What is senile dementia: causes, treatments and prognosis
- 1 general characteristics
- 2 Types of dementia
- 3 Signs of dementia
- 4 Stages
- 5 The reasons
- 6 Diagnostics
- 7 Treatment
- 8 Prevention
The spread of pathology is associated with an increase in human longevity, malnutrition, poor lifestyle choices, large amounts of drugs, and the emergence of new diseases.
Dementia (from Latin dementia – “madness”) is a complex disorder of higher mental functions associated with organic and functional brain damage. It is characterized by persistent disorder of memory, cognitive activity, emotional sphere. The patient loses the ability to empathize, to notice the love and affection of loved ones, to value others and himself, to communicate. There is a loss of interests, skills, including automatic ones. Brightly manifested violations in motor activity.
The processes are almost always irreversible (studies say about 5% of cases when the development of pathology can be stopped). The disintegration of the person is gradual, can last 15-20 years. For some cases, the disease is characterized by gradual development. Sometimes patients live the same 20 years, and sometimes go away a few weeks after the disease is diagnosed.
An important feature of the pathology is acquired. A person goes through all the stages characteristic of normal development: learning, expanding horizons, emotional-volitional sphere, deepening experience. But at some point in time a breakdown occurs, and all acquired functions are lost. This dementia differs from congenital dementia.
More often senile dementia is an age-related disorder, it affects people after 60 years. An interesting study conducted in the United States. In 2000, pathology was registered in 11.6% of the elderly, and in 2012, in 8.8%. Probably, a decrease in the spread of the disease is associated with understanding and knowing the problem, using preventive measures and maintaining a healthy lifestyle.
However, the disease develops in children. In this case, talking about early dementia. A completely healthy child has signs of pathology after a traumatic brain injury, as a result of genetic abnormalities or infectious diseases. They appear at different ages – in kindergarten, in elementary school, and in adolescence.
Types of dementia
Speaking about dementia, its symptoms in adults, diagnosis and treatment, experts identify different types depending on the following symptoms:
- lesion focus;
- the breadth of damage functions;
- primary or secondary appearance.
The lesion may be in the cerebral cortex. In this case, talking about cortical disorders. Accompanying Alzheimer’s disease, Pick and dementia, developing because of alcoholism, drug addiction.
The appearance of motor disorders associated with subcortical pathologies. A typical example of the disease that causes such dementia is Parkinson’s disease. It is accompanied by tremor, muscle stiffness, loss of facial expressions.
Vascular disorders lead to the defeat of subcortical and cortical structures. In this case, the mixed pathology is determined.
Multifocal dementia occurs when a large number of central nervous system sites are affected.
In terms of the extent of damage to the functions, total and lacunar (local) dementia is distinguished. Total affects all areas of a person’s personality: emotions, communication, thinking, memory, movement. A person loses the ability to think, speak, interests are lost, there is a depreciation of everything that was once important. Anatomically total dysfunction associated with pathologies of the frontal lobes of the cerebral cortex. Occurs due to neoplasms, hematomas, or vascular diseases.
When lacunar affects certain parts of the brain, mainly those that are responsible for memory and some cognitive processes. Emotional sphere remains intact, as well as a critical attitude towards yourself. Such changes are characteristic of the initial stage of Alzheimer’s disease.
Of great importance for diagnosis and therapy is whether senile dementia arose as a result of any disorder, such as vascular disease, or it appeared as the primary symptom of a developing disease.
Signs of dementia
The disease develops gradually or intermittently, depending on the accompanying pathology. With Alzheimer’s disease, there is a slow loss of abilities and functions, with strokes, including microstrokes, the changes are intermittent. In any case, they affect all aspects of a person’s personality: emotional, mental, communicative, physical activity.
The crucial point of change is called memory impairment. Amnesia, at first unobtrusive, then manifest itself brighter, affects all aspects of the patient’s life and turns him from an emotionally rich, living person into his flattened copy.
