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Features of electrical activity of the brain in dementia. Symptoms of dementia

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

Content:

Rapid test: rapid detection of early dementia

Want to find out if dementia is a risk for you? A person’s behavior in everyday life and 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 Golova OK website.

The first signs of dementia: 12 signals

Loss of the ability to learn new things and memory impairment are not the only signs of dementia.

In addition to mnestic disorders (the ability to remember and reproduce information), a patient with dementia has a clearly defined impairment of at least one of the following brain functions:

formulating words and sentences in your native or well-learned language;
communication with friends 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 refute the diagnosis in yourself or 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 select appropriate words and analytical abilities. In dementia there is atrophy posterior frontal and anterior temporal regions, which causes inhibition of thinking.

If you notice a steady 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 and a history of traumatic brain injury.

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 memory, make hasty decisions due to the fact that you do not remember details or noticed these symptoms in someone your surroundings? Such disorders are not always prerequisites for dementia, but they are signs of damage (inflammation or atrophy) to the prefrontal cortex, basal ganglia, and other parts of the brain.

Think about it, have you asked the same question several times? It's okay if this happens rarely. You should not leave unintentional absent-mindedness unattended if your forgetfulness begins to manifest itself constantly, and your acquaintances no longer hesitate to sullenly remind you of missed facts, without hiding their irritation.

Bad dream

The January 2018 issue of the Journal of the American Medical Association published the results of a study linking poor sleep to Alzheimer's disease. Scientists were able to find out that changes in the circiad rhythm (changes in the intensity of biological processes depending on the time of day, biological clock) appear in patients long before memory problems.

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

Increased excitability and mood swings

Dementia is not only a deterioration in cognitive functions (cognitive processes), but also a change in character traits. A person’s emotional state can completely change, and new personal qualities appear:

oppression;
anxiety;
suspicion;
panic;
moderate depression.

With dementia, mood changes usually occur when a person has to leave his comfort zone and perform unusual actions.

Misjudgments

There is a need to make a decision and the person is at a loss. From the outside, one can observe a simplification of judgments and a deterioration of logic. Relatives notice the changes well. At first, the patient himself desperately fights for the opportunity to think soberly and assess the situation, but already with an average degree of dementia (sometimes earlier) the patient does not see the problem, self-esteem changes.

What problems might arise? With a solution to any problem:

Financial issues, account and distribution of amounts.
Repairing items, assessing the risk of breakdown.
Determining the distance and contours of objects, their purpose.

Clutter in my head

You were asked a question, but you are confused: “What are they talking about?”, you cannot concentrate on one activity, you suddenly forget where you are or where you were a few minutes ago, what you were going to do or what time it was on the clock at a certain moment. At the initial stage of dementia, such a state “rolls up” unexpectedly, and 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, disturbances 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.

The first alarm bell - It takes more and more time to complete usual tasks. Confusion and poor concentration lead to decreased productivity.

Elevated amyloid beta levels

Amyloid beta 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 using positron emission tomography (PET) and cerebrospinal fluid analysis.

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

Inability to recognize humor and deception

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

A study from University College London, published in 2015 in the Journal of Alzheimer's Disease, involved fifty patients. Respondents interviewed people they knew who had known 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 situations opposite to humorous ones. Some of them laughed when watching news about disasters and mass disasters, seeing other people's mistakes, or in stressful situations.

Patients suffering from dementia prefer absurd and satirical comedies to films and shows based on a logical narrative.

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

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

Early manifestations of the disease in terms of the 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 consider funny, that is, they become more frivolous. The absurdity of perception of some situations comes in the last stages of dementia.

Apathy

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

Another case is that your friend avoids intellectual or other activities (helping around the house), but has his own interests, perhaps even negative for others, and there have been no sudden, causeless changes in his character and behavior for several years.

Neglect of self-care and personal hygiene

Paralysis of the desire to do anything applies not only to work and entertainment, but also to everyday spheres. You can suspect something is wrong if you or your relative:

does not monitor oral hygiene;
rarely washes;
rarely changes clothes, has become unkempt;
grows his nails because he is too lazy to cut them;
does not consider it necessary to comb his hair, especially if there are only “friends” around him.

And I had never made such mistakes before.

Coordination problems

Repeated falls are not normal, but sometimes a sign of cognitive impairment. Impaired spatial awareness causes people to trip and fall frequently, even with mild dementia.

Putting things in the wrong place

If you are sure that you put an item (for example, a phone) in a certain place, but it is not there, most likely someone just took it. But when a similar situation is repeated day after day in different places and teams, 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 from this article or see a neurologist or psychiatrist.

Don’t rush to make a diagnosis if you suddenly forget where something is or mix up its location. Isolated cases of forgetfulness also occur in people with a completely healthy brain.

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

What might a person with early stage 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 condition, evaluates it as steady degeneration:

The loss of some cognitive functions causes anxiety disorders.
Memory loss.
Helpless in relation to a healthy state, patients often acquire a confused look.
Depression (up to 40% of dementia cases). Due to the predominance of anxiety over common sense in moments of exacerbation, loved ones may hear not only complaints about fear and anxiety, but also assurances about dangers or illnesses.

To stop the feeling of uncertainty and logically unfounded 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 parieto-occipital areas of the cerebral cortex if Alzheimer's disease is suspected (atrophy of the frontotemporal and other areas, vascular changes in other types of disease).

A consultation with a doctor and a comprehensive examination are necessary to identify the cause of the dementia syndrome and if the disorders associated with it are combined with other symptoms. Timely response to behavior change will help identify vascular dementia and frontotemporal degeneration, which are manifested primarily by behavior change.

