gait changes (shuffling, shortening of stride length, "sticking" of the soles to the surface), slowing of movements, impoverishment of gestures and facial expressions. The diagnosis is made on the basis of the clinical picture, ultrasound and MRA of the cerebral vessels and other studies. To assess the severity of the underlying pathology and draw up a scheme of pathogenetic therapy, patients are referred for consultations to the relevant 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 course of the leading pathology.

Alcoholic dementia

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

After a complete abstinence from alcohol and treatment of alcoholism, partial recovery is possible, however, such cases are very rare. Due to a pronounced pathological craving for alcoholic beverages, a decrease in volitional qualities and a lack of motivation, most patients fail 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 in the presence of five mandatory signs. The first is memory impairment, which is revealed on the basis of a conversation with the patient, a special study and a survey of relatives. The second is at least one symptom indicating an organic brain lesion. Among these symptoms is the “three A” syndrome: aphasia (speech disorders), apraxia (loss of the ability to purposeful actions while maintaining the ability to perform elementary motor acts), agnosia (perception disorders, loss of the ability to recognize words, people and objects with intact touch , hearing and vision); reducing criticism of one's own state 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. Fourth - 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 the data of instrumental studies (CT and MRI of the brain). The diagnosis of "dementia" is made only if all the listed signs are present for six months or more.

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

Prognosis for dementia

The prognosis for dementia is determined by the underlying disease. With acquired dementia, which arose as a result of craniocerebral injuries or volumetric processes (, hematomas), 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 the ability to work, and the outcome of a small injury is severe dementia with disability and vice versa.

In dementias caused by progressive diseases, there is a steady aggravation of symptoms. Doctors can only slow down the process by adequately treating the underlying pathology. The main objectives of therapy in such cases are to maintain self-care skills and adaptive abilities, prolong life, provide proper care and eliminate unpleasant manifestations of the disease. Death occurs as a result of a serious violation of vital functions associated with the immobility of the patient, his inability to elementary self-care and the development of complications characteristic of bedridden patients.

Dementia (translated from Latin - "dementia") is a serious pathology of the nervous system. The main cause of the disease is organic damage to the brain, 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.

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Causes

The main cause of dementia is the degeneration (degeneration) of brain cells or their death.

Factors provoking the development of the disease are also:

Rarely, infectious processes are the causes of dementia:

• Viral encephalitis.
• Acquired immunodeficiency syndrome.
• Chronic meningitis.
• Neurosyphilis and others.

Sometimes a number of reasons contribute to the development of the disease at once. An example is senile mixed dementia.

Alzheimer's disease - symptoms, stages, causes and treatments

Classification

Depending on the location of the organic lesion, several types of dementia are distinguished:

1. 1. Cortical. Occurs as a result of damage to the cerebral cortex (Alzheimer's disease).
2. 2. Subcortical. Differs in the pathology of subcortical structures (Parkinson's disease).
3. 3. Cortical-subcortical. It is typical for diseases based on vascular disorders.
4. 4. Multifocal. Its feature is the defeat of all parts of the brain and the pronounced neurological clinical picture associated with it.

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.	violation of short-term memory; change of mood; tearfulness; exacerbation of sensitivity
Total. It is characterized by a complete disintegration of the personality. The reason is the defeat of the frontal lobes of the brain, which lead to vascular and atrophic diseases, as well as tumors.	violations of intellectual and cognitive activity; the disappearance of spiritual values; loss of vital interests, feelings of shame and duty; absolute social maladaptation

Depending on the severity, dementia is distinguished:

1. 1. Light degree. It is characterized by minor violations of intellectual activity and the preservation of an understanding of one's own state. The presence of the disease practically does not affect the life of the patient.
2. 2. Moderate. In this case, there is a decrease in intelligence and critical awareness of the disease. Patients can hardly use household appliances, telephones and need care from other people.
3. 3. Severe degree. It is characterized by the absolute disintegration of personality. Patients need constant care, as they are unable to perform the elementary actions necessary for life.

Common types of dementia of the elderly (presenile) and senile (senile) age:

1. 1. Atrophic, or Alzheimer's. Occurs during the primary degeneration of nerve cells.
2. 2. Vascular. This is a secondary lesion, which is based on the pathology of the blood vessels of the brain.
3. 3. Mixed. Includes primary and secondary brain lesions.

Age has a huge impact on the occurrence 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 characteristic sign of dementia is impaired cognitive functions, as well as emotional and behavioral disorders. Pathology develops gradually and reveals itself with an exacerbation of the underlying disease or with a change of scenery.