With the development of senile dementia, memory is primarily impaired. At first it is a little forgetfulness, the inability to remember what you just thought, the inability to find the word. They laugh at this, they say about the approaching old age, but they do not think that this may be a signal of the emergence of a complex disease. Gradually notice further deterioration of memory:
- A person forgets recent events, assigned tasks, misses meetings that he himself has appointed. At the same time, the events of the past remember well, which creates the illusion that everything is in order with memory, and there is only a slight deviation inherent in all people of old age.
- Loss of thought, forgetting what the person was just worried about was important.
- Spatial orientation deteriorates. The patient ceases to recognize the places, even those where he lived all his life.
- Lost temporal orientation. Dates are forgotten, a person confuses the past with the present.
- Violated memory on faces. A person loses the ability to recognize friends, friends, close relatives. At some point in time, it ceases to recognize its reflection.
Any one of these manifestations, having arisen once, does not disappear, but gradually becomes deeper, extends to more and more spheres of human life. The use of drugs aimed at improving memory, postpones the deterioration of the state for several years.
Thoughtful activity changes slowly and gradually. Cognitive disorders usually cause dementia to be referred to as senile insanity. Attention worsens – a person ignores, does not notice an important piece of information.
Gradually disappear, knowledge and skills acquired earlier are lost. First – abstract, rarely used. Then those that the person did and used on the machine, for example, reading, counting, turning on and off household appliances. A person loses the ability to drive a car, does not recognize road signs. Speech changes – sentences mostly become simple, monosyllabic. Difficult, rarely used words are forgotten, gradually lose meaning for the patient.
Following is lost the ability and ability to learn something new. At first, a person cannot understand, deeply study some unfamiliar object, establish cause-and-effect relations, and make complex calculations. Then the ability to recognize everyday things is lost.
Loss of interest in their work, work skills disappear. At first, mental ones are lost, followed by mechanical ones. As a rule, the connection between actions and their consequences is lost. Initially, there is a feeling that something is bothering a person, he becomes absent-minded. Only much later do others realize that they are observing organic brain damage and dementia.
The onset of the disease is usually accompanied by a decadent mood, depression. This is due to the awareness of the fact of pathology or individual symptoms. Among other signs, there are:
- Loss of ability to experience deep emotions and feelings. Indifference arises instead. A person is no longer captured by past interests. Beloved grandchildren become just children, then – an annoying factor, and after a while – nobody, the patient simply ceases to notice them.
- You can see the constant change of mood, which can not be associated with any events. Tears are easily replaced by fun, which is replaced by irritability and tears again.
- The understanding of socially accepted norms and the need to follow them is lost.
- Exacerbated, distorted some traits. Sociability becomes excessive talkativeness. Thrift and economy first turn into stinginess, and then into a propensity to collect everything that is lying on the street. Even leftover food is picked up. Modesty and shyness are transformed into suspicion and loss of all contact with others. Attention to relatives, care for them – in authoritarianism, grumbling, interference in their lives.
Over time, the ability to communicate with people, interact with them to achieve any goal is lost. Appear fictional interlocutors. When communicating with real people, the patient utters a meaningless set of words.
Both the surrounding people and the subject of communication become unimportant. A person does not notice and does not appreciate affection on the part of loved ones, their love. Lack of feelings, inability to experience emotions and interest push a person out of a family, society, community of friends. It becomes important itself, but gradually and it loses its value.
The complexity of the destruction of human functions captures the scope of motor activity. In adults, coordination and freedom of movement are impaired, endurance decreases.
Physical changes in Parkinson’s disease are most clearly outlined. A tremor appears – first, the fingers on one of the hands tremble a little, then the whole hand, gradually the disease passes to the other side, legs, head. The gait becomes slightly swaying, then unnatural, limited, constrained. A person can not move his legs, there is a feeling that he is afraid to walk. Movement slows down, the patient remains in the same position for a long time. Over time, the lesion also affects the muscles of the face, mimic manifestations are lost.
There are 3 stages of the disease. With a mild degree, a person continues to communicate, contact with other people, but from time to time he closes in on himself, loses interest in conversation, experiences apathy. Sometimes depression is manifested. Orientation in space and time saved. Movement changes slightly. Man is able to take care of himself.
