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

General concept

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

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

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

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

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

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

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

What to pay attention to

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

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

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

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

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

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

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

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

The most common form of dementia

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

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

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

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

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

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

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

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

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

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

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

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

Other forms of dementia

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

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

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

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

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

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

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

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

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

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

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

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

Organic dementia in children

Dementia develops in children for a number of reasons:

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

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

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

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

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

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

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

Diagnostic criteria

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

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

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

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

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

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

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

How to treat and prevent disease

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

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

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

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

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

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

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

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

A distinction is made between so-called dementia (from the Latin de - a prefix meaning decline, lowering, downward movement, + mens - mind, reason) - acquired dementia and mental retardation (from the Greek oligos - small in the sense of quantity + phren - thought, mind) - congenital dementia.

Based on the characteristics of the clinical picture, the following types of dementia are distinguished.

Organic dementia- dementia, caused mainly by vascular diseases of the brain, syphilitic and senile psychoses, and brain injuries. Organic dementia is usually divided into two groups: total (diffuse, global) and partial (dysmnestic, partial, lacunar).

Total dementia is characterized by a persistent decline in all intellectual functions, weakness of judgment, and lack of criticism of one’s condition. An example of this is the so-called senile dementia (see “Psychoses of old age”), as well as dementia with progressive paralysis (paralytic dementia - see).

The patient, in the past a very educated and cultured person, without being embarrassed by those present, walks naked around the ward, then approaches the young doctor and invites her to “marry him immediately.” He does not remember the dates of his life, known historical dates. He regards his condition without any criticism, considers himself to be quite healthy, and explains the fact of his stay in the department of a psychiatric hospital with the desire to “take a break from business in this nice environment.”

Partial (dysmnestic) dementia characterized, as the name itself indicates, by severe memory impairment. The remaining intellectual functions suffer mainly secondarily, since the “entrance gate of the intellect,” as memory is sometimes called, is disrupted. Such patients retain the ability to judge and have a critical attitude towards their condition. It is difficult for them to learn new things, but old knowledge, especially professional knowledge that is well consolidated, can be retained for quite a long time. Due to their critical attitude towards themselves, such patients understand their situation, try to avoid conversation in which they could detect memory disorders, constantly use a notebook, and write in advance what they need to say or do.

A typical picture of such partial dementia can be observed with cerebral atherosclerosis or syphilis of the brain.

According to the International Classification of Diseases (10th revision), the following types of dementia are distinguished: dementia due to Alzheimer's disease; vascular dementia; dementia in Pick's disease, Huntington's disease, Parkinson's disease, AIDS, etc.; unspecified dementia.

Among acquired dementia, schizophrenic and epileptic dementia are also distinguished.

Schizophrenic dementia, also called apathetic or atactic, is characterized by intellectual inactivity, lack of initiative, while the prerequisites for mental activity can persist for a long time. That is why the intelligence of such patients is compared to a cabinet full of books that no one uses, or to a musical instrument that is locked and never opened.

A 22-year-old young man lies motionless in bed all day long, showing no interest in anything and doing nothing. He doesn’t pick up books and is completely indifferent to the most interesting television program. At the same time, one day he unexpectedly walked up to the chess table and beat a very strong chess player. Subsequently, he continued to do nothing, and was indifferent to numerous offers to play chess.

Epileptic dementia is expressed not only in a significant decrease in memory, but also in a peculiar change in thinking, when a person begins to lose the ability to distinguish between the main and the secondary; everything seems important to him, all the little things seem significant. Thinking becomes viscous, unproductive, pathologically detailed, the patient cannot express his thoughts in any way (it is not for nothing that epileptic thinking is sometimes called labyrinthine). Also characteristic is a narrowing of the range of interests, focusing exclusively on one’s condition (concentric dementia).

A 36-year-old patient, suffering from epilepsy since childhood, reports in detail, with many details, about her condition: “So, then I went and walked, and in front of me was a door, well, I grabbed the handle, grabbed it and pushed, and there was another the grandmother was standing, she had woolen socks and size forty boots...”, etc. The patient made this entire long speech in order to inform the doctor about the appearance of seizures after bruising her head with a door. Memory is sharply reduced, the woman uses a small number of words, often using stereotyped expressions and rhymes, willingly uses diminutive words: “little eyes”, “little hands”, “little sister”, “crib”. She is completely occupied with herself, interested in those around her insofar as it has something to do with her.

