INTRODUCTION

Some psychological problems result from damage or defects in brain tissue. Damage to the brain can reduce the effectiveness of thinking, perception, and behavior. The relationship between mental disorders, organic brain damage and abnormal behavior is often confusing and difficult to understand, mainly because the structure of the brain and its functions are closely related to each other.

If morphological disorders of the brain appear in the prenatal period or at a very early age, the child may experience a lag in mental development, the degree of which depends, first of all, on the size of the damage. Some people with prenatal or perinatal (occurring at birth) brain damage may experience normal mental development, but may suffer from cognitive or motor problems, such as a learning disorder or muscle spasticity (excessive muscle contractions that interfere with normal motor activity).

Brain damage is possible even after its normal biological development has ended. A huge number of injuries, diseases and exposure to toxic substances can cause functional damage or death of neurons and their neurotransmitter connections, which often leads to obvious impairment of psychological functions. Sometimes such damage is associated with behavioral disorders that become maladapted and even psychopathic. People who have suffered serious brain damage find themselves in a completely different situation compared to those who start life with such defects. When an older child or adult suffers brain damage, some previously developed functions are lost. This loss of already acquired skills can be painful and obvious to the victim, which aggravates the already existing organic trauma psychologically. In other cases, trauma may impair the capacity for realistic self-esteem, leaving patients with little awareness of their losses and thus little motivation for rehabilitation.

In accordance with the International Classification of Diseases, Tenth Revision (ICD-10), organic mental disorders include dementia in atrophic processes of the cortex (Alzheimer’s disease, Pick’s disease), vascular (atherosclerotic) dementia, multi-infarct (vascular) dementia, traumatic dementia, epileptic dementia, and also psychogenic dementia or pseudodementia.

There is a very wide range of causes of dementia:

Intracranial tumors;

Nutritional deficiency;

Degenerative processes that often develop in old age;

Multiple cerebrovascular events or strokes;

Some infectious diseases (AIDS, syphilis, meningitis);

Severe or multiple traumatic brain injuries;

Anoxia (lack of oxygen);

Ingestion of toxic substances into the body;

Some mental illnesses (schizophrenia, epilepsy).

The current state of the environment, man-made disasters and excessive development of industry, the state of health care and economic instability, the ever-increasing level of “psychological stress” lead to the fact that no one can consider themselves immune from the mentioned problems. And, therefore, from the onset of dementia.

Object of study Dementia is a specific mental disorder.

Subject of research – intellectual impairment in various types of dementia.

The purpose of the study is to study the clinical manifestations of intellectual impairment in dementia.

Research objectives:

1. Study and analyze the literature on the problem under consideration.

2. Outline the definitions and general characteristics of dementia.

3. Describe the classifications of types of dementia.

4. Provide a description of intellectual impairments in various types of dementia.

Hypothesis: Undoubtedly, dementia requires special attention in the study not only of clinical specialists, but also of psychologists. There is an increase in cases of this disease in Russia and I believe that the sooner we sound the alarm, the sooner we pay concentrated attention to the early manifestations of dementia, the more help we can provide in the early stages of the disease, the less chance this disaster will have to spread diseases. Since dementia in most cases is irreversible and one can only hope, in the best case of treatment, to slow down the rate of progression of the disease, it seems to me that attention should be paid not to pharmacological treatment, but to the psychological side of the course of the disease. This type of help is needed not only by the patient, but also by the people around him, since the disease plunges the entire family into suffering. The loss of already acquired skills leads the patient to despair and it is important to preserve the person’s personal sphere so that the goal remains, the desire remains in the person to fight the disease, and the right environment (people) only helps to improve the course of the disease. Putting an end to the words “dementia is irreversible” is not a human act.

Methodological basis:

Dementia is addressed within special psychology and defectology, as a variant of mental retardation.

IN psychiatry Dementia refers to an organic mental disorder.

IN medical psychology dementia is interpreted as severe insufficiency of intelligence.

It should be noted that there are no contradictions in the consideration of dementia by the listed sciences, and they all agree in the description of the signs of dementia and the symptoms of the disease. Differences are present only in the formulation of the concept, which are determined by the terminology of each science and the specifics of the subject of study.

In addition, specialists in all of the above areas consider dementia according to the same scheme: etiology (cause of the disease), clinical manifestations (symptoms), diagnosis (methods of detection, distinctive features), therapy (methods and means of treatment).

Regarding the last point, it should be noted that the maximum possible treatment can only slow down the process of development of dementia - reduce the rate of deterioration of intellectual functions and loss of personality traits.

Chapter 1. GENERAL INFORMATION ABOUT DEMENTIA

1.1. Definition of dementia and symptoms of the disease

According to A.O. Bukhanovsky, Yu.A. Kutyavin and M.E. Litvak, an acquired mental defect may include predominantly personality, intellectual negative disorders, or a combination thereof. Depending on the proportion of general personality or intellectual disorders themselves, the states of acquired mental defect can be divided into three groups. The first group includes defects determined primarily by personality disorders (exhaustion of mental activity, subjectively perceived changes in the “I” and objectively determined changes in personality). The second group includes deep personality defects, accompanied by signs of intellectual deficiency (personal disharmony, decreased energy potential, decreased personality level, personality regression). The third group unites the most profound acquired mental defects, in which significant intellectual decline (amnestic disorders, dementia) comes to the fore.

Dementia (from the Latin de - cessation, mentis - mind) is a partial destruction of the psyche caused by disease or brain damage that occurs after the age of three. Most often, dementia is accompanied by impairments in memory, language, speech, judgment, cognition, affective manifestations of spatial orientation and motor skills. Dementia is usually irreversible, but in some cases it may improve if the cause is addressed. This organic mental disorder is based on more or less widespread lesions of cortical functions, confirmed by neurological and electroencephalographic studies, computed tomography, and magnetic resonance imaging.

The main symptom of dementia is the progressive deterioration of intellectual functions, most often observed after the completion of brain maturation (in people over 15 years of age). At the very beginning of the disease, a person reacts vividly and adequately to environmental events. In the early stages of the disease, the functioning of episodic (memory for events), but not necessarily semantic (language and concepts) memory is usually impaired; The memory of recent events is especially affected. People with dementia demonstrate progressive decline in abstract thinking, learning, visuospatial perception, motor control, problem solving, and judgment. This deterioration is accompanied by personality disorders and loss of motivation. Typically, dementia is accompanied by disturbances in emotional control, moral and ethical sensitivity (for example, such a person may be characterized by gross sexual demands).

1.2. Etiology of dementia

The causes of dementia are very diverse. These include degenerative processes that often, but not always, develop in older people. The cause may also be repeated cerebrovascular disorders or strokes; some infectious diseases (syphilis, meningitis, AIDS); intracranial tumors and abscesses; certain nutritional deficiency; severe or repeated head injuries; anoxia (lack of oxygen); entry of toxic substances into the body.

The most common cause of dementia is degenerative diseases of the brain, primarily Alzheimer's disease - 47.7% of cases, followed by vascular diseases, hydrocephalus and intracranial tumors - 10%, 6% and 4.8% of cases, respectively. HIV infection and AIDS can also cause dementia (1% of all dementia cases). Schizophrenia, epilepsy, as well as organic diseases of the brain in which its substance is destroyed (senile psychoses, syphilitic lesions, vascular and inflammatory diseases of the brain, severe traumatic brain injury) can also lead to dementia.

Dementia has certain characteristics depending on the disease that causes it. In some cases, the resulting mental defect still allows the patient to show, to a certain extent, a critical position in relation to his condition; in others, such criticality and consciousness of the disease are absent.

1.3. Types of dementia

Based on the structure and depth of damage to the intellect, dementia can be divided into lacunar, globar and partial dementia:

1. Lacunar dementia– with this dementia, despite the resulting intellectual-mnestic defect, the moral and ethical properties of the individual are preserved. Memory and attention are primarily affected by lacunar dementia. Memory impairments are manifested mainly by hypomnesia, the severity of which may increase. Decreased performance, increased fatigue, exhaustion and distractibility are observed. This type of disorder is characterized by uneven damage to mental processes, a “flickering” of symptoms, sometimes manifesting itself within a fairly short time. A number of properties of the intellect itself are preserved, primarily critical thinking. This type of dementia is inherent in cerebral atherosclerosis, other vascular lesions of the brain, as well as advanced brain tumors.

2. Global (diffuse) dementia– we can talk about such dementia in cases where the personality is sharply degraded, there is no consciousness of the disease, criticism and prudence are sharply reduced, and the moral properties of the individual are also reduced or completely lost. With this type of dementia, the most complex and differentiated properties of the intellect itself are primarily affected. Typical is a violation of such qualities and properties of the mind as logic, evidence, independence, inquisitiveness, originality, resourcefulness, productivity, breadth and depth of thinking. The most reliable differential diagnostic criterion for globar dementia, which allows it to be distinguished from lacunar dementia, is the patient’s uncritical attitude towards his defect. Global dementia is observed in the clinic of diffuse brain lesions (for example, senile dementia, progressive paralysis). In some progressive brain diseases, it develops after the stage of lacunar dementia.

3. Partial dementia- this is the result of damage to individual brain systems that are indirectly related to intellectual activity and play a role in its organization. This dementia can be observed, for example, with brain contusions, brain tumors, and also with encephalitis.

Based on the nature of the course, there are three types of dementia – progressive, stationary and relatively regredient dementia:

1. For progressive flow irreversibility and further increase in intellectual disability, which has a certain sequence, are mandatory. First of all, creative thinking suffers, then the ability to abstract reasoning, and last of all, the impossibility of performing simple tasks within the framework of “practical” intelligence is noted.

2. When stationary flow Intellectual deficiency is stable. There are no signs of worsening or progression of dementia.

3. May occur in a number of diseases relative regredience dementia. This is due to the fact that violations of the preconditions of intelligence and extra-intellectual processes are functional in nature, reversible, and when they disappear, the impression of a decrease in the degree of dementia is created. However, this regression does not apply to intellectual impairments themselves, which are a consequence of organic destructive damage to the brain.

Depending on the severity, the following types of dementia are distinguished:

1. Mild dementia– with this type of dementia, work and social activity are reduced, but the ability to live independently, self-care and relatively unimpaired judgment remains.

2. Moderate dementia– main criteria: independent living is difficult, some care and support is required.

3. Heavy– since daily activities and self-care are impaired, constant supervision is required. Most patients have grossly impaired speech and judgment.

D.N. Isaev distinguishes between total and partial dementia:

1. Total dementia deeply covers the entire psyche, including intellect and memory, with it there is a sharp decrease or absence of criticism, slowness of mental processes, a general decrease in the patient’s personality to the complete loss of individual characteristics. With this type of dementia there are diffuse lesions of the cerebral cortex.

2. Partial dementia characterized by uneven loss of intellectual functions, slowing down of intellectual processes, decreased intelligence, and the predominance of various memory impairments. The personality remains preserved to a certain extent, the disorder of criticism is less pronounced, professional skills are preserved, emotional instability, tearful helplessness, and easily arising confusion are observed. In this type of dementia, there is focal damage to the cerebral cortex.

Also in the literature there is a division of dementia into senile and presenile:

1. Senile dementia(senile dementia) is a mental disorder that accompanies brain degeneration and is most often found in old age (senile dementia, Alzheimer's disease). It begins with the manifestation of character traits that were previously unusual for the patient (for example, stinginess, cruelty), or the exaggeration of previously moderately expressed ones. Previous interests are lost, passivity and emotional impoverishment appear, memory disorders increase (Korsakoff's syndrome, impaired storage of information).

2. Presenile dementia– a mental disorder associated with early brain degeneration (Alzheimer’s disease, Pick’s disease, Huntington’s disease). Presenile dementia differs from senile dementia not only in that it manifests itself at an earlier age, but also in behavioral characteristics and changes in brain tissue.

