Dementia associated with mixed diseases. Forms of dementia

The number of people with dementia - dementia - is growing all over the planet, and the aging of the population only contributes to this. Today, one in three people over the age of 85 are living with dementia.

Dementia is a series of diseases associated with impaired cognitive function of the brain. These include memory disorders, lack of criticism, loss of ability to engage in daily activities, personality changes, and others. Alzheimer's disease is the most common form of dementia.
The causes of dementia are not yet fully understood, but it is assumed that genetics and lifestyle play a role. Dr. Helen McPherson, a specialist in brain aging and dementia prevention at Deakin University, in a commentary to the Daily Mail offers several ways in which you can reduce the risk of dementia.

Train your brain

Educated people are thought to have a lower risk of developing dementia than those with less than 10 years of formal education.

At the same time, computer programs of "brain training" are ineffective - a social environment is necessary for successful training of cognitive functions.

Maintain social contacts

Frequent social contacts (visiting relatives, friends, telephone conversations) reduce the risk of developing dementia. Loneliness, on the contrary, can increase it. Therefore, for the prevention of dementia, it is recommended to regularly take part in group or social events, and the size of the team is not of fundamental importance.

Monitor weight, glucose levels and heart health

There is a marked link between heart and brain health. High blood pressure and obesity, especially in adulthood, increase the risk of dementia. Combined, these conditions are responsible for more than 12% of cases of dementia.

Type 2 diabetics are twice as likely to develop dementia than healthy people, according to a study of 40,000 people.

Exercise

The risk of cognitive decline in physically active people is lower by 38%, experts say, based on an analysis of data from 33,000 people.

According to a recent review of studies examining the effectiveness of a four-week exercise regimen, sessions should be of medium to high intensity and last at least 45 minutes.

Do not smoke

In addition, they can cause oxidative stress, in which chemicals (free radicals) can damage cells, contributing to dementia.

Seek help for depression

When depression occurs, changes occur in the brain that increase the risk of dementia, because due to high levels of cortisol (a stress hormone), areas of the brain responsible for memory are reduced.

Vascular disease with subsequent damage to brain structures is observed in both depression and dementia. Researchers believe both of these conditions are the result of long-term oxidative stress and inflammation. There is a hypothesis that depression in old age may be an early symptom of age-related dementia.

A 28-year study of more than 10,000 people showed an increased risk of dementia only in those who had been suffering from depression for at least 10 years prior to diagnosis.

In general, depression before the age of 60 increases the risk of dementia, so it should be treated anyway.

Experts say that the above risk factors cause up to 35% of all cases of dementia. Reducing these factors does not guarantee full protection for dementia, but statistically, at the population level, fewer people will be affected.

From this article you will learn:

What is mixed dementia

What are the causes of mixed dementia?

What are the symptoms of mixed dementia?

Can mixed dementia be cured?

What is the prognosis for life with mixed dementia

Recent studies show that more than two million Russian citizens have been diagnosed with dementia. However, this is not the limit. The World Health Organization notes that worldwide the number of people suffering from this disease by 2030 could reach 80 million. The risk group includes mainly the elderly, their disease manifests itself in the form of serious pathologies of the brain, due to which there is a partial or complete loss of a number of abilities, including mental, speech, etc. Therefore, this disease is best known as "senile dementia" . Next, we will tell you what mixed dementia is, what are its causes and is it possible to cure this disease?

What is mixed dementia

Mixed type dementia is based on severe damage to the central nervous system (CNS). That is, this disease can be caused by a disease of any nature and theology, which results in degenerative changes, the death of cells in the gray matter of the brain.

The varieties of this pathology include dementia, in which the disorder of the central nervous system is caused by diseases that occur and manifest themselves. Namely:

Alzheimer's disease;

epilepsy;

In all other situations, the CNS disorder is secondary. In other words, dementia becomes a complication after the underlying illness. The role of the latter can be trauma, infection, a chronic form of vascular disease, etc.

Let's name the most common causes of mixed dementia:

alcoholism, tumor;

damage to the central nervous system;

head injury;

AIDS and viral encephalitis (less often);

neurosyphilis;

chronic form of meningitis.

The term "mixed dementia" means dementia, in the development and manifestation of which there are mechanisms and symptoms of the lesion:

vascular system;

primary disorder;

destruction of neural connections in the brain.

Most often combines the causes and symptoms of dementia provoked by Alzheimer's disease and Lewy bodies.

Causes of mixed dementia

As we have already mentioned, this disease usually develops against the background of a combination of vascular pathology with Alzheimer's disease (AD). True, the medical world knows other scenarios. So, with mixed dementia, three pathological processes can be detected simultaneously, for example, vascular pathology, neurodegeneration, and the consequences of trauma.

However, it should be noted that the most common combination of AD with vascular pathology in mixed dementia has a logical explanation arising from a number of factors. Let's start with the fact that these pathological processes have the same risk factors: overweight, smoking, persistent high blood pressure, diabetes mellitus, hyperlipidemia, atrial fibrillation, physical inactivity, metabolic syndrome and the presence of the apoE4 gene. With the appearance of one of the diseases in the brain, changes occur, on the basis of which favorable soil is formed for the formation of the second. Further, the patient has a rapid development of mixed dementia.

The brain of a healthy person has a certain reserve of cells, due to which it is possible to compensate for the problems associated with the death of some cells due to vascular diseases. As a result, for some time the disease may go unnoticed by the patient, since the brain is still able to work within the normal range. After vascular disease is supplemented by Alzheimer's disease, more severe damage to neurons occurs. But the body is already deprived of a reserve, as a result, decompensation of brain functions is observed in a short time, symptoms of mixed dementia appear.

During the development of AD in the substance of the brain, senile plaques or accumulations of beta-amyloid are deposited on the walls of its vessels. They cause the development of angiopathy, due to which extensive vascular damage occurs quickly when a cerebrovascular disease is attached.

Of course, the likelihood of a person developing mixed dementia is directly related to his age. So, in middle-aged people, dementias caused by one disease are more common. And the elderly are characterized by dementia, provoked by two or more diseases.

To avoid the development of mixed dementia, it is important to understand what factors can lead to it:

Sedentary lifestyle.

Obesity.

Bad habits.

Atherosclerosis, that is, blockage of blood vessels by cholesterol plaques.

Violation of lipid metabolism.

High blood pressure.

Head injury.

Diabetes.

Heredity, in other words, when close relatives were diagnosed with Alzheimer's disease.

The presence of apolipoprotein B, which are plasma proteins and are involved in cholesterol metabolism. The presence of a subspecies of this protein, anoE4, is a genetic factor in Alzheimer's disease.

Heart rhythm disturbances.

Clinical manifestations of mixed dementia

Symptoms of the disease of any form of dementia, including mixed, have some similarities and depend on the stage and degree of the disease. True, it should be understood that in the case of mixed dementia, the presented disorders occur against the background of Alzheimer's disease, vascular pathologies, in other words, strokes, cerebral ischemia, etc.

Communication problems. A person is deprived of the opportunity to formulate a thought, forgets the meaning of words, the goal that he wanted to achieve with his statement.

