Senile dementia
The content of the article:
- Causes and risk factors
- Forms of the disease
-
Senile dementia symptoms
- Atrophic senile dementia
- Vascular senile dementia
- Diagnostics
- Treatment of senile dementia
- Possible complications and consequences
- Forecast
- Prevention
Senile (senile) dementia is a persistent disorder of higher nervous activity that develops in elderly people and is accompanied by a loss of acquired skills and knowledge, as well as a decrease in the ability to learn.
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Higher nervous activity includes processes that occur in the higher parts of the human central nervous system (conditioned and unconditioned reflexes, higher mental functions). The improvement of the mental processes of higher nervous activity occurs theoretically (in the learning process) and empirical (when gaining direct experience, testing the theoretical knowledge gained in practice) ways. Higher nervous activity is associated with neurophysiological processes occurring in the cerebral cortex and subcortex.
Senile dementia is most often seen in the age group over 65. According to statistics, severe dementia is diagnosed in 5%, and mild - in 16% of people of this age group. According to the information provided by the World Health Organization, a significant increase in the number of patients with senile dementia is expected in the coming decades, which is primarily associated with an increase in life expectancy, accessibility and an improvement in the quality of medical care, which makes it possible to avoid death, even in the case of severe brain damage. …
Causes and risk factors
The main cause of primary senile dementia is organic brain damage. Secondary senile dementia can develop against the background of any disease or have a polyetiological nature. At the same time, the primary form of the disease accounts for 90% of all cases, secondary senile dementia occurs in 10% of patients, respectively.
Risk factors for developing senile dementia include:
- genetic predisposition;
- systemic circulation disorders;
- traumatic brain injury;
- infectious diseases of the central nervous system;
- neoplasms of the brain;
- arterial hypertension;
- atherosclerosis;
- metabolic disorders;
- immunodeficiency states;
- endocrine diseases;
- rheumatic diseases;
- the presence of bad habits;
- poisoning with heavy metals (in particular, zinc, copper, aluminum);
- irrational use of drugs (especially anticholinergics, antipsychotics, barbiturates);
- sedentary lifestyle;
- vitamin deficiency (in particular, lack of vitamin B 12);
- overweight.
Forms of the disease
Senile dementia is divided into primary and secondary dementia.
Depending on the degree of brain damage, the disease takes the following forms:
- mild senile dementia (decreased social activity, preservation of the ability to self-care);
- moderate senile dementia (loss of skills in using equipment and devices, inability to endure loneliness for a long time, maintaining the ability to self-service);
- severe senile dementia (complete maladjustment of the patient, loss of the ability to self-care).
Depending on the etiological factor, the following forms of senile dementia are distinguished:
- atrophic (primary damage to the neurons of the brain);
- vascular (secondary damage to nerve cells against the background of a violation of the blood supply to the brain);
- mixed.
Senile dementia symptoms
The clinical manifestations of senile dementia range from a slight decrease in social activity to an almost complete dependence of the patient on other people. The prevalence of certain signs of senile dementia depends on its form.
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Atrophic senile dementia
Memory disorders are the main symptom of atrophic senile dementia. Mild forms of the disease are manifested by loss of short-term memory. In a severe course of the disease, there are also violations of long-term memory, disorientation in time and space. In some cases, patients' speech is impaired (it is simplified and impoverished, artificially created words can be used instead of forgotten words), the ability to respond to several stimuli at the same time and keep attention in one lesson is lost. With continued self-criticism, patients may try to hide their illness.
With the course of the pathological process, personality changes and behavioral disorders occur, hypersexuality appears in combination with incontinence, the patient grows irritability, egocentrism, excessive suspicion, a tendency to edification and resentment. There is a decrease in the critical attitude to the surrounding reality and its state, sloppiness and negligence appear or increase. The pace of mental activity in patients slows down, the ability to think logically is lost, the formation of delusional ideas, the emergence of hallucinations, illusions is possible. Any people can be involved in the delusional system, but more often they are relatives, neighbors, social workers and other persons who interact with the patient. Patients with senile dementia often develop depressive states, tearfulness, anxiety,anger, indifference to others. In the case of the presence of psychopathic features before the onset of the disease, their exacerbation is noted with the progression of the pathological process. Interest in past hobbies, the ability to self-service, to communicate with other people are gradually lost. In some patients, there is a tendency to senseless and disorderly actions (for example, shifting objects from place to place).
In the later stages of the disease, behavioral disorders and delusions are leveled due to a pronounced decrease in mental abilities, patients become inactive and indifferent, they may not recognize themselves when looking at the reflection in the mirror.