An important exception to this classification is Alzheimer's disease, which is a typical and common disorder of aging that may begin at an earlier age in some people. Alzheimer's disease is associated with a characteristic dementia syndrome and is characterized by an insidious onset, usually proceeds slowly, but with progressive impairment.

1.4. Conclusions for Chapter 1.

1. Dementia is a partial destruction of the psyche caused by disease or damage to the brain that occurs after the age of three. The main symptom is a progressive deterioration of intellectual functions.

2. As a rule, dementia is not reversible.

3. The most common cause of dementia is degenerative diseases of the brain, primarily Alzheimer's disease, vascular diseases, hydrocephalus and intracranial tumors, HIV infection and AIDS.

4. Types of dementia: a) lacunar, globar and partial dementia (according to the structure and depth of damage to the intellect); b) progredient, stationary and relatively regredient (according to the nature of the flow); c) mild, moderate, severe (according to severity); d) total and partial; e) presenile and senile.

Chapter 2. CLINIC OF INTELLECTUAL IMPAIRMENTS IN VARIOUS TYPES OF DEMENTIA

2.1. Intellectual impairment in total dementia

With total dementia, gross violations of higher and differentiated intellectual functions come to the fore: comprehension, adequate handling of concepts, the ability to make correct judgments and inferences, generalization and classification. There is a slowdown in the pace of thinking. The purposefulness of thinking is preserved, but it is deprived of its former depth and breadth, the associative process becomes impoverished and becomes poorer. Thus, thinking becomes unproductive. Defects in intelligence and its prerequisites are relatively uniform, although there are gross violations of criticality (decreased or absent criticism), slowness of mental processes and pronounced changes in personal characteristics (sometimes to the complete loss of individual characteristics).

The following types of total dementia are distinguished:

1. Simple dementia– its structure is entirely represented by negative disorders in the sphere of intellectual and mnestic functions in combination with signs of personality regression of varying degrees of severity. The patient does not have a critical attitude towards these disorders.

2. Psychopathic-like dementia– in its structure, a significant place is occupied by pronounced personality changes, either in the form of an exaggerated sharpening of the patient’s premorbid personality traits, or in the form of the appearance of new abnormal (psychopathic) character traits developing in connection with the pathological process.

3. Hallucinatory-paranoid dementia– hallucinations and delusions are combined with the above-described signs of intellectual impairment, which are closely related to the characteristics of destructive brain damage, its location, structure and severity of negative symptoms.

4. Paralytic dementia– manifests itself in the rapid disappearance of criticism of one’s words and actions, in pronounced weakness of judgment, absurd and alien actions to the patient’s personality, and tactless statements. A severe intellectual defect is combined with euphoria, severe memory disorders and paralytic confabulations (false memories of absurd content - for example, the patient believes that he has a large number of orders and awards or untold wealth). The structure of paralytic dementia includes delusions and delusional statements with an overestimation of one’s own personality, often reaching the level of absurd delusions of grandeur. A typical feature of this dementia is severe exhaustion of mental activity.

5. Asemic dementia– combines signs of dementia and symptoms of focal loss of cortical activity (aphasia, agnosia, apraxia, alexia, agraphia, acalculia). With asemic dementia, fixation amnesia is observed, manifested in a sharp weakening or absence of the ability to remember current events. It should be noted that the severity of fixation amnesia gradually increases. In this regard, an increasing number of current events and facts begin to fall out of memory. Then the process begins to spread to the memory of the past, first capturing a close period, and then more and more distant periods of time.

2.2. Intellectual impairment in partial dementia

Partial dementia is characterized by uneven loss of intellectual functions, slowing of intellectual processes, decreased intelligence, and the predominance of various memory impairments. There is often a violation of critical thinking. The thinking of patients is not concrete, since it is not based on experience, and at the same time it is not abstract due to the lack of generalization. Thus, thinking in partial dementia, as well as in total dementia, is unproductive.

The following types of partial dementia are distinguished:

1. Epileptic dementia– a consequence of an unfavorably occurring epileptic disease. This type of dementia is characterized by a slowdown in mental processes, a decrease in the level of mental activity, pathological thoroughness of thinking, and amnestic aphasia. The main features of epileptic dementia are the viscosity of thinking (an extreme degree of detail in which detail distorts the main direction of thought to such an extent that it makes it practically incomprehensible), inertia, the inability to switch to something new, the inability to briefly formulate one’s ideas and the progressive impoverishment of speech. Speech becomes impoverished, stretched out, filled with verbal cliches, and diminutive words appear. The statements are shallow, poor in content and built on banal associations. The patients' reasoning is related to a specific situation, from which it is difficult for them to escape. The range of interests is narrowed to concerns about one’s own health and well-being.

2. Vascular (atherosclerotic) dementia– occurs with atherosclerotic brain damage. The core of personality remains relatively intact for a long time. The initial signs of vascular dementia are impaired memorization with intact criticism, as a result of which the patient tries to compensate for his defect with notes or memory knots. Emotional lability and explosiveness appear early. Vascular dementia usually progresses gradually, with each subsequent infarction of brain tissue. Neurological symptoms usually occur; intellectual impairments can be fragmentary with partial preservation of cognitive abilities. If dementia develops after a stroke, severe impairments in memory, comprehension, and speech (aphasia), as well as neurological symptoms, soon appear.

3. Traumatic dementia– a consequence of physical trauma to the brain (occurs in approximately 3-5% of patients who have suffered a traumatic brain injury). The clinical picture depends on the severity and location of the damage. With a frontobasal lesion, a clinical picture appears that resembles progressive paralysis. Damage to the anterior parts of the frontal lobes is manifested by apathy, aspontaneity, akinesia, decreased activity of thinking and speech, and behavioral disturbances. Damage to the temporal lobes can lead to disorders resembling those of epileptic dementia. The main feature of traumatic dementia can be called a gradually increasing intellectual decline, while due to memory impairment, old information is lost and new information is not received, and criticality towards one’s condition disappears.

4. Schizophrenic dementia– characterized by a dissociation between the inability to grasp the real meaning of everyday situations and a satisfactory state of abstract-logical thinking. Knowledge, skills and combinatorial capabilities cannot be used in life due to autistic isolation from reality, as well as due to aspontaneity and apathy. At the same time, gross memory impairments are not detected, acquired skills, knowledge and judgment remain intact. At the same time, uncritical thinking, a violation of evidence, intellectual unproductivity and personality regression are observed.

5. Psychogenic dementia (pseudo-dementia)- this is an individual’s reaction to a psychotraumatic situation that threatens its social status, manifested in the form of imaginary dementia with an imaginary loss of simple skills and an imaginary decrease in intellectual functions. With pseudodementia, the patient is characterized by absurd past responses and past actions in elementary situations (for example, when asking a teenager: “How old are you?”, we get the answer: “3 years old”). Despite the fact that patients cannot answer the simplest questions or answer them inappropriately, the answers are always in line with the question asked. In addition, patients can unexpectedly answer a difficult question. The behavior is so demonstrative and deliberate and does not lead to any benefit that there is no doubt about a mental disorder. Psychogenic dementia - “flight into illness” - is usually the reaction of a weak or hysterical personality when it is necessary to bear responsibility for one’s behavior (for example, in a situation of prosecution for an offense). Pseudodementia is a transient dementia, i.e. a disorder in which, unlike previous dementias, symptoms subsequently disappear. The duration of the state is from several days to several months; after exiting the state, intellectual and other functions are completely restored.

2.3. Intellectual impairment in presenile and senile dementia

Presenile dementias include diseases that manifest themselves mainly in presenile age and are characterized by a gradually emerging and occurring without stops or remissions (but also without exacerbations) debilitating process. ICD-10 classifies presenile dementias as dementia in Pick's disease, dementia in Huntington's disease, and dementia in early-onset Alzheimer's disease.

The morphological substrate of presenile dementia is a primary atrophic process. However, etiopathogenetically and morphologically, the diseases of this group differ significantly - for example, atrophy in early onset Alzheimer's disease is of a different nature than in Pick's disease.

The most common diseases in this group are dementias associated with Alzheimer's and Pick's disease, which present particular difficulties for differential diagnosis. Pick's disease is a relatively rare primary degenerative dementia, similar in clinical manifestations to Alzheimer's dementia. However, in Pick's disease there is more severe damage to the frontal lobes, and therefore symptoms of disinhibited behavior may appear early in the disease. In patients with this disorder, reactive gliosis is found in the frontal and temporal lobes of the brain. The diagnosis is confirmed by autopsy; Computed tomography and magnetic resonance imaging may also reveal a dominant lesion in the frontal lobe.

Senile dementias (senile dementia and Alzheimer's disease in older age) are mental disorders that accompany brain degeneration in old age.

When studying psychopathological manifestations in Pick's and Alzheimer's diseases, we are guided by the accepted division of diseases into three stages:

1. the initial stage is characterized by changes in intelligence, memory and attention, without pronounced gross focal symptoms;

2. the second stage is characterized by severe dementia and focal symptoms (aphasia, agnosia, apraxia);

3. The terminal stage is accompanied by deep mental decay, patients lead a purely vegetative existence.

Dementia of the Alzheimer's type, which occurs in both presenile and senile ages, is diagnosed when the patient experiences memory loss, aphasic, apractical, agnostic disorders or disorders of abstract thinking, which leads to a significant decrease in the previously available level of social and professional functioning. To establish a diagnosis of dementia of the Alzheimer's type in presenile age, it is necessary to exclude the cause of dementia by a brain disease (for example, cerebral atherosclerosis), extensive hematoma, hydrocephalus, or a systemic disorder (for example, deficiency of vitamin B 12 or folic acid).

2.3.1. Dementia in Huntington's disease

Huntington's disease is a genetically determined degenerative damage to the central nervous system. The disease was first described by the American neurologist George Huntington in 1872. The incidence rate is approximately 5 cases per 100 thousand people. If one parent has Huntington's disease, their children have a 50% risk of developing the disease. The disease usually begins between the ages of 30 and 50 years. However, there is also a so-called juvenile form with the onset of the disease before the age of 20 (5% of all cases). Noticeable behavioral disturbances often occur several years before the appearance of detectable neurological signs. The disease is characterized by chronic progressive chorea (involuntary and erratic sharp, twitching movements), as well as mental disorders. Dementia usually occurs in the later stages of the disease and is usually associated with psychotic symptoms. The personality is characterized by psychopathic-like disorders: excessive excitability, explosiveness, hysterical capriciousness. The clinical picture of the disease includes poorly systematized paranoid disorders (in particular, delusions of jealousy or expansive delusional syndromes with obsessions with greatness and omnipotence), as well as acute psychotic episodes with disordered psychomotor agitation. 90% of patients develop dementia, manifested in a general decrease in intellectual activity, memory impairment, acalculia, pathological distractibility, decreased ability to reason and abstraction, impoverished speech and disorientation. To a large extent, the intellectual impairments of patients depend on severe disorders of active attention. Memory impairments are pronounced - in particular, retention and memorization (when memorizing 10 words, patients reproduce no more than 3-4 of the same words). Violations of logical-semantic memory are detected early, expressed in the inability to reproduce simple stories. With the progression of the disease, the stage characterized by instability of attention and uneven intellectual performance is replaced by an increasing impoverishment of intellectual activity and the leveling of its manifestations. The course of the disease is usually slowly progressive, with a fatal outcome after 15-25 years.