Violation of abstract thinking. The simplest arithmetic operations, counting money become impossible for the patient.

Memory problems: gradually fails long-term and short-term. So, a person suffering from mixed dementia may not remember what he did that morning. But at the same time, he perfectly remembers details from early childhood: what clothes he wore, how his beloved grandmother's soup smelled, etc. Gradually, a person forgets his own name, does not remember what a knife and fork are for. The result is a breakdown of personality.

Mood swings. Emotional instability is one of the key signs of dementia.

Difficulties doing routine activities. The patient is not able to remember the order in which he performed any household actions for a long time, he is unable to repeat the things that he had previously done without thinking.

Lack of concentration.

Specialists divide dementia of mixed type into three groups according to the degree of the course of the disease: mild, moderate and severe.

In the first case, despite the fact that a person's working capacity is impaired and he needs supervision, the patient can independently serve himself. He retains critical thinking, that is, the patient is aware of his problem, so he can often worry about this.

Also, specific character traits sometimes appear: a generous person turns into a miser, collects things that seem valuable to him in garbage cans. A persistent person, for example, becomes stubborn, as a result, it is not possible to convince him.

With a moderate degree With mixed dementia, a person almost fails to take care of himself, he needs the help of others to use the simplest household appliances, cook food, and clean up. In other words, such patients do not lose only skills related to hygiene, but already look sloppy.

At this stage of the disease, a person cannot critically assess the situation. Speech, thinking work at the level of the simplest phrases, thoughts. Since serious memory impairment has already occurred, such a patient cannot be left alone at home, as he may forget to turn off the water and gas. Memory disorders are actively progressing, while the failures are replaced by fictitious events.

Often, doctors observe a process that is called pseudo-reminiscence: it seems that events that happened a long time ago have just happened. In this case, older people can rush to the first lesson at school, get ready for the wedding, etc.

With a severe degree there is a disintegration of the personality: a person no longer understands speech, is not able to serve himself. Now he needs constant care, best of all in stationary conditions or in a specialized clinic. The patient's need for food and water is significantly reduced. Now, due to the loss of the ability to chew food, he needs to cook pureed dishes. He had already lost control of his bladder action. It is not uncommon for people at this stage of mixed dementia to no longer be able to walk, sit, or swallow. As a result, there is a complete degradation of the motor apparatus, after which death soon occurs.

Diagnosis of mixed dementia

This diagnosis is made on the basis of the anamnesis, clinical picture and the results of additional studies, indicating the course of two pathological processes at once. But we note that according to the results of MRI or CT of the brain, indicating the presence of focal vascular lesions, areas of cerebral atrophy, mixed vascular dementia is not always diagnosed. According to experts, this diagnosis can be considered justified only if the manifestations or dynamics of dementia are not explained by one disease.

As practice shows, the diagnosis of "mixed dementia" is made in three situations. First of all, with the rapid aggravation of cognitive disorders after a stroke in a patient with AD. Also in the case of progressive dementia with signs of damage to the temporoparietal region, if a stroke has recently been suffered, but no symptoms of dementia have been observed before. The latter - with the simultaneous presence of symptoms of dementia in AD and vascular dementia against the background of signs of cerebrovascular disease and neurodegenerative process according to neuroimaging.

When a diagnosis is made, the doctor must take into account that Alzheimer's disease (especially in the early stages) is rather hidden. There are no dramatic manifestations of stroke, visible changes in the appointment of additional studies. About mixed dementia with damage to the vessels of the brain says a characteristic anamnesis, which includes progressive disorders of cognitive functions, memory problems. Also, the possibility of developing mixed dementia in vascular pathology is evidenced by the presence in the family of people suffering or suffering from BA.

Treatment and prognosis for mixed dementia

Unfortunately, this type of senile dementia is difficult to treat because it is accompanied by other disorders. Therefore, the treatment of mixed dementia requires an integrated approach. That is, it is necessary to eliminate the factors that caused vascular pathologies. Therefore, drugs are prescribed that reduce blood pressure, statins, antiplatelet agents, drugs that improve cerebral circulation. And it is also required to slow down the development of Alzheimer's disease - drug therapy is used to stop the development of dementia. This approach is relevant even at the last stage of mixed dementia.

As we have said, people with mixed dementia are often prone to depression. It negatively affects the activity of patients, depresses their condition. It is important that such a state negatively affects, including cognitive processes. To reduce the negative effect, prescribe antidepressants with minimal side effects. They require course treatment.

But the fight against mixed dementia is not only the use of medications, it is important to ensure the person's safety and constant monitoring. To do this, they install video cameras, blockers for gas stoves and electricity, or invite a nurse. In order for the patient to maintain social skills, he can be sent to group psychotherapy, occupational therapy.

It is not easy to talk about prognosis in mixed dementia, as they depend on a number of factors. In a person who becomes ill after 65 years, the disease can last for several years. For a person diagnosed with this problem after age 85, the disease will be rapid and lead to death in just a few months. Disappointing statistics say that in the United States, senile dementia affects every second person who has lived to be 85 years old. Therefore, we repeat, it is difficult to predict anything unambiguously here.

What is dementia, what are the manifestations of this disease and how to treat it? Another name for this disease is dementia, which covers a large group of symptoms. These manifestations affect the intellectual and social abilities of patients, seriously affecting their everyday life. Today we will find out what the symptoms are, the treatment of this disease. We will also help you figure out how to behave with such a person, how you can help him and what it is desirable to protect him from.

Symptoms depending on the stage of the disease

To understand what dementia is, you need to find out what are the manifestations of this disease. Depending on the period of development of the disease, the symptoms are of the following nature:

At stage 1, the signs of the disease are:

Absent-mindedness.

Loss of track of time.

Loss of orientation in a familiar place.

In stage 2, the symptoms of dementia are:

Behavior appears that is unusual for an ordinary elderly person (aggressiveness, fits of rage, nervousness).

Disease recognition

When the first symptoms of impaired memory, attention, behavior appear, you should quickly contact a specialist who will give you a referral for a series of tests to exclude a disease called dementia. Diagnosis of the disease consists in performing procedures such as:

CT scan.

Radioisotope brain check.

An electroencephalogram is a method for studying the electrical activity of the brain.

Checking blood vessels.

Bacteriological study of cerebrospinal fluid - a fluid circulating in the ventricles of the brain.

Biopsy of the medulla.

General analysis of blood and urine.

Examination by a neurologist, psychiatrist, ophthalmologist.

Types and types of disease

There are two forms of dementia:

1. Total.
2. Partial.

The second point is characterized by serious deviations in the process of short-term memory, at the same time, emotional changes are not particularly pronounced. There is only tearfulness and excessive sensitivity.

Total dementia is characterized by complete personal degradation. A person's intellectual, cognitive, emotional sphere of life is disturbed, his feelings and emotions change radically. For example, the patient loses a sense of shame, duty, vital interests and spiritual values ​​disappear.

