Alzheimer's disease(dementia of the Alzheimer's type) is the cause of almost half of cases of dementia.

Alzheimer's disease is a neurodegenerative disease based on the progressive death of neurons, primarily the hippocampus and temporoparietal cortex. The leading role in the pathogenesis of memory impairment and other higher mental functions in Alzheimer's disease is given to changes in neurotransmitter systems, especially acetylcholinergic.

Clinical picture (symptoms and course) is characterized by a gradual onset over the age of 40-50 years (usually after 65 years), the predominance of progressive forgetfulness in the early stages of the disease, followed by the addition of aphasia, apraxia and agnosia, acalculia, and the absence of focal neurological symptoms. Speech impairment is characterized by acoustic-mnestic aphasia with difficulties in selecting words and inaccurate word use (paraphasia), but intact repetition. Visual-spatial agnosia is manifested by a violation of the ability to draw or copy a picture, a disorder of spatial orientation. At the same time, behavioral stereotypes and motor functions on early stage diseases remain relatively intact. The actual focal neurological symptoms up to the late stages of the disease are quite scarce - patients may exhibit positive axial reflexes and extrapyramidal disorders. The course of the disease may be complicated by the occurrence of emotional, affective and other mental disorders.

Clinical manifestations of Alzheimer's disease conditionally divided into three stages.

Stage 1 Alzheimer's disease(initial) manifests itself as an isolated deterioration of working memory or memory on current events, names, prices, names of items, etc.

There is a narrowing of the range of interests, slowing down of thinking, lack of initiative, absent-mindedness, and inattention. A feature of this stage is the absence of complaints about memory impairment due to impaired adequate self-esteem. In 50% of all cases, low mood (depression) or emotional instability is observed. Household and professional skills are often preserved at this stage of the disease.

Stage 2 Alzheimer's disease(developed) is manifested by continuing deterioration short term memory, which leads to difficulties in everyday and industrial activities due to the addition of the following violations:

• speech becomes poor, difficulties arise in selecting individual words;
• violation of purposeful activity (praxis) consists of difficulties in choosing and putting on clothes, performing hygiene procedures(brushing teeth, shaving), handling correspondence, using household equipment; interest in hobbies disappears, orientation in unfamiliar surroundings becomes difficult, and the ability to drive vehicles is lost;
• violations of optical-spatial activity: it becomes impossible to draw any elementary object (cube, pillar, clock dial);
• thinking disorder (impossibility of generalizing several words, interpreting proverbs, sayings);
• violation of voluntary attention and calculation;
• affective disorders (delusions, especially delusions of jealousy, hallucinations, anxiety, fear).

Stage 3 Alzheimer's disease(final) occurs 5-10 years after the onset of the disease, when any forms of mental activity become impossible, the ability to self-care is lost, and speech remains at the level of verbal emboli.

At this stage, weight loss, increased muscle tone in the limbs, walking disorder, and epileptic seizures may occur.

An early sign of Alzheimer's disease may be atrophy of the medial parts of the temporal lobes, primarily the hippocampus according to CT or MRI (single small vascular lesions in the periventricular region and projections of the subcortical nodes or limited periventricular leukoaraiosis do not exclude the diagnosis).

MRI parameters characteristic of changes in Alzheimer's disease:

1. Increase (compared to age norm) inter-hook distance.
2. Widening of the perihippocampal fissures.
3. Reduction in hippocampal volume.

There may be no changes on MRI. Decreased temporoparietal perfusion detected on single-photon emission computed tomography may support the clinical diagnosis of Alzheimer's disease, and hypoperfusion of the medial temporal lobe may be the earliest manifestation of Alzheimer's disease.

The value of single-photon emission computed tomography in differentiating Alzheimer's disease from vascular dementia is limited. In patients with illness. Alzheimer's CT scan, and especially magnetic resonance imaging, can reveal abnormalities in the white matter or basal ganglia that give rise to Additional information about concomitant vascular damage that can affect the course of the disease.

