How do dementia symptoms manifest. Dementia - what it is, its types and symptoms

Dementia is a dysfunction of the intellect, its defeat, as a result of which there is a decrease in the ability to comprehend the connections between the surrounding realities, phenomena, events. With dementia, cognitive processes deteriorate, and a depletion of emotional reactions and character traits is observed, often until they completely disappear. In addition, the ability to separate the important (paramount) from the insignificant (secondary) is lost, and criticality to one's own behavior and speech is lost.

Dementia may be acquired or congenital. The second is called mental retardation... Acquired dementia is called dementia and manifests itself in a weakening of memory, a decrease in the stock of ideas and knowledge.

Causes of dementia

Since dementia is based on severe organic pathology nervous system, any ailment that can cause degeneration and destruction of brain cells can become a factor provoking the development of dementia.

Most often, the dysfunction in question affects people age category, however, today it is often found in young people.

Dementia at a young age can give rise to:

- craniocerebral trauma;

- past illnesses;

- intoxication leading to the death of brain cells;

- abuse of alcohol-containing liquids;

- fanaticism.

In the first turn, in the old age period, specific forms of dementia can be distinguished, in which damage to the cerebral cortex is an independent and dominant pathogenetic mechanism of the disease. These specific forms of dementia include:

- the level of development corresponds to the child's;

- the capacity for criticality disappears;

- disorientation in space.

Dementia in children- in the first turn, this is a violation of intellectual function caused by damage to the brain, which leads to social maladjustment. It manifests itself, as a rule, by a disorder of the emotional-volitional sphere of babies, speech disorders, and motor disorders.

Below are the symptoms according to the form of dementia.

The main classification of the considered ailment of late age consists of three types: vascular dementia, which include cerebral atherosclerosis, atrophic (Pick, Alzheimer's disease) and mixed dementia.

The classic and most common form of vascular dementia is cerebral atherosclerosis. Clinical picture this ailment differs depending on the stage of development of the pathology.

At the initial stage, neurosis-like disorders predominate, such as lethargy, weakness, increased fatigue and irritability, sleep disorders, and headaches. In addition, attention defects are noted, personality traits are sharpened, absent-mindedness appears, affective disorders manifested by depressive experiences, incontinence, "weakness", emotional lability.

At subsequent stages, memory disorders for names, dates, and current events become more pronounced. In the future, memory impairments become deeper and are manifested in the form of paramnesia, progressive, fixative amnesia, disorientation (). The thinking function loses its flexibility, becomes rigid, the motivational component of intellectual activity decreases.

Thus, the formation of partial atherosclerotic dementia of the dysmnestic type occurs. In other words, atherosclerotic dementia occurs with a predominance of memory impairments.

With cerebral atherosclerosis, acute or subacute psychoses are rarely noted, manifested more often at night, in a form combined with a disorder, delusional ideas, etc. Sometimes chronic delusional psychoses may appear in conjunction with paranoid delusions.

Alzheimer's disease is a primary degenerative dementia, which is accompanied by the steady progression of memory dysfunction and intellectual activity. This ailment begins, as a rule, after overcoming the sixty-five-year milestone. The described disease has several stages of its course.

The initial stage is characterized by cognitive dysfunctions and mnestic-intellectual decline, which is manifested by forgetfulness, deterioration in social interaction and professional activity, difficulty in orientation in time, an increase in symptoms of fixative amnesia, disorientation in space. In addition, this stage is accompanied by neuropsychological symptoms, including apraxia, aphasia, and agnosia. Emotional and personality disorders are also observed, such as a subdepressive response to one's own inconsistency, egocentrism, and delusional ideas. At this stage of the disease, patients are able to critically assess their own condition and try to correct the growing inconsistency.

The moderate stage is characterized by temporo-parietal neuropsychological syndrome, an increase in the phenomena of amnesia, and a quantitative progression of violations of spatio-temporal orientation. The dysfunction of the intellectual sphere is especially pronounced: a pronounced decrease in the level of judgments, difficulties with analytical and synthetic activities, and also speech disorders, disorder of optical-spatial activity, praxis, gnosis. The interests of patients at this stage are rather limited. They need constant support and care. Such patients are unable to cope with professional duties. However, they retain their basic personality traits. Patients feel inferior and adequately respond emotionally to the disease.

Severe dementia is characterized by complete memory breakdown and fragmented ideas about one's own personality. At this stage, patients cannot do without help and total support. They are unable to do the most basic things, such as personal hygiene. Agnosia reaches its peak. The breakdown of speech function often occurs as a complete sensory aphasia.

Pick's disease is less common than Alzheimer's. In addition, there are more women among the number of sick individuals. The main manifestations lie in the transformations of the emotional-personal sphere: profound personality disorders are observed, criticality is completely absent, behavior is passive, spontaneous, impulsive. The patient behaves rudely, swears, hypersexual. He is unable to adequately assess the situation.

If the initial stages of vascular dementia are characterized by the sharpening of some character traits, then Pick's disease is characterized by a sharp modification of the behavioral response up to the completely opposite, previously not inherent. So, for example, a polite person turns into a rude person, a responsible person turns into an irresponsible person.

The following transformations are observed in the cognitive sphere in the form of profound disturbances in mental activity. At the same time, automated skills (such as: counting, writing) persist for a long time. Memory impairments occur much later than personality transformations, and are not as pronounced as in Alzheimer's or vascular dementia. The patient's speech from the very beginning of the development of the pathology under consideration becomes paradoxical: the difficulty in choosing the right words is combined with verbosity.

Pick's disease is a particular type of dementia of the frontal type. This also includes: degeneration of the frontal region, motor neurons, and frontotemporal dementia with symptoms of parkinsonism.

Depending on the predominant damage to certain areas of the brain, four forms of dementia are distinguished: cortical, subcortical, cortical-subcortical and multifocal dementia.

With cortical dementia, the cerebral cortex is mainly affected. More often it occurs due to alcoholism, Pick and Alzheimer's diseases.

With the subcortical form of the disease, first of all, the subcortical structures suffer. This form of pathology is accompanied by neurological disorders such as muscle stiffness, tremors of the limbs, gait disturbances. It is more often caused by Parkinson's or Huntington's disease, and also occurs as a result of hemorrhages in the white matter.

The cerebral cortex and subcortical structures are affected in cortical-subcortical dementia, which is more often observed in vascular pathologies.

Multifocal dementia occurs due to the formation of multiple sites of degeneration and necrosis in different parts of the nervous system. Neurological disorders are quite diverse and are caused by the localization of pathological foci.

You can also systematize dementia depending on the size of the lesions for total dementia and lacunar dementia (structures responsible for certain types of mental activity suffer).

Usually, short-term memory disorders play a leading role in the symptoms of lacunar dementia. Patients may forget what they planned to do, where they are, etc. Criticality to one's own state is preserved, violations of the emotional-volitional sphere are poorly expressed. Asthenic symptoms may be noted, in particular, emotional instability, tearfulness. The lacunar form of dementia is observed in many ailments, including the initial stages of Alzheimer's disease.

With the total form of dementia, a gradual disintegration of the personality is noted, the intellectual function decreases, the ability to learn is lost, the emotional-volitional sphere is disturbed, shame disappears, the circle of interests narrows.

Total dementia develops due to volumetric circulatory disorders in the frontal areas.

Signs of dementia

There are ten common signs of dementia.

The first and earliest sign of the development of dementia is memory changes and, above all, short-term memory changes. Initial transformations are almost invisible. So, for example, the patient may remember the events of the past youth, and not remember the foods that he ate for breakfast.

