Mental disorders in old age. Diseases of the elderly: causes, signs and prevention

Aging is a natural physiological process that everyone faces sooner or later. This destructive process affects all body systems, gradually leading to a decrease in human performance. The aging of the nervous system leads to a decrease in mental flexibility, the ability to adapt to different conditions of life, and a slowdown in mental processes.

Against this background, personal psychological problems appear, which very often give rise to the development of mental illness. The most common mental illnesses in older people are hypochondria, depression and anxiety.

A bad mood accompanies many elderly people of respectable age. However, if such a state lasts not for a couple of hours, but for several weeks and becomes more persistent every day, these are the first signs of depression.

Depression reduces activity, causes a decline in vitality, decreased appetite, and sleep disturbances. With depression, an elderly person lies in bed most of the time, becomes silent, sad, and often cries.

Without appropriate treatment, depression creates a huge number of problems for both the patient and the people around him. Therefore, when the first symptoms appear, you should immediately consult a doctor. The doctor will prescribe the necessary course of rehabilitation, which will help to cope with the state of mind and prevent its development in the future.

In old age, many older people have a sense of impending disaster. Very often this feeling causes the development of neuroses accompanied by anxiety. People suffering from this disease become fussy, restless, afraid to be alone, constantly pestering those around them with their fears and concerns.

At critical moments, anxiety reaches a state of panic. Patients walk around the room, wring their hands, cry, cannot sleep. In this state, unpleasant sensations appear in the body (palpitations, trembling, abdominal cramps), which only aggravate the situation, causing new fears.

Anxiety disorders cannot be overcome by willpower or sedatives. Such a disease requires treatment by a specialist. To date, a huge number of different techniques have been developed that will help to forget about anxiety and fear forever.

The aging of the body is characterized by the gradual development of physical ailments and various painful sensations, which often becomes the basis for the development of hypochondria.

Hypochondria is characterized by an excessive fixation of a person on their bodily sensations, which can develop into a belief in the presence of a deadly disease.

Patients suffering from this ailment complain of twisting, burning, tightening of the body, of incessant pain that constantly bothers him. Such people spend a lot of time with doctors who do not find the cause of these sensations.

Therefore, patients with hypochondria often change doctors, spend a lot of money on expensive studies, which also do not bring results. Treating hypochondria is quite difficult, so it's best to start early. Self-medication will not help here, but will only aggravate the situation. Therefore, it is best to resort to the help of graduates.

One of the most complex and practically incurable mental illness is senile dementia or dementia. The most common forms of senile dementia are Alzheimer's disease and vascular dementia.

The main symptoms of the development of these diseases is a violation of higher mental functions and memory. Early signs of dementia are disorientation in time and space, a person becomes distracted, forgetful, forgets not only past events, but also current ones. Sometimes, memories from the distant past come to the fore, accompanied by hallucinations, delusions and depression. The progression of the disease in humans is inevitable and leads to worsening of symptoms.

Patients get lost on the street, forget their home address and phone number. In a more difficult situation, a sick person cannot give his name and date of birth, he does not recognize his relatives, he loses his writing and reading skills. Patients with dementia often fall into the past: they consider themselves children, they call their long-dead parents.

Mental disorders lead to impaired speech. First, the vocabulary becomes poorer, gradually the patient's statements lose all meaning, and then they are completely replaced by meaningless screams, lowing, etc.

In the later stages, people with dementia cannot exist without outside help. They cannot walk, hold a spoon, a fork. Such patients require increased attention and observation within 24 hours.

As already mentioned, dementia cannot be cured. But if you consult a doctor in time for appropriate treatment, you can significantly slow down the progression of the disease and improve the quality of life of the patient and the people around him.

The following diseases are more common in the elderly.

arterial hypertension - this is a stable increase in blood pressure above 140/90 mm Hg. Art. Genetic and environmental factors play a leading role in the development of arterial hypertension. External risk factors include: age over 55 years in men, age over 65 years in women, smoking, cholesterol level above 6.5 mmol / l, unfavorable family history of cardiovascular diseases, microalbuminuria (with concomitant diabetes), sensitivity disorder to glucose, obesity, high fibrinogen, inactive lifestyle, high ethnic, socio-economic, geographic risk.

In the elderly, arterial hypertension occurs more often as a result of atherosclerotic lesions of blood vessels (the aorta, coronary arteries, cerebral arteries are most often affected).

Atherosclerotic hypertension is distinguished - this is hypertension in elderly patients, in which predominantly systolic blood pressure rises, and diastolic blood pressure remains at a normal level, which leads to a large difference between systolic and diastolic pressure. An increase in systolic blood pressure with normal diastolic pressure is due to the presence of atherosclerosis in large arteries. When the aorta and arteries are affected by atherosclerosis, they become insufficiently elastic and to some extent lose their ability to stretch in systole and contract in diastole. Therefore, when measuring blood pressure, we record a large difference between systolic and diastolic pressure, for example, 190 and 70 mm Hg. Art.

In the classification of arterial hypertension, 111 degrees of increased blood pressure are distinguished.

I degree: blood pressure numbers 140-159/90-99 mm Hg. Art.

II degree: blood pressure numbers 160-179 / 100-109 mm Hg. Art.

III degree: blood pressure figures above 180/110 mm Hg. Art.

Clinic

With an increase in blood pressure, patients are worried about headache, dizziness, there may be tinnitus, flashing "flies" before the eyes. However, it should be noted that intense headache, accompanied by dizziness, nausea, tinnitus, is observed with a significant increase in blood pressure numbers and may be a manifestation of a hypertensive crisis. Also, patients may be disturbed by frequent palpitations (usually sinus tachycardia), various pains in the region of the heart.

In elderly patients with atherosclerotic hypertension, objective symptoms, such as headache, dizziness, are not detected. Basically, complaints occur with a significant increase in blood pressure numbers.

Often, elderly and senile patients do not experience unpleasant symptoms with a significant increase in blood pressure numbers, patients can feel good even with blood pressure of 200 and 110 mm Hg. Art. The diagnosis of arterial hypertension in such patients is often made upon accidental detection of high blood pressure (during a physical examination, hospitalization with another disease). Many of them believe that the absence of discomfort at high pressure indicates a benign course of the disease. This belief is fundamentally wrong. Such a latent (hidden) course of arterial hypertension leads to the fact that a person, without experiencing painful, painful symptoms, has no motivation to be examined and treated, as a result, antihypertensive therapy in such patients is started late or not carried out at all. It has now been proven that the risk of developing vascular accidents (myocardial infarction, acute cerebrovascular accident, thromboembolism) in such patients is much higher than in people with normal blood pressure.

Features of measuring blood pressure in elderly patients: in the elderly, there may be a pronounced thickening of the wall of the brachial artery due to the development of an atherosclerotic process in it. Therefore, it is necessary to create a higher level of pressure in the cuff to compress the sclerotic artery. As a result, there is a false overestimation of blood pressure numbers, the so-called pseudohypertension.

