Senile dementia in women and men: signs how to avoid

Many older people with age, gradually reduced mental capacity, loss of skills. Analyzing the symptoms, the doctor can put a disappointing diagnosis - senile dementia, or, to put it more clearly, senile dementia. Why do some old people develop such a disease and progress, while others avoid it? Is it possible to somehow help a loved one who suffers from dementia? How to behave to native people, where to take strength and patience, caring for a sick old man?

Speaking of senile dementia, doctors always mean a painful, growing mental malfunction in an elderly person. This disorder in all cases is complicated by other pathological conditions: cognitive processes stop, critical thinking disappears, mechanisms of activity of the brain and central nervous system are disrupted. Old people, suffering from senile dementia, experience permanent degradation of brain functionality.

[1], [2], [3], [4]

Epidemiology

The number of elderly people suffering from senile dementia is prone to a constant increase. To date, according to various sources, from 24 to 36 million people in the world have diagnosed senile dementia. Experts have calculated that if the incidence rate does not drop, then after two decades of illness will be three times more.

According to national statistics, patients with senile dementia account for 5 to 10% of all elderly people, and after 80 years, pathology is found in 20% of the elderly.

The first manifestations of the disease begin to worry about 65-78 years, while women are more often (approximately 2-3 times).

[5], [6], [7], [8], [9], [10], [11], [12],

Causes of the senile dementia

At present, specialists can not accurately answer the question of the causes of the development of senile dementia. Therefore, it is commonly believed that the slowdown of intracerebral processes depends on many factors - and, most likely, on their combination.

The first obvious factor is hereditary predisposition. For a long time scientists have observed the relationship: dementia develops more often in those patients whose direct relatives also suffered from this pathology.

The next factor is the age-related change in the working capacity of immune defense. Because of this change in the body, special autoimmune compounds are synthesized, capable of destroying brain structures.

Other factors of risk play a significant role:

• somatic pathologies (eg, cerebral vascular atherosclerosis);
• Infectious inflammatory processes (especially neuroinfections are dangerous, such as meningitis, encephalitis, syphilitic brain damage, etc.);
• oncopathology;
• any chronic intoxication (including alcohol abuse);
• head trauma in the anamnesis;
• severe stress, psychological trauma.

[13], [14], [15], [16], [17], [18],

Pathogenesis

The mechanisms of the formation of senile dementia are very complex. The starting point is the failure of functionality in the hypothalamic structures - in the first place, those responsible for the regulation of metabolic and endocrine processes in the body (pituitary system). As a result of the disturbed balance of hormones, the function of most organs changes, a negative effect on the brain appears, as a result of which its structures become defenseless in front of a huge number of external factors. It can be said that even a minor trauma of the psyche or domestic stress can undermine the higher nervous activity of people who are predisposed to the disease.

The development of senile dementia occurs within several years, during which nerve cells, responsible for intellectual and mental processes, and the quality of social adaptation die. The patient loses memory, learning ability deteriorates, ability to logical thinking disappears. Further, there is no interest in anything, the possibility of self-service suffers.

According to the morphological features of senile dementia under the influence of atrophic processes, the mass and volume of the brain decrease. Such processes evenly affect all brain structures: expansion of ventricles and furrows, sharpening of the gyri on the background of preservation of general proportions is observed.

Nerve cells seem to shrink, becoming smaller, but the contours do not change. The processes of the neurons cease to exist: in the process of sclerosing they are replaced by connective tissue.

For senile dementia, the appearance of multiple rounded necrotic foci is typical, with a brown homogeneous substance centered on the center, and threadlike formations along the edges. Similar pathological structures are called lesions of vomiting and senile plaques.

[19], [20], [21], [22], [23], [24], [25]

Symptoms of the senile dementia

Senile dementia develops so slowly that it is not always possible to clearly indicate the first signs of the disease. The first "bells" are often unobtrusive, they do not pay attention to or are not taken seriously. The only characteristic signs in the early stages of the disease are noticeable only in the diagnosis of MRI of the brain.

