dementia

The text is presented for informational purposes only. We urge you not to self-medicate. When the first symptoms appear, consult a doctor. Recommended reading: " Why not self-medicate?". Dementia is a form of dementia in which there is a persistent decline in the cognitive functions of the brain, the loss of previously acquired knowledge and skills, and the inability to acquire new ones. Acquired dementia (dementia) differs from congenital (oligophrenia) in that it is expressed by the process of disintegration of mental functions due to various brain lesions in youth due to addictive behavior, or in old age in the form of senile dementia or senile insanity.

In 2015, according to the World Health Organization, there were 46 million people living with dementia in the world. Already in 2017, this figure increased by 4 million and reached the figure of 50 million people. Such a sharp increase in the number of patients with dementia is explained by the numerous factors of the modern world that provoke the development of the disease. Every year there are 7.7 million more people with dementia in the world. Everyone suffering from this disease becomes a very big problem both for the healthcare system and for their relatives and friends.

And if earlier dementia was considered exclusively a disease of the elderly, then in the modern world, pathology has become very younger and has ceased to be a rarity for people under the age of 35.

Classification of the disease

The most common types of dementia today are vascular, atrophic and mixed, as well as a variant of the disease of the syndromic type. Each of these species has its own characteristics, varieties and causes of occurrence, so you should dwell on them in more detail.

Vascular dementia

Vascular dementia is an acquired disorder of the nervous system, which provokes the presence of pathologies in the vascular system of the brain. This is the main difference between vascular dementia and its other types, in which the pathology is caused by toxic deposits in nerve cells. The resulting problem of blood circulation in the brain leads to cognitive failures, as in other types of dementia, which manifests itself in problems of individual intellectual activity. In the event of a violation of blood circulation in the brain, its cells cease to receive the necessary amount of oxygen and die after a while. The body itself is able to compensate a little for such violations, but with the depletion of resources, the death of nerve cells will still come - sooner or later. Dementia does not manifest itself in any way until compensation is possible, however, when the compensatory mechanisms of adaptation are exhausted, memory lapses begin to appear, speech and thinking are disturbed. Behavioral reactions of a person change, he begins to treat other people differently, aggressiveness is often manifested in his character. The patient is not able to serve himself in everyday terms on his own and begins to depend on the help of outsiders.

Stroke patients are at increased risk of developing vascular dementia. The occurrence of dementia is determined by which parts of the brain are affected. Scientists have found that when about 50 milliliters of brain tissue is damaged, a similar disorder occurs in 99% of cases. This diagnosis is easily identified if the patient's marked cognitive impairment is provoked by a previous stroke. In parallel with dementia, one can observe hemiparesis (weakening or paralysis of the limbs), a pathological Babinsky reflex of the right and left limbs. Patients with vascular dementia suffer from walking disorders with a sluggish and shuffling gait, loss of stability. Sometimes a person confuses these conditions with the occurrence of dizziness.

Vascular dementia can be classified according to etiological and localization factors. According to the etiological factor, it happens:

  • against the background of a stroke;
  • due to chronic ischemia;
  • mixed.

Depending on the localization, vascular dementia is divided into:

  • subcortical;
  • temporal;
  • frontal lobes;
  • ​​
  • cerebral cortex;
  • midbrain.

Atrophic dementia

Varieties of atrophic dementia include diseases provoked by Alzheimer's disease and Pick's disease. In the course of the Alzheimer's type of dementia, the pathology manifests itself similarly to the vascular form of the disease and has 3 main stages:

  • initial;
  • moderate;
  • severe.

At the initial stage, the patient's consciousness and thinking are disturbed, intelligence decreases, a person's orientation in space and time is disturbed, problems arise in the performance of professional duties, aphasia (speech impairment), agnosia appears (a person ceases to recognize familiar and familiar objects). In parallel, at this stage, a person's egocentrism progresses, he becomes withdrawn, falls into depression. This stage still allows the patient to realize and by all means correct the decline in mental activity.