Oligophrenia is a hereditary, congenital or acquired dementia in the first years of life, expressed in general mental underdevelopment with a predominance primarily of an intellectual defect and, as a result, difficulty in social adaptation.

– an acquired form of dementia, characterized by a decrease in cognitive activity, loss of acquired practical skills and acquired knowledge. The disease is manifested by a decrease in memorization, mental functions, temporal and spatial disorientation, speech and writing disorders, and the inability to self-care. Diagnostics includes instrumental methods for studying the brain (MRI, CT), a clinical interview, examination by a neurologist, psychiatrist, psychodiagnostic methods for assessing the cognitive sphere, emotional and personal characteristics. Treatment involves the use of psychostimulants, nootropic drugs, and psychocorrection.

General information

The name of the disease “residual organic dementia” is of Latin origin. “Residual” means “remaining”, “preserved”, emphasizes a condition that cannot be changed or corrected. The word “organic” indicates the presence of damage to brain tissue. “Dementia” is translated as “decrease”, “loss of reason”. A common synonymous name is “dementia”, “organic dementia”. The epidemiology of the disease has been well studied in patients over 65 years of age; there is insufficient data on the prevalence of pathology among children. This is partly due to the complexity of the diagnostic process: symptoms overlap with manifestations of the underlying disease.

Causes of organic dementia in children

Childhood dementia develops after the child’s body is exposed to factors that disrupt the functioning of brain structures. The causes of the disease are:

• Neuroinfections. Organic dementia occurs as a complication of meningitis, encephalitis, and cerebral arachnoiditis.
• Traumatic brain injuries. The disease can result from a brain contusion or open injuries.
• HIV infection. HIV infection with clinical manifestations (AIDS) , can affect the central nervous system. Damage to the brain leads to the development of encephalopathy, manifested by dementia.
• Toxic damage to the central nervous system. In children, damage to brain structures is observed during intoxication with drugs (DNA gyrase blockers, anticholinergic substances, cortisone), heavy metals (lead, aluminum). Cases of alcohol and drug-related dementia are being identified in adolescents.

Pathogenesis

The pathogenesis of organic dementia of childhood is based on damage to brain tissue. Intoxication, infectious-inflammatory and traumatic exogenous influences provoke degenerative changes in the brain substrate. A defective state develops, manifested by degradation of mental activity: cognitive functions, practical skills, emotional reactions, personality traits. From a pathogenetic point of view, the organic form of dementia is considered as residual effects of brain lesions. It is characterized by a stable decline in mental functions without subsequent aggravation.

Classification

Organic dementia in children is divided according to the etiological factor: intoxication, infectious, etc. Another basis for classification is the severity of the pathology:

• Easy. Symptoms are smoothed out, in preschool children they are often not detected for a long time, everyday skills remain intact. Academic failure among schoolchildren is increasing and social activity is decreasing.
• Moderate. The child needs care and support from an adult.
• Heavy. Constant supervision is required, speech and self-care skills are impaired.

Symptoms of organic dementia in children

The clinical picture of organic dementia in children is determined by age. Cerebral lesions suffered at school age are characterized by a contrast between erudition, level of skill development and current cognitive capabilities. Speech is phonetically complete, grammatically and syntactically correct, the vocabulary is sufficient, everyday and school skills are formed. When communicating with a child, the predominance of specific situational thinking is revealed: experienced events are described in detail, judgments are focused on practical actions and results.

The ability to abstraction manifests itself in isolated cases or is absent: the figurative meaning of proverbs and sayings is inaccessible, humor is incomprehensible, and the transfer of experience from one situation to another is difficult. Previously acquired knowledge is retained, but its use is limited, and the actual productivity of thinking is reduced. Attention is unstable, quickly exhausted, memorization is difficult. Affective and personality disorders are determined. The child is emotionally unstable and has frequent mood swings. The nuances of emotions disappear, impoverishment and flattening increase. Severe forms are characterized by a predominance of polar states of pleasure and displeasure. Personality degradation is manifested by a narrowing of interests and a desire to satisfy basic needs.

In preschool and early age children, the symptoms of organic dementia are different. The central place is occupied by pronounced psychomotor agitation. The child is emotionally unstable - reactions of joy are quickly replaced by anger and crying. The emotional sphere is extremely impoverished: a feeling of attachment is not formed, there is no longing for the mother, there are no reactions to praise or blame. Elementary drives are strengthened, gluttony and sexuality develop. The instinct of self-preservation is weakened: the patient is not afraid of strangers, is not anxious in a new environment, and is not afraid of situations involving heights or fire. Outwardly unkempt, sloppy.