An ailment of an atrophic type (these are Alzheimer's and Pick's diseases). It occurs against the background of primary degeneration reactions occurring in the cells of the central nervous system.

It develops due to improper blood circulation in the vascular system of the brain.

A mixed disease is a combination of the first two types of the disease.

Causes

The problems of dementia have been studied for a long time, but still some people do not know that this disease is not at all an effect of evil spirits on a person (as some individuals believe). Also, people do not understand the risk factors for this disease, saying that it is just old age. However, this is not the case at all. Dementia develops as a result of certain circumstances. The reasons for the appearance of this disease are as follows:

Heredity.

The presence of pathologies that lead to the death or degeneration of brain cells.

Skull trauma.

Tumor in the brain.

Alcoholism.

Multiple sclerosis.

Viral encephalitis.

Chronic meningitis.

Neurosyphilis.

Pick's disease

Another name for the disease - frontal dementia suggests the presence of degenerative abnormalities that affected the temporal and frontal parts of the brain. In 50% of cases, Pick's disease appears due to a genetic factor. The onset of the disease is characterized by such changes as:

Passivity and isolation from society;

Silence;

apathy;

Ignoring the norms of decency;

Sexual immorality;

Urinary incontinence;

Bulimia is a mental disorder associated with eating. This disease is characterized by a sharp increase in appetite, which begins with excruciating hunger.

People who are struck by this disease live no more than 10 years. They die from immobility or the development of a genitourinary, pulmonary infection.

Alcoholic dementia: features

This type of dementia occurs as a result of prolonged exposure to alcohol on the brain (for 15-20 years). The state of alcoholic dementia may worsen after the patient completely refuses strong drinks. This type of dementia occurs in older people who drink alcohol regularly. The amount of consumption usually increases from four glasses of wine per week to an unlimited amount per day. With alcoholic dementia, the patient has various mental disorders, including psychosis, depression, anxiety, apathy. There is also a lack of sleep, nocturnal confusion, irritability, anxiety. If a person is not stopped in time and treatment is not started, then he may have a stroke. Therefore, it is necessary in this case not to start the disease and not to ignore the patient.

Treatment of the disease

To date, scientists have not created that miracle pill that could cure the disease. What is dementia, know firsthand 35 million families around the world. This is how many patients were counted by the World Health Organization. But still, you can improve the condition of the affected person by knowing and strictly following the following points:

1. Providing care, maintaining safety in relation to this category of persons.
2. Identification and timely treatment of concomitant diseases.
3. Not belated detection and correction of mental disorders and sleep disorders.
4. Drug therapy.

Treatment with medications for Alzheimer's disease, for example, includes pills such as Amiridin, Memantine, Seleginil. And for the treatment of vascular dementia, solutions such as Galantamine, Nicergoline are used.

To prevent stroke, as a possible cause of dementia, a doctor may prescribe anti-thrombotic drugs that lower blood pressure and lower cholesterol levels. Also, the specialist prescribes medications so that the patient sleeps better. And for behavioral disorders, the doctor may prescribe sedatives, antidepressants, etc.
Treatment of dementia, therefore, is aimed at eliminating the symptoms of the disease, improving memory, mental abilities, and motor functions.

Prevention

What is dementia, found out, now is the time to learn about measures to prevent the development of this disease:

1. Maintaining a healthy lifestyle, without drinking alcohol.
2. It is necessary to carry out mental exercises daily (solving crossword puzzles, puzzles, reading a book and further discussing it, etc.)
3. Normal recovery after a stroke, encephalitis and other diseases, after which dementia may develop.
4. Timely therapy of ailments of internal organs in the elderly.
5. Mandatory control of blood glucose levels.
6. Prevention of the appearance of atherosclerosis (good nutrition and annual determination of the lipid profile - a study of venous blood).
7. Work in non-toxic production conditions.
8. Control of blood cholesterol levels.
9. To give up smoking.

However, it is erroneous to believe that by fulfilling all the above points, this disease will not begin. Dementia has a hereditary factor to a large extent, because many diseases can be passed from generation to generation and they can cause dementia. Therefore, it is necessary to know how to behave towards the affected person and what to pay attention to.

Senile dementia, the signs of which pass from one stage to another, thus progressing, should be adequately perceived by the relatives of the sick person. And for this it is necessary to help your affected relative, improve his quality of life, as well as safety. In this case, you can use the following tips:

1. Prepare a plan for patient care. Such a task must be carried out and for oneself to understand what are the goals of supervision of the elderly. Doctors, lawyers, and other family members should be consulted to create such a plan. Here are the main points to which the relative must answer:

What is the treatment prognosis? What to expect from such therapy?

Does a person necessarily require care for him or can he live alone?

Which family member will be the main person responsible for the patient?

Is there a need to help a person eat, drink medicine, take a bath?

Is it necessary to install security devices in the patient's home (for example, put soft devices on the corners of furniture, buy a special bed, make locks on the windows, install CCTV cameras, etc.)?

Do you need from driving a car?

What are the wishes of the patient himself regarding his treatment and care?

2. Get a special calendar for every day.

In such a diary, it will be necessary to note everything about which the affected person can forget, up to brushing his teeth. And in front of each item you will need to put a tick that has been completed. Close people will thus be able to check everything that the patient does on the calendar, and he, in turn, will be better oriented in everyday affairs and worries.

3. Keep order and immutability of the domestic circle of people.

A constant, quiet and familiar environment will eliminate feelings of anxiety, excitement, confusion. But new situations, things and orders will only interfere with dementia patients, and then they will learn poorly and remember things new to them.

4. Put the affected person to bed on time.

The actions and deeds of the elderly may worsen in the evening due to fatigue or, for example, due to anxiety, anxiety caused by a decrease in light. Therefore, people caring for the sick need to introduce a clear procedure for timely night rest. This requires taking the patient away from the TV or active family members. It is forbidden to give coffee to an elderly person, especially in the afternoon.

The sad experience of people in relation to nursing

People who have personally encountered a problem, seen and cared for a sick family member, quite often share their experiences and spiritual impulses on the Internet. After all, it is unusual and very scary to see how an adult, successful person turns into a child who is not responsible for either his words or actions. Therefore, many people support each other, share their experience in the treatment and prevention of such a disease as dementia. Reviews of people who had to be near a feeble-minded person on the forums say that it is very difficult to control oneself when there is a loved one nearby, but at the same time a stranger. Some pour out their souls, they cry and sob because their beloved grandfather, grandmother, mother, father was overtaken by this illness. However, they still look after their beloved relatives and do not lose hope that they will get better. And this is a completely normal reaction, because everyone wants their loved ones to be healthy and happy. But there are also negative reviews, downright impartial and abusive. People simply cannot stand such a fate of their relative, they are already waiting and will not wait for his death in order to remove such a burden from themselves.

But this is fundamentally wrong. After all, the patient is not to blame for becoming a victim of such an ailment as dementia. Therefore, the task of close people is to treat such mental changes with understanding, one cannot argue and scold a weak-minded person, it is also important to control his behavior. It must be remembered that he is not aware of his actions and words, so he does not need to prove anything, to assure him of something, and even more so to be offended. Also, relatives at the first symptoms of the disease must show their affected family member to the doctors. And experts will help you choose drugs that would improve metabolic processes in the brain, and due to this, the disease will not worsen.