The phenomenon of pseudohypertension is detected by Osler's technique, for this, blood pressure on the brachial artery is measured by palpation and auscultation. If the difference is more than 15 mm Hg. Art., so the phenomenon of pseudohypertension is confirmed. True blood pressure in such patients can only be measured by an invasive method.

Orthostatic hypotension can also be observed in older people, so their blood pressure should be measured in the supine position.

Arterial hypertension needs constant treatment, regular medication. Patients with hypertension are primarily shown an active motor regime, rational nutrition, compliance with the regime of work and rest, control of body weight, refusal of alcohol, smoking. Salt consumption per day is no more than 4-6 g.

Various groups of drugs are used in the treatment of arterial hypertension, mainly ACE inhibitors (captopril, enalapril, prestarium, losinopril), diuretics (hypothiazid, furosemide, indapamide), beta-blockers (atenolol, anaprilin, egilok, concor), diuretics (furosemide, hypothiazide, indapamide), sedatives (valerian, passifit, afobazole). Often a combination of these groups of drugs is used. Arterial hypertension in elderly patients proceeds for a long time, but is more benign than hypertension at a young age.

angina pectoris is one of the most common forms of coronary heart disease. The main symptom is typical pain in angina pectoris - it is a pressing, squeezing pain behind the sternum that occurs with little physical exertion (walking 200-1000 m, depending on the functional class), stopping at rest or with sublingual administration of nitroglycerin after 3-5 minutes. This pain can radiate under the left shoulder blade, shoulder, jaw. Such coronary pain occurs when there is insufficient oxygen supply to the heart muscle, when the need for it is increased (for example, during physical exertion, emotional overstrain). An attack of angina can also occur when walking in cold windy weather or when drinking a cold drink. Usually the patient knows at what load an angina attack occurs: how far he can walk, which floor to climb. Such patients should always carry nitrate-containing drugs with them.

It should also be remembered about the so-called unstable angina, in which an attack of retrosternal pain can dramatically change its character: the distance that the patient can walk without pain will decrease, the previously effective nitroglycerin will cease to act, or its dose will have to be increased to stop the pain. The most dangerous thing is when the pain begins to appear at night. Unstable angina is always regarded as a pre-infarction condition, and such a patient needs immediate hospitalization in a hospital. With a pronounced pain syndrome, the patient must be given nitroglycerin under the tongue, you should not give the patient several tablets at once or give them continuously: you should give 1-2 tablets, wait 10-15 minutes, then another one, wait again 10-15 minutes, etc. d. Large doses of nitroglycerin can be given only by controlling blood pressure - it should not decrease.

Prolonged course of angina pectoris, inadequate treatment or its absence can subsequently lead to the development of heart failure, myocardial infarction.

It is necessary to know that not all pains in the region of the heart can be of angina pectoris origin. Often in elderly patients, there are widespread pains to the left of the sternum, which are constant, aching in nature, aggravated by certain movements. When probing along the ribs or spine, painful points can be identified. Such pains are characteristic of osteochondrosis, intercostal neuralgia, myositis. Sometimes they become aggravated against the background of colds. Such pain is well treated with non-steroidal anti-inflammatory drugs (eg, diclofenac, ibuprofen). Sometimes chest pains appear after a heavy meal, after the eater went to bed. Such pains may appear due to bloating (Remgelt's syndrome) and the associated tension of the diaphragm. Also, in the elderly, diaphragmatic hernia is quite common, when the esophageal opening of the diaphragm expands and, in a horizontal position, part of the stomach moves into the chest cavity. There are pains that pass in an upright position. Patients due to pain can sleep half-sitting.

In menopausal women, along with typical symptoms, such as a feeling of a flush of heat to the face, a feeling of goosebumps on the limbs, a feeling of anxiety, unmotivated attacks of trembling, various pains in the region of the heart can also occur. Usually they are not associated with physical activity, but on the contrary, they often occur at rest, they can disturb for quite a long time, they do not go away for hours. Valocordin, Corvalol, Valerian usually help relieve these pains, while taking nitroglycerin does not affect them in any way.

Treatment of angina pectoris mainly consists in taking a group of drugs such as nitrates. Nitrates include nitroglycerin, nitrosorbide, erinite. Taking these drugs can cause a severe headache, to reduce this unpleasant side effect, nitrates are taken together with validol. Also, cholesterol-lowering drugs are used for treatment - statins (these include Vasilip, Atorvastatin), drugs that reduce blood viscosity - anticoagulants (aspirin, thromboass, cardiomagnyl).

Heart failure- a pathological condition due to the weakness of the contractile activity of the heart and the lack of adequate blood circulation. Heart failure is usually a secondary condition complicating primary damage to the heart, blood vessels, or other organs. The causes of heart failure are the following diseases: ischemic heart disease, heart malformations, arterial hypertension, myocarditis, myocardial dystrophic changes, myocardiopathies, diffuse lung diseases.

In the initial stages of heart failure, the ability of the heart to relax is disturbed, diastolic dysfunction occurs, the left ventricular chamber fills less with blood, which leads to a decrease in the volume of blood expelled by the ventricle. However, at rest, the heart copes, the volume of blood compensates for the needs. During physical activity, when the heart rate increases, the total blood output decreases, and the body begins oxygen starvation, and the patient develops weakness, shortness of breath during any physical activity. Heart failure is characterized by a decrease in the tolerance of the patient's usual physical activity.

Distinguish between acute and chronic heart failure.

Acute left ventricular failure develops against the background of a load on the left ventricle (arterial hypertension, aortic defects, myocardial infarction can lead to this) and in the presence of a provoking factor, such as physical and emotional stress, infections.

Clinically, acute left ventricular failure manifests itself in the form of cardiac asthma or pulmonary edema.

cardiac asthma develops acutely, manifested by increasing shortness of breath, a feeling of lack of air, suffocation. In addition to these symptoms, a cough may appear with a discharge of light sputum at first, and then streaks of blood may appear in it. On auscultation in the lungs, hard breathing is heard, in the lower sections - moist fine bubbling rales. The patient sits in bed with his legs down - this position facilitates the patient's condition due to the unloading of the pulmonary circulation. In the absence of treatment and the progression of the disease, pulmonary edema may develop.

Pulmonary edema can develop not only with left ventricular failure, but also with pneumonia, the appearance of foreign bodies in the bronchi, a sharp decrease in atmospheric pressure. Pulmonary edema is an acute condition that requires emergency care, as the symptoms develop so rapidly that an unfavorable outcome can occur quite quickly. Suddenly, often at night, against the background of an attack of angina pectoris, the patient develops a sharp shortness of breath (up to suffocation), a dry cough appears, which is quickly replaced by a wet cough with a foamy, bloody sputum. The patient takes a forced semi-sitting or sitting position, lowering his legs, resting his hands on the bed, chair, auxiliary muscles participate in breathing. General excitement sets in, a feeling of fear of death appears. The skin becomes cyanotic. In the lungs, moist rales of various sizes are heard in all fields, the frequency of respiratory movements increases to 40-45 respiratory movements per minute.