The next early sign of developing dementia is speech disorders. It is difficult for patients to find the right words, it is difficult for them to explain elementary things. They may try in vain to pick up the right words... Talking to a sick person with early dementia becomes difficult and takes longer than it used to.

The fifth sign is the appearance of difficulties in performing ordinary tasks. For example, a person is unable to check the balance of a credit card.

Often in the early stages of dementia, a person feels confused. Confusion arises as a result of decreased memory function, cognition and judgment, which is the sixth symptom of the disorder described. The patient forgets faces, adequate interaction with society is disturbed.

The seventh sign is the difficulty of memorizing plot lines, the difficulty of reproducing a television program or conversation.

Spatial disorientation is considered the eighth symptom of dementia. Sense of direction and orientation in space are common mental functions that are among the first to be impaired in dementia. The patient ceases to recognize familiar landmarks or is unable to recall previously used directions. In addition, it becomes quite difficult for them to follow the step-by-step instructions.

Repetition is a common sign of dementia. People with dementia may repeat daily tasks or collect obsessively unnecessary items. They often repeat questions that have already been answered.

The last sign can be considered maladjustment to changes. For people suffering from the described ailment, a fear of change is characteristic. Since they forget familiar faces, unable to follow the speaker's thoughts, they forget why they came to the store, they strive for a routine existence and are afraid to try new things.

Dementia treatment

In the first turn, the treatment of dementia is selected depending on the etiological factor. The main therapeutic measures in the early stages of the development of the disease are reduced to the appointment of nootropics and fortifying agents.

It is possible to highlight the generally accepted methods of treating dementia: the appointment of antipsychotics, drugs that promote normal cerebral circulation, the addition of antioxidant-rich foods to the daily diet, systematic control of blood pressure.

Other methods should be used to treat vascular dementia. In this case, therapeutic measures are aimed at the main cause of neuronal destruction. In addition to the appointment of pharmacopoeial drugs, it is necessary to adjust the diet, normalize the routine, exclude smoking, develop a complex of simple physical exercise... It is also practiced to train mental activity, the solution of simple mental exercises. Daily walks are recommended as therapeutic and prophylactic measures for dementia.

Appointment drugs is carried out based on the patient's condition. Today, the following pharmacopoeial drugs are most often prescribed: antidement drugs, antipsychotics and antidepressants.

The first group of drugs is aimed at protecting neurons from destruction and improving their transmission. These drugs will not cure the disease, but they can significantly slow down the rate at which it progresses.

Antipsychotics are used to relieve anxiety and eliminate aggressive manifestations.

Antidepressants are prescribed to eliminate manifestations of anxiety, eliminate apathy.

Dementia in children suggests the following treatment: the systematic use of psychostimulants (sydnocarb or caffeine-sodium benzoate). Prescription of tonic is often recommended vegetable origin... For example, preparations based on Eleutherococcus, Schisandra, ginseng. These drugs are characterized by low toxicity, have a beneficial effect on the nervous system and increase resistance under various types of stress. Also, when treating childhood dementia, you cannot do without taking nootropics that affect memory, mental activity and learning. Most often, Piracetam, Lucetam, Noocetam are prescribed.

The information provided in this article is for informational purposes only and cannot replace professional advice and qualified medical assistance... At the slightest suspicion of the presence of this disease, be sure to consult your doctor!

Dementia is a complex of cognitive and communication disorders, steady decline functions without improvement phases (in the absence of treatment). Patients try to hide the symptoms of mental incapacity, adapt to the current status, but subsequently partially or completely lose the internal control of their actions.

Content:

Rapid test: quick detection of initial dementia

Want to know if dementia is a threat to you? Human behavior in the domestic sphere, small deviations are clear signals. Answer simple questions, and the test result will show your status, recommendations are provided for each case: what to do next. Prepared by the editors of the site "Head OK".

Early signs of dementia: 12 signals

Learning loss and memory impairment are not the only signs of dementia.

In addition to mnestic disorders (the ability to memorize and reproduce information), a patient with dementia has a clearly expressed violation of at least one of these brain functions:

• the formulation of words and sentences in a native or well-studied language;
• communication with acquaintances and strangers;
• Attention;
• ability to reason and analyze events.

In front of you 12 the first symptoms of dementia, characteristic of its various types. Focus on them to confirm or deny the diagnosis in yourself or in a relative.

If you have at least 5 of the listed signs, the likelihood of dementia is extremely high.

Difficulty expressing your thoughts

You know what you want to talk about, but you can't find the right words or convert your thoughts into text. Is it difficult to communicate with you? The left hemisphere of the brain is responsible for the depth of judgment and the ability to choose the appropriate words, analytical abilities. With dementia, its atrophy is observed posterior and anterotemporal divisions, which causes inhibition of thinking.

If you notice a systematic deterioration in your condition, it may be progressive dementia. There is a high probability of its development in old age and in young people with vascular problems, a history of craniocerebral trauma.

Short-term memory disorders

Faced with increased forgetfulness, cannot remember recent events (places and objects), the name of a friend or famous person, find it difficult to recall a recent conversation in your memory, make hasty decisions due to the fact that you do not remember the details or noticed these symptoms in someone from your environment? Such disorders are not always prerequisites for dementia, but these are signs of damage (inflammation or atrophy) of the prefrontal cortex, basal ganglia, and other parts of the brain.

Consider if you've asked the same question multiple times? It's okay if this happens rarely. You should not leave unintentional absent-mindedness unattended if your forgetfulness began to manifest itself constantly, and acquaintances no longer hesitate to sullenly remind forgotten facts, without hiding irritation.

Bad dream

A January 2018 issue of the Journal of the American Medical Association published the results of a link study bad sleep with Alzheimer's disease. Scientists managed to find out that changes in the circadian rhythm (change in the intensity of biological processes depending on the time of day, biological clock) appear in patients long before memory problems.

At the preclinical (asymptomatic) stage of Alzheimer's disease, patients developed sleep fragmentation - changes in the rhythm of sleep due to complete or partial awakening. Patients fall asleep during the day or are unproductive due to sleepiness, but cannot refuse to stay awake at night.

Increased anxiety and mood swings

Dementia is not only about cognitive impairment ( cognitive processes), but also a change in character traits. The emotional state of a person can completely change, new personal qualities appear:

• oppression;
• anxiety;
• suspicion;
• panic;
• moderate depression.

In dementia, mood swings usually occur when a person has to step out of their comfort zone and perform unusual activities.

Erroneous judgments

There is a need to make a decision and the person is at a loss. From the outside, you can trace the simplification of judgments and the deterioration of logic. Relatives notice the changes well. The patient himself at first desperately struggles for the opportunity to think soberly and assess the situation, but even with a moderate degree of dementia (sometimes earlier), the patient does not see the problem, self-esteem changes.

What problems can arise? With the solution of any problems:

1. Financial matters, account and distribution of amounts.
2. Repairing objects, assessing the risk of breakage.
3. Determination of the distance and contours of objects, their purpose.

A mess in my head

You were asked a question, but you are confused: "What are they talking about?" On initial stage dementia, a similar condition "rolls over" unexpectedly, attacks become more frequent. It is worth distinguishing between systematic loss of orientation and the transient effects of fatigue and stress.

If it is dementia, violations will lead to complete disorientation: date, time, past and future, places, objects, people - all this loses its meaning in the patient's memory. To those around him, his words and actions look like rave.

First alarm bell - it takes more and more time to complete the usual tasks. Confusion and disturbances in concentration lead to decreased productivity.

