What type of impairment of consciousness occurs in senile psychosis. Senile psychosis, symptoms and treatment

We all dream about magic pills that will defeat inevitable aging once and for all. It is no secret that today many older people maintain a beautiful appearance and high physical activity for a long time. And yet, the fear of senile mental decline is familiar to almost everyone. What to do if a loved one has symptoms age-related disorders brain function – senile psychosis?

Senile psychosis in Latin comes from the word “senilis” (Latin: “senile”) and refers to diseases of old age. With age, not only the physiological, but also the mental activity of a person gradually weakens more and more. This process is natural for the elderly, but excessive loss of consciousness is pathological.

Dementia, prolonged depressive states, paranoid manifestations are considered the main signs of this dangerous disease. It has symptoms of schizophrenia and senile dementia. However, the concept of senile psychosis presupposes only partial, and not total clouding of consciousness. In accordance with the World Health Organization classifier, it is called “delirium due to dementia” and ICD-10 code F05.1

Causes

Can provoke the development of senile psychosis whole line various factors:

1. Development of senile dementia, manic – depressive syndrome associated with age-related brain pathology: Alzheimer's disease (death of brain cells), Pick's disease (destruction and atrophy of the cerebral cortex).
2. Use of anesthesia during operations. In the postoperative period, the risk of acute brain syndrome in an elderly person it is especially large.
3. Genetic predisposition.
4. Experienced emotional trauma resulting in severe post-traumatic stress disorder.
5. Row somatic pathologies: malfunctions respiratory system, genitourinary organs, heart failure, hypovitaminosis.
6. Chronic insomnia, physical inactivity, systematically poor nutrition, visual impairment, hearing impairment.

Often, older people do not even consult a doctor with these symptoms, considering them to be normal manifestations of age. This leads to delayed treatment, which can give rise to senile disorders reason.

Although adherence to the principles of a healthy lifestyle, unfortunately, does not guarantee the absence of health problems in old age. Many older people are faced with age-related disorders of consciousness, even with careful attention to a healthy diet, routine and timely medical examinations.

Fortunately, not every elderly person develops senile psychosis. In addition, when early start treatment, deviations often do not develop into more severe pathologies.

Main symptoms

Primary signs include severe constant fatigue, insomnia, loss of appetite. An elderly person begins to demonstrate helplessness and becomes lost in reality. The main symptoms of the disease include:

• clouding of consciousness, sometimes to the point of complete deformation of the mental state of the individual;
• violation of orientation in space;
• musculoskeletal disorders;
• complete or partial amnesia (memory loss);
• The acute form is characterized by fussy motor agitation with simultaneous loss of coordination of movements.

All this leads to the fact that old man is not able to take care of himself, and may also not realize the need to see a doctor.

People over 60 years of age are at risk, but sometimes senile involutional psychoses are observed at the age of 50 years and older.

There is a separate group of pathologies (presenile), which develop in a similar way and with the same symptoms, but already at the age of 45–60 years. Studies have found that presenile and senile psychoses are observed much more often in women than in men.

Forms and types of senile psychosis

Medicine distinguishes between acute and chronic phase diseases. Acute pathology is more common. It is characterized by a sudden onset and vivid symptomatic manifestations.

Paranoid delusions are a frequent signal of impaired consciousness. For example, the patient becomes aggressive towards the people around him, and is sure that they want to harm him or his property. Before this (1-3 days), as a rule, loss of appetite and weakness, insomnia, and spatial disorientation are noted. As the deformation of consciousness develops, clouding of thinking and anxiety progress, and hallucinations may appear.

Pathology in the acute phase lasts from several days to weeks, while the general physical condition worsens. Symptoms may occur intermittently or continuously. It is important for the patient’s relatives and friends to understand what outcomes of acute senile psychosis are possible without immediate assistance doctors: this is a strong and severe clouding of the mind, causing harm to oneself and others.

Chronic pathology mainly occurs with mild symptoms of clouding of consciousness:

1. An elderly person willingly and a lot tells a large number of non-existent events and false memories. He sees all this in the present tense.
2. Hallucinations become regular. The pictures of hallucinations are very believable, endowed with volume and color. The patient sees people, animals, talks to them, and experiences imaginary life situations. He experiences tactile hallucinations: itching, burning, pain. In this case, the patient points to causes of discomfort that do not exist in reality: insects, sand, crumbs, etc.
3. Paranoid delusion.
4. Hallucinatory-paranoid syndrome. Delusions are combined with hallucinations, and symptoms of schizophrenia may appear. It can develop over a long period of life (up to 10 - 15 years).
5. Depression (a common symptom in the clinical picture of most mental disorders), accompanied by apathy and weakness. The sick person feels the unattractiveness of the future and hopelessness. Deterioration of the condition leads to high anxiety and severe mental agitation.

Suppression of the productive functions of an elderly person’s body can go unnoticed by others, manifesting itself only in minor memory disorders. However, even in this case, without the supervision of a specialist, the patient is in serious danger.

Diagnosis, treatment and prevention

It is important to distinguish the disease from classic depression, senile dementia, and manic-depressive psychosis. At the initial stages of the examination, it is also necessary to exclude vascular disorders, oncology and other pathologies. Diagnosis is carried out based on clinical picture, as well as additional studies (for example, computed tomography).

On your own or folk remedies It is impossible to successfully treat senile psychosis. You should immediately consult a psychiatrist. To treat acute psychosis in old age, the patient needs hospitalization; only in a hospital will he receive full medical and nursing care. Taking into account all manifested symptoms, treatment is prescribed strictly individually, in accordance with the full clinical picture of concomitant diseases.

Medicines used (the course of therapy is carried out strictly under the supervision of a doctor):

1. Antidepressants in combination with sedatives (for the correction of depressive conditions).
2. Neuroleptics (normalization of anxious behavior, confusion).
3. Neuroleptics in combination with tranquilizers (for severe anxiety, insomnia).

It is useful to keep the older person occupied with simple mental and physical exercise, as this stimulates the brain and reduces the risk of recurrence of acute psychosis. It is also of great importance psychological support families, proper home care.

In the video, psychiatrist Mikhail Tetyushkin examines a specific case of the disease. The doctor comments on symptoms and treatment methods, and also gives recommendations to loved ones on how to interact with a sick person.

Conclusion

Unfortunately, modern medicine still does not know methods that completely eliminate senile dementia and brain atrophy. If medical assistance is provided on time, acute senile psychosis, not accompanied by prolonged clouding of consciousness, is often curable.

The chronic phase of senile psychosis is often fraught with serious consequences: progressive personality disorders, even suicide. Its danger is that clear symptoms often appear too late - the diagnosis is not made early stage, medical measures were not taken on time. Therefore, in terms of cure, the disease has an unfavorable prognosis.

Prevention of the development of senile psychoses includes regular medical examinations, avoiding severe stressful situations and emotional overload, alcohol and drug effects on the body in old age.

If your elderly relative begins to show symptoms of senile dementia and other “age-related” disorders, it is important not to panic, but to take timely necessary measures. Do not forget that as old age approaches, our relatives and friends increasingly need our attention, care and care.