At a moderate stage, amnesia and disorientation begin to be accompanied by a sharp impairment of intelligence. The way of life of a person becomes more and more primitive, thinking is dulled, the needs of a person are greatly simplified. Patients begin to urgently need support and help from loved ones, since they themselves are no longer able to take care of themselves in everyday life. However, a person can still critically assess his own condition, so he begins to realize his inferiority. For professionals who help him in the fight against dementia, these qualities are very valuable.

In the severe stage of atrophic dementia, the patient completely loses his memory, ceases to be aware of his own personality, loses even primitive needs, ceases to observe hygiene, and requires constant help from others.

In dementia, as a result of the transfer of Pick's disease, the frontal and temporal lobes of the cerebral cortex of both hemispheres are destroyed. In the course of Pick's disease, speech is gradually impaired, problems with intelligence and perception arise. The disease is more characteristic of the elderly, who in the process of progression become lethargic, apathetic, fall into prolonged depression. At the same time, patients are characterized by outbreaks of spontaneity in behavior, aggression, and rudeness. The course of this disease is more malignant, in comparison with Alzheimer's disease, it is more intense and limits the life of a person with its presence to 5-6 years.

Mixed dementia

In the variant of mixed dementia or dementia, it is customary to single out several main factors of its occurrence at once. Most often, such factors include atrophic changes, lesions of the cerebral vessels that occur as a result of Alzheimer's disease. The manifestations of mixed dementia are also ambiguous. With cognitive disorders, all kinds of vascular pathologies (hypertension, atherosclerosis) are necessarily present in its course, the patient's thinking undergoes Alzheimer's type destruction, expressed by impaired intelligence and memory.

In contrast to Alzheimer's disease, mixed dementia is characterized by symptoms associated with damage to the frontal areas of the brain - difficulties in concentration, planning, and a decrease in the speed of mental work. A common symptom of mixed dementia and Alzheimer's disease is memory impairment, while others are quite rare.

Syndromic dementia

Also, specialists often divide dementia according to syndromic classification. According to this classification, the disease can be divided into lacunar dementia and total dementia.

Dysmnesic dementia, or its lacunar form, is characterized by changes in the patient's emotional life. This form is characterized by a decrease in self-control on the part of the patient, and his personality does not undergo changes. Memory disturbances become noticeable, easily compensated by recording all events on paper, so that the patient is independently able to establish the chronology of events.

In total dementia, the symptoms of the disease are gross, leading to a change in the patient's personality, and not just his emotional sphere. The reason for this is destruction in certain areas of the brain, occurring due to poor blood circulation or atrophy. An example of total dementia is Pick's disease, and lacunar - Alzheimer's disease.

Localization of brain lesions

According to the localization of dementia and damage to certain areas of the human brain, the disease can be classified into the following varieties:

  • cortical;
  • subcortical;
  • cortical-subcortical dementia;
  • multifocal.

Cortical dementia occurs as a result of violations of the functional activity of the cerebral cortex. The structure of the cortex responsible for memory, consciousness, praxis is rapidly degrading. In this case, cognitive functions and memory suffer first of all. Patients do not remember their own name or relatives. They are characterized by prosopagnosia - forgetfulness of faces. The awareness of what is happening disappears in such patients.

The center of praxis also suffers, like the thought centers, which leads to a drop in the ability to perform any practical activity. The ability to write is impaired, as well as other elementary and easy-to-perform actions. In parallel, speech ability is also impaired.

Alzheimer's disease, frontotemporal lobar degeneration, and alcoholic encephalopathy are considered to be the most associated diseases with cortical dementia.

Subcortical dementia includes Parkinson's disease, progressive supranuclear palsy, Huntington's disease, and others. The pathology differs from cortical dementia in that the subcortical structures that are responsible for transporting nerve impulses to the underlying parts of the brain from the cortex are infringed in this case. The ability to perform unconscious actions also atrophies. The symptomatology of this type of disease is not as radical as in the cortical form, it characterizes a change in the essence of the course of all processes. The person becomes slow, depressed, depressed.