Kushnir G.M. - Doctor of Medical Sciences, Professor, Savchuk E.A. - Ph.D., Samokhvalova V.V. - Ph.D.

“Degenerative dementia, Alzheimer’s disease as a cause of dementia, manifestations, stages”- article from the section

Dementia, or more simply put, senile dementia, is a severe disorder of higher nervous activity caused by brain damage. This is a disease that mainly affects people old age, 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 attributed to secondary dementia, which may be caused by infectious lesion brain, malignant neoplasm, metabolic problems, diseases thyroid gland, as well as brain injuries.

What is characteristic is that 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, a general decrease in understanding, an apathetic and depressive state are added to these signs. 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 mania. 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 to improve blood circulation in the brain (Nitsergoline);
- CNS mediators (Phosphatidylcholine);
- drugs that improve the utilization of glucose and oxygen by brain cells (Actovegin).

In the later stages of the fight against 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. Source -

Dementia is a generalized lesion of the intellect, memory and personality without impairment of consciousness. This is an acquired disorder. Although most cases of dementia are irreversible, a small but significant group of people with dementia are treatable. (See Berrios 1987 on the history of the concept of dementia.)

Clinical manifestations

Dementia usually manifests as memory impairment. Other signs include personality changes, mood disorders, and delusions. Although dementia usually develops gradually, in most cases it begins to be noticed by others after an exacerbation, caused either by changes in social conditions or by an intercurrent illness.

The clinical picture is also largely determined by the premorbid personality of the patient. For example, in some patients neurotic traits become worse. With good social skills, the patient is often able, despite a serious decline in intelligence, to maintain the appearance of a normal social life, while people in a state of social isolation or those suffering from deafness are less likely to compensate for the deterioration of intellectual abilities.

Behavior with dementia, often disorganized, inappropriate to the situation, restless; increased distractibility is noticeable. Such patients rarely show interest in anything; they tend to be uninitiative. Personality changes may manifest as antisocial behavior, which sometimes includes sexual disinhibition or theft. Any deviation from normal social behavior in a middle-aged or elderly person, if such abnormal actions have not previously been characteristic of him, should always suggest an organic cause. The effect of cognitive defects on behavior has been described by Goldstein (1975). Typical are a decrease in interests (“narrowing of horizons”), pedantic adherence to a constant daily routine (“organic desire for order”), and in cases where the patient is assigned any burdensome duties that go beyond his limited capabilities, sudden outbursts of anger or violent expression of other emotions (“catastrophic reaction”).

As dementia progresses, patients take less and less care of themselves and neglect social conventions. Behavior loses its purposefulness, and stereotypies and mannerisms may appear. Eventually, the patient experiences disorientation, confusion, and urinary and fecal incontinence. Thinking It becomes slow, its content becomes depleted. In particular, there are such disorders as concreteness of thinking, decreased flexibility of thinking, etc.

The ability to form correct judgments is impaired. False ideas (usually persecutory ideas) easily develop. In later stages, thinking becomes extremely fragmented and incoherent. Thinking disorder affects the quality Speeches, For which syntactic errors and nominal dysphasia are typical. With deep dementia, the patient is often able to make only meaningless sounds or is mute. In the early stages of change Moods May include anxiety, irritability and depression. As dementia progresses, emotions and reactions to events become dulled; mood can change dramatically without any apparent reason. Violations Cognitive functions- a very characteristic, conspicuous sign. Forgetfulness usually occurs early and is severe, but is sometimes difficult to recognize early on. The difficulties associated with mastering new knowledge are usually obvious. Memory loss for recent events is more pronounced than for distant events. Patients usually resort to various tricks and excuses to hide these memory defects, and some confabulate. Other cognitive impairments include poor attention and difficulty concentrating. Disorientation In time, and at a later stage in place and in one's own personality, it is almost always observed in advanced dementia. Objective assessment of your mental state, in particular, awareness of the extent of impairment and the nature of the disorder is lacking.

