Dementia due to mixed medical conditions. Forms of dementia. Features of the course of senile dementia

Dementia is a persistent violation of higher nervous activity, accompanied by a loss of acquired knowledge and skills and a decrease in the ability to learn. There are currently over 35 million dementia patients worldwide. It develops as a result of brain damage, against the background of which the noted decay of mental functions occurs, which in general makes it possible to distinguish this disease from mental retardation, congenital or acquired forms of dementia.

What kind of disease it is, why dementia occurs more often at an older age, and what symptoms and first signs are characteristic of it - let's look further.

Dementia - what is it?

Dementia is insanity, expressed in the decay of mental functions, which occurs due to brain damage. The disease must be differentiated from oligophrenia - congenital or acquired infant dementia, which is an underdevelopment of the psyche.

With dementia patients are not capable of realizing what is happening to them, the disease literally "erases" everything from their memory that was accumulated in it during the previous years of life.

Dementia syndrome manifests itself in many ways. These are violations of speech, logic, memory, causeless depressive states. People with dementia are forced to quit their jobs because they need constant treatment and supervision. The disease changes the life of not only the patient, but also his loved ones.

Depending on the degree of the disease, its symptoms and the patient's reaction are expressed in different ways:

With mild dementia, he is critical of his condition and is able to take care of himself.
With a moderate degree of damage, there is a decrease in intelligence and difficulties in everyday behavior.
Severe dementia - what is it? The syndrome denotes a complete disintegration of the personality, when an adult cannot even relieve himself and eat on his own.

Classification

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

Cortical dementia. It is mainly the cerebral cortex that suffers. It is observed in alcoholism, Alzheimer's disease and Pick's disease (frontotemporal dementia).
Subcortical dementia. Subcortical structures suffer. It is accompanied by neurological disorders (tremors of the limbs, muscle stiffness, gait disorders, etc.). Occurs with, Huntington's disease and white matter hemorrhage.
Cortical-subcortical dementia is a mixed type of lesion characteristic of pathology caused by vascular disorders.
Multifocal dementia is a pathology characterized by multiple lesions in all parts of the central nervous system.

Senile dementia

Senile (senile) dementia (dementia) is severe dementia that manifests itself at the age of 65 and older. The disease is most often caused by a rapid atrophy of the cells of the cerebral cortex. First of all, the patient's reaction rate, mental activity slows down and short-term memory deteriorates.

The mental changes that develop in senile dementia are associated with irreversible changes in the brain.

These changes occur at the cellular level, due to a lack of nutrition, neurons die. This condition is called primary dementia.
If there is a disease due to which the nervous system has suffered, the disease is called secondary. Such diseases include Alzheimer's disease, Huntington's disease, spastic pseudosclerosis (Creutzfeldt-Jakob disease), etc.

Vascular dementia

Vascular dementia is understood as a violation of mental acts, which is caused by problems with blood circulation in the vessels of the brain. Moreover, such violations significantly affect the patient's lifestyle, his activity in society.

This form of the disease usually occurs after a stroke or heart attack. Vascular dementia - what is it? This is a whole complex of signs that are characterized by a deterioration in the behavioral and mental abilities of a person after damage to the cerebral vessels. With mixed vascular dementia, the prognosis is the most unfavorable, since it affects several pathological processes.

In this case, as a rule, dementia developed after vascular accidents, such as:

Hemorrhagic stroke (vessel rupture).
(blockage of the vessel with the cessation or deterioration of blood circulation in a certain area).

Most often, vascular dementia occurs in hypertension, less often in severe diabetes mellitus and some rheumatic diseases, even less often in embolism and thrombosis due to skeletal injuries, increased blood clotting and peripheral vein diseases.

Older patients should be under control of their underlying medical conditions that can cause dementia. These include:

hypertension or hypotension,
atherosclerosis,
ischemia
diabetes mellitus, etc.

Dementia is promoted by a sedentary lifestyle, lack of oxygen, and addictions.

Alzheimer's type dementia

The most common type of dementia. It refers to organic dementia (a group of dementia syndromes that develop against the background of organic changes in the brain, such as cerebrovascular disease, traumatic brain injury, senile or syphilitic psychoses).

In addition, this disease is quite closely intertwined with types of dementias with Lewy bodies (a syndrome in which the death of brain cells occurs due to Lewy bodies formed in neurons), having many common symptoms with them.

Dementia in children

The development of dementia is associated with the influence on the child's body of various factors that can cause disturbances in the functioning of the brain. Sometimes the disease is present from the birth of the baby, but manifests itself as the child grows.

Children are distinguished:

residual organic dementia,
progressive.

These types are divided depending on the nature of the pathogenetic mechanisms. With meningitis, a residual-organic form may appear, it also occurs with significant craniocerebral trauma, and poisoning of the central nervous system with drugs.

The progressive type is considered an independent disease that can be part of the structure of hereditary-degenerative defects and diseases of the central nervous system, as well as lesions of the cerebral vessels.

With dementia, a child may become depressed. Most often, this is characteristic of the early stages of the disease. The progressive illness impairs the mental and physical abilities of children. If you do not work to slow down the disease, the child can lose a significant part of the skills, including domestic ones.

For any type of dementia, loved ones, family members, and family members should treat the patient with understanding. After all, it is not his fault that he sometimes does inadequate things, this is what the disease does. We ourselves should think about preventive measures so that the disease does not strike us in the future.

Causes

After 20 years, the human brain begins to lose nerve cells. Therefore, small problems with short-term memory are quite normal for older people. A person can forget where he put the keys to the car, what is the name of the person with whom he was introduced at a visit a month ago.

Such age-related changes happen to everyone. They usually do not lead to problems in everyday life. In dementia, the disorder is much more pronounced.

The most common causes of dementia are:

Alzheimer's disease (up to 65% of all cases);
vascular damage caused by atherosclerosis, impaired circulation and blood properties;
alcohol abuse and drug addiction;
Parkinson's disease;
Pick's disease;
traumatic brain injury;
endocrine diseases (thyroid problems, Cushing's syndrome);
autoimmune diseases (multiple sclerosis, lupus erythematosus);
infections (AIDS, chronic, encephalitis, etc.);
diabetes;
severe diseases of internal organs;
a consequence of complications of hemodialysis (blood purification),
severe renal or hepatic impairment.

In some cases, dementia develops as a result of multiple causes. Senile (senile) mixed dementia is a classic example of such a pathology.

Risk factors include:

age over 65;
hypertension;
elevated blood lipids;
obesity of any degree;
lack of physical activity;
lack of intellectual activity for a long time (from 3 years);
low estrogen levels (applies only to the female sex), etc.

First signs

The first signs of dementia are a narrowing of the horizons and personal interests, a change in the patient's character. Patients develop aggression, anger, anxiety, apathy. The person becomes impulsive and irritable.

The first signs that you must definitely pay attention to:

The first symptom of a disease of any typology is memory disorder, which is rapidly progressing.
The individual's reactions to the surrounding reality become irritable, impulsive.
Human behavior is filled with regression: rigidity (cruelty), stereotype, slovenliness.
Patients stop washing and dressing, and their professional memory is impaired.

These symptoms rarely signal others about an impending illness; they are attributed to the prevailing circumstances or to a bad mood.

Stages

In accordance with the possibilities of social adaptation of the patient, there are three degrees of dementia. In cases where the disease that caused dementia has a steadily progressive course, it is often said about the stage of dementia.

Easy

The disease develops gradually, so patients and their relatives often do not notice its symptoms and do not go to the doctor in time.

The mild stage is characterized by significant violations of the intellectual sphere, but the patient's critical attitude to his own state remains. The patient can live independently, as well as perform household activities.

Moderate

The moderate stage is marked by the presence of gross intellectual impairments and a decrease in the critical perception of the disease. Patients experience difficulties in using household appliances (washing machine, stove, TV), as well as door locks, telephone, latches.

Severe dementia

At this stage, the patient is almost completely dependent on loved ones and needs constant care.

Symptoms:

complete loss of orientation in time and space;
it is difficult for the patient to recognize relatives, friends;
constant care is required, in the later stages the patient cannot eat himself and perform the simplest hygienic procedures;
behavioral disturbances increase, the patient may become aggressive.

Dementia symptoms

Dementia is characterized by its manifestation from many sides simultaneously: changes occur in speech, memory, thinking, attention of the patient. These and other functions of the body are disturbed relatively evenly. Even the initial stage of dementia is characterized by very significant impairments, which will certainly affect a person as a person and a professional.

In a state of dementia, a person not only loses ability show previously acquired skills, but also loses the opportunity get new skills.

Symptoms:

Memory problems... It all starts with forgetfulness: a person does not remember where he put this or that object, what he just said, what happened five minutes ago (fixative amnesia). At the same time, the patient remembers in all details what happened many years ago, both in his life and in politics. And if he has forgotten something, he almost involuntarily begins to include fragments of fiction.
Thought disorders... There is a slowdown in the pace of thinking, as well as a decrease in the ability for logical thinking and abstraction. 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 an absurd and primitive content.
Speech . At first it becomes difficult to find the right words, then you may get stuck on the same words. In later cases, speech becomes intermittent, sentences do not end. With good hearing, he does not understand speech addressed to him.

Common cognitive disorders include:

memory impairment, forgetfulness (most often people close to the patient notice this);
communication difficulties (for example, problems with the choice of words and definitions);
obvious deterioration in the ability to solve logical problems;
problems with making decisions and planning their actions (disorganization);
coordination disorders (unsteadiness of gait, falls);
disorders of motor functions (imprecision of movements);
disorientation in space;
disturbances of consciousness.