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

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

Simple dementia (typical cognitive impairment).
Psychopathic-like disorders (psychological overstrain or complete exhaustion, tightening of abnormal personality traits).
Hallucinations and delusions.
Amnesia, paramnestic disorders (distortion of facts that happened in the past).
Paralytic and pseudoparalytic syndrome (euphoria, increased impressionability against the background of an erased personality).
Disturbances of higher nervous activity: speech, gnosis (the ability to recognize objects and phenomena), praxis (the ability to perform purposeful, coordinated actions).
Profound mental impairment, 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: does he have symptoms of dementia? Diagnosis likely if a person:

lost in a familiar area;
does not distinguish or notice road signs and signals;
makes the wrong actions when a decision needs to be made quickly;
cannot make or incorrectly makes turns or changes in direction;
does not adapt to the speed of the flow (not confident in himself or moves too quickly);
confused, but angry when confronted with troubles or comments;
distracted by extraneous details;
confuses the purpose of control parts.

To people diagnosed with dementia you need to stop driving due to the high danger for the patient and others.

At severe dementia the patient does not remember:

today's date, day of the week, past dates associated with events;
your address and place of residence of friends, not a single telephone number;
important details from life, facts from the biography of close relatives;
age (one’s own and others’), usually shifts towards the young, can resurrect long-dead people in the memory;
famous personalities, for example, stars, politicians;
chronology of events in one’s own and public life;
purpose of household items.

The counting function is also impaired. Answering the question: what is 21-3 may be difficult or impossible. The sequence of actions when performing mathematical tasks is disrupted. The patient is not oriented in numbers, for example, if you set the condition: subtract 4 from 32 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 yourself. The testing system is based on the Clinical Dementia Rating Scale, compiled by John Morris, professor emeritus of neurology at Washington University in St. Louis.

Distinctive features in women

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

Scientists from Duke University in the US worked with a group of people of both sexes with mild signs of dementia aged around 70 years for 4 years. Cognitive tests were performed regularly. In women, an average annual decline of 2 points was found compared to 1 point in men.

Women live longer, and dementia is predominantly a disease of the elderly. Every year the risk of its occurrence increases, which affects the predominance of female patients with this diagnosis.

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

The American Diabetes Association analyzed the results 14 studies conducted at scientific institutes in Australia and the USA. Total number of patients: more 2 million, 100 thousand of them with dementia. It was found that women with diabetes mellitus have 19 % greater risk of vascular dementia than men with the same disease.

Interesting facts about dementia from the Alzheimer's Research Group:

Female dementia at age 60 is twice as common as breast cancer.
Women take on the responsibility of caring for weak-minded relatives 2.5 times more often than men.
Most people who are forced to care for patients with dementia, had not previously planned or expected that they would have to take on such a responsibility, and are dissatisfied with the status of a caregiver.
Women caring for relatives with dementia are more likely to experience depression than men.

Women should distinguish between increased emotionality combined with fatigue and dementia. A sure sign: if cognitive functions are 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 cognitive decline, dementia in men often manifests itself as aggression. Suspicion and jealousy manifest themselves violently, and due to the absurdity of conclusions and often the relatively high physical strength of the patient, relatives cannot always coexist comfortably with him, especially during periods of exacerbations (obsessive ideas, 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 age, often of working age (20-50 years).

According to the results of a study published in the journal Neurology in the United States, the progression of dementia in men is slowed when compared with the rate of degradation of some functions in women. Speech fluency, memory, the ability to select the right words, and recognize objects and events by description remain longer in male patients. On the contrary, with depression, the likelihood of developing dementia, in particular Alzheimer's disease, is higher in men.

A study conducted by experts at the Mayo Clinic in Florida shows additional challenges in defining male dementia. Case histories and autopsy results of 1600 patients with acquired dementia were analyzed. In women, the greatest damage is caused to the hippocampus, which is responsible for memory. In men, nonspecific symptoms are primarily detected: problems with speech, disorders of purposeful movements.

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

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

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

The most severe damage to short-term memory is a decrease of 20% or more.
Working memory decreases - a person is not always able to remember and filter a large amount of information, or use knowledge at the right time.
Long-term and procedural (the use of professional and life-acquired skills) remains virtually unchanged.
Semantic memory (general knowledge about the world and society) does not suffer; some older people have improved skills in using the experience accumulated throughout 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

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

Duration: 17 min.

Speech of a patient with dementia (interview with the patient). Tips: concrete actions with which everyone can slow down the regression of intellectual capabilities.

Duration: 2 min.

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

To distinguish the signs of dementia from ordinary absent-mindedness, it is necessary to understand the scale of the disaster.

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

Symptoms	Healthy	Patient with dementia
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 an acquaintance whom he met only a few times	Can’t remember the details of yesterday’s meeting, has difficulty reproducing numbers and dates, remembers the name of an old acquaintance, but communicates as if with a stranger (does not remember the status of the relationship)
Communication problems	Cannot express his thoughts correctly when he is nervous, for example, on stage, does not formulate sentences well after a hard day	Unable to find elementary words, pronounces complex semantic constructions with errors, loses the thread of the conversation, does not delve into and does not understand the meaning of dialogues
Difficulty in orientation on the ground and in time	It takes a long time to find his way in an unfamiliar area or where he has been rarely for a long time.	Poor orientation, first in a foreign area, then in familiar surroundings. When remodeling the house, he does not find the necessary items.
Handwriting	Writes sloppily if you are tired, unaccustomed to using 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 everyday life	Didn't take suitable clothes in rainy weather	Wearing a dressing gown when going shopping or visiting, going out in pajamas in the cold
	Irritated by having to deal with additional problems	Can’t imagine how to solve a household problem (a pipe burst)
	Forgot money in my pocket, found it while doing laundry	Mixed up the bills, counted the change incorrectly
	The zipper broke due to haste	It takes a long time to figure out how to fasten buttons symmetrically
Behavioral disorders	The same as in patients with dementia syndrome, but short-term	Regularly recurring or constant: 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 the admonitions of relatives; irritability, anger, tearfulness replace each other
Emotions	Melancholy, grief, a sense of loss of youth and associated opportunities, loneliness (due to the lack of people who can understand the emotions of an older person)	Loss of interest, fear of change, symptoms of depression (in 30% of patients), feelings of hopelessness, pathological self-doubt, the correctness of one’s actions, gloomy despair, in particular due to the impending complete loss of control over oneself
Lack of initiative	Doesn’t want to continue doing monotonous work, household chores, social workloads because he’s tired. Potential is restored after proper rest or a change in activity	Indifference, loss of interest without changes after rest. Increased, but often useless intellectual activity is possible when the disease manifests itself (the first signs appear).