The general symptomatology of senile dementia includes many different conditions that manifest, depending on the course of the pathology. For example, the most common symptoms are:

• The character of the patient is somewhat coarser: for example, the previously economical old man suddenly manifests obvious stinginess.
• The patient more and more often gets hung up on the past time, without even trying to adapt to the current period. It is more comfortable for him to think "in the old way," to speak and do "the old way." Over time, this "conservatism" becomes exaggerated.
• At an early stage of dementia, a person is increasingly engaged in precepts, moralizing, it is already difficult to engage in dialogue with him, let alone to discuss.
• The patient becomes selfish, close to egocentrism. His interests are minimized, the desire to engage in something unfamiliar and new is lost.
• Deteriorated attention, lost ability to analyze and introspection.
• Thinking activity becomes a pattern, objectivity is lost.
• Separate patients in this period are characterized by bitterness, callousness, captiousness, conflictness, tactlessness, resentment. Others, on the contrary, become careless, too soft, talkative and even laughable. Often there is a loss of moral boundaries, moral principles are dismissed.
• Typical as asexuality, and perversion of sexual perception.
• Memory is very much affected. It is characteristic that the patients perfectly remember the events of "long gone days", but forget everything connected with today's day.
• An old man, suffering from dementia, can forget about his location, lose his temporary orientation. He has hallucinations, which he accepts unconditionally as a reality (it is useless to prove anything to him in such a situation).
• In relation to their native people, patients often begin to show unmotivated aggression: they express suspicions, accusations. This symptom usually becomes the most severe for the patient's relatives.

In the late stages of senile dementia neurological signs are attached:

• the pupils' reaction to light deteriorates;
• atrophy of the musculature;
• there is a small tremor of fingers and hands;
• steps shorten, gait becomes "shuffling"
• the patient loses weight;
• signs of insanity appear.

Alzheimer's disease and senile dementia

Dementia is a series of neurodegenerative disorders, which includes many similar pathologies. Their differences are explained by the defeat of different brain departments, as well as by different clinical manifestations and causes.

So, according to the location of the main focus of degenerative changes, there are such variants of dementia:

• Cortical dementia, which is caused by damage to the cerebral cortex. To this type include dementia of alcoholics, Alzheimer's disease. Similar pathologies are inherent in memory loss and cognitive impairment.
• Subcortical dementia is caused by damage to the subcortical structures that occurs in patients with Parkinson's, Huntington's diseases, etc. Typical signs of the listed pathologies are mental slowness, motor disorders.
• Mixed dementia implies damage to both cortical and subcortical structures. In this case, the clinical picture of pathologies is of a combined nature. A typical disease of a mixed variant is vascular dementia.
• Multifocal dementia is the most aggressive type of the pathology in question. The disease is characterized by the formation of multiple lesions in virtually all brain departments, which is manifested by all the well-known signs of neurodegenerative disorder. An example of this option is the Creutzfeldt-Jakob disease.

If we consider such concepts as senile dementia, dementia, then these are similar names for all the same neurodegenerative pathologies represented by the aforementioned diseases and syndromes.

[26], [27], [28]

Stages

In medicine, there are three stages related to senile dementia:

1. For an easy stage, degradation in the professional sphere is typical, some loss of social skills and interests. However, these factors, as a rule, attract little attention to themselves and do not yet affect the quality of life of the patient.
2. In the middle stage, the patient already requires outside supervision and supervision. The person has problems with spatial orientation and memory. Complexities can appear even in everyday life - for example, when using banal household appliances.
3. The severe stage is accompanied by aggravation of all previous manifestations. The old man, who is suffering from senile dementia, already needs systematic care, since he can not cope on his own with anything. He himself can no longer eat, wash, or change clothes.

[29], [30]

Complications and consequences

Senile dementia grows gradually, accompanied by new and increasingly insidious consequences:

• the signs of degradation processes are amplified: memory, emotional and strong-willed sphere suffers, thinking is inhibited;
• there is a disorganization of speech skills, the patient speaks less and less often, often out of place;
• psychotic manifestations develop, in the form of hallucinations and manic states;
• problems in the mental sphere are supplemented by somatic disorders, which, in turn, most often become the causes of death.

General complications in patients with senile dementia may be as follows:

• Sleep disturbances.

Ill people often wander at night, and in the daytime are in a sleepy state; can not sleep for a long time, aimlessly spending time.

• Hyperexcitability and aggressiveness.

Patients are aggressive, reacting to their own fears, fictional situations. Such a reaction can be caused by excessive suspicion, mania, and hallucinogenic conditions. Previously, a good old man can become vicious, vindictive and cynical.

• Hallucinations.

Hallucinations disturb many patients: visions are usually clear, detailed. They can influence behavior, because with long and obsessive visions, people's perception of the surrounding reality is disrupted.

• Delusional states, supplemented by hallucinations and confabulations.

Patients are dominated by the persecution or damage mania, spatial and personal identification is disturbed ("this is not my apartment", "not my wife", etc.). There is an aggravation of cognitive disorders.