I would like to wish relatives and friends who have such patients in their arms, patience, calmness and understanding. It is necessary to communicate more often with a weak-minded person, because he needs to be well, if the whole family will support the one who provides full-fledged care for the sick, as well as who is actually affected, and will also help and control his behavior.

Now you know what is senile dementia, symptoms, treatment of dementia in the elderly. It was determined that if a person has primary signs of the disease, then a visit to specialists should not be shelved, otherwise the disease will only progress. And at the first stage of illness, doctors will be able to help the patient as much as possible by prescribing medications that improve memory and metabolic processes in the brain. It is also important to take proper care of such a family member, because he obviously will not help himself in this situation.

dementia represents the most severe clinical variant of cognitive dysfunction in the elderly. Dementia is a diffuse disorder of mental functions as a result of organic brain damage, manifested by primary disorders of thinking and memory and secondary emotional and behavioral disorders. Y. Melikhov wrote: “ The most evil cartoons are drawn by time ».

Dementia occurs in 10% of people over 65, and in people over 80 it reaches 15-20%. There are currently 24.3 million people with dementia worldwide. At the same time, by 2040 the number of patients with dementia will reach 81.1 million.

At the stage of dementia, the patient completely or partially loses his independence and independence, often needs outside care. For example, Gerald Ford wrote about former US President Ronald Reagan: It was sad. I stayed with him for half an hour. I tried to remind him of various episodes of our friendship, but, unfortunately, nothing came of it ...". Below are paintings painted in different years by the German artist K. Horn, who suffered from dementia.

« The roles have been played out, but we have already forgotten how to live "(V. Scheucher).

In line with this, Reisberg et al. (1998) suggested the concept (theory) of retrogenesis (reverse development). It has been proven that the presence of dementia not only reduces the adaptation of a person in society, but also increases mortality by 2.5 times compared to persons without dementia (4th place in the structure of mortality). In addition, dementia ranks third among the "costly" diseases. For example, in the United States, the cost of treating one patient with dementia per year is $40,000.

Dementia is a syndrome that develops with a variety of brain diseases. The literature describes more than 100 nosological forms that can lead to dementia.

widely used in the diagnosis of dementia. ICD-10 diagnostic criteria:

Criteria for the severity of dementia

Light

Medium

heavy

The most common cause of dementia is Alzheimer's disease(at least 40% of cases of dementia). AT basis of Alzheimer's disease lies accumulation of abnormal β-amyloid protein with neurotoxic properties.

According to ICD-10, dementia of the Alzheimer's type is divided into:

With this pathology in the foreground are progressive memory impairments for current, and then to more distant events, in combination with disorders of spatial orientation, speech and other cognitive functions.

Criteria for the diagnosis of "probable Alzheimer's disease"
(G. McKahn et al., 1984):

Mandatory signs:

Additional diagnostic features:

Signs that do not contradict the diagnosis of Alzheimer's disease (after excluding other diseases of the central nervous system):

Signs that exclude the diagnosis of Alzheimer's disease:

In 10-15% of cases, vascular dementia develops. Under the term "vascular dementia"(1993) it is customary to understand several clinical-pathomorphological and clinical-pathogenetic syndromes, common to which is the relationship of cerebrovascular disorders with cognitive impairment.

According to ICD-10 vascular dementia subdivided into:

Pathophysiological classification of vascular dementia(Chui, 1993):

Criteria clinical diagnosis of "probable vascular dementia"
(G. Roman et al., 1993):

key question is to establish a reliable cause of the association between cerebrovascular disease and dementia. This requires the presence of one or two of the following features:

or stepwise progression of a cognitive defect.

The main clinical manifestations of vascular dementia
according to T. Erkinjuntti (1997) modified.

The course of the disease

Neurological/psychiatric symptoms

Accompanying illnesses

History of cardiovascular diseases (not in all cases): arterial hypertension, coronary heart disease

instrumental data

CT or MRI: focal infarcts (70-90%), diffuse or "spotted" (irregular) changes in the white matter (in 70-100% of cases), especially if pronounced changes capture more than 25% of the total area of ​​the white matter.

Single photon emission computed tomography: "spotted" (irregular) decrease in regional cerebral blood flow.

EEG: in the case of EEG changes, focal disturbances are characteristic.

Laboratory data

There are no specific tests.

According to the literature, 50-60% of cases of vascular dementia are associated with stroke(especially repetitive). Thus, a stroke increases the risk of developing dementia by 5-9 times. The overall prevalence of dementia in patients with stroke is 20-25%. " The softening of the brain is manifested in the firmness of the position "(V. Scheucher).

The presence of dementia significantly increases the mortality of post-stroke patients (37% higher compared to persons without dementia) and reduces the quality of rehabilitation treatment (i.e., dementia can be considered as a "negative predictor" of the effectiveness of rehabilitation measures). At the same time, the presence of dementia increases the cost of rehabilitation treatment by 10 times or more.

The most important risk factors development of vascular dementia are arterial hypertension, heart disease (including heart surgery) and diabetes mellitus. The prevalence of arterial hypertension among people over 60 reaches 80%. The most common form (up to 70%) of arterial hypertension in the elderly is the so-called isolated systolic arterial hypertension(SBP>140 mm Hg and DBP<90 мм рт. ст.). Артериальная гипертония приводит к изменениям сосудистой стенки (липогиалиноз), преимущественно в сосудах микроциркуляторного русла. Вследствие этого развивается артериолосклероз, что обусловливает изменение физиологической реактивности сосудов. По данным НИИ неврологии (2005), лишь только в 35% случаев у больных с цереброваскулярной патологией на фоне артериальной гипертонии отмечается физиологическая нормальная цереброваскулярная реактивность (по данным пробы с нитроглицерином). В остальных же случаях ответная реакция может быть физиологической сниженной (19%), разнонаправленной (23%), извращенной (13%) и отсутствовать (10%). В таких условиях снижение артериального давления (в том числе вследствие неадекватной гипотензивной терапии) приводит к снижению перфузии и развитию ишемии белого вещества головного мозга.

In the elderly, the prevalence of coronary heart disease exceeds 20%, while there is a diffuse and more pronounced lesion of all three main coronary arteries (painless forms of the disease are more often detected) and the severity of coronary heart disease with frequent deaths. The consequence of this pathology is a decrease in cardiac output, a decrease in arterial blood flow to the vessels of the brain, and a decrease in its blood supply. The resulting hypoxia of the brain contributes to the deterioration of cognitive functions.

The incidence of brain pathology after CABG varies from 2 to 8% (mean 5%). According to Roach G.W. et al. (1996) neurological complications of heart surgery are divided into:

According to statistics, cognitive impairment after CABG ranges from 12 to 79%.

