Senile depression, senile dementia, vascular psychoses

11.12.2020

Not every person is able to maintain a strong memory and a clear mind into old age. Only thirty percent of people over eighty years of age have common sense. The remaining seventy percent of people living on Earth have cognitive disorders, problems with thinking and memory, and suffer from senile dementia. The psyche of every person gradually weakens with age. He loses acquired skills and abilities, and is no longer able to master new ones. According to statistics, today about 36,000,000 people in the world suffer from various types of senile dementia.

At what age do signs of senile dementia appear?

Such symptoms appear in older people. Their memory and speech deteriorate, their ability to think logically weakens, and attention is lost. All this leads to the loss of professional skills and abilities. An elderly person can no longer acquire new knowledge, so he is forced to quit his job. Elderly people also need supervision and constant assistance in everyday life. At first, relatives usually do not notice the signs of senile dementia, since personality changes usually develop gradually. They explain excessive conservatism, stinginess and grumpiness by the difficulties of “adolescence”

It is necessary for the relatives of an elderly person to closely monitor the state of his intellect and mental health. A person who suffers from dementia is no longer able to adequately perceive and analyze information. His character takes on negative traits - he becomes embittered and rude. The range of interests of such a person narrows significantly, he acquires primitive, “clichéd” views. Some older people become complacent and careless, and begin to disregard the ethical standards accepted in society.

There are the following types of senile dementia:

• dementia (dystrophic-atrophic);
• vascular (caused by damage to the blood vessels of the brain);
• mixed type.

A characteristic feature of people suffering from senile dementia is to live in the past. Recent events are erased from their memory, but they remember childhood and youth very well. Their manners, gestures and habits remain the same, so their relatives do not notice the symptoms of senile dementia for a long time and do not begin treatment.

Symptoms of age-related depression

The older the age group, the more often depression and dementia (senile insanity) are registered in it. Often elderly patients at our clinic complain of the following symptoms:

1. Negative view of objects and events in life. An elderly man expresses dissatisfaction with youth, authorities, and the weather. Everything that was before is good, and everything that is now is bad.
2. Constant grievances , especially against loved ones, a feeling of “damage done . An elderly family member unreasonably reproaches his loved ones that everyone has abandoned him, they want to take something away from him, they don’t love him, and no one needs him, that they are plotting something against him and want to harm him. This is not behavioral egoism or “harmfulness of character” - but a symptom of vascular disease of the brain (dementia or senile insanity).
3. Impaired ability for integrative brain functions - recall, memorization, thinking. More often, memory for recent events suffers, while events that happened many years ago are remembered well.
4. Cardiovascular attacks due to the slightest stress. A small stimulus is perceived as large, and the released stress hormones “hit” the blood vessels, hence a disruption of the heart rhythm, a hypertensive crisis or a heart attack.
5. Pain in the back, joints, legs, head. Against the background of depression, the pain threshold always decreases and minor pains from arthrosis and osteochondrosis are perceived more clearly.

If you see such symptoms, seek help from a neurologist or psychiatrist. Perhaps brain cells die daily and in large numbers, and it is dangerous to wait. At the same time, if you start treatment in time, its results can be very noticeable. We often see cases of rapid, within 1-2 months, transformation of older people into energetic, positive, active and internally young people. Blood pressure and heart behavior are much calmer.

Causes of senile dementia

,p>The thinking abilities of an elderly person are directly affected by the state of the cortex and subcortical structures of the cerebral hemispheres. Senile dementia can develop in the presence of the following pathologies:

• simultaneous damage to the subcortex and cortex (vascular problems, neuroinfections, hematomas, brain abscesses, tumors, etc.);
• damage to the subcortical region (progressive paralysis, Parkinson's disease, multifocal dementia);
• disorders of cortical functions (multiple sclerosis, lupus erythematosus, alcoholic encephalopathy, vascular diseases of the brain, Alzheimer's disease, etc.).

Senile dementia can be mild, moderate or severe. With a mild form, an elderly person can live independently, but he is no longer able to fully engage in certain activities (especially mental ones). People with an average degree need to be supervised from time to time and help them solve everyday issues. Patients in the last stage require constant monitoring and care.

Diagnostics

Usually making a diagnosis does not cause any difficulties. To determine the severity of senile paranoia, the structure and content of delusions, doctors at the Cordia clinic use special questionnaires, tests and questionnaires. But this is not enough to create a clear treatment program.