The course of pulmonary edema is always severe, the prognosis is very serious. Even with a positive result during treatment, a relapse of the condition is always possible.

In the treatment of acute left ventricular failure, sublingual administration of nitroglycerin tablets 10 mg every 10 minutes is used, blood pressure control is mandatory, intravenous administration of narcotic painkillers (1-2 ml of 1% morphine), intravenous administration of diuretics (2.0-8.0 ml 1% solution of furosemide), intravenous administration of cardiac glycosides, it is preferable to introduce strophanthin or corglicon in small doses (0.25-0.5 ml of a 0.05% solution), combining them with potassium and magnesium preparations to improve metabolism in myocardium.

Chronic heart failure develops gradually, often its causes are arterial hypertension, coronary artery disease, aortic defects.

The clinic of chronic heart failure has three stages.

In stage I, general symptoms predominate: weakness, fatigue, increased shortness of breath, increased heart rate during physical activity. At times, acrocyanosis may appear. The size of the liver does not change. All these phenomena disappear on their own after the cessation of physical activity.

In stage II, all symptoms begin to occur already with less physical exertion: shortness of breath increases, tachycardia increases, a dry cough may appear. Local symptoms (acrocyanosis) appear, edema of the lower extremities is observed, which do not go away by morning, in the future edema may increase (up to the development of anasarca - the presence of fluid in all cavities: ascites, hydrothorax, hydropericardium). The liver increases in size, becomes dense. Moist fine bubbling rales are heard in the lungs. With decompensation of the condition, patients are in a forced position: they sit in bed with their legs down.

In stage III (final, dystrophic), against the background of a pronounced total congestive insufficiency, severe irreversible changes develop in the internal organs with a violation of their function and decompensation. Renal and liver failure develop.

Non-drug treatment consists in limiting physical activity, correcting water and electrolyte metabolism. Bed rest and restriction of fluid intake and sodium chloride are necessary. Daily diuresis should be taken into account, the patient should keep a diary of the amount of fluid drunk and excreted. Determining the volume of liquid drunk per day, it is necessary to take it into account in all the products taken by the patient.

With medical treatment it is necessary:

Treat the underlying disease that led to CHF (etiological therapy);

Strengthen the reduced contractile function of the left ventricle (cardiac glycosides);

Reduce the increased volume of circulating blood (diuretics, vasodilators);

Eliminate or reduce peripheral edema and congestion in internal organs (diuretics);

Lower blood pressure (ACE inhibitors);

Reduce heart rate (beta-blockers, cardiac glycosides, verapamil);

Improve metabolic processes in the myocardium, increasing its contractility (preparations of potassium, magnesium, riboxin).

Heart rhythm disorders

Among all rhythm disorders, especially often in old age, there are atrial fibrillation and complete blockade of the conduction system of the heart. These two rhythm disturbances are dangerous and can lead to severe complications, which in turn can lead to death. Atrial fibrillation can occur at any age, but its frequency increases with age, but the complete blockade of the conduction system of the heart is exclusively a disease of the elderly.

Atrial fibrillation- This is a frequent irregular activity of the atria. It occurs when electrical impulses emanating from the pacemaker in the right atrium begin to wander through the conduction system of the heart, add up or cancel each other out, and chaotic contractions of individual groups of atrial fibers occur at a frequency of 100-150 beats per minute. This pathology occurs more often with organic damage to the heart: cardiosclerosis, cardiomyopathy, heart defects, coronary heart disease. The occurrence of atrial fibrillation can also be when additional conducting bundles are detected (this is a congenital defect, usually recognized at a relatively young age).

With a complete blockade of the conduction system of the heart, the impulse from the atrium does not reach the ventricle. This leads to the fact that the atria contract in their own rhythm, and the ventricles in their own, much rarer than usual. At the same time, the heart ceases to respond by increasing contractions in response to demand (for example, during exercise).

Atrial fibrillation can be constant and paroxysmal.

The paroxysmal form is characterized by the fact that against the background of some provoking factor (such as: physical activity, emotional overstrain), an attack of frequent arrhythmic heartbeat occurs. At this moment, the patient subjectively feels a feeling of interruptions in the work of the heart, shortness of breath, weakness, sweating. Such an attack can pass both independently at rest, and when taking medications - in this case, the sinus rhythm is restored. Also, in some cases, you can try to eliminate the attack by pressing hard on the eyeballs or painfully massaging the supraclavicular region, quickly squatting the patient. Such techniques can have a positive effect on cardiac activity (up to the disappearance of arrhythmia).

The permanent form of arrhythmia is characterized by the presence of a constant arrhythmic heartbeat, sinus rhythm in this form is not restored. In this case, they ensure that the rhythm is not rapid - no more than 80-90 beats per minute. With a constant form of atrial fibrillation, the patient always feels interruptions in the work of the heart, shortness of breath during physical exertion. When examining the pulse, pulse waves of different content, non-rhythmic, are determined. If you compare the pulse rate and heart rate, you can identify the difference between them in the direction of increasing heart rate. This phenomenon is called "pulse deficiency" and determines the inefficiency of part of the heart contractions - the chambers of the heart do not have time to fill with blood, and an empty "pop" occurs, respectively, not all contractions are carried out to the peripheral vessels.

The long course of a constant form of atrial fibrillation leads to the progression of heart failure.

In the treatment of atrial fibrillation, cardiac glycosides are used: corglicon, digoxin; beta-blockers: atenolol, concor; cordarone isoptin, etatsizin.

With a complete blockade of the conducting pathways of the heart, blood pressure suddenly decreases, the heart rate slows down to 20-30 beats per minute, symptoms of heart failure increase. Patients with newly diagnosed complete heart block require mandatory hospitalization, since in this case the development of myocardial infarction can be missed. Currently, the treatment of this pathology consists in installing an artificial pacemaker to the patient, which, by generating electrical discharges, stimulates heart contractions through a wire inserted into the heart through a vein. An artificial pacemaker is sewn into the patient for 5-8 years. Such a patient should be away from areas with high magnetic fields (industrial transformers, high-voltage power lines, use of a radiotelephone and cellular communications, etc.), he can “interfere” with the reception of radio and television broadcasts if he is close to the antenna.

Chronical bronchitis is an inflammatory diffuse lesion of the bronchial tree. The cause of the development of bronchitis are viral and bacterial infections, exposure to toxic substances, smoking. Smokers are more likely to suffer from chronic bronchitis in the elderly.

Chronic bronchitis, like any chronic disease, occurs with periods of remission and exacerbation, which occurs more often in the cold season. During the period of exacerbation of the disease, the patient is concerned about cough (dry or with sputum), shortness of breath when walking, fever to subfebrile numbers, weakness, sweating. On auscultation, hard breathing, dry rales are heard in all fields of the lungs. The constant course of chronic bronchitis, the lack of adequate treatment, the presence of a constant irritating factor subsequently lead to the development of pulmonary emphysema, pneumosclerosis, and the development of cor pulmonale.