2.3.2. Dementia in Pick's disease

Pick's disease is a progressive neurodegenerative disease of the brain, usually beginning in presenile age with gradually increasing personality changes and impoverishment of speech. This disease was first described by Arnold Pick in 1892. Pick's disease is less common than early-onset Alzheimer's disease. The disease is accompanied by an early loss of criticism and social maladjustment and relatively quickly leads to the development of total dementia. In Pick's disease, there is atrophy of the frontal and temporal lobes of the cerebral cortex, the cause of which is unknown. The disease usually begins at the age of 45-50 years. The prevalence of Pick's disease in our country is 0.1%. Women are more susceptible to the disease than men, with an approximate incidence ratio of 1.7:1.

The disease begins slowly and gradually, usually with personality changes. At the same time, difficulties in thinking, minor memory defects, easy fatigue and often characteristic changes in the form of weakening of social inhibition are observed.

Personality changes at the initial stage depend on the predominant localization of the atrophic process. When the frontal lobes are damaged, inactivity, lethargy, apathy and indifference gradually increase, impulses decrease until they disappear completely, emotions become dulled, and at the same time the impoverishment of mental, speech and motor activity progresses.

With atrophy in the basal cortex, pseudoparalytic syndrome develops. In these cases, personal changes are expressed in the gradual loss of a sense of distance, tact, and moral principles; disinhibition of lower drives, euphoria and impulsiveness appear. At first, patients become extremely absent-minded, sloppy, untidy, stop coping with their usual work, lose tact, and become rude. Subsequently, they develop pronounced lethargy, indifference, and inactivity. So-called standing turns appear in speech - patients give the same answer to a variety of questions. For example, to the doctor’s question: “What is your name?” - the patient answers correctly: “Ivan Ivanovich.” Further, to all other questions the answer will be identical (“How old are you?” - “Ivan Ivanovich”; “Where do you live?” - “Ivan Ivanovich”). As part of the pseudoparalytic syndrome in Pick's disease, gross disturbances in conceptual thinking (generalization, understanding of proverbs) usually occur early, but no clear disturbances in memory or orientation are detected.

With atrophy of the temporal lobes or combined frontotemporal atrophy, stereotypies of speech, actions and movements appear early. In this case of the disease, memory impairment is also not typical for patients in the early stages. However, the most complex and differentiated types of mental activity are steadily declining and being destroyed - abstraction, generalization and interpretation, flexibility and productivity of thinking, criticism and the level of judgment.

As atrophy progresses, mental disorders worsen, and the clinical picture of Pick's disease increasingly approaches senile dementia with memory destruction and disorientation. The second stage of Pick's disease is characterized by a typical picture of steadily and monotonously progressing dementia, affecting the intellect "from top to bottom", starting with its most complex manifestations and ending with the most simple, elementary, automated ones involving the prerequisites of intelligence. There is a dissociation of all higher intellectual functions, their coordination is impaired. Against the background of deep global dementia, the characteristic dynamics of speech disorders are revealed.

The nature of speech pathology is largely determined by the primary localization of the atrophic process. In the frontal variant of Pick's disease, a decrease in speech activity comes to the fore, up to complete aspontaneity of speech. The vocabulary is steadily depleting, and the construction of phrases is becoming easier. Speech gradually loses its communicative meaning. In the temporal variant of Pick's disease, the stereotype for the development of speech disorders resembles a similar stereotype in Alzheimer's disease, but with some differences. There is a simplification of the semantic and grammatical design of speech and the appearance of speech stereotypies (standing figures of speech).

Stereotypes in speech and behavior characteristic of Pick's disease undergo certain dynamics. At first, standing turns of speech are used with unchanged intonations in the story (a symptom of a gramophone record), then they are increasingly simplified, reduced and reduced to a stereotypically repeated phrase, a few words, and become increasingly meaningless. Sometimes the words in them are so distorted that their original meaning cannot be determined.

The third stage of Pick's disease is characterized by profound dementia; patients lead a so-called vegetative lifestyle. Outwardly, mental functions come to a complete disintegration, contact with the patient is completely impossible.

Pick's disease is usually fatal within 2 to 7 years.

2.3.3. Dementia due to Alzheimer's disease

Alzheimer's dementia is named after Alois Alzheimer, the German neuropsychologist who first described the disease in 1907. Alzheimer's disease is a primary degenerative dementia, accompanied by a steady progression of impairments in memory, intellectual activity and higher cortical functions and leading to total dementia. In most cases (from 75 to 85%), this pathology begins at the age of 45-65 years, but earlier (before 40 years) and later (over 65 years) onset of the disease is possible. The average duration of the disease is 8-10 years.

Diagnosing Alzheimer's disease is often difficult and uncertain. The main reason for these difficulties is the inability to establish with complete certainty the presence of neuropathology characteristic of this disease in living patients. The diagnosis is usually made only after all other causes of dementia have been ruled out through medical and family history, various examinations and laboratory tests. Brain imaging techniques may provide additional evidence of pathology if enlarged ventricles or widened cortical folds are detected, indicating brain atrophy. Unfortunately, several other pathological conditions, as well as normal aging, are characterized by a similar type of atrophy, which currently makes it impossible to make a definitive diagnosis of Alzheimer's disease without an autopsy.

In older people, Alzheimer's disease usually begins gradually, with a slow breakdown of personality. In some cases, the trigger may be physical illness or other stressful events, but usually a person slips into dementia almost unnoticed, so it is impossible to accurately determine the onset of the disease. The clinical picture can vary greatly between individuals depending on the nature and extent of brain degeneration, the patient's premorbid personality, the presence of stressors, and the support provided by others.

During the course of the disease, three stages are distinguished: the initial stage, the stage of moderate dementia and the stage of severe dementia.

At the initial stage of the disease, the first sign of the disease is often the person’s gradual withdrawal from active participation in life. There is a narrowing of social activity and interests, a decrease in intelligence and mental adaptability, tolerance to new ideas and everyday problems. At this stage, initial signs of mnestic-intellectual decline are revealed, which manifest themselves in frequently repeated forgetfulness, incomplete reproduction of events, and slight difficulties in determining temporary relationships. At the same time, the adequacy of everyday functioning is completely preserved. At the beginning of this stage, patients, as a rule, manage to hide or compensate for their existing disorders. Subsequently, the phenomena of fixation amnesia and disorientation in time and place begin to increase. Difficulties arise in mental operations, especially in abstract thinking, the possibilities of generalization and comparison. Violations of higher cortical functions - speech, praxis, optical-spatial activity - appear and progressively intensify. There are also clear personality changes in the form of increased excitability, conflict, hyper-touchiness, and pronounced egocentrism. As a result of this, the patient's thinking and activity often revolve around himself and acquire a childish character.

At the initial stage of Alzheimer's disease, patients critically assess their condition and try to correct their own growing incompetence.

At the stage of moderate dementia, the clinical picture of the disease is dominated by signs of a syndrome of disorders of higher cortical functions caused by damage to the temporo-parietal parts of the brain (symptoms of amnesia, apraxia and agnosia appear). Memory impairments become more pronounced, which manifest themselves in the inability to acquire new knowledge and remember current events, as well as the inability to reproduce past knowledge and accumulated experience. Disorientation in place and time progresses. The functions of the intellect are especially grossly violated - there is a pronounced decrease in the level of judgment, difficulties in analytical and synthetic activity, disturbances in speech, praxis, gnosis and optical-spatial activity.

The listed disorders at the stage of moderate dementia do not allow patients to independently cope with any professional responsibilities. Due to their status, they can only perform simple work at home, their interests are extremely limited, and they require constant support even in such types of self-care as dressing and personal hygiene.

However, at this stage of Alzheimer's disease, patients, as a rule, retain basic personality characteristics, a sense of personal inferiority, and an adequate emotional response to the disease for a long time.

The stage of severe dementia is characterized by extremely severe memory loss. Patients retain only very meager fragments of memory reserves, the severity of orientation is limited to fragmentary ideas about their own personality. Thus, there is incomplete orientation even in one’s own personality. Judgment and mental operations become essentially inaccessible to patients. They need constant help even with basic self-care.

At the final stage of severe dementia, a total collapse of the patient’s memory, intellect and all mental activity occurs. In this case, agnosia reaches an extreme degree - patients cease not only to recognize others or determine any objective spatial relationships, but also to distinguish the direction from which speech addressed to them is heard. In addition, they cannot fix their gaze on objects even with persistent encouragement from the outside, and they do not recognize their image in the mirror.

Apraxia also reaches a maximum. In this case, patients are unable to perform any complete, purposeful movements; they cannot walk, climb or descend stairs, or sit down. Usually they stand in some awkward unnatural position, jostle around, sit sideways, sometimes next to the chair, and often hover over the chair, not knowing how to sit.

The breakdown of speech is accompanied by the formation of total sensory aphasia with loss of the ability to form words and with the loss of various speech automatisms. Sometimes there is forced speech, consisting of monotonous and monotonous repetitions of individual words or sounds.

At this final stage of the disease, the collapse of all cortical functions reaches a total degree. Such severe destruction of mental activity is rarely found in other atrophic processes or organic lesions of the brain.

The typical patient with Alzheimer's disease is an elderly person. Most patients are indeed elderly, but Alzheimer's disease, which is presenile dementia, sometimes begins at the age of 40-50 years. In such cases, the disease and associated dementia progress very quickly. The tragedy of Alzheimer's disease is especially illustrated by cases of early onset of the disease in relatively young and energetic patients.

Many people with Alzheimer's disease, with appropriate treatment, which includes medication and maintaining a calm, reassuring, and non-provocative social environment, show symptoms of improvement. However, destruction over a period of months or years leads to death. Patients forget their relatives, find themselves bedridden and lead a vegetative existence. Resistance to disease is reduced, and death usually occurs due to pneumonia or similar respiratory or cardiac diseases.

2.4. Conclusions for Chapter 2.

1. Total dementia is characterized by gross violations of higher and differentiated intellectual functions: comprehension, adequate handling of concepts, the ability to make correct judgments and inferences, generalization and classification; thinking becomes unproductive. Defects in intelligence and its prerequisites are uniform, there are gross violations of criticality (decrease or absence of criticism), slowness of mental processes and pronounced changes in personal properties.

2. Partial dementia is characterized by uneven loss of intellectual functions, slowing of intellectual processes, decreased intelligence, and the predominance of various memory impairments. Thinking is unproductive, criticality is often impaired.

3. Dementia in Huntington's disease is characterized by chronic progressive chorea (involuntary and erratic sharp, jerking movements), as well as mental disorders. In 90% of cases, there is a general decrease in intellectual activity, memory deterioration (impaired retention and memorization), pathological distractibility, decreased ability to reason and abstraction, impoverished speech and disorientation. Violations of logical-semantic memory are detected early. Gradually increasing impoverishment of intellectual activity and leveling of its manifestations. Fatal outcome in 15-25 years.

4. Dementia in Pick's disease is characterized by gradually increasing personality changes and impoverishment of speech, early onset loss of criticism and social maladjustment, and relatively quickly turns into total dementia. Initially, difficulties in thinking, minor memory defects, easy fatigue and often characteristic changes in the form of weakening of social inhibition are observed. Characteristic standing turns of speech are first used with unchanged intonations in the story (a symptom of a gramophone record), then they are increasingly simplified, reduced and reduced to a stereotypically repeated phrase. Fatal outcome in 2-7 years.

5. Dementia in Alzheimer's disease is characterized by a steady progression of impairments in memory, intellectual activity and higher cortical functions and leads to total dementia. At the beginning, there is a narrowing of social activity and interests, a decrease in intelligence and mental adaptability, tolerance to new ideas and everyday problems, frequent forgetfulness, incomplete reproduction of events, and slight difficulties in determining temporary relationships. At the final stage, a total collapse of memory, intellect and all mental activity occurs. Fatal outcome after 8-10 years.