Elevated amyloid beta

Beta-amyloid is one of the main and most discussed risk factors for Alzheimer's disease. Accumulating in the brain, this peptide leads to the destruction of neurons and forms amyloid plaques. The first symptom that reveals its accumulation is increased anxiety, which appears even before the onset of mnestic disorders (forgetfulness).

Amyloid plaques are detected by positron emission tomography (PET) and cerebrospinal fluid analysis.

A group of Australian and Japanese scientists is developing a new blood test for diagnosing the most common type of dementia. The first test results, published in early 2018, showed an accuracy of 90%. The timing of the emergence of a new method in medical practice has not yet been named.

Failure to recognize humor and deceit

Neurodegenerative diseases take away the ability to recognize the comic. Patients can take any ridicule seriously, and sometimes they show an inadequate reaction to the opposite of comical situations, which throws others into shock, but this is not their fault.

The University College London study, published in 2015 in the Journal of Alzheimer's Disease, was conducted with the participation of fifty patients. The respondents interviewed their acquaintances who knew the patients for more than 15 years before the onset of dementia symptoms.

The results of the study showed that patients saw a reason for fun in opposite humorous situations. Some of them laughed when watching the news of disasters and mass disasters, seeing other people's mistakes, or in stressful situations.

Dementia patients prefer absurd and satirical comedies to films and performances based on logical storytelling.

Inadequate perception of humor is inherent primarily in patients with the following diagnoses (by decreasing the severity):

• frontotemporal dementia;
• semantic dementia (loss of memory and ability to perceive speech);
• Alzheimer's disease.

The early manifestations of the disease in terms of perception of humor are not so pronounced. Initially, people become less attentive to any sarcasm, then they easily laugh at situations that others do not find funny, that is, they become more frivolous. The absurdity of the perception of some situations comes in the last stages of dementia.

Apathy

Even very energetic and social person with degenerative processes in the brain, he will lose interest in his favorite hobbies, active pastime, over time and in the profession. Do not rush to judge your relative if he only sleeps and watches TV. When a person nothing not interested, it is always a sign of illness (often of the brain).

Another case - your acquaintance avoids intellectual or other activity (help around the house), but has his own interests, perhaps even negative for others, and there have not been any sharp unreasonable changes in his character and behavior for several years.

Neglecting personal care and personal hygiene

The paralysis of the desire to do something concerns not only work and entertainment, but also household spheres. You can suspect something is wrong if you or your relative:

• does not follow the hygiene of the oral cavity;
• rarely washed;
• rarely changes clothes, has become unkempt;
• grows nails because they are too lazy to cut;
• does not consider it necessary to comb her hair, especially if there are only "friends" around.

And earlier similar mistakes did not allow.

Coordination disorders

Multiple falls are not the norm, and sometimes a sign of cognitive impairment. Because of impaired spatial awareness, people often stumble and fall, even with mild dementia.

Stacking things in the wrong place

If you are sure that you put a thing (for example, a phone) in a certain place, but it is not there, most likely, someone just took it. But when a similar situation repeats from day to day in different places and groups, do not rush to blame others. You probably have cognitive problems. Not necessarily a neurodegenerative disease, possibly reversible. But you need to check yourself. You can use the dementia tests in this article, or see a neurologist or psychiatrist.

Do not rush to diagnose if you suddenly forgot where the thing is or confused its location. Isolated cases of forgetfulness also occur in people with absolutely healthy brains.

The main criterion for defining dementia in older people, such as Alzheimer's disease, is not a change in habits, but a loss of function. Check if you can remember and repeat your steps to find the item? If the only problem is keeping things in new or unusual places without losing the memories of your actions, most likely this is not dementia, but natural changes in old age. You can find out the differences between the signs of dementia and the usual absent-mindedness from this article (information below).

What might a person with early dementia complain about?

At the first stage of progressive dementia, society and support are important for a person, since he is fully aware and notices changes in his state, evaluates it as a steady degeneration:

1. The loss of some of the cognitive functions is associated with anxiety disorders.
2. Decreased memory.
3. Helplessness in a relatively healthy state, patients often take on a confused look.
4. Depression (up to 40% of dementia cases). Due to the prevalence of anxiety over common sense, in moments of exacerbation, loved ones can hear not only complaints of fear and anxiety, but also assurances of dangers or illnesses.

To end the feeling of uncertainty and logically unwarranted anxiety, it is necessary to confirm the diagnosis. This can be done with the help of tests, instrumental examinations for degeneration of the hippocampus and the parieto-occipital zones of the cerebral cortex in case of suspicion of Alzheimer's disease (atrophy of the frontotemporal and other zones, vascular changes in other types of disease).

Doctor's consultation and comprehensive examination are necessary to identify the cause of dementia syndrome, and if associated disorders are combined with other symptoms. Prompt response to behavioral change will help identify vascular dementia and frontotemporal degeneration, which are manifested primarily by behavioral changes.

The main symptoms of dementia - from mild manifestations to total dementia

Depending on the affected areas of the brain with dementia, symptoms of a certain etiology predominate:

1. Simple dementia (typical cognitive impairment).
2. Psychopathic disorders (psychological stress or complete exhaustion, tightening of abnormal personality traits).
3. Hallucinations and delusions.
4. Amnesia, paramnestic disorders (distortion of facts that have occurred in the past).
5. Paralytic and pseudoparalytic syndrome (euphoria, increased sensitivity against the background of an erased personality).
6. Disorders of higher nervous activity: speech, gnosis (the ability to recognize objects and phenomena), praxis (the ability to perform targeted, coordinated actions).
7. Deep disturbance of mental activity, marasmus (in the absence of treatment or in the last stages of diseases accompanied by dementia).

Behavior on the road as a driver will help determine if he has symptoms of dementia? Diagnosis likely if the person:

• lost in a familiar area;
• does not distinguish or does not notice road signs, signals;
• makes the wrong actions when a decision needs to be made quickly;
• unable to perform or incorrectly performs turns, change of direction of movement;
• does not adjust to the flow rate (not confident or moves too fast);
• confused, but angry at troubles or comments;
• distracted by extraneous details;
• confuses the purpose of the control details.

People diagnosed with dementia you need to give up driving because of the high danger to the patient and others.

At severe dementia the patient does not remember:

• today's date, day of the week, past dates, timed to events;
• your address and place of residence of friends, not a single phone number;
• important details from life, facts from the biography of close relatives;
• age (your own and someone else's), usually shifts towards the young, can revive long-dead people in the memory;
• famous personalities, for example, stars, politicians;
• chronology of events of their own and social life;
• the purpose of household items.

The counting function is also broken. It can be difficult or impossible to answer the question: how much 21-3 will be. The sequence of actions when performing math problems is violated. The patient is not guided in numbers, for example, if you set a condition: subtract from 32 by 4 to 0.

The prevalence of dementia is uneven among both sexes. Women get sick 2 times more often than men.

Test to determine the presence and degree of dementia

We offer a test - an opportunity to make a presumptive diagnosis for yourself or your relatives on your own. The testing system is based on the Clinical Rating Scale for Dementia, compiled by Distinguished Professor of Neurology at the University of Washington, St. Louis, John Morris.

Distinctive features in women

The decline in cognitive functions in women occurs 2 times faster.

Scientists from Duke University in the United States worked with a group of people of both sexes with mild signs of dementia around the age of 70 for 4 years. Cognitive tests were performed regularly. Women showed an annual decrease in results by an average of 2 points compared to 1 point in men.

Women's life expectancy is longer, and dementia is predominantly a disease of the elderly. Every year the risk of its appearance increases, which affects the prevalence of female patients with this diagnosis.

