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December 14, 2011
Dementia is a clinical syndrome of which memory loss, and also other functions of thinking is characteristic. This phenomenon arises in case of chronic degenerative damages of a brain of the progressing character. However not only change of thought processes, but also manifestation of disturbances in behavior, and also changes of the identity of the person is characteristic of dementia.
It is important to understand that from an oligophrenia or inborn weak-mindedness dementia differs, first of all, in what arises owing to an illness or injury of a brain. As a rule, dementia is the state characteristic of people of advanced age. Because of natural aging in an organism failures in work of different systems begin to arise. Cognitive, behavioural, emotional disturbances are characteristic of the psychological sphere. Dementia belongs to disturbances of cognitive type. However, if to consider this state, being guided by its external manifestations, then also emotional disturbances (a condition of a depression, apathy), behavioural disturbances are inherent in patients with dementia (too frequent awakenings at night, the lost hygienic skills). In general the person with dementia gradually degrades as the personality.
Dementia – heavy and, as a rule, irreversible frustration which very much considerably affects usual life activity of the person, destroying his social activity. In view of the fact that dementia is inherent in elderly patients, it is called also senile dementia or dotage. On researches of specialists, about 5% of people who already were 65 years old suffer from certain manifestations of this state. The condition of dementia at patients of advanced age is considered to be not as a consequence of aging which cannot be avoided, but diseases of age character, which certain part (about 15%) therapies give in.
img class="alignright size-full wp-image-7611" alt="деменция" src="http://medicalmed.us/img/dementsiya.png" tppabs="medicalmed.us/wp-content/uploads/2011/12/dementsiya.png" width="280" height="200" />Its manifestation along with many parties is characteristic of dementia: changes happen in the speech, memory, thinking, attention of the patient. These, and also other functions of an organism are broken rather evenly. Even the initial stage of dementia is characterized by very essential disturbances that by all means affects the person as the personality and the professional. In a condition of weak-mindedness of people not only loses ability to show earlier acquired abilities, but also loses an opportunity to receive new skills. One more important symptom of dementia is rather stable manifestation of the specified frustration. All disturbances are shown regardless of in what state the consciousness of the person stays.
The very first manifestations of this state can be not especially noticeable: even to doctors with experience not always in power to define the beginning of a course of a disease. As a rule, first of all various manifestations of changes in behavior of the person begin to guard his family. At an initial stage it can be certain difficulties with resourcefulness, signs of irritability and forgetfulness, indifference to things earlier interesting to the person, impossibility to work at full capacity. Over time changes become even more noticeable. The patient shows absent-mindedness, to become inattentive, cannot think and understand as easily as earlier. Also dysmnesias are noted: most difficult to the patient to remember the current events. Changes in mood are very brightly shown, and, most often the person becomes apathetic, sometimes cries. Staying in society, the person can show deviations from the general standards of behavior. Also paranoid or crazy ideas are not alien to patients with dementia, in certain cases they can suffer also from display of hallucinations. At all described changes the person cannot adequately estimate the changes which happened to him, he does not notice that he behaves otherwise, than earlier. However in certain cases at the first displays of weak-mindedness of people fixes changes of own abilities and the general state, and it strongly disturbs it.
In case of progressing of the described changes patients lose practically all mental capacities over time. Alalias are in most cases noted – to the person very difficultly to be at loss for words in conversation, he begins to make mistakes at their pronunciation, does not understand the speech with which others address it. Through a certain period disorders of functioning of pelvic bodies are added to these symptoms, at the patient reactivity goes down. If at the first stage of a disease the patient can possess the increased appetite, then after its food requirement considerably decreases, and as a result there comes the condition of a cachexia. The movements of any character are badly coordinated. In the presence at the sick accompanying illness which is followed by a febris or frustration of a metabolism provoke emergence of confusion of consciousness. As a result there can be a stupor or a coma. The described process of degradation can last from several months to several years.
Similar behavior disorders of the person are a consequence of defeat of its nervous system. All other happening frustration arise as reaction to developing of weak-mindedness. So that to hide disturbances in memory, the patient can show too strong pedantry. His discontent in response to need of restrictions for life is shown by irritability and bad mood.
Owing to degenerative diseases of people can stay in a condition of a full decortication – not to understand what occurs around, not to speak, not to show interest in food though at the same time to swallow the food put to it in a mouth. At the person in such state muscles of extremities and the person, overactive reflexes of sinews, prehensile and sucking reflexes will be strained.
It is accepted to distinguish a condition of dementia according to severity of development of a disease. As the main criterion for similar distinguishing degree of dependence of the person on leaving of other persons is considered.
