The brain is the biggest mystery of the human body. Sometimes he presents surprises that change our lives in one way or another. Organic dementia is one of those quirks of our brain that leaves an imprint on a person’s thinking and behavior without the right to return to normal.
General concept
Dementia is a dementia acquired during life as a result of organic brain damage, trauma and infection. Unlike congenital dementia, which is characterized by insufficient development of the psyche, dementia is accompanied by its collapse. Around 50 million people worldwide suffer from this disease. It should be noted that dementia becomes a burden not only for the patient himself, but also for his family members.
Currently, more than 200 diseases are known that can provoke the development of dementia syndrome. The first place belongs to Alzheimer's disease, which affects 60% of patients. In second place are vascular pathologies as a result of hypertension and atherosclerosis. Other factors that provoke the disease include:
- GM neoplasms;
- traumatic brain injuries;
- Pick's, Parkinson's, Huntington's diseases;
- hormonal disorders - Cushing's disease, dysfunction thyroid gland;
- liver and kidney failure;
- autoimmune diseases, systemic vasculitis;
- multiple sclerosis;
- lack of B vitamins;
- infections - HIV, neurosyphilis, meningitis, encephalitis, Creutzfeldt-Jakob disease.
Dementia occurs as a result of damage to various brain structures: the cortex, subcortical structures, or multiple focal lesions in different parts brain tissue. In addition, there are combined forms that combine several types of disease.
Typically, acquired dementia is a disease old age. But in some cases it also affects young people. This is facilitated by alcohol and drug abuse, brain injury, tumors and infections. 
Among famous people there are also those who have become hostage to this disease. Actor Robin Williams' life was cut short due to dementia caused by Lewy bodies. The disease was not diagnosed during the actor’s lifetime, but was discovered only after an autopsy.
Margaret Thatcher, Britain's greatest prime minister, suffered from dementia. According to her daughter, these were monstrous days for her mother, whose psyche underwent devastating changes that she steadfastly fought until the end of her life.
What to pay attention to
Dementia is a disease that has a gradual onset. Its manifestations depend on the degree of development and localization of the process.
It all starts with minor changes. A person may begin to forget some things and get lost in familiar places. This is attributed to overwork, fatigue or age.
As the disease progresses, he forgets the names of loved ones, events that recently happened to him, is poorly oriented at home, and may ask the same question many times. There is a decrease in self-criticism and intellectual abilities. The patient loses basic skills: he cannot open the door or turn on the kettle. Such people need supervision.
At the final stage of the disease, complete degradation of the personality occurs. Patients lose the ability to perform usual actions: wash, dress, eat. Changes occur in the emotional-volitional sphere, a person ceases to adhere to the basic framework of decency.
Often such people leave home, and finding their way back becomes problematic for them. This is especially true for older people.
For example, elderly woman left home and was absent for several days. All this time, her family did not give up hope of finding her, using all possible resources to do this. Unfortunately, they found her dead: the old woman fell off a cliff.
There are two forms of the disease: total and lacunar. In lacunar dementia, short-term memory is mainly affected. People forget events that recently happened to them, what they just wanted to do, what they were thinking about. In other areas, changes are insignificant; criticality towards oneself and others remains.
Total dementia gradually leads to complete impotence and personality disintegration. At the same time, all spheres of human life suffer: memory disappears, the ability to assimilate is lost. new information and apply existing knowledge, interest in everything that happens disappears, moral and ethical foundations depreciate. A man, as they say, loses his face. You can often hear statements from relatives of a patient: he (she) has changed so much, before he was a completely different person.
The most common form of dementia
Among the causes leading to the development of dementia, Alzheimer's disease ranks first. The first mention of it dates back to 1906, and the German psychiatrist Alois Alzheimer is considered its discoverer.
The disease begins to manifest itself at the age of 55–70 years. This is one of the forms of senile insanity and refers to the atrophic type of dementia, when the destruction of brain neurons occurs. There may be several reasons contributing to this disease: internal diseases, obesity, low intellectual and physical activity, diabetes. A special place is given to the hereditary factor.
The disease begins to manifest itself with impairment of short-term memory. First, the patient forgets events that happened to him recently, and then those that happened a long time ago. A person does not recognize his children, mistaking them for deceased loved ones. He has difficulty remembering what he did a few hours ago, but talks in detail about what happened to him as a child. At this stage of the disease, the patient develops egocentrism and delusional ideas. Speech, perception, and motor disorders are observed.
The next stage is characterized by emotional disruptions. The person becomes irritable, grumpy, and shows dissatisfaction for any reason. He claims that his relatives want to get rid of him in order to take possession of his property, and his neighbors and friends want to slander him in order to spoil his reputation. 
Intelligence decreases sharply: analytical functions suffer, reasoning becomes poor. Interests are narrowed, the opportunity to perform professional skills is lost.
Such people need care and supervision. Behavior disorder is manifested by vagrancy, uncontrollability in eating and sexual intercourse. Aimless actions appear, speech contains constant repetition one word or phrase, replacing words with new ones. But, despite extensive degenerative changes, self-criticism remains.
At the final stage, the patient loses cognitive functions, the ability to care for himself, does not understand what they want from him, self-control and criticality are lost. Motor restrictions, paralysis, pathological reflexes, and convulsive seizures occur. The patient assumes the fetal position, refuses to eat, and cachexia progresses.
The disease lasts on average 10 years. But the earlier it manifests itself, the faster and more severe it progresses.
Unfortunately, at the moment there is no treatment that could stop the progression of the disease and return the patient to his former life. But early signs in women menopause can be stopped with hormone therapy.
Scientists have found that Alzheimer's in the early stages can be recognized by the nature of laughter. The fact is that in this case a person gradually loses control and does not understand what to laugh at and where it is inappropriate. He increasingly turns to black humor, laughs at absolutely unfunny, offensive, and sometimes tragic events, and at the failures of other people. Thus, one patient laughed at his wife when she was scalded by boiling water.
It is believed that a change in the sense of humor is an important criterion in establishing a diagnosis, since its diagnosis is, in principle, difficult.
Alzheimer's disease is a very common disorder. For example, Peter Falk, better known as Lieutenant Colombo, was also smitten by him. After he found out about this, he immediately stopped all his filming. Lately, the actor has completely forgotten about the existence of Columbo and wonders why people on the street call him by that name.