The risk of dementia in the presence of cardiovascular, endocrine diseases increases for both sexes, but women are in the lead.

American Diabetes Association analyzed results 14 studies conducted on the basis scientific institutions in Australia and the USA. Total number of patients: more 2 million, 100 thousand of them with dementia. It has been found that women with diabetes have 19 % a greater risk of vascular dementia than men with the same condition.

Interesting Alzheimer's Disease Study Group Facts About Dementia:

1. Female dementia at age 60 is twice as common as breast cancer.
2. The responsibility of caring for feeble-minded relatives is undertaken by women 2.5 times more often than men.
3. Most of the people who are forced to care for patients with dementia had not previously planned or imagined that they would have to take on such a responsibility, they are unhappy with the status of a caregiver.
4. Women who care for relatives with dementia are more prone to depression than men.

Women should distinguish between increased emotionality, combined with fatigue and dementia. A sure sign: if cognitive function is at least partially restored after rest, it is inappropriate to think about age-related dementia. Dementia is characterized by a steadily progressive (possibly slow) course.

How does dementia manifest in men?

In addition to the decline in cognitive function, dementia in men is often expressed as aggression. Suspicion, jealousy are manifested violently, and due to the absurdity of inferences and the often relatively high physical strength of the patient, relatives cannot always comfortably coexist with him, especially during periods of exacerbations (obsessions, inappropriate questions and actions).

Men are more likely than women to suffer from alcoholism (5: 1). Accordingly, they have a higher risk of alcoholic dementia, which occurs at any, often working age (20-50 years).

According to a study published in the US Journal of Neurology, the progression of dementia in men is slower when compared to the rate at which some functions are degraded in women. Fluency of speech, memory, the ability to choose the right words, recognize objects and events by description in male patients lasts longer. In contrast, with depression, men are more likely to develop dementia, particularly Alzheimer's disease.

Research by experts at the Mayo Clinic in Florida shows additional challenges in identifying male dementia. The medical histories and autopsy results of 1600 patients with acquired dementia were analyzed. In women, the greatest damage is done to the hippocampus, which is responsible for memory. In men, first of all, non-specific symptoms are revealed: problems with speech, violations of purposeful movements.

The onset of dementia among female patients occurs predominantly at the age of 70 years or more, compared with 60 years for men.

How not to confuse the symptoms of senile dementia with the natural withering of the body?

Degradation of cognitive functions during normal aging of the brain (without pathologies):

1. The worst damage to short-term memory is a decrease of 20% or more.
2. Working memory decreases - a person is not always able to remember and filter out a large amount of information, to use knowledge at the right time.
3. Long-term and procedural (the use of professional and acquired skills) practically does not change.
4. Semantic memory (general knowledge about the world and society) does not suffer; some older people have an improvement in the skills to use the experience gained during their life. The active use of semantic memory is expressed in the fact that people reproduce (remember) events that happened to them in the past.

Video: Everything You Wanted to Know About Senile Dementia

An overview of the symptoms and characteristics of dementia in the elderly. How patients behave, what to expect from patients and what should be feared, is it possible to slow down the disease and what people should do if someone in their family suffered from a similar disorder.

Duration: 17 minutes

Dementia patient's speech (patient interview). Tips: Specific actions that anyone can use to slow down the regression of intellectual capacity.

Duration: 2 minutes.

Comparison of the behavior of a healthy elderly person and a person with dementia

To distinguish the signs of dementia from ordinary distraction, it is necessary to understand the magnitude of the disaster.

After carefully reading the proposed comparison table, you will understand why dementia is dangerous - a high percentage of suicides. Healthy people may experience emotions similar to dementia, but their manifestations are erased when compared with another reality, into which patients gradually plunge. People with acquired dementia are in disastrously depressed state almost constantly, combining it with background despondency and global loss of intellectual functions down to basic human skills.

Symptoms	Healthy	Dementia patient
Bad memory	Forgot the day of the week on vacation or during monotonous work, did not make a small purchase on time, does not remember the name of a friend whom he met only a few times	Can't remember the details of yesterday's meeting, can hardly reproduce numbers and dates, recalls the name of an old acquaintance, but communicates as with a stranger (does not remember the status of the relationship)
Communication problems	Cannot express his thoughts correctly when worried, for example, on stage, poorly formulates sentences after a hard day	Not able to pick up elementary words, pronounces complex semantic constructions with errors, loses the thread of conversation, does not delve into and does not understand the meaning of dialogues
Difficulty orientation on the terrain and in time	For a long time he finds his way in an unfamiliar area or where he was rarely, for a long time.	Poorly navigates first in someone else's area, then in a well-known environment. When redeveloping the house, he does not find the necessary items.
Handwriting	Writes sloppily when tired, out of the habit of a ballpoint pen, or in a hurry	Writes vertically or along the edges of the page, sometimes loses a line when writing or reading
Inappropriate behavior in daily life	Didn't take suitable clothes in rainy weather	I put on a dressing gown when going shopping or visiting, went out in pajamas in the cold
	Annoyed by having to deal with additional problems	Can't imagine how to solve a household problem (pipe burst)
	Forgot money in my pocket, found it while washing	Mixed up the bills, miscalculated the change
	Burst the lightning out of the rush	It takes a long time to figure out how to symmetrically button up the buttons
Behavior disorders	Same as in patients with dementia syndrome, but short-term	Regularly repetitive or persistent: jealous for no reason; suspects loved ones of malicious intent; does not eat on time, overeats, or is picky; ignores the rules of personal hygiene and even admonitions of relatives; irritability, anger, tearfulness replace each other
Emotions	Melancholy, grief, a sense of loss of youth and associated opportunities, loneliness (due to a lack of people who can understand the emotions of an elderly person)	Loss of interest, fear of change, symptoms of depression (in 30% of patients), a feeling of hopelessness, pathological self-doubt, the correctness of their actions, gloomy despair, in particular, due to the impending complete loss of self-control
Lack of initiative	He does not want to continue doing monotonous work, household chores, social work, because he is tired. The potential is restored after a good rest or a change in the type of activity	Indifference, loss of interest unchanged after rest. Enhanced, but often useless intellectual activity is possible with the manifestation (appearance of the first signs) of the disease

Signs of different types of disease

Dementia can be easily identified by looking at the area where the brain is affected. The following are popular and rare types of the disease, accompanied by cognitive deficits and associated abnormalities.

Dementia in Alzheimer's Disease

More than 50 million people worldwide have this diagnosis. More than 60% of all cases of dementia. The first symptoms are at the age of 65 years, early onset in no more than 5% of patients.

Alzheimer's disease begins with mild cognitive decline. The onset and progression of symptoms is partly due to progressive hippocampal atrophy. The hippocampus is responsible for the formation of long-term memory from short-term memory, controls the retention of attention and the emotional component. With diagnosed Alzheimer's disease, its volume decreases by about 5% annually.

In the future, atrophic processes affect other parts of the brain. The degree of cognitive impairment is commensurate with the amount of brain tissue lost. Degenerative processes in Alzheimer's type dementia usually begin 10-20 years before the first obvious signs of the disease appear.

The main symptom of AD is memory impairment. The patient quickly loses memories of recent events, and remembers the past for a long time, bright moments right up to the last stage (Ribot's law)... May appear false memories (confabulations).

The first to worsen:

• the ability to reproduce visual images;
• memory for smells.

Patients do not remember new information well. Neither the systematization of the material, nor the hints when trying to remember helps. Interference of memory is noted: when new information arrives, old information is displaced or distorted.