Senile psychosis refers to a whole group of diseases characteristic of people over sixty years of age, whose mental activity is gradually impaired. Manifestations of pathology include senile dementia, late-onset depression and paranoid disorders. The main symptoms of the disease include states of confusion and various endomorphic disorders. At the same time, total dementia does not develop in patients. Presenile psychoses are characterized by a similar course, the onset of development of which usually occurs at the age of forty-five to sixty years. Most often, the pathology occurs in the form of involutional melancholy, that is, depression or involutionary paranoid, that is, reed disorder. Much less common are special malignant types of the disease, characterized by anxiety, confusion, and speech disorders.

Main reasons

The etiology of the development of presenile and senile psychoses still remains unknown. It is believed that the trigger point in the development of the disease can be a traumatic brain injury, other somatic pathologies, as well as any traumatic circumstances.

Senile psychoses occur as a result of brain atrophy, which is most often caused by hereditary factors. IN medical practice Cases of “familial dementia” have been encountered more than once. Unfavorable external influences and somatic pathologies can aggravate the pathological process. And although the process of destruction mental activity in humans due to aging is absolutely natural; senile psychosis is considered to be a pathological condition.

Regarding the prevalence of the disease, numerous studies have revealed that senile and presenile psychoses are much more common among women than among the male population.

Clinical picture

If presenile psychosis occurs in the form of involutional melancholy, it is characterized by increased anxiety, delusional ideas of a predominantly hypochondriacal nature, accompanied by self-deprecation, a general depressed mood, and suicidal tendencies. Most often, patients experience prolonged depression.

Involutional paranoids are characterized by concreteness. Patients may experience delusions of jealousy, persecution, damage, etc. As a rule, with such disorders it is the most close environment patient: neighbors, relatives, since they are the ones accused of intentionally causing harm, theft of property, etc. Similar symptoms are characteristic of senile psychoses.

Senile psychoses can occur in both acute and chronic forms. Acute forms, characterized by confusion and often occur against the background of certain somatic pathologies: heart disease vascular system, respiratory tract, genitourinary area, etc. In fact, acute senile psychoses are symptomatic mental disorders. Symptoms of confusion in senile psychoses usually include motor agitation, fussiness, and lack of coordinated actions. Delusional disorders may also occur, accompanied by anxiety, hallucinations, and unreasonable fears. An acute attack of illness can last up to several weeks. The disease can occur continuously or in the form of periodic relapses.

Chronic senile psychosis can occur in the form of depressive or paranoid states. Depression in a mild form usually manifests itself as a feeling of internal emptiness, a pessimistic mood, lethargy, apathy, and loss of interest in previously favorite activities. The patient may experience a feeling of disgust towards everything around him. Hypochondriacal disorders often appear. In some cases, patients experience so-called “silent” depression, in which a person expresses virtually no complaints about his mental anxiety. Such states are usually referred to as late involutional melancholia.

Sometimes senile psychoses manifest themselves as chronic paranoid interpretive delusions. It seems to patients that those around them are trying to get rid of them by all means and are deliberately damaging their property, stealing personal belongings, intending to poison them, etc. Delusional behavior begins to manifest itself at the very beginning of the development of the disease. The patient may lock his room so that no one can enter it, complain to all sorts of authorities, and even strive to change his place of residence. The gradual reduction of delusional disorders can continue throughout for long years, while the patient’s social adaptation practically does not suffer, as well as his ability to care for himself.

Additional symptoms

Other symptoms that may accompany senile psychosis are various kinds hallucinations:

• Verbal hallucinosis Bonnet. Verbal hallucinations, in which the patient can hear threats and swearing at himself. The long course of this disorder contributes to the development of anxiety and motor restlessness in patients;
• Bonnet visual hallucinosis. This disorder always occurs acutely and develops according to certain scenarios. Gradually, single planar hallucinations turn into scene-like hallucinations, and the patient himself watches with interest what is happening. A person may try to enter into a dialogue with the images they see; in other cases, patients experience fear and try to drive away the vision. Over time, visual hallucinosis decreases, while dysmnestic disorders increase;
• Tactile hallucinosis. This is the so-called dermatosus delirium, in which patients feel constant skin itching, as if they were being bitten by invisible insects. This disorder is often accompanied by hypochondriacal delusions, as well as visual hallucinations in the form of peeling skin or insect bites.

Hallucinations in senile psychoses can last for ten to fifteen years, and the clinical picture is even more complicated if the patient has paranoid delusions. Often at the age of seventy or eighty years, the course of the disease changes somewhat. Dysmnesia may develop in the absence of signs of total dementia. Fifteen to seventeen years after the onset of the disease, significant memory deterioration is possible.

Almost all forms of chronic senile psychoses are characterized by the following general symptoms:

• manifestation of any one syndrome: either paranoid or depressive;
• the severity of mental disorders, on the basis of which a specialist can accurately classify the disease;
• preservation of intelligence and memory over a long period of time;
• if memory impairments occur, they are most often presented in the form of dysmnestic disorders;
• in the absence of serious vascular pathologies brain, people suffering from senile psychoses are able to maintain normal activity.

Diagnosis and differential diagnosis

It is possible to accurately diagnose presenile psychoses only when the disease first appears in the involution phase. At the same time, the symptoms of the disease are quite difficult to differentiate from bipolar disorder and late-onset schizophrenia. Differential diagnosis can be significantly alleviated if patients at involutional age do not have any signs of senile dementia or atherosclerosis.

Senile psychosis, which occurs due to atrophic processes in the brain, can be recognized quite easily in the initial stages, excluding oncological and vascular diseases, as well as other pathologies. The diagnosis is made based on available clinical signs, as well as the results of additional research methods, for example, computed tomography.

Effective treatment of brain atrophy in humans old age does not exist. Presenile and senile psychoses require certain supportive therapy and symptomatic treatment to improve the quality of life of patients. It is recommended that such people, as far as possible, create all the conditions so that they can lead a more or less full life and provide proper care. For correction general condition may be appointed medications from the group of tranquilizers and psychotropic drugs. If the course of senile psychosis is very severe, and there is no possibility of providing constant care for the patient, he must be placed in a hospital or a special boarding school.

The symptoms of this group of diseases are of a psychotic type, which is important; a person’s intelligence can be completely preserved. Very often the disease occurs in the form of depression or delusional disorder.

Less commonly, the problem can manifest itself as anxiety, speech impairment, and confusion. Thus, partial clouding of consciousness occurs as a result of disorders in the activity of the central nervous system (CNS).

In medical practice, two types of development of senile psychosis are distinguished:

• acute senile syndrome, characterized by clouding of consciousness, maladjustment in society and loss of personality;
• chronic senile psychosis, which manifests itself in the form of depression, hallucinations, the state can be paraphrenic, hallucinatory-paranoid.

Causes of the disease

The etiology and pathogenesis of senile psychosis have not yet been well studied. According to statistics, women are more susceptible to this problem than men. The risk of developing the disease increases if there are already precedents of senile psychosis in the family, that is hereditary factor plays a big role.

The main reasons for the development of the disease are:

• gradual age-related death of groups of cells;
• degenerative processes in the brain;
• Various infectious diseases can affect the development of the disease;
• somatic pathologies;
• traumatic brain injuries;
• traumatic circumstances.

Pathogenesis can also be affected by:

• physical inactivity;
• sleep disorders;
• malnutrition (incorrect diet);
• problems with hearing and vision.

Clinical picture

If senile psychosis occurs as depression, this condition is characterized by delusional ideas, increased anxiety, general depression of mood, suicidal tendencies, and “self-destruction.”