When treating senile paranoia, attention is paid not only to the elimination of mental disorders, but also to the correction of concomitant neurological disorders. To assess the patient's health condition, it is recommended:

• general clinical tests;
• lipid profile;
• blood biochemistry;
• laboratory screening of thyroid function;
• determination of markers of diabetes mellitus;
• Echo-CG;
• brain tomography, EEG;
• Dopplerography of blood vessels, etc.

Main signs of senile dementia

If you know the main signs of senile dementia, you can detect it in the early stages. The main features are:

• Severe memory impairment. The first stage of senile dementia is characterized by memory lapses (short-term). Older people often forget events that happened recently. At the last stage, changes also occur in long-term memory - the elderly person does not react to relatives and friends, cannot navigate the area, does not remember education and profession.
• Speech disorders.
• Lack of ability to concentrate and react to several objects simultaneously. Elderly people have problems with orientation in time and space. They often forget their names and other important things.
• Behavioral disorders, personality changes. As a person ages, a person's character can change greatly. Some (usually not the best) traits may increase in him, such as touchiness, suspicion, selfishness, etc.
• Logical thinking deteriorates, and “delusional ideas” may arise.
• The emergence of emotional devices. People with dementia may become depressed, become angry and cry for no reason, or become angry or anxious for no reason.
• Inadequate perception of reality, the occurrence of hallucinations and illusions.
• Decreased critical attitude.

Diagnosis of senile dementia

If you have an elderly relative, you need to know which specialist you should contact if symptoms of senile dementia appear. If treatment is not started in time, the situation can worsen and lead to serious consequences, often even tragic. Having noticed the very first symptoms of dementia, you should immediately contact a psychiatrist or neurologist. To make a correct diagnosis, the doctor must talk with the patient and conduct the necessary diagnosis of his mental abilities and memory using special tests. During the conversation, the doctor will ask the patient to draw a picture, explain the meaning of simple things, or talk about something. When talking with a patient, the doctor will adhere to a certain technique. During the conversation, the specialist will pay close attention to the patient’s symptoms of dementia, their duration and severity of manifestation. Also of great importance for diagnosing the condition of an elderly person is the presence of concomitant diseases. To determine exactly what changes have occurred in the patient’s brain, the doctor will send him for a computed tomography scan. After receiving its results, he will compare them with the results of the “interview” and prescribe the necessary treatment.

Signs of senile paranoia

In old age, the content of delirium is usually associated with everyday situations, and it is distinguished by specificity and detail. Ideas of damage often arise. The patient is sure that someone is spoiling, breaking and stealing his things. It seems to him that in his absence, strangers are entering through windows or breaking into doors, picking up keys to cabinets, boxes, and taking away any pieces of furniture or household appliances.

Sometimes a person goes to the police with a report of theft, indicating exactly what is missing (and it can be both real and fictitious “valuables”). Often delusional ideas are associated with the fear of losing housing. The patient suspects neighbors or relatives, says that they want to “let him go around the world,” kick him out, lock him up in a nursing home (by the way, this is the reason for his categorical reluctance to see a doctor).

People suffering from senile paranoia tend to be litigious. They can go to court or threaten to sue for the slightest reason; they are sure that they are constantly being deceived in stores, when calculating pensions, and utility bills.

Typical signs of senile paranoia also include the following forms of delusion:

• Jealousy . A person is confident that “someone” is encroaching on his family and wants to “take away” his husband (wife). Sometimes delusional ideas concern children or grandchildren (for example, an obsessive thought that a son-in-law wants to leave his daughter and go to another, etc.). The patient torments not only himself, but also the “object” of jealousy, constantly striving to find evidence for his conjectures, and the conclusions made during such “investigations” cannot be explained logically.
• Hypochondriacal , accompanied by confidence in the presence of a serious disease of the internal organs. Symptoms associated with physiological age-related changes are very frightening for the patient. He constantly goes to the doctor, asking to be referred for additional examinations.
• Greatness . Characterized by belief in one's superpowers (healing, prophecy, reading other people's thoughts, etc.), and extraordinary talent.

Episodes of auditory or visual illusions cannot be excluded. But unlike schizophrenia and other disorders accompanied by hallucinosis, in senile paranoid syndrome the visions are short-lived and fully consistent with the content of delusion.

Alzheimer's disease

This disease belongs to atrophic dementia. The risk of developing this disease is inherited. If desired, it can be significantly reduced. To do this, it is necessary to study music and study foreign languages ​​from childhood. Most often, the disease develops in people aged seventy. The following provoking factors can cause its development:

• poisoning with neurotoxic substances;
• oxygen starvation of the brain;
• various head injuries.