There is no clear distinction between cortical and subcortical forms of dementia. Both disorders concern the psyche of the patient, the difference is only in the levels of these disorders. Subcortical dementia is characterized by gaps in memory relating to remembering the event rather than the ability to learn new things. Praxis in this case manifests itself in the form of emerging uncontrolled movements and failures in their coordination.

Diseases such as cortical-subcortical dementia include vascular dementia, cortical-basal degeneration, and Lewy body disease. With this dementia, processes are disrupted at the level of the cerebral cortex and at the level of subcortical structures. This is the main characteristic of the clinic of this disease, which echoes the first two types of dementia considered.

In the case of cortical-subcortical dementia, diagnostic problems often arise due to the possibility of predominance of disorders in one or another part of the human brain. If violations of the cerebral cortex are more pronounced, then a doctor without experience can confuse this dementia with cortical pathology or with Alzheimer's disease. To avoid errors in the diagnosis, it is important to carefully analyze the symptoms, including diagnosis using computed tomography or magnetic resonance imaging.

Multifocal dementia refers to Creutzfeldt-Jakob disease. Its symptoms are manifested by numerous lesions of the brain in a focal way. In this case, there is a violation of speech (aphasia) and the patient's ability to perform professional activities (apraxia), there is an inability to recognize (agnosia), spatial disturbances, amnesia.

Among the symptoms of multifocal dementia, there are also subcortical manifestations - twitching of muscle bundles (myoclonus), obsession with sensation or thought (perseveration), problems with coordination in space, gait, balance. There is also a thalamic disorder, when a person feels very lethargic and drowsy. Such dementia is very rapid, in a couple of months changes can occur in the brain that completely erase the entire human personality.

A patient with multifocal dementia is not always aware of everything that happens to him. At the same time, experts believe that during the course of the disease, the patient can be in different phases, in which he feels differently. At the same time, there are also enlightenments, when a person clearly understands that something is wrong with his memory and self-consciousness.

All the symptoms of dementia can also be observed in cases of pseudodementia, hysterical conditions, so it can be extremely difficult to diagnose the disease.

The mechanism of occurrence and development

Experts call Alzheimer's disease and vascular pathologies in the human brain as the main causes of dementia. Also, dementia is provoked by alcoholism, oncology of the brain, diseases of the nervous system, traumatic brain injuries and other reasons. For treatment, it is very important to establish the true cause of the pathology in each case, since the elimination of only manifestations will not bring the expected result from therapy. At the same time, competent therapy, based on the cause of the disease, not only stops the degradation process, but can also reverse it.

Based on the main causes of dementia, 2 main forms of the disease can be distinguished:

  • senile or senile dementia;
  • vascular dementia.

Senile dementia is expressed by disturbances in speech, thinking, attention and memory. In this case, skills are lost, and it is not possible to reverse this process. We can say that senile dementia is incurable. It can begin to develop when kidney function fails, as a result of Alzheimer's disease, with metabolic problems, or with diseases associated with immunodeficiency. Vascular dementia can occur with diabetes mellitus, high blood lipids, and other diseases.

With the availability of systems for early diagnosis of dementia in various countries, the detection of patients with such a diagnosis after the age of 55 years is increasing. The presence of a hereditary predisposition in the development of dementia is a rather topical issue these days for many who are faced with this disease.

The science of genetics, which is developing most today, indicates the possibility of transferring genes from parents to children, in whose DNA fragments of dementia are encrypted. However, experts do not talk about the direct, but about the indirect nature of such genetic factors. Thus, genetic predisposition is only one of hundreds of factors due to which a normal person may experience impaired memory and thinking. At the same time, if the heir leads a healthy lifestyle, eats rationally, refuses bad habits, the risk of dementia in him is significantly reduced, despite the burdened heredity. Direct inheritance of genes that cause dementia is very rare. More often, inheritance is provided by a combination of many factors, among which lifestyle plays an important role.

