What is dementia of the brain? Dementia - what it is, its types and symptoms Severe dementia.

As a person ages, failures begin to occur in all systems and organs. There are also deviations in mental activity, which are divided into behavioral, emotional and cognitive. The latter includes dementia (or dementia), although it has a close relationship with other disorders. Simply put, in a patient with dementia, due to mental disorders, behavior changes, causeless depression appears, emotionality decreases, and the person begins to gradually degrade.

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

General characteristics of the disease

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

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

1. Mild degree of dementia - the patient experiences a degradation of professional skills, his social activity decreases, and interest in favorite activities and entertainment weakens significantly. At the same time, the patient does not lose orientation in the surrounding space and can take care of himself independently.
2. Moderate (average) degree of dementia - characterized by the impossibility of leaving the patient unattended, since he loses the ability to use most household appliances. Sometimes it is difficult for a person to open the lock on the front door on his own. This degree of severity is often referred to colloquially as “senile insanity.” The patient requires constant help in everyday life, but he can cope with self-care and personal hygiene without outside help.
3. Severe degree - the patient has complete disadaptation to the environment and personality degradation. He can no longer cope without the help of his loved ones: he needs to be fed, washed, dressed, etc.

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

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

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

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

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

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

Vascular dementia

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

Reasons

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

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

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

As mentioned above, often the cause of such dementia can be. As a result, the so-called atherosclerotic dementia gradually develops, which is characterized by a partial stage of dementia - when the patient is able to realize that he is experiencing impairments in cognitive activity. This dementia differs from other dementias in the stepwise progression of the clinical picture, when episodic improvements and deteriorations in the patient’s condition periodically replace each other. Atherosclerotic dementia is also characterized by dizziness, speech and visual abnormalities, and slow psychomotor skills.

Signs

Typically, a doctor diagnoses vascular dementia in cases where disruptions in cognitive functions begin to appear after an experience or a stroke. A harbinger of the development of dementia is also considered to be weakening of attention. Patients complain that they cannot concentrate on a specific object or concentrate. Characteristic symptoms of dementia are changes in gait (mincing, wobbly, “skiing”, unsteady gait), voice timbre and articulation. Swallowing dysfunction is less common.

Intellectual processes begin to work in slow motion - also an alarming signal. Even at the beginning of the disease, the patient experiences some difficulties in organizing his activities and analyzing the information received. In the process of diagnosing dementia in the initial stages, the patient is given a special test for dementia. With its help, they check how quickly the subject copes with specific tasks.

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

Treatment

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

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

Cerebrolysin and nootropic drugs are used to improve cognitive processes. If the patient is subject to severe forms of depression, then, along with the main treatment of dementia, he is prescribed antidepressants. To prevent cerebral infarctions, antiplatelet agents and anticoagulants are prescribed.

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

It should be noted that Demented people often develop such an unpleasant trait as sloppiness Therefore, relatives need to provide proper care for the patient. If household members cannot cope with this, then you can resort to the services of a professional nurse. This, as well as other common questions related to the disease, should be discussed with those who have already encountered similar problems on a forum dedicated to vascular dementia.

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

Senile (senile) dementia

Many, observing elderly household members, often notice changes in their condition associated with character, intolerance and forgetfulness. From somewhere an irresistible stubbornness appears, and it becomes impossible to convince such people of anything. This is due to brain atrophy due to large-scale death of brain cells due to age, i.e., senile dementia begins to develop.

Signs

First, an elderly person begins minor memory impairments– the patient forgets recent events, but remembers what happened in his youth. As the disease progresses, old fragments begin to disappear from memory. In senile dementia, there are two possible mechanisms for the development of the disease, depending on the presence of certain symptoms.

Most elderly people with senile dementia have virtually no psychotic states, which makes life much easier for both the patient and his relatives, since the patient does not cause much trouble.

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

Treatment

Healthcare professionals do not recommend treating dementia at home, regardless of the severity and type of disease. Today there are many boarding houses and sanatoriums, the main focus of which is the maintenance of just such patients, where, in addition to proper care, treatment of the disease will be carried out. The issue is certainly controversial, since in the comfort of home it is much easier for the patient to endure dementia.

Treatment of senile type dementia begins with traditional psychostimulant drugs based on both synthetic and herbal components. In general, their effect is manifested in increasing the ability of the patient’s nervous system to adapt to the resulting physical and mental stress.

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

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

Video: Cognitive training for people with dementia

Alzheimer's type dementia

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

The most significant factors provoking the development of dementia:

1. Old age (75-80 years);
2. Female gender;
3. Hereditary factor (presence of a blood relative suffering from Alzheimer's disease);
4. Arterial hypertension;
5. Diabetes mellitus;
6. Atherosclerosis;
7. Obesity;
8. Related diseases.