The main signs of dementia:

1. 1. Violation of cognitive (cognitive) function. These include:
• Memory disorders. Depending on the severity, both short-term and long-term impairments can be disturbed. Often there is confabulation - false memories. A mild degree is characterized by a moderate impairment of memory and is accompanied by forgetting the events of the recent past. The severe form is accompanied by a rapid loss of new information up to the loss of the names of loved ones, one's own name 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.
1. 2. Violation of temporal and spatial orientation.
2. 3. Disorder of conduct and personality. The transformation of character is manifested by the 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.
3. 4. Disorder of thinking. A distinctive feature is his inhibition, a decrease in the ability to reason logically, solve problems and generalize. Often there is scarcity of speech and delusional ideas.
4. 5. Lowering the critical ratio. This determines the patient's perception of himself and the world around him. It is possible that an anxiety-depressive disorder may arise against the background of awareness of one's own intellectual inferiority.
5. 6. Emotional disturbance. It has great diversity and variability. Often occur:
• depression.
• Irritability.
• Aggression.
• Anxiety.
• Tearfulness.
• Malice.
• Insensitivity to everything.
• manic states.
• Carelessness.
• Gaiety.
1. 7. Disorder of perception. It is expressed by the appearance of visual, auditory hallucinations and illusions.



Clinical varieties

The symptoms and treatment of dementia can vary. It depends on the type of pathology.

Distinguish:

1. 1. Dementia in Alzheimer's disease.
2. 2. Against the background of vascular pathology.
3. 3. Senile dementia with Lewy bodies.
4. 4. Alcoholic dementia.
5. 5. Epileptic.

Dementia in Alzheimer's disease

Alzheimer's dementia is a common form of senile dementia. It accounts for 35–60% of actual organic lesions. The disease occurs more frequently in women than in men.

Predisposing factors for dementia of the Alzheimer's type:

1. 1. Age about 80 years old.
2. 2. Hereditary predisposition.
3. 3. Hypertension.
4. 4. Excess levels of lipids in the blood.
5. 5. Atherosclerosis.
6. 6. Diabetes.
7. 7. Sedentary lifestyle.
8. 8. Obesity.
9. 9. Chronic hypoxia of various etiologies.
10. 10. Traumatic brain injury.
11. 11. Low degree of education.
12. 12. Lack of intellectual pursuits throughout life.

Signs of dementia differ depending on the stage of the disease:

Stage	Symptoms
Initial (first signs)	a sharp decrease in memory of recent events; anxiety and absent-mindedness due to awareness of one's condition
deployed	progression of memory loss, in which only significant events are saved; false memories; the patient's loss of criticism of his condition; emotional-volitional disorders in the form of egocentrism, suspicion, grouchiness and conflict; delirium of damage - the accusation of surrounding people of theft, the desire for his death, and so on; sexual emancipation; a tendency to gluttony; vagrancy; fussiness
heavy	the collapse of the delusional system; disappearance of behavioral disorders; complete apathy; lack of hunger and thirst; movement disorders with a tendency to complete immobilization

The diagnosis of this type of dementia is based on the clinical presentation and suggests differentiation from vascular dementia. Often this can be done only after the death of the patient.

Treatment involves managing symptoms and stabilizing the patient's condition. This is a complex process, including the mandatory therapy of the underlying disease. Depending on the stage of the pathology, various drugs are used:

1. 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.
1. 2. At the advanced stage, acetylcholinesterase inhibitors (Donepezil) are recommended to improve the social adaptation of patients.

Dementia of the Alzheimer's type is a steadily progressive disease. Its 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 smaller it is, the faster the disease intensifies.

Vascular dementia

Dementia of a vascular nature is second only to dementia of the Alzheimer's type. It makes up about 20% of all types of pathology.

Common causes and risk factors for vascular dementia include:

The clinical picture of dementia of a vascular nature includes:

1. 1. Violations of concentration.
2. 2. The complexity of switching from one subject of activity to another.
3. 3. Slowdown of the intellect.
4. 4. Difficulties in organizing life, for example, making plans.
5. 5. Problems in the analysis of information.
6. 6. Emotional disorders, which are expressed in frequent changes in mood or its decrease up to depression.
7. 7. Neurological symptoms:
   1. Pseudobulbar syndrome, including:
      1. Dysarthria is a violation of articulation.
      2. 8. Dysphonia - a change in voice coloring.
      3. 9. Dysphagia - a violation of swallowing.
      4. 10. Unnatural laughter and crying.
8. Gait disorders.
9. Decreased motor activity, characterized by poor facial expressions and gestures, slow movements.

Treatment of 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 dementias that developed against the background of hemorrhagic and ischemic stroke. They are characterized by significant death of brain cells and severe focal symptoms, depending on the location of the lesion. Post-stroke dementia is characterized by a variety of clinics 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, the hallmark 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 dementias. Very often, patients are mistakenly diagnosed with vascular dementia or Parkinson's disease.