Signs of different types of disease

Dementia can be easily identified by the area of the brain affected. Listed below are common and rare types of the disease that are accompanied by cognitive deficits and associated abnormalities.

Dementia due to Alzheimer's disease

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

Alzheimer's disease begins with a mild decline in cognitive function. The onset and progression of symptoms is due in part to increasing 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. When Alzheimer's disease is diagnosed, its volume decreases by approximately 5% annually.

Subsequently, atrophic processes affect other parts of the brain. The degree of cognitive impairment is proportional to 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, but remembers long-past events for a long time, bright moments until the last stage (Ribault's law). May appear false memories (confabulation).

The first to worsen are:

ability to reproduce visual images;
memory for smells.

Patients have difficulty remembering new information. Neither systematization of the material nor hints when trying to remember help. Memory interference is noted: when new information arrives, old information is displaced or distorted.

The variety of speech disorders at various stages of Alzheimer's disease:

At first it becomes more difficult for the patient to find the necessary route in an unfamiliar area (foreign area, city, subway). It is almost impossible to rationally plan a trip itinerary (it is very difficult to wrap your head around various algorithms and sequences). Later disorientation occurs on well-known streets, a person loses his way when going, for example, to the nearest store. Ultimately can get lost even in his own home.

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

If they exist, relatives should expect:

Ideomotor and constructive apraxia (the inability to fully control one’s body and analyze the position of objects in space, and perform sequential actions).
Agnosia (impaired perception while maintaining consciousness).

Constant progression of pathological changes will lead to the patient's incapacity. He will stop caring for himself, in particular, apraxia of dressing will develop.

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

How does vascular dementia manifest? Specific symptoms

Accounts for 10-25% of all dementias and can begin at any age, most often after 60 years. In Russia, vascular dementia ranks first in prevalence (more than 5% of people over 60 years of age), probably due to low awareness of the population about the diagnosis and treatment of Alzheimer's disease. Mixed dementia, where the vascular component is combined with senile dementia, is also highly prevalent.

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

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

Ischemic or hemorrhagic stroke (high risk in the first year after the attack).
Discirculatory encephalopathy (persistent dementia is diagnosed at stage 3).
Arterial hypertension.
Atherosclerotic plaques that have caused narrowing or blockage of blood vessels in the head or neck.
Heart diseases (atrial fibrillation, ischemia, heart valve defects).

Seemingly minor cognitive impairment may be a predictor of vascular dementia. A sudden deficit in mental activity and cognitive activity is often a consequence of chronic or acute cerebral circulatory failure (hypoperfusion).

The first signs of vascular dementia:

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

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

Damaged	Signs
Intermediate and midbrain	Alternately as it progresses: confusion; transient hallucinations; apathy; decreased activity, reluctance to perform even basic hygiene procedures; drowsiness (with or without night wakefulness); Symptoms are accompanied by a decrease in short-term memory, replaying events that happened many years ago, passing them off as recent, fictitious memories
Thalamus	Meaningless speech with the replacement of letters and interspersed non-existent words while understanding what other people said, the ability to repeat simple phrases without errors is retained
Striatum	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 of (mainly short-term) memory. There are no pathologies of consciousness, sleep, hallucinations
Frontal lobes	Indifference, lack of will, initiative. Reduced criticism, as a result of which patients are characterized by meaningless repeated repetitions of their own or others’ words and actions
White matter (subcortical vascular dementia)	Basic symptoms of dementia, parkinsonian gait (legs are bent, arms are bent and pressed to the body, the first step begins with a bend, then rapid mincing movements, the body may lean forward or backward, patients often fall), “drunk” gait, slow movements and speech, increased muscle tone, involuntary movements, personality degradation, possible memory impairment
Multi-infarct brain damage (cortical dementia)	The development of symptoms corresponds to the increase in ischemic episodes (transient circulatory disorders lasting from 10 minutes to 24 hours) and cerebral infarctions provoked by them. Patients experience several of the following symptoms: tearfulness; unnatural laughter; barely audible due to low volume, sometimes incoherent speech; symptoms of oral automatism (paresis or paralysis of the facial muscles); slow movements with increased muscle tone; rhythmic twitching of muscles at rest. 1-5 years after the onset, the symptomatic picture is supplemented by a feeling of cardiac arrest, convulsions in various muscle groups, neuropathy of the lower extremities (sensitivity disorders, convulsions 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 produce speech);

Contact with the outside world is preserved.

The vascular component of dementia can be quickly identified using CT and MRI. 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 of people with vascular dementia: 20 years.

Dementia with Lewy bodies

4% of patients worldwide are diagnosed with Lewy body disease. Statistics for 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, 15% of all cases of acquired dementia are diagnosed with this type of dementia.

Lewy body disease is a non-standard dementia disorder. The first sign is behavioral deviations in the REM sleep phase. People see unusually vivid dreams, often “creepy” according to their stories. At this time, they make sudden movements, risking injury to themselves or a person nearby. Disorientation in space and time after awakening occurs before other prominent symptoms: cognitive impairment, motor abnormalities and hallucinations.

Fluctuations in concentration levels are one of the features of dementia with Lewy bodies. The patient performs any, even the simplest actions slowly, quickly gets tired from mental stress. When working intellectually, he suffers from exhaustion, is distracted by less important, intuitive tasks, or interrupts his activities.

Against the background of a typical dementia picture of decreased mental activity, there are glimpses of vigorous activity, a transition to the usual rhythm of life, and then an empty, indifferent look appears again, and cognitive activity ceases. Usually the disturbances are confined to the circadian rhythm, often the condition worsens closer to the night.