The development of the disease is caused by a disturbance in the biochemical metabolism of glucose, which provokes the formation of numerous “plaques” in the brain, causing the death of nerve cells. The presence of foci of brain damage in a patient can cause him to develop total dementia. The first sign of this disease is the appearance of memory impairment. At first they are not too noticeable. The patient exhibits absent-mindedness and slight forgetfulness. After some time, events that happened recently begin to completely “fall out” from his memory. But he remembers the past quickly and easily. However, over time, the patient begins to forget the past. Eventually he loses the ability to remember the necessary information. Elderly sick people learn new information with great difficulty. They cannot navigate in time and space, are unable to remember the day of the week and date, and also understand where they are currently located. At the same time, their sense of touch, vision and hearing are impaired. They cannot recognize their relatives or remember their surroundings. In the last stages of the disease, older people lose the ability to adequately perceive even themselves.

Symptoms of dementia gradually appear in the professional sphere. First, patients lose complex skills and abilities, and then begin to experience problems with self-care. In the early stages of the disease, patients usually behave animatedly, even somewhat fussily. Then their “mobility” is replaced by monotonous, completely simple movements, and speech also becomes more primitive. Emotionally, disorders begin with global dissatisfaction with oneself associated with professional unsuitability. At the first stage of the disease, the patient understands the problems he has and tries to solve them by any available means. As the disease progresses, his self-criticism decreases, reasoning and hobbies become more primitive. A person becomes touchy and withdrawn, begins to experience indifference to the world around him.

Pick's disease

This is another type of atrophic dementia, classified as total. It is caused by lesions of the frontal and temporal lobes of the brain. This disease differs from Alzheimer's disease in that its initial symptoms are problems in the emotional area. Patients lose the ability to be self-critical and behave too aggressively or too passively. They develop or intensify a tendency toward foul language and scandals, and they begin to react inappropriately to different situations. At the onset of the disease, behavior changes dramatically. He suddenly acquires bad inclinations that were completely unusual for him before. The speech of such a person becomes verbose and confusing, he begins to have difficulty finding the appropriate words and expressions. Very often, women who develop this disease turn from quiet prudes into scandalous, aggressive furies. Senile dementia leads to impairment of a person’s thinking abilities, which manifest themselves in the difficulty of processing received information, the inability to engage in creativity and develop new ideas. If patients have stable professional skills that have been developed over the years, they can persist with this type of senile dementia for quite a long time. Memory deterioration is observed in the later stages of this type of dementia. In this case, it does not reach complete unconsciousness.

Vascular dementia

Problems with blood vessels most often appear due to their blockage with fatty “plaques”. Senile dementia most often develops in patients with a choroid plexus cyst or cerebral aneurysm. This disease occurs more often in men than in women. Older people suffer from it 6 times more often than young people.

In the early stages, the vascular form of dementia is similar to an innocent neurosis. It has the following characteristics:

• frequent irritability, increased fatigue;
• a slight decrease in learning ability and a slight decrease in performance;
• night terrors;
• insomnia;
• migraine.

As the disease progresses, a person develops other symptoms. He becomes inattentive and absent-minded, begins to experience depression and dissatisfaction with the people around him. His behavior becomes inert and indecisive. The patient also develops tearfulness and emotional instability. He begins to worry for no reason at the slightest reason. The negative traits of his character gradually become more pronounced. With the development of this form of senile dementia, the patient begins to confuse current events and forget names and dates. Gaps appear in memory, and thinking becomes unproductive and sluggish. The desire to communicate and work disappears. Sometimes patients may experience psychosis with delusions and hallucinations, as well as paranoid manifestations.

Dementia

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, the cause of dementia is 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 from 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 - predominant damage to 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 (dysmensia 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 at a late age 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. Severity (stage) of dementia

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 objective research). 2. The presence of at least one of the following disorders characteristic of organic dementia:

vsigns of decreased ability for abstract thinking (according to objective research);

vsymptoms of decreased criticality of perception (discovered when making real plans for the next period of life in relation to oneself and others);

v syndrome three "A":

· aphasia – various kinds 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). and so on.;

vpersonal 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 (there are 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).

1. 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. Alzheimer's type dementia

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);

· hypertonic disease;

· atherosclerosis;

· increased levels of lipids in the blood plasma;

· diabetes;

· 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

At 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 (so-called confabulations - 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 this background, delusions of harm, which are very specific to dementia of the Alzheimer’s type, may develop: 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 Alzheimer's type dementia 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). 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), is considered separately. 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 brain supplied with blood, the compensatory capabilities of the body, as well as 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 the blood plasma;

· systemic atherosclerosis;

· smoking;

· cardiac pathologies (coronary heart disease, arrhythmias, heart valve damage);

· sedentary lifestyle;

· overweight;

· diabetes;

· 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 often - impaired swallowing (dysphagia), violent 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.). 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 damage, 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);

· fainting;

· arrhythmias;

· disruption of the digestive tract with a tendency to constipation;

· urinary retention, etc.