Psychological disorders:

, depressed state;
unmotivated feeling of anxiety or fear;
personality changes;
behavior that is unacceptable in society (constant or episodic);
pathological excitement;
paranoid delusions (experiences);
hallucinations (visual, auditory, etc.).

Psychoses - hallucinations, manic states, or - occur in about 10% of patients with dementia, although in a significant percentage of patients the onset of these symptoms is temporary.

Diagnostics

Brain scan of normal (left) and dementia (right)

Dementia is treated by a neurologist. Patients are also consulted by a cardiologist. If severe mental disorders develop, psychiatric help is required. Often such patients end up in psychiatric institutions.

The patient must undergo a comprehensive examination, which includes:

a conversation with a psychologist and, if required, with a psychiatrist;
dementia tests (short scale for assessing mental status, "FAB", "BPD" and others) electroencephalography
instrumental diagnostics (blood tests for HIV, syphilis, thyroid hormone levels; electroencephalography, CT and MRI of the brain, and others).

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

Treatment

How is dementia treated? Most types of dementia are currently considered incurable. Nevertheless, therapeutic techniques have been developed to control a significant part of the manifestations of this disorder.

The disease completely changes the character of a person and his desires, therefore one of the main components of therapy is harmony in the family and in relation to loved ones. At any age, help and support, the sympathy of loved ones is needed. If the situation around the patient is unfavorable, then it is very difficult to achieve any progress and improve the condition.

When prescribing medications, you need to remember the rules that must be followed so as not to harm the patient's health:

All medications have their own side effects that must be taken into account.
The patient will need help and supervision to take medication regularly and on time.
The same drug can act differently at different stages, so therapy needs periodic correction.
Many of the drugs can be dangerous if taken in large quantities.
Individual drugs may not work well with each other.

Patients with dementia are poorly educated, it is difficult for them to be interested in new ones in order to compensate somehow for the lost skills. It is important to understand during treatment that this is an irreversible disease, that is, incurable. Therefore, the question is about the patient's adaptation to life, as well as quality care for him. Many devote a certain period of time to caring for the sick, looking for caregivers, quitting their jobs.

Prognosis for people with dementia

Dementia is usually progressive. However, the rate (speed) of progression varies widely and depends on a number of reasons. Dementia shortens life expectancy, but estimates of survival vary.

Measures that ensure safety and provide an appropriate environment for life are of the utmost importance in treatment, as is the care of a caregiver. Certain medications may be helpful.

Prophylaxis

In order to prevent the occurrence of this pathological condition, doctors recommend to engage in prevention. What is required for this?

Follow a healthy lifestyle.
Give up bad habits: smoking and alcohol.
Control blood cholesterol levels.
Eat well.
Monitor blood sugar levels.
Timely engage in the treatment of emerging ailments.
Spend time doing intellectual activities (reading, doing crossword puzzles, and so on).

This is all about dementia in the elderly: what is this disease, what are its main symptoms and signs in men and women, is there a cure. Be healthy!

Are dementia and dementia the same thing? How does dementia develop in children? What is the difference between childhood dementia and mental retardation
Is unexpected untidiness the first sign of senile dementia? Are untidy and untidy symptoms always present?
What is mixed dementia? Does it always lead to disability? How is mixed dementia treated?
Among my relatives there were patients with senile dementia. How likely is it that I will develop a mental disorder? What is the prevention of senile dementia? Are there any medications that can prevent the disease?

The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!

What is dementia syndrome?

Dementia is a severe disorder of higher nervous activity caused by organic damage to the brain, and manifested, first of all, by a sharp decrease in mental abilities (hence the name - dementia in Latin means dementia).

The clinical picture of dementia depends on the cause that caused organic brain damage, on the localization and extent of the defect, as well as on the initial state of the body.

However, all cases of dementia are characterized by pronounced persistent disorders of higher intellectual activity (memory impairment, decreased ability for abstract thinking, creativity and learning), as well as more or less pronounced violations of the emotional-volitional sphere, from the accentuation of character traits (the so-called "caricature") until the complete disintegration of the personality.

Causes and types of dementia

Since the morphological basis of dementia is a severe organic lesion of the central nervous system, the cause of this pathology can be any disease that can cause degeneration and death of cells of the cerebral cortex.

First of all, specific types of dementia should be distinguished, in which the destruction of the cerebral cortex is an independent and leading pathogenetic mechanism of the disease:

Alzheimer's disease;
dementia with Lewy bodies;
Pick's disease, etc.

In other cases, damage to the central nervous system is secondary, and is a complication of the underlying disease (chronic vascular pathology, infection, trauma, intoxication, systemic damage to the nervous tissue, etc.).

The most common cause of secondary organic brain damage is vascular disorders, in particular atherosclerosis of the cerebral vessels and hypertension.

Common causes of dementia include alcoholism, tumors of the central nervous system, and head injuries.

Less commonly, the cause of dementia is infections - AIDS, viral encephalitis, neurosyphilis, chronic meningitis, etc.

In addition, dementia can develop:

as a complication of hemodialysis;
as a complication of severe renal and hepatic failure;
with some endocrine pathologies (thyroid disease, Cushing's syndrome, pathology of the parathyroid glands);
with severe autoimmune diseases (systemic lupus erythematosus, multiple sclerosis).

In some cases, dementia develops as a result of multiple causes. Senile (senile) mixed dementia is a classic example of such a pathology.

Functional and anatomical types of dementia

Depending on the predominant localization of an organic defect that has become a morphological substrate of pathology, four types of dementia are distinguished:
1. Cortical dementia is a predominant lesion of the cerebral cortex. This type is most typical for Alzheimer's disease, alcoholic dementia, Pick's disease.
2. Subcortical dementia. With this kind of pathology, the subcortical structures are primarily affected, which causes neurological symptoms. A typical example is Parkinson's disease with a predominant lesion of the neurons of the substantia nigra of the midbrain, and specific motor disorders: tremor, general muscle stiffness ("puppet gait", mask-like face, etc.).
3. Cortical-subcortical dementia is a mixed type of lesion characteristic of pathology caused by vascular disorders.
4. Multifocal dementia is a pathology characterized by multiple lesions in all parts of the central nervous system. Steadily progressing dementia is accompanied by severe and varied neurological symptoms.

Forms of dementia

Clinically distinguish between lacunar and total forms of dementia.

Lacunar

For lacunar dementia, peculiar isolated lesions of the structures responsible for intellectual activity are characteristic. In this case, as a rule, short-term memory suffers most, so that patients are forced to constantly take notes on paper. For the most pronounced feature, this form of dementia is often called dysmnestic dementia (dysmenia is literally memory impairment).

However, a critical attitude towards one's condition remains, and the emotional-volitional sphere suffers insignificantly (most often only asthenic symptoms are expressed - emotional lability, tearfulness, increased sensitivity).

A typical example of lacunar dementia is the early stages of the most common form of dementia, Alzheimer's disease.

Total

Total dementia is characterized by the complete disintegration of the personality nucleus. In addition to pronounced violations of the intellectual and cognitive sphere, gross changes in emotional and volitional activity are observed - a complete devaluation of all spiritual values occurs, as a result of which vital interests diminish, a sense of duty and shyness disappears, and a complete social maladjustment occurs.

The morphological substrate of total dementia is lesions of the frontal lobes of the cerebral cortex, which often occurs in vascular disorders, atrophic (Pick's disease) and volumetric processes of the corresponding localization (tumors, hematomas, abscesses).

Basic classification of presenile and senile dementia

The likelihood of developing dementia increases with age. So if in adulthood the proportion of patients with dementia is less than 1%, then in the age group after 80 years it reaches 20%. Therefore, it is especially important to classify dementia that occurs at a later age.

There are three types of dementias most common in presenile and senile (pre-senile and senile) age:
1. Alzheimer's (atrophic) type of dementia, which is based on primary degenerative processes in nerve cells.
2. Vascular type of dementia, in which degeneration of the central nervous system develops a second time, as a result of gross circulatory disorders in the vessels of the brain.
3. Mixed type, which is characterized by both mechanisms of the development of the disease.

Clinical course and prognosis

The clinical course and prognosis of dementia depend on the cause of the organic defect in the central nervous system.

In cases where the underlying pathology is not prone to development (for example, with post-traumatic dementia), with adequate treatment, significant improvement is possible due to the development of compensatory reactions (other parts of the cerebral cortex take over part of the functions of the affected area).

However, the most common types of dementia - Alzheimer's disease and vascular dementia - tend to progress, therefore, when they talk about treatment, then with these diseases it is only about slowing down the process, social and personal adaptation of the patient, prolonging his life, relieving unpleasant symptoms, etc. .P.

And finally, in cases where the disease that caused dementia progresses rapidly, the prognosis is extremely unfavorable: the death of the patient occurs several years or even months after the first signs of the disease appear. The cause of death, as a rule, is various concomitant diseases (pneumonia, sepsis), developing against the background of violations of the central regulation of all organs and systems of the body.

The severity (stage) of dementia

Mild degree

With a mild degree of dementia, despite significant violations of the intellectual sphere, the patient's critical attitude to his own condition remains. So the patient may well live independently, performing the usual household activities (cleaning, cooking, etc.).

Moderate degree

With a moderate degree of dementia, there are more gross intellectual impairments and a reduced critical perception of the disease. At the same time, patients experience difficulties when using ordinary household appliances (stove, washing machine, TV), as well as a telephone, door locks and latches, therefore, in no case should the patient be left to himself completely.