However, genes, one way or another, always affect the tendency to certain pathologies. Some inherited cardiovascular diseases also make a person prone to developing dementia, even if a close relative did not suffer from it.

The genetic predisposition to Alzheimer's disease, which is the most common cause of dementia, has been best studied to date. Predisposition to this disease can be transmitted monogenically (through a single gene) or polygenically (through a huge set of gene combination variants). At the same time, vascular dementia due to a gene mutation is a rather rare case.

Approximately 15% of all patients with frontotemporal dementia have a family history of the disease, that is, at least three relatives in the next two generations with a similar problem. An additional 15% may have another type of dementia with the same family history, suggesting a real heredity impact in frontotemporal dementia among patients.

The main symptoms of the disease

The main symptoms of dementia can be divided into main groups:

  • failures in cognitive function;
  • orientation failures;
  • behavioral personality disorders;
  • mental disorders;
  • decreased critical thinking;
  • emotional disorders;
  • problems in perception.

Impaired cognitive functions can be expressed in disorders of memory, attention, higher brain functions. With a memory disorder, both short-term and long-term memory can be affected, and confabulations (false memories) are also possible. With a mild form of dementia, memory impairment is also moderate, associated rather with forgetfulness (phones, calls, etc.). In severe dementia, only carefully memorized information can be retained in memory, and in the last stages a person does not even remember his name, personal disorientation occurs. With an attention disorder, the ability to respond to several stimuli at the same time is lost, a person cannot switch from one topic to another in a conversation. The disorder of higher functions is divided into aphasia (loss of healthy speech), apraxia (inability to perform purposeful actions) and agnosia (violation of tactile, auditory, visual perception).

Orientation disorders occur, to a greater extent, at the onset of the disease. Disturbed orientation in time usually becomes a harbinger of violations of orientation on the ground, as well as personal orientation. Advanced dementia is characterized by a complete loss of orientation even in a well-known space, which leads to the fact that the patient can get lost in areas where he often happens.

Personality change and behavioral disturbance in dementia occurs gradually. The main personality traits are greatly exaggerated. For example, if a person has always been energetic, then with the development of dementia, he becomes fussy, and if thrifty, then greed comes to the fore. Patients suffer from increased selfishness, they cease to respond to the needs of the environment, provoke conflict situations. Often a person has a disinhibition of a sexual nature, he may begin to collect garbage and wander. Sometimes patients completely lose their communicative interest, withdraw into themselves.

They are also characterized by untidyness, since the patients often neglect the rules of hygiene.

Thinking disorder is characterized by a decrease in the ability to logic and abstraction. A person cannot generalize and solve even elementary problems at all, his speech becomes meager, stereotyped, in the process of disease progression it completely disappears. Patients may have various crazy ideas, most often they are based on jealousy, the loss of values ​​that never existed, and so on.

Patients often become less critical of themselves and the surrounding reality. Any unforeseen, and even more so, stressful situations provoke the emergence of panic, during which the patient may begin to realize the state of his own intellectual inferiority. If the patient's critical abilities are preserved, this makes it possible to assess the defects of the intellect, which will lead to sharpness in reasoning, a quick change in conversation, and playfulness.

Emotional disturbances in dementia are very diverse and changeable. Often they are expressed by depression, anxiety, irritability, aggressiveness, tearfulness, or complete unemotional to everything that happens. Rarely, but manic states can develop, combined with carelessness and fun.

In perceptual disorders, patients experience hallucinations and illusions. Often they are of a very strange nature and cannot be explained from a logical point of view.

Severity of the disease

The complexity of the course of the disease can be determined based on its three main stages - mild, moderate and severe.

At the initial stage, the symptoms appear quite easily, their intensity can vary, while the intellectual component suffers first of all. The patient is still able to critically evaluate himself, understands that he is sick, and is ready for treatment. A person is completely self-serving and does not need outside help. Any household activity is available to him - cooking, shopping, personal hygiene, cleaning. With a timely and targeted start of treatment, the course of the initial stage of dementia can be slowed down, and the disease itself can be completely cured.

