The brain is the biggest mystery of the human body. Sometimes he presents surprises that change our lives in one way or another. Organic dementia is one of those quirks of our brain that leaves an imprint on a person’s thinking and behavior without the right to return to normal.

General concept

Dementia is a dementia acquired during life as a result of organic brain damage, trauma and infection. Unlike congenital dementia, which is characterized by insufficient development of the psyche, dementia is accompanied by its collapse. Around 50 million people worldwide suffer from this disease. It should be noted that dementia becomes a burden not only for the patient himself, but also for his family members.

Currently, more than 200 diseases are known that can provoke the development of dementia syndrome. The first place belongs to Alzheimer's disease, which affects 60% of patients. In second place are vascular pathologies as a result of hypertension and atherosclerosis. Other factors that provoke the disease include:

• GM neoplasms;
• traumatic brain injuries;
• Pick's, Parkinson's, Huntington's diseases;
• hormonal disorders - Cushing's disease, thyroid dysfunction;
• liver and kidney failure;
• autoimmune diseases, systemic vasculitis;
• multiple sclerosis;
• lack of B vitamins;
• infections - HIV, neurosyphilis, meningitis, encephalitis, Creutzfeldt-Jakob disease.

Dementia occurs as a result of damage to various brain structures: the cortex, subcortical structures, or multiple focal lesions in different parts of the brain tissue. In addition, there are combined forms that combine several types of disease.

As a rule, acquired dementia is a disease of old age. But in some cases it also affects young people. This is facilitated by alcohol and drug abuse, brain injury, tumors and infections.

Among famous people there are also those who have become hostage to this disease. The life of actor Robin Williams was cut short due to dementia, for which Lewy bodies are to blame. The disease was not diagnosed during the actor’s lifetime, but was discovered only after an autopsy.

Margaret Thatcher, Britain's greatest prime minister, suffered from dementia. According to her daughter, these were monstrous days for her mother, whose psyche underwent devastating changes that she steadfastly fought until the end of her life.

What to pay attention to

Dementia is a disease that has a gradual onset. Its manifestations depend on the degree of development and localization of the process.

It all starts with minor changes. A person may begin to forget some things and get lost in familiar places. This is attributed to overwork, fatigue or age.

As the disease progresses, he forgets the names of loved ones, events that recently happened to him, is poorly oriented at home, and may ask the same question many times. There is a decrease in self-criticism and intellectual abilities. The patient loses basic skills: he cannot open the door or turn on the kettle. Such people need supervision.

At the final stage of the disease, complete degradation of the personality occurs. Patients lose the ability to perform usual actions: wash, dress, eat. Changes occur in the emotional-volitional sphere, a person ceases to adhere to the basic framework of decency.

Often such people leave home, and finding their way back becomes problematic for them. This is especially true for older people.

For example, an elderly woman left home and was absent for several days. All this time, her family did not give up hope of finding her, using all possible resources to do this. Unfortunately, they found her dead: the old woman fell off a cliff.

There are two forms of the disease: total and lacunar. In lacunar dementia, short-term memory is mainly affected. People forget events that recently happened to them, what they just wanted to do, what they were thinking about. In other areas, changes are insignificant; criticality towards oneself and others remains.

Total dementia gradually leads to complete impotence and personality disintegration. At the same time, all spheres of human life suffer: memory disappears, the ability to assimilate new information and apply existing knowledge is lost, interest in everything that happens disappears, moral principles are devalued. A man, as they say, loses his face. You can often hear statements from relatives of a patient: he (she) has changed so much, before he was a completely different person.

The most common form of dementia

Among the causes leading to the development of dementia, Alzheimer's disease ranks first. The first mention of it dates back to 1906, and the German psychiatrist Alois Alzheimer is considered its discoverer.

The disease begins to manifest itself at the age of 55–70 years. This is one of the forms of senile insanity and refers to the atrophic type of dementia, when the destruction of brain neurons occurs. There may be several reasons contributing to this disease: internal diseases, obesity, low intellectual and physical activity, diabetes mellitus. A special place is given to the hereditary factor.

The disease begins to manifest itself with impairment of short-term memory. First, the patient forgets events that happened to him recently, and then those that happened a long time ago. A person does not recognize his children, mistaking them for deceased loved ones. He has difficulty remembering what he did a few hours ago, but talks in detail about what happened to him as a child. At this stage of the disease, the patient develops egocentrism and delusional ideas. Speech, perception, and motor disorders are observed.

The next stage is characterized by emotional disruptions. The person becomes irritable, grumpy, and shows dissatisfaction for any reason. He claims that his relatives want to get rid of him in order to take possession of his property, and his neighbors and friends want to slander him in order to spoil his reputation.

Intelligence decreases sharply: analytical functions suffer, reasoning becomes poor. Interests are narrowed, the opportunity to perform professional skills is lost.

Such people need care and supervision. Behavior disorder is manifested by vagrancy, uncontrollability in eating and sexual intercourse. Aimless actions appear, speech contains constant repetition of one word or phrase, and replacement of words with new ones. But, despite extensive degenerative changes, self-criticism remains.

At the final stage, the patient loses cognitive functions, the ability to care for himself, does not understand what they want from him, self-control and criticality are lost. Motor restrictions, paralysis, pathological reflexes, and convulsive seizures occur. The patient assumes the fetal position, refuses to eat, and cachexia progresses.

The disease lasts on average 10 years. But the earlier it manifests itself, the faster and more severe it progresses.

Unfortunately, at the moment there is no treatment that could stop the progression of the disease and return the patient to his former life. But early signs in menopausal women can be stopped with hormonal therapy.

Scientists have found that Alzheimer's in the early stages can be recognized by the nature of laughter. The fact is that in this case a person gradually loses control and does not understand what to laugh at and where it is inappropriate. He increasingly turns to black humor, laughs at absolutely unfunny, offensive, and sometimes tragic events, and at the failures of other people. Thus, one patient laughed at his wife when she was scalded by boiling water.

