Senile dementia

Description:

Senile dementia (dementia senilis, synonym: senile dementia, senile weak-mindedness) — the mental disease beginning preferential at senile age; it is shown by gradually accruing disintegration of mental activity to degree of total weak-mindedness with the dysmnesia developing as the progressing amnesia.

Among the mental diseases arising at senile age, senile weak-mindedness is the most frequent (from 12 to 34,4% of all cases of mental diseases fall to its share). The expressed senile dementia about 5,6% of persons of senile age, and together with persons at whom senile weak-mindedness proceeds in the easy or moderately expressed degree — about 10 — 15% have. With increase in average life expectancy the risk of a disease increases. Senile weak-mindedness occurs at women by 2 — 3 times more often than at men. At the vast majority of patients the disease develops in the period between 65 — 76 years. Middle age at which the disease at men — 73,4 begins women have 75,3 years.

Symptoms of Senile dementia:

Allocate several forms of senile dementia — simple, to a presbiofreniye, psychotic. Forms  depend on rate of the atrophic processes happening in a brain, which joined somatopathies, constitutional and genetic factors.

The simple form begins hardly noticeably, with the mental disorders inherent to aging. The acute onset of the illness demonstrates strengthening of the existing earlier mental disturbances provoked by any somatopathy. At patients mental activity decreases: rate of mental activity is slowed down, there is high-quality and its quantitative deterioration (ability to concentrate and switch attention is broken, its volume is narrowed; the imagination, ability to abstraction, the analysis and generalization, and also resourcefulness and an ingenuity at the solution of the questions raised by life weaken). The diseased everything more shows conservatism in judgments, acts, attitude. The present is regarded by it as small, not deserving attention, or just rejected. In the past of the patient sees preferential positive, worthy to serve as a sample in various life situations. There is a tendency to edification, the intractability reaching obstinacy, irritability at disagreement or contradictions. At the same time the selective increased suggestibility is often noted. The interests inherent earlier which are especially concerning the general questions are narrowed. The patient pays attention to the physical state, especially to physiological departures to a large extent. The affective resonance decreases: indifference to what does not mention directly sick appears and increases. Weaken (up to total disappearance) attachments, including to relatives. The understanding of the relations existing between people is lost. At many decreases or just the feeling of a step and bashfulness disappears. Range of shades of mood is narrowed. At one patients the complacency, carelessness, tendency to jesting or uniform jokes, at others — a capriciousness, discontent, petty fault-finding begin to prevail. In all cases there is depletion of former characterologic lines. Consciousness of the listed personal changes disappears early or at all does not arise.

If to a disease at patients the expressed psychopathic lines, especially stenichny were noted (persistence, greed, a categoriality, authoritativeness), in an onset of the illness they are usually pointed, often grotesquely (a senile psikhopatization). The avarice which is often followed by accumulation of stuff develops, the reproaches to relatives concerning irrational grow (according to patients) daily expenditure, the existing customs, first of all the matrimonial relations are usually blamed, inconsiderate intervention in intimate life of relatives is quite often noted.

Initial psychological shifts and personal changes accompanying them are followed by decrease in memory, first of all on the current events. People around notice them usually later, than changes of character of patients. It is connected with the fact that at patients memories of events of the antecedents taken by relatives for safety of memory quicken ("she so well remembers everything"), and also in connection with safety at them some external forms of behavior. Disintegration of memory happens on patterns of the progressing amnesia. In the beginning memory on the distracted and differentiated concepts, for example names, dates, names, terms suffers, then the fixating amnesia which is expressed in inability to remember the current events joins. Arise an anamnestic disorientation in time (patients cannot call number, a day of the week, month), an anamnestic chronological disorientation (cannot designate dates of the major events of public and private life). Further appear an anamnestic disorientation in a surrounding situation (patients cannot tell where they are or call other place) and at last an anamnestic space disorientation (having left the house, patients do not find a way back, confuse an arrangement of rooms in the apartment). Recognition of persons of the immediate environment is broken, them begin to call by others names (for example, the daughter is taken for mother and respectively call). At development of total weak-mindedness recognition of own appearance is broken: "What it there for the old woman?" — the patient says, examining herself in a mirror. Zabyvaniye of the present is followed by revival of memoirs of the past often relating to youth and the childhood. In some cases there is "life in the past". At the same time patients consider themselves young people, even children, tell about antecedents, as about present events. Often such "memoirs" are pure fiction (ekmnestichesky confabulations).