The middle stage is characterized by loss of contact with others and family members. Patients need supervision and help. Actions lose awareness, reduced to automatism. Memory is deteriorating, thinking is disturbed. A person loses orientation, can harm himself and others.
At a severe stage there are no conscious actions, there is a loss of orientation, recognition of friends and relatives. Appears aggressiveness. Patients need constant care and care.
Dementia results from the accelerated death of brain neurons and the breakdown of neural connections. Nerve cells begin to die mainly after 20 years, this is part of the involutional process. Destruction occurs slowly, noticeably in rare cases, does not have a special impact on the activity and condition of the person. In the presence of certain disorders, the process accelerates, has a brighter expression, destroys everyday life.
The pathologies that cause dementia include:
- neurodegenerative diseases;
- infectious diseases;
- pathology of internal organs;
- disorders caused by a lack of vitamins.
The most common type is Alzheimer’s-type dementia. Pathology occurs in 60-80% of patients. It is characterized by the accumulation in the nerve cells of abnormal proteins: tau proteins and beta amyloids. As a result, neurons die, and the brain volume decreases. Women develop more often than men.
In 30% of patients, dementia is associated with the accumulation of plaques in nerve cells – Levi’s Taurus. A feature of this type of pathology is the occurrence of cognitive disorders in the first year of the disease.
Levi bodies are also formed in Parkinson’s disease. Dopamine producing neurons die, a hormone that plays an important role in mental activity. Symptoms are distinguished by the fact that first of all there are movement disorders, tremors, and after a while – signs of disorders of thinking, memory, and emotional sphere.
Another common disease leading to dementia is stroke and other disorders of cerebral circulation. Brain cells do not receive oxygen and nutrients, this leads to their death. Tumors, hematomas, abscesses also lead to impaired blood flow.
Alcohol abuse leads to the destruction of neurons by the breakdown of ethyl alcohol.
Dementia is caused by the human immunodeficiency virus. How is the brain damage, is still unknown. Another common cause is tick-borne encephalitis and Lyme disease. With infection and late treatment, the myelin sheath of nerve cells is destroyed.
Diseases caused by infectious agents, prions, lead to the loss of memory, emotions, and cognitive decline.
Pathology of internal organs
In renal and hepatic insufficiency, a violation of the withdrawal of toxic substances from the body occurs. Accumulating, they have a damaging effect on the brain.
One of the causes of dementia is hormonal imbalance. So, Itsenko-Cushing syndrome is characterized by the production of a large number of glucocorticoids in the adrenal glands, as a result of which the metabolism is disturbed.
Multiple sclerosis and systemic lupus erythematosus lead to cognitive impairment. Multiple sclerosis appears in 15-40 years old, characterized by the destruction of myelin in the brain and spinal cord. Systemic lupus erythematosus affects small blood vessels, leading to disruption of the supply of blood to the cerebral vessels.
In some cases, acute long-term lack of vitamins B1, B3, B9, B12 leads to impaired blood flow and synthesis of myelin.
Age-related dementia also occurs due to the abuse of medications, including cold medicine, memory impairment. At any age, pathology can appear due to head injuries, depression. In the latter case, a successful treatment of the disorder is possible, such dementia is called pseudo-dementia.
To clarify the diagnosis, a multilateral study is conducted, which includes a conversation with the patient, his relatives, and instrumental methods. It turns out the mental state of a person, especially thinking and memory, analyzes all the symptoms.
Conversation with the patient
Neurologists and psychiatrists communicate with the patient before making a diagnosis. The conversation goes according to a certain plan using standard techniques. This is done in order to avoid the doctor’s subjective impressions of the patient. They are asked 10 basic questions that developed in the 70s. XX century. Henry Hodkins. Since then, his technique, called the abbreviated assessment of the mental test, has repeatedly proved its relevance for the diagnosis of dementia.
The doctor asks questions about the patient’s age, date of birth, time at which the study is conducted, the city, the hospital where the doctor and the patient are located. The patient is asked to find out two people whom he has seen before, count up to 20 to 1, repeat the address that he saw. Also asked about who is the current head of state and the date of the beginning of a significant and well-known event.