Symptoms of dementia with Lewy bodies:

Features of symptoms:

1. 1. Small fluctuations - temporary inability to concentrate and complete the task.
2. 2. Large fluctuations - a violation of the recognition of people, locations, objects. Sometimes there is disorientation in space and confusion.
3. 3. Visual illusions and hallucinations.
4. 4. Behavioral disorder during sleep (sudden movements, injury).
5. Vegetative disorders:
   • Orthostatic hypotension - a sharp drop in blood pressure when changing body position from horizontal to vertical.
   • Arrhythmia.
   • Fainting.
   • Constipation.
   • Urinary retention.

Therapy for senile dementia with Lewy bodies includes:

1. 1. Acetylcholinesterase inhibitors - Donepezil.
2. 2. Atypical antipsychotics - Clozapine.
3. 3. Levodopa in small doses - used for symptoms of parkinsonism.

Dementia with Lewy bodies is a rapidly progressive disease. It takes about 4-5 years to develop.

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:

1. 1. Decrease in intelligence:
   1. 2. Deterioration of memory.
   2. 2. Reduced concentration.
   3. 3. Loss of abstract thinking and others.
1. 2. Degradation of personality:
   1. Emotional callousness.
   2. 3. Destruction of social ties.
   3. 4. Primitive thinking.
   4. 5. Loss of vital values.

The prognosis is favorable. With a complete refusal to drink alcohol during the year, dementia regresses and organic brain damage smooths 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:

1. 1. Inhibition of thinking.
2. 2. Deterioration of memory.
3. 3. Scarcity of vocabulary.
4. 4. Decreased intelligence against the background of changes in individual personality traits:
   1. Selfishness.
   2. 5. Vengeance.
   3. 6. Viciousness.
   4. 7. Bigotry.
   5. 8. Suspicion.
   6. 9. Quarrelsome.
   7. 10. Pedantry.

Epileptic dementia is an invariably progressive disease. In a severe course, malice disappears, but obsequiousness and hypocrisy remain, as well as apathy and indifference to everything.

Symptoms of childhood dementia

Dementia mostly occurs in adults. In children, it acts as a symptom of certain pathologies:

1. 1. Oligophrenia.
2. 2. Schizophrenia.
3. 3. Other mental disorders.

The signs of dementia are:

1. 1. Decrease in mental abilities, manifested by a violation of memorization, up to the inability to restore one's own name.
2. 2. Loss of some information from memory.
3. 3. Spatial and temporal disorientation.
4. 4. Loss of previously acquired skills.
5. 5. Violation of speech or its complete loss.
6. 6. Sloppiness.
7. 7. Uncontrolled defecation and urination.

Persistent intellectual disability that occurs in a child over the age of 2-3 years on the background of an injury or infection is considered organic dementia with its characteristic symptoms:

• lack of thinking and criticism;
• severe deterioration of memory and attention;
• emotional disturbances;
• pathology of instincts (increased or perverted attraction, excessive impulsivity, lack of fear and weakening of the instinct of self-preservation;
• inconsistency of the child's behavior with a specific situation;
• lack of attachment to relatives;
• absolute indifference of the child.

Diagnostics

Clear criteria for diagnosing dementia are:

1. 1. Memory disorders (long-term and short-term).
2. 2. Presence of one of the following pathologies:
   1. Gradual loss of abstract thinking.
   2. 3. Decreased perception criticism.
   3. 4. Aphasia.
   4. 5. Apraxia.
   5. 6. Agnosia.
   6. 7. Change in personality traits (aggressiveness, rudeness, lack of shame).
1. 3. Social maladaptation.
2. 4. The absence of hallucinations, temporal, spatial and personal disorientation - as far as the patient's condition allows at the time of diagnosis.
3. 5. The presence of an organic lesion on the basis of anamnesis and instrumental diagnosis.

To accurately determine the disease, the presence of all signs for six months is necessary. Otherwise, a hypothetical conclusion is made.

Differential diagnosis is carried out in relation to depressive pseudodementia. This is a complex process that requires long-term monitoring of the patient.

Treatment

Currently, there is no effective treatment for dementia, especially senile. The main therapy is aimed at caring for the patient, relieving symptoms, eliminating concomitant pathologies and observing the daily regimen with maximum activity.

Psychotropic drugs are prescribed only in case of insomnia and hallucinations. Their reception is limited to nootropics and tranquilizers.

Forecast

The clinical picture and prognosis of dementia depend on the underlying cause that contributes to the occurrence of an organic lesion of 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 only slows down the process of personal and social maladaptation, prolongs the life of the patient, relieves unpleasant symptoms.

In the case of a rapidly progressive underlying disease, an extremely unfavorable prognosis is noted. The death of the patient occurs within a few years or months after the onset of the first symptoms of the pathology. The cause of death is comorbidities that develop as a result of a violation of the central regulation of organs and systems.