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

Then the patient develops delusions of “damage,” when he begins to blame others for stealing something from him or wanting to kill him, etc. The patient develops a craving for gluttony and vagrancy. At the severe stage, the patient is consumed by complete apathy, he practically does not walk, does not talk, does not feel thirst or hunger.

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

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

Epileptic dementia

Quite a rare disease occurring, as a rule, against the background of schizophrenia. For him, the typical picture is a paucity of interests; the patient cannot highlight the main essence or generalize something. Often, epileptic dementia in schizophrenia is characterized by excessive sweetness, the patient constantly expresses himself in diminutive words, vindictiveness, hypocrisy, vindictiveness and ostentatious fear of God appear.

Alcoholic dementia

This type of dementia syndrome is formed due to long-term alcohol-toxic effects on the brain (over 1.5-2 decades). In addition, factors such as liver lesions and disorders of the vascular system play an important role in the development mechanism. According to research, at the last stage of alcoholism, the patient experiences pathological changes in the brain area that are atrophic in nature, which outwardly manifests itself as personality degradation. Alcoholic dementia can regress if the patient completely abstains from alcoholic beverages.

Frontotemporal dementia

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

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

Dementia in children

We looked at types of dementia that exclusively affect the adult population. But there are pathologies that develop mainly in children (Lafora disease, Niemann-Pick disease, etc.).

Childhood dementias are conventionally divided into:

Dementia in children may be a sign of a certain mental pathology, for example, schizophrenia or mental retardation. Symptoms appear early: the child suddenly loses the ability to remember anything, and his mental abilities decrease.

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

With any type of dementia, loved ones, relatives and household members should treat the patient with understanding. After all, it’s not his fault that he sometimes does inappropriate things, it’s the illness that does it. We ourselves should think about preventive measures so that the disease does not affect us in the future. To do this, you should move more, communicate, read, and engage in self-education. Walking before bed and active rest, giving up bad habits - this is the key to old age without dementia.

Dementia of the Alzheimer's type is senile dementia.

The phenomenon was first described by a doctor, from whose name the disease later received its name. He studied the brain of a patient with early signs of senile dementia.

After an autopsy, it turned out that the brain cells were changed in a degenerative manner.

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According to statistics, up to 60% of cases of organic dementia are associated with.

Dementia of the Alzheimer's type is characterized by a primary degenerative process in the functioning of neurons. Without timely and competent treatment, dementia leads to complete personality disintegration.

Early-onset dementia of the Alzheimer's type occurs in people under 65 years of age. If the disease occurs at age 70 or older, late-onset dementia of the Alzheimer's type is diagnosed.

It has been established that on average 10 years pass from the first signs of the disease to absolute senile dementia. Moreover, months and even years may pass from the onset of the disease to the appearance of the first mild signs.

Risk factors

A certain hierarchy has been derived, according to which risk factors for the occurrence of dementia of the Alzheimer's type are manifested:

• age limit of 80 years;
• hereditary factor associated with the presence of relatives suffering from a similar disease;
• hypertension;
• atherosclerosis;
• physical inactivity;
• diabetes mellitus of all types;
• obesity of varying degrees;
• chronic hypoxia;
• low level of education, due to the poor development of the intellectual sphere;
• women are more susceptible to the disease.

Each of the above factors may be key to the onset of Alzheimer's disease. If a complex of factors occurs, the risk increases significantly.

Reasons

The morphological basis of dementia is represented by severe organic damage to the central nervous system. Thus, the cause of the disease can be any brain damage that leads to the death of cells in the cerebral cortex.

Dementia can occur as a result of:

• lupus erythematosus;
• complications of hemodialysis;
• endocrine disorders;
• autoimmune failures

In the case of mixed dementia, several factors play a role.

Symptoms of Alzheimer's type dementia

Signs of an obligate lifetime disease:

• dementia syndrome;
• cognitive disorders associated with impaired speech and mnemonic functions, decreased motor activity and intellectual function;
• adaptive function regarding social and professional connections decreases;
• the progressive nature of the disease, the course of which in the initial stage is almost imperceptible;
• exclusion of connections between symptoms and other mental disorders.

These symptoms contribute to the diagnosis with a 90% degree of probability. An accurate conclusion is possible only after an autopsy and detailed examination of the patient’s cerebral cortex.