The main mechanisms of brain damage in patients undergoing CABG under cardiopulmonary bypass:

Massive cerebral embolism as a complication of cardiac surgery is relatively rare. According to Barbut D. et al. (1996), cerebral microembolism during heart surgery using cardiopulmonary bypass is recorded in 100% of patients. According to Pugsley et al. (1994), in the case of detection of 1000 or more microembolic signals (TCD method), changes in the neuropsychological status 8 weeks after surgery are observed in 43% of patients, while with the registration of 200 or less microembolic signals, this figure is 8.6%.

As for diabetes, according to the figurative expression of A. Efimov, "... diabetes begins as a metabolic disease, and ends as a vascular pathology." At the same time, even despite the usefulness of hypoglycemic therapy, the incidence of diabetic encephalopathy (as a manifestation of central neuropathy), the clinical picture of which is dominated by cognitive impairment, reaches 78%. It should be noted that the previous hypoglycemic conditions have a pronounced effect on the development of memory disorders in diabetes mellitus.

However, in recent years, much attention has been paid to mixed dementia(10-15% among all dementias). For example, stroke can be considered as the direct cause of dementia in only 50% of patients with post-stroke dementia. In other cases, the nature of the cognitive defect is of the primary degenerative (often Alzheimer's) nature of dementia or a combination of vascular and Alzheimer's changes (mixed dementia). Such a frequent combination is explained by the presence of common risk factors. Table 2 presents the main risk factors for cardiovascular disease that can trigger the development of Alzheimer's disease.

table 2

Dementia defines an acquired form of dementia, in which patients experience a loss of previously acquired practical skills and acquired knowledge (which can occur in varying degrees of intensity of manifestation), while at the same time a persistent decrease in their cognitive activity. Dementia, the symptoms of which, in other words, are manifested in the form of a breakdown of mental functions, is most often diagnosed in old age, but the possibility of its development at a young age is not excluded.

general description

Dementia develops as a result of damage to the brain, against which the marked disintegration of mental functions occurs, which generally makes it possible to distinguish this disease from mental retardation, congenital or acquired forms of dementia. Mental retardation (it is also oligophrenia or dementia) implies a stop in the development of the personality, which also occurs with brain damage as a result of certain pathologies, but predominantly manifests itself in the form of damage to the mind, which corresponds to its name. At the same time, mental retardation differs from dementia in that with it the intellect of a person, a physically adult, does not reach normal levels corresponding to his age. In addition, mental retardation is not a progressive process, but is the result of a disease suffered by a sick person. However, in both cases, and when considering dementia, and when considering mental retardation, there is a development of a disorder of motor skills, speech and emotions.

As we have already noted, dementia overwhelmingly affects people in old age, which determines its type as senile dementia (it is this pathology that is usually defined as senile insanity). However, dementia also appears in youth, often as a result of addictive behavior. Addiction implies nothing more than addictions or addictions - a pathological attraction, in which there is a need to perform certain actions. Any type of pathological attraction increases the risk of a person developing mental illness, and often this attraction is directly related to social or personal problems that exist for him.

Often, addiction is used in connection with such phenomena as drug addiction and drug dependence, but more recently, another type of addiction has been identified for it - non-chemical addictions. Non-chemical addictions, in turn, define psychological addiction, which itself acts as an ambiguous term in psychology. The fact is that predominantly in the psychological literature this kind of dependence is considered in a single form - in the form of dependence on narcotic substances (or intoxicating substances).

However, if we consider this type of addiction at a deeper level, this phenomenon also occurs in the everyday mental activity that a person encounters (hobbies, hobbies), which, thereby, determines the subject of this activity as an intoxicating substance, as a result of which he, in in turn, is considered as a source-substitute, causing certain missing emotions. This includes shopaholism, Internet addiction, fanaticism, psychogenic overeating, gambling addiction, etc. At the same time, addiction is also considered as a way of adaptation, through which a person adapts to conditions that are difficult for him. Under the elementary agents of addiction are considered drugs, alcohol, cigarettes, which create an imaginary and short-term atmosphere of "pleasant" conditions. A similar effect is achieved when performing relaxation exercises, when resting, as well as during actions and things that cause short-term joy. In any of these options, after their completion, a person has to return to reality and conditions from which he managed to “leave” in such ways, as a result of which addictive behavior is seen as a rather complex problem of internal conflict, based on the need to avoid specific conditions, against which background and there is a risk of developing mental illness.

Returning to dementia, we can highlight the current data provided by WHO, on the basis of which it is known that the world incidence rates are about 35.5 million people with this diagnosis. Moreover, it is assumed that by 2030 this figure will reach 65.7 million, and by 2050 it will be 115.4 million.

With dementia, patients are not able to realize what is happening to them, the disease literally “erases” everything from their memory that accumulated in it during the previous years of life. Some patients experience the course of such a process at an accelerated pace, which is why they quickly develop total dementia, while other patients can linger for a long time at the stage of the disease as part of cognitive-mnestic disorders (intellectual-mnestic disorders) - that is, with mental performance disorders, a decrease in perception, speech and memory. In any case, dementia not only determines the outcome for the patient in the form of problems of an intellectual scale, but also problems in which many human personality traits are lost. The severe stage of dementia determines for patients dependence on others, maladjustment, they lose the ability to perform the simplest actions related to hygiene and food intake.

Causes of dementia

The main causes of dementia are the presence of Alzheimer's disease in patients, which is defined, respectively, as dementia of the Alzheimer's type, as well as with actual vascular lesions to which the brain is exposed - the disease is defined in this case as vascular dementia. Less often, any neoplasms that develop directly in the brain act as causes of dementia, and this also includes craniocerebral injuries ( non-progressive dementia ), diseases of the nervous system, etc.

The etiological significance in considering the causes leading to dementia is assigned to arterial hypertension, systemic circulatory disorders, lesions of the main vessels against the background of atherosclerosis, arrhythmias, hereditary angiopathy, repeated disorders relevant to cerebral circulation. (vascular dementia).

As etiopathogenetic variants leading to the development of vascular dementia, its microangiopathic variant, macroangiopathic variant and mixed variant are distinguished. This is accompanied by multi-infarct changes occurring in the substance of the brain and numerous lacunar lesions. In the macroangiopathic variant of the development of dementia, such pathologies as thrombosis, atherosclerosis and embolism are isolated, against the background of which occlusion develops in a large artery of the brain (a process in which the lumen narrows and the vessel is blocked). As a result of such a course, a stroke develops with symptoms corresponding to the affected pool. As a result, vascular dementia subsequently develops.

As for the next, microangiopathic variant of development, here angiopathy and hypertension are considered as risk factors. The features of the lesion in these pathologies lead in one case to demyelination of the white subcortical substance with the simultaneous development of leukoencephalopathy, in the other case they provoke the development of a lacunar lesion, against which Binswanger's disease develops, and due to which, in turn, dementia develops.

In about 20% of cases, dementia develops against the background of alcoholism, the appearance of tumor formations and the previously mentioned traumatic brain injuries. 1% of the incidence is due to dementia due to Parkinson's disease, infectious diseases, degenerative diseases of the central nervous system, infectious and metabolic pathologies, etc. Thus, a significant risk is determined for the development of dementia against the background of current diabetes mellitus, HIV, infectious diseases of the brain (meningitis, syphilis) , thyroid dysfunction, diseases of internal organs (renal or liver failure).