Chapter 3. PROVIDING HELP FOR DEMENTIA

3.1. Dementia in the early stages

Before talking about possible options for providing assistance to people suffering from dementia, it is worth mentioning the original origins of the disease . There is a serious problem of underdiagnosis of dementia only in its initial stages, but this is the most important period in the development of the disease, since at this stage the therapeutic possibilities are greatest. The later the diagnosis is made and adequate treatment is started, the less amenable to correction are the manifestations of this disease.

Dementia is, in most cases, a long process that begins many months before it becomes apparent to the patients’ relatives and friends. The first signs of approaching dementia may include weakening interest in the environment, decreased initiative, social, physical and intellectual activity, increased dependence on others, and the desire to shift responsibility for making decisions related to financial matters or housekeeping to a spouse and other close people. Patients experience increased drowsiness during the day and evening, interest and activity decrease during conversations, and the thread of the conversation often slips away due to weakening of attention. Often there is a depressed mood, increased anxiety, a tendency towards self-isolation, and the circle of friends is sharply limited. Many of these changes have long been considered by those around the patient as manifestations of aging. In order not to miss developing dementia, it is necessary to conduct extensive screening neuropsychological examinations in elderly patients who contact neurologists, therapists, and general practitioners regarding certain complaints.

After the diagnosis has been established, it will be possible to try to implement the treatment itself.

Treatment of patients with dementia can be divided into three groups of measures: elimination or compensation of the cause of dementia; pathogenetic therapy with modern drugs; individual symptomatic therapy.

Chapter 3.2. Eliminating or compensating for the cause of dementia

Elimination or compensation of the cause of dementia is an attempt to eliminate or regress “reversible” dementia. With potentially reversible dementia, it is possible to achieve complete or partial regression of cognitive impairment, curing the disease or achieving its compensation.

Although reversible dementias are rare, they should be excluded first in patients with increasing cognitive impairment. A thorough physical examination (it is important to pay attention to possible signs of liver, kidney, lung, heart or thyroid disease) can help diagnose reversible dementia. Generally, the faster the dementia progresses and the younger the patient's age, the higher the likelihood that it may be reversible dementia and the more aggressive the testing should be.

Chapter 3.3. Pathogenetic therapy with modern drugs

Pathogenetic therapy - Advances achieved in the 80–90s of the 20th century in the study of the neurochemistry of cognitive disorders led to the development of effective methods of pathogenetic therapy for the main forms of dementia. The most promising direction of therapy is currently considered to be the use of drugs - acetylcholinesterase inhibitors, such as, for example , galantamine (reminyl), and NMDA glutamate receptor modulators (akatinol memantine). These drugs are widely used all over the world, and in recent years they have become available in Russia. Regular use of these medications helps improve memory and attention, increases the activity and independence of patients, regulates their behavior, improves self-care skills, and slows down the progression of memory impairment. The drugs are usually well tolerated and can be used as primary treatment or in combination with other drugs.

It is important to emphasize that, like other medications, these drugs have a positive effect only when prescribed by a doctor with the correct indications for use. Therefore, before you start taking them, you need to consult a neurologist. Self-medication can be harmful to health, while properly selected therapy can significantly reduce the severity of disturbing symptoms and stop the progression of forgetfulness.

Chapter 3.4. Individual symptomatic therapy

Individual symptomatic therapy includes, first of all, the correction of affective, behavioral, autonomic disorders, sleep disorders, which can affect the state of adaptation of patients almost to a greater extent than the intellectual decline itself.

It is also necessary to emphasize the importance of the role of those around the patient. The socio-economic and emotional burden of dementia falls not only on the patients themselves, but also on their relatives, immediate and more distant surroundings, and therefore on society as a whole. The fact is that with dementia, the patient exhibits disorders that make him not completely independent when performing ordinary types of daily household activities. The first to suffer are professional skills, the ability to independently communicate productively with other people, make financial transactions, use modern household appliances, drive a car or navigate the city. Everyday difficulties in self-care develop at the stage of moderate and severe dementia, when diagnosing this condition no longer poses significant difficulties.

In the family of patients with developing dementia, conflict situations may often arise due to the relatives’ lack of understanding of the problems of the sick person. In particular, the aggressive behavior of patients is a defensive reaction and is due to the fact that they do not understand and cannot explain their condition to their loved ones. Unfortunately, it is not so rare that the patient’s relatives, not understanding the essence of the disease, begin to blame the patient for his forgetfulness, allow themselves unacceptable jokes, or try to “teach” him lost skills again. The natural result of such activities is irritation of the patient and inevitable family conflicts. Therefore, after diagnosing a patient with dementia and prescribing adequate treatment, the doctor must carry out explanatory work with him and his relatives.

3.5. Chapter 3 Conclusion

It is important to inform the patient’s family about the nature of the disease and prognosis, timely registration of the disability group, creating a comfortable, safe, maximally simplified environment around the patient, maintaining a clear daily routine, monitoring nutrition and taking medications, performing hygiene measures, maintaining social connections patient, recognition and adequate treatment of all concomitant somatic diseases, maximum limitation of taking drugs that can worsen cognitive functions, including psychotropic drugs (especially benzodiazepines, barbiturates, neuroleptics), drugs with anticholinergic activity, etc., timely treatment of decompensations that can be associated with intercurrent infection, worsening somatic diseases, and drug overdose.

The efforts spent by the patient and his relatives on understanding the problem, correct diagnosis and selection of adequate treatment will not be in vain: all this will lead to improved functional adaptation of the patient and an increase in the quality of life not only of the patient himself, but also of his loved ones.

CONCLUSION

There is no doubt that dementia is not a common disease. According to epidemiological data from the World Health Organization, about 1% of people aged 14 to 65 years, about 8% of people over 65 years old suffer from manifestations of acquired dementia. However, the Russian Ministry of Health gives the following figures: 2% of people aged 14 to 65 years, about 10% of people over 65 years old. Moreover, there is a steady increase in the incidence rate from 1993 to 2003: by 0.3% in the first age group and by 2% in the second. We can conclude that if this trend continues, dementia may become a common disease in Russia in the near future.

Knowledge of the etiology and main symptoms of this disease is certainly necessary for special psychologists, speech pathologists, psychiatrists, medical psychologists, i.e. people professionally dealing with intellectual disabilities. Identifying dementia in the early stages allows you to slow down the development of dementia, delay the deterioration of intellectual functions and the loss of personality traits. In some cases, timely diagnosis and treatment can extend a person’s relatively acceptable state of mind for many years.

It is important for teachers, social workers and psychologists to promptly refer students to clinical specialists if they suspect dementia and to be able to distinguish it from other types of intellectual disabilities. The latter is necessary for all workers in the psychological and pedagogical sphere.

However, for people whose professional activities are in no way related to mental disorders, knowledge of the symptoms of dementia and its possible causes will not be superfluous - none of us and our relatives are immune from the development of such a disease and, therefore, every person should be ready to provide help and psychological support if the disease occurs in any of them.

LIST OF REFERENCES USED:

1. Bleikher V.M., Kruk I.V., Bokov S.N. Clinical pathopsychology: a guide for doctors and clinical psychologists - M., 2002.

2. Bukhanovsky A.O., Kutyavin Yu.A., Litvak M.E. General psychopathology: a manual for doctors - Rostov-on-Don, 2000.

3. Zeigarnik B.V. Pathopsychology - M., 1986.

4. Isaev D.N. Psychopathology of childhood: a textbook for universities - St. Petersburg, 2001.

5. Carson R., Butcher J., Mineka S. Abnormal psychology (11th edition) - St. Petersburg, 2004.

6. Clinical psychiatry: a guide for doctors and students (translation from English, revised, additional) / Ch. ed. T.B. Dmitrieva - M., 1999.

7. Clinical psychology: textbook / Ed. B.D. Karvasarsky - St. Petersburg, 2004.

8. Marilov V.V. Private psychopathology: a textbook for students of higher educational institutions - M., 2004.

9. Mendelevich V.D. Clinical and medical psychology: a practical guide - M., 2001.

10. Myagkov I.F., Bokov S.N., Chaeva S.I. Medical psychology: propaedeutic course (second ed., revised and supplemented) - M., 2003.

11.Marilov V.V. General psychopathology: a textbook for students of higher educational institutions - M., 2002.

Senile dementia is a common disease.

It is characterized by the collapse of personality and leads to complete maladjustment of the patient.

Changes in the brain are organic in nature and therefore irreversible. Doctors have adopted various classifications of the disease.

Dementia is an organic lesion of the brain (organic dementia), leading to the loss of all previously acquired skills, knowledge, abilities and the inability to acquire new ones.

According to ICD 10, the disease is coded F00-F03.

The classification of pathology is based on the following characteristics:

• cause of occurrence;
• localization of the lesion;
• nature of manifestations.

Functional and anatomical forms

Depending on which part of the brain the changes occur, there are several types of dementia. Dementia is divided into:

According to the degree of intellectual impairment, the following types of senile insanity are distinguished:

1. Lacunar dementia. Changes occur in memory and attention. A patient with lacunar dementia often gets tired and cannot concentrate on anything. But criticism of one’s actions remains.

   The disease is a consequence of atherosclerosis (atherosclerotic dementia), cerebellar tumors, and the initial stage of Alzheimer's disease.

2. Partial dementia. Shallow changes occur due to contusion, encephalitis, meningitis. A person is aware of his condition and tries to compensate for shortcomings.
3. Total dementia (diffuse, global). Total dementia develops in the late stages of Alzheimer's disease, Pick's disease, and brain tumors.

The patient experiences a complete breakdown of personality, loss of all skills, and lacks a critical attitude towards himself.

Etiopathogenetic varieties

Dementia occurs for many reasons. Depending on the condition that caused the collapse of the personality, dementia is divided into the following types:

1. Vascular. (F01). It develops secondarily as a complication of cerebrovascular accident. The main provoking factors are atherosclerosis and hypertension, which cause minor cerebral hemorrhage.

   The first symptoms are nervous and mental disorders (depression), then memory and thinking deteriorate.



2. Alzheimer's type dementia. (G30-39). With this disease, the death of brain neurons occurs, and the cerebral cortex atrophies.

   The first sign of the disease is memory impairment. As it progresses, complete maladjustment of the patient develops.

3. Idiopathic dementia (dementia of an unspecified type). (G30.9). The causes have not been established. The symptoms are no different from the Alzheimer's type: memory impairment, movement, loss of all cognitive functions.
4. Presenile dementia. It is a variant of Alzheimer's dementia. Develops in the 5th year of illness. The main symptom is speech impairment. The patient confuses the names of objects, his speech is meaningless.
5. Pick's disease. (G31.0). With this disease, the frontotemporal cerebral lobes, which are responsible for human behavior and self-control, atrophy. At the initial stage, memory remains unchanged, but behavioral skills are lost, speech and thinking are impaired.
6. Consequence of Parkinson's disease. (G20). Characterized by impaired movement and loss of coordination. In later stages, the ability to walk and perform simple physical activities is lost.
7. . Occurs due to the destructive effects of large doses of alcohol. Violations occur in the departments responsible for memory, thinking, perception, and coordination of movement. At a later stage, the personality completely degrades.
8. Traumatic dementia. Development depends on repeated trauma. With a single injury it does not progress.

   Another type of traumatic dementia is boxer's dementia. It occurs as a result of repeated traumatic brain injuries, leading to atrophy of brain cells.
   

   Symptoms depend on the location of the lesion. Speech disturbances, decreased intelligence, and mental disorders are observed.

9. Toxic (drug-induced) dementia. Occurs due to long-term use of medications in large doses. Drugs such as blood pressure lowerers, antidepressants, antipsychotics, and heart medications can provoke disorders in the brain. This species has a reversible course.
10. (a consequence of epilepsy). However, the cause is not the disease itself, but injuries from falls, brain hypoxia, and treatment with phenobarbital. The emotional-volitional sphere is affected. The patient becomes aggressive, vindictive, perception and thinking are disrupted.