Psychoses are characterized by disorders involving jealousy, persecution and self-harm. Thus, the main “victims” of a suffering old man can be relatives and friends, neighbors, people around him, as they can be accused of theft, causing damage to their property, etc.

Senile psychosis in acute form occurs quite often, its symptoms appear mainly in people undergoing treatment for somatic and mental disorders. It is in the process of complications of these diseases that the impetus for the development of psychoses appears.

Symptoms of acute psychosis include:

• confusion;
• motor excitement;
• fussiness;
• lack of coordinated actions;
• delusional disorders;
• hallucinations (verbal, visual, tactile);
• unreasonable fears;
• anxiety.

This type of disease progression can be observed over several weeks, or can occur continuously as repeated relapses.

The development of acute psychosis can be determined by the presence of certain symptoms:

• loss of appetite;
• sleep disturbance;
• disorientation in space, which is episodic in nature;
• severe fatigue;
• helplessness;
• problems with self-care.

Further stupefaction is accompanied by amnesia. The clinical picture is fragmentary. Patients may experience motor activity, as well as various forms of clouding of consciousness (amentia, delirium, stupor), which occur both individually and in combination.

Chronic senile psychosis is observed mainly in elderly women. In mild forms the following may occur:

During the course of the disease, symptoms may appear unreasonable feeling guilt, hypochondria, anxiety. This disease occurs with a minor manifestation of mental disorder, which over time suppresses the functions of the body.

Such sluggish depression in some cases can lead to suicide. Psychosis can develop over 10 years, with only minor memory impairment present.

Diagnostic criteria

On early stages It is almost impossible to determine the presence of the disease, since it has a lot of symptoms similar to other pathologies: the cardiovascular system, tumors and other problems.

The reason for the diagnosis is a progressive impoverishment of the psyche, leading over several years to irreversible dementia.

A visit to the doctor is mandatory if the patient has a number of factors: disorders for more than six months, leading to disturbances in social, professional, and daily activities. At the same time, the person has a completely clear consciousness, there are no mental disorders that could lead to a decrease in intelligence.

Differentiated diagnosis

Differential diagnosis helps to distinguish senile syndrome from diseases with similar symptoms, for example, schizophrenia.

Dementia is often accompanied by depressive disorders (pseudo-dementia), so differentiating the disease is quite difficult.

Set of measures

After the clinical picture has been studied and accurate diagnosis, you can begin treating the patient. With the permission of the patient's relatives, he is placed in a medical facility.

The main goal of treatment is to arrest the progression of the disease, symptomatic treatment and alleviation of these characteristic symptoms.

In case of depression, a specialist may prescribe psychotropic drugs, such as Melipramine, Pyrazidol, Azafen. In some cases, drugs can be combined at a certain dose. For all other types of senile psychosis, Propazine, Sonapax, and Haloperidol are prescribed.

In each specific case, the patient is prescribed an individually selected drug and additional medications that correct the accompanying symptoms.

Typically, the acute form of senile psychosis responds more successfully to treatment. A protracted disease can only be suppressed with medications, but it is impossible to completely get rid of it.

What should relatives and friends do?

To maintain the mental state of a patient diagnosed with senile psychosis, the people around him must be understanding of the current situation and understand that this process is inevitable and incurable. This disease is objective and does not depend at all on the patient himself.

In severe cases of senile psychosis, patients require special care, which is best organized in a medical facility. If the patient is inactive, bedsores may appear, which can significantly worsen the health condition.

Patients who are characterized by untidiness need special care. So, relatives or medical staff(depending on the location of the patient) are required to wipe him with camphor alcohol, wash him regularly, change bed linen and prevent sleeping on a wet bed. Cleansing enemas should also be regular.

What to expect?

The most favorable prognosis is given to patients with an acute form of the disease, especially if medical help was sought on time and consciousness was not in a state of confusion for long.

The chronic form does not entail anything good and the prognosis in this case is not comforting: the disease develops from one to ten years and the later this process begins, the better, since ultimately the disease ends with cachexia, problems with making movements and even constructing phrases and pronunciation of words.

Experts believe that if you start preventing senile psychosis at the age of 35, then in the future a person will be able to avoid a similar disease:

• the person must be physically active;
• an important factor is the development of mental abilities;
• attention to body weight;
• control blood pressure;
• cholesterol control;
• proper nutrition.

This section was created to take care of those who need a qualified specialist, without disturbing the usual rhythm of their own lives.

/ Spurs in psychiatry / Private / Vascular dementia

Vascular dementia is the so-called lacunar (partial, dysmnestic) type of dementia. This type of vascular dementia is determined by increasing disturbances in memory and selective reproduction, disturbances in chronological dating and time orientation (with relative preservation of allo- and autopsychic orientation), progressive difficulty and slowdown of all mental processes. It is accompanied by asthenia and decreased mental activity, difficulties in verbal communication and finding the right words, a decrease in the level of judgment and criticism with a certain preservation of the consciousness of one’s own insolvency and basic personal attitudes (the core of personality is preserved), a feeling of illness and helplessness, a reduced tearful mood, weakness and “incontinence of affects.” This type of dementia develops mainly due to atherosclerotic processes that manifest themselves between the ages of 50 and 65 years. It is most often formed gradually by intensifying psychoorganic disorders that arose in the early stages of the disease. In some patients, lacunar dementia syndrome occurs more acutely after cerebrovascular accidents (postapoplectic dementia). In such cases, dementia is preceded by a transient amnestic (Korsakoff-like) syndrome.

After acute cerebrovascular accidents (stroke, severe hypertensive crises, subarachnoid hemorrhages), and often after acute vascular psychoses, amnestic dementia syndrome with severe memory impairments such as fixation amnesia, severe disorientation and confabulations is possible. The picture of such amnestic dementia is in some cases reversible to some extent.

Another type of dementia, which occurs with vascular lesions of the brain, is called “pseudoparalytic” due to the predominance in the clinical picture of carelessness, euphoria, talkativeness, disinhibition of drives, lack of a sense of illness, a sharp decrease in criticism and level of judgment - with a relatively less pronounced memory impairment and orientation. The pseudoparalytic type of vascular dementia is usually found in patients under 65 years of age with severe hypertensive encephalopathy or with frontal localization of softening foci.

With severe hypertensive encephalopathy, sometimes there is a rare form of vascular dementia, with the workload and stunnedness of patients, adynamia and reduced motor and speech activity, pronounced difficulties in fixating, perceiving and comprehending what is happening - this form of vascular dementia is described as “pseudotumorous”. It requires especially careful differentiation from a brain tumor.

Dementia syndromes observed during the manifestation of the vascular process in old age also have certain clinical features. Due to some similarities in the clinical picture of these syndromes with senile dementia, they speak of a senile-like type of vascular dementia. As with senile dementia, the initial stage of this type of vascular dementia is characterized by pronounced personality changes, a gloomy or displeased or irritable mood, a distrustful and hostile attitude towards others, individual ideas of attitude and detachment. The clinical picture of dementia is determined by deeper and more diffuse memory impairments (than with dysmnestic dementia), more pronounced disorientation, and elements of “shifting the situation into the past,” and a deeper decline in all types of mental activity.

Independent clinical variant Vascular dementia is an Alzheimer's-like form with focal cortical disorders caused by a special localization of the vascular process, resulting from the addition of atherosclerotic changes in blood vessels cerebral cortex to the senile-atrophic process.