Subcortical dementia

In 1974, Albert and colleagues coined the term "subcortical dementia" to define the decline in intelligence observed in progressive supranuclear palsy. The meaning of the term has been expanded to include a syndrome of cognitive retardation, difficulty solving complex intellectual problems, and affective disturbances without impairment of speech, numeracy, or learning. Probable causes of subcortical dementia include Parkinson's disease, Wilson's disease, and multiple sclerosis. , in contrast to the listed diseases, is usually considered an example of cortical dementia. Until now, a clear distinction between these two forms of dementia has not been convincingly established. (See: Whitehouse 1986; Cummings 1986.)

Causes of occurrence

Dementia is caused by many factors; the most important of possible reasons are listed in table. 11.3. The etiology of dementia in older people is discussed separately in Chap. 16. In elderly patients, in most cases, degenerative and vascular factors play a major role, but in other age groups there is no predominance of any of these causes. Therefore, when assessing a patient's condition, the clinician must be aware of a number of causes, paying particular attention to those whose development can be delayed or stopped by treatment (for example, an operable tumor, cerebral syphilis, or hydrocephalus with normal pressure). Care should be taken not to miss any of these reasons.

– an acquired form of dementia, characterized by a decrease cognitive activity, loss of acquired practical skills and acquired knowledge. The disease is manifested by a decrease in memorization, mental functions, temporal and spatial disorientation, speech and writing disorders, and the inability to self-care. Diagnostics includes instrumental methods for studying the brain (MRI, CT), a clinical interview, examination by a neurologist, psychiatrist, psychodiagnostic methods for assessing the cognitive sphere, emotional and personal characteristics. Treatment involves the use of psychostimulants, nootropic drugs, psychocorrection.

General information

The name of the disease “residual organic dementia” is of Latin origin. “Residual” means “remaining”, “preserved”, emphasizes a condition that cannot be changed or corrected. The word “organic” indicates the presence of damage to brain tissue. “Dementia” is translated as “decrease”, “loss of reason”. A common synonymous name is “dementia”, “organic dementia”. The epidemiology of the disease has been well studied in patients over 65 years of age; there is insufficient data on the prevalence of pathology among children. This is partly due to the complexity of the diagnostic process: symptoms overlap with manifestations of the underlying disease.

Causes of organic dementia in children

Childhood dementia develops after the child’s body is exposed to factors that disrupt the functioning of brain structures. The causes of the disease are:

• Neuroinfections. Organic dementia occurs as a complication of meningitis, encephalitis, and cerebral arachnoiditis.
• Traumatic brain injuries. The disease can result from a brain contusion or open injuries.
• HIV infection. HIV infection with clinical manifestations (AIDS) , capable of hitting the central nervous system. Damage to the brain leads to the development of encephalopathy, manifested by dementia.
• Toxic damage to the central nervous system. In children, damage to brain structures is observed during intoxication with drugs (DNA gyrase blockers, anticholinergic substances, cortisone), heavy metals (lead, aluminum). Cases of alcohol and drug-related dementia are being identified in adolescents.

Pathogenesis

The basis of pathogenesis organic dementia childhood there is damage to brain tissue. Intoxication, infectious-inflammatory and traumatic exogenous influences provoke degenerative changes brain substrate. A defective state develops, manifested by degradation of mental activity: cognitive functions, practical skills, emotional reactions, personality traits. From a pathogenetic point of view, the organic form of dementia is considered as residual effects of brain lesions. It is characterized by a stable decline in mental functions without subsequent aggravation.

Classification

Organic dementia in children is divided according to the etiological factor: intoxication, infectious, etc. Another basis for classification is the severity of the pathology:

• Easy. Symptoms are smoothed out, in preschool children they are often not detected for a long time, everyday skills remain intact. Academic failure among schoolchildren is increasing and social activity is decreasing.
• Moderate. The child needs care and support from an adult.
• Heavy. Constant supervision is required, speech and self-care skills are impaired.