In case of infectious diseases, metabolic disorders, exacerbation of cardiovascular diseases, as a consequence of severe injuries and surgical operations, as well as several years after the onset of dementia, drowsy states occur - incomplete awakening. Only the simplest functions are preserved, which is why patients cannot distinguish reality from dreams, commit thoughtless, sometimes dangerous actions, being predominantly in an aggressive state.

Fuzzy consciousness, loss of concept 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 dementia with Lewy bodies from other neurodegenerative diseases:

Progressive cognitive impairment that interfere with professional activity and continuation of the usual lifestyle (functioning in society, hobbies, personal and family life). Memory impairments intensify gradually, in accordance with the intensification of other abnormalities. At stage 1, disturbances in attention, orientation, regulation of behavior and activity are noticeable.
Illusions(giving objects fictitious properties), then hallucinations at stage 1 in 25% of patients, later up to 80%. Patients recognize them as fictitious images, but subsequently become progressively worse at distinguishing reality from objects generated by the consciousness. Patients report primarily visual hallucinations, but auditory and, less commonly, olfactory and tactile hallucinations may be present.
Delusional disorders at 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 final stages of dementia, delirium disappears.
Movement disorders: difficulty in muscle mobility due to increased tone, unstable, shuffling gait with impaired balance, tremors (uncontrolled rhythmic movements of muscle groups when holding a pose and when moving) of any severity, frequent falls.
Neuroendocrine disorders: a sharp decrease in blood pressure when standing up (provokes attacks of dizziness, retardation of movements and foggy consciousness, sometimes fainting), insufficient blood supply to organs, sleep apnea, slow digestion of food, constipation, rare urination.
Adverse reactions to antipsychotics when trying to get rid of hallucinations and delusions 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 the expansion of the dorsal horns of the lateral ventricles of the brain; often an additional rarefaction of white matter neurons is detected along the periphery of the lateral ventricles (leukoaraiosis).

Parkinson's disease: connection with dementia and characteristic symptoms

5% of the elderly population receives the diagnosis. Dementia manifests itself, according to various sources, in 19-40% of all cases of Parkinson's disease, and usually develops in the later stages of old patients.

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

Symptoms characteristic of Parkinson's disease:

Akinetic-rigid syndrome - slowing of movements with hypertonicity of muscles, fixation of the torso and limbs (taking unnatural poses, sometimes the inability to sit down, stand up, or perform basic functions), absence of small movements characteristic of various actions.
Rest tremor or muscle stiffness (possibly both symptoms).
The first manifestations of motor disorders are asymmetric.

The diagnosis is confirmed if there are no:

Factors that cause similar (temporary) disorders: poisoning, trauma, encephalitis or other brain infections.
At stage 1: pronounced dysfunction of organs due to autonomic failure, movement disorders, dementia syndrome.
Uncoordinated eye movements.
Episodic states of eye immobility, accompanied by involuntary movements of the pupils.
Unsteady gait.

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

Early onset (from 50 years of age), a third of cases are hereditary.

Rough speech, antisocial behavior, sexual incontinence, inexplicable gaiety, followed by passivity and indifference with reduced or absent self-criticism are the main symptoms of frontotemporal dementia. There are no memory impairments among the first manifestations of the disease, but progressive speech disorders occur.

Behavioral traits change. The patient becomes unkempt, more impulsive and at the same time cowardly, easily switches from an important matter to an insignificant one, can only follow clear instructions, is poorly oriented in the current situation when unexpected changes occur (intellectual rigidity), and changes eating habits.

At stage 2, the symptomatic picture is supplemented by a violation of recognition of the emotions of 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 memory loss, and violations of counting operations occur only at stage 3 of frontotemporal degeneration. The last stage is also characterized by pronounced impairments of various speech functions, mutism is possible (the patient does not come into contact with the interlocutor either with the help of his voice or with the use of non-verbal signs, while understanding speech and retaining the ability to speak).

In frontotemporal dementia there are no:

disturbances of orientation in space;
movement disorders (exceptions include 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 by local, often unilateral brain atrophy in the frontal lobe.

People with frontotemporal dementia live on average 8-12 years.

Huntington's disease

Attacks at an early age, risk from age 30. 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, reminiscent of facial expressions in dance;
sweeping movements;
special gait: the patient spreads his legs wide, sways;
Fixing 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 (the patient finds it difficult to carry out actions according to instructions, concentrate, switch from one type of activity to another);
difficulties in using accumulated knowledge for learning and solving problems, the inability to operate with a large volume of data, and simultaneously work with several sources of information;
decreased ability to recognize familiar objects and phenomena, especially if they are depicted unclearly or with superimposed surface effects;
it is difficult to concentrate on the object being studied (orientation using an interactive map, studying statistics, graphs, algorithms presented in a visual format).

The patient needs hints and encouragement to improve the results of cognitive activity. Speech and memory for general events are preserved.

Changes behavior (specific sign of disease):

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

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

Pick's disease

Appears at the age of 50 years.

There is a degradation of higher psychological functions while maintaining clear consciousness.

Onset of illness:

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

Memory saved.

At stage 2:

sensorimotor aphasia (the ability to understand the meaning of speech and speak is lost);
loss of ability to read and write;
memory impairment;
perception disorders, lack of understanding of what is happening around;
failure to take action as planned.

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

Average 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. Other varieties are caused by injuries and neuroinfections.

Dementia is an acquired dementia, characterized by degradation of thinking, memory, and behavior. Manifestations of dementia are very diverse. A person loses previously acquired household and professional skills, his interests fade, and his thinking becomes illogical. In the most severe cases, a person is not able to realize what is happening to him, where he is, ceases to recognize anyone and needs constant outside care.

Depending on the level of social adaptation and the need for outside help, several forms of dementia are distinguished: mild, moderate and severe.

Senile dementia

Senile dementia is associated with irreversible changes in the brain that occur due to a lack of nutrition of its cells.

