Dementia: symptoms, diagnosis, stages, treatment
Dementia is an acquired form of dementia.In this condition, there is a pronounced impairment of mental functions.In patients, there is a loss of household and social skills in parallel with a persistent decline in cognitive abilities and memory.Most often, dementia develops in old age;Very frequent, but not the only cause of it is Alzheimer's disease.
Important: memory impairment does not mean that dementia has begun to develop.Decrease in the ability to remember can be due to many reasons. However, in such cases it is necessary to consult with a neurologist or psychiatrist .
Effective treatment of this pathology is not currently developed by .Patients are assigned symptomatic therapy, allowing to achieve a certain improvement.Table of contents: Causes of dementia and classification of pathology Clinical manifestations Diagnosis Treatment of dementia
Causes of dementia and classification of pathology
The direct cause of dementia is the damage to nerve cells of certain brain zones caused by various diseases and pathological conditions.
It is customary to distinguish between progressive dementias characterized by an irreversible course of the process, and conditions reminiscent of them, but amenable to treatment( encephalopathies).
Progressive dementias include:
- Alzheimer's disease;
- dementia with Levi bodies.
Note: development of dementia often results from repeated brain trauma( for example, in professional boxers).
Alzheimer's disease is more common in elderly and elderly people.The exact cause of the pathology has not yet been identified.It is believed that a certain role is played by genetic predisposition.In the brain of patients, in most cases, pathological deposits of protein( beta-amyloid) and neurofibrillatory tangles are found.
Vascular dementia develops against the backdrop of pathological changes in the blood vessels of the brain, and they, in turn, appear due to stroke and a number of other diseases.
Some people with progressive dementia in the brain have pathological protein compounds - so-called.The Levi body.They are found in patients with diagnosed Parkinson's and Alzheimer's diseases.
Frontal temporal dementia is a group of serious disorders of higher nervous activity, caused by atrophic changes in the frontal and temporal lobe.It is these areas of the human brain that are responsible for the perception of speech, personality and behavioral characteristics.
With mixed dementias, several factors are immediately identified that cause disorders in the central nervous system.In particular, the pathology of the vessels and the Lewi body can be observed in parallel.
Diseases accompanied by progressive dementia:
- Parkinson's disease;
- Huntington's disease;
- Creutzfeldt-Jakob disease.
Parkinson's disease is caused by the gradual death of neurons;It is accompanied by dementia often, but not in 100% of cases.
Huntington's disease is a hereditary disease.A genetic mutation leads to atrophic changes in the cells of individual structures of the central nervous system.Strongly expressed disorders of thinking in most cases appear after 30 years.
The cause of Creutzfeldt-Jakob disease is the presence of pathological protein compounds - prions - in the body.Their presence can be hereditary.The disease is incurable, and on average by the age of 60 leads to the death of patients.
The cause of treatable encephalopathies can be:
- pathology of infectious and autoimmune genesis;
- reactions to pharmacological agents;
- poisoning( acute and chronic);
- metabolic disorders;
- endocrine pathology;
- deficient conditions;
- brain tumors;
- subdural hematomas;
- hydrocephalus( with normal indices of intracranial pressure);
- hypoxia( anoxia).
Signs of dementia may appear against the backdrop of a severe course of infectious and inflammatory diseases.Symptoms of dementia also often make themselves felt when immunity attacks its own nerve cells, perceiving them as alien.A vivid example of autoimmune pathology is, for example, multiple sclerosis.
Personality changes and cognitive impairment are able to develop against the backdrop of pathologies of endocrine glands( for example - the thyroid gland).The activity of the central nervous system is adversely affected by low sugar levels, deficiency or overabundance of calcium and sodium, as well as impaired absorption of vitamin B12.
Symptomatic, characteristic of dementia, occurs with hypovitaminosis( especially in group B), dehydration( dehydration), taking certain medications, consuming narcotic drugs and alcoholic beverages. Extremely severe consequences for the nervous system causes poisoning with salts of heavy metals.With adequate treatment of intoxications and deficient states, in many cases it is possible to achieve a significant improvement in the condition or complete recovery.
Hypoxia is the oxygen starvation of nerve cells.It can be caused by CO poisoning( carbon monoxide), myocardial infarction and a severe asthmatic attack.
Brain tumors cause mechanical compression of tissues;Memory and thinking are often violated in certain localizations of neoplasms.A similar effect is produced by subdural hematomas - blood accumulations under the brain envelope formed after blunt head injuries.
Important: among the factors that increase the risk of developing dementia include age, moderate thinking disorders and a burdened family history.Pathology often develops in smokers, people with alcoholism and drug addicts.The likelihood of progressive dementia is higher in hypertensive patients, patients with diabetes mellitus, and those with episodes of nocturnal apnea( short-term breathing stops in snoring during snoring).
Symptoms of dementia and combinations may vary depending on the causes of the disorder.