Stages

There are three stages of disease development:

Early	Symptoms of the early stages of Alzheimer's disease include the following: memory deteriorates, the patient cannot remember the usual route and orient himself in his location; financial difficulties arise in terms of calculating and paying bills; there is constant asking of the same questions; time costs increase even for everyday activities; the analysis of the situation and its assessment are distorted; Loss of things or the way they are stored becomes a frequent problem; Personal qualities also undergo changes. The early stages of dementia of the Alzheimer's type most often occur at age 60. It is at this stage that in most cases the diagnosis is made.
Moderate	The moderate stage of dementia is characterized by a worsening of the symptoms of the previous stage and is manifested by the following symptoms: the appearance of confusion; progressive memory loss; difficulties arise in recognizing relatives and people from close circles; the ability to learn is lost; step-by-step processes cannot be carried out independently, for example, the patient cannot dress correctly and neatly; the new situation causes misunderstanding; hot temper appears; mental disorders such as megalomania and delusional ideas are detected. At this stage, the brain is damaged specifically in the areas responsible for thinking, speech and intelligence. In some cases, manifestations of sexual preoccupation are possible. Patients may suffer from bouts of gluttony, preferring exclusively sweet foods. Daily activities become chaotic and fussy, patients can walk from corner to corner for no reason. Possible urge to wander.
Heavy	The severe stage of Alzheimer's type dementia is characterized by a lack of communication between the patient and others. Independent activity is practically excluded. The patient cannot do without helpers. Usually at this stage the patient is in a supine state. Symptoms of the severe stage: the patient ceases to recognize relatives and people from close circles; communication is reduced to zero; the patient's weight decreases; frequent convulsions appear; skin infections develop; the act of swallowing becomes difficult; the patient is haunted by constant drowsiness, he sniffles and groans; Bowel and bladder activity is not controlled. Pneumonia can be a complication at this stage. In this case, it develops as a result of food particles entering the lungs. The severe stage of dementia is associated with complete apathy. The patient ceases to feel thirst and hunger. Mental activity at this stage is at an extremely low level.

Diagnostics

Two specialists can diagnose Alzheimer's disease: a neurologist or a psychiatrist. The conclusion is made as a result of an assessment of the symptoms of the disease, as well as on the basis of magnetic resonance imaging and computed tomography data.

Research using medical technology allows us to identify brain atrophy and its severity.

If necessary and to eliminate possible doubts when making a diagnosis, the doctor may prescribe additional research methods:

• biochemical blood test;
• blood test for folic acid and vitamin B12;
• study of thyroid function;
• determination of the composition of cerebrospinal fluid;
• identification of genetic disorders;
• reaction of the pupils to the administration of mydriatics.

The difficulty in making a diagnosis, as a rule, lies in the fact that many of the symptoms of Alzheimer's type dementia are similar to other diseases. For this reason, other disorders are initially excluded, and only then conclusions are reached about the presence of Alzheimer's disease.

Treatment

The main goal of treatment for Alzheimer's type dementia is to reduce the severity of symptoms and slow the progression of the disease, stabilizing this process.

The effectiveness of treatment directly depends on the extent to which concomitant diseases that have a negative impact on dementia are treated:

• hypertension;
• atherosclerosis;
• obesity;
• diabetes.

Therapy for the disease should be comprehensive and include the following medications:

• homeopathy;
• nootropic compounds;
• medications to improve blood circulation;
• stimulants of the central nervous system;
• phosphatidylcholine, which activates the activity of mediators and cells of the cerebral cortex;
• actovegin, saturated with glucose and aimed at increasing the energy potential of the brain.

At the stage of advanced manifestations, inhibitors are included in drug therapy. With their help, it is possible to increase the patient’s social adaptability.

The prognosis of the disease is unfavorable due to the fact that dementia of the Alzheimer's type is steadily progressing. As a result, the person becomes deeply disabled and dies.

Prevention

It is so arranged by nature that with age the human body spends resources both physically and intellectually. Therefore, the main recommendations regarding Alzheimer's type dementia and its prevention are as follows:

• practicing accessible sports, regular feasible physical activity;
• as a hobby, have a summer cottage, engage in plant growing or floriculture;
• free up time for travel;
• start learning or strengthen existing skills in foreign languages;
• devote time to solving crossword puzzles;
• learn songs and poems by heart.

Preventive measures for the development of the physical and intellectual sphere are of paramount importance.

Dementia of the Alzheimer's type is a progressive disease. occurs quite often and the reason for this is age-related characteristics. The risk group consists of people over 60 years of age.

Alzheimer's disease can be associated with other diseases, which is why timely medical care and an integrated approach to treatment are so important.

Treatment of dementia can reduce the manifestation of the main symptoms and stabilize the functioning of the brain. However, it is worth remembering that the maximum effectiveness of therapy is achieved only at the early stage of the disease. And the progressive nature of dementia cannot be stopped.

Dementia is a condition when, at one rate or another, those brain functions that make a person an individual are irreversibly lost. The ability to think, analyze and compare, and assimilate new information is lost; interests and motivation fade away, control over one’s own behavior and emotions deteriorates. At the same time, the person does not understand that he is sick.

Dementia is a condition that develops in senile and pre-senile age. More than 50% of its cases are due to Alzheimer's disease, with vascular diseases in second place (15-20%).