Cognitive functions are completely impaired. Perception is vague, judgments are superficial, random in nature, built on the basis of spontaneous formation of associations, repetition without comprehension. Analysis of the situation and transfer of experience are not available - learning ability is reduced, learning new material is difficult. There is no abstract thinking. Severe attention disorders are determined. An intellectual defect and internal disorganization are manifested by a simplification of the game: aimless running around, rolling on the floor, throwing and destroying toys and objects predominates. Accepting the rules and mastering game roles is not available.

Complications

Damage to areas of the brain affects the mental development of the child. The ontogenetic process does not stop, but is distorted, which leads to complications. The insufficiency of the regulatory mechanisms of the central nervous system reduces the body's adaptation to changing conditions of the external and internal environment. Crisis stages of ontogenesis are often accompanied by cerebrasthenic, psychopathic states, convulsive seizures, and psychotic episodes. For example, puberty can provoke a pathological change in character (aggressiveness, disregard for social norms) and give rise to epilepsy. During mild infectious diseases and injuries, inappropriately intense reactions are observed.

Diagnostics

Organic dementia in children is detected using clinical, instrumental and pathopsychological methods. The diagnostic process includes the following steps:

• Consultation with a neurologist. The specialist conducts a survey, collects anamnesis, assesses the general condition of the child and the integrity of reflexes. To determine the nature of the damage and identify atrophic processes, he is referred for instrumental examinations of the brain: EchoEG, MRI, EEG, CT. Based on the results of clinical and instrumental examination, the doctor establishes the main diagnosis and assumes the presence of dementia.
• Consultation with a psychiatrist. The study is aimed at identifying emotional, personal and cognitive disorders. A child psychiatrist conducts a diagnostic conversation: assesses the child’s mental abilities, emotional responses, and behavior. To clarify the depth of the defect, a pathopsychological examination is prescribed.
• Consultation with a clinical psychologist. After a conversation with the patient, the pathopsychologist selects a set of diagnostic methods aimed at studying the level of memory, intelligence, attention, and thinking. The results describe the current state of cognitive functions, totality or partiality of decline, and learning ability. For concomitant disorders of the emotional-personal sphere, projective methods (drawing, interpretive with figurative material), questionnaires (Lichko questionnaire, pathocharacterological diagnostic questionnaire) are used. Based on the results, the pathocharacterological development, the predominance of the emotional radical is determined, and the risk of personal and social disadaptation is assessed.

Organic dementia in children requires differential diagnosis with mental retardation and progressive dementia. In the first case, the main difference lies in the nature of the decline in cognitive functions and the course of the disease: with mental retardation, a decrease in intelligence, abstract thinking, the relative norm of memory, and attention comes to the fore. The decline is determined by insufficient development, and not by the breakdown of functions (as in dementia). The distinction between progressive and organic forms of dementia is made on the basis of the etiological factor and the assessment of intellectual functions over time.

Treatment of organic dementia in children

Treatment of childhood organic dementia is a long process that requires consistency and organization from children, parents, and doctors. The main therapy is aimed at eliminating the neurological disease. Correction of cognitive and emotional disorders is performed using the following methods:

• Pharmacotherapy. Drugs are prescribed that improve the metabolism of brain nerve cells and cerebral blood flow. The use of nootropic drugs and psychostimulants contributes to increasing mental abilities and endurance during mental and physical stress.
• Psychological and pedagogical assistance. Psychocorrection classes are conducted by a psychologist-educator, clinical psychologist. They are aimed at developing thinking abilities, attention, and memory. Organized taking into account cerebrasthenic/encephalopathic disorders of the patient’s central nervous system. Depending on the degree of dementia, the level of study load is determined.

Prognosis and prevention

With constant medical supervision, the prognosis for dementia in most cases is favorable: slow progress is observed, in some cases stable remission is achieved - the patient attends a regular school and copes with stress. It is worth remembering that the recovery process is very long and requires daily care and treatment. Prevention of organic dementia in children is difficult, since the disorder is a consequence of another disease. Supportive measures include careful attention to the child’s well-being, timely treatment of infectious and other diseases, and the creation of conditions to minimize the risk of injury. The development of psycho-emotional disorders is prevented by creating a favorable, friendly family environment and active time spent together.

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

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

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

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

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

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

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

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

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

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

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

MRI parameters characteristic of changes in Alzheimer's disease:

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

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

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

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