Dementia in the elderly by the nature of the process is irreversible, even if the possible factors that provoked it (for example, taking medications and canceling them) are eliminated.

Dementia: classification

Actually, on the basis of a number of the listed features, the types of dementia are determined, namely senile dementia and vascular dementia . Depending on the degree of social adaptation relevant to the patient, as well as the need for supervision and receiving third-party assistance, in combination with his ability to self-service, the corresponding forms of dementia are distinguished. So, in the general variant of the course, dementia can be mild, moderate or severe.

mild dementia implies a condition in which a sick person is faced with degradation in terms of his professional skills, in addition to this, his social activity is also reduced. Social activity in particular means a reduction in the time spent for everyday communication, thereby spreading to the immediate environment (colleagues, friends, relatives). In addition, in a state of mild dementia, patients also lose interest in the conditions of the outside world, as a result of which it is important to abandon their usual options for spending free time, from hobbies. Mild dementia is accompanied by the preservation of existing self-care skills, in addition, patients are adequately oriented within the limits of their home.

moderate dementia leads to a state in which patients can no longer be alone with themselves for a long period of time, which is caused by the loss of skills to use the equipment and devices that surround them (remote control, telephone, stove, etc.), even difficulties are not excluded using door locks. Requires constant monitoring and assistance from others. As part of this form of the disease, patients retain the skills to self-care and perform activities related to personal hygiene. All this, accordingly, complicates the life and environment of patients.

With regard to such a form of the disease as severe dementia, here we are already talking about the absolute maladjustment of patients to what surrounds them, while at the same time the need to provide constant assistance and control, which is necessary even for performing the simplest actions (eating, dressing, hygiene measures, etc.).

Depending on the location of the brain lesion, the following types of dementia are distinguished:

• cortical dementia - the lesion predominantly affects the cerebral cortex (which occurs against the background of conditions such as lobar (frontotemporal) degeneration, alcoholic encephalopathy, Alzheimer's disease);
• subcortical dementia - in this case, subcortical structures are predominantly affected (multi-infarct dementia with white matter damage, supranuclear progressive paralysis, Parkinson's disease);
• cortical-subcortical dementia (vascular dementia, cortical-basal form of degeneration);
• multifocal dementia - many focal lesions are formed.

The classification of the disease we are considering also takes into account dementia syndromes that determine the appropriate variant of its course. In particular, this may be lacunar dementia , which implies a predominant memory lesion, manifested in the form of a progressive and fixative form of amnesia. Compensation for such a defect by patients is possible due to important notes on paper, etc. In this case, the emotional-personal sphere is slightly affected, because the core of the personality is not subject to damage. Meanwhile, the appearance of emotional lability (instability and changeability of moods), tearfulness and sentimentality in patients is not excluded. Alzheimer's disease is an example of this type of disorder.

Dementia of the Alzheimer's type , the symptoms of which appear after the age of 65, within the initial (initial) stage, proceeds in combination with cognitive-mnestic disorders with an increase in disorders in the form of orientation in place and time, delusional disorders, the appearance of neuropsychological disorders, subdepressive reactions in relation to one's own insolvency . At the initial stage, patients are able to critically assess their condition and take measures to correct it. Moderate dementia within the framework of this condition is characterized by the progression of the listed symptoms with a particularly gross violation of the inherent functions of the intellect (difficulties in conducting analytical and synthetic activities, a reduced level of judgment), the loss of opportunities to perform professional duties, and the need for care and support. All this is accompanied by the preservation of basic personality traits, a sense of one's own inferiority with an adequate response to an existing disease. In the severe stage of this form of dementia, the breakdown of memory occurs in full, support and care are needed in everything and constantly.

The following syndrome is considered total dementia. It implies the appearance of gross forms of violations of the cognitive sphere (violation of abstract thinking, memory, perception and attention), as well as personality (moral disorders are already distinguished here, in which their forms such as modesty, correctness, politeness, sense of duty, etc.) disappear. . In the case of total dementia, as opposed to lacunar dementia, the destruction of the personality core becomes relevant. Vascular and atrophic forms of damage to the frontal lobes of the brain are considered as the causes leading to the considered state. An example of such a state is Pick's disease .

This pathology is diagnosed less frequently than Alzheimer's disease, mainly among women. Among the main characteristics, actual changes are noted within the emotional-personal sphere and the cognitive sphere. In the first case, the condition implies gross forms of personality disorder, a complete lack of criticism, spontaneous, passive and impulsive behavior; relevant hypersexuality, foul language and rudeness; assessment of the situation is disturbed, there are disorders of drives and will. In the second, with cognitive disorders, there are gross forms of impaired thinking, automated skills persist for a long time; memory disorders are noted much later than personality changes, they are not as pronounced as in the case of Alzheimer's disease.

Both lacunar and total dementia are generally atrophic dementias, while there is also a variant of a mixed form of the disease. (mixed dementia) , which implies a combination of primary degenerative disorders, which mainly manifests itself in the form of Alzheimer's disease, and a vascular type of brain damage.

Dementia: symptoms

In this section, we will consider in a generalized form those signs (symptoms) that characterize dementia. As the most characteristic of them, disorders associated with cognitive functions are considered, and such disorders are the most pronounced in their own manifestations. No less important clinical manifestations are emotional disorders in combination with behavioral disorders. The development of the disease occurs gradually (often), its detection most often occurs as part of an exacerbation of the patient's condition, which occurs due to changes in the environment surrounding him, as well as during an exacerbation of a somatic disease that is relevant to him. In some cases, dementia can manifest itself in the form of aggressive behavior of a sick person or sexual disinhibition. In the case of personality changes or changes in the behavior of the patient, the question is raised about the relevance of dementia for him, which is especially important if he is over 40 years old and if he does not have a mental illness.

So, let us dwell in more detail on the signs (symptoms) of the disease of interest to us.

