Senile dementia (senile dementia)
disease of old age, caused by brain atrophy, manifested by the gradual disintegration of mental activity with the loss of individual personality traits and the outcome in total dementia. Senile dementia
- The central problem of late psychiatry. Patients with senile dementia make up 3-5% in the population of people over 60 years old, 20% among 80-year-olds and from 15 to 25% of all mentally ill old people. The cause of senile dementia, as well as other atrophic processes, is still unknown. There is no doubt about the role of heredity, which is confirmed by the cases of "marital dementia." The disease begins at 65-75 years, the average duration of the disease is 5 years, but there are cases with a slow course over 10-20 years. The disease develops imperceptibly, with gradual personality changes in the form of sharpening or exaggerating former character traits. For example, thrift turns into stinginess, perseverance turns into stubbornness, distrust turns into suspicion, and so on. At first, it resembles the usual characterological shifts in old age: conservatism in judgments, actions; rejection of the new, praise of the past; propensity to morals, edification, intractability; narrowing of interests, egoism and egocentrism. Along with this, the rate of mental activity decreases, attention and the ability to switch and concentrate it deteriorates. Thinking processes are disturbed: analysis, generalization, abstraction, logical reasoning and judgment. With the coarsening of personality, its individual properties are leveled and the so-called senile features emerge: the narrowing of horizons and interests, stereotyped views and statements, the loss of previous connections and affections, callousness and stinginess, captiousness, stinginess, malice. In some patients, complacency and carelessness, a tendency to talk and jokes, complacency and impatience of criticism, tactlessness and loss of moral standards of behavior predominate. In such patients, modesty and elementary moral attitudes disappear. In the presence of impotence, there is often an increase in sexual attraction with a tendency to sexual perversions (public exposure of the sex organs, seduction of minors).
Along with the "deterioration" of character, which relatives often regard as a normal age-related phenomenon, memory disorders gradually increase. Memorization is violated, the ability to acquire new experience is lost. Suffering and reproduction of available information in the memory. First, the most recently acquired experience falls out of memory, then memory also disappears into distant events. Forgetting the present and recent past, patients remember the events of childhood and adolescence quite well. There appears to be a shift of life to the past right up to "life in the past", when an 80-year-old old woman considers herself an 18-year-old girl and behaves according to this age. Neighbors in the ward and medical staff names the persons who were at that time in her environment (long dead). In answering questions, patients report facts of bygone years or talk about fictional events. At times, patients become fussy, businesslike, collect and tie things into knots - “get ready for a trip”, and then, sitting with a knot in their knees, wait for the trip. This is due to gross violations of orientation in time, the surrounding, self.
However, it should be noted that in senile dementia there is always a discrepancy between severe dementia and the preservation of certain external forms of behavior. For a long time, the manner of behavior with features of mimicry, gesticulation, use of habitual expressions is preserved This is especially pronounced on the streets with a certain professional style of behavior developed over the course of many years: teachers, doctors. Due to the preservation of external forms of behavior, lively mimicry, several popular speech patterns and some memory reserves, especially for past events, such patients at first glance can create an impression of completely healthy. And only by chance, a question asked can reveal that a person leading a lively conversation with you and demonstrating an “excellent memory” to past events does not know how old he is, cannot determine the date, month, year, time of year, does not represent where is with whom he is talking, etc. Physical exhaustion develops relatively slowly compared with the increase in the mental disintegration of the personality. However, over time, neurological symptoms appear: constriction of the pupils, weakening of their reaction to light, reduction in muscle strength, trembling of the hands (senile tremor), gait with small, mincing steps (senile gait). Patients lose weight, the skin becomes dry and wrinkled, the function of internal organs is disturbed, insanity sets in.
During the course of the disease, psychotic disorders with hallucinations and delusions may occur. Patients hear “voices” containing threats, accusations, talk about torture and reprisals against loved ones. There may also be visual frauds of perception (they see a person who has come to their apartment), tactile ("bugs" crawl on the skin). Crazy ideas mainly spread to the persons of the inner circle (relatives, neighbors), their contents are ideas of damage, robbery, poisoning, less often persecution.
Recognition of atrophic processes of the brain is difficult in the initial stages of the disease, when it is necessary to exclude vascular pathology, brain tumor and other diseases. With a pronounced clinical picture of the disease, the diagnosis does not present any particular difficulties. To confirm the diagnosis using modern methods of research (computed tomography of the brain).
Treatment:Effective methods of treatment of atrophic processes do not currently exist. However, proper care and prescription of symptomatic remedies (from individual symptoms of the disease) are of great importance for the fate of such patients. At the onset of the disease, it is desirable to keep them at home without abrupt changes in the life stereotype. Hospital admission can cause deterioration.
The patient needs to create conditions for a sufficiently active lifestyle, so that he moves more, lies less during the daytime, and is more occupied with his usual household chores. In cases of severe dementia and in the absence of the possibility of constant care and monitoring the patient at home, inpatient treatment or staying in a special boarding school is indicated. Psychotropic drugs are prescribed only for sleep disorders, fussiness, delusional and hallucinatory disorders. Preference is given to drugs that do not cause weakness, lethargy, other side effects and complications. Tranquilizers are recommended only for the night (Radeorm, eupoctin). Of the antidepressants used pyrazidol, azafen; from neuroleptics
- Sonapaks, teralen, eposterazin, haloperidol in drops. All drugs are prescribed in minimal doses in order to avoid unwanted complications. Treatment with nootropics and other metabolic agents is advisable only in the early stages of the disease, when it contributes to some extent to stabilize the process.
Prevention of senile dementia does not exist. Good care, timely treatment of internal diseases and maintenance of the mental state can significantly prolong the patient's life.