The variety of speech disorders at different stages of Alheimer's disease:

At first it becomes more difficult for the patient to find the necessary route in an unfamiliar area (foreign area, city, in the subway). Rational planning of the trip scheme is practically impossible (it is very difficult to fit various algorithms and sequences in the head). Later disorientation occurs on well-known streets, a person gets lost on the road when going, for example, to the nearest store. In the end can even get lost in your own home.

It is not for nothing that when taking tests to determine dementia of the Alzheimer's type, patients are asked to draw geometric shapes and clock hands. This is necessary to detect violations of spatial orientation.

If they are, relatives should expect:

1. Ideomotor and constructive apraxia (inability to fully control your body and analyze the position of objects in space, perform consistent actions).
2. Agnosia (impaired perception with preserved consciousness).

The constant progression of pathological changes will lead to the disability of the patient. He will cease to serve himself, in particular, apraxia of dressing will develop.

Life expectancy in senile dementia of the Alzheimer's type is on average 10 years after the manifestation of the first bright signs of the disease. Fewer than 20% live to 15-20 years, mostly with slow progression of dementia and behavioral disorders.

How does vascular dementia manifest? Specific symptoms

It accounts for 10-25% of all dementias; it can begin at any age, more often after 60 years. In Russia, the indicator of vascular dementia is in 1st place in terms of prevalence (more than 5% of people over 60 years old), probably due to the low awareness of the population about the diagnosis and treatment of Alzheimer's disease. Mixed dementia also has a high prevalence, where the vascular component is combined with senile dementia.

Vascular dementia is manifested by a deficiency of most cognitive functions, develops as a result of the destruction of brain cells due to insufficient blood circulation. Dyscirculatory encephalopathy leads to vascular dementia with constant progression of diffuse cerebral atrophy (in the absence of treatment and improvement).

Vascular dementia develops mainly in patients with a history of certain diagnoses:

1. Ischemic or hemorrhagic stroke (high risk in the first year after the attack).
2. Dyscirculatory encephalopathy (persistent dementia is diagnosed in 3 stages).
3. Arterial hypertension.
4. Atherosclerotic plaques that cause narrowing or blockage of blood vessels in the head or neck.
5. Heart disease (atrial fibrillation, ischemia, valvular heart disease).

Seemingly minor cognitive impairment can be a precursor to vascular dementia. Suddenly onset mental and cognitive deficits are often the result of chronic or acute failure cerebral circulation (hypoperfusion).

The first signs of vascular dementia are:

1. Changes caused by somatic disorders (the list of the most common ones is indicated above).
2. General cerebral symptoms - nausea, dizziness and headache, emotional lability (sudden changes in mood, a strong reaction to minor events, emotional instability), possibly a pre-morbid state or short-term loss of consciousness, rapid fatigue, the appearance of a craving for loneliness, increased meteosensitivity.
3. Memory impairment (optional criterion, its presence depends on the area of ​​brain damage).
4. More than one of the following symptoms (distracted attention, problems with orientation, impaired visual control, speech, impaired praxis - inability to plan and perform a specific sequence of actions to achieve a set goal while maintaining involuntary movements).

Dependence of the symptoms of vascular dementia on the area of ​​brain damage:

Damaged	Signs
Diencephalon and midbrain	Alternately as it progresses: confusion of consciousness; transient hallucinations; apathy; decreased activity, unwillingness to perform even basic hygiene procedures; drowsiness (with or without sleep at night); Symptoms are accompanied by a decrease in short-term memory, a replay of events that occurred many years ago, with the presentation of them as recent, fictional memories
Thalamus	Meaningless speech with the replacement of letters and interspersed with non-existent words when understanding what other people say, it remains possible to repeat simple phrases without mistakes
Striped body	Cognitive degeneration and neurological disorders(muscle hypertonicity, involuntary motor reflexes, delayed formation of conditioned reflexes) in acute form
Hippocampus	Attention disorders, insufficient semantic processing of voice and text information, disorders of all types (mainly short-term) memory. There are no pathologies of consciousness, sleep, hallucinations
Frontal lobes	Indifference, lack of will, initiative. Decrease in criticism, as a result of which the patients are characterized by senseless repeated repetitions of their own or other people's words, actions
White matter (subcortical vascular dementia)	Basic symptoms of dementia, parkinsonian gait (legs bent, arms bent and pressed to the body, the first step begins with a bend, then rapid mincing movements, the body can lean forward or backward, patients often fall), "drunk" gait, slow movements and speech, increased muscle tone, involuntary movements, personality degradation, possible memory impairment
Multi-infarction brain damage (cortical dementia)	The development of symptoms in accordance with an increase in ischemic episodes (transient circulatory disorders lasting from 10 minutes to 24 hours), provoked by them cerebral infarctions. Patients have several of the following symptoms: tearfulness; unnatural laughter; barely discernible due to low volume, sometimes incoherent speech; symptoms of oral automatism (paresis or paralysis of the facial muscles); slowed down movements with increased muscle tone; rhythmic twitching of muscles at rest. 1-5 years after the onset, the symptomatic picture is complemented by a feeling of heart sinking, convulsions in various muscle groups, neuropathy lower limbs(sensitivity disorders, seizures and spasms), fainting, urinary and fecal incontinence

With vascular dementia, there are no:

• disturbances of consciousness (delirium, highly distorted perception of the current situation);
• severe sensory aphasia (loss of the ability to understand and reproduce speech);

Contact with the outside world is preserved.

CT and MRI can quickly identify the vascular component of dementia. One or more pathological changes are detected:

• focal disorders caused by ongoing or previous stroke;
• changes in white matter due to chronic cerebral ischemia.

Average life expectancy for people with vascular dementia: 20 years.

Lewy body dementia

The diagnosis of Lewy body disease in the world is received by 4% of patients. Statistics from individual European countries confirm that due to the similarity of symptoms with other types of dementia, doctors do not always recognize it. In the UK, this type of dementia is diagnosed in 15% of all cases of acquired dementia detected.

Lewy body disease is a non-standard dementia disorder. The first sign is behavioral abnormalities during REM sleep. People see unusually vivid, often "creepy" dreams according to their stories. At this time, they make sudden movements, risking injury to themselves or to a person nearby. Disorientation in space and time after awakening comes before other vivid symptoms: cognitive disorders, movement abnormalities and hallucinations.

Fluctuations in concentration levels are a feature of Lewy body dementia. The patient performs any, even the simplest, actions slowly, quickly gets tired of mental stress. In intellectual work, suffers from exhaustion, is distracted by less important, intuitive tasks, or interrupts activities.

Against the background of a picture of a decrease in mental activity typical for dementia, there are flashes of vigorous activity, a transition to the usual rhythm of life, and then an empty, indifferent look appears again, and cognitive activity stops. Usually violations are confined to the circadian rhythm, often the condition worsens towards night.

For infectious diseases, disorders metabolic processes, exacerbation of cardiovascular diseases, as a consequence of severe injuries and surgical operations, as well as a few years after the onset of dementia, subsonic states appear - incomplete awakening. Only the simplest functions are preserved, due to which patients cannot distinguish reality from sleep, perform meaningless, sometimes dangerous actions, being mainly in an aggressive state.

Fuzzy consciousness, loss of time and place, distorted perception of objects, hallucinations are disorders that not only patients with dementia, but also their families have to face.