In treatment, irritating and provoking factors should first be excluded. The patient needs bed rest. The following groups of drugs are used: antibacterial drugs, expectorants (mucaltin, bromhexine), herbal decoctions (chest collection No. 3, 4), non-steroidal anti-inflammatory drugs (aspirin, ortafen, nise).

Often a long course of chronic bronchitis leads to the development of chronic obstructive pulmonary disease. The disease is characterized by the presence of shortness of breath, dry paroxysmal excruciating cough. After the discharge of sputum, the patient's condition improves, it becomes easier for him to breathe. Locally, acrocyanosis can be noted, often the color of the skin has an earthy tint, fingers in the form of drumsticks and nails in the form of watch glasses. Auscultatory in such patients are heard hard breathing, dry whistling rales in all fields, prolonged exhalation.

In the treatment of such patients, antibacterial drugs, expectorants, inhalations of berodual, salbutamol, and inhaled glucocorticosteroids are used. Often such patients are prescribed oral glucocorticosteroids.

Physical therapy, hardening, and physiotherapy play an important role in the treatment of respiratory diseases.

Elderly people should be protected from drafts, but the room in which the elderly patients are located should be well ventilated, and wet cleaning should be carried out regularly. Such patients should walk more often - it is necessary to be in the fresh air for 30-40 minutes daily.

Diabetes- a disease characterized by a violation of the absorption of blood glucose by cells, resulting in a progressive lesion of large and small vessels. Type I and II diabetes are distinguished; older people are characterized by type II diabetes mellitus. Type II diabetes mellitus occurs as a result of exposure to the body of many factors, among which are smoking, alcoholism, severe stress.

Patients with diabetes develop itching of the genital organs, thirst, they begin to consume a lot of fluids, and polydipsia also occurs (patients eat a lot), polyuria (patients excrete a lot of urine). However, in older patients, not all of these symptoms are pronounced. The exact diagnostic criteria for the development of diabetes in a patient are the detection of a high blood glucose level (above 6.0 mmol / l) in a biochemical blood test and in the study of a glycemic profile, as well as the presence of sugar in a general urinalysis.

In the treatment of diabetes mellitus, adherence to a diet that excludes sugar, foods containing carbohydrates is of great importance. Patients are advised to use sugar substitutes - saccharin and aspartame. Regular testing of blood glucose in the clinic or at home is necessary.

Patients are prescribed hypoglycemic drugs: glibenclamide, maninil. In severe cases, when the correction of blood sugar levels with hypoglycemic drugs is not possible, insulin administration is prescribed during operations.

The presence of diabetes in an elderly patient always complicates the course of coronary heart disease, arterial hypertension. Since small and large vessels are affected in diabetes mellitus, the sensitivity in such patients is reduced, and the clinic of many diseases is not so typical, more blurred. For example, myocardial infarction in such patients may occur with a less intense pain syndrome. This can lead to delayed medical care and death of the patient.

In diabetes mellitus, a hypoglycemic state can develop, which can lead to coma, and hyperglycemic coma.

With hypoglycemia, the patient has a feeling of anxiety, trembling throughout the body, a feeling of hunger. He is covered with cold sweat, weakness, confusion appear. In this state, the patient must be given a piece of sugar under the tongue, this will improve his well-being. In a hyperglycemic state, the level of glycemia is corrected by the careful administration of insulin under the control of a blood sugar test.

With a long course of diabetes mellitus, patients develop damage to the vessels of the lower extremities - diabetic angiopathy of the lower extremities. This disease initially leads to coldness of the feet and legs, a feeling of numbness of the extremities, pain occurs when walking, which disappears as soon as a person stops ("intermittent claudication"). In the future, the sensitivity of the skin of the lower extremities decreases, pains appear at rest, ulcers and necrosis occur on the legs and feet. If left untreated, ischemic damage to the lower limb ends with amputation of the leg.

The defeat of small vessels that feed the nerve endings leads to a loss of sensitivity of the skin of the legs, disturbances in its nutrition, and a "diabetic foot" develops. At the same time, the patient does not feel pain from small wounds, abrasions on the skin, which turn into long-term non-healing ulcers. In combination with lower limb ischemia or without them, "diabetic foot" can lead to amputation.

For the treatment of diabetic foot use plavika, vasoprostan.

Proper foot care is also essential. You should wash your feet every day with warm water and soap, wear warm cotton socks without an elastic band. Feet should be protected from hypothermia, wear comfortable, soft, loose shoes, carefully observe safety when cutting nails, entrust it to a partner or caregiver, treat nail beds with iodine solution. When scuffed, you need to use various creams.

Chronic pyelonephritis- non-specific infectious disease of the kidneys, affecting the renal parenchyma. The occurrence of the disease in old age is facilitated by the presence of urolithiasis, prostate adenoma, diabetes mellitus, and poor hygiene of the genital organs. The disease proceeds for a long time, with periods of remission and exacerbation. In the period of exacerbation, subfebrile temperature, dull aching pain in the lumbar region, frequent painful urination appear. In elderly patients, the disease can proceed without a pronounced temperature, sometimes there are changes in the psyche - anger, irritability.

In the treatment of pyelonephritis, antibacterial drugs, uroseptics, collections of renal herbs are used. Such patients should avoid hypothermia, observe personal hygiene.

Chronic renal failure occurs as a result of a long course of chronic diseases of the urinary system (pyelonephritis, glomerulonephritis, prostate adenoma), diabetes mellitus, hypertension, or as a result of aging of the body (sclerotic changes occur in the vessels of the kidneys).

This disease is characterized by the replacement of nephrons with connective tissue, as a result of which the kidneys can no longer function adequately, their functions progressively deteriorate.

At the onset of the disease, patients have weakness, polyuria, nocturia, and anemia may be detected. For a long time, the only symptom of chronic renal failure may be a persistent increase in blood pressure.

The disease is diagnosed in a biochemical blood test, which reveals an increased level of urea and creatinine, in a urine test, which reveals the presence of protein, a decrease in the relative density of urine.

If patients have arterial hypertension, diabetes mellitus without adequate treatment, an infectious process, chronic renal failure begins to progress quite quickly. Patients develop severe weakness, nausea, vomiting, unbearable skin itching, sleep is disturbed. There is a significant decrease in excreted urine, hyperhydration develops, anemia, azotemia, and hyperkalemia increase. Patients develop symptoms of heart failure: shortness of breath, tachycardia increase. Patients have a characteristic appearance: the skin is yellowish-pale in color, dry, with traces of scratching, pronounced edema. Further progression of the disease can lead to the development of uremic coma.

In the treatment of chronic renal failure, hemodialysis is used on the “artificial kidney” apparatus. However, this method of treatment is quite expensive, and elderly patients can hardly tolerate hemodialysis. Therefore, at present, for patients of elderly and senile age, methods of conservative treatment are most often used. First of all, it is necessary to treat those diseases that can lead to the development of chronic renal failure: arterial hypertension, diabetes mellitus, chronic pyelonephritis, prostate adenoma. Early detection of these diseases and their adequate treatment are very important. Such patients should be observed in the clinic at the place of residence, regularly undergo examinations to correct therapy.