Other forms of dementia
When brain neurons are damaged as a result of impaired blood circulation, they speak of vascular dementia. It develops as a consequence of stroke or ischemia.
For dementia that develops as a result of a stroke, neurological symptoms are more typical: paralysis, paresis, speech problems. Ischemic dementia is accompanied to a greater extent by symptoms of dementia.
The main signs of vascular dementia include mental instability, absent-mindedness, irritability, sleep disorders, and low mood. Memory suffers, but with leading questions the patient remembers what was asked of him. Speech disorders are associated with pathological changes in the functioning of the speech-motor system, gait changes, and movements slow down.
Another common form of acquired dementia is alcoholic dementia. It occurs as a result of constant, uncontrolled consumption of alcohol for 15 years and affects the age of 40 years and above. With this form of the disease, thinking and memory disorders and inadequate emotional reactions come to the fore.
Personal degradation is manifested by maladjustment in society, loss of moral values, and lack of care for one’s appearance. Delusional statements are typical, often of a jealous nature. Tremors appear in the limbs and myopathies develop. The disease is also called alcoholic pseudoparalysis, as it can repeat the symptoms of progressive paralysis. In this case, differential diagnosis in the form of serological reactions is needed.
Huntington's chorea (Huntington's) is another form of senile dementia. It combines mental and neurological disorders, as well as choreo-like movement disorders.
The disease begins at the age of 45–50 years, its duration is 10–15 years. Motor dysfunction precedes the development of the disease. This could be a gait disorder, a change in handwriting - it becomes incomprehensible, frankly bad, ugly. Clumsy and inappropriate, involuntary movements are especially characteristic. At this stage, a decrease in mental abilities is noted.
Huntington's chorea is accompanied by psychopathic reactions of the following types:
- excitability – anger, irritability, short temper;
- hysteria - demonstrative behavior, tearfulness;
- isolation.
Due to the fact that pathological processes in chorea occur slowly, dementia may not be too obvious. In particular, some patients are able to perform primitive work, but when they find themselves in an unfamiliar situation, they get lost. Thinking has a spasmodic character.
Speech disorders are caused by choreatic contractions of the speech muscles. Subsequently, speech becomes scarce and the desire to talk is lost. Delusions often appear - jealousy, persecution, grandeur, poisoning. Hallucinations occur less frequently.
Neurological symptoms include hyperkinesis in the form of involuntary twitches of small amplitude. Such patients end their lives in a state of complete insanity; hyperkinesis ceases by this period.
Organic dementia in children
Dementia develops in children for a number of reasons:
- neuroinfections;
- AIDS;
- neurointoxication medicines, toxic substances.
The clinical picture of the disease depends on the age of the child and can occur in mild, moderate, and severe forms. 
In preschoolers, dementia is primarily manifested by changes in emotional sphere. Such children are especially excitable and emotionally labile. They do not form attachments, even to their mother. There is no fear of dangerous situations: they can easily leave with a stranger.
Cognitive functions suffer. Perception and attention are grossly impaired, making it difficult to acquire new knowledge and learn. Profound intellectual impairments appear. Games are unorganized: aimless throwing, jumping, running, jumping. There is no understanding of the role assigned to the child.
Children school age unable to think abstractly. The meanings of proverbs, humor, and figurative meanings become incomprehensible to them. Thinking decreases, and the child cannot even apply previously acquired knowledge.
The emotional sphere is unstable. Emotional impoverishment appears, the range of interests is narrowed down to the satisfaction of basic needs.
Dementia acquired in childhood, especially in the early stages of development, threatens the child with a stop in development or the acquisition of pathological character traits.
Diagnostic criteria
To make a diagnosis of organic dementia, the patient should consult a neurologist and psychiatrist. Data about the disease are collected during the history taking and examination of the patient. A psychological examination may be ordered.
For children, consultation with a clinical psychologist is mandatory. He selects a number of techniques to assess the child’s cognitive functions, learning ability, and analyze the extent of the lesion.
To determine which pathological process caused dementia, instrumental research methods are prescribed:
- echoencephalography – EchoEG;
- MRI – magnetic resonance therapy;
- CT – computed tomography;
- EEG – electroencephalography.
Organic dementia requires differential diagnosis with other diseases. In children, it is compared with congenital dementia. It is more characterized by a decrease in mental abilities while maintaining normal memory and attention.
In adults, dementia is differentiated from pseudodementia, a severe form of depression whose symptoms are disguised as dementia.
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Signs |
Dementia |
Depression |
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Decrease in intelligence |
Decreased mood |
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Symptom awareness |
Denies their presence, tries to hide them |
Reports a decrease in memory and thinking. He fixes his attention on this. |
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Appearance |
Sloppy, carefree behavior |
Depressed mood, slow reactions |
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Response to questions |
Aggression, avoids answering or ignores them |
The response comes late. Monosyllabic expression. |
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Mood disorders |
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Development of the disease |
Gradual |
More progresses |
In addition, organic dementia should be distinguished from physiological aging. With it, some decrease in thinking and memory is possible, but they do not limit a person in his everyday life.
How to treat and prevent disease
Unfortunately, it is unlikely that it will be possible to completely get rid of the disease, but it is possible to pause the process and remove negative symptoms quite possible. For this, complex therapy is used:
- treatment of the underlying disease, if dementia is a consequence of pathology of internal organs;
- prescribing drugs that slow down the breakdown of the neurotransmitter acetylcholine. This is a substance that helps conduct nerve impulses and, therefore, improves the conductivity of nerve tissue;
- means for improving metabolism and blood circulation in the brain;
- nootropics, vitamins to improve cognitive abilities;
- antidepressants, antipsychotics to normalize mental background;
- physiotherapy;
- psychotherapist consultations.
In order to prevent the development of acquired dementia, various diseases should be prevented. In particular, such as diabetes, hypertension, obesity, depression and others. 
And in order to protect yourself from atrophic dementia in old age, you must follow the basic rules:
- give up bad habits:
- exercise;
- eat right.
Very important factor is training your thinking abilities. It is necessary to systematically strain the brain, exposing it to mental stress, of course, in dosed form. Scientists have found that among people with higher education dementia is much less common. Its prevention is also facilitated by learning and speaking foreign languages.