Signs that, when combined, can distinguish Lewy body dementia from other neurodegenerative diseases:

1. Progressing cognitive impairment that hinder professional activity, the continuation of the usual way of life (functioning in society, hobbies, personal, family life). Memory impairments increase gradually, in line with the increase in other deviations. At stage 1, violations of attention, orientation, regulation of behavior and activity are noticeable.
2. Illusions(giving fictitious properties to objects), then hallucinations at stage 1 in 25% of patients, later up to 80%. Patients recognize them as fictional images, but subsequently they are getting worse at distinguishing reality from objects generated by consciousness. Patients report primarily visual hallucinations, but auditory, less often olfactory and tactile hallucinations may be present.
3. Delusional disorders in the middle stage. Patients claim that they are being persecuted, someone wants to harm them, or a (positive or negative) double has appeared. In the last stages of dementia, delirium disappears.
4. Movement disorders: difficulty in muscle mobility due to increased tone, unstable, shuffling gait with imbalance, tremor (uncontrolled rhythmic movements of muscle groups when holding a posture and when moving) of any severity, frequent falls.
5. Neuroendocrine disorders: a sharp decrease in blood pressure when standing up (provokes attacks of dizziness, inhibition of movements and blurred consciousness, sometimes fainting), insufficient blood supply to organs, sleep apnea, delayed digestion of food, constipation, rare urination.
6. Adverse reactions to antipsychotics when trying to get rid of hallucinations, delirium with the help of medications, which are successfully used in the treatment of mental disorders.

The main diagnostic sign of dementia with Lewy bodies on neuroimaging is enlargement of the posterior horns of the lateral ventricles of the brain, often additionally there is a rarefaction of white matter neurons along the periphery of the lateral ventricles (leukoaraiosis).

Parkinson's disease: association with dementia and characteristic symptoms

The diagnosis is received by 5% of the elderly population. Dementia manifests itself, according to various sources, in 19-40% of all cases of Parkinson's disease, usually develops on later stages at old age patients.

The disease is genetically determined. Carriers of genes encoding Lewy bodies - proteins synuclein and ubivictin - are at high risk, as well as for dementia of the same name.

Symptoms typical for Parkinson's disease:

1. Akinetic-rigid syndrome - slowing down of movements with hypertonicity of the muscles, fixation of the trunk and limbs (adoption of unnatural postures, sometimes the inability to sit down, get up, perform elementary functions), the absence of small movements characteristic of various actions.
2. Rest tremor or muscle hardness (both are possible).
3. The first manifestations of movement disorders are asymmetric.

The diagnosis is confirmed if absent:

1. Factors that cause similar (temporary) disorders: poisoning, trauma, encephalitis, or other brain infections.
2. At stage 1: pronounced organ dysfunctions due to autonomic insufficiency, movement disorders, dementia syndrome.
3. Inconsistent eye movements.
4. Episodic states of immobility of the eyes, accompanied by involuntary movements of the pupils.
5. Unstable gait.

Frontotemporal degeneration: how does it manifest? Differences from other forms of dementia

Early onset (from 50 years old), one third of cases are hereditary.

Rude speech, antisocial behavior, sexual restraint, unexplained gaiety, alternating with passivity and indifference with reduced or no self-criticism are the main symptoms of frontotemporal dementia. Among the first manifestations of the disease, there are no memory impairments, but progressive speech disorders occur.

Behavioral traits change. The patient becomes untidy, more impulsive and at the same time faint-hearted, easily switches from an important task to an insignificant one, can only follow clear instructions, poorly orientates himself in the current situation when unexpected changes appear (intellectual rigidity), changes his eating habits.

At stage 2, the symptomatic picture is complemented by a violation of the recognition of the emotions of the surrounding people, expressed in facial expressions and speech, close and painful attention to any (even insignificant) objects, hyperoralism (chewing, smacking, eating objects unsuitable for food).

Pathologies of the motor sphere, partial or complete loss of memory, violations of counting operations occur only at 3 stages of frontotemporal degeneration. The last stage is also characterized by pronounced disorders of various functions of speech, mutism is possible (the patient does not come into contact with the interlocutor either with the help of voice or with the use of non-verbal signs, while he understands speech and retains the ability to speak).

With frontotemporal dementia, there are no:

• disorientation in space;
• movement disorders (exceptions - a combination of frontotemporal lesions with other diseases);

Differential diagnosis of vascular and frontotemporal dementia is based on the assessment of symptoms and neuroimaging results. Dementia of vascular etiology is characterized by focal changes in brain structures and white matter. Frontotemporal degeneration is detected with local, often unilateral atrophy of the brain in the frontal lobe.

People with frontotemporal dementia live an average of 8-12 years.

Huntington's disease

Attacks at an early age, risk from 30 years. Most cases are hereditary.

Motor disorders- manifestations of chorea (primary in 75% of cases):

• grimaces similar to normal facial muscle movements, but more intense and expressive, resemble facial expressions in dance;
• sweeping movements;
• special gait: the patient spreads his legs wide, sways;
• fixation of the posture with muscle tension is impossible.

Cognitive violations(primary in 25% of patients or more):

• distorted perception of the shape and location of objects in space;
• limited regulation of voluntary activity (it is difficult for a patient to follow instructions, concentrate, switch from one type of activity to another);
• difficulties in using the accumulated knowledge for training and solving problems, the inability to operate with a large amount of data, simultaneously work with several sources of information;
• decreased ability to recognize familiar objects and phenomena, especially if they are depicted indistinctly or with superimposed surface effects;
• concentration on the object under study is difficult (orientation on an interactive map, research of statistics, graphs, algorithms presented in a visual format).

The patient needs hints and rewards to improve cognitive performance. Speech and memory for general events are saved.

Changes behavior (specific symptom of the disease):

1. Hot temper and aggressiveness (up to 60% of patients). They appear unexpectedly.
2. Apathy (up to 50%). There is no craving for knowledge and new achievements.
3. Depression (up to 1/3 of cases).
4. Mental disorders (less than 1/4). Persecution mania, hallucinations are characteristic of young patients.

An accurate diagnosis in the presence of symptoms can be made after a DNA test for the number of repetitions of amino acid chains (triplets) in huntingtin, a protein that provokes the disease.

Pick's disease

It manifests itself at the age of 50 years.

Degradation of higher psychological functions occurs while maintaining clear consciousness.

Onset of the disease:

• asocial behavior: selfish traits, disinhibition of basic instincts, as in frontotemporal dementia (described above);
• repetition of the same phrases, stories, jokes;
• contrasting emotions: apathy or euphoric state.

The memory is saved.

Stage 2:

• sensorimotor aphasia (the ability to understand the meaning of speech and speak is lost);
• loss of the ability to read and write;
• memory impairment;
• disorders of perception, lack of understanding of what is happening around;
• inability to act according to the plan.

At stage 3, a person is incapacitated, immobility, disorientation sets in, memory is completely lost. Full care required.

Life expectancy for Pick's disease: 6-10 years.

Now you know the symptoms of the 7 most common (96%) types of dementia and can distinguish it from other diseases in yourself and your relatives. The rest of the varieties are caused by trauma and neuroinfections.

Dementia- this is clinical syndrome characterized by loss of memory , as well as other functions of thinking. This phenomenon occurs in the case of chronic degenerative brain lesions of a progressive nature. However, dementia is characterized by more than just a change thought processes, but also the manifestation of behavioral disturbances, as well as changes in a person's personality.

It is important to understand that from oligophrenia or congenital dementia differs, first of all, in that it occurs as a result of illness or damage to the brain. Generally, dementia is a condition common in older people. Due to natural aging in the body, malfunctions of various systems begin to occur. The neuropsychic sphere is characterized by cognitive , behavioral , emotional violations. Dementia is a cognitive impairment. However, if we consider this condition, guided by its external manifestations, then patients with dementia are also characterized by emotional disorders (condition , ), behavioral disorders(too frequent awakenings at night, lost hygiene skills). In general, a person with dementia gradually degrades as a person.