11. Dementia resulting from multiple sclerosis. In multiple sclerosis, the myelin sheath of the nerves is destroyed.

    If the disease is not treated, at a later stage the changes will affect the brain. Memory, thinking, and self-criticism suffer.

12. Dementia due to mixed diseases. It is a consequence of a combination of diseases that provoke the destruction of neurons.

    For example, a patient may have epilepsy and schizophrenia, Alzheimer's disease and multiple sclerosis. In this case, all the signs inherent in existing diseases are present.

13. . Develops against the background of schizophrenia. Characterized by a psychopathic course. Depression and manic pursuit begin, then orientation in space and coordination of movement are lost.

    The peculiarity of this type is that the symptoms can weaken, sometimes disappear completely, then return with renewed vigor.

14. Hypothermic. Some doctors classify this type of dementia as a separate group. It is considered a consequence of metabolic disorders in the blood vessels of the brain that occur under the influence of high or low temperatures (prolonged exposure to frost).
15. Senile(). It is the result of natural aging of the body. The death of neurons occurs due to hormonal imbalance, and the volume and weight of the brain decreases. Diagnosed at a late age.

Other types of disease and their brief characteristics

In medicine, there are types of dementia that are not so widespread. According to the ICD, this type of disease is designated by code F02.8.

Each type of senile insanity is characterized by its own cognitive impairment. Only in some cases is there a combination of multiple symptoms. The doctor's task is to determine the source of progressive dementia.

Therapy is prescribed in accordance with the disease that provoked the process of degradation of brain cells. The classification of the disease is adopted to identify the root cause of the pathology and prescribe adequate treatment.

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

General information

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

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

Causes of dementia

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

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

Classification of dementia

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

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

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

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

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

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

Symptoms of dementia

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

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

Clinical variants of dementia

Alzheimer's type dementia

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

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

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

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

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

Vascular dementia

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

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

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

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

Alcoholic dementia

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

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

Diagnosis of dementia

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

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

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

Prognosis for dementia

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

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

• Are dementia and dementia the same thing? How does dementia occur in children? What is the difference between childhood dementia and mental retardation?
• Is unexpected untidiness the first sign of senile dementia? Are symptoms such as untidiness and sloppiness always present?
• What is mixed dementia? Does it always lead to disability? How to treat mixed dementia?
• Among my relatives there were patients with senile dementia. How likely am I to develop a mental disorder? What is the prevention of senile dementia? Are there any medications that can prevent the disease?

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What is dementia syndrome?

Dementia is a severe disorder of higher nervous activity caused by organic damage to the brain, and is manifested, first of all, by a sharp decrease in mental abilities (hence the name - dementia translated from Latin means feeble-mindedness).

The clinical picture of dementia depends on the cause that caused organic brain damage, on the localization and extent of the defect, as well as on the initial state of the body.

However, all cases of dementia are characterized by pronounced stable disorders of higher intellectual activity (memory deterioration, decreased ability to abstract thinking, creativity and learning), as well as more or less pronounced disturbances of the emotional-volitional sphere, from the accentuation of character traits (the so-called “caricature”) until the complete collapse of personality.

Causes and types of dementia

Since the morphological basis of dementia is severe organic damage to the central nervous system, the cause of this pathology can be any disease that can cause degeneration and death of cells in the cerebral cortex.

First of all, it is necessary to highlight specific types of dementia in which destruction of the cerebral cortex is an independent and leading pathogenetic mechanism of the disease:

• Alzheimer's disease;
• dementia with Lewy bodies;
• Pick's disease, etc.

In other cases, damage to the central nervous system is secondary, and is a complication of the underlying disease (chronic vascular pathology, infection, trauma, intoxication, systemic damage to nervous tissue, etc.).

The most common cause of secondary organic brain damage is vascular disorders, in particular cerebral atherosclerosis and hypertension.

Common causes of dementia also include alcoholism, tumors of the central nervous system, and traumatic brain injury.

Less commonly, dementia is caused by infections - AIDS, viral encephalitis, neurosyphilis, chronic meningitis, etc.

In addition, dementia can develop:

• as a complication of hemodialysis;
• as a complication of severe renal and liver failure;
• for some endocrine pathologies (thyroid disease, Cushing's syndrome, pathology of the parathyroid glands);
• for severe autoimmune diseases (systemic lupus erythematosus, multiple sclerosis).

In some cases, dementia develops as a result of multiple causes. A classic example of such a pathology is senile (senile) mixed dementia.

Functional and anatomical types of dementia

Depending on the predominant localization of the organic defect, which has become the morphological substrate of the pathology, four types of dementia are distinguished:
1. Cortical dementia is a predominant lesion of the cerebral cortex. This type is most typical for Alzheimer's disease, alcoholic dementia, and Pick's disease.
2. Subcortical dementia. With this type of pathology, the subcortical structures are primarily affected, which causes neurological symptoms. A typical example is Parkinson's disease with predominant damage to the neurons of the substantia nigra of the midbrain, and specific motor disorders: tremor, general muscle stiffness ("doll gait", mask-like face, etc.).
3. Cortical-subcortical dementia is a mixed type of lesion, characteristic of pathology caused by vascular disorders.
4. Multifocal dementia is a pathology characterized by multiple lesions in all parts of the central nervous system. Steadily progressing dementia is accompanied by severe and varied neurological symptoms.

Forms of dementia

Clinically, lacunar and total forms of dementia are distinguished.

Lacunarnaya

Lacunar dementia is characterized by peculiar isolated lesions of the structures responsible for intellectual activity. In this case, as a rule, short-term memory suffers the most, so patients are forced to constantly take notes on paper. Based on its most pronounced symptom, this form of dementia is often called dysmnestic dementia (dysmenia literally means memory impairment).

However, a critical attitude towards one’s condition remains, and the emotional-volitional sphere suffers slightly (most often only asthenic symptoms are expressed - emotional lability, tearfulness, increased sensitivity).

A typical example of lacunar dementia is the initial stages of the most common form of dementia, Alzheimer's disease.

Total

Total dementia is characterized by complete disintegration of the core of personality. In addition to pronounced violations of the intellectual-cognitive sphere, gross changes in emotional-volitional activity are observed - a complete devaluation of all spiritual values ​​occurs, as a result of which vital interests become impoverished, the sense of duty and modesty disappears, and complete social disadaptation occurs.

The morphological substrate of total dementia is damage to the frontal lobes of the cerebral cortex, which often occurs with vascular disorders, atrophic (Pick's disease) and volumetric processes of the corresponding localization (tumors, hematomas, abscesses).

Basic classification of presenile and senile dementias

The likelihood of developing dementia increases with age. So if in adulthood the proportion of patients with dementia is less than 1%, then in the age group after 80 years it reaches 20%. Therefore, the classification of dementias that occur in late life is especially important.

There are three types of dementia that are most common in presenile and senile (presenile and senile) ages:
1. Alzheimer's (atrophic) type of dementia, which is based on primary degenerative processes in nerve cells.
2. Vascular type of dementia, in which degeneration of the central nervous system develops secondarily, as a result of severe circulatory disorders in the vessels of the brain.
3. Mixed type, which is characterized by both mechanisms of disease development.

Clinical course and prognosis

The clinical course and prognosis of dementia depend on the cause that caused the organic defect of the central nervous system.

In cases where the underlying pathology is not prone to development (for example, with post-traumatic dementia), with adequate treatment, significant improvement is possible due to the development of compensatory reactions (other areas of the cerebral cortex take on part of the functions of the affected area).

However, the most common types of dementia - Alzheimer's disease and vascular dementia - have a tendency to progress, therefore, when they talk about treatment, for these diseases we are only talking about slowing down the process, social and personal adaptation of the patient, prolonging his life, relieving unpleasant symptoms, etc. .p.

And finally, in cases where the disease that causes dementia progresses rapidly, the prognosis is extremely unfavorable: the patient’s death occurs several years or even months after the first signs of the disease appear. The cause of death, as a rule, is various concomitant diseases (pneumonia, sepsis), developing against the background of disturbances in the central regulation of all organs and systems of the body.

Dementia severity (stages)

In accordance with the patient’s social adaptation capabilities, three degrees of dementia are distinguished. In cases where the disease that causes dementia has a steadily progressive course, we often speak of the stage of dementia.

Mild degree

With mild dementia, despite significant impairments in the intellectual sphere, the patient remains critical of his own condition. So the patient can easily live independently, performing familiar household activities (cleaning, cooking, etc.).

Moderate degree

With moderate dementia, there are more severe intellectual impairments and a reduced critical perception of the disease. At the same time, patients experience difficulties in using ordinary household appliances (stove, washing machine, TV), as well as telephones, door locks and latches, so in no case should the patient be completely left to his own devices.

Severe dementia

In severe dementia, a complete breakdown of the personality occurs. Such patients often cannot eat on their own, observe basic hygiene rules, etc.

Therefore, in the case of severe dementia, hourly monitoring of the patient is necessary (at home or in a specialized institution).

Diagnostics

To date, clear criteria for diagnosing dementia have been developed:
1. Signs of memory impairment – ​​both long-term and short-term (subjective data from a survey of the patient and his relatives are supplemented by an objective study).
2. The presence of at least one of the following disorders characteristic of organic dementia:

• signs of decreased ability for abstract thinking (according to objective research);
• symptoms of decreased criticality of perception (discovered when making real plans for the next period of life in relation to oneself and others);
• triple A syndrome:
  • aphasia – various types of disorders of already formed speech;
  • apraxia (literally “inactivity”) – difficulties in performing purposeful actions while maintaining the ability to move;
  • Agnosia – various disturbances of perception while maintaining consciousness and sensitivity. For example, the patient hears sounds, but does not understand the speech addressed to him (auditory-verbal agnosia), or ignores a part of the body (does not wash or put on one foot - somatoagnosia), or does not recognize certain objects or faces of people with intact vision (visual agnosia). etc.;
• personal changes (rudeness, irritability, disappearance of shame, sense of duty, unmotivated attacks of aggression, etc.).

3. Violation of social interactions in the family and at work.
4. Absence of manifestations of delirious changes in consciousness at the time of diagnosis (no signs of hallucinations, the patient is oriented in time, space and his own personality, as far as his condition allows).
5. A certain organic defect (results of special studies in the patient’s medical history).

It should be noted that in order to make a reliable diagnosis of dementia, it is necessary that all of the above symptoms be observed for at least 6 months. Otherwise, we can only talk about a presumptive diagnosis.

Differential diagnosis of organic dementia

Differential diagnosis of organic dementia must be carried out, first of all, with depressive pseudodementia. With deep depression, the severity of mental disorders can reach a very high degree and make it difficult for the patient to adapt to everyday life, simulating the social manifestations of organic dementia.

Pseudodementia often also develops after severe psychological shock. Some psychologists explain this kind of sharp decline in all cognitive functions (memory, attention, ability to perceive and meaningfully analyze information, speech, etc.) as a defensive reaction to stress.

Another type of pseudodementia is weakening of mental abilities due to metabolic disorders (vitaminosis B12, lack of thiamine, folic acid, pellagra). With timely correction of disorders, signs of dementia are completely eliminated.

Differential diagnosis of organic dementia and functional pseudodementia is quite complex. According to international researchers, about 5% of dementias are completely reversible. Therefore, the only guarantee of a correct diagnosis is long-term observation of the patient.

Alzheimer's type dementia

Concept of dementia in Alzheimer's disease

Dementia of the Alzheimer's type (Alzheimer's disease) received its name from the name of the doctor who first described the pathology clinic in a 56-year-old woman. The doctor was alerted by the early manifestation of signs of senile dementia. A post-mortem examination showed peculiar degenerative changes in the cells of the patient’s cerebral cortex.

