Dementia - what is this disease? Causes, Symptoms and Treatment

Dementia is an acquired form of dementia, in which patients have a loss of previously acquired practical skills and acquired knowledge, while simultaneously steadily reducing their cognitive activity.

Dementia, the symptoms of which, in other words, manifest themselves in the form of the disintegration of mental functions, are most often diagnosed in old age, but the possibility of its development at a young age is not ruled out. In the most severe cases a person is not able to realize what is happening to him, where he is, ceases to recognize someone and needs constant extraneous care.

Depending on the level of social adaptation and the need for help, there are several forms of dementia: mild, moderate and severe.

Dementia - what is it?

This disease develops as a result of brain damage, against which there is a marked disintegration of mental functions, which as a whole, makes it possible to distinguish this disease from mental retardation, congenital or acquired form of dementia. Mental retardation (it is - oligophrenia or low-mindedness) implies a stopping of personality development, which also occurs with the defeat of the head the brain as a result of certain pathologies, but in a prevailing way manifests itself in the form of defeat of the mind, which corresponds to its name. At the same time, mental retardation differs from dementia in that the intellect of a person, an adult physically, does not reach the normal parameters, its age, corresponding to it. In addition, mental retardation is not a progressive process, but is the result of a patient suffering from a disease. Nevertheless, in both cases, and when considering dementia, and when considering mental retardation, there is a development of motor, speech and emotion disorder.

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As we have already noted, dementia overwhelmingly affects people in old age, which determines such a type as senile dementia (this pathology is usually defined as senile senility). Nevertheless, dementia appears in youth, which often occurs as a result of addictive behavior. Addiction implies, by itself, nothing more than addictions or pernicious habits, a pathological attraction in which it becomes necessary to perform certain actions. Any type of pathological attraction contributes to an increased risk of developing a person's mental illness, and often this the attraction is directly related to the social problems or personal problems that exist for it.

Often, addiction is used in association with such phenomena as drug addiction and drug dependence, but from a relatively recent time for her, and another kind of dependencies - dependencies are non-chemical. Non-chemical dependencies, in turn, define a psychological dependence, which itself acts as an ambiguous term in psychology. The fact is that mainly 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 look at a deeper level of this type of dependence, this phenomenon also occurs in ordinary mental activity, (hobbies, hobbies), which, thus, defines as an intoxicating substance the subject of this activity, as a result of which he, in turn, is seen as a source of substitute, causing certain missing emotions. Here you can include shopaholism, Internet addiction, fanaticism, psychogenic overeating, gambling, etc. At the same time, addiction is also seen as a way of adaptation, through which a person adapts to conditions that are difficult for himself. Under the elementary agents of addiction are considered narcotic substances, alcohol, cigarettes, creating an imaginary and short-term atmosphere of "pleasant" conditions. A similar effect is achieved when performing relaxation exercises, at rest, as well as with actions and things, in which short-term joy arises. In either of these options, after completing them, a person has to return to reality and conditions, from which such ways have turned out "to leave", as a result of which addictive behavior is considered as a rather complex problem of internal conflict, based on the need to avoid specific conditions, against which there is a risk of developing mental illness.

Returning to dementia, it is possible to highlight the actual data provided by WHO, on the basis of which it is known that the world incidence rates amount to about 35.5 million. a person with this diagnosis. Moreover, it is expected that by 2030 this figure will reach the figure of 65.7 million, and by 2050 will be 115.4 million.

With dementia, patients are not capable of realizing what is happening to them, the disease literally "erases" all that from their memory that has accumulated in it during previous years of life. Some patients survive the course of such a process at an accelerated pace, in view of which they develop rapidly dementia, while others may stay long at the stage of the disease in the context of cognitive-mnestic disorders (intellectual-mnestic disorders) -that is, with mental working capacity disorders, a decrease in perception, speech, and memory. In any case, dementia not only determines for the patient the result in the form of problems of an intellectual scale, but also the problems in which they lose many human personality traits. The severe stage of dementia determines for patients dependence on others, disadaptation, they lose the opportunity to perform simple actions related to hygiene and eating.