Reasons

The mechanism of development of pathology differs depending on its cause. For example, in Alzheimer's disease, this is a primary process with an unknown cause, which causes the formation of specific plaques in the cerebral cortex - sites of neuronal death. In case of vascular pathology, neurons will die due to insufficient blood supply for their functioning; in case of tumors, as a result of compression by an atypical cell mass. As a result, one or more functions of higher nervous activity suffer.

Manifestations of dementia will depend not only on its cause (each dementia has a unique “handwriting”), but also on the individual himself. For example, the death of the neurons of the center responsible for mathematical analysis will be noticeable in accountants, teachers and mathematics teachers, but will go unnoticed in a humanist or a person of manual labor.

Therefore, further loss of memory and disintegration of personality will seem to others in the second case to be more acute, developing suddenly.

There are a huge number of reasons that cause the development of dementia. Depending on them, there is the following classification of pathology:

1. Primary neurodegenerative (atrophic) dementia, the causes of which are not fully understood. These include Alzheimer's disease and frontotemporal dementia.
2. Vascular dementia, which develops with cerebral atherosclerosis, hypertension, inflammatory or non-inflammatory vascular diseases, blood flow disorders, diabetes mellitus.
3. Associated with intoxication: develops with chronic alcohol consumption, when working with arsenic and nitrogenous compounds.
4. Infection-related dementia: with neurosyphilis, cryptococcosis, HIV-associated dementia, Lyme borreliosis, dementia that developed as a result of encephalitis.
5. Dementia that develops as a result of a prion disease is Creutzfeldt-Jakob disease.
6. Developed due to structural damage to the brain: as a result of a brain tumor that does not progress, a subdural hematoma that does not increase.
7. Dementia resulting from epilepsy.
8. Consequence of brain injury (in 3-5% of patients who have suffered a TBI).
9. As a result of suffering from schizophrenia.
10. Developed as a result of diseases of internal organs: chronic renal, liver failure, lung problems (when there is a constant lack of oxygen in the vessels).

Species

Nature of brain damage:

1. Lacunar dementia, which is based on damage to memory and attention; at the same time, intelligence and social qualities practically do not suffer.
2. Diffuse dementia, accompanied by personality degradation: the most complex qualities of the intellect suffer, there is no criticism of one’s own condition.
3. Partial dementia, when the lesions have one localization. Occurs with injuries, brain tumors, encephalitis.

And finally, dementia is divided into senile (occurs in old age) and presenile (develops in the elderly). The reasons are different in these two cases.

Symptoms

As mentioned above, each type of dementia has its own characteristics of manifestation, nature of the course and rate of progression of symptoms. Sometimes the only manifestation of dementia for a long time is only the loss of short-term memory; in other cases, the core of personality undergoes irreversible and rapid changes.

Below we list the main general features of symptoms, which can be divided into early, late and intermediate symptoms.

Early signs:

• problems with choosing words in a sentence;
• forgetting the location of things, roads;
• gradual progression of impairment of daily self-care;
• decreased abstract thinking;
• decreased judgment;
• with preserved sensitivity, a person cannot recognize objects by touch;
• emotional lability;
• gradually it becomes difficult for a person to perform a motor act that has already been performed many times;
• loss of ability to reproduce or understand speech.

Intermediate signs:

• inability to perceive new knowledge;
• decreased memory for distant events;
• partial loss of self-care ability;
• increase in personal changes (character changes);
• violation of spatial orientation even within one’s own apartment;
• change in sleep-wake rhythm.

Late symptoms:

• the ability to walk is lost;
• need help with feeding;
• urinary and fecal incontinence;
• loss of long-term and short-term memory.

At this stage, due to the immobility of patients, they develop bedsores, pneumonia, and sepsis. In some types of dementia, seizures, hallucinatory-delusional syndrome, manic and paranoid states develop. Death mainly occurs from infectious complications.

The best test for dementia is a short-term memory test where the patient is asked to remember 3 items and list them after 5 minutes. They are also asked to list items from different categories (eg plants, animals, clothes). In addition, at least one of the following violations must be detected:

1. difficulty performing an action while maintaining motor activity;
2. speech understanding;
3. speech reproduction;
4. loss of the ability to follow the sequence of actions when performing habitual manipulations;
5. loss of ability to analyze;
6. inability to think abstractly;
7. inability to identify an object by touch with preserved sensitivity;
8. change in social behavior;
9. impaired ability to retain urine in the absence of urological problems.

• tomograms: computer or magnetic resonance imaging;
• radioisotope study of the brain;
• Dopplerography of the great vessels;
• examinations by a neurologist, ophthalmologist, psychiatrist;
• determination of lipids and blood clotting factors;
• bacteriological examination of cerebrospinal fluid.