Subsequently, this kind of violation was discovered in cases where the disease manifested itself much later. This was a revolution in views on the nature of senile dementia - previously it was believed that senile dementia was a consequence of atherosclerotic damage to the blood vessels of the brain.

Dementia of the Alzheimer's type is the most common type of senile dementia today, and, according to various sources, accounts for 35 to 60% of all cases of organic dementia.

Risk factors for developing the disease

There are the following risk factors for developing dementia of the Alzheimer's type (arranged in descending order of importance):

• age (the most dangerous limit is 80 years);
• the presence of relatives suffering from Alzheimer's disease (the risk increases many times if the relatives develop the pathology before the age of 65);
• hypertension;
• atherosclerosis;
• increased levels of lipids in blood plasma;
• obesity;
• sedentary lifestyle;
• diseases occurring with chronic hypoxia (respiratory failure, severe anemia, etc.);
• traumatic brain injuries;
• low level of education;
• lack of active intellectual activity throughout life;
• female

First signs

It should be noted that degenerative processes in Alzheimer's disease begin years and even decades before the first clinical manifestations. The first signs of Alzheimer's type dementia are very characteristic: patients begin to notice a sharp decline in memory for recent events. At the same time, a critical perception of their condition persists for a long time, so that patients often feel understandable anxiety and confusion, and consult a doctor.

Memory impairment in dementia of the Alzheimer's type is characterized by the so-called Ribot's law: first short-term memory is impaired, then recent events are gradually erased from memory. Memories from distant times (childhood, adolescence) are retained the longest.

Characteristics of the advanced stage of progressive dementia of the Alzheimer's type

In the advanced stage of dementia of the Alzheimer's type, memory impairment progresses, so that in some cases only the most significant events are remembered.

Gaps in memory are often replaced by fictitious events (the so-called confabulation– false memories). The criticality of perception of one's own state is gradually lost.

At the advanced stage of progressive dementia, disorders of the emotional-volitional sphere begin to appear. The following disorders are most characteristic of senile dementia of the Alzheimer's type:

• egocentrism;
• grouchiness;
• suspicion;
• conflict.

These signs are called senile (senile) personality restructuring. In the future, against their background, a very specific type of Alzheimer’s dementia may develop. delirium of damage: the patient accuses relatives and neighbors of constantly robbing him, wishing for his death, etc.

Other types of disturbances in normal behavior often develop:

• sexual incontinence;
• gluttony with a special penchant for sweets;
• craving for vagrancy;
• fussy, disorderly activity (walking from corner to corner, shifting things, etc.).

At the stage of severe dementia, the delusional system disintegrates, and behavioral disorders disappear due to extreme weakness of mental activity. Patients plunge into complete apathy and do not experience hunger or thirst. Movement disorders soon develop, so that patients cannot walk or chew food normally. Death occurs from complications due to complete immobility, or from concomitant diseases.

Diagnosis of Alzheimer's type dementia

The diagnosis of dementia of the Alzheimer's type is made on the basis of the characteristic clinical picture of the disease, and is always probabilistic. Differential diagnosis between Alzheimer's disease and vascular dementia is quite difficult, so often a final diagnosis can only be made posthumously.

Treatment

Treatment of dementia of the Alzheimer's type is aimed at stabilizing the process and reducing the severity of existing symptoms. It should be comprehensive and include therapy for diseases that aggravate dementia (hypertension, atherosclerosis, diabetes, obesity).

In the early stages, the following drugs showed a good effect:

• homeopathic remedy ginkgo biloba extract;
• nootropics (piracetam, cerebrolysin);
• drugs that improve blood circulation in the vessels of the brain (nicergoline);
• stimulator of dopamine receptors in the central nervous system (piribedil);
• phosphatidylcholine (part of acetylcholine, a neurotransmitter of the central nervous system, therefore improves the functioning of neurons in the cerebral cortex);
• actovegin (improves the utilization of oxygen and glucose by brain cells, and thereby increases their energy potential).

At the stage of advanced manifestations, drugs from the group of acetylcholinesterase inhibitors (donepezil, etc.) are prescribed. Clinical studies have shown that the use of this type of medication significantly improves the social adaptation of patients and reduces the burden on caregivers.

Forecast

Dementia of the Alzheimer's type is a steadily progressive disease that inevitably leads to severe disability and death of the patient. The process of disease development, from the appearance of the first symptoms to the development of senile insanity, usually takes about 10 years.

The earlier Alzheimer's disease develops, the faster dementia progresses. In patients under 65 years of age (senile dementia or presenile dementia), neurological disorders (apraxia, agnosia, aphasia) develop early.

Vascular dementia

Dementia due to cerebral vascular lesions

Dementia of vascular origin ranks second in prevalence after dementia of the Alzheimer's type, and accounts for about 20% of all types of dementia.

In this case, as a rule, dementia that develops after vascular accidents, such as:
1. Hemorrhagic stroke (vascular rupture).
2. Ischemic stroke (blockage of a vessel with cessation or deterioration of blood circulation in a certain area).

In such cases, massive death of brain cells occurs, and the so-called focal symptoms, depending on the location of the affected area (spastic paralysis, aphasia, agnosia, apraxia, etc.), come to the fore.

So the clinical picture of post-stroke dementia is very heterogeneous, and depends on the degree of damage to the vessel, the area of ​​​​the blood supply to the region of the brain, the compensatory capabilities of the body, as well as on the timeliness and adequacy of medical care provided in case of a vascular accident.

Dementias that occur with chronic circulatory failure develop, as a rule, in old age and demonstrate a more homogeneous clinical picture.

What disease can cause vascular type dementia?

The most common causes of vascular type dementia are hypertension and atherosclerosis - common pathologies characterized by the development of chronic cerebrovascular insufficiency.

The second large group of diseases leading to chronic hypoxia of brain cells is vascular damage in diabetes mellitus (diabetic angiopathy) and systemic vasculitis, as well as congenital disorders of the structure of cerebral vessels.

Acute cerebral circulatory failure can develop due to thrombosis or embolism (blockage) of a vessel, which often occurs with atrial fibrillation, heart defects, and diseases with an increased tendency to thrombus formation.

Risk factors

The most significant risk factors for the development of dementia of vascular origin:

• hypertension, or symptomatic arterial hypertension;
• increased levels of lipids in blood plasma;
• systemic atherosclerosis;
• cardiac pathologies (coronary heart disease, arrhythmias, heart valve damage);
• sedentary lifestyle;
• overweight;
• diabetes mellitus;
• tendency to thrombosis;
• systemic vasculitis (vascular diseases).

Symptoms and course of senile vascular dementia

The first warning signs of vascular dementia are difficulty concentrating. Patients complain of fatigue and have difficulty concentrating for long periods of time. At the same time, it is difficult for them to switch from one type of activity to another.

Another harbinger of developing vascular dementia is slowness of intellectual activity, so for the early diagnosis of cerebral circulatory disorders, tests for the speed of performing simple tasks are used.

Early signs of developed dementia of vascular origin include violations of goal setting - patients complain of difficulties in organizing elementary activities (making plans, etc.).

In addition, already in the early stages, patients experience difficulties in analyzing information: it is difficult for them to identify the main and secondary, to find the common and different between similar concepts.

Unlike dementia of the Alzheimer's type, memory impairment in dementia of vascular origin is not as pronounced. They are associated with difficulties in reproducing perceived and accumulated information, so that the patient easily remembers “forgotten” when asking leading questions, or chooses the correct answer from several alternative ones. At the same time, memory for important events is retained for quite a long time.

For vascular dementia, disturbances in the emotional sphere are specific in the form of a general decrease in mood, up to the development of depression, which occurs in 25-30% of patients, and pronounced emotional lability, so that patients can cry bitterly, and a minute later move on to quite sincere fun.

Signs of vascular dementia include the presence of characteristic neurological symptoms, such as:
1. Pseudobulbar syndrome, which includes impaired articulation (dysarthria), changes in voice timbre (dysphonia), less commonly, impaired swallowing (dysphagia), forced laughter and crying.
2. Gait disturbances (shuffling, mincing gait, “skier’s gait”, etc.).
3. Decreased motor activity, so-called “vascular parkinsonism” (poor facial expressions and gestures, slowness of movements).

Vascular dementia, which develops as a result of chronic circulatory failure, usually progresses gradually, so the prognosis largely depends on the cause of the disease (hypertension, systemic atherosclerosis, diabetes mellitus, etc.).

Treatment

Treatment of vascular dementia is primarily aimed at improving cerebral circulation - and, consequently, at stabilizing the process that caused dementia (hypertension, atherosclerosis, diabetes, etc.).

In addition, pathogenetic treatment is standardly prescribed: piracetam, Cerebrolysin, Actovegin, donepezil. The regimens for taking these drugs are the same as for Alzheimer's type dementia.

Senile dementia with Lewy bodies

Senile dementia with Lewy bodies is an atrophic-degenerative process with the accumulation of specific intracellular inclusions – Lewy bodies – in the cortex and subcortical structures of the brain.

The causes and mechanisms of development of senile dementia with Lewy bodies are not fully understood. Just as with Alzheimer's disease, the hereditary factor is of great importance.

According to theoretical data, senile dementia with Lewy bodies ranks second in prevalence, and accounts for about 15-20% of all senile dementias. However, during life such a diagnosis is made relatively rarely. Typically, such patients are misdiagnosed as having vascular dementia or Parkinson's disease with dementia.

The fact is that many symptoms of dementia with Lewy bodies are similar to the listed diseases. Just as with the vascular form, the first symptoms of this pathology are a decrease in the ability to concentrate, slowness and weakness of intellectual activity. Subsequently, depression, decreased motor activity similar to parkinsonism, and walking disorders develop.

At the advanced stage, the clinical picture of dementia with Lewy bodies is in many ways reminiscent of Alzheimer's disease, since delusions of harm, delusions of persecution, and delusions of doubles develop. As the disease progresses, delusional symptoms disappear due to complete exhaustion of mental activity.

However, senile dementia with Lewy bodies has some specific symptoms. It is characterized by so-called small and large fluctuations - sharp, partially reversible disturbances in intellectual activity.

With small fluctuations, patients complain of temporary impairments in the ability to concentrate and perform some task. With large fluctuations, patients note impaired recognition of objects, people, terrain, etc. Often the disorders reach the point of complete spatial disorientation and even confusion.

Another characteristic feature of dementia with Lewy bodies is the presence of visual illusions and hallucinations. Illusions are associated with a violation of orientation in space and intensify at night, when patients often mistake inanimate objects for people.

A specific feature of visual hallucinations in dementia with Lewy bodies is their disappearance when the patient tries to interact with them. Visual hallucinations are often accompanied by auditory hallucinations (speaking hallucinations), but auditory hallucinations do not occur in their pure form.

As a rule, visual hallucinations are accompanied by large fluctuations. Such attacks are often provoked by a general deterioration in the patient’s condition (infectious diseases, fatigue, etc.). When recovering from a large fluctuation, patients partially amnesize what happened, intellectual activity is partially restored, however, as a rule, the state of mental functions becomes worse than the original one.

Another characteristic symptom of dementia with Lewy bodies is sleep behavior disorder: patients can make sudden movements, and even injure themselves or others.

In addition, with this disease, as a rule, a complex of autonomic disorders develops:

• orthostatic hypotension (a sharp decrease in blood pressure when moving from a horizontal to a vertical position);
• arrhythmias;
• disruption of the digestive tract with a tendency to constipation;
• urinary retention, etc.

