Dementia
The content of the article:
- Causes and risk factors
- Forms of the disease
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Dementia is a syndrome of acquired memory impairment in combination with one of the following disorders: speech impairment, impaired ability to perform complex, purposeful planned actions (praxis) or the ability to recognize objects and their characteristics based on sensations (gnosis), which have been observed for at least six months and are difficult work activity or limiting the social activity of the patient.
Dementia is a syndrome in which cognitive decline occurs
Globally, dementia is caused by a pronounced decrease in cognitive functions (cognitive impairment), when the patient loses independence and is unable to perform routine activities without assistance.
After 40-45 years, in a number of cases, there is a physiological decrease in cognitive activity, memory, concentration, but these changes do not provoke significant consequences for work and social life, which is a fundamental difference between dementia and natural non-dementia processes of changes in brain activity.
Dementia is quite common in neurological practice, its progression with age is characteristic: for example, in people 65 years and older, pathology is observed in approximately 5-10% of cases, in patients 90 years and older - in 20% of cases or more.
The number of people with dementia is on the rise, which is associated with an increase in life expectancy. Currently, about 50 million patients with this diagnosis have been registered in the world, more than 7.5 million new cases of the disease are detected annually.
Synonym: acquired dementia.
Causes and risk factors
In about 80% of elderly patients, dementia is due to:
- Alzheimer's disease (more than 50% of reported cases of progressive decline in cognitive functions);
- vascular diseases of the brain (cerebrovascular pathology) - in 5-10% of cases;
- dementia with Lewy bodies;
- a combination of these causal factors (in 10–20% of patients).
Researchers have noted a characteristic relationship between the patient's intelligence level and the severity of the clinical manifestations of the pathological condition. It is indicated, for example, that persons with a high level of intellectual development demonstrate a stable course of dementia for a longer time and are less prone to intensive progression of the condition.
In addition to the main reasons, other diseases and conditions can provoke dementia:
- traumatic brain injury;
- malignant neoplasms of the brain;
- Creutzfeldt-Jakob disease (degenerative changes in brain structures associated with the accumulation of abnormal prion protein);
- parkinsonism;
- multiple sclerosis;
- AIDS;
- amyotrophic lateral sclerosis;
- encephalitis;
- epilepsy;
- syphilitic damage to the central nervous system;
- Huntington's disease (chorea);
- Pick's disease;
- genetically determined diseases;
- chronic intoxication (drug addiction, substance abuse, alcoholism);
- metabolic disorders;
- taking certain medications (antipsychotics, tranquilizers, antiepileptoid drugs); and etc.
In some cases, it is not possible to reliably identify the cause of acquired dementia, then they speak of unspecified dementia.
Forms of the disease
According to the etiological factor, dementia can be:
- vascular;
- atrophic;
- mixed.
Depending on localization:
- cortical (cortical centers of the brain are affected);
- subcortical (pathology of the basal nuclei, white matter of the brain, limbic system, etc.);
- cortical-subcortical;
- multifocal (multiple foci of brain tissue damage).
Prevalence of different types of dementia in people over 65
According to the syndromic classification, acquired dementia is divided into:
- to total - the changes are pronounced, rude;
- on lacunar (dysmnestic) - characterized by a milder course.
A separate form is pseudodementia - a disease in which there is a sharp deterioration in cognitive functions due to some psychiatric pathology, more often hysteroid psychopathy or depressive spectrum disorders.
Symptoms
In the vast majority of cases, the disease develops gradually. Early signs of acquired dementia:
- forgetting frequently used terms, names of relatives and friends, names of objects;
- narrowing the range of interests;
- difficulty in orientation in place and time;
- limitation of social contacts, loss of desire to communicate with people in close circle;
- difficulties in professional activities (difficulties with reporting, memorizing, systematizing and processing incoming information, difficulties in making accurate calculations);
- irritability, resentment, anger, excessive sentimentality (usually egocentric orientation), emotional lability.
Dementia symptoms in the elderly
As the disease progresses, the symptoms worsen, significantly narrowing the patient's options:
- forgetfulness in relation to recent events, actions, even stereotypical (natural dispositions, food intake, hygiene procedures, etc.);
- violation of orientation in your own home;
- behavioral changes (aimless walking, repeated repetition of phrases, questions);
- the need for help in self-care.
For the late stage of dementia, the following manifestations are characteristic:
- loss of orientation in time and place;
- lack of recognition of close relatives, everyday objects;
- speech and writing disorders;
- significant difficulties with the implementation of the simplest purposeful actions and motor acts (for example, the inability to hold a spoon, comb, tie shoelaces, dress, button up);
- the use of stereotyped phrases due to the difficulty of constructing detailed sentences;
- the need for constant help in self-service;
- difficulties in movement;
- emotional-affective disorders.
Dementia is characterized by the preservation of consciousness up to the terminal stage of the process.
Diagnostics
In order to diagnose dementia, a comprehensive examination of the patient is carried out in the following areas:
- collection of anamnestic data [family (hereditary) history, the presence of somatic and mental diseases that can provoke the development of acquired dementia];
- neuropsychological testing using the Clinical Rating Scale for Dementia, scales for assessing mental status, frontal dysfunction, etc.;
- electroencephalography;
- computed or magnetic resonance imaging;
- positron or single-photon emission tomography (allow detecting changes in metabolism in brain tissues before the formation of clinically significant cerebral atrophy).
CT or MRI can help diagnose dementia
Treatment
The main factors determining the treatment strategy for acquired dementia are the severity of the clinical manifestations of the disease and its causes. As part of complex therapy, the following are prescribed:
- central acetylcholinesterase (AChE) inhibitors and / or competitive blockers of glutamatergic NMDA receptors memantine (in case of confirmation of Alzheimer's disease);
- phosphodiesterase inhibitors;
- calcium channel blockers;
- metabolic drugs (peptidergic and amino acid nootropic drugs);
- neuroprotectors.
Symptomatic therapy of concomitant disorders of the somatic and mental spheres is also carried out.
Medical treatment for dementia is long-term, sometimes life-long. When a stable therapeutic concentration of drugs in blood plasma is reached, approximately half of the patients (according to other data - in 70%) show regression of symptoms: independence in daily activity increases, speech disorders, motor disorders are leveled, memory improves, cognitive processes are activated, and is restored to varying degrees social activity.
In addition to pharmacotherapy, patients with acquired dementia are recommended regular cognitive training (reading, doing crossword puzzles, etc.) in order to stimulate intellectual activity.
Doing crosswords and reading can help slow the dementia process
Possible complications and consequences
Complications of dementia can include:
- complete loss of the ability to self-service;
- high risk of an emergency (fire, gas leak, flooding, etc.) or injury to the patient;
- the formation of bedsores, their infection (in immobilized patients);
- exhaustion, dehydration;
- the formation of aggressive behavior towards others, bouts of autoaggression;
- acute mental disorders (delirium, hallucinosis, etc.).
Forecast
The duration of the disease is, as a rule, 5-10 years, the patient's death occurs from an exacerbation of concomitant somatic diseases, the addition of infectious processes.
Prevention
Intellectual training is the basis for the prevention of irreversible cognitive decline. It has been proven that people who are engaged in intense intellectual work or who have an initially high level of intelligence are less likely to develop cognitive impairments, and in the case of their development, they progress more slowly than people who are physically involved or have a low level of intelligence.
An important factor in the prevention of dementia is rational diet therapy. The preventive effect of the so-called Mediterranean diet (vegetables in large quantities, olive oil, seafood) in relation to memory and attention disorders in old age has been established.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
