Senile dementia: symptoms, treatment

Senile dementia is a dementia that develops in the old age as a final pathological involution of the body, arising from the progressive diffuse atrophy of brain structures. In the people this disease is known as senile dementia, senile senility, senile dementia. This pathology is an actual problem of psychiatry, since it affects about 3-5% of people over 60 and 20% of 80-year-old patients. About how senile dementia manifests, what are the principles of its diagnosis and treatment, and we'll talk about this in our article.

The causes of senile dementia

For today it is impossible to reliably say why this disease develops. It is believed that the speed of involutive processes in the brain depends on the complex impact of a number of factors on it.

One of such factors is heredity. It is known that the risk of developing senile dementia is increased in those persons whose parents or grandparents suffered from this disease.

The second factor is the age-related impairment of the functions of the immune system, as a result of which the body produces special autoimmune complexes destroying the cells of the brain.

Undoubtedly, external pathogenic factors also play a role:

• somatic diseases, in particular, atherosclerosis of cerebral vessels, due to which the cells lack the nutrients they need to function properly and are destroyed;
• infection (especially neuroinfections - meningitis, encephalitis, neurosyphilis and others);
• oncological diseases;
• intoxication, in particular alcoholic nature;
• craniocerebral trauma;
• mental trauma.

The mechanism of development of senile dementia

The mechanism of development (that is, the pathogenesis) of involuntary mental disorders is complex. The primary link is the change in the structure of the hypothalamus, especially those that regulate the exchange-endocrine functions of the body, in particular the pituitary gland. As a result of hormonal imbalance, the functioning of many organs of the body is disrupted, in addition, it negatively affects on the cortex and subcortical structures, making them vulnerable to a variety of external factors that do not pose a risk to a healthy person. That is, minimal psychotraumatism, domestic stress lead to a breakdown of higher nervous activity in predisposed individuals.

Gradually die neurons, responsible for mental, mental activity and social adaptation: the patient loses memory, the ability to learn, can not think logically, he has lost interest in others and life, in the later stages even the ability to self-service is lost.

Morphologically, with senile dementia due to atrophy, the volume and mass of the brain decrease. The furrows and ventricles widen, the gyruses become pointed, and the configuration of the brain regions and the proportions between them remain, that is, the atrophy is uniform.

Neurons decrease in size, shrink, but their contours remain the same. The nerve processes die and are replaced by a connective tissue (sclerized), glued together.

Typical for senile dementia are multiple foci of necrosis of circular shape, centered with a brown homogeneous mass, and on the periphery - by filaments. These are the so-called foci of desolation and senile druses.

Stages of senile dementia

Depending on how pronounced the symptoms of the disease, in its current are divided into 3 stages:

• initial (the intellect of the patient is reduced, but the ability to self-criticism is preserved, the patient is able to serve himself independently);
• moderate (intellectual abilities of a person are reduced, elementary skills to use the surrounding household appliances (cooker, iron, door locks, etc.) reduced - the patient can unintentionally harm himself and his housing, but can not cook himself a meal; at this stage of the patient it is very undesirable to leave without supervision, however care for him is not so very complicated, since a person is nevertheless capable of self-service and his personal hygiene skills are preserved);
• severe dementia (the patient loses the ability to perform elementary actions, can not service himself, does not recognize relatives, needs 24-hour outside care).

Symptoms of senile dementia

Patients with dementia often suffer from insomnia.

As a rule, the first signs of this pathology occur at the age of 65-78 years, with one sick man having 2-3 sick women. The onset of the disease is almost imperceptible, but it progresses steadily to full dementia.

At an early stage of dementia, there is an increase in, a sharpening of certain traits of the patient's character: greed, become mean, persistent - stubborn, distrustful - get suspicious. Over time, there are new features that are not typical of a specific person: excessive selfishness, callousness towards others, even close ones, people, a sharp narrowing of the circle of interests. Emotions are lost.

Sick patients, the level of criticism is significantly reduced. Instinctive drives of them, on the contrary, are disinhibited: hypersexuality is noted, the patient can bare with all genitals and even molest children.

The sleep is disturbed: often patients are drowsy during the day and suffer from sleeplessness at night, while wandering around the apartment, fussing, try to cook, eat furniture, move things, and so on, which hamper family and neighbors.

There is a gradual disintegration of a person's mental activity, and first of all, complex, abstract levels of thinking, creative sides and critical possibilities are violated, recently obtained, loose skills and knowledge, while simple, firmly secured and acquired long-time knowledge, ideas and skills are lost much later.