To reduce the progression of renal failure, ACE inhibitors (enalapril, captopril, fosinopril), antiplatelet agents (Plavik), sorbents (enterosgel, polyphepan) are used. Also in the treatment used ketoanalogues of amino acids (ketosteril) up to 8-12 tablets per day, activated charcoal up to 10 g per day or enterodesis 5-10 g per day. It is important to follow a diet with restriction of salt and protein (reduced consumption of meat and fish), with a sufficient amount of liquid under the obligatory control of diuresis and carbohydrates. All this improves the quality of life of the patient, and often prolongs the life of the patient for several years.

Chronic cholecystitis is an inflammatory disease of the gallbladder wall. At the same time, the ability of the gallbladder to contract and secrete bile, which is necessary for normal digestion, is disrupted. As a result of this, stones can form in the lumen of the gallbladder - cholelithiasis. The reasons for the development of cholecystitis can be: bacterial infections, viruses, a toxic or allergic nature is possible, sometimes malnutrition.

The disease proceeds with periods of remission and exacerbation, is expressed by the presence of pain in the right hypochondrium after exercise, errors in the diet (the use of fried, salty, smoked), nausea, a feeling of bitterness in the mouth. When the bile ducts are blocked by a stone, sharp paroxysmal pains occur in the right hypochondrium, similar to hepatic colic, yellowness of the skin and mucous membranes may appear - in this case, surgical treatment is necessary.

In the treatment of uncomplicated cholecystitis, antibacterial drugs, antispasmodics, anticholinergic drugs are used. You should also follow a diet with the exception of alcohol, fried, fatty, salty, spicy foods.

BPH- Benign neoplasm of the prostate. It occurs in men over 50 years old, the disease is based on age-related changes in the hormonal background, resulting in the growth of prostate tissue with impaired bladder emptying.

Patients complain of frequent urination in small portions, urination at night, in the future, urinary incontinence may occur.

Previously, only surgical treatment of the disease was practiced. Currently, there are drugs that allow you to reduce the size of the prostate without surgery. Dalfaz, omnic are most widely used - these drugs reduce spasm of the urinary tract and in this way eliminate the main signs of the disease. When using them, there may be a decrease in blood pressure, so they are not recommended or taken in small doses with low blood pressure.

Deforming osteoarthritis- a group of diseases of the joints. It is caused by damage to the articular cartilage, its thinning, proliferation of bone tissue, pain in the affected joint. Factors contributing to the occurrence of deforming osteoarthritis in the elderly are obesity, occupational stress on the joint, and endocrine disorders.

The disease progresses gradually. Initially, patients experience rapid muscle fatigue and pain in the joints after exercise, a slight crunch in the joints during movement, and slight morning stiffness. With the progression of the disease, the symptoms become more pronounced, the restriction of movement in the joint increases, joint deformities, muscle atrophy appear. The joints of the spine, lower extremities, interphalangeal joints are most often affected. In the area of the distal interphalangeal joints, dense formations appear that deform the joint (Heberden's nodes), the joint increases in volume, takes a fusiform shape (Bouchard's nodes). When the spine is damaged, local pain with symptoms of radiculitis, stiffness appear.

In the treatment, therapeutic exercises, massage, diet for body weight correction are used. To stop the pain syndrome, non-steroidal anti-inflammatory drugs are used: nise, movalis, diclofenac. Kenalog and hydrocortisone are also injected into the joint.

Physiotherapy is widely used.

This group includes mental illnesses that develop in presenile (45–60 years) and senile (after 65 years) age, characteristic only of this period of life. According to modern classification, this period is also referred to as the age of reverse development or the second half of life.

It is generally accepted to divide mental illnesses characteristic only of this period of life into presenile and senile psychoses.

Such a classification is determined not only by age signs, but also by the characteristics of the clinical picture of the disease.

Presenile psychoses. Within the framework of presenile (presenile) psychoses, presenile, or involutional, melancholia, involutional paranoid and involutional dementia are distinguished.

Involutional melancholia is the most common clinical variant among involutionary psychoses, it develops mainly in women aged 45–60 years against the background of menopause.

The development of psychosis is preceded by a whole range of hazards - hormonal restructuring of the menopause, exacerbation or the appearance of somatic diseases, psychogenic factors. At the same time, age itself with a complex of psycho-traumatic experiences associated with impending old age also acts as a psychogenic traumatic circumstance. It is in this period that changes and breaking of the usual way of life occur - retirement, loss of former positions, loneliness due to the death of a spouse, the need to adapt to new living conditions. Along with this, additional psychogenic traumatizing circumstances are also important, often minor, but pathologically perceived by patients in this period of life. Therefore, they are called small psychogenies or conditionally pathological.

The development of the disease, as a rule, is immediately preceded by such minor psychogenies - family conflicts, moving to another apartment, to a family of children, etc.

The initial period is characterized by increased fatigue, depressed mood, anxiety over every minor everyday occasion, the expectation of all sorts of troubles. In patients, the mood constantly fluctuates with a predominance of low, with increasing anxiety. Anxiety, timid expectation of imminent misfortune are accompanied by complaints of vague fears, excitement, fears about one's health. Most patients have some hysterical manifestations.

As the disease progresses, the increase in anxiety-dreary affect is accompanied by excitation. At the height of psychosis, anxiety often reaches great strength, taking on the character of a melancholic rampage with suicidal tendencies and attempts.

Against the background of deep anguish and anxiety, delusional ideas of guilt, self-accusation and self-abasement, damage, ruin, and death develop. Patients are convinced of their global guilt before humanity. They expect a punishment that is exceptional in its severity and excruciating punishment, considering at the same time that they deserve it. They constantly blame themselves for the mistakes they allegedly made in the past, while recalling various minor episodes for which they should be severely punished. In many cases, patients have a variety of hypochondriacal disorders from complaints about their health to hypochondriacal delirium. They are sure that they are ill with syphilis and other serious diseases, consider themselves contagious, dangerous to others. In some cases, these complaints take on the character of hypochondriacal delusions of denial and enormity (they do not have a stomach, intestines, their brains are dried up, all internal organs atrophy and do not work).

Sometimes motor retardation predominates in the clinical picture, but motor excitation is more often noted - agitated depression.

Such an acute period lasts from several months to a year or more. Gradually, the anxious and dreary affect becomes less intense. All the symptoms seem to freeze and every year become less expressive and monotonous. However, the anxiety-depressive affect persists. The former content of delusional ideas remains unchanged. Motor excitation gradually turns into a simple and monotonous motor restlessness, fussiness.

The course of involutional melancholy usually takes on a long-term unfavorable character, dragging on for several years.