Dementia is a severe and, as a rule, irreversible disorder that very noticeably affects the normal life of a person, destroying his social activity. Because dementia is common in older patients, it is also called senile dementia or senile marasmus ... According to research by specialists, approximately 5% of people who are already 65 years old suffer from certain manifestations of this condition. The state of dementia in elderly patients is considered not to be a consequence of aging, which cannot be avoided, but as age-related diseases, some of which (about 15%) are treatable.

Dementia symptoms

Dementia is characterized by its manifestation from many sides simultaneously: changes occur in speeches , memory , thinking , attention sick. 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 the ability to demonstrate previously acquired skills, but also loses the ability to acquire new skills. Another important sign of dementia is the relatively stable manifestation of these disorders. All violations are manifested regardless of the state of the person's consciousness.

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

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

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

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

Forms of dementia

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

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

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

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

Dementia causes

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

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

Dementia diagnosis

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

The onset of secondary dementia is mainly provoked by cardiovascular disease , excessive addiction to alcohol , violations metabolism ... In this case, the dementia may disappear after the cause of the dementia is healed.

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

Long-term testing is required to fully confirm the presence of dementia symptoms. There are also specially designed scales for assessing dementia.

It is important to distinguish dementia from a number of mental disorders. So, if among the symptoms inherent in the patient is observed, nervousness, sleep disturbances, then, assuming the absence of changes in mental activity, the doctor may assume the presence of a mental illness. In this case, it is important to take into account that mental disorders in middle-aged and elderly people, these are the consequences of either organic brain damage or depressive psychosis.

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.

After diagnosing a patient with a state of dementia, the doctor prescribes a number of other examinations in order to identify signs of diseases of a neurological or therapeutic nature, which makes it possible to correctly classify dementia. The study includes computed tomography, EEG, MRI,. Toxic metabolic products are also being investigated. In some cases, it is necessary to monitor the patient for a certain amount of time to make a diagnosis.

Dementia treatment

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

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

With the right approach to treatment vascular factors in older people, the progression of the disease can be noticeably halted.

The doctors

Medicines

Prevention of dementia

To prevent the onset of dementia, measures are used to reduce the risk of this disease to some extent. It is important to monitor the state of the level cholesterol and - it shouldn't be high. Should not be allowed to develop ... An active social life, regular intellectual activity, and an active lifestyle are an important factor in the prevention of dementia. Prevention of vascular dementia involves quitting smoking, drinking too much alcohol, salt and fatty foods. It is important to control blood sugar and avoid head injuries.

Diet, nutrition for dementia

List of sources

• Damulin I.V. Alzheimer's Disease and Vascular Dementia / Ed. Yakh-but N.N. M., 2002.
• Damulin I.V., Parfenov V.A., Skoromets A.A. and others. Circulatory disorders in the brain and spinal cord. Diseases of the Nervous System: A Guide for Physicians. Vol. 1. Ed. N.N. Yakhno. 4th ed., Rev. and add. M .: JSC "Medicine Publishing House", 2005;
• Levin O.S. Modern approaches to the diagnosis and treatment of dementia // Handbook of an outpatient doctor. - 2007. - No. 1
• Damulin I.V. Cognitive disorders: modern aspects of diagnosis and treatment. - M., 2005.

Dementia - pathology characterized by changes in the cognitive sphere.

The disease proceeds with a deterioration in perception, memory and thinking, as well as behavioral disorders(loss of the ability to take care of oneself, take care of one's life and health, etc.).

Dementia is a progressive disease that often results in disability.

What should relatives do if a family member has been diagnosed with this disease?

Carry out the care yourself or place the patient in a specialized institution?

These are questions ethics, financial condition and the ability to stay with the patient around the clock.

By choosing a boarding house for elderly people with dementia, relatives will provide them with qualified care and appropriate treatment. You can also take care of such patients at home, periodically visiting doctors and undergoing examination.

Although dementia most often affects the elderly and seniors, and about 5 million people on earth suffer from it, it is not the result of natural aging. This is a pathology that needs treatment. The disease completely disappears in very rare cases, but it is possible to slow down its development by applying complex measures - combining the advantages of pharmacological agents and psychotherapy.

Video

ICD-10 code

Medical science classifies disease as an organic dysfunction that occurs with psychological disorders thinking, memory, behavior, she gives it another name - dementia .

This violation has its own typology and codes ( F00-F09).
1. Senile dementia caused by Alzheimer's disease ( F00) is considered a poorly studied phenomenon, its causes are practically unknown. This type of dementia has a slow but steadily progressive course.

2. Vascular dementia, the symptoms and treatment of which depend on the underlying disease, has a code - F01. This is a secondary pathology, it is the result of brain damage as a result of strokes, atherosclerosis or trauma (bruises, wounds, contusions). With timely initiation of therapy with this form of dementia, the cognitive sphere is partially restored. And although patients cannot carry out complex mental operations (counting money, analyzing readings, etc.), they successfully take care of themselves (go to the toilet, take a shower and food, etc.).
3. Dementia due to other diseases ( F02), is associated with tumor processes, neuronal damage during infections, inflammatory and degenerative diseases.
4. Cases of dementia of unspecified origin (origin) by code F03, arise against the background of psychosis, depression.

ICD-10 gives a decryption for each type of dementia known to science and its short decoding.

Alcoholic, idiopathic or inorganic forms of dementia received their own individual code and description in it.

Causes of occurrence

1. Alzheimer's disease, which accounts for more than 60% of dementia in old age.
2 Pick's disease, or frontotemporal dementia, affects adults between the ages of 40 and 45.
3. Progressive vascular pathologies (arteritis, atherosclerosis) or metabolic disorders (diabetes mellitus, obesity).
4. Intoxication, against the background of which mental deficiency develops, caused by the mass death of neuronal cells under the influence of biological toxins (in case of infections) or chemical reagents (in case of poisoning, alcoholism, drug addiction).
5. Neoplasms and injuries. In these cases, the degeneration of normal tissues causes a pronounced impairment of cognitive functions and behavior of patients.
6.. In some forms of this disease, progressive dementia can begin.
7., often with exacerbation of mental illness, schizophrenic dementia manifests itself.
8. Chronic lack of oxygen in diseases of the lungs, heart, kidneys, blood.
9. Dementia with levi bodies (degenerated protein fractions) affects people at any age, contributing to the degeneration of healthy brain tissue.

Symptoms and Signs

Dementia in older people, the symptoms of which can manifest themselves gradually or abruptly, in most cases is characterized by:

• blackouts;
• a decrease in the ability to perceive and analyze new information, to master new motor and everyday skills;
• loss of spatial orientation;
• changes in character, emotional mood, ways of interacting with others;
  - narrowing the circle of communication and interests;
• the appearance of confusion, hallucinations, delirium;
• severe disturbances in sleep and wakefulness.

Presenile dementia develops in old age and differs more acute development... Senile dementia (senile) is less aggressive, but with steady progression.

The severity of clinical signs of dementia depends on the form and severity of the disease.