Psychotic syndromes. In direct causal dependence on the vascular process (its nature, course, rate and degree of progression) are acute and subacute psychoses of the exogenous and exogenous-organic type - “arteriosclerotic states of confusion.” These psychoses are distinguished by a number of common clinical properties: 1) syndromes of altered consciousness that arise within these psychoses (exogenous types of reactions), as a rule, are atypical, rudimentary and syndromic incomplete. Manifestations of acute vascular psychoses do not always correspond to the known syndromic types of delirium, amentia, twilight states and others, which has allowed many modern psychiatrists to generally qualify them as “states of confusion”; 2) acute psychotic disorders are quite often short-term, episodic. Their duration often does not exceed several hours. They occur predominantly at night, and during the day patients can be clearly conscious and do not exhibit psychotic disorders. Confusion at night, in particular, recurs frequently; 3) the course of acute vascular psychoses differs significantly from the course of symptomatic psychoses of other etiologies. 4) with a more protracted (subacute) course of vascular psychoses, in addition to syndromes of altered consciousness, there may be observed not accompanied by stupefaction, but also reversible syndromes, which were called transitional or intermediate. In vascular psychoses, almost all types of intermediate syndromes can occur (preceding or following syndromes of altered consciousness): neurotic and affective (asthenic, depressive, anxious-depressive), hallucinatory-paranoid (schizoform) into organic circle syndromes (adynamic, apathetic-abulic , euphoric, expansive-confabulatory, amnesic-Korsakoff-like).

Acute psychotic states are sometimes observed in the prodrome of stroke. Such post-stroke psychoses with confusion, disorientation, delirious agitation, anxiety, individual hallucinatory and delusional disorders usually turn into prolonged asthenodepressive states, but can also transform into various states of dementia through an amnestic intermediate syndrome.

Acute psychotic episodes can occur during exacerbation of the vascular process against the background of various, even stabilized, mental changes (including dementia).

Of all the so-called endoform (protracted) vascular psychoses (as well as in atrophic processes), the most clinically justified is the identification of protracted vascular paranoid psychoses. They are most often observed in men in the form of paranoid delusions of jealousy. The plot of the delusion contains many naked sexual details. Typical storylines: cheating on a wife with young people, young family members, including a son or son-in-law. Delusions of jealousy are usually combined with ideas of damage (the wife feeds rivals better, gives them the patient’s things), a tearfully depressed mood with outbursts of irritability, anger, and aggressiveness.

There is also no doubt that chronic verbal hallucinosis is classified as vascular psychosis. Chronic vascular hallucinosis is defined by polyvocal true verbal hallucinosis. It flows in waves, often at the height of development it becomes scenic (scenes of public condemnation of the patient), usually intensifies in the evening and night hours and has a predominantly threatening content.

TREATMENT, PREVENTION AND ORGANIZATION OF CARE FOR PATIENTS. The main focus should be on the treatment of the underlying vascular disease and the hemodynamic disorders caused by it. Psychotropic drugs prescribed for general indications, with with utmost care. Preferably drugs with moderate or even relatively weak neuroleptic activity are administered (aminazine, usually no more than 50-75 mg/day, thioridazine - Melleril). Small doses of haloperidol (for hallucinosis), tizercin (for anxiety-delusional states) are used. Particular care should be taken when handling combined use psychotropic drugs. Such combinations are indicated only for short-term use to reduce anxiety and agitation (for example, in the form of a combination of 25-50 mg/day amitriptyline and 20-25 mg melleril or aminazine). A combination of antidepressants or neuroleptics with weak neuroleptic activity and small doses of tranquilizers (seduxen, tazepam) is advisable. In case of pronounced anxiety agitation and vital fear, intravenous drip administration seduxena. With vascular inferiority of the brain, there is an increased risk of developing side effects of psychotropic drugs - cardiovascular disorders and early appearance neuroleptic. Amitriptyline, which is preferable for anxiety and depression due to its sedative effect, is prescribed in doses not exceeding 50-75 mg/day. The use of pyrazidol is recommended.

In the early stages of development of vascular mental changes, restoratives and thoughtful regulation of the regime. In some cases, a course of treatment with aminalon (Gammalon), piracetam (Nootropil) or Cerebrolysin is useful.

It is also necessary, if possible, to eliminate all hazards that can negatively affect the course of vascular diseases.

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Dementia (dementia): signs, treatment, causes of senile, vascular

As a person ages, failures begin to occur in all systems and organs. There are also deviations in mental activity, which are divided into behavioral, emotional and cognitive. The latter includes dementia (or dementia), although it has a close relationship with other disorders. Simply put, in a patient with dementia, due to mental disorders, behavior changes, causeless depression appears, emotionality decreases, and the person begins to gradually degrade.

Dementia usually develops in older people. It affects several psychological processes: speech, memory, thinking, attention. Already at the initial stage of vascular dementia, the resulting disorders are quite significant, which affects the patient’s quality of life. He forgets already acquired skills, and learning new skills becomes impossible. Such patients have to leave their professional career, and they simply cannot do without the constant supervision of family members.

General characteristics of the disease

Acquired cognitive impairments that negatively affect a patient's daily activities and behavior are called dementia.

The disease can have several degrees of severity depending on social adaptation patient:

1. Mild degree of dementia - the patient experiences a degradation of professional skills, his social activity, interest in favorite activities and entertainment weakens significantly. At the same time, the patient does not lose orientation in the surrounding space and can take care of himself independently.
2. Moderate (average) degree of dementia - characterized by the impossibility of leaving the patient unattended, since he loses the ability to use most household appliances. Sometimes it is difficult for a person to open the lock on his own. front door. This degree of severity is often referred to colloquially as “ senility" The patient requires constant help in everyday life, but he can cope with self-care and personal hygiene without outside help.
3. Severe degree - the patient has complete disadaptation to the environment and personality degradation. He can no longer cope without the help of his loved ones: he needs to be fed, washed, dressed, etc.

There can be two forms of dementia: total and lacunar (dysmnestic or partial). The latter is characterized by serious deviations in the process of short-term memory, while emotional changes are not particularly pronounced (excessive sensitivity and tearfulness). A typical variant of lacunar dementia can be considered Alzheimer's disease in the early stages.

The form of total dementia is characterized by absolute personal degradation. The patient is exposed to intellectual and cognitive disorders, the emotional-volitional sphere of life changes radically (there is no sense of shame, duty, vital interests and spiritual values ​​disappear).

WITH medical point In terms of vision, there is the following classification of types of dementia:

• Dementia of the atrophic type (Alzheimer's disease, Pick's disease) usually occurs against the background of primary degenerative reactions occurring in the cells of the central nervous system.
• Vascular dementia (atherosclerosis, hypertension) - develops due to circulatory pathologies in the cerebral vascular system.
• Dementia of mixed type - the mechanism of their development is similar to both atrophic and vascular dementia.

Dementia often develops due to pathologies leading to the death or degeneration of brain cells (as an independent disease), and can also manifest itself as a severe complication of the disease. In addition, conditions such as skull trauma, brain tumors, alcoholism, multiple sclerosis etc.

For all dementias, such signs as emotional-volitional (tearfulness, apathy, causeless aggression, etc.) and intellectual (thinking, speech, attention) disorders, up to personal disintegration, are relevant.