Severe dementia

In severe dementia, the personality collapses completely. Such patients often cannot eat food on their own, observe basic hygiene rules, etc.

Therefore, in the case of severe dementia, it is necessary to monitor the patient hourly (at home or in a specialized institution).

Diagnostics

To date, clear criteria for the diagnosis of dementia have been developed:
1. Signs of memory impairment - both long-term and short-term (subjective data from a survey of a patient and his relatives are supplemented by objective research).
2. The presence of at least one of the following disorders characteristic of organic dementia:

signs of a decrease in the ability to abstract thinking (according to objective research);
symptoms of a decrease in the criticality of perception (found when building real plans for the next period of life in relation to oneself and others);
syndrome three "A":
- aphasia - all sorts of violations of already formed speech;
- apraxia (literally "inactivity") - difficulties in performing targeted actions while maintaining the ability to move;
- agnosia - a variety of disturbances in perception with the preservation of consciousness and sensitivity. For example, the patient hears sounds, but does not understand the speech addressed to him (auditory-verbal agnosia), or ignores a part of the body (does not wash or does not put shoes on one leg - somatoagnosia), or does not recognize certain objects or faces of people with preserved vision (visual agnosia) etc.;
personal changes (rudeness, irritability, the disappearance of shame, a sense of duty, unmotivated attacks of aggression, etc.).

3. Disruption of social interactions in the family and at work.
4. Absence of manifestations of delirious changes in consciousness at the time of diagnosis (there are no signs of hallucinations, the patient is oriented in time, space and his own personality, as far as the state allows).
5. Certain organic defect (results of special studies in the patient's medical history).

It should be noted that in order to make a reliable diagnosis of dementia, it is necessary that all of the above symptoms be observed for at least 6 months. Otherwise, we can only talk about a presumptive diagnosis.

Differential diagnosis of organic dementia

Differential diagnosis of organic dementia should be carried out, first of all, with depressive pseudodementia. In severe depression, the severity of mental disorders can reach a very high degree, and make it difficult for the patient to adapt to everyday life, simulating the social manifestations of organic dementia.

Pseudodementia also often develops after severe psychological shock. Some psychologists explain this kind of sharp decline in all cognitive functions (memory, attention, the ability to perceive and meaningfully analyze information, speech, etc.), as a protective response to stress.

Another type of pseudodementia is the weakening of mental abilities in metabolic disorders (vitamin deficiency B 12, lack of thiamine, folic acid, pellagra). With the timely correction of violations, the signs of dementia are completely eliminated.

Differential diagnosis of organic dementia and functional pseudodementia is rather difficult. According to international researchers, about 5% of dementias are completely reversible. Therefore, the only guarantee of a correct diagnosis is long-term observation of the patient.

Alzheimer's type dementia

Understanding dementia in Alzheimer's

Dementia of the Alzheimer's type (Alzheimer's disease) got its name from the name of the doctor who first described the clinic of pathology in a 56-year-old woman. The doctor was alarmed by the early manifestation of signs of senile dementia. Posthumous research showed a kind of degenerative changes in the cells of the patient's cerebral cortex.

Subsequently, such violations were found in those cases when the disease manifested itself much later. This was a revolution in views on the nature of senile dementia - before that it was believed that senile dementia is a consequence of atherosclerotic lesions of the cerebral vessels.

Dementia of the Alzheimer's type today is the most common type of senile dementia, and, according to various estimates, from 35 to 60% of all cases of organic dementia.

Risk factors for developing the disease

The following risk factors for the development of Alzheimer's type dementia exist (ranked in decreasing order of importance):

age (the most dangerous line is 80 years);
the presence of relatives suffering from Alzheimer's disease (the risk increases many times if the pathology in relatives has developed before the age of 65);
hypertonic disease;
atherosclerosis;
elevated plasma lipids;
obesity;
sedentary lifestyle;
diseases occurring with chronic hypoxia (respiratory failure, severe anemia, etc.);
traumatic brain injury;
low level of education;
lack of active intellectual activity during life;
female.

First signs

It should be noted that degenerative processes in Alzheimer's disease begin years, and even decades before the first clinical manifestations. The first signs of dementia of the Alzheimer's type are very characteristic: patients begin to notice a sharp decrease in memory for recent events. At the same time, a critical perception of their condition persists for a long time, so that patients often feel quite understandable anxiety and confusion, and turn to a doctor.

For memory impairment in dementia of the Alzheimer's type, the so-called Ribot's law is characteristic: first, short-term memory is disturbed, then recent events are gradually erased from memory. Memories of a distant time (childhood, adolescence) are preserved for the longest time.

Characteristics of the advanced stage of progressive dementia of the Alzheimer's type

At the advanced stage of dementia of the Alzheimer's type, memory disorders progress, so that in some cases only the most significant events are remembered.

Memory gaps are often replaced by fictional events (so-called confabulations- false memories). The criticality of perception of one's own state is gradually lost.

At the advanced stage of progressive dementia, disorders of the emotional-volitional sphere begin to appear. The following disorders are most characteristic of senile dementia of the Alzheimer's type:

egocentrism;
grouchiness;
suspicion;
conflicts.

These signs are called senile (senile) personality restructuring. In the future, against their background, a very specific for dementia of the Alzheimer's type may develop. delirium damage: the patient blames relatives and neighbors for being constantly robbed, wishes for his death, etc.

Other types of violations of normal behavior often develop:

sexual incontinence;
gluttony with a particular taste for sweets;
craving for vagrancy;
fussy chaotic activities (walking from corner to corner, shifting things, etc.).

At the stage of severe dementia, the delusional system disintegrates, and behavioral disorders disappear due to extreme weakness of mental activity. Patients are immersed in complete apathy, do not experience hunger and thirst. Movement disorders soon develop, so patients cannot walk and chew food normally. Death occurs from complications due to complete immobility, or from concomitant diseases.

Diagnosis of Alzheimer's type dementia

The diagnosis of dementia of the Alzheimer's type is made on the basis of the characteristic clinical picture of the disease, and is always probabilistic in nature. Differential diagnosis between Alzheimer's disease and vascular dementia is difficult enough that often the final diagnosis can only be made posthumously.

Treatment

Treatment for dementia of the Alzheimer's type is aimed at stabilizing the process and reducing the severity of existing symptoms. It should be comprehensive and include therapy for diseases that aggravate dementia (hypertension, atherosclerosis, diabetes mellitus, obesity).

In the early stages, the following drugs showed a good effect:

homeopathic remedy ginkgo biloba extract;
nootropics (piracetam, cerebrolysin);
medicines that improve blood circulation in the vessels of the brain (nicergoline);
a stimulant of dopamine receptors in the central nervous system (piribedil);
phosphatidylcholine (part of acetylcholine - a mediator of the central nervous system, therefore it improves the functioning of neurons in the cerebral cortex);
actovegin (improves the utilization of oxygen and glucose by brain cells, and thereby increases their energy potential).

At the stage of expanded manifestations, drugs are prescribed from the group of acetylcholinesterase inhibitors (donepezil, etc.). Clinical studies have shown that prescribing these types of drugs significantly improves the social adaptation of patients and reduces the burden on caregivers.

Forecast

Alzheimer's type dementia refers to a steadily progressive disease that inevitably leads to severe disability and death of the patient. The process of development of the disease, from the appearance of the first symptoms to the development of senile marasmus, usually takes about 10 years.

The earlier Alzheimer's disease develops, the faster dementia progresses. Patients under 65 (early senile dementia or presenile dementia) develop early neurological disorders (apraxia, agnosia, aphasia).

Vascular dementia

Dementia with lesions of the cerebral vessels

Dementia of vascular origin ranks second in prevalence after dementia of the Alzheimer's type, and accounts for about 20% of all types of dementia.

In this case, as a rule, dementia developed after vascular accidents, such as:
1. Hemorrhagic stroke (vessel rupture).
2. Ischemic stroke (blockage of a vessel with cessation or deterioration of blood circulation in a specific area).

In such cases, massive death of brain cells occurs, and the so-called focal symptoms, depending on the localization of the affected area (spastic paralysis, aphasia, agnosia, apraxia, etc.), come to the fore.

So the clinical picture of post-stroke dementia is very heterogeneous, and depends on the degree of vascular lesion, the area of the brain supplied with blood, the compensatory capabilities of the body, as well as on the timeliness and adequacy of medical care provided in case of a vascular accident.

Dementia that occurs with chronic circulatory failure usually develops in old age and exhibits a more homogeneous clinical picture.

What disease can cause vascular dementia?

The most common causes of vascular dementia are hypertension and atherosclerosis - common pathologies characterized by the development of chronic cerebrovascular insufficiency.

The second large group of diseases leading to chronic hypoxia of brain cells is vascular lesions in diabetes mellitus (diabetic angiopathy) and systemic vasculitis, as well as congenital disorders of the cerebral vascular structure.

Acute cerebral circulation failure can develop with thrombosis or embolism (blockage) of the vessel, which often occurs with atrial fibrillation, heart defects, and diseases that occur with an increased tendency to thrombus formation.

Risk factors

The most significant risk factors for developing vascular dementia are:

hypertension, or symptomatic arterial hypertension;
elevated plasma lipids;
systemic atherosclerosis;
cardiac pathologies (coronary heart disease, arrhythmias, damage to the heart valves);
sedentary lifestyle;
overweight;
diabetes;
tendency to thrombosis;
systemic vasculitis (vascular disease).