Mental changes that develop during senile dementia are associated with irreversible changes in the brain. These changes occur at the cellular level; neurons die due to lack of nutrition. This condition is called primary dementia. If there is a disease that affects the nervous system, the disease is called secondary dementia. Such diseases include Huntington's disease, spastic pseudosclerosis (Creutzfeldt-Jakob disease), etc. Alcoholism, drug addiction, (especially in boxers), and infectious diseases can also cause the development of dementia.

Symptoms of senile dementia

With a mild form of dementia, a person’s social activity decreases, patients are forced to leave work, it becomes more difficult for them to contact people, and apathy appears. This condition can lead to depression, which often masks the initial manifestations of dementia. At the same time, a person is able to fully take care of himself.

Moderate dementia is a more severe stage of the disease. Sick people almost completely lose interest in the world around them. There is a loss of habitual skills (they can no longer turn on the TV or stove on their own). Hygienic skills are still preserved, patients can control physiological needs. Such people need control and help from loved ones or a caregiver.

In severe forms of dementia (this is its last stage), patients become insane and it is impossible to explain anything to them. Absolutely all skills are lost, even the simplest ones (patients are unable to hold a spoon or brush their teeth). Patients require constant outside care. Often, patients can resist attempts to help them, which makes life much more difficult for their loved ones.

Vascular dementia

This type of dementia deserves special attention, since pathological processes in the brain develop very slowly, and for a long time a person may not be aware that the disease has already begun.

Disruption of brain activity occurs due to disturbances in blood flow in the vessels of the brain. Due to lack of oxygen and nutrients, brain cells begin to die. When a small number of neurons die, symptoms of the disease do not appear, since other brain cells take over some of the functions of the dead neurons. But when a large area of the brain is damaged, manifestations of dementia begin.

One of the most common causes of vascular dementia is, and it does not matter whether the ischemic (cerebral vascular thrombosis) or hemorrhagic (hemorrhage) type is a violation of cerebral circulation. Elderly people often suffer from diseases that increase the risk of developing dementia: hypertension, vascular atherosclerosis, arrhythmias.

Manifestations of vascular dementia are usually difficult to identify. Usually we talk about this form of dementia if its symptoms appeared after a stroke or heart attack.
Impaired thinking and memory depend on the area of the brain where the damage occurs.

Dementia treatment

Patients with dementia need understanding from relatives, their support and help.

Unfortunately, dementia is irreversible because the changes in the brain that caused it are irreversible.

Patients need quality care, communication, and activities they enjoy. By maintaining normal life, patients have the opportunity to maintain their brain functions much longer and slow down the progression of the disease. Patients need good nutrition, rich in antioxidants, vitamin therapy, moderate mental stress at the early stage of the disease (reading, retelling and memorizing what they read).

Treating the conditions that cause dementia helps slow the progression of dementia. Typically, patients need to be monitored by a cardiologist and neurologist to prescribe adequate therapy for cardiovascular diseases.

Drugs that improve interneuronal connections (Memantine, anticholinesterase drugs) and also ensure normal blood circulation and metabolic processes in brain cells (Glycine) help slow down the progression of the disease.

Patients suffering from dementia should be constantly monitored by a doctor, since progression of the disease is inevitable and treatment adjustments may be necessary. Self-treatment of dementia is impossible.

Dementia is a challenge not only for the patients themselves, but also for their loved ones. In many cases, the length of a relatively full life of a sick person depends on correct behavior and adequate assessment by relatives of the need for treatment.

Which doctor should I contact?

Manifestations of dementia are treated by a neurologist. Patients are also advised by a cardiologist. If severe mental disorders occur, the help of a psychiatrist is required. Often such patients end up in psychiatric institutions.

The problem of dementia (vascular dementia), discussed in the program “Live Healthy!”:

Senile dementia is a persistent disorder of higher nervous activity that develops in older people and is accompanied by a loss of acquired skills and knowledge, as well as a decrease in learning ability.

Source: mozgvtonuse.com

Higher nervous activity includes processes that occur in the higher parts of the human central nervous system (conditioned and unconditioned reflexes, higher mental functions). Improvement of mental processes of higher nervous activity occurs in theoretical (during the learning process) and empirical (by obtaining direct experience, testing acquired theoretical knowledge in practice) ways. Higher nervous activity is associated with neurophysiological processes occurring in the cerebral cortex and subcortex.

Timely adequate treatment can slow down the progression of the pathological process, improve social adaptation, maintain self-care skills and prolong life.

Senile dementia is most often observed in the age group over 65 years. According to statistics, severe dementia is diagnosed in 5%, and mild dementia in 16% of people in this age category. According to information provided by the World Health Organization, a significant increase in the number of patients with senile dementia is expected in the coming decades, which is primarily due to an increase in life expectancy, accessibility and improvement in the quality of medical care, allowing to avoid death even in cases of severe brain damage .

Causes and risk factors

The main cause of primary senile dementia is organic brain damage. Secondary senile dementia can develop against the background of any disease or have a polyetiological nature. At the same time, the primary form of the disease accounts for 90% of all cases, secondary senile dementia occurs in 10% of patients, respectively.

Risk factors for developing senile dementia include:

genetic predisposition;
disorders of systemic circulation;
infectious diseases of the central nervous system;
brain tumors;
metabolic disorders;
endocrine diseases;
presence of bad habits;
poisoning with heavy metals (in particular, zinc, copper, aluminum);
irrational use of medications (especially anticholinergics, antipsychotics, barbiturates);
vitamin deficiency (in particular, lack of vitamin B 12);
overweight.

Forms of the disease

Senile dementia is divided into primary and secondary.

The main symptom of atrophic senile dementia is memory impairment.

Depending on the degree of brain damage, the disease occurs in the following forms:

mild senile dementia(decreased social activity, maintaining the ability to self-care);
moderate senile dementia(loss of skills in using technology and instruments, inability to endure loneliness for a long time, maintaining the ability to self-care);
severe senile dementia(complete maladaptation of the patient, loss of ability to self-care).

