Dementia: what it is, symptoms, treatment in the elderly

Introduction

Dementia is not a specific medical condition, but a general term used to describe the gradual decline in mental capacity. It affects intellectual and social capabilities, making everyday life difficult. Dementia can alter memory, language skills, judgment, disorientation, and personality changes.

Dementia can be caused by a variety of diseases that affect the brain, the most common of which is Alzheimer's disease.

Other forms of this disorder include vascular dementia, Lewy body dementia (abbreviated DTL), frontotemporal dementia, and mixed dementia.

These types of dementia differ for deeper causes and can affect certain specific symptoms as well as their progression.

What is dementia?

Dementia (acquired dementia) is a pathology that is a severe form of a disorder of the highest brain and nervous activity, provoked by organic in nature lesions of the brain brain.

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Causes

Disease Alzheimer's is the most a common cause of dementia. It accounts for 60% to 80% of dementia cases and affects about 5% of people over 65. It usually occurs in old age, affecting 20% ​​to 25% of people over the age of 80.

Despite constant advances in science and many promising theories, the exact causes of Alzheimer's are currently unclear. Aging and genetic factors (family history) are considered the most important risk factors for developing Alzheimer's disease.

Vascular dementia occurs due to decreased blood flow, leading to cell death in the brain. This can occur as a result of a blockage of blood vessels in the brain by blood clots or fatty deposits, for example, during stroke. Vascular dementia accounts for 15% to 25% of dementia cases. This disorder causes a loss of mental capacity that can be sudden, gradual, and permanent.

Lewy body dementia ranges from 5% to 15% of dementia cases. Lewy bodies are abnormal protein formations that accumulate in the brain, causing mood swings, motor problems, and impaired thinking and behavior. This type of dementia usually progresses rapidly and often includes visual hallucinations among its symptoms.

Frontotemporal dementia results from cracks in nerve cells in two specific parts of the brain called the frontal lobe and the temporal lobe. It provokes speech disorders, changes the character and behavior of the victim.

Dementia can also be of mixed origin, especially in old age. The most common form of dementia is mixed dementia, associated with a combination of Alzheimer's disease and vascular dementia.

Diseases such as Huntington's disease, Parkinson's disease and Creutzfeldt-Jakob diseasecan cause specific symptoms of dementia. Dementia can also be caused by a number of factors that can damage the brain, such as alcoholism and drug use.

The most common factors leading to the development of a pathological disorder include:

• oncology (tumor in the brain);
• alcoholism and drug use;
• blockage of blood vessels in the brain;
• trauma and damage to the head;
• AIDS and viral encephalitis;
• neurosyphilis;
• chronic form meningitis;
• and so on ..

Some cases of dementia may be reversible or may improve once the cause has been corrected. Unfortunately, when dementia is caused by conditions such as Alzheimer's, brain damage, or blockage of blood vessels, the disorder is irreversible.

Symptoms

Sometimes we forget where we left our car keys or tell the same story to a friend or relative. This behavior is usually attributed to information overload resulting from an active and stressful life and is not necessarily a sign of dementia.

As people age, memory sometimes functions differently. For example, it can process information more slowly. These changes are normal and do not affect daily life. In contrast, dementia is disabling and not associated with the normal aging process.

Although dementia manifests itself differently in every person, the most common symptoms are as follows:

• gradual loss of memory of recent events and the inability to learn new things;
• an increased tendency to repeat, lose objects, get confused and lost in familiar places;
• the ability to reason and think logically is undermined;
• increased tendency to irritability, anxiety, depression, confusion and agitation;
• communication and use of words becomes more and more difficult (for example, forgetting words or using them incorrectly);
• changes in personality, behavior, or mood swings;
• decreased ability to concentrate or be attentive;
• an inability to plan and complete multi-step tasks (such as paying bills);

Before a person is diagnosed with dementia, their symptoms must be severe enough to affect their independence and ability to perform daily tasks.

The symptoms of dementia can vary depending on their original cause. For example, people with Lewy body dementia often have prolonged visual hallucinations. Some forms of dementia can also affect young people, not just older people, and progress faster.

Dementia severity

1. Lightweight. In this case, the patient retains the ability for independence and awareness of everything that is happening, but social adaptation is impaired. Patients experience lethargy and rapid fatigue from any, even the most insignificant, loads, there is a loss of interest in everything that happens, a frequent change in mood.
2. Moderate. Pathological changes manifest themselves more vividly, memory is impaired, the ability to navigate even in one's apartment, house, in any familiar area is lost. The patient does not recognize the faces of people he knows and relatives, he should not be left alone due to the fact that he can harm himself.
3. Heavy. At this stage, there is a complete degradation of the patient and his personality, he completely ceases to understand where he is and what he is being told, is unable to eat and swallow food himself, involuntarily urinates in his pants.