Symptoms and course of senile vascular dementia

Difficulty concentrating is the first predictor of vascular dementia. Patients complain of rapid fatigability, experience difficulty with prolonged concentration of attention. At the same time, it is difficult for them to switch from one type of activity to another.

Another harbinger of developing vascular dementia is the slowdown in intellectual activity, so tests for the speed of performing simple tasks are used for early diagnosis of cerebrovascular accidents.

The early signs of developed dementia of vascular genesis include violations of goal-setting - patients complain of difficulties in organizing elementary activities (making plans, etc.).

In addition, already in the early stages, patients experience difficulties in analyzing information: it is difficult for them to distinguish the main and the secondary, to find common and different between similar concepts.

Unlike dementia of the Alzheimer's type, memory impairment in dementia of vascular origin is not so pronounced. They are associated with difficulties in reproducing the perceived and accumulated information, so that the patient easily recalls the "forgotten" when asking leading questions, or chooses the correct answer from several alternative ones. At the same time, the memory for important events is retained for a rather long time.

For vascular dementia, violations of the emotional sphere are specific in the form of a general decrease in the background of mood, up to the development of depression, which occurs in 25-30% of patients, and pronounced emotional lability, so that patients can cry bitterly, and after a minute go to quite sincere fun.

Signs of vascular dementia include the presence of characteristic neurological symptoms such as:
1. Pseudobulbar syndrome, which includes a violation of articulation (dysarthria), a change in the timbre of the voice (dysphonia), less often - a violation of swallowing (dysphagia), violent laughter and crying.
2. Gait disorders (shuffling, mincing gait, "skier gait", etc.).
3. Decreased motor activity, the so-called "vascular parkinsonism" (poverty of facial expressions and gestures, slow motion).

Vascular dementia, which develops as a result of chronic circulatory failure, usually progresses gradually, so the prognosis largely depends on the cause of the disease (hypertension, systemic atherosclerosis, diabetes mellitus, etc.).

Treatment

Treatment of vascular dementia is primarily aimed at improving cerebral circulation - and, therefore, at stabilizing the process that caused dementia (hypertension, atherosclerosis, diabetes mellitus, etc.).

In addition, pathogenetic treatment is usually prescribed: piracetam, cerebrolysin, actovegin, donepezil. The dosage regimen for these drugs is the same as for Alzheimer's dementia.

Senile Lewy Body Dementia

Senile dementia with Lewy bodies is an atrophic-degenerative process with the accumulation in the cortex and subcortical structures of the brain of specific intracellular inclusions - Lewy bodies.

The causes and mechanisms of development of senile dementia with Lewy bodies are not fully understood. As with Alzheimer's disease, the hereditary factor is of great importance.

According to theoretical data, senile Lewy body dementia is the second most common, accounting for about 15-20% of all senile dementia. However, this diagnosis is relatively rare during life. Typically, these patients are misdiagnosed as vascular dementia or Parkinson's disease with dementia.

The fact is that many of the symptoms of Lewy body dementia are similar to these diseases. Just as in the vascular form, the first symptoms of this pathology are a decrease in the ability to concentrate, slowness and weakness of intellectual activity. In the future, depressions develop, a decrease in motor activity like parkinsonism, and walking disorders.

At the advanced stage, the clinic of Lewy body dementia is in many ways similar to Alzheimer's disease, as delusions of harm, delusions of persecution, delusions of doubles develop. With the progression of the disease, delusional symptoms disappear due to complete exhaustion of mental activity.

However, senile Lewy body dementia has some specific symptoms. It is characterized by the so-called small and large fluctuations - sharp, partially reversible violations of intellectual activity.

With small fluctuations, patients complain of temporary impairments in the ability to concentrate and complete some task. With large fluctuations, patients note violations of recognition of objects, people, terrain, etc. Often, the disorders reach the degree of complete spatial disorientation and even confusion of consciousness.

Another characteristic feature of Lewy body dementia is the presence of visual illusions and hallucinations. Illusions are associated with disorientation in space and intensify at night, when patients often mistake inanimate objects for people.

A specific feature of visual hallucinations in dementia with Lewy bodies is their disappearance when the patient tries to interact with them. Often, visual hallucinations are accompanied by auditory hallucinations (speaking hallucinations), but auditory hallucinations do not occur in their pure form.

As a rule, visual hallucinations are accompanied by large fluctuations. Such attacks are often triggered by a general deterioration in the patient's condition (infectious diseases, overwork, etc.). Upon exiting the large fluctuation, patients partially amnesize what happened, intellectual activity is partially restored, however, as a rule, the state of mental functions becomes worse than the initial one.

Another characteristic symptom of Lewy body dementia is sleep behavior disorder: patients can make sudden movements, and even injure themselves or others.

In addition, with this disease, as a rule, a complex of autonomic disorders develops:

orthostatic hypotension (a sharp decrease in blood pressure when moving from a horizontal position to a vertical one);
arrhythmias;
disruption of the digestive tract with a tendency to constipation;
urinary retention, etc.

Treatment of senile dementia with Lewy bodies similar to treatment for Alzheimer's type dementia.

In case of confusion, acetylcholinesterase inhibitors (donepezil, etc.) are prescribed, in extreme cases, atypical antipsychotics (clozapine). The appointment of standard antipsychotics is contraindicated due to the possibility of developing severe movement disorders. Undaunted hallucinations, with adequate criticism, are not subject to special drug elimination.

To treat the symptoms of parkinsonism, small doses of the drug levodopa are used (one should be very careful not to cause an attack of hallucinations).

The course of dementia with Lewy bodies is rapidly and steadily progressing, so the prognosis is much more serious than with other types of senile dementia. The period from the appearance of the first signs of dementia to the development of complete insanity usually takes no more than four to five years.

Alcoholic dementia

Alcohol dementia develops as a result of prolonged (15-20 years or more) toxic effects of alcohol on the brain. In addition to the direct influence of alcohol, indirect effects (poisoning with endotoxins in alcoholic liver damage, vascular disorders, etc.) take part in the development of organic pathology.

Almost all alcoholics at the stage of development of alcoholic degradation of personality (the third, last stage of alcoholism) exhibit atrophic changes in the brain (expansion of the ventricles of the brain and furrows of the cerebral cortex).

Clinically, alcoholic dementia is a diffuse decrease in intellectual abilities (impairment of memory, concentration of attention, ability to abstract thinking, etc.) against the background of personal degradation (coarsening of the emotional sphere, destruction of social ties, primitivism of thinking, complete loss of value orientations).

At this stage in the development of alcohol dependence, it is very difficult to find incentives to induce the patient to treat the underlying disease. However, in cases where complete abstinence is achieved for 6-12 months, the signs of alcoholic dementia begin to regress. Moreover, instrumental studies also show some smoothing of the organic defect.

Epileptic dementia

The development of epileptic (concentric) dementia is associated with a severe course of the underlying disease (frequent seizures with a transition to status epilepticus). In the genesis of epileptic dementia, mediated factors (long-term use of antiepileptic drugs, injuries during falls during seizures, hypoxic damage to neurons in status epilepticus, etc.) can take part.

Epileptic dementia is characterized by slowness of thought processes, the so-called viscosity of thinking (the patient cannot distinguish between the main and the secondary, and is fixated on describing unnecessary details), memory loss, and vocabulary depletion.

A decrease in intellectual abilities occurs against the background of a specific change in personality traits. Such patients are characterized by extreme selfishness, malice, vindictiveness, bigotry, quarrelsomeness, suspiciousness, accuracy up to pedantry.

The course of epileptic dementia is steadily progressing. With severe dementia, malice disappears, but hypocrisy and obsequiousness persist, lethargy and indifference to others grow.

How to prevent dementia - video

Answers to the most popular questions about the causes, symptoms and
dementia treatment

Are dementia and dementia the same thing? How does dementia develop in children? What is the difference between childhood dementia and mental retardation

The terms "dementia" and "dementia" are often used interchangeably. Nevertheless, in medicine, dementia is understood as irreversible dementia that develops in a mature person with normally formed mental abilities. Thus, the term "childhood dementia" is inappropriate, since in children the higher nervous activity is in the developmental stage.

The term "mental retardation", or mental retardation, is used to refer to childhood dementia. This name is retained when the patient reaches adulthood, and this is true, since dementia that occurs in adulthood (for example, post-traumatic dementia) and oligophrenia proceed in different ways. In the first case, we are talking about the degradation of an already formed personality, in the second, about underdevelopment.

Is unexpected untidiness the first sign of senile dementia? Are untidy and untidy symptoms always present?

Suddenly appearing sloppiness and untidiness are symptoms of disturbances in the emotional-volitional sphere. These signs are very nonspecific, and are found in many pathologies, such as: deep depression, severe asthenia (exhaustion) of the nervous system, psychotic disorders (for example, apathy in schizophrenia), various kinds of addiction (alcoholism, drug addiction), etc.

At the same time, patients with dementia in the early stages of the disease can be completely independent and neat in their usual everyday environment. Sloth can be the first sign of dementia only when the development of dementia is already in the early stages accompanied by depression, exhaustion of the nervous system or psychotic disorders. This kind of debut is more typical for vascular and mixed dementias.

What is mixed dementia? Does it always lead to disability? How is mixed dementia treated?

Mixed dementia is called dementia, in the development of which the vascular factor and the mechanism of primary degeneration of brain neurons are simultaneously involved.

It is believed that circulatory disorders in the vessels of the brain can trigger or intensify the primary degenerative processes characteristic of Alzheimer's disease and Lewy body dementia.