It is believed that a change in the sense of humor is an important criterion in establishing a diagnosis, since its diagnosis is, in principle, difficult.

Alzheimer's disease is a very common disorder. For example, Peter Falk, better known as Lieutenant Columbo, was also smitten by him. After he found out about this, he immediately stopped all his filming. Lately, the actor has completely forgotten about the existence of Columbo and wonders why people on the street call him by that name.

Other forms of dementia

When brain neurons are damaged as a result of impaired blood circulation, they speak of vascular dementia. It develops as a consequence of stroke or ischemia.

For dementia that develops as a result of a stroke, neurological symptoms are more typical: paralysis, paresis, speech problems. Ischemic dementia is accompanied to a greater extent by symptoms of dementia.

The main signs of vascular dementia include mental instability, absent-mindedness, irritability, sleep disorders, and low mood. Memory suffers, but with leading questions the patient remembers what was asked of him. Speech disorders are associated with pathological changes in the functioning of the speech-motor apparatus, gait changes, and movements slow down.

Another common form of acquired dementia is alcoholic dementia. It occurs as a result of constant, uncontrolled consumption of alcohol for 15 years and affects the age of 40 years and above. With this form of the disease, thinking and memory disorders and inadequate emotional reactions come to the fore.

Personal degradation is manifested by maladjustment in society, loss of moral values, and lack of care for one’s appearance. Delusional statements are typical, often of a jealous nature. Tremors appear in the limbs and myopathies develop. The disease is also called alcoholic pseudoparalysis, as it can repeat the symptoms of progressive paralysis. In this case, differential diagnosis in the form of serological reactions is needed.

Huntington's chorea (Huntington's) is another form of senile dementia. It combines mental and neurological disorders, as well as choreo-like movement disorders.

The disease begins at the age of 45–50 years, its duration is 10–15 years. Motor dysfunction precedes the development of the disease. This could be a gait disorder, a change in handwriting - it becomes incomprehensible, frankly bad, ugly. Clumsy and inappropriate, involuntary movements are especially characteristic. At this stage, a decrease in mental abilities is noted.

Huntington's chorea is accompanied by psychopathic reactions of the following types:

• excitability – anger, irritability, short temper;
• hysteria - demonstrative behavior, tearfulness;
• isolation.

Due to the fact that pathological processes in chorea occur slowly, dementia may not be too obvious. In particular, some patients are able to perform primitive work, but when they find themselves in an unfamiliar situation, they get lost. Thinking has a spasmodic character.

Speech disorders are caused by choreatic contractions of the speech muscles. Subsequently, speech becomes scarce and the desire to talk is lost. Delusions often appear - jealousy, persecution, grandeur, poisoning. Hallucinations occur less frequently.

Neurological symptoms include hyperkinesis in the form of involuntary twitches of small amplitude. Such patients end their lives in a state of complete insanity; hyperkinesis ceases by this period.

Organic dementia in children

Dementia develops in children for a number of reasons:

• neuroinfections;
• AIDS;
• neurointoxication with drugs and toxic substances.

The clinical picture of the disease depends on the age of the child and can occur in mild, moderate, and severe forms.

In preschoolers, dementia is primarily manifested by changes in the emotional sphere. Such children are especially excitable and emotionally labile. They do not form attachments, even to their mother. There is no fear of dangerous situations: they can easily leave with a stranger.

Cognitive functions suffer. Perception and attention are grossly impaired, making it difficult to acquire new knowledge and learn. Profound intellectual impairments appear. Games are unorganized: aimless throwing, jumping, running, jumping. There is no understanding of the role assigned to the child.

School-age children are unable to think abstractly. The meanings of proverbs, humor, and figurative meanings become incomprehensible to them. Thinking decreases, and the child cannot even apply previously acquired knowledge.

The emotional sphere is unstable. Emotional impoverishment appears, the range of interests is narrowed down to the satisfaction of basic needs.

Dementia acquired in childhood, especially in the early stages of development, threatens the child with a stop in development or the acquisition of pathological character traits.

Diagnostic criteria

To make a diagnosis of organic dementia, the patient should consult a neurologist and psychiatrist. Data about the disease are collected during the history taking and examination of the patient. A psychological examination may be ordered.

For children, consultation with a clinical psychologist is mandatory. He selects a number of techniques to assess the child’s cognitive functions, learning ability, and analyze the extent of the lesion.

To determine which pathological process caused dementia, instrumental research methods are prescribed:

• echoencephalography – EchoEG;
• MRI – magnetic resonance therapy;
• CT – computed tomography;
• EEG – electroencephalography.

Organic dementia requires differential diagnosis with other diseases. In children, it is compared with congenital dementia. It is more characterized by a decrease in mental abilities while maintaining normal memory and attention.

In adults, dementia is differentiated from pseudodementia, a severe form of depression, the symptoms of which are disguised as dementia.

Signs	Dementia	Depression
	Decrease in intelligence	Decreased mood
Symptom awareness	Denies their presence, tries to hide them	Reports a decrease in memory and thinking. He fixes his attention on this.
Appearance	Sloppy, carefree behavior	Depressed mood, slow reactions
Response to questions	Aggression, avoids answering or ignores them	The response comes late. Monosyllabic expression.
Mood disorders
Development of the disease	Gradual	More progresses

In addition, organic dementia should be distinguished from physiological aging. With it, some decreases in thinking and memory are possible, but they do not limit a person in his daily life.

How to treat and prevent disease

Unfortunately, it is unlikely that it will be possible to completely get rid of the disease, but it is quite possible to pause the process and remove negative symptoms. For this, complex therapy is used:

• treatment of the underlying disease, if dementia is a consequence of pathology of internal organs;
• prescribing drugs that slow down the breakdown of the neurotransmitter acetylcholine. This is a substance that helps conduct nerve impulses and, therefore, improves the conductivity of nerve tissue;
• means for improving metabolism and blood circulation in the brain;
• nootropics, vitamins to improve cognitive abilities;
• antidepressants, antipsychotics to normalize mental background;
• physiotherapy;
• psychotherapist consultations.