And one more interesting fact: the disorder more often overtakes single people than family people.
Dementia is a serious disorder caused not only by health risks, but also by the torment and restrictions that patients, as well as their relatives, are forced to endure. Therefore, it is very important to pay due attention to prevention this state so as not to involve yourself in a series of torments lasting several decades.
Dementia, or more simply put, senile dementia, is a severe disorder of higher nervous activity caused by brain damage. This disease, which mainly affects older people, manifests itself as a decrease in mental abilities and gradual degradation of personality. It is impossible to cure dementia, but it is quite possible to slow down the progression of the disease, the main thing is to know the cause that caused the brain damage and the principles of treating the disease.
Causes and types of dementia
Depending on the cause of the disease, dementia is divided into primary and secondary. Primary, or organic dementia, occurs when there is massive death of neurons in the brain or when there is a malfunction blood vessels. This is caused by diseases such as Alzheimer's disease, Pick's disease or dementia with Lewy bodies. In 90% of cases, senile dementia is caused precisely by these reasons. The remaining 10% is secondary dementia, which can be caused by brain infections, malignancies, metabolic problems, thyroid disease, and brain injuries.
What is characteristic is secondary dementia, with timely treatment, is completely reversible, while organic or primary dementia is an irreversible process in which one can only slow down its development and remove unpleasant symptoms, thereby prolonging the patient’s life.
Signs of dementia
Dementia of the organic type is characterized by manifestations of Alzheimer's disease. Initially, they are faintly noticeable, and therefore they can only be identified by closely observing the patient. In the early stages of dementia, a person's behavior changes - he becomes aggressive, irritable and impulsive, often suffers from forgetfulness, loses interest in his next activity and is unable to perform work in accordance with the norms.
A little later, absent-mindedness is added to these signs, general decline understanding, apathetic and depressive state. The patient may get lost in space and time, forget what happened to him a few hours ago, but remember in detail the events of many years ago. A characteristic feature dementia is sloppiness and lack of a critical attitude towards one's appearance. Approximately 20% of such patients experience psychosis, hallucinations and manic state. It often seems to them that close people are preparing a conspiracy around them and are trying only for their lives.
Dementia affects not only the patient’s psyche and cognitive functions. In most cases, people with this condition have problems with speech, which becomes slow, inconsistent, and sometimes incoherent. Another sign of the disease is seizures, which occur at all stages of the disease.
Dementia treatment
The fight against the disease in question is aimed at stabilizing the pathological process, as well as reducing the severity of existing symptoms. Treatment is complex and must necessarily include the fight against diseases that aggravate dementia (atherosclerosis, hypertension, obesity, diabetes).
Organic dementia at an early stage is treated with the following drugs:
- nootropics (Cerebrolysin, Piracetam);
- homeopathic remedies (Ginkgo biloba);
- dopamine receptor stimulants (Piribedil);
- means for improving blood circulation in the brain (Nitsergoline);
- CNS mediators (Phosphatidylcholine);
- drugs that improve the utilization of glucose and oxygen by brain cells (Actovegin).
On late stages To combat dementia, the patient is prescribed acetylcholinesterase inhibitors, which means the drug Donepezil and others. These funds help improve the social adaptation of patients, and therefore reduce the burden on people caring for such patients. Take care of yourself!
A characteristic model of the damaged mental development is organic dementia.
Its etiology is associated with past infections, intoxications, injuries nervous system, hereditary degenerative, metabolic diseases of the brain.
Unlike oligophrenia, which also often has a similar origin, dementia occurs or begins to progress roughly after the age of 2-3 years. This chronological factor largely determines the difference between the pathogenesis and clinical and psychological structure of dementia from oligophrenia. By the age of 2-3 years, a significant part of the brain structures is relatively formed, so exposure to harm causes their damage, and not just underdevelopment. Delay in mental development of cerebral-organic origin from organic dementia characterized by significantly less massive damage to the nervous system.
Systematics of organic dementia, especially in childhood, presents significant difficulties due to the multiplicity of pathogenetic factors that determine the complex combination of the phenomena of damage and underdevelopment in its clinical and psychological structure, the different extent of the lesion, and the variability of its localization. Based on the criterion of the dynamics of the disease process, a distinction is made between so-called “residual” organic dementia, in which dementia is the residual effects of brain damage due to trauma, infection, intoxication, and progressive dementia caused by so-called ongoing organic processes (chronic meningitis and encephalitis, tumors, hereditary degenerative and metabolic diseases, progressive cerebral sclerosis, etc.). Types of organic dementia are also classified according to etiological criteria (epiletic, postencephalitic, traumatic, sclerotic, etc.). On the classification of G. E. Sukhareva (1965), based on the specifics of the clinical and psychological structure.
Dementia (lat. dementia - madness) - acquired dementia, persistent decline cognitive activity with the loss, to one degree or another, of previously acquired knowledge and practical skills and the difficulty or impossibility of acquiring new ones. In contrast to mental retardation (oligophrenia), congenital or acquired dementia in infancy, which is an underdevelopment of the psyche, dementia is a breakdown of mental functions that occurs as a result of brain damage, often in youth as a result of addictive behavior, and most often in old age (senile dementia; from Latin senilis - senile, old man). Popularly, senile dementia is called senile dementia. According to WHO, there are approximately 35.6 million people with dementia worldwide. This number is expected to double by 2030 to 65.7 million and more than triple by 2050 to 115.4 million.
Classification
By localization there are:
- · cortical - with predominant damage to the cerebral cortex (Alzheimer's disease, frontotemporal lobar degeneration, alcoholic encephalopathy);
- · subcortical - with predominant damage to subcortical structures (progressive supranuclear palsy, Huntington's disease, Parkinson's disease, multi-infarct dementia (white matter damage));
- Cortical-subcortical (Lewy body disease, corticobasal degeneration, vascular dementia);
- · multifocal - with multiple focal lesions (Creutzfeldt-Jakob disease).
Types of dementia
Main classification of late-life dementia
- 1. Vascular dementia (cerebral atherosclerosis).
- 2. Atrophic dementia (Alzheimer's disease, Pick's disease).
- 3. Mixed.