At the second stage of moderate dementia, severe intellectual impairments begin to appear, the ability to critically perceive reality decreases, the patient ceases to understand that he is sick and needs medical help, which complicates the possibility of treatment. Also, a person has difficulties of a domestic nature - he often cannot use elementary home appliances, make a phone call, may not close the door when he leaves the house on the street, does not turn off the gas and lights in the apartment. The patient already needs total control and supervision, since the probability of harming others and himself becomes quite high at the moderate stage.

In the third severe stage, the disintegration of the personality occurs under the influence of the symptoms of dementia. A person loses the ability to eat independently, does not follow hygiene rules and procedures, and does not recognize loved ones. Most often, severe dementia is accompanied by the extinction of logical, critical and speech abilities. A person does not even feel thirst or hunger, becomes indifferent to everything. All this occurs against the background of a gradual disorder of motor functions, the patient loses mobility, chewing function. Such patients already need constant close care.

If dementia is age-related (senile dementia), then it is practically impossible to prevent its development and reverse the course of the disease.

Methods of diagnosis

Diagnosis of dementia is more likely to be made by a psychiatrist or a neurologist. The reason for diagnosing and establishing such a pathology may be the inability to perform professional duties, everyday tasks, problems of memorization, decrease or lack of attention, deterioration in thinking or temporal orientation, behavioral disorders identified by a specialist. After examining the patient, communicating with him and his environment, the specialist prescribes various diagnostic procedures, as well as neuropsychological personality testing, to clarify the nature of the disease.

Diagnostic measures for dementia should be understood as a whole range of procedures that allow you to determine the factors that lead to the death of nerve cells and eliminate them with medication. Among them, there may be a disturbed metabolism in the body, oncological or vascular diseases, and so on.

Among the most commonly used diagnostic procedures for dementia, modern medicine uses:

  • history taking based on complaints and psychiatric observation;
  • neurological examination of the patient;
  • testing in the clinic by a psychologist, which allows to assess the memory, mental and intellectual abilities of the patient;
  • general and biochemical blood tests;
  • neurotesting, computed and magnetic resonance imaging, electroencephalography.

Dementia implies a symptomatic disorder of the emotional sphere and mental activity (abstract, intellectual thinking and memory). The reason to seek the advice of a specialist may be tearfulness, pettiness, irritability of a person, which were not characteristic of him before. Also, household forgetfulness, inattention and aggression on the basis of this in relation to loved ones should alert. It is best if all methods are used to diagnose dementia. Then the diagnosis can be made accurate and a decision on effective therapy can be made in a timely manner.

Methods, means of treatment and care of patients

Medical means (preparations, medicines, vitamins, medicines) are mentioned for informational purposes only. We do not recommend using them without a doctor's prescription. Recommended reading: " Why can't you take medications without a doctor's prescription?". Treatment of dementia usually proceeds in several directions at once. The remaining brain cells must be made to work actively, for which two groups of drugs are used. The first group of drugs includes substances that can maintain the proper level of the neurotransmitter acetylcholine in the brain. This mediator of nerve impulse transport directly affects the symptoms of dementia. Maintaining the concentration of acetylcholine is much safer and easier by blocking the enzyme in the body responsible for the breakdown of this substance. The substance that blocks this enzyme is called an acetylcholinesterase inhibitor. Such substances today include rivastigmine, galantamine and donepezil.

The second group of drugs includes a substance that can “preserve” and maintain the efficiency of the cells of the cerebral cortex, preventing their self-destruction. This is important even when these cells are not included in the active brain activity of the patient. This substance is called memantine hydrochloride.

These drugs are used in combination or in isolation from each other. The effectiveness of therapy or its absence when the process is running can only be assessed after a long time. In the event of improvement from 3-4 months of treatment, medications are prescribed on a lifelong basis. Such therapy will be effective if there are a large number of active nerve cells at the start, which can be assessed by stopping the progression of memory deterioration or even by improving it. The patient's behavior will become more orderly and calm.