With the further progression of the pathological process, the ability to move independently, to chew food is lost, which causes the need for constant professional care. Some patients may experience single seizures similar to epileptic seizures or fainting.
Senile dementia in atrophic form is steadily progressing and leads to a complete breakdown of mental functions. After diagnosis, the average life expectancy of the patient is about 7 years. Death often occurs as a result of the progression of concomitant somatic diseases or the development of complications.
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Vascular senile dementia
The first signs of vascular senile dementia are difficulties that the patient experiences when trying to concentrate, inattention. Then there is rapid fatigue, emotional instability, a tendency to depression, headaches and sleep disorders. Sleep duration can be 2-4 hours or, conversely, reach 20 hours a day.
Memory disorders in this form of the disease are less pronounced than in patients with atrophic dementia. In post-stroke vascular dementia, focal disorders (paresis, paralysis, speech disorders) predominate in the clinical picture. Clinical manifestations depend on the size and location of the hemorrhage or the area with impaired blood supply.
In the case of the development of a pathological process against the background of a chronic disturbance of blood supply, signs of dementia prevail, at the same time, neurological symptoms are less pronounced and are usually represented by changes in gait (decrease in stride length, shuffling), slowing down of movements, impoverishment of facial expressions, and impaired vocal function.
Diagnostics
The diagnosis of senile dementia is based on the characteristics of the disease. Memory impairments are determined during a conversation with a patient, interviewing relatives and conducting additional research. If senile dementia is suspected, the presence of symptoms indicating organic brain damage (agnosia, aphasia, apraxia, personality disorders, etc.), impaired social and family adaptation, and the absence of signs of delirium is determined. The presence of organic brain lesions is confirmed by computed tomography or magnetic resonance imaging. The diagnosis of senile dementia is confirmed by the presence of these symptoms for six months or more.
In the presence of concomitant diseases, additional studies are shown, the volume of which depends on the existing clinical manifestations.
Differential diagnosis is carried out with functional and depressive pseudodementia.
Treatment of senile dementia
Treatment of senile dementia consists of psychosocial and drug therapy aimed at slowing the progression of the disease and correcting existing disorders.
Drug therapy, first of all, is indicated for insomnia, depression, hallucinations, delirium, aggression towards others. The administration of drugs that improve cerebral circulation, neurometabolic stimulants, vitamin complexes is shown. In case of anxiety, tranquilizers can be used. If a depressive condition develops, antidepressants are prescribed. For the vascular form of senile dementia, antihypertensive drugs are used, as well as drugs that help lower blood cholesterol levels.
In addition to drug therapy, psychotherapeutic methods are used, the purpose of which is to return the patient to acceptable behavioral reactions in society. A patient with mild forms of senile dementia is advised to lead an active social life.
Quitting bad habits, as well as the therapy of concomitant diseases, is of no small importance. So, when dementia develops against the background of a stroke, it is recommended to take a number of measures to reduce the risk of recurrent stroke (adjust excess weight, control blood pressure, perform therapeutic exercises). With concomitant hypothyroidism, adequate hormonal therapy is indicated. In case of detection of brain tumors, the neoplasms are removed in order to reduce the pressure on the brain. In the presence of concomitant diabetes mellitus, it is necessary to monitor the blood glucose level.
When caring for a patient with senile dementia at home, it is recommended to get rid of objects that can be dangerous, as well as unnecessary things that obstruct the patient's movement around the house, equip the bathroom with handrails, etc.
It is recommended to use the services of a professional nurse to care for a patient with severe senile dementia. If it is impossible to create comfortable conditions for the patient at home, he should be placed in a boarding house specializing in caring for such patients. A patient with senile dementia is recommended to be placed in psychiatric clinics only in severe forms of the disease, in all other cases it is not necessary, moreover, it can increase the progression of the pathological process.
Possible complications and consequences
The main complication of senile dementia is social maladjustment. Due to problems with thinking and memory, the patient loses the ability to contact with people around him. In the case of a combination of pathology with laminar necrosis, in which neuronal death and proliferation of glial tissues are observed, vascular occlusion and cardiac arrest are possible.
Forecast
The prognosis for senile dementia depends on the timely diagnosis and initiation of treatment, the presence of concomitant diseases. Timely adequate treatment can slow down the progression of the pathological process, improve social adaptation, maintain self-care skills and prolong life.
Prevention
In order to prevent the development of senile dementia, it is recommended:
- adequate physical and intellectual activity;
- socialization of elderly people, their involvement in feasible work, communication with other people, vigorous activity;
- adequate treatment of existing diseases;
- strengthening the body's defenses: balanced nutrition, rejection of bad habits, regular walks in the fresh air.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
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!