A psychiatrist and neurologist provide the following types of therapy:

1. Treatment of the disease that causes dementia.
2. Psychotherapeutic techniques used to improve the patient's cognitive abilities.
3. Drug therapy:​ ​

• cholinesterase inhibitors: “Galantamine”;
• NMDA receptor modulators: “Akatinol”, “Memantine”;
• neuroprotectors: “Somazina”, “Cerebrolysin”, “Cortexin”;
• Antidepressants, sleeping pills, and tranquilizers are prescribed symptomatically.

An important part of therapy is explanatory work with the patient’s relatives.

Forecast

The disease, especially caused by Alzheimer's disease, does not tend to reverse. With adequate and timely treatment, the rate of progression of the disease can be somewhat slowed, but it significantly shortens life expectancy.

Prevention

Preventing the development of dementia is:

• blood glucose control;
• prevention of atherosclerosis (nutrition and annual determination of lipid profile);
• work in non-toxic production conditions;
• timely treatment of diseases of internal organs;
• maintaining blood pressure at levels no higher than 130/90 mm Hg;
• adequate rehabilitation after strokes, encephalitis, TBI;
• daily mandatory mental activity;
• maintaining a healthy lifestyle.

It is impossible to 100% prevent the development of pathology, since there is a hereditary factor in the transmission of many diseases that cause dementia.

Video about dementia prevention:

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

Symptoms depending on the stage of the disease

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

At stage 1, the signs of the disease are:

Absent-mindedness.

Losing track of time.

Loss of orientation in a familiar place.

At stage 2, the symptoms of dementia are:

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

Recognition of the disease

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

Computed tomography.

Radioisotope brain test.

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

Checking blood vessels.

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

Brain biopsy.

General blood and urine analysis.

Examination by a neurologist, psychiatrist, ophthalmologist.

Types and types of disease

There are two forms of dementia:

1. Total.
2. Partial.

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

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

The disease is of the atrophic type (these are Alzheimer's and Pick's diseases). It occurs against the background of primary degenerative reactions occurring in the cells of the central nervous system.

Develops due to improper blood circulation in the cerebral vascular system.

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

Causes

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

Heredity.

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

Skull injuries.

Tumor in the brain.

Alcoholism.

Multiple sclerosis.

Viral encephalitis.

Chronic meningitis.

Neurosyphilis.

Pick's disease

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

Passivity and isolation from society;

Silence;

Apathy;

Ignoring standards of decency;

Sexual immorality;

Urinary incontinence;

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

People who are affected by this disease live no more than 10 years. They die from immobility or the development of genitourinary or pulmonary infections.

Alcoholic dementia: features

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

Treatment of the disease

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

1. Providing care and maintaining safety for this category of persons.
2. Identification and timely treatment of concomitant diseases.
3. Early detection and correction of mental and sleep disorders.
4. Drug therapy.

Treatment with medications for Alzheimer's disease, for example, includes tablets such as Amiridine, Memantine, and Seleginil. And for the treatment of vascular dementia, solutions such as “Galantamine” and “Nicergoline” are used.

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

Prevention

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

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

However, it is a mistake to believe that by following all the above points, this disease will not begin. Dementia is largely hereditary, as many diseases can be passed on from generation to generation and can cause dementia. Therefore, it is necessary to know how to behave towards an affected person and what to pay attention to.

Senile dementia, the symptoms of which pass from one stage to another, thus progressing, must be adequately perceived by the relatives of the sick person. And to do this, you need to help your affected relative, improve his quality of life, as well as his safety. You can use the following tips:

1. Prepare a care plan for the patient. You need to complete this task and understand for yourself what the goals of supervising the elderly are. To create such a plan, you must consult with doctors, lawyers, and other family members. Here are the main points that a relative must answer:

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

Does the person necessarily require care or can he live alone?

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

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

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

Is it necessary to drive a car?

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

2. Buy a special calendar for every day.

In such a diary, it will be necessary to note everything that the affected person may forget about, right down to brushing his teeth. And opposite each item you will need to put a tick indicating what was completed. Close people will thus be able to check on the calendar everything that the patient does, and he, in turn, will be better able to navigate his daily affairs and worries.

3. Maintain order and consistency in your home circle.

A constant, quiet and familiar environment will eliminate feelings of anxiety, excitement, and confusion. But new situations, things and orders will only disturb people with dementia, and then they will have difficulty learning and remembering things that are new to them.

4. Put the affected person to bed on time.

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

People's sad experiences with caregiving

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

But this is fundamentally wrong. After all, it is not the patient’s fault that he has become a victim of such an illness as dementia. Therefore, the task of loved ones is to treat such mental changes with understanding; you cannot argue or scold a weak-minded person; it is also important to control his behavior. We must remember that he is not aware of his actions and words, so there is no need to prove anything to him, assure him of anything, much less be offended. Also, at the first symptoms of the disease, relatives must show their affected family member to doctors. And experts will help you choose drugs that would improve metabolic processes in the brain, and due to this, the disease will not worsen.