• Depressive states.

Depression can visit a patient already in the early stages of the disease, as they are a kind of mental response to the formation of problems with memory and thinking. If the patient still has self-criticism, then he begins to feel his own failure. Depression can be accompanied by anxiety attacks and periods of anguish and hypochondria. The sick person becomes compassionate, aching, languid, lack of initiative. When there is a violation of sleep and appetite, there is emaciation.

Frequent or prolonged depression worsen the prognosis of senile dementia, so doctors often prescribe antidepressants to improve the well-being and quality of life of the sick old man.

• Injuries: bruises, fractures.

In older people, the bones are more fragile due to the processes of osteoporosis. It's no secret that the old people often suffer from a lack of coordination, and the danger of getting injuries increases many times. With senile dementia, gait changes, dizziness is often observed. And on the background of absent-mindedness the patient can fall practically on an equal place. Fractures in patients with senile dementia are not uncommon - such traumas can immobilize the victim for several months or even years.

Other unpleasant complications in senile dementia are:

• loss of control over urination and defecation;
• the appearance of skin diseases, diaper rash, and pressure sores.

Loss of hygiene skills in senile dementia

People suffering from senile dementia always have problems with personal hygiene sooner or later. As a result of mental degradation, patients begin to neglect hygienic procedures. To this you need to be ready, so relatives should always carefully monitor, wash the patient, whether he does it qualitatively. Approach to this issue should be as delicately as possible, so as not to offend and not humiliate an already vulnerable old man.

A special article of hygiene is the care of a sick person who already has no control over urination and defecation. The patient may simply "forget" in time to go to the toilet, or "get lost" in his own apartment in search of a lavatory. If the problems are related specifically to the above situations, then you can try to find a way out:

• on the door to the toilet should be glued the image of the toilet to give the patient an orientation;
• The door to the latrine should be kept ajar, in order to avoid difficulties with its opening;
• The patient's clothing should be easily unbuttoned and removed so that there are no corresponding problems when going to the toilet;
• some old men, shortly before direct urge to urinate or defecate, begin to noticeably worry, fuss, change their pose; these signs often allow you to "calculate" the moment to timely lead the patient to the toilet.

At a late stage of senile dementia, it is advisable to use special diapers and diapers intended for adults.

[31], [32], [33], [34], [35], [36], [37], [38], [39]

Diagnostics of the senile dementia

Despite the mass of characteristic symptoms, it is not so easy to immediately identify senile dementia in an elderly person: functional and organic disorders of the psyche require a complex diagnostic approach.

Of course, the basis for proper diagnosis is the examination and questioning of the patient during the initial medical consultation.

The doctor, first of all, will ask:

• what painful signs became the reason for seeking medical help;
• which could cause the development of the disease (frequent use of alcohol, infection, trauma, severe stress, taking psychoactive drugs);
• from what age relatives began to notice suspicious symptoms in a person;
• whether the patient had problems with remembering information, whether the ability to express thoughts was daring, whether introspection and planning were preserved;
• whether there are any problems in the home;
• whether the patient's mood often changes.

The polling step is also important for the differentiation of senile dementia from pseudodementia, oligophrenia and other variants of dementia.

Further, differential diagnosis involves the provision of special psychological "dementia-tests".

• The Mini-Cog test evaluates the quality of the short-term memory mechanism and spatial-visual coordination. Duration of testing - no more than five minutes.

1. The doctor offers the patient to memorize three words different in meaning (for example, "tea, table, pencil").
2. Then the patient draws a clock dial with a pencil and marks the time 9:15.
3. After that, the doctor asks the patient to voice the three words suggested earlier.

• Among complex tests, KSHOPS (MMSE) and BLD (FAB) are very popular. KSHOPS - a scale that assesses mental status, allows you to determine the quality of speech, mindfulness, memory, as well as the patient's temporal and spatial orientation. The quality is assessed by points: if the patient receives 24 points or less, this indicates the presence of severe cognitive impairment. BPD is able to confirm frontal dementia in humans. If the patient receives less than eleven points, the diagnosis can be considered confirmed. Also, after carrying out the listed studies, a test evaluating the daily activity is carried out. This method involves answers to ten questions that characterize the patient's everyday habits. If a person received less than 24 points according to the SSHRS and then answered negatively at least one of ten questions, then the doctor without doubt can establish a diagnosis of senile dementia.