Treatment of senile dementia with Lewy bodies similar to the treatment of dementia of the Alzheimer's type.

In case of confusion, acetylcholinesterase inhibitors (donepezil, etc.) are prescribed, and in extreme cases, atypical antipsychotics (clozapine). The use of standard antipsychotics is contraindicated due to the possibility of developing severe movement disorders. Non-frightening hallucinations, if adequately criticized, cannot be eliminated with special medications.

To treat the symptoms of parkinsonism, small doses of the drug levodopa are used (being very careful not to cause an attack of hallucinations).

The course of dementia with Lewy bodies is rapidly and steadily progressive, so the prognosis is much more serious than for other types of senile dementia. The period from the appearance of the first signs of dementia to the development of complete insanity usually takes no more than four to five years.

Alcoholic dementia

Alcohol-induced dementia develops as a result of long-term (15-20 years or more) toxic effects of alcohol on the brain. In addition to the direct influence of alcohol, indirect effects (endotoxin poisoning due to alcoholic liver damage, vascular disorders, etc.) take part in the development of organic pathology.

Almost all alcoholics at the stage of development of alcoholic personality degradation (the third and final stage of alcoholism) exhibit atrophic changes in the brain (expansion of the cerebral ventricles and sulci of the cerebral cortex).

Clinically, alcoholic dementia is a diffuse decrease in intellectual abilities (memory deterioration, concentration, ability for abstract thinking, etc.) against the background of personal degradation (coarsening of the emotional sphere, destruction of social connections, primitivism of thinking, complete loss of value orientations).

At this stage of development of alcohol dependence, it is very difficult to find incentives to encourage the patient to treat the underlying disease. However, in cases where it is possible to achieve complete abstinence for 6-12 months, the signs of alcoholic dementia begin to regress. Moreover, instrumental studies also show some smoothing of the organic defect.

Epileptic dementia

The development of epileptic (concentric) dementia is associated with a severe course of the underlying disease (frequent seizures with transition to status epilepticus). Indirect factors may be involved in the genesis of epileptic dementia (long-term use of antiepileptic drugs, injuries from falls during seizures, hypoxic damage to neurons during status epilepticus, etc.).

Epileptic dementia is characterized by slowness of thought processes, the so-called viscosity of thinking (the patient cannot distinguish the main from the secondary, and gets fixated on describing unnecessary details), decreased memory, and impoverished vocabulary.

A decrease in intellectual abilities occurs against the background of a specific change in personality traits. Such patients are characterized by extreme selfishness, malice, vindictiveness, hypocrisy, quarrelsomeness, suspiciousness, accuracy, even pedantry.

The course of epileptic dementia is steadily progressive. With severe dementia, malice disappears, but hypocrisy and servility remain, and lethargy and indifference to the environment increases.

How to prevent dementia - video

Answers to the most popular questions about causes, symptoms and
dementia treatment

Are dementia and dementia the same thing? How does dementia occur in children? What is the difference between childhood dementia and mental retardation?

The terms “dementia” and “dementia” are often used interchangeably. However, in medicine, dementia is understood as irreversible dementia that has developed in a mature person with normally formed mental abilities. Thus, the term “childhood dementia” is inappropriate, since in children higher nervous activity is at a developmental stage.

The term “mental retardation” or oligophrenia is used to refer to childhood dementia. This name is retained when the patient reaches adulthood, and this is fair, since dementia that occurs in adulthood (for example, post-traumatic dementia) and mental retardation proceed differently. In the first case, we are talking about the degradation of an already formed personality, in the second - about underdevelopment.

Is unexpected untidiness the first sign of senile dementia? Are symptoms such as untidiness and sloppiness always present?

Sudden untidiness and untidiness are symptoms of disturbances in the emotional-volitional sphere. These signs are very nonspecific and are found in many pathologies, such as: deep depression, severe asthenia (exhaustion) of the nervous system, psychotic disorders (for example, apathy in schizophrenia), various types of addictions (alcoholism, drug addiction), etc.

At the same time, patients with dementia in the early stages of the disease can be quite independent and neat in their usual everyday environment. Sloppiness can be the first sign of dementia only if the development of dementia is accompanied in the early stages by depression, exhaustion of the nervous system or psychotic disorders. This kind of debut is more typical for vascular and mixed dementias.

What is mixed dementia? Does it always lead to disability? How to treat mixed dementia?

Mixed dementia is called dementia, the development of which involves both a vascular factor and the mechanism of primary degeneration of brain neurons.

It is believed that circulatory disorders in the blood vessels of the brain can trigger or intensify the primary degenerative processes characteristic of Alzheimer's disease and dementia with Lewy bodies.

Since the development of mixed dementia is caused by two mechanisms at once, the prognosis for this disease is always worse than for the “pure” vascular or degenerative form of the disease.

The mixed form is prone to steady progression, therefore inevitably leading to disability and significantly shortening the patient's life.
Treatment of mixed dementia is aimed at stabilizing the process, and therefore includes combating vascular disorders and mitigating the developed symptoms of dementia. Therapy, as a rule, is carried out with the same drugs and according to the same regimens as for vascular dementia.

Timely and adequate treatment for mixed dementia can significantly prolong the patient’s life and improve its quality.

Among my relatives there were patients with senile dementia. How likely am I to develop a mental disorder? What is the prevention of senile dementia? Are there any medications that can prevent the disease?

Senile dementias are diseases with a hereditary predisposition, especially Alzheimer's disease and dementia with Lewy bodies.

The risk of developing the disease increases if senile dementia in relatives developed at a relatively early age (before 60-65 years).

However, it should be remembered that hereditary predisposition is only the presence of conditions for the development of a particular disease, therefore even an extremely unfavorable family history is not a death sentence.

Unfortunately, today there is no consensus on the possibility of specific drug prevention of the development of this pathology.

Since risk factors for the development of senile dementia are known, measures to prevent mental illness are primarily aimed at eliminating them, and include:
1. Prevention and timely treatment of diseases leading to circulatory disorders in the brain and hypoxia (hypertension, atherosclerosis, diabetes mellitus).
2. Dosed physical activity.
3. Constantly engaged in intellectual activity (you can make crosswords, solve puzzles, etc.).
4. Quitting smoking and alcohol.
5. Prevention of obesity.

Before use, you should consult a specialist.

Dementia(literal translation from Latin: dementia– “madness”) – acquired dementia, a condition in which disturbances occur in cognitive(cognitive) sphere: forgetfulness, loss of knowledge and skills that a person previously possessed, difficulties in acquiring new ones.

Dementia is an umbrella term. There is no such diagnosis. This is a disorder that can occur in various diseases.

Dementia in facts and figures:

• According to 2015 statistics, there are 47.5 million people with dementia in the world. Experts believe that by 2050 this figure will increase to 135.5 million, that is, approximately 3 times.
• Doctors diagnose 7.7 million new cases of dementia every year.
• Many patients are unaware of their diagnosis.
• Alzheimer's disease is the most common form of dementia. It occurs in 80% of patients.
• Dementia (acquired dementia) and oligophrenia (mental retardation in children) are two different conditions. Oligophrenia is an initial underdevelopment of mental functions. In dementia, they were previously normal, but over time they began to disintegrate.
• Dementia is popularly called senile insanity.
• Dementia is a pathology and not a sign of the normal aging process.
• At age 65, the risk of developing dementia is 10%, and it increases significantly after age 85.
• The term "senile dementia" refers to senile dementia.

What are the causes of dementia? How do brain disorders develop?

After the age of 20, the human brain begins to lose nerve cells. Therefore, slight problems with short-term memory are quite normal for older people. A person may forget where he put his car keys, or the name of the person he was introduced to at a party a month ago.

These age-related changes happen to everyone. They usually do not cause problems in everyday life. In dementia, the disorders are much more pronounced. Because of them, problems arise both for the patient himself and for the people who are close to him.

The development of dementia is caused by the death of brain cells. Its reasons may be different.

What diseases cause dementia?

Name	Mechanism of brain damage, description	Diagnostic methods
Neurodegenerative and other chronic diseases
Alzheimer's disease	The most common form of dementia. According to various sources, it occurs in 60-80% of patients. During Alzheimer's disease, abnormal proteins accumulate in brain cells: Amyloid beta is formed by the breakdown of a larger protein that plays an important role in the growth and regeneration of neurons. In Alzheimer's disease, amyloid beta accumulates in nerve cells in the form of plaques. Tau protein is part of the cell skeleton and ensures the transport of nutrients inside the neuron. In Alzheimer's disease, its molecules clump together and are deposited inside cells. In Alzheimer's disease, neurons die and the number of nerve connections in the brain decreases. The volume of the brain decreases.	examination by a neurologist, observation over time; positron emission tomography; single photon emission computed tomography.
Dementia with Lewy bodies	Neurodegenerative disease, the second most common form of dementia. According to some data, it occurs in 30% of patients. In this disease, Lewy bodies, plaques consisting of the protein alpha-synuclein, accumulate in the neurons of the brain. Brain atrophy occurs.	examination by a neurologist; computed tomography; magnetic resonance imaging; positron emission tomography.
Parkinson's disease	A chronic disease characterized by the death of neurons that produce dopamine, a substance necessary for the transmission of nerve impulses. In this case, Lewy bodies are formed in nerve cells (see above). The main manifestation of Parkinson's disease is movement disorder, but as degenerative changes in the brain spread, symptoms of dementia can occur.	The main diagnostic method is examination by a neurologist. Positron emission tomography is sometimes done to help detect low levels of dopamine in the brain. Other tests (blood tests, CT scan, MRI) are used to rule out other neurological diseases.
Huntington's disease (Huntington's chorea)	A hereditary disease in which a mutant mHTT protein is synthesized in the body. It is toxic to nerve cells. Huntington's chorea can develop at any age. It is detected in both 2-year-old children and people over 80 years of age. Most often, the first symptoms appear between 30 and 50 years of age. The disease is characterized by movement disorders and mental disorders.	examination by a neurologist; MRI and CT - atrophy (reduction in size) of the brain is detected; positron emission tomography (PET) and functional magnetic resonance imaging - changes in brain activity are detected; genetic research (blood is taken for analysis) - a mutation is detected, but there are not always symptoms of the disease.
Vascular dementia	The death of brain cells occurs as a result of impaired cerebral circulation. Disruption of blood flow leads to the fact that neurons stop receiving the required amount of oxygen and die. This occurs with stroke and cerebrovascular diseases.	examination by a neurologist; rheovasography; biochemical blood test (for cholesterol); angiography of cerebral vessels.
Alcoholic dementia	It occurs as a result of damage to brain tissue and cerebral vessels by ethyl alcohol and its decay products. Often, alcoholic dementia develops after an attack of delirium tremens or acute alcoholic encephalopathy.	examination by a narcologist, psychiatrist, neurologist; CT, MRI.
Space-occupying formations in the cranial cavity: brain tumors, abscesses (ulcers), hematomas.	Space-occupying formations inside the skull compress the brain and disrupt blood circulation in the cerebral vessels. Because of this, the process of atrophy gradually begins.	examination by a neurologist; ECHO-encephalography.
Hydrocephalus (water on the brain)	Dementia can develop with a special form of hydrocephalus - normotensive (without increased intracranial pressure). Another name for this disease is Hakim-Adams syndrome. Pathology occurs as a result of a violation of the outflow and absorption of cerebrospinal fluid.	examination by a neurologist; Lumbar puncture.
Pick's disease	A chronic progressive disease characterized by atrophy of the frontal and temporal lobes of the brain. The causes of the disease are not fully known. Risk factors: heredity (presence of the disease in relatives); intoxication of the body with various substances; frequent operations under general anesthesia (the effect of the drug on the nervous system); head injuries; past depressive psychosis.	examination by a psychiatrist;
Amyotrophic lateral sclerosis	A chronic incurable disease during which the motor neurons of the brain and spinal cord are destroyed. The causes of amyotrophic lateral sclerosis are unknown. Sometimes it occurs as a result of a mutation in one of the genes. The main symptom of the disease is paralysis of various muscles, but dementia can also occur.	examination by a neurologist; electromyography (EMG); general blood test; biochemical blood test; genetic research.
Spinocerebellar degeneration	A group of diseases in which degeneration processes develop in the cerebellum, brain stem, and spinal cord. The main manifestation is a lack of coordination of movements. In most cases, spinocerebellar degeneration is hereditary.	examination by a neurologist; CT and MRI - reveal a decrease in the size of the cerebellum; genetic research.
Hallerwarden-Spatz disease	A rare (3 per million people) inherited neurodegenerative disease in which iron is deposited in the brain. A child is born sick if both parents are sick.	genetic research.
Infectious diseases
HIV-associated dementia	Caused by the human immunodeficiency virus. Scientists do not yet know how the virus damages the brain.	Blood test for HIV.
Viral encephalitis	Encephalitis is an inflammation of the brain. Viral encephalitis can lead to the development of dementia. Symptoms: impaired hematopoiesis and the development of anemia; disruption of the synthesis of myelin (the substance that makes up the sheaths of nerve fibers) and the development of neurological symptoms, including memory impairment.	examination by a neurologist, therapist; general blood test; determination of the level of vitamin B 12 in the blood.
Folate deficiency	Deficiency of folic acid (vitamin B 9) in the body can occur as a result of its insufficient content in food or impaired absorption in various diseases and pathological conditions (the most common cause is alcohol abuse). Hypovitaminosis B 9 is accompanied by various symptoms.	examination by a neurologist, therapist; general blood test; determination of the level of folic acid in the blood.
Pellagra (vitamin B3 deficiency)	Vitamin B 3 (vitamin PP, niacin) is necessary for the synthesis of ATP (adenosine triphosphate) molecules - the main carriers of energy in the body. The brain is one of the most active “consumers” of ATP. Pellagra is often called the “three D disease” because its main manifestations are dermatitis (skin lesions), diarrhea and dementia.	The diagnosis is made mainly on the basis of the patient's complaints and clinical examination data.
Other diseases and pathological conditions
Down syndrome	Chromosomal disease. People with Down syndrome usually develop Alzheimer's disease at a young age.	Diagnosis of Down syndrome before birth: Ultrasound of a pregnant woman; biopsy, examination of amniotic fluid, blood from the umbilical cord; cytogenetic study - determination of the set of chromosomes in the fetus.
Post-traumatic dementia	Occurs after traumatic brain injuries, especially if they occur repeatedly (for example, this is common in some sports). There is evidence that one traumatic brain injury increases the risk of developing Alzheimer's disease in the future.	examination by a neurologist or neurosurgeon; radiography of the skull; MRI, CT; In children - ECHO-encephalography.
Interactions of some drugs	Some medications may cause symptoms of dementia when used together.
Depression	Dementia can occur in conjunction with a depressive disorder and vice versa.
Mixed dementia	Occurs as a result of a combination of two or three different factors. For example, Alzheimer's disease can be combined with vascular dementia or dementia with Lewy bodies.