Syndromic classification
- · Lacunar (dysmnestic) dementia. Memory suffers the most: progressive and fixation amnesia. Patients can compensate for their defect by writing down important things on paper, etc. The emotional-personal sphere suffers only slightly: the core of the personality is not affected, sentimentality, tearfulness and emotional lability. Example: Alzheimer's disease (see below).
- · Total dementia. Gross violations as in cognitive sphere(pathology of memory, disturbances of abstract thinking, voluntary attention and perception) and personality (moral disorders: feelings of duty, delicacy, correctness, politeness, modesty disappear; the core of personality is destroyed). Causes: local atrophic and vascular lesions frontal lobes brain Example: Pick's disease (see below).
Vascular dementias
The classic and most common variant is cerebral atherosclerosis. Symptoms vary at different stages of the disease.
Initial stage. Neurosis-like disorders (weakness, lethargy, fatigue, irritability), headaches, and sleep disturbances predominate. Absent-mindedness and attention deficits appear. Affective disorders appear in the form of depressive experiences, incontinence of affect, “weakness,” and emotional lability. Sharpening personality traits.
At the next stages, memory impairments (for current events, names, dates) become more pronounced, which can take on more severe forms: progressive and fixation amnesia, paramnesia, disturbances in orientation (Korsakov's syndrome). Thinking loses flexibility, becomes rigid, and the motivational component of thinking decreases.
Thus, partial atherosclerotic dementia of the dysmnestic type is formed, that is, with a predominance of memory disorders.
Relatively rare when cerebral atherosclerosis Acute or subacute psychoses occur, more often at night, in the form of delirium with impaired consciousness, delusions and hallucinations. Chronic delusional psychoses can often occur, often with paranoid delusions.
Atrophic dementias
Alzheimer's disease
This is a primary degenerative dementia, accompanied by a steady progression of memory impairment, intellectual activity and other higher cortical functions and leading to total dementia. Typically begins after age 65. Stages:
- · Initial stage. Cognitive impairment. Mnestic-intellectual decline: forgetfulness, difficulty in determining time, deterioration in social, including professional, activities; phenomena of fixation amnesia and disturbances in orientation in time and place are increasing; neuropsychological symptoms, including aphasia, apraxia, agnosia. Emotional and personal disorders: egocentrism, subdepressive reactions to one’s own failure, delusional disorders. At this stage of Alzheimer's disease, patients critically evaluate their condition and try to correct their own growing incompetence.
- · Stage of moderate dementia. Temporoparietal neuropsychological syndrome; amnesia increases; Disorientation in place and time progresses quantitatively. The functions of the intellect are especially grossly violated (a decrease in the level of judgment, difficulties in analytical and synthetic activities are expressed), as well as its instrumental functions (speech, praxis, gnosis, optical-spatial activity). The interests of patients are extremely limited; constant support and care are needed; fail to cope with professional responsibilities. However, at this stage, patients retain basic personal characteristics, a sense of inferiority and an adequate emotional response to the disease.
- · Stage of severe dementia. There is a complete breakdown of memory, and ideas about one’s own personality are fragmented. Now total support is needed (patients cannot observe the rules of personal hygiene, etc.). Agnosia reaches an extreme degree (of the occipital and frontal type simultaneously). Speech breakdown is often of the type of total sensory aphasia.
Pick's disease
Alzheimer's disease is less common, and more women are affected than men. The pathological substrate is isolated atrophy of the cortex in the frontal, less often in the frontotemporal regions of the brain. Key Features:
- · Changes in the emotional and personal sphere: severe personality disorders, criticism is completely absent, behavior is characterized by passivity, spontaneity, impulsiveness; rudeness, foul language, hypersexuality; the assessment of the situation is impaired, disorders of the will and drives are noted.
- · Changes in the cognitive sphere: gross disturbances in thinking; automated skills (counting, writing, professional stamps, etc.) are retained for quite a long time. Memory disorders appear much later than personality changes and are not as severe as in Alzheimer's disease and vascular dementia. Systemic perseverations in the speech and praxis of patients.
Severity of dementia
- 1. Lightweight. Although work social activities significantly impaired, the ability to live independently is preserved, with the observance of personal hygiene rules and the relative safety of criticism.
- 2. Moderate. Leaving a patient to his own devices is risky and requires some supervision.
- 3. Heavy. Daily activities are so impaired that constant supervision is required (for example, the patient is unable to follow the rules of personal hygiene, does not understand what is said to him and does not speak himself).
Dementia(literal translation from Latin: dementia– “madness”) – acquired dementia, a condition in which disturbances occur in cognitive(cognitive) sphere: forgetfulness, loss of knowledge and skills that a person previously possessed, difficulties in acquiring new ones.
Dementia is an umbrella term. There is no such diagnosis. This is a disorder that can occur in various diseases.
Dementia in facts and figures:
- According to 2015 statistics, there are 47.5 million people with dementia in the world. Experts believe that by 2050 this figure will increase to 135.5 million, that is, approximately 3 times.
- Doctors diagnose 7.7 million new cases of dementia every year.
- Many patients are unaware of their diagnosis.
- Alzheimer's disease is the most common form of dementia. It occurs in 80% of patients.
- Dementia (acquired dementia) and oligophrenia (mental retardation in children) are two different conditions. Oligophrenia is an initial underdevelopment of mental functions. In dementia, they were previously normal, but over time they began to disintegrate.
- Dementia is popularly called senile insanity.
- Dementia is a pathology and not a sign of the normal aging process.
- At age 65, the risk of developing dementia is 10%, and it increases significantly after age 85.
- The term "senile dementia" refers to senile dementia.
What are the causes of dementia? How do brain disorders develop?
After the age of 20, the human brain begins to lose nerve cells. Therefore, minor problems with short-term memory are quite normal for older people. A person may forget where he put his car keys, or the name of the person he was introduced to at a party a month ago.These age-related changes happen to everyone. They usually do not cause problems in everyday life. In dementia, the disorders are much more pronounced. Because of them, problems arise both for the patient himself and for the people who are close to him.
The development of dementia is caused by the death of brain cells. Its reasons may be different.