Vascular dementia

Cerebrovascular accident in vascular dementia

This type of disease is associated with impaired cognitive function due to abnormal blood flow in the brain. Vascular dementia is characterized by a long development pathological processes. The patient practically does not notice that he is developing brain dementia. Due to disturbances in blood flow, certain brain centers begin to experience oxygen starvation, which causes the death of brain cells. A large number of such cells leads to brain dysfunction, which manifests itself as dementia.

Causes

Stroke is one of the root causes of vascular dementia. Both rupture and thrombosis of blood vessels, which characterize a stroke, deprive brain cells of proper nutrition, which leads to their death. Therefore, stroke patients are at particularly high risk of developing dementia.

Hypotension can also trigger dementia. Because of low blood pressure the volume of blood circulating through the vessels of the brain decreases (hyperfusion), which subsequently leads to dementia.

In addition, dementia can also be caused by atherosclerosis, hypertension, ischemia, arrhythmia, diabetes, heart defects, infectious and autoimmune vasculitis, etc.

As mentioned above, often the cause of such dementia can be cerebral atherosclerosis. As a result, the so-called atherosclerotic dementia gradually develops, which is characterized by a partial stage of dementia - when the patient is able to realize that he is experiencing impairments in cognitive activity. This dementia differs from other dementias in the stepwise progression of the clinical picture, when episodic improvements and deteriorations in the patient’s condition periodically replace each other. Atherosclerotic dementia is also characterized by fainting, dizziness, speech and visual abnormalities, and slow psychomotor skills.

Signs

Typically, a doctor diagnoses vascular dementia when disruptions in cognitive function begin to appear after a heart attack or stroke. A harbinger of the development of dementia is also considered to be weakening of attention. Patients complain that they cannot concentrate on a specific object or concentrate. Characteristic symptoms of dementia are changes in gait (mincing, wobbly, “skiing”, unsteady gait), voice timbre and articulation. Swallowing dysfunction is less common.

Intellectual processes begin to work in slow motion - also an alarming signal. Even at the beginning of the disease, the patient experiences some difficulties in organizing his activities and analyzing the information received. In the process of diagnosing dementia in the initial stages, the patient is given a special test for dementia. With its help, they check how quickly the subject copes with specific tasks.

By the way, when vascular type dementia, memory deviations are not particularly pronounced, which cannot be said about the emotional sphere of activity. According to statistics, about a third of patients with vascular dementia are depressed. All patients are susceptible frequent changes moods. They can laugh until they cry, and suddenly suddenly begin to cry bitterly. Patients often suffer from hallucinations, epileptic seizures, show apathy towards the world around them, and prefer sleep to wakefulness. In addition to the above, symptoms of vascular dementia include impoverishment of gestures and facial movements, i.e., motor activity is impaired. Patients experience urinary disturbances. A characteristic feature of a patient suffering from dementia is also sloppiness.

Treatment

There is no standard, template method for treating dementia. Each case is considered by a specialist separately. This is due to the huge amount pathogenetic mechanisms, preceding the disease. It should be noted that dementia is completely incurable, so the disorders caused by the disease are irreversible.

Treatment of vascular dementia, and other types of dementia too, is carried out with the help of neuroprotectors that provide positive impact on brain tissue, improving their metabolism. Also, dementia therapy involves treating directly the diseases that led to its development.

Calcium antagonists (Cerebrolysin) and nootropic drugs are used to improve cognitive processes. If the patient is subject to severe forms of depression, then, along with the main treatment of dementia, he is prescribed antidepressants. To prevent cerebral infarctions, antiplatelet agents and anticoagulants are prescribed.

Do not forget about the prevention of vascular and heart diseases: quit smoking and alcohol, fatty and too salty foods, you should move more. Life expectancy with advanced vascular dementia is about 5 years.

It should be noted that people with dementia often develop such an unpleasant trait as sloppiness, so relatives need to provide proper care for the patient. If household members cannot cope with this, then you can resort to the services of a professional nurse. This, as well as other common questions related to the disease, should be discussed with those who have already encountered similar problems on a forum dedicated to vascular dementia.

Video: vascular dementia in the program “Live Healthy!”

Senile (senile) dementia

Many, observing elderly household members, often notice changes in their condition associated with character, intolerance and forgetfulness. From somewhere an irresistible stubbornness appears, and it becomes impossible to convince such people of anything. This is due to brain atrophy due to the large-scale death of its cells due to age, i.e., senile dementia begins to develop.

Signs

First, an elderly person begins to experience minor deviations in memory - the patient forgets recent events, but remembers what happened in his youth. As the disease progresses, old fragments begin to disappear from memory. In senile dementia, there are two possible mechanisms for the development of the disease, depending on the presence of certain symptoms.

Most elderly people with senile dementia have virtually no psychotic states, which makes life much easier for both the patient and his relatives, since the patient does not cause much trouble.

But there are also frequent cases of psychosis accompanied by insomnia or sleep inversion. This category of patients is characterized by such signs of senile dementia as hallucinations, excessive suspicion, mood swings from tearful tenderness to righteous anger, i.e. A global form of the disease is developing. Psychosis can be triggered by changes in blood pressure (hypotension, hypertension), changes in blood sugar levels (diabetes), etc. Therefore, it is important to protect elderly people with dementia from all kinds of chronic and viral diseases.

Treatment

Health care providers do not recommend treating dementia at home, regardless of the severity and type of disease. Today there are many boarding houses and sanatoriums, the main focus of which is the maintenance of precisely such patients, where, in addition to proper care, treatment of the disease will be carried out. The issue is certainly controversial, since in the comfort of home it is much easier for the patient to endure dementia.

Treatment of senile type dementia begins with traditional psychostimulant drugs based on both synthetic and herbal ingredients. In general, their effect is manifested in increasing the ability of the patient’s nervous system to adapt to the resulting physical and mental stress.

As mandatory medications For the treatment of dementia of any type, nootropic drugs are used that significantly improve cognitive abilities and have a restorative effect on memory. In addition, modern drug therapy often uses tranquilizers to relieve anxiety and fear.

Since the onset of the disease is associated with serious memory impairment, you can use some folk remedies. For example, blueberry juice has a positive effect on all processes related to memory. There are many herbs that have a calming and hypnotic effect.

Video: Cognitive training for people with dementia

Alzheimer's type dementia

This is perhaps the most common type of dementia today. It refers to organic dementia (a group of dementive syndromes that develop against the background of organic changes in the brain, such as cerebrovascular diseases, traumatic brain injuries, senile or syphilitic psychoses). In addition, this disease is quite closely intertwined with types of dementia with Lewy bodies (a syndrome in which the death of brain cells occurs due to Lewy bodies formed in neurons), having many common symptoms. Often even doctors confuse these pathologies.

Pathological process in the brain of a patient with Alzheimer's type dementia

The most significant factors provoking the development of dementia:

1. Old age (75-80 years);
2. Female;
3. Hereditary factor (presence of a blood relative suffering from Alzheimer's disease);
4. Arterial hypertension;
5. Diabetes;
6. Atherosclerosis;
7. Excess of lipids in plasma;
8. Obesity;
9. Diseases associated with chronic hypoxia.

The symptoms of Alzheimer's type dementia are generally identical to those of vascular and senile dementia. These are memory impairments; first, recent events are forgotten, and then facts from life in the distant past. As the disease progresses, emotional and volitional disturbances appear: conflict, grumpiness, egocentrism, suspicion (senile personality restructuring). Untidyness is also present among the many symptoms of dementia syndrome.