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

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Mixed dementia

This type of senile dementia is caused by additive conditions that can be provoked by taking drugs and psychotropic drugs. Currently, this phenomenon is quite common due to the fact that many psychotherapists prescribe such drugs to their patients. A person who takes any psychotropic drugs for several years exposes his body to chronic intoxication, against the background of which senile dementia can develop. Psychotropic substances not only provoke addiction and euphoria, but also disorganize the brain activity of the person taking them. He develops various nervous disorders, sudden mood swings, insomnia develops, hypochondria and depression occur. A person gradually shows signs of asthenia, a feeling of complete loss of strength. This leads to the appearance of severe apathy and the development of various psychoses, as a result of which the elderly person completely loses interest in the world around him. Since the breakdown of personality in people who are dependent on drugs occurs due to the influence of toxic substances on the body, it is quite possible to cure them and help them adapt to reality. Unlike people suffering from vascular pathologies or Alzheimer's disease.

Causes of senile paranoia

Unlike schizophrenia and some other mental illnesses, the appearance of signs of this disease is not associated with genetic causes (although some experts do not abandon this theory).
However, most doctors are of the opinion that pathology is primarily associated with internal psychological problems. Due to stereotypes of behavior and thinking, which are usually formed in childhood, numerous complexes, self-doubt, excessive pedantry, and rigidity of thinking are formed. All actions are performed only with an eye on the opinions of others. But signs of the disease appear either under the influence of stress factors (retirement, loneliness, loss of usual social status, awareness of the very fact of old age) or, what happens more often, due to age-related changes.

Atherosclerosis, thinning of vessel walls, deterioration of cerebral circulation leads to sustained ischemia of brain cells. This, in turn, negatively affects the ability to perceive and analyze information and adequately respond to what is happening. Gradually, this leads to the formation of systematized delusional ideas.

Therapy for senile dementia

If therapy for senile dementia is started in a timely manner and done with the help of properly selected medications, a positive effect can be achieved. Of course, senile dementia is irreversible, so it is impossible to completely cure this disease. However, if desired, the patient's condition can be stabilized and then maintained without allowing it to worsen. In this case, the disease will stop developing, the disintegration of personality will stop, as a result of which the patient will be able to live many more full years of life.

Dementia therapy is prescribed taking into account the “provoking” factors. If pathological processes occur in the brain, its cells gradually die, which leads to the development of the disease. It is impossible to completely cure a person with degenerative pathologies. However, modern medicine makes it possible to slow down the pathological processes that cause gradual destruction of the brain. Drugs alone cannot cure dementia. If the illness is severe, he needs constant care, and therefore needs a nurse. Experts advise not to change the usual environment for such a patient, so as not to aggravate the situation with unnecessary stress. People suffering from dementia should not be sent to nursing homes or psychiatric hospitals. Experts advise people who are showing signs of dementia to move more and also try to show interest in all the things that surround them. Movement is beneficial for anyone, not just the elderly or sick. A sedentary lifestyle can provoke diseases of the joints and lungs, as well as lead to skin problems. To improve the condition of the immune system, experts advise taking multivitamin complexes. In the early stages of the disease, doctors prescribe patients to take nootropic medications that improve brain function.

For older people suffering from insomnia, doctors advise them to rest, but not sleep during the day, to organize their daily routine, to be outdoors as much as possible, and to constantly engage in some activity. If constant insomnia has led to the patient developing a mental disorder or depression, taking a sleeping pill is acceptable. If senile dementia is accompanied by severe anxiety, the patient should take antipsychotic medications.

Treatment at the Echinacea Clinic

Treating older adults with age-related depression, dementia, and vascular problems is a process that requires patience and a positive attitude. We will be happy to help you.

1. If necessary, we will offer you the help of a neurologist, psychiatrist, psychotherapist, cardiologist, examination of the heart and blood vessels, and the necessary laboratory tests.
2. Visits to the clinic are only when absolutely necessary.
3. We need cooperation between the doctor, the patient and his relatives, you must be prepared for this.

What do we do. First of all, we will find out what led to the brain damage. The reasons may be in different combinations:

1. Atherosclerotic plaques;
2. Increased blood clotting with blockage of small and large cerebral vessels;
3. Stroke;
4. Arrhythmias leading to the formation of microthrombi in the vessels of the brain;
5. High blood pressure accompanied by spasm of cerebral vessels;
6. Alzheimer's disease and other primary dementias.