Diseases that may be accompanied by dementia

List of diseases that may be accompanied by dementia:

Alzheimer's disease (50-60% of all cases of dementia);
cardiovascular (multi-infarction) dementia (10-20%);
alcoholism (10-20%);
intracranial volumetric processes - tumors, subdural hematomas and brain abscesses (10-20%);
anoxia, craniocerebral trauma (10-20%);
normotensive hydrocephalus (10-20%);
Parkinson's disease (1%);
Huntington's chorea (1%);
progressive supranuclear palsy (1%);
Pick's disease (1%);
amyotrophic lateral sclerosis;
spinocerebellar ataxia;
ophthalmoplegia in combination with metachromatic leukodystrophy (adult form);
Gallerwarden-Spatz disease;

Classification

In view of the primary lesion of these or those parts of the brain, there are four types of dementia:

Cortical dementia. Mostly the cortex of the cerebral hemispheres is affected. It is observed with alcoholism, Alzheimer's disease and Pick's disease (frontotemporal dementia).
Subcortical dementia. Subcortical structures suffer. It is accompanied by neurological disorders (trembling of limbs, stiffness of muscles, gait disorders, etc.). Occurs in Parkinson's disease, Huntington's disease and hemorrhages in white matter.
Cortical-subcortical dementia. It affects both the cortex and the subcortical structures. It is observed in vascular pathology.
Multifocal dementia. In different departments of the central nervous system, multiple areas of necrosis and degeneration are formed. Neurological disorders are very diverse and depend on the localization of lesions.

Depending on the extent of the lesion, there are two forms of dementia: total and lacunar. Lacunar dementia affects the structures responsible for certain types of intellectual activity. The leading role in the clinical picture is usually played by short-term memory disorders. Patients forget where they are, what they planned to do, as agreed only a few minutes ago. Criticism to its state is preserved, emotional-volitional violations are weakly expressed. There may be signs of asthenia: tearfulness, emotional instability. Lacunar dementia is observed in many diseases, including - at the initial stage of Alzheimer's disease.

With total dementia, there is a gradual disintegration of the personality. The intellect decreases, the ability to learn is lost, the emotional-volitional sphere suffers. The circle of interests is narrowing, shame disappears, the former moral and moral norms become insignificant. Total dementia develops with volume formations and circulatory disorders in the frontal lobes.

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

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

Degrees of severity (stage) of dementia

In accordance with the possibilities of social adaptation of the patient, three degrees of dementia are distinguished. In those cases when the disease that caused dementia has a steadily progressing course, it is often said about the stage of dementia.

Easy degree

With mild degree of dementia, in spite of significant violations of the intellectual sphere, the patient's critical attitude to his own condition remains. So the patient can quite live independently, carrying out habitual household activities (cleaning, cooking, etc.).

Moderate degree

With a moderate degree of dementia, grosser intellectual disabilities are present and the critical perception of the disease is reduced. In this case, patients have difficulty in using ordinary household appliances (cooker, washing machine, TV), as well as phone, door locks and latches, so completely to provide the patient himself can in no case be.

Severe dementia

With severe dementia, a complete disintegration of personality occurs. Such patients often can not eat on their own, observe basic hygiene rules, and so on.

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

Dementia: Symptoms

In this section, we will consider in a generalized form those signs (symptoms) that characterize dementia. As the most characteristic of them are considered violations associated with cognitive functions, and such violations are most pronounced in their own manifestations. Emotional disorders in combination with behavioral disorders become no less important clinical manifestations. The development of the disease occurs in a gradual manner (often), its detection often occurs in the context of exacerbation of the patient, arising due to changes in the environment, its surroundings, as well as with the aggravation of the actual for him physical illness. In some cases, dementia may 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 patient's behavior, the question is raised about the relevance of dementia for him, which is especially important in the case of his age of more than 40 years and in the absence of a mental illness.

So, let's stop in detail on the signs (symptoms) of the disease we are interested in.