Then the patient develops delusions of “damage,” when he begins to blame others for stealing something from him or wanting to kill him, etc. The patient develops a craving for gluttony and vagrancy. At the severe stage, the patient is consumed by complete apathy, he practically does not walk, does not talk, does not feel thirst or hunger.

Since this dementia refers to total dementia, the treatment is complex, covering therapy accompanying pathologies. This type of dementia is classified as progressive, it leads to disability and then death of the patient. As a rule, no more than a decade passes from the onset of the disease to death.

Video: how to prevent the development of Alzheimer's disease?

Epileptic dementia

Enough rare disease, which usually occurs against the background of epilepsy or schizophrenia. For him, the typical picture is a paucity of interests; the patient cannot highlight the main essence or generalize something. Often, epileptic dementia in schizophrenia is characterized by excessive sweetness, the patient constantly expresses himself in diminutive words, vindictiveness, hypocrisy, vindictiveness and ostentatious fear of God appear.

Alcoholic dementia

This type of dementia syndrome is formed due to long-term alcohol-toxic effects on the brain (over 1.5-2 decades). In addition, factors such as liver lesions and disorders of the vascular system play an important role in the development mechanism. According to research, at the last stage of alcoholism the patient experiences pathological changes in areas of the brain that are atrophic in nature, which outwardly manifests itself as personality degradation. Alcoholic dementia may regress if complete failure sick from alcoholic drinks.

Frontotemporal dementia

This presenile dementia, often called Pick's disease, involves the presence of degenerative abnormalities affecting the temporal and frontal lobes brain In half of cases, frontotemporal dementia develops due to genetic factor. The onset of the disease is characterized by emotional and behavioral changes: passivity and isolation from society, silence and apathy, disregard for decency and sexual promiscuity, bulimia and urinary incontinence.

Drugs such as Memantine (Akatinol) have proven effective in the treatment of such dementia. Such patients live no more than ten years, dying from immobility or the parallel development of genitourinary and pulmonary infections.

Dementia in children

We looked at types of dementia that exclusively affect the adult population. But there are pathologies that develop mainly in children (Lafora disease, Niemann-Pick disease, etc.).

Childhood dementias are conventionally divided into:

• Progressive dementia – independently developing pathology, belonging to the category of genetically degenerative defects, vascular lesions and diseases of the central nervous system.
• Residual organic dementia - the development of which is caused by traumatic brain injury, meningitis, and drug poisoning.

Dementia in children may be a sign of a certain mental pathology, for example, schizophrenia or mental retardation. Symptoms appear early: the child suddenly loses the ability to remember anything, and his mental abilities decrease.

Therapy for childhood dementia is based on curing the disease that triggered the onset of dementia, as well as on the general course of the pathology. In any case, dementia is treated with medications that improve cerebral blood flow and cellular metabolism.

With any type of dementia, loved ones, relatives and household members should treat the patient with understanding. After all, it’s not his fault that he sometimes does inappropriate things, it’s the illness that does it. We ourselves should think about preventive measures so that the disease does not affect us in the future. To do this, you should move more, communicate, read, and engage in self-education. Walking before bed and leisure, refusal bad habits- this is the key to old age without dementia.

Video: dementia syndrome

Hello, my grandmother is 82 years old, all the signs of dementia are on her face, anxiety, she forgets that she ate after half an hour, she always tries to get up and walk somewhere, although her legs no longer obey her and she simply crawls out of bed, she can no longer take care of herself, Her son is with her for 24 hours, but her nerves also give in, because there is no peace, especially at night, she doesn’t let her sleep at all, she asks her to drink, then to go to the toilet, and so on all night. The medications prescribed by doctors are of no use, sedatives do not work. Can you recommend something that will help both her and us rest at least at night? Are there sedatives for such patients? I will be glad to hear your answer.

Hello! Dementia - serious condition, which cannot be treated, and most drugs actually turn out to be ineffective. We cannot recommend any medications over the Internet; it is better for you to contact a psychiatrist or neurologist for this. Perhaps the doctor will prescribe something stronger than what has already been prescribed, although there is still no guarantee that the grandmother will become calmer. Unfortunately, such patients are a difficult test for relatives, and medicine is often powerless, so you and your family can only have patience and courage in caring for your sick grandmother.

Hello. My mother-in-law, 63 years old, was diagnosed with atherosclerosis, stage II DEP. Previously, we lived more or less normally. Her husband argued with her because of her character traits, but this was not so often. Now it has become completely impossible to live with her. She drinks expired milk, hides jars of pickles next to her bed, they become moldy, she continues to eat them. The apartment is dirty. She almost never washes her bed linen; she puts her dirty clothes in clumps in a pile and doesn’t wash them. In her room there are moldy cans, smelly things smell of sweat and sourness. Instead of throwing away every broken thing, he keeps it, even pens worth 5-10 rubles without refills. Speaks for others. This is expressed in the words “Yes, he didn’t want to do this,” dragging food home that still has a day or two of expiration date. When we throw out expired soaps, creams, and perfumes into the trash, she pulls them out of the trash and takes them back to her room. Recently it got to the point where she takes the discarded milk out of the trash and puts it in the refrigerator. She cannot prepare food for herself. He lies in his room all day, does nothing and doesn’t want to. Complete apathy towards the world around you and towards yourself. She says that she feels bad and needs to go to the doctors. 1-2 days pass, and she already believes that there is no need to go to the doctors. He speaks for the doctor who made the diagnoses, that he said that there was nothing wrong with her. Although she has changes in the tissues of the liver and kidneys. When I talked to the doctor, he said that she was doing poorly. She eats what she shouldn't. Butter, bread, marinades and fermented milk, meat products, margarine, coffee, smokes. We tell her that this cannot be eaten, in response we hear: “well, I’m a little.” Without thinking about her actions, she collected credits for a huge amount. Constantly screams about the lack of money, although there is some. She constantly lies, day after day, says one thing, and literally an hour later she says that she didn’t say anything like that. If earlier she could hear movies on her laptop perfectly well, now movies and TV series are screaming throughout the entire apartment. He screams a little, periodically shows aggression and bulges his eyes. He cannot step on his feet normally in the morning and towards night. He oohs and ahhs and steps heavily on them. He takes a dish sponge and washes the floor with it. The entire apartment was recently washed with a rag that was covered in cat urine. And she denied the suffocating smell of urine! She doesn't smell anything at all, even when you put it right in her nose. Denies any facts! What to do? Can this person be deprived of legal capacity? Otherwise, we will have problems with her loans. Became secretive, goes somewhere. He says he’s going to work, but goes along a different road. The sick people themselves. My husband has meningococcemia, he has stage 1 DEP and SPA. I have a pituitary tumor. It's impossible to live like that. We have scandals all day long...

Hello! We sincerely sympathize with you; your family is in a very difficult situation. You describe quite typical behavior for patients with severe DEP; you probably yourself understand that the mother-in-law is not aware of her actions and words, because she is sick, and it is really very difficult with such a family member. You can try to recognize her as incompetent, contact a neurologist or psychiatrist, explain the situation. If the doctor writes an appropriate conclusion, then it will certainly be easier to avoid problems with loans, mother-in-law’s appeals to various authorities, etc., because such patients can be extremely active in their initiatives. Aggression, deceit, and sloppiness are symptoms that are very unpleasant and irritating to others, but nevertheless associated with the disease, and not with the mother-in-law’s desire to ruin your life. It is difficult to give advice on communicating with a sick person, not everyone has the nerves and patience, and if you break down and make trouble, then this is a completely natural phenomenon in the current situation. Unfortunately, encephalopathy of such severity is not treated or cured; the outcome, as a rule, is dementia. On the one hand, contact will become completely impossible, you will need care, like caring for a small child, on the other hand, your life will become easier to some extent, since the mother-in-law’s activity will gradually decrease and it will become easier to control the situation. Try to get the maximum from the doctor in order to somehow protect your family and mother-in-law from her inappropriate actions, and we wish you courage and patience.

