Senile dementia in women and men: signs, how to avoid it

Many elderly people experience a gradual decline in mental abilities and loss of skills with age. After analyzing the symptoms, a doctor may make a disappointing diagnosis - senile dementia, or, to put it more clearly, senile dementia. Why does this disease develop and progress in some elderly people, while it bypasses others? Is it possible to somehow help a loved one suffering from dementia? How should relatives behave, where to get strength and patience when caring for a sick elderly person?

When speaking about senile dementia, doctors always mean a painful, increasing mental failure in an elderly person. This disorder is always complicated by other pathological conditions: cognitive processes stop, critical thinking disappears, the mechanisms of brain activity and the central nervous system are disrupted. In elderly people suffering from senile dementia, there is a permanent degradation of brain functionality.

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

Epidemiology

The number of elderly people suffering from senile dementia is likely to increase steadily. According to various sources, 24 to 36 million people worldwide have been diagnosed with senile dementia. Experts have calculated that if the incidence rate does not decrease, the number of people suffering from the disease will be three times greater in two decades.

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

The first manifestations of the disease begin to bother people at about 65-78 years of age, and women are more likely to get sick (approximately 2-3 times).

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

Causes senile dementia

At present, specialists cannot give a precise answer to the question of the causes of senile dementia. Therefore, it is generally accepted that the slowing down of intracerebral processes depends on many factors – and, most likely, on their combination.

The first obvious factor is considered to be hereditary predisposition. Scientists have long traced the relationship: dementia more often develops in those patients whose immediate relatives also suffered from this pathology.

The next factor can be called age-related changes in the functionality of the immune defense. As a result of this change, special autoimmune compounds are synthesized in the body, capable of destroying brain structures.

Other risk factors also play a significant role:

• somatic pathologies (for example, vascular atherosclerosis of the brain);
• infectious inflammatory processes (especially dangerous are neuroinfections such as meningitis, encephalitis, syphilitic brain damage, etc.);
• oncopathologies;
• any chronic intoxication (including alcohol abuse);
• history of head trauma;
• severe stress, psychological trauma.

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

Pathogenesis

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

The development of senile dementia occurs over several years, during which the nerve cells responsible for intellectual and mental processes, the quality of social adaptation die. The patient loses memory, his learning ability deteriorates, the ability for logical thinking disappears. Then interest in anything disappears, the ability to take care of oneself suffers.

According to morphological signs, in senile dementia, under the influence of atrophic processes, there is a decrease in the mass and volume of the brain. Such processes uniformly affect all brain structures: there is an expansion of the ventricles and furrows, a sharpening of the convolutions against the background of the preservation of general proportions.

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

Senile dementia is characterized by the appearance of multiple round necrotic foci, in the center of which there is a brown homogeneous substance, and at the edges - threadlike formations. Such pathological structures are called foci of desolation and senile plaques.

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

Symptoms senile dementia

Senile dementia develops so slowly that it is not always possible to clearly identify the first signs of the disease. The first "alarm bells" are often barely noticeable, they are ignored or not taken seriously. The only characteristic signs in the early stages of the disease are noticeable only when performing MRI diagnostics of the brain.

General symptoms of senile dementia include many different conditions that manifest themselves depending on the course of the pathology. For example, the most typical symptoms are:

• The patient's character becomes somewhat coarser: for example, a previously thrifty old man suddenly shows obvious stinginess.
• The patient increasingly becomes fixated on the past, not even trying to adapt to the current period. He feels more comfortable thinking "in the old way", speaking and acting "in the old way". Over time, such "conservatism" becomes exaggerated.
• At the early stage of dementia, a person increasingly engages in instructions and moralizing; it is already difficult to conduct a dialogue with him, and, even more so, to debate.
• The patient acquires selfishness, close to egocentrism. His interests are minimized, the desire to do anything unfamiliar and new is lost.
• Attention deteriorates, the ability to analyze and introspect disappears.
• Mental activity becomes stereotyped, objectivity is lost.
• Some patients during this period are characterized by bitterness, callousness, pickiness, conflict, tactlessness, and touchiness. Others, on the contrary, become careless, overly soft, talkative, and even laughable. Often, there is a loss of moral boundaries, and moral principles are discarded.
• Both asexuality and perversion of sexual perception are typical.
• Memory suffers to a significant extent. It is typical that patients remember events of "long gone days" very well, but forget everything connected with today.
• An old man suffering from dementia may forget his location, lose his time orientation. He may have hallucinations, which he unconditionally accepts as reality (proving anything to him in such a situation is useless).
• Patients often begin to show unmotivated aggression towards their relatives: they express suspicions and accusations. This symptom usually becomes the most severe for the patient's relatives.

In the later stages of senile dementia, neurological signs are added:

• the pupils' reaction to light worsens;
• the muscles atrophy;
• slight tremors of fingers and hands are observed;
• steps become shorter, gait becomes shuffling
• the patient loses weight;
• signs of insanity appear.