What diseases cause dementia?
| Name | Mechanism of brain damage, description | Diagnostic methods |
| Neurodegenerative and other chronic diseases |
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| Alzheimer's disease | The most common form of dementia. According to various sources, it occurs in 60-80% of patients. During Alzheimer's disease, abnormal proteins accumulate in brain cells:
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| Dementia with Lewy bodies | Neurodegenerative disease, the second most common form of dementia. According to some data, it occurs in 30% of patients.
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| Parkinson's disease |  A chronic disease characterized by the death of neurons that produce dopamine, a substance necessary for the transmission of nerve impulses. In this case, Lewy bodies are formed in nerve cells (see above). The main manifestation of Parkinson's disease is movement disorder, but as degenerative changes in the brain spread, symptoms of dementia can occur. | The main diagnostic method is examination by a neurologist. Positron emission tomography is sometimes performed to help detect low level dopamine in the brain. Other tests (blood tests, CT scan, MRI) are used to rule out other neurological diseases. |
| Huntington's disease (Huntington's chorea) | A hereditary disease in which a mutant mHTT protein is synthesized in the body. It is toxic to nerve cells. Huntington's chorea can develop at any age. It is detected in both 2-year-old children and people over 80 years of age. Most often, the first symptoms appear between 30 and 50 years of age. The disease is characterized by movement disorders and mental disorders. |
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| Vascular dementia |  Brain cell death occurs as a result of disruption cerebral circulation. Disruption of blood flow leads to the fact that neurons stop receiving the required amount of oxygen and die. This occurs with stroke and cerebrovascular diseases. |
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| Alcoholic dementia |  Occurs as a result of damage ethyl alcohol and the products of its breakdown of brain tissue and cerebral vessels. Often, alcoholic dementia develops after an attack of delirium tremens or acute alcoholic encephalopathy. |
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| Space-occupying formations in the cranial cavity: brain tumors, abscesses (ulcers), hematomas. |  Space-occupying formations inside the skull compress the brain and disrupt blood circulation in the cerebral vessels. Because of this, the process of atrophy gradually begins. |
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| Hydrocephalus (water on the brain) |  Dementia can develop with a special form of hydrocephalus - normotensive (without increased intracranial pressure). Another name for this disease is Hakim-Adams syndrome. Pathology occurs as a result of impaired outflow and absorption cerebrospinal fluid. |
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| Pick's disease |  A chronic progressive disease characterized by atrophy of the frontal and temporal lobes of the brain. The causes of the disease are not fully known. Risk factors:
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| Amyotrophic lateral sclerosis |  A chronic incurable disease during which the motor neurons of the brain and spinal cord are destroyed. The causes of amyotrophic lateral sclerosis are unknown. Sometimes it occurs as a result of a mutation in one of the genes. The main symptom of the disease is paralysis various muscles, but dementia may also occur. |
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| Spinocerebellar degeneration | A group of diseases in which degeneration processes develop in the cerebellum, brain stem, spinal cord. The main manifestation is a lack of coordination of movements. In most cases, spinocerebellar degeneration is hereditary. |
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| Hallerwarden-Spatz disease | A rare (3 per million people) inherited neurodegenerative disease in which iron is deposited in the brain. A child is born sick if both parents are sick. |
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| Infectious diseases |
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| HIV-associated dementia | Caused by the human immunodeficiency virus. Scientists do not yet know how the virus damages the brain. | Blood test for HIV. |
| Viral encephalitis |  Encephalitis is an inflammation of the brain. Viral encephalitis can lead to the development of dementia. Symptoms:
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| Shortage folic acid |  Deficiency of folic acid (vitamin B 9) in the body can occur as a result of its insufficient content in food or impaired absorption in various diseases and pathological conditions (the most common cause is alcohol abuse). Hypovitaminosis B 9 is accompanied by various symptoms. |
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| Pellagra (vitamin B3 deficiency) |  Vitamin B 3 (vitamin PP, niacin) is necessary for the synthesis of ATP (adenosine triphosphate) molecules - the main carriers of energy in the body. The brain is one of the most active “consumers” of ATP. Pellagra is often called the “three D disease” because its main manifestations are dermatitis (skin lesions), diarrhea and dementia. | The diagnosis is made mainly on the basis of the patient's complaints and clinical examination data. |
| Other diseases and pathological conditions |
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| Down syndrome |  Chromosomal disease. People with Down syndrome usually have at a young age Alzheimer's disease develops. | Diagnosis of Down syndrome before birth:
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| Post-traumatic dementia |  Occurs after traumatic brain injuries, especially if they occur repeatedly (for example, this is common in some sports). There is evidence that one traumatic brain injury increases the risk of developing Alzheimer's disease in the future. |
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| Interactions of some drugs | Some medications may cause symptoms of dementia when used together. | |
| Depression | Dementia can occur in association with a depressive disorder and vice versa. | |
| Mixed dementia | It occurs as a result of a combination of two or three different factors. For example, Alzheimer's disease can be combined with vascular dementia or dementia with Lewy bodies. | |
In this disease, Lewy bodies, plaques consisting of the protein alpha-synuclein, accumulate in the neurons of the brain. Brain atrophy occurs.Manifestations of dementia
Symptoms that should prompt you to consult a doctor:- Memory impairment. The patient does not remember what happened recently, immediately forgets the name of the person he was just introduced to, asks the same thing several times, does not remember what he did or said a few minutes ago.
- Difficulty performing simple, familiar tasks. For example, a housewife who has been cooking all her life is no longer able to cook dinner; she cannot remember what ingredients are needed or in what order they need to be put into the pan.
- Communication problems. The patient forgets familiar words or uses them incorrectly, and has difficulty finding the right words during a conversation.
- Loss of orientation on the ground. A person with dementia may go to the store along their usual route and not find their way back home.
- Shortsightedness. For example, if you leave a patient to babysit a small child, he may forget about it and leave home.
- Impaired abstract thinking. This manifests itself most clearly when working with numbers, for example, during various transactions with money.
- Violation of the arrangement of things. The patient often puts things in places other than their usual places - for example, he may leave his car keys in the refrigerator. Moreover, he constantly forgets about it.
- Sudden mood changes. Many people with dementia become emotionally unstable.
- Personality changes. The person becomes overly irritable, suspicious, or begins to constantly fear something. He becomes extremely stubborn and is practically unable to change his mind. Everything new and unfamiliar is perceived as threatening.