Hello! Perhaps you should look not only for a competent neurologist or psychiatrist, but also for a lawyer, because a person who is potentially incapacitated due to mental health cannot account for his actions and, therefore, should not give consent to an examination, which should be carried out for medical reasons and with the consent of relatives. A neurologist, therapist or psychiatrist must prescribe drug therapy based on the underlying disease; a sick person cannot be left without treatment, which he is entitled to by law. We wish you a speedy resolution to this difficult situation.

Hello! Vascular dementia begins long before obvious symptoms negative symptoms with minor changes, you are absolutely right that the process began many years ago. Unfortunately, the first signs are non-specific and it can be problematic to distinguish them from the symptoms of other diseases and to distinguish them from many other age-related changes. On the other hand, it is not at all necessary that other family members will be affected by significant mental and behavioral changes, because everything is individual, depending on the character of the person and the degree of brain damage. Most older people have some form of vascular encephalopathy, but for many it is limited to a decrease in memory and intellectual performance, while the character and behavior remain quite adequate. Salvation from cerebral vascular damage is a healthy lifestyle, proper nutrition, and ensuring that the brain functions well into old age. It is no secret that solving crossword puzzles, solving interesting mathematical problems, reading books and other literature trains the brain, helps it adapt to conditions of imperfect blood flow and cope with the progression of age-related changes. And it is absolutely not necessary that a disease like your grandmother’s will overtake everyone else; you are too pessimistic. If other elderly family members already have signs of brain aging, then the listed measures plus taking vascular medications, vitamins, and regular doctor's examinations will help slow down the development of dementia. We wish your family health and patience in caring for your grandmother!

Good afternoon. It doesn't sound rude. It's hard for you. We have the same situation. Grandmother, the sweetest and kindest person, has turned into an aggressive and angry person (she fights, throws her fists and wants us all to die), we understand that this is not her fault, she did not ask for such a pain. But it is what it is. We get out of the situation in this way: my grandmother went to a neurologist for an appointment - she was prescribed antidepressants and once a month she went to a paid boarding house for a week. For us this is a week of rest. Close people of such people need to rest, because it is not uncommon for those caring for such patients to pass away (due to moral burnout and nervous stress) faster than the patients themselves. Strength and patience to you.

- this is one of those mental illnesses that manifests itself exclusively after 60 years, is expressed by various kinds of disorders, according to external signs very similar to endogenous mental illnesses, but it is worth noting the absence of senile dementia with this diagnosis.

In order for the disease to proceed without complications and the symptoms to be less pronounced, it is necessary to consult a specialist in a timely manner.

Causes

Lately, this disease has been discovered frequently, but in the vast majority of cases, a doctor is consulted already at acute stage. The manifestation is most often caused by somatic disorders, therefore they are defined as somatogenic psychoses of old age.

This can be influenced by the most various factors, for example, diseases of the respiratory tract, genitourinary or cardiovascular systems, as well as surgical interventions. In some cases, the reason may be poor nutrition, impaired vision or hearing. Diagnosing such a disease is not so easy, which is why treatment is not provided in a timely manner.

Symptoms depending on classification

In medicine, senile psychoses are divided into two forms: acute, which is characterized by clouding of consciousness, and chronic, which is fundamentally distinguished by hallucinations and a depressive state.

Acute form

The most common causes are: insufficient vitamins in the diet, hearing impairment, decreased vision, physical inactivity, as well as lack of sleep or upper respiratory tract disease. Most often, acute psychosis in older people is diagnosed when the situation is extremely advanced.

Such an exacerbation can be avoided in 9 out of 10 cases if you seek help in time. qualified help. Like any other disease, acute psychosis develops gradually and allows time for its detection.

In old age, problems cannot be ignored somatic nature, since in the future this can lead to a deterioration in their mental state and health. Acute psychosis always manifests itself unexpectedly and sharply, but, as a rule, it is preceded by a prodromal stage, which lasts for 1 to 3 days.

This period is determined by the following criteria:

• weakness;
• problems in self-care;
• violation of orientation in space;
• loss of appetite;
• sleep disturbance;

The end of such a period means only one thing - the onset of the stage of acute psychosis, which is expressed in increased motor activity, anxiety, concern, the need to do something or go somewhere, confusion of thinking, and unclear formulation of demands and requests.

The pathology is accompanied by the emergence of delusional thoughts, unreasonable aggression, and the belief that everyone around them wants to cause harm in one way or another.

Hallucinogenic phenomena may occur that are not sustainable. During this period, an exacerbation of those somatic disorders that had a key influence on the deterioration of the patient’s health is considered normal.

Acute psychosis manifests itself over 2-3 weeks, during which time a person’s behavior can be stable, without any significant changes, or it can be accompanied by regular exacerbations and outbursts, during the intervals between which the patient is in a deeply depressed and apathetic state.

Chronic form

This form of the disease can also be divided into several types, which differ in symptoms and types of manifestation.

The following symptoms are recognized as the main ones:

1. Depressive state . Older women are most susceptible to this disorder; it can begin with a mild form - apathy, lethargy, awareness of the futility of everything that is happening, a feeling of hopelessness. A more complex form of this disorder may result in increased anxiety, aggression, deepest depression, self-flagellation and not even long-term memory loss. According to statistics, depression lasts from 12 to 17 years.
2. Paranoid state- this is aggravated mental condition a person, accompanied by chronic delusions aimed at his own environment, in addition to this, the patient can be completely sure that everyone wants to cause him irreparable harm, get rid of him and even kill him, also anxiety and the desire to protect him from influence extends to things and property. This condition can last throughout life.
3. Hallucinosis is a type of psychotypical disorder in which mental clarity is maintained, but hallucinogenic phenomena, illusions, visions and sensations caused by various receptors occur. Such a manifestation can take the following forms.
   • verbal hallucinosis is that during an attack the patient does not hear existing voices, which in most cases carry a semantic load, they threaten or insult the patient. During such an attack, an elderly person becomes anxious, his motor activity and aggressiveness increase. The rest of the time, such vocal manifestations are perceived less critically;
   • visual hallucinosis is manifested by the appearance of planar hallucinations in the form of pictures, As the patient’s condition progresses, the pictures become more voluminous and colorful, closer to reality, and their number also increases.

     Most often, the patient adequately assesses the situation, understanding its unreality, but despite this, he can enter into dialogue with the characters of the hallucinations, and even perform some actions under the influence of the latter. The age of such patients is often close to 80 years;

     Changes in the psyche under the influence of anthropogenic factors are inevitable, but such critical deviations and disorders can cause inconvenience not only to others, but also to the patient himself, who can cause damage to his physical health.

     That is why, when identifying initial signs any form of disorder, it is necessary to immediately consult a doctor, even if it is forced on the patient.