Depending on the etiological factor, the following forms of senile dementia are distinguished:

atrophic(primary damage to brain neurons);
vascular(secondary damage to nerve cells due to impaired blood supply to the brain);
mixed.

Clinical manifestations of senile dementia vary from a slight decrease in social activity to the patient’s almost complete dependence on other people. The predominance of certain signs of senile dementia depends on its form.

Source: feedmed.ru

Atrophic senile dementia

The main symptom of atrophic senile dementia is memory impairment. Mild forms of the disease are manifested by loss of short-term memory. In severe cases of the disease, long-term memory impairment and disorientation in time and space are also observed. In some cases, patients' speech is impaired (simplified and impoverished; artificially created words can be used instead of forgotten words), the ability to respond to several stimuli at the same time and to maintain attention in one lesson is lost. If self-criticism persists, patients may try to hide their illness.

Drug therapy is primarily indicated for insomnia, depression, hallucinations, delusions, and aggression towards others.

As the pathological process progresses, personality changes and behavioral disorders occur, hypersexuality appears in combination with incontinence, the patient develops irritability, egocentrism, excessive suspicion, a tendency to edify and resentment. There is a decrease in the critical attitude towards the surrounding reality and one’s condition, and sloppiness and negligence appear or increase. The pace of mental activity in patients slows down, the ability to think logically is lost, the formation of delusional ideas, the occurrence of hallucinations and illusions is possible. Any people can be involved in a delusional system, but more often these are relatives, neighbors, social workers and other persons who interact with the patient. Patients with senile dementia often develop depressive states, tearfulness, anxiety, anger, and indifference to others. In the case of the presence of psychopathic traits before the onset of the disease, their exacerbation is noted with the progression of the pathological process. Gradually, interest in former hobbies, the ability to self-care, and communicate with other people are lost. Some patients have a tendency to engage in meaningless and disorderly actions (for example, moving objects from place to place).

In the later stages of the disease, behavioral disturbances and delusions are leveled out due to a pronounced decrease in mental abilities, patients become sedentary and indifferent, and may not recognize themselves when looking at their reflection in the mirror.

To care for a patient with senile dementia with severe clinical manifestations, it is recommended to use the services of a professional nurse.

With further progression of the pathological process, the ability to move independently and chew food is lost, which creates the need for constant professional care. Some patients may experience isolated attacks similar to epileptic seizures or fainting.

Senile dementia in its atrophic form steadily progresses and leads to complete collapse of mental functions. Once diagnosed, the average life expectancy of the patient is about 7 years. Death often occurs as a result of the progression of concomitant somatic diseases or the development of complications.

Source: imgsmail.ru

Vascular senile dementia

The first signs of vascular senile dementia are the difficulty the patient experiences when trying to concentrate and inattention. Then fatigue, emotional instability, tendency to depression, headaches and sleep disorders appear. The duration of sleep can be 2–4 hours or, on the contrary, reach 20 hours a day.

Memory disorders in this form of the disease are less pronounced than in patients with atrophic dementia. In post-stroke vascular dementia, the clinical picture is dominated by focal disorders (paresis, paralysis, speech disorders). Clinical manifestations depend on the size and location of the hemorrhage or the area with impaired blood supply.

It is recommended to place a patient with senile dementia in psychiatric clinics only in severe forms of the disease; in all other cases this is not necessary.

In the case of the development of a pathological process against the background of a chronic circulatory disorder, signs of dementia prevail, at the same time, neurological symptoms are less pronounced and are usually represented by changes in gait (decreased step length, shuffling), slowed movements, impoverished facial expressions, and impaired vocal function.

Diagnostics

The diagnosis of senile dementia is made based on the characteristic signs of the disease. Memory impairments are determined during a conversation with the patient, interviews with relatives and additional research. If senile dementia is suspected, the presence of symptoms indicating organic brain damage (agnosia, aphasia, apraxia, personality disorders, etc.), impaired social and family adaptation, and the absence of signs of delirium are determined. The presence of organic brain lesions is confirmed using computed tomography or magnetic resonance imaging. The diagnosis of senile dementia is confirmed by the presence of the listed signs for six months or more.

In the presence of concomitant diseases, additional studies are indicated, the scope of which depends on the existing clinical manifestations.

Differential diagnosis is carried out with functional and depressive pseudodementia.

Treatment of senile dementia

Treatment of senile dementia consists of psychosocial and drug therapy aimed at slowing the progression of the disease and correcting existing disorders.

If self-criticism persists, patients may try to hide their illness.

Drug therapy is primarily indicated for insomnia, depression, hallucinations, delusions, and aggression towards others. The use of drugs that improve cerebral circulation, neurometabolic stimulants, and vitamin complexes is indicated. In case of anxiety, tranquilizers can be used. In case of development of a depressive state, antidepressants are prescribed. For the vascular form of senile dementia, antihypertensive drugs are used, as well as drugs that help lower blood cholesterol levels.

In addition to drug therapy, psychotherapeutic methods are used, the purpose of which is to return the patient to socially acceptable behavioral reactions. A patient with mild forms of senile dementia is recommended to lead an active social life.

Giving up bad habits, as well as treating concomitant diseases, is of no small importance. Thus, if dementia develops due to a stroke, it is recommended to take a number of measures to reduce the risk of developing a recurrent stroke (adjust excess weight, control blood pressure, perform therapeutic exercises). With concomitant hypothyroidism, adequate hormonal therapy is indicated. If brain tumors are detected, the tumors are removed to relieve pressure on the brain. In the presence of concomitant diabetes mellitus, it is necessary to monitor blood glucose levels.

When caring for a patient with senile dementia at home, it is recommended to get rid of objects that may pose a danger, as well as unnecessary things that create obstacles when the patient moves around the house, equip the bathroom with grab bars, etc.

According to information provided by the World Health Organization, a significant increase in the number of patients with senile dementia is expected in the coming decades.