- Behavior Changes. Many patients become selfish, rude, and unceremonious. They always put their interests first. They can do weird things. They often show increased interest in young people of the opposite sex.
- Decrease in initiative. The person becomes uninitiated and shows no interest in new beginnings or other people’s proposals. Sometimes the patient becomes completely indifferent to what is happening around him.
| Lightweight | Moderate | Heavy |
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Stages of dementia (WHO classification, source:
| Early | Average | Late |
| The disease develops gradually, so patients and their relatives often do not notice its symptoms and do not consult a doctor in time. Symptoms:
| Symptoms of the disease become more pronounced:
| At this stage, the patient is almost completely dependent on loved ones and needs constant care. Symptoms:
|
Diagnosis of dementia
Neurologists and psychiatrists are involved in the diagnosis and treatment of dementia. First, the doctor talks with the patient and offers to undergo simple tests, helping to assess memory and cognitive abilities. A person is asked about generally known facts, asked to explain the meanings simple words and draw something. It is important that during the conversation the specialist doctor adheres to standardized methods, and does not rely only on his impressions of the patient’s mental abilities - they are not always objective.
Cognitive tests
Currently, when dementia is suspected, cognitive tests are used, which have been tested many times and can accurately indicate impaired cognitive abilities. Most were created in the 1970s and have changed little since then. The first list of ten simple questions was developed by Henry Hodkins, a specialist in geriatrics who worked at a London hospital. Hodgkins' technique was called the abbreviated mental test score (AMTS).
Test questions:
- What is your age?
- What time is it to the nearest hour?
- Repeat the address that I will now show you.
- What year is it now?
- What hospital and what city are we in now?
- Can you now recognize two people you saw before (for example, a doctor, a nurse)?
- State your date of birth.
- In what year did the Great Great Britain begin? Patriotic War(can I ask about any other generally known date)?
- What is the name of our current president (or other famous person)?
- Count in reverse order from 20 to 1.
GPCOG test
This is a simpler test than the AMTS and has fewer questions. It allows for rapid diagnosis of cognitive abilities and, if necessary, referral of the patient for further examination.
One of the tasks that the test taker must complete during the GPCOG test is to draw a dial on a circle, approximately observing the distances between the divisions, and then mark a certain time on it.
If the test is carried out online, the doctor simply notes on the web page which questions the patient answers correctly, and then the program automatically displays the result.
The second part of the GPCOG test is a conversation with a relative of the patient (can be done by telephone).
The doctor asks 6 questions about how the patient’s condition has changed over the past 5-10 years, which can be answered “yes”, “no” or “I don’t know”:
- Does more problems with remembering recently occurring events, things that the patient uses?
- Has it become more difficult to remember conversations that happened a few days ago?
- Has it become more difficult to find the right words when communicating?
- Has it become more difficult to manage money, manage your personal or family budget?
- Has it become more difficult to take your medications on time and correctly?
- Has it become more difficult for the patient to use public or private transport (this does not include problems arising due to other reasons, such as injuries)?
The patient is examined by a neurologist and, if necessary, by other specialists.
Laboratory and instrumental tests that are most often used when dementia is suspected are listed above when considering the causes.
Dementia treatment
Treatment for dementia depends on its causes. During degenerative processes in the brain, nerve cells die and cannot recover. The process is irreversible, the disease is constantly progressing. Therefore, in Alzheimer's disease and other degenerative diseases complete cure impossible - at least, such drugs do not exist today. The main task of the doctor is to slow down pathological processes in the brain and prevent further growth of disorders in the cognitive sphere.
If degeneration processes in the brain do not occur, then the symptoms of dementia may be reversible. For example, restoration of cognitive function is possible after traumatic brain injury or hypovitaminosis.
Symptoms of dementia rarely come on suddenly. In most cases, they increase gradually. Dementia is preceded for a long time by cognitive impairments, which cannot yet be called dementia - they are relatively mild and do not lead to problems in everyday life. But over time they increase to the point of dementia.
If these violations are identified early stages and take appropriate measures, this will help delay the onset of dementia, reduce or prevent a decrease in performance and quality of life.
Caring for a person with dementia
Patients with advanced dementia require constant care. The disease greatly changes the life of not only the patient himself, but also those who are nearby and care for him. These people experience increased emotional and physical stress. You need a lot of patience to care for a relative who at any moment can do something inappropriate, create a danger for himself and others (for example, throw an unextinguished match on the floor, leave a water tap open, turn on a gas stove and forget about it), react with violent emotions to any little thing. Because of this, patients around the world are often discriminated against, especially in nursing homes, where they are cared for by strangers who often lack knowledge and understanding of dementia. Sometimes even medical staff behave quite rudely with patients and their relatives. The situation will improve if society knows more about dementia, this knowledge will help treat such patients with more understanding.
Prevention of dementia
Dementia can develop for a variety of reasons, some of which are not even known to science. Not all of them can be eliminated. But there are risk factors that you can completely influence. Basic measures to prevent dementia:
- Quitting smoking and drinking alcohol.
- Healthy eating . Vegetables, fruits, nuts, grains, olive oil, lean meats (chicken breast, lean pork, beef), fish, seafood. Excessive consumption of animal fats should be avoided.
- Fighting excess body weight. Try to monitor your weight and keep it normal.
- Moderate physical activity . Physical exercise has a positive effect on the cardiovascular and nervous system.
- Try to engage in mental activity. For example, a hobby such as playing chess can reduce the risk of dementia. It is also useful to solve crosswords and solve various puzzles.
- Avoid head injuries.
- Avoid infections. In the spring, it is necessary to follow recommendations for the prevention of tick-borne encephalitis, which is carried by ticks.
- If you are over 40 years old, have your blood tested annually for sugar and cholesterol. This will help to detect diabetes mellitus, atherosclerosis in time, prevent vascular dementia and many other health problems.
- Avoid psycho-emotional fatigue and stress. Try to get full sleep and rest.
- Monitor your blood pressure levels. If it periodically increases, consult a doctor.
- When the first symptoms of nervous system disorders appear, immediately contact a neurologist.