Violations of cognitive functions.In this case, memory disorders, 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, besides, confabulation is not excluded. Confabulation in particular implies a false memory. Facts from them, occurring earlier in reality, or facts that previously occurred, but which have undergone a certain modification, are transferred to patients at another time (often in the near future), with their possible combination with events that are completely fictitious. The mild form of dementia is accompanied by moderate memory impairments, mainly related to events occurring 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 retention in memory of only previously learned material with a rapid forget of the newly arrived information. The last stages of the disease can be accompanied by forgetting the names of relatives, a kind of activity and name, manifested in the form of personal disorientation.
- Attention breakdown.In the case of a disease of interest to us, this disorder implies a loss of ability to respond on several actual 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.
  - Aphasiaimplies a speech disorder, within which the ability to use phrases and words as means is lost to express their own thoughts, which is due to the actual brain damage in certain areas of its cortex.
  - Apraxiaindicates a violation of the patient's ability to perform targeted actions. In this case, the skills acquired earlier have been lost, and the skills that have been formed over the years (speech, everyday, motor, professional).
  - Agnosiadefines a violation of various types of perception in the patient (tactile, auditory, visual) with simultaneous preservation of consciousness and sensitivity.
Impaired orientation.This type of disorder occurs in time, and mainly - within the initial stage of the disease. In addition, the violation of orientation in the time space precedes the violation of orientation in the scale of orientation in place, and also within the framework of one's own personality (here the symptom is different for dementia from delirium, the characteristics of which determine the preservation of orientation within the framework of self-examination). The progressive form of the disease with far-reaching dementia and marked manifestations of impaired orientation in the scale of the surrounding space determines for the patient the likelihood that he can freely get lost even in an environment for a friend.
Disorders of behavior, personality changes.The beginning of these manifestations is gradual. The main features characteristic of individuals are gradually amplified, transforming to the inherent states of this disease as a whole. So, energetic and cheerful people become restless and fussy, and people are thrifty and tidy, respectively, greedy. Similarly, the transformations inherent in other features are also considered. In addition, there is an increase in the egoism of patients, the disappearance of responsiveness and sensitivity to the environment, they become suspicious, conflictful and sensitive. Sexual disinhibition is also defined, sometimes the patients begin to wander and collect various rubbish. It also happens that patients, on the contrary, become extremely passive, they lose interest in communication. Slovenliness is a symptom of dementia, arising in accordance with the progression of the general picture of the course of this disease, it combines with the unwillingness of self-care (hygiene, etc.), with unscrupulousness and, in general, a lack of response to the presence of people near to you.
Disorders of thinking.There is a slowing of the pace of thinking, as well as a decrease in the capacity for logical thinking and abstraction. 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 an absurd and primitive content. So, for example, a woman with dementia in the breakdown of thinking before the appearance of delusional ideas can argue that she stole a mink fur coat, and this action can go beyond her environment (ie family or friends). The essence of delirium in this idea is that she never had a mink fur coat at all. Dementia in men in this disorder often develops according to a delirium scenario based on the jealousy and infidelity of the spouse.
Decrease in critical attitude.It is about the attitude of patients to themselves, and to the world, their surroundings. Stressful situations often lead to the emergence of acute forms of anxiety-depressive disorders (defined as "catastrophic reaction "), within which there is a subjective awareness of inferiority in the intellectual plan. Partially preserved criticism in patients determines the possibility for them to maintain their own intellectual defect, that can look like a sharp change in the topic of conversation, the translation of a conversation into a playful form or distraction in other ways from it.
Emotional disorders.In this case, it is possible to determine the variety of such disorders and their overall variability. Often, these are depressive conditions in patients in combination with irritability and anxiety, anger, aggression, tearfulness or, on the contrary, complete absence 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 state of appearance of illusions and hallucinations in patients is considered. For example, with dementia the patient is sure that he hears in the next room the cries of the children being killed in her.

Alzheimer's dementia

Alzheimer's disease was described in 1906 by the German psychiatrist Alois Alzheimer. Until 1977, this diagnosis was exhibited only in cases of early dementia (at the age of 45-65 years), and with the appearance of symptoms over the age of 65, senile dementia was diagnosed. Then it was found that the pathogenesis and clinical manifestations of the disease are the same regardless of age. Currently, Alzheimer's disease is diagnosed regardless of the time of appearance of the first clinical signs of acquired dementia. Among the risk factors include age, the presence of relatives suffering from this disease, atherosclerosis, hypertension, overweight, sugar diabetes, low motor activity, chronic hypoxia, craniocerebral trauma and lack of mental activity throughout life. Women are sick more often than men.

The first symptom is a pronounced breach of short-term memory while preserving the critique of one's own condition. Subsequently, memory disorders are aggravated, while there is a "backward movement in time" - the patient first forgets the recent events, then - what happened in the past. The patient ceases to recognize his children, accepts them for long-dead relatives, does not know what he did today in the morning, but can tell in detail about the events of his childhood, as if they had occurred quite recently. In place of lost memories, confabulation can occur. Criticism to its condition is reduced.

In the expanded stage of Alzheimer's disease, the clinical picture is supplemented by emotional-volitional disorders. Patients become grouchy and uncomfortable, often demonstrate discontent with the words and actions of others, are annoyed by any little things. In the future, there may be a delusion of damage. Patients claim that the loved ones deliberately leave them in dangerous situations, pour poison into their food to poison and take possession apartment, talk about them muck to spoil the reputation and leave without the protection of the public, etc. In a delusional system, not only family members are involved, but also neighbors, social workers and other people interacting with patients. Other behavior disorders can also be detected: vagrancy, intemperance and indiscriminate eating habits and in sex, meaningless random actions (for example, shifting objects from place to place). Speech is simplified and impoverished, there are paraphases (use of other words instead of forgotten ones).