Since the development of mixed dementia is due to two mechanisms at once, the prognosis for this disease is always worse than for the "pure" vascular or degenerative form of the disease.

The mixed form is prone to steady progression, therefore it inevitably leads to disability, and significantly shortens the patient's life.
Treatment of mixed dementia is aimed at stabilizing the process, therefore, it includes combating vascular disorders and alleviating the developed symptoms of dementia. Therapy, as a rule, is carried out with the same drugs and according to the same schemes as for vascular dementia.

Timely and adequate treatment for mixed dementia can significantly prolong the patient's life and improve its quality.

Among my relatives there were patients with senile dementia. How likely is it that I will develop a mental disorder? What is the prevention of senile dementia? Are there any medications that can prevent the disease?

Senile dementia refers to diseases with a hereditary predisposition, especially Alzheimer's disease and Lewy body dementia.

The risk of developing the disease increases if senile dementia in relatives develops at a relatively early age (up to 60-65 years).

However, it should be remembered that hereditary predisposition is only the presence of conditions for the development of a particular disease, therefore even an extremely unfavorable family history is not a verdict.

Unfortunately, today there is no consensus on the possibility of specific drug prevention of the development of this pathology.

Since there are known risk factors for the development of senile dementia, measures to prevent mental disorder are primarily aimed at eliminating them, and include:
1. Prevention and timely treatment of diseases leading to circulatory disorders in the brain and hypoxia (hypertension, atherosclerosis, diabetes mellitus).
2. Dosed physical activity.
3. Constant intellectual activity (you can make crosswords, solve puzzles, etc.).
4. Quitting smoking and alcohol.
5. Prevention of obesity.

Before use, you must consult a specialist.

With age, a person begins to malfunction in all systems and organs. Abnormalities in mental activity are also observed, which are divided into behavioral, emotional and cognitive. The latter includes dementia (or dementia), although it has a close relationship with other disorders. Simply put, a patient with dementia, against the background of mental abnormalities, changes behavior, appears unreasonable depression, decreases emotionality and the person begins to gradually degrade.

Dementia develops, as a rule, in elderly people. It affects several psychological processes: speech, memory, thinking, attention. Already at the initial stage of vascular dementia, the emerging disorders are quite significant, which affects the patient's quality of life. He forgets already acquired skills, and learning new skills becomes impossible. Such patients have to leave their professional career, and they simply cannot do without the constant supervision of their household.

General characteristics of the disease

Acquired cognitive disorders that negatively affect the patient's daily activities and behavior are called dementia.

The disease can have several degrees of severity, depending on the patient's social adaptation:

A mild degree of dementia - the patient has a degradation of professional skills, his social activity decreases, interest in his favorite activities and entertainment is significantly weakened. In this case, the patient does not lose orientation in the surrounding space and can serve himself independently.
Moderate (average) degree of dementia - characterized by the impossibility of leaving the patient unattended, since he loses the ability to use most household appliances. Sometimes it is difficult for a person to open the lock on the front door on his own. This degree of severity in common parlance is often referred to as "senile marasmus". The patient needs constant help in everyday life, but he can cope with self-care and personal hygiene without assistance.
Severe degree - the patient has a complete maladjustment to the environment and personality degradation. He can no longer do without the help of loved ones: he needs to be fed, washed, clothed, etc.

There can be two forms of dementia: total and lacunar(dysmnestic or partial). The latter is characterized by serious deviations in the process of short-term memory, while emotional changes are not particularly pronounced (excessive sensitivity and tearfulness). A typical variant of lacunar dementia can be considered in the initial stage.

The form of total dementia is characterized by absolute personal degradation. The patient is exposed to intellectual and cognitive impairments, the emotional-volitional sphere of life changes radically (there is no feeling of shame, duty, vital interests and spiritual values disappear).

From a medical point of view, there is such a classification of types of dementia:

Dementia of the atrophic type (Alzheimer's, Pick's) - usually occurs against the background of primary degenerative reactions occurring in the cells of the central nervous system.
Vascular dementia (atherosclerosis, hypertension) - develops due to circulatory pathologies in the cerebral vascular system.
Dementia of mixed type - the mechanism of their development is similar to both atrophic and vascular dementia.

Dementia often develops due to pathologies leading to the death or degeneration of brain cells (as an independent disease), and can also manifest itself as a serious complication of the disease. In addition, conditions such as trauma to the skull, tumors in the brain, alcoholism, etc., can cause dementia.

For all dementias, such signs as emotional-volitional (tearfulness, apathy, unreasonable aggression, etc.) and intellectual (thinking, speech, attention) disorders, up to personal decay, are relevant.

Vascular dementia

This type of disease is associated with impaired cognitive functions due to abnormal blood flow in the brain. Long-term development of pathological processes is characteristic of vascular dementia. The patient practically does not notice that he is developing dementia of the brain. Due to disturbances in blood flow, certain brain centers begin to experience, which causes the death of brain cells. A large number of these cells leads to brain dysfunction, which manifests itself as dementia.

Causes

Stroke is one of the root causes of vascular dementia. And, and, which distinguish a stroke, deprive brain cells of proper nutrition, which leads to their death. Therefore, stroke patients are particularly at risk of developing dementia.

It can also trigger dementia. Due to low pressure, the volume of blood circulating through the vessels of the brain decreases (hyperfusion), which subsequently leads to dementia.

In addition, dementia can also be caused by ischemia, arrhythmia, diabetes, infectious and autoimmune vasculitis, etc.

As mentioned above, often the cause of such dementia can be. As a result, the so-called atherosclerotic dementia gradually develops, which is characterized by a partial stage of dementia - when the patient is able to realize that he has cognitive impairment. This dementia is different from other dementias, the gradual progress of the clinical picture, when episodic improvements and deterioration of the patient's condition periodically replace each other. Atherosclerotic dementia is also characterized by dizziness, speech and visual abnormalities, retarded psychomotor skills.

Signs

Usually, a doctor diagnoses vascular dementia in a case when disruptions in cognitive functions began to appear after an experience or a stroke. Weakening of attention is also considered a harbinger of the development of dementia. Patients complain that they cannot concentrate on a certain object, to concentrate. Changes in gait (mincing, wobbly, "ski", unsteady gait), timbre of voice and articulation are considered characteristic symptoms of dementia. Swallowing dysfunction is less common.

Intellectual processes start to work in slow motion - also an alarming signal. Even at the onset of the disease, the patient is faced with some difficulties in organizing his activities and analyzing the information received. In the early stages of diagnosing dementia, the patient is given a special test for dementia. It is used to check how quickly the subject copes with specific tasks.

By the way, with a vascular type of dementia memory deviations are not particularly pronounced, which cannot be said about the emotional sphere of activity... According to statistics, about a third of patients with vascular dementia are depressed. All patients are subject to frequent mood swings. They can laugh to tears, and suddenly begin to cry bitterly. Patients often suffer from hallucinations, epileptic seizures, show apathy towards the world around them, prefer sleep to wakefulness. In addition to the above, the symptoms of vascular dementia include the impoverishment of gestures and facial movements, that is, motor activity is impaired. Patients have urinary disorders. A characteristic feature of a patient suffering from dementia is also slovenliness.

Treatment

There is no standard, formulaic method for treating dementia. Each case is considered by a specialist separately. This is due to the huge number of pathogenetic mechanisms that precede the disease. It should be noted that dementia is completely incurable, therefore, the disorders caused by the disease are irreversible.

Treatment of vascular dementia, and other types of dementia, too, is carried out with the help that has a positive effect on brain tissue, improving their metabolism. Also, therapy for dementia involves the treatment of the diseases that led to its development directly.

To improve cognitive processes (cerebrolysin) and nootropic drugs are used. If the patient is exposed to severe forms of depression, then antidepressants are prescribed along with the main treatment for dementia. For the prevention of cerebral infarctions, antiplatelet agents and anticoagulants are prescribed.

Do not forget about: giving up smoking and alcohol, fatty and too salty foods, you should move more. Life expectancy with advanced vascular dementia is about 5 years.

It should be noted that dementy people often develop such an unpleasant trait as slovenliness, therefore, relatives need to take proper care of the patient. If the household cannot cope with this, then you can resort to the services of a professional nurse. This, as well as other common issues related to the disease, is worth discussing with those already faced with similar problems in the forum dedicated to vascular dementia.

Video: vascular dementia in the “Live Healthy!” Program

Senile (senile) dementia

Many, observing elderly households, often notice changes in their condition associated with character, intolerance and forgetfulness. An irresistible stubbornness appears from somewhere, it becomes impossible to convince such people of something. This is due to atrophy of the brain due to the large-scale death of its cells due to age, that is, senile dementia begins to develop.

Signs

First, an older person begins slight deviations in memory- the patient forgets recent events, but remembers what happened in his youth. With the development of the disease, old fragments also begin to disappear from memory. In senile dementia, there are two possible mechanisms for the development of the disease, depending on the presence of certain symptoms.

Most elderly people with senile dementia have practically no psychotic states, which greatly facilitates the life of both the patient himself and his relatives, since the patient does not cause much trouble.

But there are also frequent cases of psychosis, accompanied by or inversion of sleep. This category of patients is characterized by such signs of senile dementia as hallucinations, excessive suspicion, mood swings from tearful affection to righteous anger, i.e. a global form of the disease develops. The onset of psychosis can be triggered by changes in blood pressure (hypotension, hypertension), changes in the level in the blood (diabetes), etc. Therefore, it is important to protect dementy elderly people from all kinds of chronic and viral diseases.