As an additional therapy for the affected brain, it is now common to use drugs that were previously substitutes for first-line drugs. They are prescribed at the initial presentation of the patient by therapists or by neurologists.

Many patients with dementia also experience so-called mental symptoms. A person is tormented by hallucinations, delusional states, aggression, anxiety, discrepancy between sleep and wakefulness, depression, and the inability to adequately assess what is happening. Such symptoms are very depressing for the patient, and bring suffering to those close to him and caring for him. This is the main syndrome that the patient requires inpatient medical care. The doctor can help the patient overcome such symptoms. It is important to exclude the parallel presence of other diseases - infectious diseases, the consequences of exposure to the body of medications, since they can cause severe confusion in the patient's consciousness. It is important to understand that behavioral disorders are not always treated with medication. In this case, pharmacological agents are necessarily used if such violations cause suffering to the patient and pose a threat to the people around them. Treatment of behavioral disorders with pharmacological drugs must necessarily take place under medical supervision, which is periodically supplemented by various methods for diagnosing changes.

Sleep disorders, which are very common, are treated separately for dementia. The process is complex, requiring the involvement of many specialists from several fields of medicine. Initially, sleep disorders are tried to be treated with non-drug interventions (by studying susceptibility to reactions to light sources, the effect of the patient's physical activity on sleep, etc.), and if such therapy fails, special medications are used.

Patients with dementia of various stages experience problems with swallowing or chewing food, which may completely refuse food. In such cases, constant care is simply necessary for them. At the same time, sometimes patients are no longer even able to understand the commands of the caregiver, for example, requests to bring a spoon to their mouths. Caring for patients in the advanced stages of dementia is a very heavy burden, as they become not just like newborns, often their reactions are contradictory and directed at resisting common sense. At the same time, it is important to understand that an adult has a certain body weight, and it’s not even possible to wash him just like that. The difficulty in caring for patients with dementia is aggravated with each passing day of the progression of the disease, so it is important to start timely treatment and care in order to be able to slow down this process.

Prevention of dementia

In science today, as many as 15 reliable ways are known to prevent the onset of dementia and Alzheimer's disease. Experts talk about the benefits of learning an additional language, which will not only expand cultural horizons, but also activate memory and thought processes. The relationship between the number of languages ​​learned and the occurrence of dementia and Alzheimer's disease has been scientifically proven.

It is also important for the prevention of dementia to drink plenty of fresh vegetable and fruit juices from youth to old age. Such vitamin-mineral cocktails have a very positive effect on the functionality of the human body, and their intake more than 3 times a week throughout life provides a 76% reduction in the risk of Alzheimer's disease.

The use of vitamin K, unjustifiably forgotten by many , postpones the aging of the human body and the onset of Alzheimer's disease for many years. To get enough of it with food, you need to eat a lot of green leafy vegetables - cabbage, lettuce and others.

Throughout life, it is very important for a person to be able to control stressful situations and their impact on their own body. Medical studies show that stress very often leads to the development of dementia, especially in the presence of some other risk factors for this disease. Thus, it was found that with a mild form of cognitive impairment due to stress, a person develops dementia 135% more often than the average.

Regular exercise is also important for the prevention of dementia. They preserve the volume of the hippocampus - that area of ​​the brain that is most susceptible to the lesion in question. The most effective physical activities are cycling, swimming, walking, dancing, running. If you run about 25 kilometers a week, you can reduce the risk of mental pathologies by as much as 40%. Also, all sports can replace garden work performed at a pace.

An excellent and effective remedy for dementia is laughter. A positive attitude and frequent sincere laughter have a beneficial effect on thinking. Eating a large amount of fruit gives the body the flavonoid fisetin, an anti-inflammatory and antioxidant substance that prevents the aging of the body's cellular system. Most of this substance is found in strawberries and mangoes.