I would like to wish the family and friends who have such patients in their arms patience, calm and understanding. It is necessary to communicate more often with a weak-minded person, because he needs help. It would be good if the whole family supports the one who provides full care for the patient, as well as who is actually affected, and also helps and controls his behavior.

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

- This is a slowly developing decline in mental abilities, in which problems occur in thinking, memory, learning and concentration. In addition, personality changes are possible with dementia. Sometimes, dementia can occur immediately if brain cells die as a result of disease, injury, or exposure to a toxic substance. Typically, the disease develops gradually and begins to appear in people over 60 years of age. As we age, changes in the brain lead to some decline in short-term memory and learning in most people. Forgetfulness in old age is not necessarily a sign of dementia. While healthy older people sometimes forget details, people with dementia may not remember recent events at all.

Vascular dementia

Vascular dementia occurs due to damage to brain tissue, causing cerebrovascular accidents. Various vascular diseases: atherosclerosis, arterial hypertension, cerebral vascular ischemia - can cause vascular dementia. Often the cause of the disease is a cyst resulting from a myocardial infarction. Risk factors are diabetes mellitus, cardiac pathologies, elevated levels of lipids in the blood - hyperlipidemia. A symptom of vascular dementia is a sharp decrease in cerebral circulation. As a rule, vascular type dementia is diagnosed in older people aged 60-75 years, one and a half times more often in men than in women and accounts for half of all cases of dementia.

The mechanism of development of vascular dementia

When blood vessels are damaged in certain areas of the brain, nerve cells do not receive the oxygen and nutrients necessary for their normal functioning, which leads to their death. For some time, the brain copes with compensation for the violations that occur, and they do not manifest themselves externally. But when the potential is depleted, negative changes begin to affect the state of memory, speech and thinking. Against the background of these cognitive disorders, the patient’s behavior also changes, and his independence decreases.

Symptoms of vascular dementia

Typically, a diagnosis of vascular dementia is made if cognitive impairment is preceded by an episode of stroke. Often, accompanying signs are symptoms of focal brain damage: for example, weakening of the strength of the limbs (hemiparesis), differences in the reflexes of the left and right limbs, the appearance of a pathological Babinski reflex. A characteristic sign of vascular dementia is considered to be walking disorders - a slow, shuffling gait and unsteadiness (patients themselves often confuse unsteadiness and dizziness, complaining of dizziness to loved ones).

The cause of vascular dementia is circulatory disorders in the brain. These disorders, as well as associated infarcts (cell death), can occur in different areas of the brain. Therefore, the symptoms of vascular dementia vary significantly in each individual case. We list only the most typical ones.

Dementia caused by damage to the midbrain is manifested by mesencephalothalamic syndrome. Its first manifestations are episodes of confusion and hallucinations. Then the person loses interest in various aspects of everyday life, withdraws into himself, stops caring about his appearance, and neglects personal hygiene. His psychophysical state is usually characterized by increased sleepiness. In some cases, speech is noticeably affected.

A symptom of dementia caused by damage to the hippocampus is considered to be primarily a violation of the ability to retain information about current events in memory (distant memories can be retained).

An infarction in the prefrontal regions of the frontal lobes leads to general apathy of the patient (apathetic-abulnic syndrome). The patient behaves inappropriately without realizing it. He repeatedly repeats either his own words and actions, or the words and actions of others.

When disturbances are localized in the subcortical zones, voluntary activity first suffers: it is difficult for the patient to concentrate on one object or maintain the same activity for a long time; Problems arise with planning activities, many things remain unfinished. Another symptom is a violation of the skills of analyzing information, separating the main from the secondary.

Among the stable markers of vascular dementia, we also note impaired urination, observed in almost all patients.

Vascular dementia manifests itself not only in the cognitive, but also in the emotional sphere. A general decrease in mood, emotional instability, depression - all these are symptoms of dementia of vascular origin. The patient's self-esteem decreases, self-confidence is lost, and pessimistic forecasts begin to prevail.

Senile dementia

Senile dementia (senile dementia, senile dementia) is a disease that begins in old age and is manifested by gradually increasing dementia, a memory disorder such as progressive amnesia, leading to the collapse of mental activity. Among mental illnesses that develop in older people, senile dementia is the most common - 12-35% of all cases of mental illness. Senile dementia occurs 2-3 times more often in women than in men. Most often, the disease progresses between 65-76 years.

Symptoms of senile dementia

Mild dementia

He begins to forget current or recent events, but remembers perfectly everything that happened a long time ago. May forget the date, first name, last name, name of something. Forgets where he put something. At home he orients himself well, but in an unfamiliar environment he can get confused. Feels difficulties in solving complex intellectual problems and financial issues. Sloppiness and carelessness appear.

A person becomes grumpy, categorical, and greedy. Gradually, you lose interest in your hobbies, but new ones appear, for example, collecting unnecessary items (junk).