Treatment

Healthcare providers discourage home treatment for dementia, regardless of the severity and type of disease. Today there are many boarding houses, sanatoriums, the main focus of which is the maintenance of just such patients, where, in addition to proper care, the treatment of the disease will also be carried out. The question is, of course, controversial, since it is much easier for a patient to endure dementia in a home environment.

Senile-type dementia is treated with traditional psychostimulants based on both synthetic and plant components. In general, their effect is manifested in an increase in the ability of the patient's nervous system to adapt to the arising physical and mental stress.

As mandatory drugs for the treatment of dementia of any type, nootropic drugs are used that significantly improve cognitive abilities and have a restorative effect on memory. In addition, tranquilizers are often used in modern drug therapy to relieve anxiety and fear.

Since the onset of the disease is associated with severe memory impairment, you can use some folk remedies. For example, blueberry juice has a positive effect on all processes related to memory. There are many herbs that have sedative and hypnotic effects.

Video: Cognitive Training for People with Dementia

Alzheimer's type dementia

It is perhaps the most common type of dementia today. It refers to organic dementia (a group of dementia syndromes that develop against the background of organic changes in the brain, such as cerebrovascular disease, traumatic brain injury, senile or syphilitic psychoses). In addition, this disease is quite closely intertwined with types of dementias with Lewy bodies (a syndrome in which the death of brain cells occurs due to Lewy bodies formed in neurons), having many common symptoms with them. Often even doctors confuse these pathologies.

The most significant contributing factors to the development of dementia are:

Elderly age (75-80 years old);
Female;
Hereditary factor (the presence of a blood relative with Alzheimer's disease);
Arterial hypertension;
Diabetes;
Atherosclerosis;
Obesity;
Disease-related.

The symptoms of Alzheimer's dementia are generally identical to those of vascular and senile dementia. These are memory impairments, at first recent events are forgotten, and then facts from life in the distant past. With the course of the disease, emotional and volitional disorders appear: conflict, grumpiness, egocentrism, suspicion (senile personality restructuring). Untidiness is also present among the many symptoms of dementia syndrome.

Then the patient develops a delusion of "damage" when he begins to blame others for the fact that something was stolen from him or they want to kill him, etc. The patient develops a craving for gluttony, vagrancy. At a severe stage, the patient is absorbed by complete apathy, he practically does not walk, does not talk, does not feel thirst and hunger.

Since this dementia belongs to total dementia, then the treatment is selected as a complex one, covering the therapy of concomitant pathologies. This type of dementia is classified as progressive, it leads to disability, and then death of the patient. From the onset of the disease to death, as a rule, no more than a decade passes.

Video: how to prevent the development of Alzheimer's disease?

Epileptic dementia

Quite a rare disease arising, usually in the background or schizophrenia... For him, a typical picture is the paucity of interests, the patient cannot highlight the main essence, or generalize something. Often, epileptic dementia in schizophrenia is characterized by excessive sugaryness, the patient is constantly expressed in diminutive words, revengefulness, bigotry, rancor and ostentatious fear of God appear.

Alcoholic dementia

This type of dementia syndrome is formed due to a long alcohol-toxic effect on the brain (over 1.5-2 decades). In addition, factors such as hepatic lesions and disorders of the vascular system play an important role in the development mechanism. According to research data, at the last stage of alcoholism, the patient has pathological changes in the brain area, which are atrophic in nature, which outwardly manifests itself as personality degradation. Alcohol dementia can regress if the patient completely refuses to drink alcohol.

Frontotemporal dementia

This pre-senile dementia, often referred to as Pick's disease, involves degenerative abnormalities affecting the temporal and frontal lobes of the brain. In half of the cases, frontotemporal dementia develops due to a genetic factor. The onset of the disease is characterized by emotional and behavioral changes: passivity and isolation from society, silence and apathy, disregard for decency and sexual promiscuity, bulimia and urinary incontinence.

Such drugs as Memantine (Akatinol) have proven effective in the treatment of such dementia. Such patients live no more than a dozen years, dying from immobility, or the parallel development of genitourinary and pulmonary infections.

Dementia in children

We have considered the varieties of dementia that affect exclusively the adult population. But there are pathologies that develop mainly in children (Lafor, Niemann-Pick diseases, etc.).

Childhood dementia is conventionally divided into:

Dementia in children can be a sign of a particular mental disorder, such as schizophrenia or mental retardation. Symptoms appear early: the child's ability to remember something abruptly disappears, mental abilities decrease.

Therapy for childhood dementia is based on the cure of the disease that triggered the onset of dementia, as well as on the general course of pathology. In any case, the treatment of dementia is carried out with the help and metabolism of cellular substances.

For any type of dementia, loved ones, relatives and household members should treat the patient with understanding. After all, it is not his fault that he sometimes does inadequate things, this is what the disease does. We ourselves should think about preventive measures so that the disease does not strike us in the future. To do this, you should move more, communicate, read, educate yourself. Walking before going to bed and active rest, giving up bad habits are the key to old age without dementia.

Dementia defines an acquired form of dementia, within which patients have 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, manifest themselves in the form of a breakdown of mental functions, is most often diagnosed in old age, but the possibility of its development at a young age is not excluded.

general description

Dementia develops as a result of brain damage, against the background of which a marked breakdown 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 mental retardation or dementia) means a cessation of personality development, which also occurs with damage to the brain 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 indicators, corresponding to his age. In addition, mental retardation is not a progressive process, but is the result of a sick person's illness. Nevertheless, in both cases, and when considering dementia, and when considering mental retardation, there is a development of disorders 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, which often occurs as a result of addictive behavior. Addiction means nothing more than addictions or addictions - a pathological attraction, in which there is a need to perform certain actions. Any type of pathological attraction contributes to an increase in the risk of developing mental illness in a person, and often this attraction is directly related to social or personal problems existing for him.

Often, addiction is used to familiarize oneself 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 is an ambiguous term in psychology. The fact is that mainly in the psychological literature this kind of dependence is considered in a single form - in the form of dependence on narcotic substances (or intoxicants).

However, if we consider at a deeper level this type of addiction, this phenomenon also arises in everyday mental activity that a person encounters (hobbies, hobbies), which, thereby, determines the object 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 can include 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 himself. Under the elementary agents of addiction are considered drugs, alcohol, cigarettes, creating an imaginary and short-term atmosphere of "pleasant" conditions. A similar effect is achieved when performing relaxation exercises, during rest, as well as during actions and things in which short-term joy arises. In any of these options, after their completion, the person has to return to reality and the conditions from which it was possible to “escape” in such ways, as a result of which addictive behavior is considered as a rather complex problem of internal conflict based on the need to escape from specific conditions, against the background of which and there is a risk of developing mental illness.

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

With dementia, patients are not capable of realizing what is happening to them, the disease literally "erases" everything from their memory that has accumulated in it during the previous years of life. Some patients experience the course of such a process at an accelerated rate, due to which they quickly develop total dementia, while others can linger for a long time at the stage of the disease within the framework of cognitive-mnestic disorders (intellectual-mnestic disorders) - that is, with disorders of mental performance, 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 he loses many human personality traits. The severe stage of dementia determines for patients dependence on others, maladjustment, they lose the ability to perform the simplest actions associated with hygiene and food intake.

Dementia causes

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 commonly, any neoplasms developing directly in the brain act as the causes of dementia; this also includes traumatic brain injury ( 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 great vessels against the background of atherosclerosis, arrhythmias, hereditary angiopathies, repeated disorders relevant to cerebral circulation (vascular dementia).

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

As for the next, microangiopathic variant of development, here angiopathies and hypertension are considered as risk factors. The peculiarities of the lesion in these pathologies lead in one case to demyelination of the white subcortical substance with the simultaneous development of leukoencephalopathy, in another case they provoke the development of lacunar lesions, 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 craniocerebral trauma. 1% of the incidence falls on dementia against the background of Parkinson's disease, infectious diseases, degenerative diseases of the central nervous system, infectious and metabolic pathologies, etc. , dysfunction of the thyroid gland, diseases of internal organs (renal or hepatic failure).

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

Dementia: classification

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

Mild dementia means a state in which a sick person faces degradation in terms of his professional skills, in addition to this, his social activity also decreases. Social activity in particular means a decrease 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 weaken their interest in the conditions of the external world, as a result of which it is relevant to abandon their usual options for spending their free time, from hobbies. Mild dementia is accompanied by the preservation of existing self-care skills, in addition, patients are adequately oriented within the boundaries of their home.

Moderate dementia leads to a condition in which patients can no longer remain alone with themselves for a long period of time, which is caused by the loss of skills in using equipment and devices that surround them (remote control, telephone, stove, etc.), even difficulties are not excluded using door locks. Requires constant monitoring and help from others. Within the framework of this form of the disease, patients retain the skills for self-care and performing actions related to personal hygiene. All this, accordingly, makes life difficult for the environment of patients.

As for such a form of the disease as severe dementia then here we are already talking about the absolute maladjustment of patients to what surrounds them with the simultaneous need to provide constant help and control, which are 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, the subcortical structures are predominantly affected (multi-infarction dementia with lesions of the white matter, supranuclear progressive paralysis, Parkinson's disease);
cortical subcortical dementia (vascular dementia, cortical-basal form of degeneration);
multifocal dementia - many focal lesions are formed.