Symptoms of organic dementia in children

The clinical picture of organic dementia in children is determined by age. Cerebral lesions transferred to school age, are characterized by the contrast between erudition, level of skill development and current cognitive capabilities. Speech is phonetically complete, grammatically and syntactically correct, lexicon sufficient, household and school skills are formed. When communicating with a child, the predominance of specific situational thinking is revealed: experienced events are described in detail, judgments are focused on practical actions and results.

The ability to abstraction manifests itself in isolated cases or is absent: not available figurative meaning proverbs, sayings, humor is incomprehensible, transferring experience from one situation to another is difficult. Previously acquired knowledge is retained, but its use is limited, and the actual productivity of thinking is reduced. Attention is unstable, quickly exhausted, memorization is difficult. Affective and personality disorders are determined. The child is emotionally unstable and has frequent mood swings. The nuances of emotions disappear, impoverishment and flattening increase. Severe forms are characterized by a predominance of polar states of pleasure and displeasure. Personality degradation is manifested by a narrowing of interests and a desire to satisfy basic needs.

In preschool and early age children, the symptoms of organic dementia are different. The central place is occupied by pronounced psychomotor agitation. The child is emotionally unstable - reactions of joy are quickly replaced by anger and crying. Emotional sphere extremely impoverished: a sense of attachment is not formed, there is no longing for the mother, there are no reactions to praise or blame. Elementary drives are strengthened, gluttony and sexuality develop. The instinct of self-preservation is weakened: the patient is not afraid of strangers, is not anxious in a new environment, and is not afraid of situations involving heights or fire. Outwardly unkempt, sloppy.

Cognitive functions are completely impaired. Perception is vague, judgments are superficial, random in nature, built on the basis of spontaneous formation of associations, repetition without comprehension. Analysis of the situation and transfer of experience are not available - learning ability is reduced, learning new material is difficult. There is no abstract thinking. Severe attention disorders are determined. An intellectual defect and internal disorganization are manifested by a simplification of the game: aimless running around, rolling on the floor, throwing and destroying toys and objects predominates. Accepting the rules and mastering game roles is not available.

Complications

Damage to areas of the brain affects mental development child. The ontogenetic process does not stop, but is distorted, which leads to complications. The insufficiency of the regulatory mechanisms of the central nervous system reduces the body's adaptation to changing conditions of the external and internal environment. Crisis stages of ontogenesis are often accompanied by cerebrasthenic, psychopathic states, convulsive seizures, and psychotic episodes. For example, puberty can provoke a pathological change in character (aggression, neglect social norms), give rise to epilepsy. During mild infectious diseases and injuries, inappropriately intense reactions are observed.

Diagnostics

Organic dementia in children is identified using clinical, instrumental and pathopsychological methods. The diagnostic process includes the following steps:

• Consultation with a neurologist. The specialist conducts a survey, collects anamnesis, evaluates general state child, preservation of reflexes. To determine the nature of the damage and identify atrophic processes, he is referred for instrumental examinations of the brain: EchoEG, MRI, EEG, CT. According to the results of clinical and instrumental examination The doctor establishes the main diagnosis, suggesting the presence of dementia.
• Consultation with a psychiatrist. The study is aimed at identifying emotional, personal and cognitive disorders. A child psychiatrist conducts a diagnostic conversation: assesses the child’s mental abilities, emotional responses, and behavior. To clarify the depth of the defect, a pathopsychological examination is prescribed.
• Consultation with a clinical psychologist. After a conversation with the patient, the pathopsychologist selects a complex diagnostic methods aimed at studying the level of memory, intelligence, attention, thinking. The results describe the current state of cognitive functions, totality or partiality of decline, and learning ability. For concomitant disorders of the emotional-personal sphere, projective methods (drawing, interpretive with figurative material), questionnaires (Lichko questionnaire, pathocharacterological diagnostic questionnaire) are used. Based on the results, the pathocharacterological development, the predominance of the emotional radical is determined, and the risk of personal and social disadaptation is assessed.