• Cognitive disorders. In this case, disorders of memory, attention and higher functions are considered.
  • Memory disorders. Memory disorders in dementia consist in the defeat of both short-term memory and long-term memory, in addition, confabulations are not excluded. Confabulation specifically refers to false memories. Facts from them that occur earlier in reality or facts that occur earlier, but have undergone a certain modification, are transferred by the patient to another time (often in the near future) with their possible combination with events completely fictional by them. A mild form of dementia is accompanied by moderate memory impairment, they are mainly associated with events that occur in the recent past (forgetting conversations, phone numbers, events that occurred within a certain day). Cases of a more severe course of dementia are accompanied by the retention of only previously memorized material in memory with a quick forgetting of newly received information. The last stages of the disease may be accompanied by forgetting the names of relatives, one's own occupation and name, this manifests itself in the form of personal disorientation.
  • Attention disorder. In the case of the disease of interest to us, this disorder implies the loss of the ability to respond to several relevant stimuli at once, as well as the loss of the ability to switch attention from one topic to another.
  • Disorders associated with higher functions. In this case, the manifestations of the disease are reduced to aphasia, apraxia and agnosia.
    • Aphasia implies a speech disorder, in which the ability to use phrases and words as a means of expressing one's own thoughts is lost, which is caused by actual damage to the brain in certain areas of its cortex.
    • Apraxia indicates a violation in the patient's ability to perform targeted actions. In this case, the skills previously acquired by the patient are lost, and those skills that have been formed over many years (speech, everyday, motor, professional).
    • agnosia determines a violation of various types of perception in a patient (tactile, auditory, visual) while maintaining consciousness and sensitivity.
• orientation disorder. This type of violation occurs in time, and mainly - within the initial stage of the development of the disease. In addition, disorientation in temporal space precedes disorientation on the scale of orientation on the spot, as well as within the framework of one's own personality (here, the symptom differs in dementia from delirium, the features of which determine the preservation of orientation within the framework of considering one's own personality). The progressive form of the disease with advanced dementia and pronounced manifestations of disorientation on the scale of the surrounding space determines for the patient the likelihood that he can freely get lost even in a familiar environment.
• Behavioral disorders, personality changes. The onset of these manifestations is gradual. The main features inherent in the personality gradually increase, transforming to the states inherent in this disease as a whole. So, energetic and cheerful people become restless and fussy, and people who are thrifty and tidy, respectively, become greedy. Similarly, transformations inherent in other features are considered. In addition, there is an increase in egoism in patients, the disappearance of responsiveness and sensitivity to the environment, they become suspicious, conflicting and touchy. Sexual disinhibition is also determined, sometimes patients begin to wander and collect various rubbish. It also happens that patients, on the contrary, become extremely passive, they lose interest in communication. Untidiness is a symptom of dementia that occurs in accordance with the progression of the general picture of the course of this disease, it is combined with the unwillingness of self-service (hygiene, etc.), with uncleanliness and, in general, a lack of reaction to the presence of people next to them.
• Thinking disorders. There is a slowdown in the pace of thinking, as well as a decrease in the ability to think logically and abstract. Patients lose the ability to generalize and solve problems. Their speech is detailed and stereotyped, its scarcity is noted, and with the progression of the disease, it is completely absent. Dementia is also characterized by the possible appearance of delusional ideas in patients, often with ridiculous and primitive content. So, for example, a woman with dementia with a thought disorder before the appearance of delusional ideas may claim that her mink coat was stolen from her, and this action may go beyond her environment (ie, family or friends). The essence of the nonsense in such an idea lies in the fact that she never had a mink coat at all. Dementia in men within the framework of this disorder often develops according to the scenario of delirium based on jealousy and infidelity of the spouse.
• Reducing the critical attitude. We are talking about the attitude of patients both to themselves and to the world around them. Stressful situations often lead to the appearance of acute forms of anxiety-depressive disorders (defined as a "catastrophic reaction"), in which there is a subjective awareness of intellectual inferiority. Partially preserved criticism in patients determines the possibility for them to preserve their own intellectual defect, which may look like a sharp change in the topic of conversation, turning the conversation into a joking form, or otherwise distracting from it.
• Emotional disorders. In this case, it is possible to determine the diversity of such disorders and their general variability. Often these are depressive states in patients, combined with irritability and anxiety, anger, aggression, tearfulness, or, conversely, a complete lack of emotions in relation to everything that surrounds them. Rare cases determine the possibility of developing manic states in combination with a monotonous form of carelessness, with gaiety.
• Perceptual disorders. In this case, the states of the appearance of illusions and hallucinations in patients are considered. For example, with dementia, the patient is sure that he hears the screams of children being killed in it in the next room.

Senile dementia: symptoms

In this case, a similar definition of the state of senile dementia is the previously indicated senile dementia, senile insanity or senile dementia, the symptoms of which occur against the background of age-related changes occurring in the structure of the brain. Such changes occur within the framework of neurons, they arise as a result of insufficient blood supply to the brain, the impact on it of acute infections, chronic diseases and other pathologies, which we discussed in the corresponding section of our article. We also repeat that senile dementia is an irreversible disorder that affects each of the areas of the cognitive psyche (attention, memory, speech, thinking). With the progression of the disease, there is a loss of all skills and abilities; it is extremely difficult, if not impossible, to acquire new knowledge in senile dementia.

Senile dementia, being among the mental illnesses, is the disease most common among the elderly. Senile dementia is almost three times more common in women than in men. In most cases, the age of patients is 65-75 years, on average in women the disease develops at 75 years, in men - at 74 years.
Senile dementia manifests itself in several varieties of forms, manifesting itself in a simple form, in the form of presbyophrenia and in the psychotic form. The specific form is determined by the current rate of atrophic processes in the brain, somatic diseases associated with dementia, as well as by constitutional and genetic factors.

simple form characterized by low visibility, flowing in the form of disorders generally inherent in aging. With an acute onset, there is reason to believe that pre-existing mental disorders have been aggravated due to one or another somatic disease. There is a decrease in mental activity in patients, which is manifested in a slowdown in the pace of mental activity, in its quantitative and qualitative deterioration (it implies a violation of the ability to concentrate and switch attention, its volume narrows; the ability to generalize and analyze, to abstract and, in general, weakens the imagination is disturbed; the ability for ingenuity and resourcefulness is lost in the framework of solving problems that arise in everyday life).

Increasingly, a sick person adheres to conservatism in terms of their own judgments, worldview and actions. What is happening in the present tense is considered as something insignificant and not worthy of attention, and often is completely rejected. Returning to the past, the patient primarily perceives it as a positive and worthy model in certain life situations. A characteristic feature is a tendency to edification, intractability bordering on stubbornness and increased irritability arising from contradictions or disagreement on the part of the opponent. Pre-existing interests are narrowed to a great extent, especially if they are in one way or another connected with general issues. Increasingly, patients are focusing their own attention on their physical condition, especially physiological functions (ie, bowel movements, urination).

In patients, affective resonance also decreases, which is manifested in the growth of complete indifference to what does not directly concern them. In addition, attachments are also weakening (this applies even to relatives), in general, understanding of the essence of relations between people is lost. Many lose their modesty and sense of tact, and the range of shades of mood is also subject to narrowing. Some patients may show carelessness and general complacency, while adhering to monotonous jokes and a general tendency to jokes, while in other patients discontent, captiousness, capriciousness and pettiness prevail. In any case, the past characterological traits inherent in patients become scarce, and the awareness of personality changes that have arisen either disappears early or does not occur at all.

The presence of pronounced forms of psychopathic traits before the disease (especially those that are sthenic, this applies to authority, greed, categoricalness, etc.) leads to their exacerbation in manifestation at the initial stage of the disease, often to a caricature form (which is defined as senile psychopathization ). Patients become stingy, begin to accumulate rubbish, on their part, various reproaches against the immediate environment are increasingly heard, in particular, this concerns the irrationality, in their opinion, of expenses. Also, morals that have developed in public life are subject to censure on their part, especially in relation to marital relations, intimate life, etc.
The initial psychological shifts, combined with the personality changes that occur with them, are accompanied by a deterioration in memory, in particular, this applies to current events. Surrounding patients, they are noticed, as a rule, later than the changes that have occurred in their character. The reason for this is to revive the memories of the past, which is perceived by the environment as a good memory. Its decay actually corresponds to the patterns that are relevant for a progressive form of amnesia.