Alzheimer's disease and senile dementia

Dementia is a series of neurodegenerative disorders that includes many similar pathologies. Their differences are explained by the damage to different parts of the brain, as well as different clinical manifestations and causes.

Thus, according to the location of the main focus of degenerative changes, the following types of dementia are distinguished:

• Cortical dementia, which is caused by damage to the cerebral cortex. This type includes alcoholic dementia, Alzheimer's disease. Such pathologies are characterized by memory loss and cognitive impairment.
• Subcortical dementia is caused by damage to the subcortical structures, which occurs in patients with Parkinson's, Huntington's, etc. Typical signs of the listed pathologies are slowness of thought and movement disorders.
• Mixed dementia implies damage to both cortical and subcortical structures. In this case, the clinical picture of pathologies is combined. A typical disease of the 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 almost all parts of the brain, which manifests itself in all the well-known signs of a neurodegenerative disorder. An example of such a variant is Creutzfeldt-Jakob disease.

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

[ 26 ], [ 27 ], [ 28 ]

Stages

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

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

[ 29 ], [ 30 ]

Complications and consequences

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

• signs of degradation processes are intensified: memory, emotional and volitional spheres suffer, thinking is inhibited;
• disorganization of speech skills occurs, the patient speaks less and less, often out of place;
• psychotic manifestations develop in the form of hallucinations and manic states;
• Problems in the mental sphere are complemented by somatic disorders, which, in turn, most often become the causes of death.

Common complications in patients with senile dementia may include:

• Sleep disorders.

Sick people often wander at night and are sleepy during the day; they may not sleep for a long time, spending time aimlessly.

• Hyperexcitability and aggressiveness.

Patients show aggression, reacting to their own fears, imaginary situations. Such a reaction can be caused by excessive suspiciousness, manias, hallucinogenic states. A previously kind old man can become spiteful, vengeful and cynical.

• Hallucinations.

Hallucinations disturb many patients: the visions are usually clear and detailed. They can affect behavior, since with prolonged and intrusive visions, a person's perception of the surrounding reality is disrupted.

• Delusional states, accompanied by hallucinations and confabulations.

Patients are dominated by persecution or damage mania, spatial and personal identification is disrupted (“this is not my apartment”, “not my wife”, etc.). Cognitive disorders worsen.

• Depressive states.

Depressions can visit the patient already at the early stages of the disease, as they are a kind of mental response to the development of problems with memory and thinking. If the patient still has self-criticism, he begins to feel his own failure. Depression can be accompanied by anxiety attacks and periods of melancholy and hypochondria. The sick person becomes pitiful, whiny, sluggish, and lacking initiative. With sleep and appetite disorders, weight loss is observed.

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

• Injuries: bruises, fractures.

Older people have more fragile bones due to osteoporosis. It is no secret that old people often suffer from impaired coordination, and the risk of injury increases many times over. With senile dementia, gait changes, dizziness is often observed. And due to absent-mindedness, the patient can fall practically on level ground. Fractures in patients with senile dementia are not uncommon - such injuries can immobilize the victim for several months or even years.

Other unpleasant complications of senile dementia include:

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

Loss of hygiene skills in senile dementia

People suffering from senile dementia always sooner or later have problems with maintaining personal hygiene. As a result of mental degradation, patients begin to neglect hygiene procedures. You need to be prepared for this, so relatives should always carefully monitor whether the patient washes and whether he does it well. This issue should be approached as delicately as possible, so as not to offend or humiliate an already vulnerable old man.

A special article of hygiene is caring for a sick person who no longer has control over urination and defecation. The patient may simply “forget” to go to the toilet on time, or “get lost” in his own apartment looking for a toilet. If the problems are related to the above situations, then you can try to find a way out:

• An image of a toilet should be pasted on the door to the restroom to give the patient orientation;
• the door to the toilet should be kept slightly open to avoid difficulties with opening it;
• The patient's clothing should be easy to unbutton and remove so that problems do not arise when going to the toilet;
• Some elderly people, shortly before the direct urge to urinate or defecate, begin to noticeably worry, fuss, and change their position; these signs often allow one to “calculate” the moment in order to promptly take the patient to the toilet.

In the late stages of senile dementia, it is advisable to use special diapers and nappies intended for adults.

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

Diagnostics 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 mental disorders require a comprehensive diagnostic approach.

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

The doctor will first of all ask:

• what painful symptoms were the reason for seeking medical help;
• what could have caused the development of the disease (frequent consumption of alcoholic beverages, infections, injuries, severe stress, taking psychoactive drugs);
• at what age did relatives begin to notice suspicious symptoms in the person;
• has the patient developed problems with memorizing information, has the ability to express thoughts changed, has self-analysis and planning been preserved;
• are there any problems in everyday life;
• How often does the patient's mood change?

The survey stage is also important for differentiating senile dementia from pseudodementia, oligophrenia and other types of dementia.

Further differential diagnostics involves conducting special psychological “dementia tests”.