Organic dementia in children requires differential diagnosis with mental retardation and progressive dementia. In the first case, the main difference lies in the nature of the decline in cognitive functions and the course of the disease: with mental retardation a decrease in intelligence, abstract thinking, relative norms of memory, and attention come to the fore. The decline is determined by insufficient development, and not by the breakdown of functions (as in dementia). The distinction between progressive and organic forms of dementia is made based on etiological factor, assessment of intellectual functions in dynamics.

Treatment of organic dementia in children

Treatment of childhood organic dementia is a long process that requires consistency and organization from children, parents, and doctors. The main therapy is aimed at eliminating neurological disease. Cognitive correction, emotional disturbances performed using the following methods:

• Pharmacotherapy. Drugs that improve brain metabolism are prescribed nerve cells, cerebral blood flow. Increasing mental abilities, endurance during mental and physical activity contributes to the use of nootropic drugs and psychostimulants.
• Psychological and pedagogical assistance. Psychocorrection classes are conducted by a psychologist-educator, clinical psychologist. They are aimed at developing thinking abilities, attention, and memory. Organized taking into account cerebrasthenic/encephalopathic disorders of the patient’s central nervous system. Depending on the degree of dementia, the level of study load is determined.

Prognosis and prevention

At constant medical supervision The prognosis for dementia in most cases is favorable: slow progress is observed, in some cases stable remission is achieved - the patient attends a regular school and copes with stress. It is worth remembering that the recovery process is very long and requires daily care and treatment. Prevention of organic dementia in children is difficult, since the disorder is a consequence of another disease. Supportive measures include attentive attention to the child’s well-being, timely treatment infectious and other diseases, creating conditions to minimize the risk of injury. The development of psycho-emotional disorders is prevented by creating a favorable, friendly family environment and active time spent together.

– 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 in 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. 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 people suffering from dementia 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 organic damage 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 total number cases of dementia. 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 when infectious diseases: AIDS, neurosyphilis, chronic meningitis or viral encephalitis. Sometimes dementia develops when serious illnesses 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.
• Cortico-subcortical dementia. Both the cortex and subcortical structures are affected. Observed in vascular pathology.
• Multifocal dementia. IN various departments The central nervous system develops multiple areas of necrosis and degeneration. 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. Short-term memory disorders usually play a leading role in the clinical picture. 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, and previous moral and moral norms become insignificant. Total dementia develops when volumetric 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 socially adapt, three stages of dementia are distinguished. 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).

With moderate dementia, 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 questions. 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 onset of the first clinical signs 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 grouchy 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 their loved ones purposely leave them in dangerous situations, they add poison to food in order to poison them and take over the apartment, they 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 the sick. Other behavioral disorders may also be detected: vagrancy, intemperance and indiscriminateness in food and sex, senseless disorderly 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).

On final stage 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 need constant professional care. Death occurs as a result typical complications(pneumonia, bedsores, etc.) or progression of concomitant somatic pathology.

The diagnosis of Alzheimer's disease is based on clinical symptoms. Treatment is symptomatic. Does not currently exist medicines and non-drug methods 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. At chronic disorders blood supply, 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 diseases of peripheral veins. The likelihood of developing acquired dementia increases with illness of cardio-vascular system, smoking and excess weight.

The first sign of the disease is difficulty trying to concentrate, distracted attention, fast fatiguability, some mental rigidity, 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, depression and subdepression are possible.

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 clinical picture, USDG 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 (for 15 or more years) 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 (distracted 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 if five mandatory signs are present. 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).

Third diagnostic sign dementia – 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). A diagnosis of dementia is made only if all of the above symptoms are present 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 of affective disorders, the presence or absence of daily mood swings and the feeling of “painful insensibility.” If vitamin deficiency is suspected, the doctor examines the medical history (malnutrition, severe intestinal damage with prolonged diarrhea) and excludes symptoms characteristic of a deficiency of certain vitamins (anemia due to deficiency 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 acute period It is very difficult to predict the degree of recovery; the outcome of extensive damage can be good compensation with preservation of ability to work, 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 providing adequate treatment of the underlying pathology. The main goals of therapy in such cases are maintaining self-care skills and adaptability, prolonging life, providing proper 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.