After the exit from psychosis, peculiar personality changes are usually determined, expressed in instability of mood, fatigue, easy onset of anxiety. Patients remain focused on the functioning of internal organs, alert in relationships with people. Occasionally, relapses occur.

Involutional paranoid. It first develops in presenile age, more often in women against the background of menopause. In the initial period, patients develop suspicion, alertness towards others, including relatives and friends. Crazy ideas of persecution, attitudes of jealousy, damage are gradually formed. Crazy ideas are united by a common content associated with experiences of material and moral damage. Delusions are built solely on the basis of the interpretation of real facts and are distinguished by seeming plausibility. Crazy ideas are exhausted by ordinary content and represent, as it were, an exaggerated and distorted reality, especially situational everyday relationships.

Patients are convinced that they are being robbed, spoiling things, “pulling threads out of the material”, flatmates and relatives are “intriguing”, “want to get rid of”, to get their own area, employees at work seek to compromise, take their place in order to “receive double salary”, spouses “cheat”, “plan to take possession of property”, “living space”, rivals “resort to various tricks”, “want to lime”. Delusions are characterized by monotony, small scale, “small scale”, patients getting stuck on the same ideas and facts, poor argumentation, directed against a narrow circle of people from their inner circle and determines the behavior of patients. They are trying in various ways to establish what products and in what quantity are stolen from them, for this they make special marks on dishes and places where food is stored. At the door of their apartment or room, they arrange various objects in a special way, attach threads to the lock, etc. in order to establish that in their absence someone enters their house. They review their things, while finding “minor damage”, monitor their spouses and neighbors.

The disease is characterized by a long-term monotonous course. In this case, the clinical picture remains unchanged. Patients maintain an even mood, activity. Despite the presence of delusions, the behavior remains outwardly ordered. In many cases, there is a tendency to dissimulate their delusional experiences. Their delusional interpretation of real events, ideas of damage often remain unknown to relatives, spouses, and neighbors who constantly communicate with them. At the same time, these patients retain adaptive capabilities. Being sick, they adapt well to life.

The course of the disease is long-term with sufficient preservation of intellectual-mnestic functions and relatively good physical condition. In the process of treatment, only some blanching of individual crazy ideas is noted along with the persistence and preservation of the tendency to delusional interpretation of specific facts in terms of delusions of material damage.

Presenile dementia, or presenile dementia, which occurs in presenile age as a result of atrophic processes in the brain. Various variants of presenile dementia, named after the authors who described them (Alzheimer's disease, Pick's disease, etc.), share common clinical signs. Characterized by a gradual, inconspicuous onset, increasing dementia and irreversibility of advancing disorders.

Alzheimer's and Pick's diseases are of the greatest practical importance.
In Alzheimer's disease, the average age of onset is 54–56 years, and its average duration, according to some authors, is 8–10 years. Women get sick significantly more often than men.
In typical cases, progressive dementia is characterized by early-onset memory impairment, orientation in space, while maintaining consciousness of one's mental failure.
A distinctive feature of developing dementia is the growing impairment of speech (up to its complete collapse), writing, as well as the progressive loss of habitual skills.

The developed epileptic seizures are quite often noted.

The prognosis in all cases is unfavorable. The course of the disease has an irreversible progressive character. Patients die at different times from the onset of the disease.

Pick's disease begins more often between the ages of 53 and 55 years, with the same frequency in men and women. The disease develops gradually with personality changes in the form of increasing lethargy, apathy, indifference.

In patients, emotional dullness, a decrease in mental activity, and a general impoverishment occur. Sometimes disinhibition of the lower drives, high spirits are revealed. At the same time, the higher forms of intellectual activity are weakening. The level of judgments, the productivity of thinking, and criticism are steadily declining. At the same time, memory and orientation, as well as formal knowledge and skills, remain relatively intact.

With the further development of dementia, there is a weakening of memory, the disintegration of speech, followed by its complete disappearance.

The prognosis is unfavorable. In the final stage, pronounced physical exhaustion occurs - cachexia, the phenomena of marasmus join. Death usually occurs as a result of infection.

Senile psychoses are mental illnesses that first occur in old age (after 65–70 years), characteristic only of this period of life; associated with pathological age-related changes in the body. The incidence among men and women, according to a number of authors, is approximately the same.

Within the framework of senile psychoses, senile dementia and senile psychoses proper are distinguished.
Senile dementia begins gradually with the mental changes inherent in aging.

In patients, former attachments to relatives and friends weaken and disappear, coarsening of the personality is revealed. There is a narrowing of the circle of interests. The main importance is the satisfaction of vital needs, care for physical well-being. At the same time, some are dominated by constant discontent, quarrelsomeness, captiousness, while others have complacency, high spirits, and carelessness.

Gradually, personality changes give way to gross intellectual disorders.

A progressive amnesia is revealed from later acquired and less firmly fixed to previously acquired and firmly learned. Memory disorders relate primarily to current events, as well as abstract concepts. Forgetting the present and the recent past, patients remember long past events. Subsequently, amnesia extends to earlier periods of life. Patients fill memory gaps with fictions - confabulations. At the same time, there is a dissociation between profound dementia and the preservation of some external habitual forms of behavior, for example, demeanor, as well as skills. Over time, patients become more and more passive, inert, inactive. However, in some cases, senseless fussiness is noted, which takes the so-called form of "travel fees", patients are striving somewhere, tying their things in a bundle, waiting for something.

In a number of cases, disinhibition of the lower drives is revealed - increased appetite, sexual excitability, usually there is a violation of the rhythm of sleep. Patients sleep from 2-4 to 20 hours. In the initial stage, cachexia occurs. Psychotic forms of senile dementia usually occur at the onset of the disease, delusions of damage, impoverishment, combined with delusions of poisoning and persecution, are more common than others. Crazy ideas are associated with a specific situation, are based on a painful interpretation of real circumstances and apply mainly to people in the immediate environment.

Sometimes delusional ideas are combined with hallucinations, more often visual ones, which are directly related to delusional ideas in their content. The duration of this condition ranges from 1 year to 4 years, sometimes more. With the growth of dementia, delirium breaks up. Perhaps a wave-like course of delusional psychoses.

Forensic psychiatric assessment. Patients with presenile psychosis can be dangerous to themselves and to others. In involutional melancholia, patients at the height of depression sometimes commit so-called extended suicides. Convinced of the inevitable death and torment that awaits them and their family members, especially children and grandchildren, the sick, before committing suicide, kill them for altruistic reasons in order to save them from the forthcoming torment.

Crazy ideas of persecution and jealousy in involutional paranoids determine the aggressive behavior of such patients, directed at imaginary pursuers and "robbers", as well as rivals.

Patients who have committed socially dangerous actions for painful reasons cannot be aware of the actual nature and social danger of their actions and manage them. In accordance with Art. 21 of the Criminal Code of the Russian Federation, they are not subject to criminal liability. The social danger of patients with involutional paranoids is due to the peculiarities of their delusional ideas, which are distinguished by the specificity of the content and are aimed at real people in the immediate environment. With involutional melancholy, the suicidal tendencies of patients are stable, as well as the possibility of their implementation as an extended suicide. These features of presenile psychoses must be taken into account when choosing the recommended medical measures in accordance with Art. 99 of the Criminal Code.