So, first, the memory associated with differentiated and abstract topics (terminology, dates, titles, names, etc.) comes under attack, then the fixative form of amnesia is added here, manifesting itself in the form of an inability to remember current events. Amnestic disorientation with respect to time also develops (i.e. patients are not able to indicate a specific date and month, day of the week), chronological disorientation also develops (the impossibility of determining important dates and events with their binding to a specific date, regardless of whether such dates concern private life or public life). On top of this, spatial disorientation develops (it manifests itself, for example, in a situation where, when leaving the house, patients cannot return, etc.).

The development of total dementia leads to a violation of self-recognition (for example, when looking at oneself in the reflection). Forgetting the events of the present is replaced by the revival of memories relating to the past, often this can relate to youth or even childhood. Often, such a time substitution leads to the fact that patients begin to "live in the past", considering themselves young or children, depending on the time at which such memories fall. Stories about the past in this case are reproduced as events relating to the present time, while it is not excluded that these memories are generally fiction.

The initial periods of the course of the disease can determine the mobility of patients, the accuracy and speed of performing certain actions, motivated by random necessity or, conversely, habitual performance. Physical insanity is noted already within the framework of a far-reaching disease (complete disintegration of behavior patterns, mental functions, speech skills, often with the relative preservation of skills of somatic functions).

With a pronounced form of dementia, the states of apraxia, aphasia and agnosia considered by us earlier are noted. Sometimes these disorders manifest themselves in a sharp form, which may resemble the picture of the course of Alzheimer's disease. Few and single epileptic seizures similar to fainting are possible. Sleep disturbances appear in which patients fall asleep and get up at an indefinite time, and the duration of their sleep is on the order of 2-4 hours, reaching an upper limit of about 20 hours. In parallel with this, periods of prolonged wakefulness may develop (regardless of the time of day).

The final stage of the disease determines for patients the achievement of a state of cachexia, in which an extreme pronounced form of exhaustion sets in, in which there is a sharp weight loss and weakness, reduced activity in terms of physiological processes with concomitant changes in the psyche. In this case, the adoption of the fetal position is characteristic when the patients are in a drowsy state, there is no reaction to surrounding events, sometimes muttering is possible.

Vascular dementia: symptoms

Vascular dementia develops against the background of the previously mentioned disorders that are relevant for cerebral circulation. In addition, as a result of the study of brain structures in patients after their death, it was revealed that vascular dementia often develops after a heart attack. More precisely, the point is not so much in the transfer of the specified condition, but in the fact that because of it a cyst is formed, which determines the subsequent likelihood of developing dementia. This probability is determined, in turn, not by the size of the cerebral artery affected, but by the total volume of the cerebral arteries that have undergone necrosis.

Vascular dementia is accompanied by a decrease in indicators that are relevant for cerebral circulation in combination with metabolism, otherwise the symptoms correspond to the general course of dementia. When the disease is combined with a lesion in the form of laminar necrosis, in which glial tissue grows and neurons die, the possibility of developing serious complications (blockage of blood vessels (embolism), cardiac arrest) is allowed.

As for the predominant category of people who develop the vascular form of dementia, in this case, the data indicate that this predominantly includes people aged 60 to 75 years, and one and a half times more often these are men.

Dementia in children: symptoms

In this case, the disease, as a rule, acts as a symptom of certain diseases in children, which can be oligophrenia, schizophrenia, and other types of mental disorders. This disease develops in children with a decrease in mental abilities characteristic of it, this manifests itself in a violation of memorization, and in severe cases of the course, difficulties arise even with remembering one's own name. The first symptoms of dementia in children are diagnosed early, in the form of loss of certain information from memory. Further, the course of the disease determines the appearance of disorientation in them within the framework of time and space. Dementia in young children manifests itself in the form of a loss of skills previously acquired by them and in the form of a speech disorder (up to its complete loss). The final stage, similar to the general course, is accompanied by the fact that patients cease to follow themselves, they also lack control over the processes of defecation and urination.

Within childhood, dementia is inextricably linked with oligophrenia. Oligophrenia, or, as we previously defined it, mental retardation, is characterized by the relevance of two features related to an intellectual defect. One of them is that mental underdevelopment is total, that is, both the child's thinking and his mental activity are subject to defeat. The second feature is that with general mental underdevelopment, the “young” functions of thinking are most affected (young - when considered on a phylo- and ontogenetic scale), they are identified as underdeveloped, which makes it possible to attach the disease to oligophrenia.

Intellectual deficiency of a persistent type, which develops in children over the age of 2-3 years against the background of injuries and infections, is defined as organic dementia, the symptoms of which are manifested due to the decay of relatively formed intellectual functions. Such symptoms, due to which it is possible to differentiate this disease from oligophrenia, include:

• lack of mental activity in its purposeful form, lack of criticism;
• a pronounced type of memory and attention impairment;
• emotional disturbances in a more pronounced form, not correlating (i.e., not associated) with the degree of decrease in intellectual abilities that is relevant for the patient;
• frequent development of violations relating to instincts (perverted or increased forms of attraction, performance of actions under the influence of increased impulsivity, weakening of existing instincts (self-preservation instinct, lack of fear, etc.) is not excluded;
• often the behavior of a sick child does not adequately correspond to a specific situation, which also occurs if a pronounced form of intellectual deficiency is irrelevant for him;
• in many cases, the differentiation of emotions is also subject to weakening, there is no attachment to loved ones, and the child is completely indifferent.

Diagnosis and treatment of dementia

Diagnosis of the condition of patients is based on a comparison of their actual symptoms, as well as on the recognition of atrophic processes in the brain, which is achieved through computed tomography (CT).

As far as the treatment of dementia is concerned, there is currently no effective treatment, especially when considering cases of senile dementia, which, as we have noted, is irreversible. Meanwhile, proper care and the use of therapeutic measures aimed at suppressing symptoms can, in some cases, seriously alleviate the patient's condition. It also considers the need to treat concomitant diseases (with vascular dementia in particular), such as atherosclerosis, arterial hypertension, etc.

Treatment of dementia is recommended within the framework of a home environment, placement in a hospital or a psychiatric department is relevant for a severe degree of development of the disease. It is also recommended to create a daily regimen so that it includes a maximum of vigorous activity with periodic household chores (with an acceptable form of load). The appointment of psychotropic drugs is made only in the case of hallucinations and insomnia, in the early stages it is advisable to use nootropic drugs, then - nootropic drugs in combination with tranquilizers.

Prevention of dementia (in the vascular or senile form of its course), as well as effective treatment of this disease, is currently excluded due to the practical absence of appropriate measures. When symptoms appear that indicate dementia, a visit to such specialists as a psychiatrist and a neurologist is necessary.