Criticism persists, the person feels uncomfortable because of his mistakes, so he withdraws and narrows his circle of contacts. Despite this, the interlocutor may not notice anything: speech, facial expressions, emotionality are preserved, “excellent memory” delights; minor inaccuracies go unnoticed.

Moderate dementia

Forgetfulness turns into loss of large layers of memory. An elderly person does not remember the rules for using household appliances and cannot figure out how to open the lock with a key. Confused about the names of loved ones, their ages and degrees of relationship. Doesn't recognize himself in the mirror. There is almost no criticism; he often ignores personal hygiene, although he is still able to take care of himself. Needs constant monitoring and care.

Severe dementia

Characterized by complete loss of memory, orientation in place and time, and practical skills. He does not control pelvic functions, does not eat on his own, and spends all his time in bed. Needs constant care.

Causes of dementia

Since the main factor in the occurrence of the disease is severe organic damage to the central nervous system, the cause of dementia can be any disease that results in the death of cells of the cerebral cortex. Diseases in which damage to the central nervous system is the main pathogenetic mechanism are Alzheimer's disease, Pick's disease, dementia with Lewy bodies. In other cases, the death of cells in the cerebral cortex of the central nervous system is secondary and is a complication of the underlying disease: infection, chronic vascular pathology, trauma, systemic damage to nervous tissue or intoxication.

The main cause of secondary organic brain damage leading to dementia is vascular disorders such as hypertension and cerebral atherosclerosis. Other causes of dementia include traumatic brain injury, alcoholism, brain tumors, neurosyphilis, AIDS, chronic meningitis and viral encephalitis. In addition, dementia can occur as a result of complications of hemodialysis, complications of severe liver and kidney failure, severe autoimmune diseases: multiple sclerosis and systemic lupus erythematosus, as well as certain endocrine disorders.

Types of Dementia

Depending on the location of the organic defect, four types of dementia are distinguished:

• Cortical dementia is a lesion of the cerebral cortex, which is characteristic of alcoholic dementia, Alzheimer's disease and Pick's disease.
• Subcortical dementia is a lesion of subcortical structures, specific, for example, to Parkinson's disease.
• Cortical-subcortical dementia is a mixed type of lesion, which is typical of pathology caused by vascular disorders.
• Multifocal dementia is a pathology characterized by multiple lesions in all parts of the central nervous system.

Symptoms of dementia

As a rule, the disease develops slowly, so dementia cannot be detected in the initial stages. Memory and the ability to recognize places, people and objects gradually deteriorate. It becomes difficult for a person to think abstractly and select the necessary words. Personality changes are a common symptom of dementia. The first symptom of Alzheimer's dementia is forgetting recent events. Sometimes the disease begins with fears, depression, anxiety, apathy and other personality changes. Another symptom of dementia is changes in speech - the person begins to use words incorrectly or cannot find the necessary words. As the disease progresses, the patient gradually loses the ability to fully communicate with people.

Dementia progresses at different rates in different people. AIDS-related dementia develops steadily over months or years, while Creutzfeldt-Jakob disease results in severe dementia within a year. In the most severe cases, dementia leads to complete impairment of brain function. Patients become self-absorbed and lose the ability to control their behavior. Sudden mood swings and unmotivated emotional outbursts appear. A person can wander without any goal. Little by little, people with dementia lose the ability to carry on a conversation and stop speaking.

Dementia treatment

Dementia is usually incurable. Alzheimer's disease is sometimes treated with the drug donepezil, which can slow the progression of the disease. Ibuprofen can have a similar effect. Dementia, which is caused by repeated micro-strokes, is incurable, but its development can be slowed down and sometimes even stopped as a result of treatment for diabetes or high blood pressure. No cure has yet been found for the treatment of dementia caused by AIDS or Creutzfeldt-Jakob disease. If memory loss is caused by depression, then recommendations from a psychotherapist and taking antidepressants may help. Antipsychotic drugs such as haloperidol and Sonapax are often used to reduce the emotional outbursts and agitation that often accompany severe dementia.

Although dementia is a chronic disease and intellectual abilities cannot be restored, supportive measures have a good effect. For example, large clocks and calendars can help a patient navigate time. A stable and simple daily routine, realistic expectations of others, and continued self-esteem and self-esteem slow the progression of the disease and may even bring some improvement. As dementia progresses, planning for the future requires the combined efforts of health visitors, nurses, doctors and family members.

A familiar environment helps the patient. Moving to a new house, and even more so to another city, changing furniture or simply making repairs can have a devastating effect on the patient’s psyche. A regular routine of eating, walking, and sleeping gives the patient a sense of stability. In addition, periodic meetings with familiar people are necessary. You should not punish or scold a person suffering from dementia, as this worsens his condition and leads to increased manifestations of the disease.