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

Alzheimer's type dementia , the symptoms of which appear after the age of 65, within the initial (initial) stage occurs in combination with cognitive-mnestic disorders with an increase in disorders in the form of orientation in place and in time, delusional disorders, the appearance of neuropsychological disorders, subdepressive reactions in relation to their own incapacity ... At the initial stage, patients are capable of a critical assessment of their condition and of taking measures to correct it. Moderate dementia within this state is characterized by the progression of the listed symptoms with a particularly gross violation of the functions inherent in the intellect (difficulties in conducting analytical and synthetic activities, a low level of judgment), loss of opportunities for performing professional duties, and the emergence of the need for care and support. All this is accompanied by the preservation of basic personal characteristics, a sense of their own inferiority with an adequate response to the existing disease. In the severe stage of this form of dementia, memory decay occurs in full, support and care is needed in everything and constantly.

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

This pathology is diagnosed less often than Alzheimer's disease, mainly among women. Among the main characteristics, there are actual changes in the emotional-personal sphere and the cognitive sphere. In the first case, the condition implies gross forms of personality disorder, complete absence of criticism, spontaneity, passivity and impulsive behavior; hypersexuality, foul language and rudeness are relevant; assessment of the situation is violated, there are disorders of drives and will. In the second, with cognitive disorders, there are gross forms of thinking impairment, 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 dementia, while there is also a variant of the mixed form of the disease (mixed dementia) , which implies a combination of primary degenerative disorders, which is mainly manifested in the form of Alzheimer's disease, and vascular type of brain lesions.

Dementia Symptoms

In this section, we will summarize the signs (symptoms) that characterize dementia. As the most characteristic of them, disorders associated with cognitive functions are considered, and such disorders are most pronounced in their own manifestations. Emotional disorders in combination with behavioral disorders are becoming no less important clinical manifestations. The development of the disease occurs in a gradual manner (often), its detection most often occurs within the framework of an exacerbation of the patient's condition, arising from changes in the environment around him, as well as 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 patient's behavior, the question is raised about the relevance of dementia for him, which is especially important in the case of his age over 40 years and in the absence of a mental illness.

So, let's 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 to this, confabulation is not excluded. Confabulations in particular involve false memories. Facts from them, occurring earlier in reality or facts that previously occurred, but underwent a certain modification, are transferred by the patient to another time (often in the near future) with their possible combination with events completely fictitious by them. A mild form of dementia is accompanied by mild memory impairments, mainly associated with events occurring in the recent past (forgetting conversations, phone numbers, events that occurred on a particular day). Cases of a more severe course of dementia are accompanied by the retention of only previously memorized material in memory, while the newly received information is quickly forgotten. The last stages of the disease can be accompanied by forgetting the names of relatives, their own kind of activity 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 means 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 an actual lesion of the brain in certain parts of its cortex.
  - Apraxia indicates a violation of the patient's ability to perform targeted actions. In this case, the skills acquired earlier by the patient are lost, and those skills that have been formed over the years (speech, everyday, motor, professional).
  - Agnosia defines a violation of various types of perception in the patient (tactile, auditory, visual) with the simultaneous preservation of consciousness and sensitivity.
Disorder of orientation. This type of violation occurs over 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 local orientation, as well as within one's own personality (here the difference between a symptom in dementia and delirium is manifested, the features of which determine the preservation of orientation within the framework of considering one's own personality). The progressive form of the disease with advanced dementia and pronounced manifestations of disorientation in the scale of the surrounding space determines for the patient the likelihood that he can freely get lost even in an environment familiar to himself.
Conduct disorders, personality changes. The onset of these manifestations is gradual. The main traits inherent in a person are gradually strengthened, transforming to the states inherent in this disease as a whole. Thus, energetic and cheerful people become restless and fussy, and people who are thrifty and tidy, respectively, become greedy. The transformations inherent in other features are considered in a similar way. 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 unwillingness to self-service (hygiene, etc.), with untidiness and, in general, lack of response to the presence of people near you.
Thought disorders. There is a slowdown in the pace of thinking, as well as a decrease in the ability for logical thinking and abstraction. 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 an absurd and primitive content. So, for example, a woman with dementia with thought disorder before the appearance of delusional ideas may claim that her mink coat has been stolen, and such an action may go beyond her environment (i.e. family or friends). The essence of the nonsense in this idea is that she never had a mink coat at all. Dementia in men within the framework of this disorder often develops in a delusional scenario based on the jealousy and infidelity of the spouse.
Decrease in 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 in them of acute forms of anxiety-depressive disorders (defined as a "catastrophic reaction"), within which there is a subjective awareness of intellectually 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, translation of the conversation into a playful form, or distraction from it in other ways.
Emotional Disorders. In this case, it is possible to determine the variety of such disorders and their general variability. Often these are depressive states in patients in combination with irritability and anxiety, anger, aggression, tearfulness, or, conversely, a complete absence 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 appearance of illusions and hallucinations in patients are considered. For example, with dementia, a patient is sure that he hears the screams of children being killed in the next room.

Senile dementia: symptoms

In this case, senile dementia, senile dementia, or senile dementia, the symptoms of which arise against the background of age-related changes occurring in the structure of the brain, acts as a similar definition of the state of senile dementia. Such changes occur within neurons, they arise as a result of insufficient blood supply to the brain, the impact on it in acute infections, chronic diseases and other pathologies, which we have considered 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, all skills and abilities are lost; new knowledge to acquire in senile dementia is extremely difficult, if not impossible.

Senile dementia, among mental illnesses, is the most common illness among the elderly. Senile dementia in women is almost three times more common 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 forms, manifesting itself in a simple form, in the form of presbyophrenia and in a psychotic form. The specific form is determined by the current rate of atrophic processes in the brain, somatic diseases associated with dementia, as well as by factors of a constitutional and genetic scale.

Simple form characterized by low visibility, proceeding in the form of disorders generally inherent in aging. With an acute onset, there is reason to believe that previously existing mental disorders have been exacerbated by one or another somatic disease. There is a decrease in mental activity in patients, which is manifested in a slowdown in the pace of mental activity, in its quantitative and qualitative deterioration (impairment to the ability to concentrate attention and to switch it, there is a narrowing of its volume; the ability to generalize and analyze, to abstraction and in general the imagination is disturbed; the ability to inventiveness and resourcefulness is lost in the framework of solving problems that arise in everyday life).

An increasingly sick person adheres to conservatism in terms of their own judgments, worldview and actions. What happens in the present tense is viewed as something insignificant and not worthy of attention, and is often rejected altogether. Returning to the past, the patient predominantly perceives it as a positive and worthy model in certain life situations. A characteristic feature is a tendency to edification, obstinacy bordering on obstinacy and increased irritability, arising from contradictions or disagreements on the part of the opponent. Interests that existed in the past are largely narrowed, especially if they are in one way or another related to general issues. Increasingly, patients focus their own attention on their physical condition, in particular for physiological functions (i.e., bowel movement, urination).

Patients also have a decrease in affective resonance, which is manifested in an increase in complete indifference to what does not directly concern them. In addition, attachments are weakened (this even applies to relatives), in general, understanding of the essence of relations between people is lost. Many people lose their bashfulness and sense of tact; the range of shades of moods is also subject to narrowing. Some patients can show carelessness and general complacency, while adhering to monotonous jokes and a general tendency to joke, while in other patients, dissatisfaction, picky, capriciousness and pettiness prevail. In any case, the past characterological traits inherent in the patient become scarce, and the awareness of the personality changes that have arisen either disappears early, or does not occur at all.

The presence of pronounced forms of psychopathic traits before the disease (especially those of them that are stenic, this applies to imperiousness, greed, categoricalness, etc.) leads to their aggravation 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, and more and more often they hear various reproaches against their immediate environment, especially with regard to the irrationality, in their opinion, of expenses. Also, the morals that have developed in public life are subject to censure on their part, in particular, this applies to marital relations, intimate life, etc.
Initial psychological changes, combined with personal changes that occur with them, are accompanied by memory impairment, in particular for current events. They are noticed by the patients' environment, 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 disintegration actually corresponds to the laws that are relevant for the progressive form of amnesia.

So, at first, memory associated with differentiated and abstract topics (terminology, dates, names, names, etc.) comes under attack, then a fixation form of amnesia is attached here, which manifests itself in the form of an inability to remember current events. Also, amnestic disorientation about time develops (i.e. patients are not able to indicate a specific date and month, day of the week), chronological disorientation also develops (the inability to determine important dates and events with reference to a specific date, regardless of whether such dates concern personal life or public life). On top of this, spatial disorientation develops (manifests itself, for example, in a situation when, when leaving the house, patients cannot go back, etc.).

The development of total dementia leads to a violation of self-recognition (for example, when looking at oneself in reflection). Forgetting the events of the present is replaced by the revival of memories of the past, often this can relate to youth or even childhood. Often, such a change in time leads to the fact that patients begin to "live in the past", while considering themselves young or children, depending on the time at which such memories fall. In this case, stories about the past are reproduced as events related to the present time, while it is possible that these memories are generally fictional.

The initial periods of the course of the disease can determine the mobility of patients, the accuracy and speed of performing certain actions, motivated by random necessity or, conversely, by the habit of performing. Physical insanity is noted already within the framework of an advanced disease (complete disintegration of behavioral models, mental functions, speech skills, often with a relative preservation of the skills of somatic functions).