In a condition of slight dementia cognitive disturbances are shown by deterioration in professional abilities of the person and to lowering of its social activity. Thereof interest of the patient in the outside world in general weakens. However in this condition of people services itself independently and keeps accurate orientation in own dwelling.
At moderate dementia the following stage of cognitive frustration is shown. Periodic leaving is already necessary for the patient, it cannot master the majority of pieces of household appliances, it is difficult to it to open a key the lock. People around are forced to prompt constantly to it certain actions, but nevertheless the patient can service himself independently and keeps ability to carry out personal hygiene.
At heavy dementia of people it is completely deadapted to environment and directly depends on the help of other people, and needs it when performing the elementary actions (acceptance of food, clothing, hygiene).
The reasons because of which there is a development of senile dementia are various. So, the pathological disturbances which are negatively influencing cells sometimes happen directly in a brain. As a rule, neurons perish because of existence of deposits, pernicious for their functioning, or because of their weak food owing to bad blood circulation. In this case the disease has organic character (dementia primary). This state arises approximately in 90% of cases.
Owing to deterioration in functioning of a brain some other diseases — malignant tumors, infections, deterioration in a metabolism can be shown. The course of such diseases negatively influences work of a nervous system and, as a result, secondary dementia is shown. This state arises approximately in 10% of cases.
Diagnosis of dementia
Correctly to make the diagnosis, it is important to define character of dementia, first of all, correctly. It directly influences purpose of a method of treatment of an illness. Changes of neurodegenerative character (for example, Alzheimer's disease) and vascular character are considered as the most eurysynusic reasons of display of primary dementia (for example, a hemorrhagic stroke, a brain heart attack).
Developing of secondary dementia is generally provoked by cardiovascular diseases, excessive hobby for alcohol, disbolism. In this case dementia can disappear after treatment of the reason for which it arose.
At statement of the diagnosis the doctor first of all leads detailed discussion with the patient to find out whether really at the patient intellectual indicators are lowered and changes of the personality take place. In the course of a kliniko-psychological assessment of a condition of the patient the doctor conducts the research directed to definition of a condition of Gnostic function, memory, intelligence, subject actions, speeches, attention. At the same time it is important to consider stories of the close people of the patient having with it continuous contact in the course of research. Such information promotes an objective assessment.
Completely to make sure of nalichiya of symptoms of dementia, long inspection is required. There are also specially developed scales of an assessment of dementias.
It is important to distinguish weak-mindedness from a number of disorders of mental character. So, if among symptoms inherent in the patient the exhaustion, nervousness, sleep disorders is observed, then, having assumed lack of changes in cerebration, the doctor can assume existence of a mental illness. In this case it is important to consider that mental disorders at people of middle and advanced age are an effect or organic lesion of a brain, or depressive psychosis.
At statement of the diagnosis the doctor considers that patients with dementia very seldom can adequately estimate the condition and are not inclined to note degradation of own mind. An exception are only patients with dementia at early stages. Therefore, own assessment of sick its state cannot become defining for the specialist.
After diagnosing at a sick condition of dementia the doctor appoints some other inspections for the purpose of identification of symptoms of diseases of neurologic or therapeutic character that allows to classify dementia correctly. Research includes a computer tomography, EEG, MRI, a lumbar puncture. Also toxic products of an exchange are investigated. In certain cases for statement of the diagnosis it is necessary to make certain time observation over the patient.
Treatment of dementia
There is an opinion on inefficiency of treatment of dementia in view of irreversibility of age changes. However this statement is right only partially, not all kinds of dementia are irreversible. The most important point is the exception of attempts of self-treatment and purpose of therapy only after careful inspection and statement of the diagnosis.
Today in the course of treatment of dementia medicamentous therapy by appointment to the patient of drugs which improve bonds between neurons is used and stimulate process of blood circulation in a brain. The constant control of arterial pressure, reduction of loadings of intellectual and physical character (an early stage of a disease), ensuring food with the products rich with natural antioxidants is important. In case of frustration of behavior antidepressants and neuroleptics are used.
At the correct approach to treatment of vascular factors at elderly people it is possible to suspend progressing of an illness considerably.
Prevention of dementia
The measures allowing to reduce somewhat risk of display of this disease are applied to prevention of developing of dementia. It is important to watch a condition of level of cholesterol and a gomotsistein – it should not be high. It is not necessary to allow developments of a hypertension. An important factor in prevention of dementia is active social life, regular intellectual activity, active lifestyle. Measures of prevention of dementia of vascular type assume refusal of smoking, excessive alcohol intake, salt and greasy food. It is important to control the content of sugar in blood, to avoid head injuries.