All manifestations of pathology can be divided into two large groups - cognitive disorders and mental disorders.
Specific cognitive impairment includes:
- memory impairment, forgetfulness( most often noticed by people close to the patient);
- communication difficulties( for example, problems with the selection of words and definitions);
- obviously worsening the ability to solve logical problems;
- problems with making decisions and planning their actions( disorganization);
- impaired coordination( unsteadiness of gait, fall);
- disorders of motor functions( imprecision of movements);
- disorientation in space;
- is a disorder of consciousness.
- depression, depressed state;
- unmotivated sense of anxiety or fear;
- personality changes;
- behavior unacceptable in the society( permanent or episodic);
- pathological agitation;
- paranoid nonsense( experiences);
- hallucinations( visual, auditory, etc.).
As dementia progresses, it causes loss of important skills and leads to disorders of a number of organs and systems.
Effects of dementia:
- eating disorders( with severe disability patients lose the ability to chew and swallow food);
- pneumonia( pneumonia is a consequence of aspiration of food particles);
- inability to service itself;
- security risk;
- fatal outcome( often - against a background of severe infectious complications).
Higher mental functions include thinking, speech, memory, and the ability to adequately perceive.If at least two of them have suffered so much that it directly affects the life of the patient, a diagnosis of "dementia" can be made.
At the first stage of the examination, the neurologist collects an anamnesis by talking to the patient and his relatives .
Various neuropsychological tests are used to evaluate cognitive functions. With their help, you can detect changes in the ability to remember, logical reasoning and concentration.Particular attention is paid to the speech of the patient.
Neurological examination allows to reveal deviations from the motor functions, visual perception and sensitivity.The patient's reflexes are evaluated, and his ability to maintain equilibrium is studied.
To determine some possible causes of dementia, laboratory blood tests of are helpful.Signs of the infectious and inflammatory process and specific markers of some degenerative pathologies of the nervous system can be detected in the cerebrospinal fluid.
To verify the diagnosis, a number of additional( neuroimaging) studies are needed - different types of tomography:
- magnetic resonance;
- positron emission.
CT and MRI can detect neoplasms, hematomas, hydrocephalus, as well as signs of circulatory disorders( including hemorrhagic or ischemic stroke).
With the help of positron emission tomography, the intensity of metabolism in the central nervous system is determined and the deposition of pathological protein is detected.The method makes it possible to clarify or refute the presence of Alzheimer's disease.
Note: consultation of a psychiatrist is required for the differential diagnosis of dementia with individual mental disorders and oligophrenia.
Treatment of dementia
Currently, most varieties of dementia are considered incurable.Nevertheless, treatment methods have been developed that allow controlling a significant part of the manifestations of this disorder.
Drug treatment for dementia
The temporary improvement of the patients' condition is facilitated by the pharmacotherapy .
To increase the level of neurotransmitters in the CNS, improving cognitive ability and memory, patients are shown to receive funds from the group of cholinesterase inhibitors.
Such preparations include:
- Galantamine( trade name - Razadin);Donepezil( Ariccept);
- Rivastigmine( Exelon).
Indications for their use are Parkinson's and Alzheimer's diseases, as well as vascular dementia.During therapy, undesirable effects are possible - dyspeptic disorders and bowel dysfunction( diarrhea).
The level of the neurotransmitter glutamate allows you to increase the drug Namende( Memantine).
According to the indications for a patient suffering from dementia, drugs are prescribed to fight insomnia and increased excitability.In some cases, the course of taking antidepressants is necessary.
Important: all medicines must be taken under the control of relatives and friends to avoid overdose or missed admission due to forgetfulness.It is unacceptable to take medications without a doctor's appointment!
Non-pharmacological assistance in the treatment of dementia
To prevent accidents, it is necessary to make the home safer. It is recommended to minimize the noise level and other external stimuli that can interfere with concentration of attention.Objects through which the patient is able to accidentally harm himself or others, it is advisable to hide.
To cope with disorientation in time and space will help to observe a certain daily routine.Relatively complex problems need to be divided into several consecutive simple ones.
Please note: has received data indicating a slowdown in the development of Alzheimer's disease with the regular intake of vitamin E preparations. However, it is believed that this biologically active compound increases the death rate among persons suffering from serious heart and vascular disease.
The risk of developing dementia decreases the regular intake of omega-3 fatty acids, which in particular are many in marine fish.There is reason to believe that making adjustments to the diet can slow the progression of dementia.
To reduce anxiety and improve mood, patients are helped to listen to quiet music and communicate with pets( especially cats).
Stabilization of the psychoemotional state is facilitated by aromatherapy and general relaxing massage.
The effectiveness of such a technique as art therapy has been proved.She can assume drawing, modeling and other forms of creativity.In the course of the classes, special attention is given to the process, not the result, which positively affects the patient's emotional state.
Plisov Vladimir, medical reviewer