In all these cases, the treatment will be different and will correspond to the source of the problem. For example, drugs to prevent blood clots will not affect the growth of atherosclerotic plaques and will not normalize blood pressure.

Our clinic has the necessary diagnostic capabilities to assess the condition of cerebral vessels, heart rhythm disturbances, blood clotting and cholesterol levels in an elderly person. If any types of diagnostics have already been performed before, be sure to show their results to the doctor, this will help avoid unnecessary tests.

Treatment will be based on the results of the research. It may include a number of medications, diet, daily routine and exercise, psychotherapy and, if necessary, even therapeutic hypnosis.

Preventive measures

Senile dementia never occurs unexpectedly. It is impossible to determine exactly when it started. It always develops gradually, affecting the body of an older person more and more. What are currently just prerequisites can soon become the cause of dementia.

Some indirect signs indicating the need to reboot your brain:

• You often begin to criticize other people, but you perceive criticism addressed to you very poorly.
• You don't want to learn anything new. For example, you don’t want to buy a new mobile phone so as not to understand an unfamiliar device, so you prefer to have your old gadget repaired.
• You often remember the past and feel strong nostalgia for it.
• You can spend hours telling your interlocutor something interesting to you personally, not paying attention to the fact that he is bored listening to it.
• When reading serious literature, you find it difficult to concentrate. You cannot understand and remember what you read. Having read to the middle of the book, you can no longer remember what was said at the beginning of the work.
• You can spend hours talking about issues with which you were previously completely unfamiliar and are completely confident that you understand them well.
• You prefer to watch light, primitive films, not wanting to strain your brain, and you consider the works of cult directors too boring and difficult to understand.
• You are fully confident that those around you are obliged to adapt to your desires and interests.
• Your whole life consists of rituals that are familiar to you. For example, you drink tea from the same cup in the morning, and if this ritual is changed, it will unsettle you for a long time.
• You tyrannize the people around you with your actions, but not out of malice, but only because you consider such behavior to be correct.

Creative people and scientists usually retain a strong memory and clarity of mind into old age. Due to their occupation, these people have to constantly engage in mental work, monitor the emergence of new trends, and try to keep up with the times. Thanks to all this, they manage to maintain clarity of mind for many years, living a full life.

A few tips to help you protect yourself from senile dementia:

• Every few years, learn a new activity. You don't have to go to college to learn new skills. You can simply enroll in courses that teach you a profession or improve your existing qualifications.
• Try to live surrounded by young people. They will help you learn new things that will allow you to keep up with the times.
• Try to constantly search for new and interesting things.
• Systematically solve various intellectual problems, take tests - all this is available in huge quantities on the Internet.
• Take up learning a foreign language. Even if you cannot speak the language fluently, memorizing new words is very useful.
• Try not only to acquire new knowledge, but also to consolidate existing knowledge. Buy school textbooks and periodically look at them, repeating the school curriculum.
• Systematic physical activity helps fight senile dementia, so you should go in for sports.
• Try to train your memory more often, remember poems you previously knew by heart, learn new ones, memorize various dance moves, etc.
• Be open to everything new, try to leave your comfort zone more often. Don't get hung up on your usual rituals, change your habits. Find a new hobby, take different routes to work, etc.
• Try never to limit freedom - your own and other people's. You need to approach everything creatively. The more creative and creative a person is in life, the longer he will be able to maintain the clarity of his mind.

Four simple exercises to help prevent dementia

To protect yourself from the harmful effects of age, you need to exercise systematically. It is necessary to train all organs, including the brain. Try to resist depression and blues, constantly develop your intellect - this will protect you from illness.

The following exercises will help you maintain cognitive functions into old age:

• Multicolored text. This exercise uses a list of words written in colored ink. The color of these words does not match their content. The word "red" is yellow, "black" is green, etc. Looking at each word in turn, name the color that was used to write it - this will help you strengthen the connections between the hemispheres of the brain.
• Schulte table. Find with your eyes one by one all the numbers in order from one to nineteen, and then do the same thing, but in reverse order.
• Finger signs. At the same time, fold the fingers of your left hand in the form of a “peace” sign, and your right hand in the form of an “OK” symbol. Then at the same time change the position of your fingers so that everything is the other way around. Do this exercise several times in a row.
• Synchronous writing. Take 2 sheets of paper, a felt-tip pen and a pencil. Draw different geometric shapes at the same time on different sheets or write different numbers, letters and words.