The most striking symptom is memory disorders. At an early stage the patient loses the ability to memorize new data and current events, forgets some points from the nearest past (names, street names, items, dates), but the data of a past life he confidently reproduces. Later, a person forgets more and more: progressive amnesia develops. It consists in the fact that the disintegration of life experience and the loss of the memory of the patient comes from a later earlier, from more complex to simple, from emotionally indifferent to sensually brightly colored.

In the late stages of the disease, patients often perceive themselves as if in youth, others - those who were near in the past; they lose their orientation in time and, as it were, are transferred to the past life stage. At the final stage, a person does not recognize others, confuses children with siblings, the latter perceives them as parents and, in the end, even he does not recognize himself in the mirror, because he considers himself to be a child, and in reflection he sees an old man (he is called a stranger or grandparent).

Delirious ideas of stealing, impoverishment, persecution are also typical in the later stages of senile dementia. The patient accuses his family of stealing, claims that everything was stolen from him - money, things, food, and now he has nowhere to live and nothing to eat, and he remained on the street, alone, without means of subsistence. Wherever there is (on the street, in the hospital department, at home), the patient collects all the trash, ties it into a knot, hides it in the bed, forgets where hid it; in a state of excitement at night, suddenly gathers with this node "on departure", takes it with him for walks and so on.

The mood of patients varies from discontented, gloomy at the beginning of the disease to indifferent, indifferent, down to emotional stupor at its late stage.

On the part of other organs and systems in patients with senile dementia, a labile (unstable) pulse and arterial pressure with a tendency to increase it are noted. Turgor tissues are reduced, the skin of the face is wrinkled, the hair is gray and falls out. The patients look older than their age. There is depletion, senile cataract, senile arch on the cornea, bedsores and other disorders of nutrition of body tissues.

Neurological disorders are not as pronounced as in other degenerative diseases of the central nervous system, and are manifested by some parity of the musculature (because of this facial expression of the patient as if frozen, the expression is sluggish, the tremor of the hands is determined and the unsteady slow gait is determined by small steps). The pupil's reaction to light is reduced. There are no gross neurological disorders.

Such patients, as a rule, die from intercurrent (concurrent) diseases on the background of complete physical exhaustion and mental marasmus.

Diagnostics

Talking with the patient and conducting a survey, the doctor reveals his signs of senile dementia.

Diagnosis of senile dementia causes difficulties only at the initial stage of the disease, especially in the case of her debut at an early age. Under such conditions, a differential diagnosis with somatic diseases with similar symptoms is required. At the stage of detailed clinical manifestations, the diagnosis of senile dementia does not cause difficulties and, if necessary, can be confirmed by CT.

Treatment

Unfortunately, senile dementia is an incurable disease, but proper care and adequate supportive therapy can slow the progression of atrophy processes and significantly improve the quality of life of the patient and his relatives.

First of all, I want to say that it is desirable to conduct treatment in the usual conditions for the patient, that is, at home, and not in the hospital. Changing these conditions for hospitals is fraught with stress for the patient, new emotional experiences, and therefore his condition can deteriorate sharply, and the disease will progress.

The active lifestyle of the patient is extremely important. A person should not lie day and night, but, on the contrary, must deal with familiar domestic matters, as far as his condition allows: clean up the house, cook food, walk on the street.

If there is no possibility of permanent home care or dementia is very severe, the patient is placed in a hospital or in a special boarding school.

Nutrition should be regular, rational and balanced. Bed lying patient - is equipped with a special table. The duration of sleep is 7-8 hours a day or more, if desired. Before going to bed - a walk in the fresh air or just down the corridor.

Since the coordination of movements and visual acuity of the patient with senile dementia are reduced, the risk of domestic trauma increases. Therefore, it is necessary to remove from his room excess furniture, put protection on the corners or mechanically round them. The floor must be dry and not slippery. The bathroom needs handrails. On the legs of the patient - slippers, but not slippers.

Of drugs at the initial stage of the disease can be assigned nootropics. These drugs increase the adaptation of the nervous system to mental and physical stress, improve mental performance, stimulate memory, reduce the need for tissues in the brain in oxygen.

In sleep disorders, reception of small doses of tranquilizers is indicated.

In the case of pronounced depressive mood, antidepressants are prescribed (also in small doses).

Important role and psychotherapy, when a specialist helps a patient to restore or re-create some or other behavioral reactions.

Prophylaxis and prognosis

Unfortunately, to date, there are no preventive measures for the development of senile dementia. The later the disease develops, the more slowly it progresses and the more favorable the prognosis. Proper care for the patient and regular adequate medication support help to slow the progression of the disease and significantly improve the quality of life of such patients. The duration of the disease ranges from 7-9 months to 10 years or more.

Expertise

Patients with senile dementia are assigned the disability of the first group with the imposition of custody of the person and property. In the case of committing an offense by such a person, he is found insane and sent to compulsory treatment.