At the place of its localization, dementia is:

• Cork. Damage to the cerebral cortex. Most often this form provokes Alzheimer's disease and alcoholism.
• Subcortical. The structure of the brain is affected in its subcortical part.
• Cortical-subcortical. The cortex and structures in the brain are affected.
• Multifocal. It is marked by the formation of many lesions in the brain.

Major forms of dementia

Alzheimer's type dementia

This type of dementia is a common type of dementia, accounting for 35 to 60% of the total number of pathological abnormalities in all types of organic disorders.

Common factors that trigger this form of dementia include:

• age - most often it is diagnosed in patients over the age of 80;
• the presence of close relatives diagnosed with Alzheimer's disease;
• hypertension and atherosclerosis;
• diabetes mellitus and obesity;
• previous head injuries and the patient's lack of intense intellectual activity for a long time;
• belonging to the female sex.

Signs of this type of dementia:

• weakening of short-term memory, while a person critically perceives his condition for a sufficiently long period of time, feeling justified anxiety, a certain absent-mindedness;
• characterized by a disorder of the central nervous system and manifestations of egocentrism and senile grumbling, a certain suspicion, gradually developing into manic conflict;
• gradually, against the background of the symptoms described above, the patient may develop peculiar for this type dementia is a delusional type of damage - a person will blame neighbors, relatives, their surroundings and strangers of people.

Treatment of this type of dementia is complex, taking into account the treatment of diseases that aggravate the manifestation of the disease (obesity and diabetes, hypertension or atherosclerosis).

In the early stages, herbal remedies are prescribed - this is an extract of ginkgo biloba, nootropic formulations - cerebrolysin or piracetam, medications that increase blood flow in the brain - nitrogoline, CNS stimulants and actovegin.

If the manifestation of the pathology is more serious, doctors prescribe medications assigned to the group inhibitors - this will significantly improve the socialization and adaptation in the society of patients with similar diagnosis.

Vascular dementia

In this case, dementia as a separate, independent pathology is considered after the following vascular diseases:

• after the transferred hemorrhagic type strokewhen there is a rupture of blood vessels.
• after the patient has suffered an ischemic stroke - in this case, we are talking about pathological blockage of the vessel and subsequent deterioration or cessation of blood flow in a certain area.

In this case, there is a large-scale damage and death of brain cells - focal symptoms in their manifestations, which will be directly predetermined by the localization of the affected in the patient plot.

With regard to the risk factors that provoke this type of dementia, due to its genesis by vascular pathologies, the following are distinguished:

• developing hypertension;
• an increase in the level of lipids in the blood;
• systemic course of atherosclerosis;
• smoking;
• problems with the heart muscle - the development of coronary artery disease, arrhythmias, or valve damage;
• sedentary lifestyle;
• diabetes;
• blood clots and systemic vasculitis.

In addition to the symptoms already described above, many patients often complain of rapid fatigue and difficulty with concentration of attention during one or another long-term activity, problems with switching attention from an object to an object.

Another characteristic of this type of dementia is a slow response to intellectual activity - it is the impaired blood circulation that contributes to such a delayed reaction even when performing the most simple tasks.

Treatment of vascular dementia at the very beginning involves, first of all, the normalization and improvement of the disturbed blood flow in the brain. After - a course of stabilization of the process is carried out, provoking the development of the senile form of dementia, that is:

• hypertension treatment;
• atherosclerosis;
• normalization of blood sugar (glucose) in diabetes mellitus.

Mixed dementia

Most often it combines the causes and symptoms of dementia triggered by Alzheimer's disease and vascular dementia.

The treatment regimen is similar to the vascular type of dementia.

Lewy body dementia

The root causes of this degenerative process, as well as the mechanisms of its development, have not yet been studied by specialists. The only thing that doctors note is that a hereditary predisposition is of no small importance in this pathology - in accordance with medical statistics, this type of dementia occupies about 15-20% of the total number of senile manifestations in the total number of diagnoses disorders of the central nervous system.

So in many of its symptoms, this type of dementia is often similar to the forms described above. The characteristic symptoms of this type of dementia are manifestations of fluctuations - these are sharp deviations in intellectual, mental activity.