At the final stage of Alzheimer's disease, delusions and behavioral disorders are leveled due to a pronounced decrease in intelligence. Patients become passive, inactive. The need for liquid and food disappears. The speech is almost completely lost. As the disease worsens, the ability to chew food and self-walking is gradually lost. Because of complete helplessness, patients need constant professional care. Lethal outcome occurs as a result of typical complications (pneumonia, pressure sores, etc.) or the progression of concomitant somatic pathology.

Diagnosis of Alzheimer's disease is made on the basis of clinical symptoms. Treatment is symptomatic. Currently, there are no medications and non-medicinal methods that can cure patients with Alzheimer's disease. Dementia progresses steadily and ends with complete disintegration of mental functions. The average life expectancy after diagnosis is less than 7 years. The earlier the first symptoms appeared, the faster dementia is aggravated.

Vascular dementia

There are two types of vascular dementia - arose after a stroke and developed as a result of chronic insufficiency of the blood supply to the brain. With postinsult acquired dementia, focal disorders (speech, paresis, and paralysis) usually prevail in the clinical picture. The nature of the neurological disorders depends on the location and size of the hemorrhage or the site with the disturbed blood supply, the quality of the treatment in the first hours after the stroke and some other factors. With chronic disorders of the blood supply, symptoms of dementia predominate, and neurological symptoms are rather monotonous and less pronounced.

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

The first sign of the disease are difficulties in trying to concentrate, distracted attention, fatigue, some stiffness of mental activity, difficulty in planning and a decrease in the ability to analyze. Memory disorders are less pronounced than in Alzheimer's. There is some forgetfulness, but with a "jerk" in the form of a suggestive question or suggesting several variants of the answer, the patient easily recalls the necessary information. Many patients experience emotional instability, mood is reduced, depression and subdepression are possible.

Neurological disorders include dysarthria, dysphonia, changes in gait (shuffling, reduction the length of the step, the "adhesion" of the soles to the surface), slowing down of movements, impairing gestures and facial expressions. Diagnosis is made on the basis of clinical picture, UZDG and MRA of cerebral vessels and other studies. To assess the severity of the underlying pathology and make a scheme of pathogenetic therapy, patients are referred for consultations to the appropriate specialists: the therapist, endocrinologist, cardiologist, phlebologist. Treatment - symptomatic therapy, therapy of the underlying disease. The rate of development of dementia is determined by the features of the course of the leading pathology.

Alcoholic dementia

The cause of alcoholic dementia is a prolonged (for 15 years or more) abuse of alcoholic beverages. Along with the direct destroying effect of alcohol on brain cells, the development of dementia is due to violation of the activities of various organs and systems, gross metabolic disorders and vascular pathology. For alcoholic dementia typical typical personality changes (coarsening, loss of moral values, social degradation) in combination with total decreased mental abilities (distraction of attention, reduced ability to analyze, plan and abstract thinking, memory disorders).

After completely giving up alcohol and treating alcoholism, partial recovery is possible, however, such cases are very rare. Because of the pronounced pathological craving for alcoholic beverages, the reduction of strong-willed qualities and lack of motivation, most patients can not stop taking ethanol-containing liquids. The prognosis is unfavorable, the cause of death is usually somatic diseases caused by alcohol use. Often, such patients die as a result of criminal incidents or accidents.

Diagnosis and treatment of dementia

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

As for the issue of treating dementia, there is currently no effective method of treatment, in particular, if the cases of senile dementia are considered, which, as we noted, is irreversible. Meanwhile, the proper care and the use of therapy measures aimed at suppressing symptoms, in some cases, can seriously alleviate the condition of the patient. It also considers the need for treatment of concomitant diseases (with vascular dementia in particular), such as atherosclerosis, hypertension, etc.

Treatment of dementia is recommended under the conditions of a home environment, placement in a hospital or psychiatric ward is relevant for a severe degree of the disease. It is also recommended to make the regime of the day so that it includes the maximum of active activity in the periodic fulfillment of household duties (with an allowable form of load). The appointment of psychotropic drugs is made only in the case of hallucinations and insomnia, within 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 the effective treatment of this disease, is currently excluded due to the practical lack of appropriate measures. When there is a symptom that indicates dementia, it is necessary to visit such specialists as a psychiatrist and a neurologist.

Research facts

One study, conducted in 2013 by specialists from the Nizam Institute of Medical Sciences in India, found that the use of two languages could delay the development of dementia. Analysis of medical records of 648 cases of dementia showed that those who speak two languages, Dementia develops on average 4.5 years later than those who speak only one language.

Recently, there have been studies showing a slight decrease in the percentage of people suffering from dementia in the total number of elderly in developed countries. So, if in 2000 dementia in the United States was in 11.6 percent of people after 65, in 2012 such became much less: 8.8 percent.