With a pronounced form of dementia, the previously considered states of apraxia, aphasia and agnosia are noted. Sometimes these disorders appear in a sharp form, which may resemble the picture of the course of Alzheimer's disease. A few and isolated epileptic seizures, similar to fainting, are possible. Sleep disorders 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 the upper limit in terms 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 occurs, in which there is a sharp weight loss and weakness, decreased activity in terms of physiological processes with concomitant mental changes. In this case, it is characteristic to adopt an embryo's posture when 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 previously mentioned disorders that are relevant to cerebral circulation. In addition, as a result of studying the brain structures in patients after their death, it was revealed that vascular dementia often develops with a previous 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 affected cerebral artery, but by the total volume of necrotic cerebral arteries.

Vascular dementia is accompanied by a decrease in indicators relevant to 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 the proliferation of glial tissues and the death of neurons occurs, the possibility of the development of serious complications (blockage of blood vessels (embolism), cardiac arrest) is allowed.

As for the predominant category of persons who develop a vascular form of dementia, in this case the data indicate that mainly persons aged 60 to 75 years are included here, 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 characteristic decrease in mental abilities, this is manifested in a violation of memorization, and in severe variants of the course, difficulties arise even with memorizing their 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 speech impairment (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 concerning 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 most affected are "young" functions of thinking (young - when considered on a phylo- and ontogenetic scale), for them underdevelopment is determined, which allows the disease to be attributed to oligophrenia.

A persistent type of intellectual disability that develops in children after the age of 2-3 years against the background of trauma and infections is defined as organic dementia, the symptoms of which are manifested due to the decay of relatively well-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;
severe type of impairment of memory and attention;
emotional disturbances in a more pronounced form that do not correlate (that is, are not associated) with the degree of decrease in intellectual abilities that is relevant to the patient;
frequent development of disorders related to instincts (perverted or increased forms of attraction, performance of actions under the influence of increased impulsivity, weakening of existing instincts is not excluded (self-preservation instinct, lack of fear, etc.);
often the behavior of a sick child does not adequately correspond to a specific situation, which also happens in the case of a pronounced form of intellectual disability that is irrelevant for him;
in many cases, the differentiation of emotions is also subject to weakening, there is no attachment in relation to close people, complete indifference of the child is noted.

Diagnosis and treatment of dementia

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

With regard to the issue of treating dementia, there is currently no effective treatment, especially when considering cases of senile dementia, which, as we noted, is irreversible. Meanwhile, proper care and the use of symptom suppression therapy measures can, in some cases, significantly alleviate the patient's condition. It also considers the need to treat concomitant diseases (in vascular dementia in particular), such as atherosclerosis, arterial hypertension, etc.

Treatment of dementia is recommended within the framework of the home environment, placement in a hospital or psychiatric ward is relevant in case of severe development of the disease. It is also recommended to draw up a daily regimen so that it includes a maximum of vigorous activity with periodic household chores (with an acceptable form of load). Psychotropic drugs are prescribed only in the case of hallucinations and insomnia, within 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. If symptoms suggestive of dementia appear, a visit to a specialist such as a psychiatrist and a neurologist is necessary.

Dementia is a disease characterized by persistent and irreversible impairment of human intellectual activity, accompanied by various deviations in behavior and physical condition. This type of mental disorder can occur due to any infectious brain disease, strokes, brain trauma. Often, this disease is observed in the elderly due to various micro-strokes and age-related changes.

If dementia is caused by two or more diseases, it is called mixed. By its nature, this is as extensive, irreversible deterioration in intellectual activity as dementia. Symptoms of mixed dementia include:

Memory problems such as forgetfulness, difficulty remembering. A person suffering from mixed dementia can remember the events of distant years, but cannot say exactly what he ate for breakfast;

A variety of behavioral disorders. A person can behave inappropriately: hyperactive or, conversely, too sluggish. As a rule, at such moments he is not aware of the actions;

Decreased mental activity. With mixed dementia, it is quite difficult to perform simple addition or subtraction actions, solving elementary problems. A person cannot understand the speech addressed to him, as well as express his needs, feelings at the verbal level;

Various cognitive impairments occur, characterized by impaired causation. The person is disoriented, he is not interested in anything.

In addition to intellectual and cognitive disorders, mixed dementia is accompanied by hypertension and atherosclerosis. With the disease, narrowing of the blood vessels occurs, the appearance of plaques, which leads to an increase in pressure. All this together contributes to the deterioration of the general condition of a person, making him unadapted to social life.

To make a diagnosis of mixed dementia, a qualified doctor is needed who will compare the symptoms of each individual type of mental disorder and collect a competent anamnesis. In addition, for clarification, additional studies will be needed, for example, MRI, complete blood count, identification of the dynamics of blood pressure.

There is no cure for mixed dementia, except in rare cases. However, it is possible to alleviate the patient's condition with the help of ancillary drugs and procedures, as well as help him to adjust to life in society.

Since mixed dementia occurs due to brain damage, vascular changes, about half of the patients also suffer from, which also provokes dementia.

Causes of mixed dementia

Like any other disease, mixed dementia develops due to certain reasons, the main of which is vascular pathology. It can occur at any age, but the benefit is diagnosed in people over the age of 50. Vessels wear out not only in terms of age.

Wrong way of life: smoking, alcohol, fatty food can accelerate the process of deterioration of the quality of blood vessels. With the addition of Alzheimer's disease to vascular pathologies, mixed dementia is also provoked in most cases.

To all of the above, brain injury can also be added. However, trauma can itself cause illness. Trauma provokes vascular pathology - mixed dementia ensues.

The main risk factors for vascular problems that can lead to the diagnosis of mixed dementia include:

smoking. It has long been known that this bad habit provokes pollution not only of the lungs, but also of the vessels themselves. And prolonged and frequent smoking is detrimental not only for blood vessels, but also for brain cells;
diabetes. This disease in itself causes exorbitant damage to blood vessels, clogging them with plaque, which is difficult to treat;
the presence of the apoE4 gene. This gene can be detected only after passing a special analysis. Unfortunately, this gene provokes the disease, although there is no one hundred percent certainty that it is activated during life, but there is a risk;
atrial fibrillation, constant uncontrolled hypertension, physical inactivity, metabolic syndrome.

The brain has its own reserve of so-called reserve cells. In the presence of some kind of disease that is asymptomatic in the brain, diseased cells are replaced with healthy ones, compensating them. In people who have had latent infections, there is an increased risk that the reserve of healthy cells will quickly deplete, thereby provoking mixed dementia.

All of the above are just prerequisites that, under certain conditions, can be combined, causing dementia of mixed genesis.

Treatment and prognosis of mixed dementia

To improve the patient's well-being, a comprehensive treatment is required, which will be aimed at correcting all aspects of neurophysiological disorders. First of all, this is drug therapy. Patients are prescribed drugs for vasodilation, normalization of their activity. Constant dynamic monitoring of blood pressure is carried out, and in case of its persistent violation, drugs are prescribed to normalize the pressure.

In the presence of Alzheimer's disease, drugs are prescribed that reduce the consequences of the pathology. It is important to combine drug therapy with the creation of a psychologically supportive atmosphere. For this, the patient is equipped in a quiet, calm place, without annoying elements: bright light, loud sounds. It is useful to watch quiet, calm programs. Usually such patients require good care, for this it is better to hire a nurse who will be with the patient at all times. Psychotherapy, music therapy and fairy tale therapy, along with alternation of other psychotherapeutic means, give a good effect.

Dementia - what is it?

Classification

Senile dementia

Vascular dementia

Alzheimer's type dementia

Dementia in children

Causes

Risk factors include:

First signs

Stages

Easy

Moderate

Severe dementia

Dementia symptoms

Diagnostics

Treatment

Prognosis for people with dementia

Prophylaxis

What is dementia syndrome?

Causes and types of dementia

Functional and anatomical types of dementia

Forms of dementia

Lacunar

Total

Basic classification of presenile and senile dementia

Clinical course and prognosis

The severity (stage) of dementia

Mild degree

Moderate degree

Severe dementia

Diagnostics

Differential diagnosis of organic dementia

Alzheimer's type dementia

Understanding dementia in Alzheimer's

Risk factors for developing the disease

First signs

Characteristics of the advanced stage of progressive dementia of the Alzheimer's type

Diagnosis of Alzheimer's type dementia

Treatment

Forecast

Vascular dementia

Dementia with lesions of the cerebral vessels

What disease can cause vascular dementia?

Risk factors

Symptoms and course of senile vascular dementia

Treatment

Senile Lewy Body Dementia

Alcoholic dementia

Epileptic dementia

How to prevent dementia - video

Answers to the most popular questions about the causes, symptoms and dementia treatment

Are dementia and dementia the same thing? How does dementia develop in children? What is the difference between childhood dementia and mental retardation

Is unexpected untidiness the first sign of senile dementia? Are untidy and untidy symptoms always present?

What is mixed dementia? Does it always lead to disability? How is mixed dementia treated?

Among my relatives there were patients with senile dementia. How likely is it that I will develop a mental disorder? What is the prevention of senile dementia? Are there any medications that can prevent the disease?

General characteristics of the disease

Vascular dementia

Causes

Signs

Treatment

Video: vascular dementia in the “Live Healthy!” Program

Senile (senile) dementia

Signs

Treatment

Video: Cognitive Training for People with Dementia

Alzheimer's type dementia

Video: how to prevent the development of Alzheimer's disease?

Epileptic dementia

Alcoholic dementia

Frontotemporal dementia

Dementia in children

general description

Dementia causes

Dementia: classification

Dementia Symptoms

Senile dementia: symptoms

Vascular dementia: symptoms

Dementia in children: symptoms

Diagnosis and treatment of dementia

Causes of mixed dementia

Answers to the most popular questions about the causes, symptoms and
dementia treatment