If we are talking about the manifestation of small forms of fluctuations, then patients most often complain of temporary manifestations of disorders in the inability to concentrate on one object, object or task, their process execution.

If we are talking about large forms of fluctuations, the patient is unable to recognize certain objects, relatives and friends, does not orient himself on the terrain.

The hallucinations of this type of dementia are auditory and visual, in some cases, gustatory and tactile hallucinations.

Among other things, the patient develops a number of autonomic disorders:

• hypotension of the orthostatic type;
• fainting and arrhythmia;
• problems with the digestive tract, frequent constipation.
• failure in the urinary system.

The course of treatment for Lewy body dementia is similar in its drugs and treatment regimens for Alzheimer's pathology.

Alcohol-type dementia

The alcoholic type of dementia develops in a patient with prolonged, protracted, more than 15-20 years, alcohol abuse, due to poisoning with toxins and brain poisons.

In addition to the fact that toxins act directly on the gray matter of the brain itself and the work of the central nervous system, alcohol and its toxins has an effect on other organs and the system, provoking damage to the structure of liver cells, disturbances in the work of the vascular systems.

Every alcohol addict at the last stage of its course is diagnosed with personality degradation, enhanced by atrophic, negative and irreversible changes in the structure of the brain in the form of destruction of the grooves of the cerebral cortex and ventricles brain.

In its manifestation, the alcoholic type of dementia shows itself as a decrease in the patient's intellectual abilities, such as memory and the ability to concentrate on one task, thoughts, ability think abstractly.

Diagnostics

The diagnosis of dementia is made by examining previous symptoms and a physical examination.

Your doctor may ask you a series of questions to assess your intelligence, that is, all brain functions related to memory, memories, decision making, language, daily recognition of familiar objects and the ability to follow appropriate instructions.

Magnetic resonance imaging and CT scans of the brain will reveal changes that have occurred in the structure of the brain. Computed tomography (CT) or magnetic resonance imaging (MRI) are useful for detecting conditions (such as stroke) that can cause dementia.

Final confirmation of the diagnosis can only be obtained after a biopsy to examine the structure of a piece of brain tissue or an autopsy performed after death.

Treatment and prevention

Treatment for dementia can vary depending on the underlying cause. Alzheimer's therapy is needed to minimize memory loss and behavioral symptoms that gradually worsen.

Treatment for Alzheimer's disease usually involves the use of a number of medications (which can also be used to treat other forms of dementia), including:

• cognitive enhancers;
• tranquilizers;
• antidepressants;
• anxiolytic drugs;
• anticonvulsants.

There is no definite cure for Alzheimer's disease, and there is no medication that can stop or reverse the brain damage it has caused. However, medications are available to reduce the severity of some symptoms and slow the progression of the disease.

Drugs such as Donepezil, Rivastigmine and Galantaminecan help stop memory regression.

Stroke prevention is very important in cases of vascular dementia. People with high blood pressure or high blood cholesterol who have transient ischemic attacks (TIA) or stroke survivors should undergo ongoing treatment for these diseases in order to prevent the occurrence of vascular dementia in the future.

In order to treat and help people with dementia, it is important to focus on all the activities that the person can still safely do. They should be encouraged to continue their daily activities and maintain social relationships as much as possible.

It is also important to help them lead a healthy lifestyle through exercise, proper nutrition, and adequate fluid intake. Special diets and supplements are usually unnecessary.

Here are some tips that you may find helpful if you are caring for elderly people with dementia:

• provide patients with action listswhat needs to be done, including time, place and appropriate phone numbers, to facilitate these tasks;
• structure and stabilize the habitat, minimize unnecessary sounds and noises causing anxiety;
• establish the order of performance of activities during the daytime and during sleep to try to reduce disorientation and anxiety;
• speak slowly and calmly, formulate only one idea and only one task at a time;
• reduce the risks of human loss and wanderingby putting a card in your pocket with his name, address and phone number;
• make sure the house is safeby leaving the furniture in the same place, removing unnecessary dangerous items, the first aid kit and setting the water heater to a low temperature to avoid burns;
• prohibit the person with dementia from driving while driving. Take a driver or have someone take the person wherever you want.

Caring for someone with dementia is a very difficult task. It is important to show understanding, patience and compassion. Participation in support groups and communities is sometimes beneficial for those caring for an Alzheimer's patient.

We must be prepared for a gradual deterioration in the condition of a loved one and plan for constant care. In some cases, it may be best for the Alzheimer's patient and family members to send the person to a nursing home.