Questions and answers on the topic "Dementia"

Question:What to do if you suspect the onset of dementia in a loved one, but the doctor finds nothing. After all, it’s one thing to see a patient for 20 minutes at an appointment, and another thing to live next to him and see how problems with his head appear.

Answer: Recognizing the symptoms of oncoming dementia (especially while the disorders are minor) is really difficult. But we should not exclude another possibility. In older people, memory deteriorates over the years and thinking slows down. These are considered to be signs of normal aging of the body, and not symptoms of disease. If your husband's condition really worries you and you think that he is not receiving the necessary treatment, try talking to the head of the department about the possibility of consulting with another doctor or find out about medical institutions where your husband can be examined. In any case, before you consult a doctor again (the same one or another), try keeping a diary for some time, noting the nature of the deviations, the frequency of their occurrence, as well as the situations in which they arise. Perhaps this will help the doctor make a more accurate diagnosis.

Question:What is the minimum age for dementia to appear?

Answer: In the specialized literature devoted to the study of senile dementia, the most common age is 65 years. It is believed that the symptoms of this disease most often appear after 65 years of age. Although in some cases there is an early development of this disease. The first insignificant and unnoticeable, at first glance, symptoms can generally occur long before the development of the main symptoms. They can be detected 6-8 years before the manifestation of the main, already obvious problems with the patient’s consciousness and behavior.

Question:Will Actovegin tablets help with dementia. If they help, how?

Answer: They will slow down the development of dementia a little, but nothing more. They improve the brain’s absorption of nutrients and oxygen, but you yourself understand that the brain affected by old age cannot be renewed.

Question:Hello. My mother is 89 years old. Until recently, despite her age, she was fully memory and sane. But recently (2 weeks ago) she had a pinched sciatic nerve, had severe pain in the lower back and leg, and she hardly slept at night. Now the pain is almost gone (we gave her ketonal and melaxicam). But during her illness she developed mental disorders - she doesn’t recognize her relatives well, forgets where she is, etc. Can senile dementia develop so suddenly (in 7-10 days)? Are these changes irreversible? What can you do?

Answer: This is how vascular dementia (dementia) can suddenly develop. You should show your mother to a psychiatrist and neurologist as soon as possible.

Question:We have a problem with mom. Age 79 years. I have been suffering from diabetes for 15 years. Takes a large amount of medications. Everything. With age, obsessive phobias develop (someone steals meat from the refrigerator, books disappear, things disappear, my father was tormented by attacks of jealousy, hysterics and scandals). Comes up with different stories. They beat her, then she fell. She exhausted everyone. He doesn’t want to go to a psychiatrist, he says, “I’m not crazy.” Tell me how to help her. Surely there are drugs that help in such situations.

Answer: Hello. Unfortunately, no one can completely cure your mother, but you can ease your fate by visiting a psychiatrist. To do this, you need to explain to your mother that she is not crazy, of course, but people’s brains tend to age and this process can and should be significantly slowed down. Ask your mother if she wants to grow old? The medications that your mother needs, for the most part, can only be purchased by prescription. And these prescriptions can be written out by a psychiatrist.

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

Answer: Senile dementias are diseases with a hereditary predisposition, especially Alzheimer's disease and dementia with Lewy bodies. The risk of developing the disease increases if senile dementia in relatives developed at a relatively early age (before 60-65 years). However, it should be remembered that hereditary predisposition is only the presence of conditions for the development of a particular disease, therefore even an extremely unfavorable family history is not a death sentence. Unfortunately, today there is no consensus on the possibility of specific drug prevention of the development of this pathology. Since risk factors for the development of senile dementia are known, measures to prevent mental illness are primarily aimed at eliminating them, and include: prevention and timely treatment of diseases leading to circulatory disorders in the brain and hypoxia (hypertension, atherosclerosis, diabetes mellitus) ; dosed physical activity; constant intellectual activity (you can make crosswords, solve puzzles, etc.); quitting smoking and alcohol; prevention of obesity.

Question:Is unexpected untidiness the first sign of senile dementia? Are symptoms such as untidiness and sloppiness always present?

Answer: Sudden untidiness and untidiness are symptoms of disturbances in the emotional-volitional sphere. These signs are very nonspecific and are found in many pathologies, such as: deep depression, severe asthenia (exhaustion) of the nervous system, psychotic disorders (for example, apathy in schizophrenia), various types of addictions (alcoholism, drug addiction), etc. At the same time, patients with dementia in the early stages of the disease can be quite independent and neat in their usual everyday environment. Sloppiness can be the first sign of dementia only when the development of dementia is already accompanied in the early stages by depression, exhaustion of the nervous system or psychotic disorders. This kind of debut is more typical for vascular and mixed dementias.

Question:How does dementia occur in children? What is the difference between childhood dementia and mental retardation?

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