Manifestations of dementia

Symptoms that should prompt you to consult a doctor:

• Memory impairment. The patient does not remember what happened recently, immediately forgets the name of the person he was just introduced to, asks the same thing several times, does not remember what he did or said a few minutes ago.
• Difficulty performing simple, familiar tasks. For example, a housewife who has been cooking all her life is no longer able to cook dinner; she cannot remember what ingredients are needed or in what order they need to be put into the pan.
• Communication problems. The patient forgets familiar words or uses them incorrectly, and has difficulty finding the right words during a conversation.
• Loss of orientation on the ground. A person with dementia may go to the store along their usual route and not find their way back home.
• Shortsightedness. For example, if you leave a patient to babysit a small child, he may forget about it and leave home.
• Impaired abstract thinking. This manifests itself most clearly when working with numbers, for example, during various transactions with money.
• Violation of the arrangement of things. The patient often puts things in places other than their usual places - for example, he may leave his car keys in the refrigerator. Moreover, he constantly forgets about it.
• Sudden mood changes. Many people with dementia become emotionally unstable.
• Personality changes. The person becomes overly irritable, suspicious, or begins to constantly fear something. He becomes extremely stubborn and is practically unable to change his mind. Everything new and unfamiliar is perceived as threatening.
• Behavior Changes. Many patients become selfish, rude, and unceremonious. They always put their interests first. They can do weird things. They often show increased interest in young people of the opposite sex.
• Decrease in initiative. The person becomes uninitiative and shows no interest in new beginnings or other people’s proposals. Sometimes the patient becomes completely indifferent to what is happening around him.

Degrees of dementia:

Lightweight	Moderate	Heavy
Performance is impaired. The patient can take care of himself independently and practically does not need care. Criticism often persists - a person understands that he is sick, and is often very worried about it.	The patient is unable to fully care for himself. It is dangerous to leave him alone and requires care.	The patient almost completely loses the ability to self-care. He understands very poorly what is said to him, or does not understand at all. Requires constant care.

Stages of dementia (WHO classification, source:

Early	Average	Late
The disease develops gradually, so patients and their relatives often do not notice its symptoms and do not consult a doctor in time. Symptoms: the patient becomes forgetful; time is lost; Orientation in the area is impaired, the patient may get lost in a familiar place.	Symptoms of the disease become more pronounced: the patient forgets recent events, names and faces of people; orientation in one’s own home is disturbed; Difficulties in communication increase; the patient cannot take care of himself and requires outside help; behavior is disrupted; the patient may perform monotonous, aimless actions for a long time, asking the same question.	At this stage, the patient is almost completely dependent on loved ones and needs constant care. Symptoms: complete loss of orientation in time and space; it is difficult for the patient to recognize relatives and friends; constant care is required; in the later stages, the patient cannot eat or perform simple hygiene procedures; behavioral disturbances increase, the patient may become aggressive.

Diagnosis of dementia

Neurologists and psychiatrists are involved in the diagnosis and treatment of dementia. First, the doctor talks with the patient and suggests taking simple tests to help evaluate memory and cognitive abilities. A person is asked about well-known facts, asked to explain the meaning of simple words and to draw something.

It is important that during the conversation the specialist doctor adheres to standardized methods, and does not rely only on his impressions of the patient’s mental abilities - they are not always objective.

Cognitive tests

Currently, when dementia is suspected, cognitive tests are used, which have been tested many times and can accurately indicate impaired cognitive abilities. Most were created in the 1970s and have changed little since then. The first list of ten simple questions was developed by Henry Hodkins, a specialist in geriatrics who worked at a London hospital.

Hodgkins' technique was called the abbreviated mental test score (AMTS).

Test questions:

1. What is your age?
2. What time is it to the nearest hour?
3. Repeat the address that I will now show you.
4. What year is it now?
5. What hospital and what city are we in now?
6. Can you now recognize two people you saw before (for example, a doctor, a nurse)?
7. State your date of birth.
8. In what year did the Great Patriotic War begin (you can ask about any other well-known date)?
9. What is the name of our current president (or other famous person)?
10. Count backwards from 20 to 1.

For each correct answer the patient receives 1 point, for each incorrect answer – 0 points. A total score of 7 points or more indicates a normal state of cognitive abilities; 6 points or less indicates the presence of violations.

GPCOG test

This is a simpler test than the AMTS and has fewer questions. It allows for rapid diagnosis of cognitive abilities and, if necessary, referral of the patient for further examination.

One of the tasks that the test taker must complete during the GPCOG test is to draw a dial on a circle, approximately observing the distances between the divisions, and then mark a certain time on it.

If the test is carried out online, the doctor simply marks on the web page which questions the patient answers correctly, and then the program automatically displays the result.

The second part of the GPCOG test is a conversation with a relative of the patient (can be done by telephone).

The doctor asks 6 questions about how the patient’s condition has changed over the past 5-10 years, which can be answered “yes”, “no” or “I don’t know”:

1. Do you have more problems remembering recently occurring events or things that the patient uses?
2. Has it become more difficult to remember conversations that happened a few days ago?
3. Has it become more difficult to find the right words when communicating?
4. Has it become more difficult to manage money, manage your personal or family budget?
5. Has it become more difficult to take your medications on time and correctly?
6. Has it become more difficult for the patient to use public or private transport (this does not include problems arising due to other reasons, such as injuries)?

If the test results reveal problems in the cognitive sphere, then more in-depth testing and a detailed assessment of higher nervous functions are carried out. This is done by a psychiatrist.

The patient is examined by a neurologist and, if necessary, by other specialists.

Laboratory and instrumental tests that are most often used when dementia is suspected are listed above when considering the causes.

Dementia treatment

Treatment for dementia depends on its causes. During degenerative processes in the brain, nerve cells die and cannot recover. The process is irreversible, the disease is constantly progressing.

Therefore, for Alzheimer's disease and other degenerative diseases, a complete cure is impossible - at least, such drugs do not exist today. The main task of the doctor is to slow down pathological processes in the brain and prevent further growth of disorders in the cognitive sphere.

If degeneration processes in the brain do not occur, then the symptoms of dementia may be reversible. For example, restoration of cognitive function is possible after traumatic brain injury or hypovitaminosis.

Symptoms of dementia rarely come on suddenly. In most cases, they increase gradually. Dementia is preceded for a long time by cognitive impairments, which cannot yet be called dementia - they are relatively mild and do not lead to problems in everyday life. But over time they increase to the point of dementia.

If you identify these disorders in the early stages and take appropriate measures, this will help delay the onset of dementia, reduce or prevent a decrease in performance and quality of life.

Caring for a person with dementia

Patients with advanced dementia require constant care. The disease greatly changes the life of not only the patient himself, but also those who are nearby and care for him. These people experience increased emotional and physical stress. You need a lot of patience to care for a relative who at any moment can do something inappropriate, create a danger for himself and others (for example, throw an unextinguished match on the floor, leave a water tap open, turn on a gas stove and forget about it), react with violent emotions to any little thing.

Because of this, patients around the world are often discriminated against, especially in nursing homes, where they are cared for by strangers who often lack knowledge and understanding of dementia. Sometimes even medical staff behave quite rudely with patients and their relatives. The situation will improve if society knows more about dementia, this knowledge will help treat such patients with more understanding.

Prevention of dementia

Dementia can develop for a variety of reasons, some of which are not even known to science. Not all of them can be eliminated. But there are risk factors that you can completely influence.

Basic measures to prevent dementia:

• Quitting smoking and drinking alcohol.
• Healthy eating. Vegetables, fruits, nuts, grains, olive oil, lean meats (chicken breast, lean pork, beef), fish, seafood are healthy. Excessive consumption of animal fats should be avoided.
• Fighting excess body weight. Try to monitor your weight and keep it normal.
• Moderate physical activity. Physical exercise has a positive effect on the cardiovascular and nervous system.
• Try to engage in mental activity. For example, a hobby such as playing chess can reduce the risk of dementia. It is also useful to solve crosswords and solve various puzzles.
• Avoid head injuries.
• Avoid infections. In the spring, it is necessary to follow recommendations for the prevention of tick-borne encephalitis, which is carried by ticks.
• If you are over 40 years old, have your blood tested annually for sugar and cholesterol. This will help to detect diabetes mellitus, atherosclerosis in time, prevent vascular dementia and many other health problems.
• Avoid psycho-emotional fatigue and stress. Try to get full sleep and rest.
• Monitor your blood pressure levels. If it periodically increases, consult a doctor.
• When the first symptoms of nervous system disorders appear, immediately contact a neurologist.