– acquired dementia caused by organic brain damage. It may be a consequence of one disease or be of a polyetiological nature (senile or senile dementia). Develops when vascular diseases, Alzheimer's disease, trauma, brain tumors, alcoholism, drug addiction, central nervous system infections and some other diseases. Persistent intellectual disorders, affective disorders and decreased volitional qualities are observed. The diagnosis is made based on clinical criteria and instrumental studies (CT, MRI of the brain). Treatment is carried out taking into account the etiological form of dementia.
General information
Dementia is a persistent disorder of higher nervous activity, accompanied by the loss of acquired knowledge and skills and a decrease in learning ability. There are currently more than 35 million dementia patients worldwide. The prevalence of the disease increases with age. According to statistics, severe dementia is detected in 5%, mild – in 16% of people over 65 years of age. Doctors assume that the number of patients will increase in the future. This is due to increased life expectancy and improved quality medical care, which makes it possible to prevent death even in cases of severe injuries and diseases of the brain.
In most cases, acquired dementia is irreversible, so the most important task of doctors is timely diagnosis and treatment of diseases that can cause dementia, as well as stabilization of the pathological process in patients with acquired acquired dementia. Treatment of dementia is carried out by specialists in the field of psychiatry in collaboration with neurologists, cardiologists and doctors of other specialties.
Causes of dementia
Dementia occurs when there is organic damage to the brain as a result of injury or disease. Currently, there are more than 200 pathological conditions that can provoke the development of dementia. The most common cause of acquired dementia is Alzheimer's disease, accounting for 60-70% of the total number of dementia cases. In second place (about 20%) are vascular dementias caused by hypertension, atherosclerosis and other similar diseases. In patients suffering from senile dementia, several diseases that provoke acquired dementia are often detected at once.
In young and middle age, dementia can occur with alcoholism, drug addiction, traumatic brain injury, benign or malignant neoplasms. In some patients, acquired dementia is detected due to infectious diseases: AIDS, neurosyphilis, chronic meningitis or viral encephalitis. Sometimes dementia develops with severe diseases of internal organs, endocrine pathology and autoimmune diseases.
Classification of dementia
Taking into account the predominant damage to certain areas of the brain, four types of dementia are distinguished:
- Cortical dementia. The cerebral cortex is predominantly affected. It is observed in alcoholism, Alzheimer's disease and Pick's disease (frontotemporal dementia).
- Subcortical dementia. Subcortical structures suffer. Accompanied by neurological disorders (trembling limbs, muscle stiffness, gait disorders, etc.). Occurs in Parkinson's disease, Huntington's disease and white matter hemorrhages.
- Cortical-subcortical dementia. Both the cortex and subcortical structures are affected. Observed in vascular pathology.
- Multifocal dementia. Multiple areas of necrosis and degeneration form in various parts of the central nervous system. Neurological disorders are very diverse and depend on the location of the lesions.
Depending on the extent of the lesion, two forms of dementia are distinguished: total and lacunar. With lacunar dementia, the structures responsible for certain types of intellectual activity suffer. Disorders usually play a leading role in the clinical picture short term memory. Patients forget where they are, what they planned to do, what they agreed on just a few minutes ago. Criticism of one’s condition is preserved, emotional and volitional disturbances are weakly expressed. Signs of asthenia may be detected: tearfulness, emotional instability. Lacunar dementia is observed in many diseases, including initial stage Alzheimer's disease.
With total dementia, there is a gradual disintegration of the personality. Intelligence decreases, learning abilities are lost, and the emotional-volitional sphere suffers. The circle of interests narrows, shame disappears, former moral and moral standards. Total dementia develops with space-occupying formations and circulatory disorders in the frontal lobes.
The high prevalence of dementia in the elderly led to the creation of a classification of senile dementias:
- Atrophic (Alzheimer's) type– provoked by primary degeneration of brain neurons.
- Vascular type– damage to nerve cells occurs secondary, due to disturbances in the blood supply to the brain due to vascular pathology.
- Mixed type– mixed dementia - is a combination of atrophic and vascular dementia.
Symptoms of dementia
The clinical manifestations of dementia are determined by the cause of acquired dementia and the size and location of the affected area. Taking into account the severity of symptoms and the patient’s ability to social adaptation There are three stages of dementia. For dementia mild degree the patient remains critical of what is happening and of his own condition. He retains the ability to self-service (can do laundry, cook, clean, wash dishes).
For dementia moderate degree criticism of one’s condition is partially impaired. When communicating with the patient, a clear decrease in intelligence is noticeable. The patient has difficulty caring for himself, has difficulty using household appliances and mechanisms: cannot answer the phone call, open or close the door. Care and supervision required. Severe dementia is accompanied by a complete collapse of personality. The patient cannot dress, wash, eat, or go to the toilet. Constant monitoring is required.
Clinical variants of dementia
Alzheimer's type dementia
Alzheimer's disease was described in 1906 by the German psychiatrist Alois Alzheimer. Until 1977, this diagnosis was made only in cases of dementia praecox (aged 45-65 years), and when symptoms appeared after the age of 65 years, senile dementia was diagnosed. It was then found that the pathogenesis and clinical manifestations diseases are the same regardless of age. Currently, the diagnosis of Alzheimer's disease is made regardless of the time of appearance of the first clinical signs of acquired dementia. Risk factors include age, the presence of relatives suffering from this disease, atherosclerosis, hypertension, excess weight, diabetes mellitus, low physical activity, chronic hypoxia, traumatic brain injury and lack of mental activity throughout life. Women get sick more often than men.
The first symptom is a pronounced impairment of short-term memory while maintaining criticism of one’s own condition. Subsequently, memory disorders worsen, and a “movement back in time” is observed - the patient first forgets recent events, then what happened in the past. The patient ceases to recognize his children, mistakes them for long-dead relatives, does not know what he did this morning, but can talk in detail about the events of his childhood, as if they had happened quite recently. Confabulations may occur in place of lost memories. Criticism of one's condition decreases.
In the advanced stage of Alzheimer's disease, the clinical picture is complemented by emotional and volitional disorders. Patients become grumpy and quarrelsome, often demonstrate dissatisfaction with the words and actions of others, and become irritated by every little thing. Subsequently, delirium of damage may occur. Patients claim that loved ones deliberately leave them in dangerous situations, add poison to their food in order to poison them and take over the apartment, say nasty things about them in order to ruin their reputation and leave them without public protection, etc. Not only family members are involved in the delusional system, but also neighbors social workers and other people interacting with patients. Other behavioral disorders may also be detected: vagrancy, intemperance and indiscriminateness in food and sex, meaningless erratic actions (for example, shifting objects from place to place). Speech becomes simplified and impoverished, paraphasia occurs (the use of other words instead of forgotten ones).