In order to verify the correctness of the diagnosis, a number of additional studies are prescribed:

• blood test (general clinical, biochemistry);
• determination of hormonal balance (first of all, thyroid function is being studied);
• analyzes for the presence of syphilis and human immunodeficiency virus.

Instrumental diagnostics in senile dementia is represented by such diagnostic procedures:

• computer and magnetic resonance imaging (the brain is being examined);
• encephalography;
• ultrasound diagnosis of cerebral vessels;
• methods of emission tomography (one and two-photon CT);
• lumbar puncture (in some cases).

If necessary, resort to the help and advice of narrow specialists (ophthalmologist, psychiatrist, endocrinologist, etc.).

It is often necessary to differentiate senile dementia from pseudodementia, which is a consequence of a prolonged depressive state. To clarify the diagnosis apply psychological tests, as well as a test with Dexamethasone. The essence of the sample is as follows:

• in a patient with senile dementia, after administration of the drug, the content of cortisol in the blood decreases;
• in a patient with pseudodementation, the content of cortisol continues to be within the normal range.

It is also important to distinguish primary dementia from secondary dementia.

What is the difference between Alzheimer's disease and senile dementia? Alzheimer's disease, in fact, is the initial stage in the development of senile cortical dementia. You can call this pathology, as a kind of dementia, and a kind of senile dementia. Therefore, doctors usually do not differentiate these disease states, because of the common pathogenetic, clinical and therapeutic aspects.

[40], [41], [42], [43], [44], [45], [46], [47], [48],

Treatment of the senile dementia

Medicine does not have any one therapeutic principle that could be applied everywhere to inhibit the development of senile dementia. For each patient, treatment is selected individually, which is easily explained by the large number of pathogenetic directions that can lead to such a disease. Of course, the patient's relatives are immediately warned that senile dementia is recognized as an irreversible process, and there is no possibility of eradicating pathology completely.

Details about the methods of treatment of senile dementia read in this article.

Prevention

Everyone knows: for the prevention of diseases of the respiratory system, you need to stop smoking, and to prevent myocardial infarction, you should regularly exercise and walk in the fresh air. But is it possible to prevent the development of senile dementia?

Unfortunately, medicine still can not pinpoint the cause of the onset of the disease, and therefore specific methods of prevention for it are not developed.

Of course, age is the main risk factor. For example, in the UK, every third old man who has crossed the 95-year threshold is suffering from senile dementia.

What do the doctors say about this?

• It is important to monitor the operation of the cardiovascular system, minimizing the risk of complications on its part.
• Smoking should be abandoned once and for all.
• We need to fight against obesity, eat right, exercise regularly, monitor blood cholesterol and blood sugar, monitor blood pressure.

[49], [50], [51],

Forecast

The severe course of senile dementia is characteristic of the early development of the disease. The quality of the prognosis is also dependent on how constant and qualitative the treatment has become: if the patient carefully and regularly takes prescribed medications, tries to be physically active, promptly consults the doctor about other somatic pathologies, then the further course of the illness can be considered relatively favorable.

To fully stop the development of senile dementia is impossible today. However, treatment should be done: this will make the life of elderly patients more comfortable and stable.

How many live with senile dementia?

Despite the fact that each case of senile dementia is individual, there are also statistics, indicators that we will consider. It is believed that after the diagnosis of dementia the patient lives on average from seven to ten years. But there are cases when the patient lived 20 or even 25 years.

What can affect the life expectancy of old people with senile dementia?

First of all, this is the quality of care for a sick person. If close people show patience, compassion, and are ready at any moment to come to the rescue - then in such families, patients with dementia have all the chances to live longer. Among other factors of longevity should be allocated physical activity, regular exercises for the development of intellectual capabilities, a full vitaminized diet. Doctors believe that these factors can affect the life expectancy of a patient with senile dementia.

[52], [53], [54], [55], [56],

Disability in senile dementia

Senile dementia refers to acquired diseases. Certainly, a patient who suffers from this disease, in most cases, is not able not only to work, but also to engage in self-service. The patient gradually loses practical skills, his memory weakens, depression and apathy often occur, so he often requires extraneous care and observation. Therefore, senile dementia is a real reason for disability registration. The only condition: the patient must issue a power of attorney, since it is unlikely he will be able to handle the registration independently.

Disability is appropriated, given the type of illness and the degree of disability. However, most patients with a disease such as senile dementia, appoint the first group without a period of validity. An exception may be the first, mild stage of the disease.

[57], [58], [59], [60], [61], [62], [63]