Yoga enthusiasts are also less likely to get dementia. Meditation helps to relax, reduce the level of nervous tension, and normalize cortisol (“stress hormone”) in the cells. After relaxation, you can feast on sea fish rich in omega-3 fatty acids. Such food takes part in the construction of cell membranes, prevents thrombosis, saves brain neurons from destruction. A high concentration of omega-3 fatty acids prevents the development of dementia.

Stopping smoking is essential to prevent dementia. Tobacco smoking increases the risk of dementia by as much as 45%. But the products of Mediterranean cuisine, on the contrary, must be included in your daily diet. Vegetables, poultry, nuts, fish, olive oil help to saturate the cells of the human brain and cardiovascular system. Thus, vascular dementia and Alzheimer's disease can be prevented. And if, with proper nutrition and giving up bad habits, you also sleep 7-8 hours a day, thus restoring the nervous system, you can ensure timely cleansing of the brain from cellular waste - beta-amyloid, which is a marker of emerging dementia.

It is also very important in the diet to limit the intake of sugar that causes insulin resistance. Recent studies have proven the relationship between Alzheimer's disease and diabetes mellitus. By controlling blood sugar levels, dementia can be avoided. Well, if the slightest symptoms of dementia began to appear, it is better to immediately consult a doctor and diagnose the disease.

Early diagnosis helps to fully cure and prevent further progression of the disease.

Complications and consequences

Dementia often leads to irreversible consequences in the body or severe complications. But even if these processes are not so scary at first glance, they still greatly complicate the life of the patient and loved ones who are constantly nearby.

In dementia, various malnutrition often occurs, up to a complete cessation of fluid and food intake. The patient forgets about eating or believes that he has already eaten. The gradual progression of the disease leads to a loss of control over the muscles involved in chewing food and swallowing it. This process can cause choking on food, fluid entering the lungs, respiratory blockage, and pneumonia. Progressive dementia deprives the patient of hunger in principle. This problem partly causes difficulty in taking medications. The patient may simply forget about it, or may not physically be able to take the pill.

Personal and emotional changes provoke deterioration in psychological health. This is the most obvious consequence of dementia that has arisen, expressed in aggressiveness, disorientation, and cognitive failures. Also, patients with severe forms of the disease lose the ability to maintain basic personal hygiene.

As a consequence of dementia, patients often experience hallucinations or delusions (false thoughts), disturbed sleep patterns, which are characterized by restless leg syndrome or rapid eye movement. Progressive dementia also causes communication failures, the patient stops remembering the names of objects, the names of loved ones, he has a failure in speech skills. As a result, a person develops a persistent long-term depression, which only complicates the treatment process. It is also very important to understand that a person with dementia is often not allowed to perform the simplest activities - driving a car, cooking, as this can lead to a threat to his health.

Dementia in children often leads to depression, deterioration of physical or mental development. With an untimely start of treatment, the child may lose many skills and knowledge, become dependent on third-party care.

Lifespan

​​

The progression of dementia contributes to the disintegration of the human psyche. A patient with such a diagnosis can no longer be considered a full-fledged member of society, completely dependent on others. That is why loved ones are often worried about the life expectancy of such patients. Most often, patients with dementia live 5-10 years, sometimes longer, but this disease, its clinical manifestations and course are so individual that doctors today do not officially give an answer to this question. If we are talking about dementia of an elderly person, then these are some numbers, if suffering from parallel pathologies, then others.

To predict the life expectancy of a particular patient, it is important to consider where this pathology originates from. Approximately 5% of all detected cases of dementia are reversible pathologies. When such a disease occurs due to infectious or tumor processes, it all depends on how quickly and whether it is possible to get rid of these causes at all. With a positive solution to this problem, dementia is treatable and the patient's life expectancy increases. Sometimes dementia is provoked in the body by a lack of folic acid, vitamin D, which can be corrected by additional intake of such substances inside.

In 10-30% of cases, symptoms of dementia develop after a stroke. Patients have problems with movement, memory, speech, counting, depression, mood swings. If dementia also occurred in parallel with a stroke, this leads to the death of such a patient 3 times more often. However, elderly patients who have had a stroke can prolong life and improve their well-being by timely and high-quality therapy of both post-stroke and dementia manifestations. Sometimes you can extend the life of such therapy even for 10 years.