At the final stage of Alzheimer's disease, delusions and behavioral disorders are leveled out due to a pronounced decrease in intelligence. Patients become passive and inactive. The need to take fluids and food disappears. Speech is almost completely lost. As the disease worsens, the ability to chew food and walk independently is gradually lost. Due to complete helplessness, patients require constant professional care. Fatal outcome occurs as a result of typical complications (pneumonia, bedsores, etc.) or the progression of concomitant somatic pathology.
The diagnosis of Alzheimer's disease is made based on clinical symptoms. Treatment is symptomatic. There are currently no drugs or non-drug treatments that can cure patients with Alzheimer's disease. Dementia progresses steadily and ends with complete collapse of mental functions. Average duration life after diagnosis is less than 7 years. The earlier the first symptoms appear, the faster the dementia worsens.
Vascular dementia
There are two types of vascular dementia - those that arose after a stroke and those that developed as a result of chronic insufficiency of blood supply to the brain. In post-stroke acquired dementia, the clinical picture is usually dominated by focal disorders (speech disorders, paresis and paralysis). Character neurological disorders depends on the location and size of the hemorrhage or area with impaired blood supply, the quality of treatment in the first hours after the stroke and some other factors. In chronic circulatory disorders, symptoms of dementia predominate, and neurological symptoms are quite monotonous and less pronounced.
Most often, vascular dementia occurs with atherosclerosis and hypertension, less often - with severe diabetes mellitus and some rheumatic diseases, even less often - with embolism and thrombosis due to skeletal injuries, increased blood clotting and peripheral venous diseases. The likelihood of developing acquired dementia increases with illness cardiovascular system, smoking and excess weight.
The first sign of the disease is difficulty trying to concentrate, distracted attention, fatigue, some rigidity of mental activity, difficulty planning and decreased ability to analyze. Memory disorders are less severe than in Alzheimer's disease. Some forgetfulness is noted, but when given a “push” in the form of a leading question or offered several answer options, the patient easily recalls the necessary information. Many patients exhibit emotional instability, low mood, and possible depression and subdepression.
Neurological disorders include dysarthria, dysphonia, gait changes (shuffling, decreased step length, “sticking” of the soles to the surface), slowing of movements, impoverishment of gestures and facial expressions. The diagnosis is made based on the clinical picture, ultrasound and MRA of cerebral vessels and other studies. To assess the severity of the underlying pathology and draw up a pathogenetic therapy regimen, patients are referred for consultation to the appropriate specialists: therapist, endocrinologist, cardiologist, phlebologist. Treatment is symptomatic therapy, therapy of the underlying disease. The rate of development of dementia is determined by the characteristics of the leading pathology.
Alcoholic dementia
The cause of alcoholic dementia is long-term (over 15 years or more) abuse of alcoholic beverages. Along with the direct destructive effect of alcohol on brain cells, the development of dementia is caused by disruption of the activity of various organs and systems, severe metabolic disorders and vascular pathology. Alcoholic dementia is characterized by typical personality changes (coarsening, loss of moral values, social degradation) combined with a total decrease in mental abilities (distraction of attention, decreased ability to analyze, plan and abstract thinking, memory disorders).
After complete cessation of alcohol and treatment of alcoholism, partial recovery is possible, however, such cases are very rare. Due to a pronounced pathological craving for alcoholic beverages, decreased volitional qualities and lack of motivation, most patients are unable to stop taking ethanol-containing liquids. The prognosis is unfavorable; the cause of death is usually somatic diseases caused by alcohol consumption. Often such patients die as a result of criminal incidents or accidents.
Diagnosis of dementia
The diagnosis of dementia is made when five mandatory features. The first is memory impairment, which is identified based on a conversation with the patient, special research and interviews with relatives. The second is at least one symptom indicating organic brain damage. These symptoms include the “three A” syndrome: aphasia (speech disorders), apraxia (loss of the ability to perform purposeful actions while maintaining the ability to perform elementary motor acts), agnosia (perceptual disorders, loss of the ability to recognize words, people and objects while maintaining the sense of touch , hearing and vision); reducing criticism of one’s own condition and the surrounding reality; personality disorders (unreasonable aggressiveness, rudeness, lack of shame).
The third diagnostic sign of dementia is a violation of family and social adaptation. The fourth is the absence of symptoms characteristic of delirium (loss of orientation in place and time, visual hallucinations and delirium). Fifth – the presence of an organic defect, confirmed by instrumental studies (CT and MRI of the brain). The diagnosis of dementia is made only if all listed signs for six months or more.
Dementia most often has to be differentiated from depressive pseudodementia and functional pseudodementia resulting from vitamin deficiency. If you suspect depressive disorder the psychiatrist takes into account the severity and nature affective disorders, the presence or absence of daily mood swings and a feeling of “painful insensibility.” If vitamin deficiency is suspected, the doctor examines the medical history (malnutrition, severe intestinal damage with long-term diarrhea) and eliminates symptoms characteristic of a deficiency of certain vitamins (anemia due to a lack of folic acid, polyneuritis due to a lack of thiamine, etc.).
Prognosis for dementia
The prognosis for dementia is determined by the underlying disease. With acquired dementia resulting from traumatic brain injury or space-occupying processes (hematomas), the process does not progress. Often there is a partial, less often a complete reduction of symptoms due to the compensatory capabilities of the brain. In the acute period, it is very difficult to predict the degree of recovery; the outcome of extensive damage can be good compensation with preservation of work ability, and the outcome of minor damage can be severe dementia leading to disability and vice versa.
In dementia caused by progressive diseases, there is a steady worsening of symptoms. Doctors can only slow down the process by adequate treatment main pathology. The main goals of therapy in such cases are maintaining self-care skills and adaptability, prolonging life, providing appropriate care and eliminating unpleasant manifestations of the disease. Death occurs as a result of a serious impairment of vital functions associated with the patient’s immobility, his inability to perform basic self-care and the development of complications characteristic of bedridden patients.