In order to prevent the development of acquired dementia, various diseases should be prevented. In particular, such as diabetes, hypertension, obesity, depression and others.

And in order to protect yourself from atrophic dementia in old age, you must follow the basic rules:

• give up bad habits:
• exercise;
• eat right.

A very important factor is training your thinking abilities. It is necessary to systematically strain the brain, exposing it to mental stress, of course, in dosed form. Scientists have found that dementia is much less common among people with higher education. Its prevention is also facilitated by learning and speaking foreign languages.

And one more interesting fact: the disorder more often overtakes single people than family people.

Dementia is a serious disorder caused not only by health risks, but also by the torment and restrictions that patients, as well as their relatives, are forced to endure. Therefore, it is very important to pay due attention to the prevention of this condition, so as not to involve yourself in a series of torments lasting several decades.

Dementia defines an acquired form of dementia, in which patients experience a loss of previously acquired practical skills and acquired knowledge (which can occur in varying degrees of intensity of manifestation), while at the same time a persistent decrease in their cognitive activity. Dementia, the symptoms of which, in other words, manifest themselves in the form of a breakdown of mental functions, is most often diagnosed in old age, but the possibility of its development at a young age cannot be ruled out.

General description

Dementia develops as a result of brain damage, against which a marked decline in mental functions occurs, which generally makes it possible to distinguish this disease from mental retardation, congenital or acquired forms of dementia. Mental retardation (also known as oligophrenia or dementia) implies a stop in personality development, which also occurs with brain damage as a result of certain pathologies, but predominantly manifests itself in the form of damage to the mind, which corresponds to its name. At the same time, mental retardation differs from dementia in that with it the intelligence of a person, a physically adult, does not reach normal levels corresponding to his age. In addition, mental retardation is not a progressive process, but is the result of a disease suffered by a sick person. However, in both cases, both when considering dementia and when considering mental retardation, there is the development of a disorder of motor skills, speech and emotions.

As we have already noted, dementia overwhelmingly affects people in old age, which determines its type as senile dementia (this pathology is usually defined as senile insanity). However, dementia also appears in youth, often as a result of addictive behavior. Addiction means nothing more than addiction or addictions - a pathological attraction in which there is a need to perform certain actions. Any type of pathological attraction increases the risk of a person developing mental illness, and often this attraction is directly related to social problems or personal problems that exist for him.

Addiction is often used in connection with such phenomena as drug addiction and drug dependence, but more recently another type of addiction has been defined for it - non-chemical addictions. Non-chemical addictions, in turn, define psychological addiction, which itself acts as an ambiguous term in psychology. The fact is that predominantly in the psychological literature this kind of dependence is considered in a single form - in the form of dependence on narcotic substances (or intoxicants).

However, if we consider this type of addiction at a deeper level, this phenomenon also arises in the everyday mental activity that a person encounters (hobbies, interests), which, thereby, defines the subject of this activity as an intoxicating substance, as a result of which he, in in turn, is considered as a substitute source that causes certain missing emotions. These include shopaholism, Internet addiction, fanaticism, psychogenic overeating, gambling addiction, etc. At the same time, addiction is also considered as a method of adaptation, through which a person adapts to conditions that are difficult for himself. The elementary agents of addiction are drugs, alcohol, and cigarettes, which create an imaginary and short-term atmosphere of “pleasant” conditions. A similar effect is achieved when performing relaxation exercises, while resting, as well as through actions and things that bring short-term joy. In any of these options, after their completion, a person has to return to reality and conditions from which he managed to “escape” in such ways, as a result of which addictive behavior is considered as a rather complex problem of internal conflict, based on the need to escape from specific conditions, against the background of which and there is a risk of developing mental illness.

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

With dementia, patients are not capable of realizing what is happening to them; the disease literally “erases” everything from their memory that accumulated in it during the previous years of life. Some patients experience the course of such a process at an accelerated pace, due to which they quickly develop total dementia, while other patients can linger for a long time at the stage of the disease within the framework of cognitive-mnestic disorders (intellectual-mnestic disorders) - that is, with disorders of mental performance, decreased perception, speech and memory. In any case, dementia not only determines the result for the patient in the form of problems of an intellectual scale, but also problems in which he loses many human personality traits. The severe stage of dementia determines for patients dependence on others, maladaptation, they lose the ability to perform simple actions related to hygiene and eating.

Causes of dementia

The main causes of dementia are the presence of Alzheimer's disease in patients, which is defined, respectively, as Alzheimer's type dementia, as well as with actual vascular lesions to which the brain is exposed - the disease in this case is defined as vascular dementia. Less commonly, the causes of dementia are any neoplasms that develop directly in the brain; this also includes traumatic brain injuries ( non-progressive dementia ), diseases of the nervous system, etc.

Etiological significance in considering the causes leading to dementia is assigned to arterial hypertension, disorders of the systemic circulation, lesions of the great vessels against the background of atherosclerosis, arrhythmias, hereditary angiopathy, repeated disorders relevant to cerebral circulation (vascular dementia).

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

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

In about 20% of cases, dementia develops against the background of alcoholism, the appearance of tumor formations and the previously mentioned traumatic brain injuries. 1% of the incidence is due to dementia due to Parkinson's disease, infectious diseases, degenerative diseases of the central nervous system, infectious and metabolic pathologies, etc. Thus, a significant risk has been identified for the development of dementia due to actual diabetes mellitus, HIV, infectious diseases of the brain (meningitis, syphilis) , dysfunction of the thyroid gland, diseases of internal organs (renal or liver failure).