It is important to understand that in "senile insanity" patients who are bedridden live longer than those who walk because they are not able to harm themselves - they do not fall, they cannot cut themselves or get hit by a car. With quality care for the patient, his life is lengthened for many years.

If Alzheimer's disease led to dementia, then such patients live much less. If Alzheimer's disease proceeds in a severe form, for example, there is severe apathy, a person loses speech skills, cannot move, then this indicates the duration of his subsequent life within only 1-3 years.

Vascular dementia very often occurs in senile circulatory disorders. This complication can provoke arrhythmia, atherosclerosis, hypertension, pathology of the heart valve. At the same time, brain cells die, feeling a lack of oxygen and nutrition. With vascular dementia with its bright signs, patients live for about 4-5 years, but if the disease develops implicitly and slowly - more than 10 years. At the same time, 15% of all patients can be completely cured. A heart attack or stroke can provoke multiple complications, disease progression and even death.

However, it is important to remember that dementia does not always affect only the elderly - young people also suffer from it. Already at the age of 28-40 years, many are faced with the first symptoms of pathology. Such anomalies, first of all, are provoked by an unhealthy lifestyle. Gambling, smoking, alcoholism and drug addiction greatly slow down brain activity, and sometimes lead to obvious signs of degradation. At the first symptoms, the young patient is still completely curable, but if the process is started, one can reach the most severe forms of dementia. Constant medication, unfortunately, is the only way to prolong life. In young people, when dementia is detected, the subsequent life expectancy can be 20-25 years. But there are cases (for example, with a hereditary factor) of rapid development, when death occurs after 5-8 years.

Disability due to dementia

Older people with cardiovascular problems or after a stroke are most likely to suffer from dementia. However, even with the course of dementia in young people, they are recognized as persons with disabilities and assigned a disability group. You do not need to prove your own illness to the patient, a medical opinion after a medical and social examination or a court decision is enough. The court decision is made on the suit of the board of trustees in relation to the patient.

The inevitable attribution of disability is important to regard as state support and protection. Special authorities will timely pay disability benefits in cash so that the patient can always provide himself with medicines, and also guarantee him rehabilitation assistance. It is important that in order to register the status of a disabled person, it is necessary to prove to the state the impossibility of existence without such assistance, since simply incapacity is not the reason for recognizing a person as disabled.

The procedure for assigning a disability consists of several stages. First, the patient or his caregiver must apply to the medical institution at the place of residence to issue a referral to the ITU for the purpose of an examination. In case of refusal to issue a referral, the patient can independently go to the ITU with a written refusal. An expert meeting is held, where the board of trustees confirms the incapacity of the patient.

After the initial diagnosis of dementia, a disability group can be assigned after a maximum of 2 years. Even if the stage of the disease is primary and the patient can independently serve himself and go to work, only the first group of disability in dementia is always assigned. When considering each specific case, the functional impairment in the body, the severity of limitations and their impact on a person’s life in the future, the ability to self-service and independent movement, the adequacy of reality assessments, the degree of recognition of acquaintances, the ability to control one’s own behavior, learning ability and working capacity are taken into account. With positive test indicators for each of these signs of disability, the patient cannot be denied. Refusal may follow if the procedure for submitting documents has not been followed, for which the patient's guardian is responsible. At the same time, there may be no certificate from a psychiatrist, no registration in the PND, no expert confirmation of the diagnosis.

Personal presence at the commission for the appointment of disability in dementia is not required. The doctor can visit the patient at home, conduct an examination and issue the necessary conclusion. In some cases, additional examinations are prescribed.

Dementia is a very complex disease, the treatment of which is very difficult, especially if it is detected late or if you do not want to follow all medical prescriptions.

Sources
  1. Website of the Ministry of Health, State of Israel. – What is dementia?
  2. World Health Organization (WHO). – Dementia.
  3. MSD Handbook. – Dementia.