There are 16 scientific studies demonstrating the effect of phosphatidylserine on reducing symptoms of dementia or impaired cognitive function. In May 2003, the US Food and Drug Administration (FDA) approved a so-called "Statement about the health benefits "(" Qualified health claim ") for phosphatidylserine, which allows manufacturers in the United States to specify on the labels that "the consumption of phosphatidylserine can reduce the risk of developing dementia and cognitive impairment in the elderly." However, this statement should still be accompanied by a reservation that "very limited, and preliminary scientific studies show that phosphatidylserine can to reduce the risk of cognitive dysfunction in the elderly, "because the Office felt that there was still no unambiguous opinion on the topic in the scientific community, and the majority The studies were done using phosphatidylserine derived from a cow's brain, rather than soy phosphatidylserine, which is now used.

Dementia and dementia are one and the same? How is dementia in children? What is the difference between pediatric dementia and oligophrenia?

The terms "dementia" and "dementia" are often used, as synonyms. Nevertheless, in medicine, dementia is understood as irreversible dementia, developed in a mature person with normally formed mental abilities. Thus, the term "pediatric dementia" is not legal, since in children the higher nervous activity is in the developmental stage.

The term "mental retardation" or oligophrenia is used to refer to child dementia. This name is preserved when the patient reaches adulthood, and this is true, as dementia, emerged in adulthood (for example, post-traumatic dementia) and oligophrenia proceed in different ways. In the first case, we are talking about the degradation of an already formed personality, in the second - about underdevelopment.

Unexpectedly appeared untidiness - this is the first sign of senile dementia? Are there always symptoms such as slovenliness and slovenliness?

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

At the same time, patients with dementia in the early stages of the disease can be quite independent and accurate in their familiar domestic environment. Slackness may be the first sign of dementia only if the development of dementia is already on early stages is accompanied by depression, depletion of the nervous system or psychotic disorders. This kind of debut is more typical for vascular and mixed dementias.

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

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

It is believed that circulatory disorders in the cerebral vessels can trigger or enhance the primary degenerative processes characteristic of Alzheimer's disease and dementia with Levy bodies.

Since the development of mixed dementia is caused by two mechanisms at once - the prognosis for this disease is always worse than with a "pure" vascular or degenerative form of the disease.

Mixed form is prone to steady progression, therefore inevitably leads to disability, and significantly reduces the patient's life.
Treatment of mixed dementia is aimed at stabilizing the process, therefore it includes combating vascular disorders and alleviating the developed symptoms of dementia. Therapy, as a rule, is carried out by the same drugs and according to the same schemes as in vascular dementia.

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

Among my relatives were patients with senile dementia. What is the probability of developing a mental disorder in me? What is the prevention of senile dementia? Are there any medications that can prevent the disease?

Senile dementia refers to diseases with a hereditary predisposition, especially for Alzheimer's disease and dementia with Levy bodies. The risk of developing the disease increases if senile dementia in relatives develops at a relatively early age (up to 60-65 years). However, it should be remembered that hereditary predisposition is only the presence of conditions for the development of or another disease, so even an extremely unfavorable family history is not a verdict.

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

Since the risk factors for the development of senile dementia are known, measures to prevent mental disorder are primarily aimed at their elimination, and include:

Prevention and timely treatment of diseases leading to circulatory disorders in the brain and hypoxia (hypertension, atherosclerosis, diabetes mellitus).
Dosed physical activity.
Permanent pursuits of intellectual activity (you can make crosswords, solve puzzles, etc.).
Refusal from smoking and alcohol.
Prevention of obesity.

Prognosis for dementia

The prognosis for dementias is determined by the underlying disease. With acquired dementia, which has arisen as a result of craniocerebral injuries or volumetric processes (tumors, hematomas), the process does not progress. Often observed partial, less often - a complete reduction of symptoms due to compensatory capabilities of the brain. In the acute period, it is very difficult to predict the degree of recovery, the outcome of extensive damage can be a good compensation with the preservation of work capacity, and the outcome of a small injury - severe dementia with access to disability and vice versa.

With dementias caused by progressive diseases, the symptoms are steadily worsening. Doctors can only slow down the process, carrying out adequate treatment of the underlying pathology. The main objectives of therapy in such cases is to preserve self-service skills and abilities to adaptation, prolongation of life, provision of proper care and elimination of unpleasant manifestations of the disease. Death occurs as a result of a serious impairment of vital functions associated with the immobility of the patient, his inability to elementary self-care and the development of complications that are characteristic of bedridden patients.