• The Mini-Cog test allows you to evaluate the quality of the short-term memory mechanism and spatial-visual coordination. The test lasts no more than five minutes.

1. The doctor asks the patient to memorize three words with different meanings (for example, “tea, table, pencil”).
2. Next, the patient draws a clock face with a pencil and marks the time 9:15 on it.
3. After this, the doctor asks the patient to pronounce the three words suggested earlier.

• Among the complex tests, the most popular are the MMSE and FAB. The MMSE is a scale that evaluates mental status and allows one to determine the quality of speech, attentiveness, memory, as well as the patient’s temporal and spatial orientation. Quality is assessed by points: if the patient receives 24 points or less, this indicates the presence of severe cognitive disorders. FAB can confirm frontal dementia in a person. If the patient receives less than eleven points, the diagnosis can be considered confirmed. Also, after conducting the above studies, a test is conducted that evaluates daily activity. This method involves answering ten questions that characterize the patient’s everyday skills. If a person receives less than 24 points on the MMSE and then answers negatively to at least one of the ten questions, the doctor can undoubtedly establish a diagnosis of senile dementia.

In order to ensure 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 examined);
• tests for syphilis and human immunodeficiency virus.

Instrumental diagnostics for senile dementia is represented by the following diagnostic procedures:

• computed tomography and magnetic resonance imaging (the brain is examined);
• encephalography;
• ultrasound diagnostics of cerebral vessels;
• emission tomography techniques (single- and dual-photon CT);
• lumbar puncture (in some cases).

If necessary, seek help and consultation from specialists (ophthalmologist, psychiatrist, endocrinologist, etc.).

It is often necessary to differentiate senile dementia from pseudodementia, which is a consequence of a long-term depressive state. To clarify the diagnosis, psychological tests are used, as well as a Dexamethasone test. The essence of the test is as follows:

• in a patient with senile dementia, after administration of the drug, there is a decrease in the level of cortisol in the blood;
• In a patient with pseudodementia, cortisol levels continue to be within normal limits.

It is also important to distinguish primary from secondary dementia.

What is the difference between Alzheimer's disease and senile dementia? Alzheimer's disease is essentially the initial stage of development of senile dementia of the cortical type. This pathology can be called both a type of dementia and a type of senile dementia. Therefore, doctors usually do not differentiate these disease states, due to the commonality of pathogenetic, clinical and therapeutic aspects.

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

Treatment senile dementia

Medicine does not have any single therapeutic principle that could be applied universally to slow down the development of senile dementia. Treatment is selected individually for each patient, 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 it is not possible to completely eradicate the pathology.

Read more about methods of treating senile dementia in this article.

Prevention

Everyone knows: to prevent respiratory diseases, you need to quit smoking, and to prevent myocardial infarction, you need to regularly do exercises and walk in the fresh air. But is it possible to prevent the development of senile dementia?

Unfortunately, medicine still cannot pinpoint the exact cause of the disease, so specific prevention methods have not been developed for it.

Age is certainly a major risk factor. For example, in the UK, every third person over 95 suffers from senile dementia.

What do doctors say about this:

• It is important to monitor the functioning of the cardiovascular system, minimizing the risk of complications from it.
• You need to give up smoking once and for all.
• You need to fight obesity, eat right, exercise regularly, monitor your cholesterol and blood sugar levels, and keep an eye on your blood pressure.

[ 49 ], [ 50 ], [ 51 ]

Forecast

Severe course of senile dementia is typical for the early development of the disease. The quality of the prognosis also depends on how constant and high-quality the treatment has become: if the patient diligently and regularly takes the prescribed medications, tries to be physically active, promptly consults a doctor about other somatic pathologies, then the further course of the disease can be considered relatively favorable.

It is currently impossible to completely stop the development of senile dementia. However, treatment must be carried out: this will make the life of elderly patients more comfortable and stable.

How long do people live with senile dementia?

Despite the fact that each case of senile dementia is individual, there are also statistics, the indicators of which 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 and even 25 years.

What can affect the life expectancy of elderly people suffering from senile dementia?

First of all, it is the quality of care for a sick person. If loved ones show patience, compassion, and are ready to come to the rescue at any moment, then in such families, patients with dementia have every chance of living longer. Among other factors of longevity, it is necessary to highlight physical activity, regular exercises to develop intellectual abilities, and a complete vitamin-rich diet. Doctors believe that the listed factors can affect the life expectancy of a patient with senile dementia.

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

Disability in senile dementia

Senile dementia is an acquired disease. Of course, a patient who suffers from this disease is in most cases unable not only to work, but also to take care of himself. The patient gradually loses practical skills, his memory weakens, depression and apathy often occur, so he often requires outside care and observation. Therefore, senile dementia is a valid reason for registering a disability. The only condition: the patient must issue a power of attorney, since he is unlikely to be able to do the paperwork on his own.

Disability is assigned taking into account the type of disease and the degree of loss of working capacity. However, most patients with a disease such as senile dementia are assigned the first group without a validity period. An exception may be the first, mild stage of the disease.

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