At senile dementia there is a clear dissociation between expressed and even very deep weak-mindedness and safety of the automated former external forms of behavior: the manner to behave existing in the past, including gesticulation, the correct speech, often with live intonations remains, patients pertinently use separate ordinary expressions. Safety of external forms of behavior, quite often garrulity of patients, their "fine memory" (on separate events of the past), usually mislead strangers; they think that they talk to absolutely healthy people. And only accidentally asked question suddenly finds out that the person conducting lively conversation, reporting various, sometimes interesting, the facts from the past and as though correctly reacting to words of the interlocutor, does not know, how old is he, of whom his family what now year, does not represent where lives consists and to whom talks.

During initial stages of a disease the association between clear weak-mindedness and a good physical shape is constant. Sick S. of page are usually mobile, quickly make the exact movements if necessary to perform these or those usual operations. Only in far come cases physical marasmus develops.

The expressed weak-mindedness is followed by development of anamnestic aphasia, the initial phenomena of touch aphasia and apraxia. These frustration are in certain cases expressed sharply, and the clinical picture begins to remind Alzheimer a disease. The single and not numerous reduced epileptic seizures are possible, the reminding faints are more often. Sleep disorders are characteristic: patients fall asleep and waken in indefinite time, duration (usually deep sleep) fluctuates from 2 — 4 to 20 h. At the same time there are periods of long wakefulness. If they fall on night time, then patients wander about the apartment, perform usual household operations, for example light gas, put an empty pan on a ring, open cranes. If patients are in hospital, then correct a bed of neighbors, efficiently look under beds, etc. Often similar activity is shown in the form of "collecting to the road"; at the same time patients collect bed and personal linen in a node, look for something, sit on a bed or are trampled down about it. Often answer the asked questions that they need to go, quite often speak "home, to mother".

In a final stage of senile dementia the cachexia develops. Patients lie in an embryo pose, are in a drowsy state, do not react on people around, sometimes muffledly mutter something. Oral avtomatizm are usually observed.

Presbiofreniya (chronic presbiofreniya of Vernike, or konfabulyatorny form) is the most softly proceeding form of senile dementia; it arises at a complication of a simple form atherosclerosis of vessels of a brain. Living, mobile and good-natured people sick with a presbiofreniya. They speak much, their lexicon is rich. In statements the fiction relating to events of the past and partially to the present prevails. The false recognitions connected with a dysmnesia are characteristic: people around patients take for persons who were known earlier. Presbiofreniya reminds a korsakovsky syndrome; distinction consists that at it the progressing amnesia is noted. Presbiofreniya develops preferential at persons of cycloid type. In the past it is usually active, living, cheerful and mobile people.

When the simple form of senile dementia becomes complicated somatic, including infectious, the acute presbiofreniya arises diseases. Conditions of stupefaction in the form of a professional or mussitans delirium, occasionally amentias are characteristic of it. After their disappearance the expressed strengthening of weak-mindedness is observed.

The psychotic form (senile insanity) can arise in the form of crazy, hallucinatory-dilision, paraphrenic and affective psychoses. In a debut of senile insanity psychopatholike changes of the personality are constantly expressed. Dysmnesias develop slowly. Usually in 2 — 7 years psychosis is noted. The paranoiac syndrome with nonsense of damage, a robbery is characteristic of crazy psychoses, poisonings are more rare with a persecution complex. The nonsense extends preferential to persons of the immediate environment. At a part of patients the paranoiac syndrome in the subsequent becomes complicated verbal hallucinosis. In the maintenance of hallucinations threats, charges, damage prevail. Verbal hallucinosis is possible also without the previous paranoiac syndrome. Usually hallucinosis in short terms becomes complicated fantastic contents, there is a picture of a hallucinatory, then konfabulyatorny paraphrenia.