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

Dementia: classification

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

Mild dementia implies a condition in which a sick person is faced with degradation in terms of his existing professional skills; in addition, his social activity also decreases. Social activity in particular means a reduction in the time spent on everyday communication, thereby spreading to the immediate environment (colleagues, friends, relatives). In addition, in a state of mild dementia, patients also have a weakened interest in the conditions of the outside world, as a result of which it is important to abandon their usual options for spending free time and hobbies. Mild dementia is accompanied by the preservation of existing self-care skills, in addition, patients adequately navigate within the confines of their home.

Moderate dementia leads to a condition in which patients can no longer remain alone with themselves for a long period of time, which is caused by the loss of skills in using technology and devices surrounding them (remote control, telephone, stove, etc.), difficulties even using door locks. Constant monitoring and assistance from others is required. As part of this form of the disease, patients retain the skills to self-care and perform actions related to personal hygiene. All this, accordingly, makes life more difficult for those around the patients.

As for such a form of the disease as severe dementia then here we are talking about the absolute disadaptation of patients to what surrounds them with the simultaneous need to provide constant assistance and control, which are necessary even to perform the simplest actions (eating, dressing, hygiene measures, etc.).

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

• cortical dementia - the lesion predominantly affects the cerebral cortex (which occurs against the background of such conditions as lobar (frontotemporal) degeneration, alcoholic encephalopathy, Alzheimer's disease);
• subcortical dementia - in this case, subcortical structures are predominantly affected (multi-infarct dementia with white matter lesions, supranuclear progressive palsy, Parkinson's disease);
• cortical-subcortical dementia (vascular dementia, cortical-basal form of degeneration);
• multifocal dementia - many focal lesions are formed.

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

Alzheimer's type dementia , the symptoms of which appear after the age of 65 years, within the initial (initial) stage occurs in combination with cognitive-mnestic disorders with increasing disturbances in the form of orientation in place and time, delusional disorders, the appearance of neuropsychological disorders, subdepressive reactions in relation to one’s own incompetence . At the initial stage, patients are capable of critically assessing their condition and taking measures to correct it. Moderate dementia within this condition is characterized by the progression of the listed symptoms with a particularly severe violation of the inherent functions of the intellect (difficulties in conducting analytical and synthetic activities, a reduced level of judgment), loss of ability to perform professional duties, and the emergence of a need for care and support. All this is accompanied by the preservation of basic personal characteristics, a feeling of one’s own inferiority while adequately responding to the existing disease. In the severe stage of this form of dementia, memory decay occurs completely; support and care are needed in everything and at all times.

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

This pathology is diagnosed less frequently than Alzheimer's disease, mainly among women. Among the main characteristics, current changes are noted within the emotional-personal sphere and the cognitive sphere. In the first case, the condition implies gross forms of personality disorder, a complete lack of criticism, spontaneity, passivity and impulsiveness of behavior; hypersexuality, foul language and rudeness are relevant; the assessment of the situation is impaired, there are disorders of desires and will. In the second, with cognitive disorders, there are severe forms of thinking impairment, and automated skills are retained for a long time; Memory disorders are noted much later than personality changes; they are not as pronounced as in the case of Alzheimer's disease.

Both lacunar and total dementia are, in general terms, atrophic dementias, while there is also a variant of a mixed form of the disease (mixed dementia) , which implies a combination of primary degenerative disorders, which mainly manifests itself in the form of Alzheimer's disease, and a vascular type of brain damage.

Dementia: symptoms

In this section we will consider in a generalized form those signs (symptoms) that characterize dementia. The most characteristic of them are disorders associated with cognitive functions, and this kind of impairment is the most pronounced in its own manifestations. Emotional disorders in combination with behavioral disorders are no less important clinical manifestations. The development of the disease occurs gradually (often), its detection most often occurs as part of an exacerbation of the patient’s condition, arising due to changes in the environment surrounding him, as well as during an exacerbation of a somatic disease that is relevant to him. In some cases, dementia can manifest itself in the form of aggressive behavior of the sick person or sexual disinhibition. In the event of personality changes or changes in the patient’s behavior, the question is raised about the relevance of dementia for him, which is especially important if he is over 40 years old and does not have a mental illness.

So, let’s take a closer look at the signs (symptoms) of the disease we are interested in.