In forensic psychiatric practice, there are observations, especially among women, in which involutional melancholy is detected after the commission of the offense, when these patients first come to the attention of psychiatrists.

The main task of the examination in these cases is to establish the time of the onset of the disease - before or after the commission of a dangerous act.

To resolve expert issues, a clinical analysis of the condition of patients during their stay at the examination is necessary in comparison with objective data characterizing their behavior before committing a dangerous act. In some cases, this allows you to establish the onset of the disease before the commission of criminal acts. Patients are recognized as incapable of realizing the actual nature and social danger of their actions and directing them with all the ensuing consequences.

In other observations, involutional melancholy develops after the commission of criminal acts in a psychogenic traumatic situation - during the investigation, before or after the sentencing, or while serving a sentence. In these cases, patients are released from serving their sentence due to illness (Article 81 of the Criminal Code of the Russian Federation); various types of coercive medical measures are applied to them.

Forensic psychiatric examination in relation to patients with senile dementia and senile psychosis is assigned relatively rarely.

Some patients in the initial stages of senile dementia can be held criminally liable for sexual disinhibition, which determines the incorrect behavior of such patients (debauchery towards minors, etc.).

The delusional ideas of jealousy and persecution determine the pathological motivation for aggressive actions directed at imaginary rivals and enemies or spouses.

In such cases, just as in presenile psychosis, patients are recognized as incapable of realizing the actual nature and social danger of their actions. They are assigned compulsory medical measures.

When considering civil cases, a forensic psychiatric examination is usually assigned to patients with presenile and senile psychoses in connection with the execution of wills, deeds, transactions, claims for divorce, etc. These issues are set out in the chapter on examination in civil proceedings.

Depressive disorders in old age

At a later age, the most common type of disorder is depressive states. The essence of depression lies in the predominance of negative emotions (sadness, melancholy, sadness, anxiety), which determine the emotional background of the patient's mood.

Decreased mood can be associated with various symptoms: lethargy, anxiety, insomnia, refusal of food, ideas of self-blame, self-abasement, sinfulness. Depression can be expressed in varying degrees: from mild to severe forms, with despair and suicidal attempts. With depression, the somatic state changes: headaches, intestinal disorders (constipation), peripheral circulatory disorders (cold extremities), increased heart rate, upward fluctuations in blood pressure, dry skin, and weight loss occur. Often with depression, there is difficulty in tearing (longing with dry eyes).

There are several main depressive symptom complexes:

SH melancholic;
Ш anxious-depressive;
SH depressive - hypochondriacal.

With a melancholic syndrome, a depressed mood, a slow flow of thoughts, and motor retardation come to the fore. Anxiety and fear are not typical for this condition. The present is drawn in gloomy colors, everything seems dull, indistinct, "as if in a fog." Patients do not perceive colors so brightly, taste sensations worsen. The circle of interests narrows. Volitional violations are manifested in the impossibility of activity. The pace of thinking is slow. Patients talk about the weakening of memory, about their "mental dullness." Ideas of self-accusation are frequently expressed; patients analyze their lives, trying to find fault in the past.

Anxiety-depressive syndrome is characterized by fear, anxiety, apprehension. Patients are motor restless, do not find a place for themselves, rush about. The excited state of the patients is combined with the delirium of the death of relatives, property, country, the entire globe. Patients wring their hands, tear their hair and clothes on their heads.

Astheno-depressive syndrome is a combination of two syndromes: asthenic and depressive. It is characterized by an unsharply pronounced depressive background of mood, increased fatigue, rapid exhaustion, difficulty concentrating and concentrating.

Hypochondriacal depression is characterized by the appearance of thoughts about the presence of any serious illness, accompanied by corresponding sensations, which, with the most careful examination, cannot be explained by the pathology of the internal organs. Patients usually define their sensations as a feeling of burning, perforation, pressure, expansion.

Among the syndromes observed mainly at a later age, a special place, in terms of suicidal risk, is occupied by the syndrome of anxiety-delusional depression, which is characterized by ideas of self-blame, anxiety, inevitable punishment for committing a crime, tendencies and enormity. The main content of the syndrome consists of experiences caused by the inevitability of retribution and supported by the intense affect of anxiety and fear of the possibility of punishment at any moment. These ideas are often combined with ideas of a nihilistic nature, when patients claim that they have no internal organs, and at the height of their experiences, statements reach a climax: there is no body, all organs are dissolved.

At a later age, the likelihood of developing depressive disorders increases by 2-3 times, but some scientists argue that in older people, depression is determined only in 10-20% of cases, in other patients it remains unrecognized.

Consciousness and its disorders

Old people with mental disorders can be divided into two groups. Some patients quite clearly perceive everything that happens, they know where they are, who surrounds them. Other patients are completely unable to navigate the environment, they do not know where they are, or who is next to them. Often everything that happens around is perceived by old people in an extremely vague, indistinct form. This state of confusion is called confusion. Psychosis with confusion occurs in debilitated, somatically seriously ill people. The statements of patients in this state are fragmentary, the orientation is inaccurate, the severity of the condition gradually increases. The severity of the somatic condition is exacerbated by mental disorders, which ultimately leads to death.

Amentia (confusion of consciousness) is characterized by confusion, bewilderment, manifested in the inability to perceive the events as a whole, to capture individual fragments of the situation and link them into a single whole. A patient in a state of amentia is a person with "broken glasses", that is, everything is perceived piece by piece, separately. The patient's speech is incoherent, he pronounces a meaningless set of words that are often mundane. Chaotic motor excitation is noted, deep disorientation and depersonalization are observed. There is no memory of the amentia period. Amentia is observed in severe chronic somatic diseases of the brain. These states culminate in a course of psychoses with confusion. At a later age in patients with various mental disorders, the addition of any somatic disease dramatically changes the course of the underlying disease, causing clouding of consciousness up to amentia. At this age, if not enough intensive therapeutic and resuscitation measures are taken, these conditions are predictably hopeless.

The psychopathological picture of the oneiroid state does not reveal the richness of experiences, as in young or middle age, but appears in an erased fragmentary form. Oneiroid disorders are short-term, patients periodically freeze with a fixed gaze. The reduced nature of oneiroid disorders is also expressed in the limitation of the subjects of patients' experiences. Such old sick people present some difficulties in their care and therapy. At times they try to run away somewhere, they are impulsive, they are hardly kept by the medical staff or, conversely, with an expression of anxiety, fear on their faces, they can stagnate for a long time. After leaving this psychotic state, the memories of the experiences experienced by these patients are extremely scarce, often incoherent.

Presenile (presenile) dementias

This includes a group of diseases that occur as a result of atrophic processes in the cortical and subcortical structures of the brain in patients aged 45-50 years, leading to the development of involutional dementia. These are Pick's disease, Alzheimer's, Creutzfeldt-Jakob's disease, Huntington's chorea.