Development stages and life expectancy prognosis

The disease usually has several stages in its development:

1. Elementary ... Signs of dementia are subtle, these are:
- instant forgetfulness (failure is observed immediately upon receipt new information);
- deterioration in temporal and spatial orientation;
- insomnia, emotional decline (manifestations of joy and sadness are reduced, the person has an apathetic appearance).
2. Early ... Proceeds with difficulties in the selection of words n
When talking and writing, forgetting the names and location of things. Lack of understanding the thoughts of other people when communicating (requests, reasoning), emotional state interlocutor. The ability to self-service is partially reduced (they cannot do laundry, prepare food, clean the room, etc.). There are atypical changes in character, tearfulness, aggression, withdrawal, or, conversely, hysterical fits, a desire to gather around more “spectators” may appear.
2. Intermediate ... During this period, sick people lose their spatial reference points, sometimes do not respond to calls to them, lose the ability to provide household services, often forget the names of loved ones and cannot remember events from the past.
It is possible that such a course of the disease will require constant monitoring of the life of patients, since they unconsciously can harm themselves and others (leave open water in the tap, gas, go outside and get lost, etc.).
3. Late ... The last stage of dementia before death proceeds with immobilization of patients, incontinence of urine and feces, loss of memory and the ability to adequately perceive reality.
In some forms of dementia (Alzheimer's type, alcoholic or schizophrenic), as well as in its mixed course, delusions of persecution, hallucinations, phobias, mania are observed.

Treatment

Disease therapy includes medications and psychotherapeutic techniques.

• Pharmacological preparations are used to improve the nutrition of brain tissues and enrich them with oxygen.
• Psychotherapy for better socialization of patients in society.

Since dementia is caused by certain diseases or conditions, the basis of treatment is precisely their correction.

Intently therapy needs attention dementia among women, they get sick more often than men. Therefore, when diagnosing, it is important to study the hormonal background of women, and when treating, take into account that their emotional sphere is more mobile and requires the use of sedative and antidepressant drugs.

Dementia therapy in children (with oligophrenia, psychosis, cerebral palsy, tumors and other diseases) has been carried out for many years. With vascular pathologies and traumatic injuries, progress and improvement of the child's cognitive functions and memory are possible.

With a difficult course, the degeneration processes can be temporarily "slowed down" and the quality of life of young patients can be improved.

Using drug-free methods, specialists try to correct the emotional sphere of patients and their behavioral reactions.

To do this, apply:

• psychotherapy(supporting, with the technique of recalling pleasant memories from the past, sensory, musical, art therapy, animation, etc.);
• psychocorrection(exercises for the formation of stable stereotypes of behavior in everyday life and society, orientation in space and time, training of self-service skills).

Drugs

After a comprehensive examination in a hospital, further treatment at home is possible. Patients are prescribed drugs for the treatment of the underlying disease.
The basic treatments for most forms of dementia are:

• inhibitors cholinesterase: (Galantamine, Donepizil), their action is based on the accumulation of acetylcholine in the neurons of the brain, a substance that slows down degenerative processes;
• modulators NMDA receptors: (Akatinol,), these agents effectively reduce the production of glutamate, a substance that negatively affects and destroys brain cells;
• antipsychotic , sedatives and antidepressants, their use is justified with pronounced changes in the emotional background, the appearance of aggression, anxiety, fears, manias.
• neuroprotectors (Somazin, Cerebrolysin,), which improve the trophism of brain tissues, their nutrition and oxygen supply, are effective in vascular pathologies.

For dementia, it is important to start early adequate therapy, this will allow the patient to maintain independent skills in everyday life and mental functions for a longer time, and, in some forms, restore many of the lost abilities.

How many years patients receiving treatment live with such a diagnosis depends on the form and severity of the disease.

In milder forms, with normal functioning of cardio-vascular system, -many years.

In severe cases, with a loss of motor activity, patients die from concomitant complications (sepsis, heart, pulmonary or renal failure).

Video

Dementia defines an acquired form of dementia, within the framework of 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 (aka oligophrenia or dementia) implies 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, up to normal performance, corresponding to his age, never reaches. 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, the development of disorders of motor skills, speech and emotions occurs.

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 development in a person mental illness, and often this attraction is directly related to the existing social problems or problems of a personal nature.

Often, addiction is used in familiarizing with such phenomena as drug addiction and drug dependence, but more recently, another type of addiction has been defined for it - non-chemical addictions. Non-chemical addictions, in turn, determine psychological dependence, which itself acts as 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 subject of this activity as an intoxicating substance, as a result of which he, in in turn, is considered as a source-substitute, causing certain missing emotions. These 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, a person has to return to reality and the conditions from which it was possible to “get away” 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 avoid 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 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, angiopathies and hypertonic disease... 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 the background of 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 is due to dementia associated with Parkinson's disease, infectious diseases, degenerative diseases of the central nervous system, infectious and metabolic pathologies, etc. diabetes mellitus, HIV, infectious diseases of the brain (meningitis, syphilis), thyroid dysfunction, diseases internal organs(renal or hepatic impairment).

Dementia in the elderly 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 assistance 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 patients' environment.

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 for such a defect by patients is possible due to important notes on paper, etc. The emotional-personal sphere in this case is slightly affected, because the core of the personality is not subject to 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 (difficulty in conducting analytical and synthetic activities, a low level of judgment), loss of opportunities to perform professional duties, 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 next 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 the most pronounced in their own manifestations. No less important clinical manifestations are emotional disorders in combination with behavioral disorders. The development of the disease occurs 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. Light form dementia is accompanied by mild memory impairments, mainly associated with events occurring in the recent past (forgetting conversations, phone numbers, events that occurred within 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 orientation on the spot, 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 enhanced, 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 arises 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, the patient is sure that he hears in the next room the screams of children killed in it.

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 the framework of neurons, they arise as a result of insufficient blood supply to the brain, the impact exerted on it when acute infections, chronic diseases and other pathologies discussed by us 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 the form of psychotic. 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 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 pre-existing mental disorders have undergone strengthening due to one or another somatic disease. There is a decrease in mental activity in patients, which manifests itself 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 considered 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 disagreement on the part of the opponent. Interests that existed before 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 shyness and sense of tact, and the range of mood shades is subject to narrowing. Some patients may 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 trash, from their side more and more often sound various reproaches addressed to the 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 in combination with personal changes occurring with them are accompanied by memory impairment, in particular, this concerns current events. Surrounding patients, they are noticed, as a rule, later than the changes that have occurred in their character. The reason for this is to revive the memories of the past, which is perceived by the environment as a good memory. Its 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. Amnestic disorientation about time also develops (i.e. patients are not able to indicate a specific date and month, day of the week), chronological disorientation also develops (the 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 (it manifests itself, for example, in a situation when, at the exit from 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. Few and isolated epileptic seizures similar to fainting. 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 changes in the psyche. In this case, it is characteristic to adopt an embryo 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. To be more precise, 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, then 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 manifests itself 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 children early age manifests itself in the form of a loss of skills previously acquired by them and in the form of a speech disorder (up to its complete loss). The final stage, similar to the general course, is accompanied by the fact that patients cease to follow themselves, they also lack control over the processes of defecation and urination.

Within childhood, dementia is inextricably linked with oligophrenia. Oligophrenia, or, as we previously defined it, mental retardation, is characterized by the relevance of two features 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 the "young" functions of thinking (young - when considered on a phylo- and ontogenetic scale), for them insufficient development is determined, which makes it possible to attach the disease 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 elevated forms attraction, performance of actions under the influence of increased impulsivity, weakening of existing instincts (the instinct of self-preservation, lack of fear, etc.) is not excluded;
• 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. In the meantime, 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 case of hallucinations and insomnia, within the framework of early stages it is advisable to apply 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 this disease is currently excluded due to the practical lack of appropriate measures. If symptoms suggestive of dementia appear, a visit to a specialist such as a psychiatrist and a neurologist is necessary.