• Disorders related to cognitive functions. In this case, disorders of memory, attention and higher functions are considered.
  • Memory disorders. Memory disorders in dementia involve damage to both short-term memory and long-term memory; in addition, confabulations are not excluded. Confabulations in particular involve false memories. Facts from them that occurred earlier in reality or facts that previously occurred but underwent a certain modification are transferred to the patient at another time (often in the near future) with their possible combination with events that were completely fictitious by them. A mild form of dementia is accompanied by moderate memory impairment, mainly associated with events occurring in the recent past (forgetting conversations, phone numbers, events that occurred within a certain day). Cases of more severe dementia are accompanied by retention in memory of only previously learned material while quickly forgetting newly received information. The last stages of the disease may be accompanied by forgetting the names of relatives, one’s own occupation and name, this manifests itself in the form of personal disorientation.
  • Attention disorder. In the case of the disease we are interested in, this disorder implies a loss of the ability to respond to several relevant stimuli at once, as well as a loss of the ability to switch attention from one topic to another.
  • Disorders associated with higher functions. In this case, the manifestations of the disease are reduced to aphasia, apraxia and agnosia.
    • Aphasia implies a speech disorder in which the ability to use phrases and words as a means of expressing one’s own thoughts is lost, which is caused by actual damage to the brain in certain areas of its cortex.
    • Apraxia indicates a violation of the patient’s ability to perform purposeful actions. In this case, the skills previously acquired by the patient are lost, and those skills that have been formed over many years (speech, household, motor, professional).
    • Agnosia determines a violation of various types of perception in the patient (tactile, auditory, visual) with the simultaneous preservation of consciousness and sensitivity.
• Disorientation. This type of disorder occurs over time, and mainly within the initial stage of development of the disease. In addition, disturbance of orientation in temporal space precedes disturbance of orientation on the scale of orientation in place, as well as within the framework of one’s own personality (here the difference between a symptom in dementia and delirium is manifested, the features of which determine the preservation of orientation within the framework of considering one’s own personality). The progressive form of the disease with advanced dementia and pronounced manifestations of disorientation on the scale of the surrounding space determines for the patient the likelihood that he can freely get lost even in an environment that is familiar to him.
• Behavioral disorders, personality changes. The onset of these manifestations is gradual. The main features characteristic of the individual gradually intensify, transforming into conditions inherent to this disease as a whole. Thus, energetic and cheerful people become restless and fussy, and people who are thrifty and neat, accordingly, become greedy. Transformations inherent in other traits are considered similarly. In addition, there is an increase in selfishness in patients, a disappearance of responsiveness and sensitivity to the environment, they become suspicious, conflictual and touchy. Sexual disinhibition is also detected; sometimes patients begin to wander and collect various rubbish. It also happens that patients, on the contrary, become extremely passive, they lose interest in communication. Untidyness is a symptom of dementia that occurs in accordance with the progression of the general picture of the course of this disease; it is combined with a reluctance to self-care (hygiene, etc.), with uncleanliness and a general lack of reaction to the presence of people next to you.
• Thinking disorders. There is a slowness in the pace of thinking, as well as a decrease in the ability for logical thinking and abstraction. Patients lose the ability to generalize and solve problems. Their speech is detailed and stereotypical; it is scarce, and as the disease progresses, it is completely absent. Dementia is also characterized by the possible appearance of delusional ideas in patients, often with absurd and primitive content. So, for example, a woman with dementia with a thought disorder may claim that her mink coat was stolen before the appearance of delusional ideas, and such an action may go beyond her environment (i.e., family or friends). The crux of the nonsense in this idea is that she never had a mink coat at all. Dementia in men within this disorder often develops according to a scenario of delusion based on the jealousy and infidelity of the spouse.
• Decreased critical attitude. We are talking about the attitude of patients both to themselves and to the world around them. Stressful situations often lead to the development of acute forms of anxiety-depressive disorders (defined as a “catastrophic reaction”), in which there is a subjective awareness of intellectual inferiority. Partially preserved criticism in patients determines the possibility for them to maintain their own intellectual defect, which may look like a sharp change in the topic of conversation, turning the conversation into a humorous form, or distracting from it in other ways.
• Emotional disorders. In this case, it is possible to determine the diversity of such disorders and their overall variability. Often these are depressive states in patients combined with irritability and anxiety, anger, aggression, tearfulness or, conversely, a complete lack of emotions in relation to everything that surrounds them. Rare cases determine the possibility of developing manic states in combination with a monotonous form of carelessness, with gaiety.
• Perception disorders. In this case, the conditions of the appearance of illusions and hallucinations in patients are considered. For example, with dementia, a patient is sure that he hears the screams of children being killed in the next room.

Senile dementia: symptoms

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

Senile dementia, being among the mental illnesses, is the most common disease among older people. Senile dementia occurs almost three times more often in women than in men. In most cases, the age of patients is 65-75 years, on average, in women the disease develops at 75 years, in men - at 74 years.
Senile dementia manifests itself in several varieties of forms, manifesting itself in a simple form, in a presbyophrenic form and in a psychotic form. The specific form is determined by the current rate of atrophic processes in the brain, somatic diseases associated with dementia, as well as factors of a constitutional-genetic scale.

Simple form characterized by inconspicuousness, occurring in the form of disorders generally inherent in aging. With an acute onset, there is reason to assume that pre-existing mental disorders have been intensified due to one or another somatic disease. There is a decrease in mental activity in patients, which is manifested in a slowdown in the pace of mental activity, in its quantitative and qualitative deterioration (implying a violation of the ability to concentrate attention and switch it, its volume is narrowed; the ability to generalize and analyze, to abstract and in general weakens imagination is impaired; the ability to be inventive and resourceful in solving problems that arise in everyday life is lost).

To an increasing extent, a sick person adheres to conservatism in terms of his own judgments, worldview and actions. What happens in the present tense is viewed as unimportant and not worth attention, and is often completely rejected. Returning to the past, the patient primarily perceives it as a positive and worthy example in certain life situations. A characteristic feature is a tendency to edify, intractability bordering on stubbornness and increased irritability that arise when there are contradictions or disagreement on the part of the opponent. Interests that previously existed are significantly narrowed, especially if they are in one way or another related to general issues. Increasingly, patients focus their attention on their physical condition, especially with regard to physiological functions (i.e. bowel movements, urination).

Patients also have a decrease in affective resonance, which is manifested in an increase in complete indifference to what does not directly affect them. In addition, attachments weaken (this even applies to relatives), and in general, understanding of the essence of relationships between people is lost. Many people lose their modesty and sense of tact, and the range of moods is narrowed. Some patients may show carelessness and general complacency, sticking to monotonous jokes and a general tendency to joke, while other patients are dominated by dissatisfaction, pickiness, capriciousness and pettiness. In any case, the patient’s past characterological traits become scarce, and awareness of the personality changes that have arisen either disappears early or does not occur at all.

The presence of pronounced forms of psychopathic traits before the disease (especially those that are sthenic, this concerns power, greed, categoricalness, etc.) leads to their aggravation in manifestation at the initial stage of the disease, often to a caricatured form (which is defined as senile psychopathization ). Patients become stingy, begin to accumulate rubbish, and they increasingly make various reproaches towards their immediate environment, especially regarding irrationality, in their opinion, of expenses. Also subject to censure on their part are the morals that have developed in public life, especially with regard to marital relations, intimate life, etc.
Initial psychological changes, combined with the personal changes that occur with them, are accompanied by memory deterioration, in particular with regard to current events. They are usually noticed by those around the patients later than the changes that have occurred in their character. The reason for this is the revival of past memories, which is perceived by the environment as a good memory. Its decay actually corresponds to those patterns that are relevant for a progressive form of amnesia.