To care for a patient with senile dementia with severe clinical manifestations, it is recommended to use the services of a professional nurse. If it is impossible to create comfortable conditions for the patient at home, he should be placed in a boarding house that specializes in caring for patients of this kind. It is recommended to place a patient with senile dementia in psychiatric clinics only in severe forms of the disease; in all other cases this is not necessary, and it can also increase the progression of the pathological process.

Possible complications and consequences

The main complication of senile dementia is social maladjustment. Due to problems with thinking and memory, the patient loses the opportunity to contact other people. In the case of a combination of pathology with laminar necrosis, in which the death of neurons and proliferation of glial tissues is observed, blockage of blood vessels and cardiac arrest are possible.

Forecast

The prognosis for senile dementia depends on the timeliness of diagnosis and initiation of treatment, and the presence of concomitant diseases. Timely adequate treatment can slow down the progression of the pathological process, improve social adaptation, maintain self-care skills and prolong life.

Prevention

In order to prevent the development of senile dementia, it is recommended:

adequate physical and intellectual activity;
socialization of older people, involving them in feasible work, communication with other people, active work;
adequate treatment of existing diseases;
strengthening the body's defenses: balanced nutrition, giving up bad habits, regular walks in the fresh air.

Video from YouTube on the topic of the article:

Dementia (or dementia)- a word of Latin origin, it means “madness”. This disorder most often affects older people (60-65 years old). The disease progresses steadily, completely transforming the human personality. But sometimes the disease can develop suddenly and rapidly due to local death of brain cells.

Dementia, what is it, why does a sick person lose the ability to think and appreciate the world around them? Who is to blame for the complete loss of interest in life, lost memory, loss of logic and speech abilities? What to expect from the disease - degradation and depression or a successful recovery?

Dementia (or dementia) is an irreversible mental disorder

The impetus for the development of pathology is the emergence of a certain situation, as a result of which mass death of brain cells begins. The diagnosis of dementia is heard more and more often in the modern world - according to statistics, about 50 million people suffer from this disease and this figure is growing every year.

More than 250 different pathologies can provoke dementia. The disease develops not only due to the aging of the body.

Dementia can be either a separate (independent) disease or a sign (consequence) of a serious illness.

The most common causes of the disorder include:

Alzheimer's disease (the most common cause, dementia develops in 65-70% of cases). A neurodegenerative disease, popularly known as “senile insanity.”
Diseases that cause vascular damage. These are: atherosclerosis, hypertension, thromboembolism, arterial thrombosis, ischemic attacks, stroke.
Long-term abuse of psychotropic substances, drugs, alcohol.
Parkinson's disease (or idiopathic syndrome). A slowly progressive neurological disorder that affects specific areas of the brain.
Severe traumatic brain injuries.
Endocrine diseases: Cushing's syndrome (hypercortisolism), diabetes mellitus, autoimmune thyroiditis, thyrotoxicosis, hypoparathyroidism.
Pick's disease. A chronic disorder of the central nervous system, leading to atrophy and destruction (destruction) of the cerebral cortex.
Autoimmune pathologies: lupus erythematosus, scleroderma, multiple sclerosis, systemic vasculitis, phospholipid syndrome, sarcoidosis.
Severe infectious diseases affecting brain structures (neuroinfections): meningitis, encephalitis, toxoplasmosis, cerebral cysticercosis, trichinosis, cerebral abscess, polio, HIV encephalitis and AIDS, neurosyphilis.
Consequences of hemodialysis (blood purification), which caused various complications.
Severe diseases of internal organs (liver, kidney failure).

Types of pathology

Dementia is a disease characterized by a variety of manifestations and the nature of its course. The disease has many types, the characteristic manifestations depend on many factors: which parts of the brain are damaged, the age of the patient, the presence of concomitant pathologies.

Dementia can also occur in childhood

According to the degree of localization of the process, the classification of dementia is as follows:

cortical (the cerebral cortex is affected), this pathology has its own subtypes: frontotemporal (the frontotemporal lobes are affected) and frontal (the frontal lobes are affected);
subcortical (subcortical) with the involvement of subcortical structures in the degradation process;
cortical-subcortical, including both of the above types;
multifocal with the formation of numerous areas of damage in the brain.

Dementia also has several forms, which are determined depending on the causes that provoked the disease:

Vascular. The cause of the disease is a persistent violation of cerebral circulation, causing degradation of blood vessels and brain tissue. Vascular dementia is caused by numerous vascular diseases. Patients with diabetes mellitus and those who have had a stroke or heart attack are at risk.

This type of pathology is typical for people in the older age category (65-75 years). It has been noted that men suffer from vascular dementia 2 times less often than women.

Senile (cyanocystic dementia). The second most common pathology. It, like the vascular one, manifests itself in old age. This type of disease is characterized by rapid progression, which leads to a complete breakdown of a person’s mental makeup. The patient experiences persistent progressive memory impairment.

According to statistics, the peak of prussic dementia occurs in the period of 65-70 years. The culprit of the disease is the death of neurons in the brain. This disease is very insidious; it does not immediately make itself felt. People attribute the very first signs (tiredness and decreased attention) to fatigue.

The alarm should be sounded when the symptoms are accompanied by a noticeable weakening of the intellect, mood swings and difficulties in carrying out basic actions.

Alcoholic. What is alcohol-related brain dementia? Dementia doesn't just affect the elderly. If a person abuses alcohol for a long time (over 10 years), he or she runs the risk of developing dementia.

Alcoholic dementia is one of the most severe manifestations of pathology

In 20% of cases, alcoholism provokes the development of pathology. The main symptoms of alcoholic dementia are:

decline in morality;
attention and memory disorder;
loss of mental abilities;
social degradation of personality;
loss of all moral values.

Ethyl alcohol is a strong poison for the body; it is destructive to neurotransmitters responsible for the emotional component of the psyche. Gradually all parts of the brain atrophy. More often, alcoholic dementia is observed when a person is diagnosed with stage III alcoholism.

Organic. Organic type dementia syndrome develops due to severe physical trauma to the head, bruises, and infectious lesions of the brain. This pathology has two types:

Total, affecting all components responsible for cognitive abilities. These are memory, thinking, concentration, attention.
Partial (or partial), destroying part of a person’s cognitive ability. But the thinking remains intact.

