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Senile dementia (senile dementia)


a disease of senile age, caused by atrophy of the brain, manifested by the gradual breakdown 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-age patients. The cause of senile dementia, as well as other atrophic processes, is still unknown. There is no doubt the role of heredity, which is confirmed by cases of "family 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 for 10-20 years. The disease develops imperceptibly, with gradual personality changes in the form of sharpening or exaggerating the former character traits. For example, frugality turns into stinginess, perseverance into stubbornness, distrust into suspicion, and so on. At first, it resembles the usual characterological shifts in old age: conservatism in judgments and actions; rejection of the new, praise of the past; propensity for moralizing, edification, intransigence; narrowing of interests, selfishness and self-centeredness. Along with this, the pace of mental activity decreases, attention and the ability of its switching and concentration deteriorate. Thinking processes are disturbed: analysis, generalization, abstraction, logical inference and judgment. With the coarsening of the personality, its individual properties are leveled and the so-called senile features appear more prominently: narrowing of horizons and interests, stereotyped views and statements, loss of old ties and affections, callousness and stinginess, pickiness, grumpiness, and viciousness. Some patients are dominated by complacency and carelessness, a tendency to talk and joke, complacency and impatience of criticism, tactlessness and loss of moral standards of behavior. In such patients, bashfulness and elementary moral attitudes disappear. In the presence of sexual impotence, there is often an increase in sexual desire with a tendency to sexual perversions (exposure of public genitals, seduction of minors).
Along with the "deterioration" of the character, which relatives often regard as a normal age-related phenomenon, memory disorders gradually increase. Memorization is broken, the ability to acquire new experience is lost. The reproduction of information in memory suffers. First, the most recently acquired experience falls out of memory, then the memory of distant events disappears. Forgetting the present and recent past, patients quite well remember the events of childhood and adolescence. There is a kind of shift of life into the past up to “life in the past,” when an 80-year-old woman considers herself an 18-year-old girl and behaves accordingly to this age. The roommate and the medical staff call the names of people who were at that time in her environment (long dead). In response to questions, patients report facts of bygone years or talk about fictitious events. At times, patients become fussy, businesslike, collect and bundle things into knots - “gather on the road”, and then, sitting with a bundle on their knees, expect a trip. This is due to gross misalignment in the time surrounding the self.
However, it should be noted that with senile dementia there is always a mismatch between severe dementia and the safety of some external forms of behavior. For a long time, the manner of behavior with the features of facial expressions, gestures, the use of familiar expressions is preserved. This is especially pronounced in the streets with a certain professional, developed over many years, behavior style: teachers, doctors. Due to the preservation of external forms of behavior, lively facial expressions, several common speech turns and some reserves of memory, especially to past events, such patients at first glance can create the impression of quite healthy. And only a randomly asked question can reveal that a person who has a lively conversation with you and demonstrates a “wonderful memory” for past events does not know how old he is, cannot determine the date, month, year, time of year, does not represent where he who is talking to, etc. Physical decrepitude develops relatively slowly, compared with an increase in the mental decay of the individual. However, neurological symptoms appear over time: narrowing of the pupils, weakening of their reaction to light, decreased muscle strength, trembling 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 disrupted, senility occurs.
During the development of the disease, psychotic disorders with hallucinations and delusions can occur. Patients hear "voices" containing threats, accusations, talk about torture and reprisals against loved ones. There can also be visual deceptions of perception (see a person who went into their apartment), tactile ("insects" crawl over their skin). Delusional ideas mainly apply to people in the immediate environment (family, neighbors), their content is the idea of ​​damage, robbery, poisoning, less often prosecution.
Recognition of atrophic processes of the brain is difficult at 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 is not particularly difficult. To confirm the diagnosis, modern research methods are used (computed tomography of the brain).
Treatment:
Effective methods of treating atrophic processes currently do not exist. However, proper care and prescription of symptomatic agents (from individual symptoms of the disease) are of great importance for the fate of such patients. At the beginning of the disease, it is desirable to keep them at home without drastic changes in the stereotype of life. Admission to the hospital can cause a worsening of the condition.
The patient needs to create conditions for a sufficiently active lifestyle so that he moves more, lies less in the daytime, and is more occupied with usual household chores. With severe dementia and in the absence of the possibility of constant care and monitoring the patient at home, in-patient treatment or stay 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 (Radedorm, Eupoktin). Of the antidepressants, pyrazidol, azafen are used; from antipsychotics
- sonapax, teralen, etaperazine, 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 helps to some extent to stabilize the process.
Prevention of senile dementia does not exist. Good care, timely treatment of internal diseases and maintaining a mental state can significantly extend the patient's life.