So, first, memory associated with differentiated and abstract topics (terminology, dates, titles, names, etc.) comes under attack, then a fixation form of amnesia is added here, manifesting itself in the form of an inability to remember current events. Amnestic disorientation regarding time also develops (i.e., patients are unable to indicate a specific date and month, day of the week), and chronological disorientation also develops (the inability to determine important dates and events linking them to a specific date, regardless of whether such dates relate to personal life or public life). To top it off, spatial disorientation develops (manifests itself, for example, in a situation where patients cannot return back when leaving home, etc.).

The development of total dementia leads to impairment of self-recognition (for example, when viewing oneself in reflection). Forgetting the events of the present is replaced by the revival of memories relating to the past, often this can concern youth or even childhood. Often, such a substitution of time leads to the fact that patients begin to “live in the past,” while considering themselves young or children, depending on the time in which such memories occur. Stories about the past in this case are reproduced as events relating to the present time, while it is not excluded that these memories are generally fiction.

The initial periods of the course of the disease can determine the mobility of patients, the accuracy and speed of performing certain actions, motivated by random necessity or, conversely, by habitual performance. Physical insanity is observed already within the framework of an advanced disease (complete collapse of behavior patterns, mental functions, speech skills, often with relative preservation of somatic function skills).

In severe forms of dementia, the previously discussed states of apraxia, aphasia and agnosia are noted. Sometimes these disorders manifest themselves in a sharp form, which may resemble the course of Alzheimer's disease. Few and isolated epileptic seizures, similar to fainting, are possible. Sleep disorders appear, in which patients fall asleep and get up at an unspecified time, and the duration of their sleep ranges from 2-4 hours, reaching an upper limit of about 20 hours. In parallel with this, periods of prolonged wakefulness may develop (regardless of the time of day).

The final stage of the disease determines for patients the achievement of a state of cachexia, in which an extreme form of exhaustion occurs, in which there is a sharp weight loss and weakness, decreased activity in terms of physiological processes with accompanying changes in the psyche. In this case, it is typical to assume a fetal position when the patient is in a drowsy state; there is no reaction to surrounding events, and sometimes muttering is possible.

Vascular dementia: symptoms

Vascular dementia develops against the background of previously mentioned disorders that are relevant for cerebral circulation. In addition, as a result of studying the brain structures of patients after their death, it was revealed that vascular dementia often develops after a heart attack. To be more precise, the point is not so much in the transfer of this condition, but in the fact that because of it a cyst is formed, which determines the subsequent likelihood of developing dementia. This probability is determined, in turn, not by the size of the cerebral artery that has been damaged, but by the total volume of the cerebral arteries that have undergone necrosis.

Vascular dementia is accompanied by a decrease in indicators relevant for cerebral circulation in combination with metabolism, otherwise the symptoms correspond to the general course of dementia. When the disease is combined with a lesion in the form of laminar necrosis, in which glial tissue grows and neurons die, serious complications may develop (vascular blockage (embolism), cardiac arrest).

As for the predominant category of people who develop the vascular form of dementia, in this case the data indicate that this mainly includes people aged 60 to 75 years, and one and a half times more often they are men.

Dementia in children: symptoms

In this case, the disease, as a rule, acts as a symptom of certain diseases in children, which may include mental retardation, schizophrenia and other types of mental disorders. This disease develops in children with a characteristic decrease in mental abilities, which manifests itself in impaired memorization, and in severe cases difficulties arise even with remembering one’s own name. The first symptoms of dementia in children are diagnosed early, in the form of loss of certain information from memory. Further, the course of the disease determines the appearance of disorientation within the framework of time and space. Dementia in young children manifests itself in the form of loss of previously acquired skills and in the form of speech impairment (up to its complete loss). The final stage, similar to the general course, is accompanied by the fact that patients stop taking care of themselves; they also lack control over the processes of defecation and urination.

Within childhood, dementia is inextricably linked with oligophrenia. Oligophrenia, or, as we previously defined it, mental retardation, is characterized by the relevance of two features relating to intellectual defect. One of them is that mental underdevelopment is total, that is, both the child’s thinking and his mental activity are subject to damage. The second feature is that with general mental underdevelopment, the “young” functions of thinking are most affected (young - when considering them on a phylo- and ontogenetic scale); insufficient development is determined for them, which makes it possible to associate the disease with oligophrenia.

Intellectual disability of a persistent type, developing in children after the age of 2-3 years against the background of trauma and infections, is defined as organic dementia, the symptoms of which manifest themselves due to the collapse of relatively formed intellectual functions. Such symptoms, due to which it is possible to differentiate this disease from oligophrenia, include:

• lack of mental activity in its purposeful form, lack of criticism;
• pronounced type of memory and attention impairment;
• emotional disturbances in a more pronounced form, not correlating (i.e. not associated) with the actual degree of decline in intellectual abilities for the patient;
• frequent development of disorders relating to instincts (perverted or increased forms of desire, performance of actions under the influence of increased impulsiveness, weakening of existing instincts (instinct of self-preservation, lack of fear, etc.) is not excluded);
• Often the behavior of a sick child does not adequately correspond to a specific situation, which also happens if a pronounced form of intellectual disability is irrelevant for him;
• in many cases, the differentiation of emotions is also subject to weakening, there is a lack of attachment in relation to close people, and the child’s complete indifference is noted.

Diagnosis and treatment of dementia

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

Regarding the issue of treating dementia, there is currently no effective treatment, especially if cases of senile dementia are considered, which, as we noted, is irreversible. Meanwhile, proper care and the use of therapy measures aimed at suppressing symptoms can, in some cases, seriously alleviate the patient’s condition. It also discusses the need to treat concomitant diseases (with vascular dementia in particular), such as atherosclerosis, arterial hypertension, etc.