The correct answers to 7 questions indicate the absence of cognitive impairment.
Another diagnostic test is GPCOG (“General Practical Assessment of Cognitive Abilities”). The patient is asked to draw the dial and set aside the equal distance between the divisions. The second part of the test contains questions for close relatives of the patient.
Conversation with relatives
From a conversation with close relatives of the patient learn information about the history of the disease. The doctor asks questions about the first manifestations of the pathology, at what age, how long the symptoms of the disorder had appeared, and whether the communication takes a rude form. Be sure to ask about changes in the nature, behavior, interests, attitudes towards loved ones, yourself.
Important data about events preceding the appearance of signs. Whether the patient was abused by alcohol, were there any events that dramatically changed a person’s life, for example, relocation, retirement. Often the cause of the diagnosed disorders can be senile depression.
The GPCOG test, in addition, includes 6 questions about how difficult it is for the patient to memorize events, recall conversations, pick words, manage money, take medicine, use transport.
Instrumental research methods
An important method for determining organic and functional lesions is computed tomography or MRI. Both methods allow you to see vascular disorders, neoplasms, symptoms of atherosclerosis. In some cases, an electroencephalogram is assigned to determine the electrical activity of various parts of the brain.
The diagnosis takes into account the data of the general, biochemical blood test, sugar test, cholesterol, HIV, urinalysis, ECG. If you suspect a congenital cause of the disease can be assigned to genetic examination. In the case when there is a suspicion about the viral nature of the pathology, conduct spinal puncture. In some situations, a brain biopsy is also prescribed.
On the basis of the diagnostic measures carried out, a diagnosis of “dementia” is made if the patient has the following distinct signs for a patient for at least 6 months:
- Deterioration of long-term or short-term memory.
- Violation of one of the functions: abstract thinking, perception, critical thinking or speech.
- Difficulties in performing complex movements.
- Disruption of communication and interaction with others.
- The absence of hallucinations, delirium during a medical reception.
- Detection of organic lesions.
In most cases, senile dementia is not cured. The prognosis is favorable if organic brain lesions are not found. Recovery is possible with vitamin deficiency, mental disorders, some injuries.
The medical complexes developed to date make it possible to slow the development of the disease and are symptomatic treatment. These include:
- drugs aimed at improving the blood supply;
- dopamine stimulants;
- drugs that improve brain absorption of glucose and oxygen;
- brain stimulants.
In case of confusion, atypical antipsychotics are prescribed.
If senile pathology has arisen as a result of arterial hypertension, thyroid dysfunction, renal or hepatic insufficiency, these diseases are treated in parallel.
Dementia in older people gradually leads to loss of control over their actions, so their medication should be constantly monitored, they should not be left in an accessible place.
Some drugs can be addictive, side effects, or be effective only at a certain stage in the development of pathology. Some drugs are badly combined. For these reasons, treatment tactics require regular correction.
Treatment for dementia depends on ensuring the proper care of the sick. At the first stage, it is enough to adjust the mode of the day, remind of important events, engage a person, stimulate his cognitive activity. At the middle stage, you will need full control over the medication intake, assistance in hygiene and feeding.
In the later stages it is important to ensure the cleanliness of the patient, the room in which he is located, the beds, the timely replacement of diapers, and the feeding.
At each stage of the disease, it is necessary to exclude aggression, contempt for the patient, ridicule at him, violence. It is important to distinguish between a person and his illness, to surround him with care and attention.
Not all factors causing dementia can be controlled. However, the power of the person to reduce the risk of developing some of those diseases that are accompanied by dementia in the elderly. To do this, you need to give up alcohol and smoking, observe a healthy lifestyle, principles of proper nutrition, and do regular exercises. With increasing pressure and identifying other pathologies to observe the doctor’s prescription.
Reduce the risk of developing brain pathologies will help normal sleep, reducing mental stress.
If you find signs of dementia in relatives and friends, and, perhaps, in yourself, you should immediately consult a doctor. Timely diagnosis, properly prescribed treatment will delay the onset of symptoms, improve the quality of life, and possibly cure the disease.