Schizophrenic. Pathology that develops due to existing mental illnesses. In schizophrenic dementia, some part of intelligence and memory is preserved. The main symptoms are the formation of persistent apathy towards everything, inappropriate behavioral reactions, the manifestation of disorientation and psychosis.

Exacerbation of schizophrenic dementia occurs simultaneously with a sharp depression of the patient’s psycho-emotional state. During the paroxysm (peak) of the disease, a person begins to behave inappropriately and falls into complete helplessness.

How to recognize the disease

Dementia quietly and imperceptibly creeps up on a person, without making itself known at first. Symptoms of brain dementia begin to appear only after a sharp, visible deterioration in a person’s condition.

Relapse and obvious signs of the disease occur after any nervous shock to a person (change of environment, tragic event) or after diagnosis and treatment of a somatic illness.

Initial signs of the disease

The earliest and most prominent common symptom of dementia is loss of cognitive function in a person. At first, the patient stops wanting something, becomes apathetic, and then stops trying to learn something new.

Diagnosis of pathology

The human brain, which constantly needs new experiences and discoveries, begins to atrophy. The first signs of the disease include other symptoms. Human:

cannot remember recent events;
quickly forgets everything that happened to him during the day;
unable to remember simple telephone numbers;
ceases to navigate, cannot find the way home, does not remember the address and apartment number.

Progressive dementia

With the gradual development of the disease, the individual retains memories only of firmly memorized data. A person forgets the names of loved ones, does not recognize them, cannot say where he worked or studied. Events and memories of your personal life are also erased. Sometimes patients cannot remember their name or even recognize themselves in the mirror.

Main symptoms of dementia

The disorder develops gradually, slowly erasing the individual’s usual skills. A feature of the disease is the exacerbation of all inherent qualities of character and temperament:

the thrifty becomes a gloomy miser;
a cheerful and good-natured person turns into a fussy, always irritated person;
a pedantic and obligatory person becomes a notorious, constantly dissatisfied egocentric.

A patient with dementia shows coldness towards all the people he once loved; now he willingly enters into any conflict, sometimes provoking quarrels himself. As the disorder progresses, the individual shows more and more uncleanliness and sloppiness. Patients can drag into the house everything they find in the trash heap and indulge in vagrancy.

The ability to think logically and adequately assess situations gradually fades away. Speech skills fade, vocabulary becomes scarce. Often patients stop communicating completely. Severe delusional disorders, absurd desires, and ideas take their place. Emotionally, there is depression, anxiety, cruelty, and aggressiveness.

The disease is in its last stage

Dementia in the last stage is marked by a strong increase in muscle tone, and convulsive states are possible. Such symptoms gradually cause persistent autonomic disorder, which can lead to death. The patient becomes completely helpless, unable to even eat or relieve personal needs on his own.

How to treat pathology

To effectively stop the disease, treatment should begin as early as possible. The methods and tactics of therapy depend on many factors: the age of the patient, the presence of additional diseases, the type and type of disorder.

Dementia is an incurable disease. But in 10-15% of cases, the progression of dementia can be corrected and stopped.

There are no clear recommendations or treatment options for the disease. Each case of illness is too individual. The main goal of therapy is to stop the progression of the disease and relieve (mitigate) the accompanying symptoms. Treatment takes place in two stages:

Medication. The basis of drug therapy is the use of drugs that inhibit the death of brain cells. Medicines are selected that strengthen blood vessels and neural connections of the brain, normalize blood circulation and improve nervous processes.
Psychological. Patients with dementia are in great need of help and support from loved ones. Psychosocial adjustment is aimed at improving and restoring the patient’s cognitive functions. Beneficial assistance in the general rehabilitation of a patient with dementia comes from normalizing the lifestyle (diet, sleep), music therapy, and communication with animals.

An important question that worries the patient’s relatives is how to make his life easier. It is important for the patient’s loved ones to realize that dementia is a unique behavioral pattern. People around you need to tune in to optimistic interactions.

Dementia is a difficult challenge for the patient’s loved ones

It depends on the relatives whether the patient will maintain contact with reality. To do this, you need to follow these simple recommendations:

Give hints in a timely manner.
Don't get annoyed and learn to wait.
Speak to the patient in a loud and unhurried tone.
Conduct communication only in a positive mood.
Formulate questions clearly and concisely without complicating them.
Break down actions for the patient into a chain of subsequent simple steps.

How to keep illness at bay

Is it possible to avoid a devastating disease? It is quite possible to prevent the onset of dementia. Rare medicines and some magical potions are not needed here. Just study and follow these helpful tips:

Stop smoking and drinking alcohol.
Organize and maintain peace of mind. Try to avoid stress and anxiety.
Do not self-medicate. Take medications strictly only as prescribed by your doctor.
Monitor your blood levels (sugar, cholesterol). Their pathological indicators directly affect the state of the brain.
Promote healthy blood circulation. Daily walks, moderate exercise, and exercise in the pool will help with this.
Get your diet in order. Include nuts, seafood, raw fruits and vegetables in your regular menu. The brain especially loves this kind of nutrition.
Train your brain! Try to constantly improve your intellectual level, because dementia occurs as a result of prolonged “calmness” and weakening of brain functions. Crossword puzzles, complex puzzles, reading, going to theater productions and classical music concerts are excellent help.

Such simple rules are an excellent “trainer” for brain activity and clarity of thinking. By following the list of these recommendations, a person is guaranteed to remain sane and have clear memory until old age.

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

General information

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

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

Causes of dementia

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

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

Classification of dementia

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

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

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

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

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

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

Symptoms of dementia

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

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

Clinical variants of dementia

Alzheimer's type dementia

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

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

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

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

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

Vascular dementia

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

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

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

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

Alcoholic dementia

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

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

Diagnosis of dementia

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

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

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

Prognosis for dementia

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

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