Senile dementia (senile dementia)

A disease of senile age, caused by cerebral atrophy, manifested by the gradual disintegration of mental activity with the loss of individual personality characteristics and the outcome of total dementia. Senile Dementia
- the central problem of psychiatry of a late age. Patients with senile dementia make up 3-5% in the population over 60, 20% among 80-year-olds and 15-25% of all mentally ill seniors. The cause of senile dementia, as well as of 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 changes in personality in the form of sharpening or exaggeration of the previous character traits. For example, frugality turns into stinginess, persistence - into stubbornness, distrust - into suspicion, and so on. At first it resembles the usual characterological shifts in old age: conservatism in judgments, actions; The rejection of the new, the glorification of the past; Propensity to moralizing, edifying, intractable; Narrowing of interests, selfishness and egocentrism. Along with this, the rate of mental activity decreases, the attention and ability of its switching and concentration deteriorates. The processes of thinking are broken: analysis, generalization, abstraction, logical inference and judgment. With the coarsening of the personality, its individual properties are leveled, and so-called senile features are becoming more prominent: narrowing of the outlook and interests, the stereotypedness of views and utterances, the loss of previous ties and attachments, callousness and stinginess, fault-finding, quarrelsomeness, spitefulness. In some patients, complacency and carelessness prevail, a tendency to talk and joke, complacency and impatience of criticism, tactlessness and loss of moral norms of behavior. In such patients, modesty and elementary moral attitudes disappear. In the presence of sexual impotence, there is often a rise in sexual desire with a penchant for sexual perversion (public exposure of the sex organs, seduction of minors).
Along with the "deterioration" of the character, which is often regarded by relatives as a normal age, memory disorders gradually increase. The memory is lost, the ability to acquire new experience is lost. The reproduction of the information stored in memory also suffers. First, the most recently acquired experience falls out of memory, then memory also disappears to distant events. Forgetting the present and recent past, the patients fairly well remember the events of childhood and adolescence. There is, as it were, a shift in life back to the "life in the past," when the 80-year-old woman considers herself an 18-year-old girl and behaves according to this age. Neighbors in the ward and medical personnel names the names of people who were then in her environment (long dead). In answers to questions, patients report the facts of the past years or talk about fictitious events. At times the patients become fussy, businesslike, collect and bind things in knots - "get ready for the road", and then, sitting with a knot in their laps, await a trip. This is due to gross violations of orientation in time, surrounding, self.
However, it should be noted that with senile dementia there is always a discrepancy between pronounced dementia and the safety of some external forms of behavior. For a long time the manner of behavior with features of facial expressions, gestures, and the use of habitual expressions is preserved. This is particularly clearly manifested streets with a certain professional, developed over the years, a style of behavior: educators, doctors. Due to the safety of external forms of behavior, live mimicry, several popular speech and some memory stocks, especially past events, such patients at first glance may create the impression of quite healthy. And only an accidentally asked question can reveal that a person who is leading a lively conversation with you and demonstrating a "beautiful memory" of past events does not know how old he is, can not determine the number, month, year, time of year, does not represent where he is Is with whom he talks, etc. Physical senescence develops relatively slowly, compared with the increase in the mental disintegration of the individual. However, with time, neurological symptoms appear: narrowing of the pupils, weakening of their reaction to light, a decrease in muscle strength, trembling of the hands (senile tremor), gait in small, seminal steps (senile gait). Patients lose weight, the skin becomes dry and wrinkled, the function of the internal organs is disrupted, marasmus occurs.
During the development of the disease, psychotic disorders can arise with hallucinations and delirium. Patients hear "voices" containing threats, accusations, talk about torture and massacre of close people. There may also be visual deceptions of perception (see the person who went to their apartment), tactile ("crap" creeps on the skin). Delusional ideas mostly apply to people in the immediate environment (relatives, neighbors), their contents are ideas of damage, robbery, poisoning, less frequent persecution.
Recognition of the 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).
There are currently no effective methods for treating atrophic processes. However, the proper withdrawal and administration of symptomatic remedies (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 sudden changes in the life stereotype. Placement in a hospital can cause deterioration.
The patient needs to create conditions for a sufficiently active way of life, so that he moves more, falls less in the daytime, is more occupied with familiar household chores. With severe dementia and in the absence of permanent care and monitoring of the patient at home, in-patient treatment or stay in a special boarding school is indicated. Psychotropic drugs are prescribed only for violations of sleep, fussiness, delusions and hallucinatory disorders. Preference is given to drugs that do not cause weakness, lethargy, other side effects and complications. Tranquilizers recommend only at night (radedorm, eupotin). Of antidepressants apply pyrazidol, azafen; From antipsychotics
- sonapaks, teralene, etaperazine, haloperidol in drops. All drugs are prescribed in minimal doses in order to avoid unwanted complications. Treatment with nootropics and other metabolic means is advisable only in the early stages of the disease, when it to some extent helps stabilize the process.
Prevention of senile dementia does not exist. Good care, timely treatment of internal illnesses and maintaining a mental state can significantly prolong the patient's life.