Affective psychoses are shown maniacal and depressions. The maniacal state — a senile (senile) mania — is characterized is raised by complacent mood, confused efficiency, revaluation of the personality, the erotic ideas. At a depression, or a senile depression, the uniform alarming suppressed mood with the separate crazy ideas of ruin, an impoverishment, hypochiondrial or nigilistic character is usually noted.

Weak-mindedness at a psychotic form develops slowly, often to the death of patients without reaching that degree which is observed at a simple form.

The diagnosis is established on the basis of the anamnesis and a clinical picture. At the differential diagnosis the greatest difficulties are presented by differentiation of initial displays of senile dementia with age mental changes, especially when the last arise at psychopathic persons. Quite often diagnostic difficulties are allowed only by a catamnesis. In some cases S. of page should be differentiated from Alzheimer the disease arising after 60 years. The psychotic form of senile dementia in an initial stage of development should be distinguished from senile psychoses, and also the schizophrenia demonstrating in old age.

Reasons of Senile dementia:

At senile dementia aging of a brain happens quicker and in more expressed degree, than normal. The reasons causing such accelerated aging are little-known. Immune theories of aging which recognize the fact that at senile age there are disturbances of immunoregulatory mechanisms, and as a result, development of autoimmune processes move forward. The autoantibodies which are formed at the same time in a significant amount have the direct damaging effect on cells and tissues of a brain. It is established that cerebrospinal liquid contains the main types of the immunocompetent cells playing normal a protective role. At senile age their ratio, functional properties change, as is the reason of pathological changes in the central nervous system.

Pathological aging is caused also by a genetic factor. The risk of a disease is 4,3 times higher in those families in which there were already cases of senile dementia. For separate forms  the constitutional factor matters. So, at a presbiofreniya at patients cycloid gipertimny character and quite often pyknic constitution is noted, patients with senile insanity with dominance of crazy and hallucinatory frustration have paranoiac and epileptoidny traits of character, and among relatives of patients persons often meet a psychopathic warehouse of character and suffering from mental diseases (schizophrenia and shizofrenopodobny psychoses) arising for the first time at senile age. Somatic diseases are capable to reveal symptoms of earlier softly proceeding senile dementia, to alter his clinical picture, to accelerate development of weak-mindedness. Timely elimination of somatic diseases in some cases is capable to cause the subsequent softer development of senile dementia.

Treatment of Senile dementia:

Patients with senile dementia need first of all leaving and supervision. They adapt to well-known to them to a situation better (it is not necessary to transport them from one relatives to others). The patients who is in house conditions need to provide preservation certain, let the simplest, a life rhythm. At the same time stimulation of their physical activity is important (available cleaning of the apartment, washing of small things, participation in cooking, etc.). It is necessary to interfere with finding of the patient in a bed in the afternoon. If he wants to have a rest in the afternoon, then it is more preferable to do it sitting in a pose, convenient for it. Active lifestyle promotes preservation of physical health of such patients and by that to slower development of weak-mindedness. It is necessary to monitor physiological departures. In a food allowance vitamin-rich food has to prevail. At clear weak-mindedness the crushed food is recommended. If the patient suddenly begins to eat or sleep badly, activity at him is replaced by slackness, it is possible to assume a somatopathy. At purpose of nootrop at a part of patients the night sleep can be interrupted and amplify irritability. Use of psychotropic drugs (for improvement of a dream, elimination of motive concern, nonsense, the changed affect) has to be careful because at patients easily there come lacks of coordination of movements, slackness that can lead to falling.

Forecast. The disease steadily progresses and comes to an end with marasmus. Usually intercurrent diseases are a proximate cause of death. At an onset of the illness after 75 years and at senile insanity rate of development of atrophic process in a brain is slowed down. What senile dementia began earlier, its development happens that in more short time. Duration of senile dementia fluctuates from 7 months to 11 years and more.