Treatment of dementia is recommended within the framework of a home environment; placement in a hospital or psychiatric ward is important in severe cases of the disease. It is also recommended to create a daily routine so that it includes a maximum of vigorous activity while periodically performing household chores (with an acceptable form of load). Psychotropic drugs are prescribed only in the case of hallucinations and insomnia; in the early stages it is advisable to use nootropic drugs, then nootropic drugs in combination with tranquilizers.

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

Dementia, or more simply put, senile dementia, is a severe disorder of higher nervous activity caused by brain damage. This disease, which mainly affects older people, manifests itself as a decrease in mental abilities and gradual degradation of personality. It is impossible to cure dementia, but it is quite possible to slow down the progression of the disease, the main thing is to know the cause that caused the brain damage and the principles of treating the disease.

Causes and types of dementia

Depending on the cause of the disease, dementia is divided into primary and secondary. Primary, or organic dementia, occurs when there is massive death of neurons in the brain or when blood vessels malfunction. This is caused by diseases such as Alzheimer's disease, Pick's disease or dementia with Lewy bodies. In 90% of cases, senile dementia is caused precisely by these reasons. The remaining 10% is secondary dementia, which can be caused by brain infections, malignancies, metabolic problems, thyroid disease, and brain injuries.

What is typical is that secondary dementia, with timely treatment, is completely reversible, while organic or primary dementia is an irreversible process in which one can only slow down its development and relieve unpleasant symptoms, thereby prolonging the patient’s life.

Signs of dementia

Dementia of the organic type is characterized by manifestations of Alzheimer's disease. Initially, they are faintly noticeable, and therefore they can only be identified by closely observing the patient. In the early stages of dementia, a person's behavior changes - he becomes aggressive, irritable and impulsive, often suffers from forgetfulness, loses interest in his next activity and is unable to perform work in accordance with the norms.

A little later, absent-mindedness, a general decrease in understanding, an apathetic and depressive state are added to these signs. The patient may get lost in space and time, forget what happened to him a few hours ago, but remember in detail the events of many years ago. A characteristic sign of dementia is sloppiness and a lack of a critical attitude towards one's appearance. Approximately 20% of such patients experience psychosis, hallucinations and mania. It often seems to them that people close to them are preparing a conspiracy around them and are trying only for their lives.

Dementia affects not only the patient’s psyche and cognitive functions. In most cases, people with this condition have problems with speech, which becomes slow, inconsistent, and sometimes incoherent. Another sign of the disease is seizures, which occur at all stages of the disease.

Dementia treatment

The fight against the disease in question is aimed at stabilizing the pathological process, as well as reducing the severity of existing symptoms. Treatment is complex and must necessarily include the fight against diseases that aggravate dementia (atherosclerosis, hypertension, obesity, diabetes).

Organic dementia at an early stage is treated with the following drugs:

• nootropics (Cerebrolysin, Piracetam);
• homeopathic remedies (Ginkgo biloba);
• dopamine receptor stimulants (Piribedil);
• means for improving blood circulation in the brain (Nitsergoline);
• CNS mediators (Phosphatidylcholine);
• drugs that improve the utilization of glucose and oxygen by brain cells (Actovegin).

In the later stages of the fight against dementia, the patient is prescribed acetylcholinesterase inhibitors, which means the drug Donepezil and others. These funds help improve the social adaptation of patients, and therefore reduce the burden on people caring for such patients. Take care of yourself!

Alzheimer's disease(dementia of the Alzheimer's type) is the cause of almost half of cases of dementia.

Alzheimer's disease is a neurodegenerative disease based on the progressive death of neurons, primarily the hippocampus and temporoparietal cortex. The leading role in the pathogenesis of memory impairment and other higher mental functions in Alzheimer's disease is given to changes in neurotransmitter systems, especially acetylcholinergic systems.

Clinical picture (symptoms and course) is characterized by a gradual onset over the age of 40-50 years (usually after 65 years), the predominance of progressive forgetfulness in the early stages of the disease, followed by the addition of aphasia, apraxia and agnosia, acalculia, and the absence of focal neurological symptoms. Speech impairment is characterized by acoustic-mnestic aphasia with difficulties in selecting words and inaccurate word use (paraphasia), but intact repetition. Visual-spatial agnosia is manifested by a violation of the ability to draw or copy a picture, a disorder of spatial orientation. At the same time, behavioral stereotypes and motor functions at the early stage of the disease remain relatively intact. The actual focal neurological symptoms up to the late stages of the disease are quite scarce - patients may exhibit positive axial reflexes and extrapyramidal disorders. The course of the disease may be complicated by the occurrence of emotional, affective and other mental disorders.

Clinical manifestations of Alzheimer's disease conditionally divided into three stages.

Stage 1 Alzheimer's disease(initial) manifests itself as an isolated deterioration of RAM or memory for current events, names, prices, names of objects, etc.

There is a narrowing of the range of interests, slowing down of thinking, lack of initiative, absent-mindedness, and inattention. A feature of this stage is the absence of complaints about memory impairment due to impaired adequate self-esteem. In 50% of all cases, low mood (depression) or emotional instability is observed. Household and professional skills are often preserved at this stage of the disease.

Stage 2 Alzheimer's disease(developed) is manifested by the ongoing deterioration of short-term memory, which leads to difficulties in everyday and work activities due to the addition of the following disorders:

• speech becomes poor, difficulties arise in selecting individual words;
• violation of purposeful activity (praxis) consists of difficulties in choosing and putting on clothes, performing hygiene procedures (brushing teeth, shaving), handling correspondence, using household equipment; interest in hobbies disappears, orientation in unfamiliar surroundings becomes difficult, and the ability to drive vehicles is lost;
• violations of optical-spatial activity: it becomes impossible to draw any elementary object (cube, pillar, clock dial);
• thinking disorder (impossibility of generalizing several words, interpreting proverbs, sayings);
• violation of voluntary attention and calculation;
• affective disorders (delusions, especially delusions of jealousy, hallucinations, anxiety, fear).