     Treatment

     To diagnose an illness, it is necessary to observe the complete picture, consisting of a set of symptoms to differentiate the existing form of psychosis and disorder from other diagnoses with similar symptoms.

     After assessing the clinical picture and making a correct diagnosis, the doctor has the right to recommend hospitalization, which can only be carried out with the consent of the patient’s relatives.
     Treatment is carried out in this case, taking into account all the factors influencing the condition:

     • degree of neglect of the disease;
     • form;
     • cause;
     • a set of somatic disorders that have affected psychological condition person.

     In the treatment of depressive disorder, psychotropic drugs are prescribed, either individually or in combination. In other cases, they resort to medications such as haloperidol, Sonapax, triftazin and others.

     In addition, corrective medications may be prescribed.

     For each patient, the type of treatment is selected individually, taking into account the characteristics of the psychosomatic condition. Such courses should only be carried out under the supervision of a physician.

     Oddly enough, the acute form of the disease in question is considered more favorable for cure, since with a long course of the disease, drugs most often only relieve attacks and alleviate the patient’s suffering, but do not completely eliminate them.

     In this case, it is necessary to warn the patient’s relatives that attacks and exacerbations will recur regularly and teach them to live with this, to be tolerant of the current situation, because the elderly person is unable to influence his behavior.

     Forecast

     Experts give the most favorable prognosis for the acute form of the disease, since otherwise the development of a stable psychoorganic syndrome is observed. In the case of chronic forms of the disease, the most adaptive form of the paranoid state is considered, despite the manifestations of delirium. In other cases, the chance of recovery is minimal.

Senile psychosis (synonyms: senile dementia, senile psychosis, senile dementia, senile dementia, senile dementia) is the general name for cognitive disorders in the elderly, accompanied by the loss of skills acquired during life, a decrease in mental and intellectual activity, due to age-related atrophic damage brain parenchyma responsible for one or another type of human activity.

Regardless of the wide range of abilities and capabilities lost by a person, the basis of senile psychosis is always memory loss, which develops against the background of a genetic predisposition to this pathology. Atrophic foci in the brain are located in certain, localized areas, which causes different manifestation symptoms of some diseases that have similar symptoms to senile dementia, but manifest themselves in more early age: Pick's disease and. Based on this, the symptoms of senile psychosis and its treatment are often identified with these diseases.

Pick's disease

It occurs much less frequently than other brain diseases of atrophic etiology, but is characterized by a more malignant, progressive course, which relatively quickly leads to the complete disintegration of personality. One of the synonyms for the disease is “lobar sclerosis,” which is caused by atrophic destruction of the cerebral cortex in the area of ​​the frontal and temporal lobes.

Another characteristic sign of the disease is the age at which progressive changes are activated - 50-60 years, and subsequent life expectancy does not exceed 6, less often - 8 years.

The basis of the symptoms of Pick's disease are signs of senile dementia, disturbances in speech and logic of thinking, and signs of extrapyramidal disorders often appear - uncontrolled spontaneous movements of skeletal muscles. Patients are characterized by a rude attitude towards others, foul language, and a lack of ethical behavior in society.

Alzheimer's disease

The most common disease with symptoms of senile dementia, affecting the parietal, temporal lobes of the brain and the cingulate gyrus. Alzheimer's disease is discovered, on average, at the age of 65 years, but science knows of rare cases of earlier disease. The disease has a strong tendency towards population spread - by 2050, about 100 million people are expected to become ill in the world, although today there are no more than 30 million.

For initial symptoms diseases are characterized by individual differences associated with the characteristics of a person’s environment and his life experience. However, regardless of the specifics of the symptoms, they are united by a consistent disorder and loss of short-term memory, which loved ones mistakenly associate with temporary stress factors. More accurate behavior analysis, cognitive tests and magnetic resonance imaging (MRI) results can accurately diagnose a patient's Alzheimer's disease.

At subsequent stages of the disease, loss of long-term memory occurs, along with a decrease and subsequent loss of body functions, which leads to death, on average, 7-9 years after diagnosis.

Symptoms and course of senile psychosis

Senile dementia, as mentioned above, may represent a separate disease or be one of the symptoms or stages of other diseases that occur in an earlier age. age period. The disease occurs in patients 70-75 years of age and is caused by several forms:

• The simple form is characterized by a sharpening of the boundaries of individual character traits: thriftiness turns into greed, perseverance into stubbornness and harmfulness, accuracy into excessive scrupulosity and pedantry, pedagogical inclinations into despotism, and some, especially humane, traits can completely disappear from personal behavior. A radical change in personality traits to the opposite symbolizes a more severe course of a simple form of senile dementia.
  Patients are characterized by fixation on their own person, a tendency to egocentrism and callousness, overeating, excessive monitoring of their physiological needs, development of indifference to loved ones, lack of tact and similar changes.
  In addition, characteristic signs for a simple form of senile dementia are: rejection of everything new, irritation over trifles, turning into aggression and malice, childish capriciousness. Patients are often prone to wandering, chronic alcoholism, collecting garbage and absolutely useless things. There is often a delusion of material or financial damage on the part of people who are closest to the patient;
• The expanded form is characterized by the progression of amnestic phenomena in the field of not only short-term, but also universal memory, disorientation in space and time. Patients often forget the names of loved ones, their age and their own, and may confuse the family affiliation of a loved one. A feature of this form is a return to the past, when patients imagine themselves again in at a young age when they were planning to get married or were studying at an educational institution.
  Increased sleepiness in daytime and excessive activity at night combined with absurd behavior is one of the characteristic signs in this period of the disease;
• Final form. This form is characterized by a relatively rapid transformation from an expanded form, which can occur within a few weeks. The patient does not respond to stimuli, is immobilized and is in the grip of a complete marasmic state. Death occurs due to any concomitant diseases of vital organs and systems, due to the loss of their functions;
• Confabulatory form is an alternative course of senile psychosis during the initial or advanced forms. It is characterized by the predominance of confabulations - delusional inventions not related to reality, which find outlet in the patient’s activities. The genesis of the confabulatory form is due to the complication of dementia by atherosclerosis. The patient is characterized by excessive good nature, fantasy-intricate behavior and statements, emphatically correct speech and a persistent desire for meaningless activities.

Senile dementia must be differentiated from postoperative psychosis in the elderly and other types of dementia, where memory impairment occurs due to any external etiological factors.

It is worth noting that atrophic lesions nerve cells are an irreversible and stable process, therefore there are no cure methods for senile dementia. All medication and psychotherapy are aimed at supporting the patient and providing some relief from the symptoms of the disease.

Psychosocial intervention in the patient’s life makes some positive adjustments during the course of the disease:

• Behavioral intervention aims to focus the patient's attention on the incorrectness and illogicality of his behavior and possible complications as a result;
• Emotional intervention - treatment with memories and simulation of presence. Psychotherapy is based on the influence of positive subjective memories that evoke a positive mood in the patient, which helps reduce anxiety levels and stabilize behavior;
• Cognitive intervention is based on forced orientation of the patient in time and space, as well as stimulation of cognitive abilities - games that require mental load, solution theoretical problems and puzzles;
• Stimulating intervention with art therapy, listening to music, contact with pets.

Caring for patients with senile dementia, especially last stages course is very difficult work emotionally and physically, which is aggravated by the consistent loss of self-care skills in the patient. But, in spite of everything, it is necessary to create such a favorable emotional environment for the patient that will not provoke an increase in the symptoms of the disease.