Stage 3 Alzheimer's disease(final) occurs 5-10 years after the onset of the disease, when any forms of mental activity become impossible, the ability to self-care is lost, and speech remains at the level of verbal emboli.

At this stage, weight loss, increased muscle tone in the limbs, walking disorder, and epileptic seizures may occur.

An early sign of Alzheimer's disease may be atrophy of the medial parts of the temporal lobes, primarily the hippocampus according to CT or MRI (single small vascular lesions in the periventricular region and projections of the subcortical nodes or limited periventricular leukoaraiosis do not exclude the diagnosis).

MRI parameters characteristic of changes in Alzheimer's disease:

1. Increase (compared to the age norm) of the interhook distance.
2. Widening of the perihippocampal fissures.
3. Reduction in hippocampal volume.

There may be no changes on MRI. Decreased temporoparietal perfusion detected on single photon emission computed tomography may support the clinical diagnosis of Alzheimer's disease, and hypoperfusion of the medial temporal lobe may be the earliest manifestation of Alzheimer's disease.

The value of single-photon emission computed tomography in differentiating Alzheimer's disease from vascular dementia is limited. In patients with illness. Alzheimer's computed tomography, and especially magnetic resonance imaging, can reveal abnormalities in the white matter or basal ganglia, which provide additional information about associated vascular damage that may affect the course of the disease.

Kushnir G.M. - Doctor of Medical Sciences, Professor, Savchuk E.A. - Ph.D., Samokhvalova V.V. - Ph.D.

“Degenerative dementia, Alzheimer’s disease as a cause of dementia, manifestations, stages”- article from the section

Dementia is a generalized lesion of the intellect, memory and personality without impairment of consciousness. This is an acquired disorder. Although most cases of dementia are irreversible, a small but significant group of people with dementia are treatable. (See Berrios 1987 on the history of the concept of dementia.)

Clinical manifestations

Dementia usually manifests as memory impairment. Other signs include personality changes, mood disorders, and delusions. Although dementia usually develops gradually, in most cases it begins to be noticed by others after an exacerbation, caused either by changes in social conditions or by an intercurrent illness.

The clinical picture is also largely determined by the premorbid personality of the patient. For example, in some patients neurotic traits become worse. With good social skills, the patient is often able, despite a serious decline in intelligence, to maintain the appearance of a normal social life, while people in a state of social isolation or those suffering from deafness are less likely to compensate for the deterioration of intellectual abilities.

Behavior with dementia, often disorganized, inappropriate to the situation, restless; increased distractibility is noticeable. Such patients rarely show interest in anything; they tend to be uninitiative. Personality changes may manifest as antisocial behavior, which sometimes includes sexual disinhibition or theft. Any deviation from normal social behavior in a middle-aged or elderly person, if such abnormal actions have not previously been characteristic of him, should always suggest an organic cause. The effect of cognitive defects on behavior has been described by Goldstein (1975). Typical are a decrease in interests (“narrowing of horizons”), pedantic adherence to a constant daily routine (“organic desire for order”), and in cases where the patient is assigned any burdensome duties that go beyond his limited capabilities, sudden outbursts of anger or violent expression of other emotions (“catastrophic reaction”).

As dementia progresses, patients take less and less care of themselves and neglect social conventions. Behavior loses its purposefulness, and stereotypies and mannerisms may appear. Eventually, the patient experiences disorientation, confusion, and urinary and fecal incontinence. Thinking It becomes slow, its content becomes depleted. In particular, there are such disorders as concreteness of thinking, decreased flexibility of thinking, etc.

The ability to form correct judgments is impaired. False ideas (usually persecutory ideas) easily develop. In later stages, thinking becomes extremely fragmented and incoherent. Thinking disorder affects the quality Speeches, For which syntactic errors and nominal dysphasia are typical. With deep dementia, the patient is often able to make only meaningless sounds or is mute. In the early stages of change Moods May include anxiety, irritability and depression. As dementia progresses, emotions and reactions to events become dulled; mood can change dramatically without any apparent reason. Violations Cognitive functions- a very characteristic, conspicuous sign. Forgetfulness usually occurs early and is severe, but is sometimes difficult to recognize early on. The difficulties associated with mastering new knowledge are usually obvious. Memory loss for recent events is more pronounced than for distant events. Patients usually resort to various tricks and excuses to hide these memory defects, and some confabulate. Other cognitive impairments include poor attention and difficulty concentrating. Disorientation In time, and at a later stage in place and in one's own personality, it is almost always observed in advanced dementia. Objective assessment of your mental state, in particular, awareness of the extent of impairment and the nature of the disorder is lacking.

Subcortical dementia

In 1974, Albert and colleagues coined the term "subcortical dementia" to define the decline in intelligence observed in progressive supranuclear palsy. The meaning of the term has been expanded to include a syndrome of cognitive retardation, difficulty solving complex intellectual problems, and affective disturbances without impairment of speech, numeracy, or learning. Probable causes of subcortical dementia include Parkinson's disease, Wilson's disease and multiple sclerosis. , in contrast to the listed diseases, is usually considered an example of cortical dementia. Until now, a clear distinction between these two forms of dementia has not been convincingly established. (See: Whitehouse 1986; Cummings 1986.)

Causes

Dementia is caused by many factors; the most important possible causes are listed in table. 11.3. The etiology of dementia in older people is discussed separately in Chap. 16. In elderly patients, in most cases, degenerative and vascular factors play a major role, but in other age groups there is no predominance of any of these causes. Therefore, when assessing a patient's condition, the clinician must be aware of a number of causes, paying particular attention to those whose development can be delayed or stopped by treatment (for example, an operable tumor, cerebral syphilis, or normal pressure hydrocephalus). Care should be taken not to miss any of these reasons.