Pick's disease

This disease is characterized by progressive dementia due to atrophy of the frontal and temporal cortex. At the onset of the disease, personality changes are detected, which have different shades depending on the location of the atrophic process.

With damage to the outer surface of the frontal lobes, patients experience lethargy, apathy, narrowing of circles of interests, unexpected inadequate actions.

With atrophy in the orbital region of the cerebral cortex, disorders of the moral and ethical attitudes of the individual, disinhibition of drives against the background of euphoria and a decrease in a critical attitude towards one's behavior are more pronounced. Occasionally, patients have a perversion of drives in the form of kleptomania, pyromania, sexual deviations.

Gradually, patients develop speech disorders in the form of perseverations (multiple repetition of words, phrases), echolalia, and the disappearance of the ability to spontaneous statements. Disorders like amnesic aphasia appear and grow with the inability to characterize objects. The vocabulary decreases until the onset of mutism. Apraxia and agnosia occur. The mimicry of patients becomes meager, inexpressive, reaching a pronounced amimia. For 5-7 years of the course of Pick's disease, a picture of deep insanity develops.

Alzheimer's disease

The atrophic process in this disease predominates in the parietal and temporal regions of the cerebral cortex.

Manifestations of the disease usually begin with an increase in memory disorders, spatial disorientation, and apraxia. Such violations, while maintaining critical self-esteem, give rise to a feeling of confusion, bewilderment, and a decrease in mood in patients.

The disorder of written speech gradually increases up to alexia and agraphia. In oral speech, disorders like sensory aphasia appear. A person develops and intensifies manifestations of dysarthria, and speech gradually becomes more and more incomprehensible. There is a gradual loss of accumulated knowledge and skills, the collapse of mental operations.

Against this background, anxiety-depressive conditions, acute speech confusion, delusions, epileptiform seizures are sometimes observed. In the final stage, dementia is accompanied by disinhibition of primitive reflexes in the form of oral automatisms.

Creutzfeldt-Jakob disease

Degeneration of neurons in the cortex of the frontal, temporal lobes, cerebellum and subcortical nuclei. Dementia progresses extremely malignantly (up to 6 months) and is fatal. It is accompanied by dysarthria, myoclonus, extrapyramidal disorders and a sharp decrease in body weight.

Huntington's disease

Atrophic processes in this disease capture mainly the frontal lobes of the brain. At the beginning of the disease, hyperkinesis (chorea) appears, activity, initiative, the ability to plan and take consistent actions gradually decrease. Against the background of increasing intellectual insufficiency, there is a depressive background of mood with irritability, tearfulness, with suicidal tendencies. Dementia progresses relatively slowly.

Senile (senile dementia)

Mental disorders occur at the age of 65-70 due to atrophic processes in the neurons of the brain. This is facilitated by psychotraumatic situations, past infections, severe somatic diseases.

In the initial stage, the pace of mental processes gradually slows down, mental activity decreases, and personal changes slowly progress. Character traits are sharpened, rejection of everything new is growing, pronounced conservatism is noted. Patients begin to praise the past and constantly return to it in their memories. They become irritable, grouchy, prone to constant teaching, self-centered, stubborn and touchy. Emotional attachments to loved ones and the ability to empathize weaken, while weak-heartedness increases, the range of emotional reactions decreases.

In patients, dominance, categoricalness, pettiness, suspicion, distrust and stinginess are sharpened. Reduced ethical skills and tactful actions of patients. There is cynicism and eroticism with a penchant for pedophilia.

In parallel with the growth of personality changes, memory defects arise and become more severe. At first, patients find it difficult to reproduce names, dates, terminology, then they hardly recall recent facts, gradually forgetting more and more distant events. Fixation amnesia develops with confabulations.

In the stage of dementia, a decrease in intellectual activity is detected and progresses. Many skills acquired in the process of life are lost. There is an amnestic disorientation in time and space, a false recognition of living and deceased relatives in those around them. Patients cease to recognize themselves in the mirror, taking the reflection for an outsider. There is a phenomenon of "life in the past", in which old people, considering themselves young, build relationships with others, using a distorted plot of the events of their own youth. At the same time, they are businesslike, fussy and inadequately active. Agnosia, aphasia and apraxia, focal neurological symptoms, sleep disturbance and cachexia gradually increase.

Against the background of deepening dementia, productive psychopathological symptoms may appear in patients: delusions of damage, persecution, robbery occur. Often joining confabulations create a picture of a fantastic delirium (senile paraphrenia).

In the first place in the clinical picture, affective disorders in the form of a depressive syndrome with ridiculous hypochondriacal delusions, ideas of self-blame and Kotard's delirium can also come out.

In the presence of productive psychopathological symptoms, dementia usually grows more slowly than in its absence. The stage of physical and mental insanity completes the development of senile psychosis. Patients lose all skills, voracious, untidy in bed. Most of the time they lie in a fetal position: the legs are sharply bent at the knee and hip joints, the arms are crossed on the chest. Speech is almost completely absent. At this stage, patients often develop bedsores, sepsis, pneumonia, and they can die from the attached infection.

Pathological and anatomical studies in senile psychoses reveal a general atrophy of the brain, a decrease in its mass, expansion of the ventricles and swelling of the pia mater. Microscopically revealed "senile drusen".

Confusion (delirium).

Confusion is the most important (along with dementia) syndrome of cognitive impairment in old age. As we age, confusion more and more crowds out other potentially reversible mental disorders (depression Delusions), and in people 85-90 years old, it is almost the only kind of this kind of disorder. Confusion is a condition, the development of which is most directly related to the aging process not only of the brain, but also of other organs and the organism as a whole. It can occur both in diseases of the brain initiated by aging, and in many extracerebral diseases that develop in old age. Therefore, being in its essence a psychopathological phenomenon, confusion at the same time, as we age, more and more acquires the character of a universal clinical symptom, which can be a manifestation of almost any disease observed in an old person. At the same time, confusion is a kind of "urgent" syndrome, the appearance of which may indicate the presence of a rather severe pathology that requires immediate treatment.

The clinical picture of confusion consists of the following acutely developing (from several minutes to several hours) signs:

disturbance of consciousness in the form of stupefaction of varying severity;
Attention disorders
Disorientation in time and place
memory impairment;
Disorders of understanding of the situation and their condition;
psychomotor and speech disorders;
Disruption of the sleep-wake cycle
Emotional, illusory - hallucinatory and delusional disorders.

It is customary to distinguish between two main types of confusion - hyperactive and hypoactive.

The hyperactive type is characterized by a predominance of general and verbal arousal with anxiety, fear, hallucinations, and delirium. There are intervals during which patients can have adequate behavior and even adequately serve themselves. This usually prognostically favorable type of confusion is more common in relatively young people. The hypoactive type proceeds with a predominance of spontaneity, with silence or episodes of incomprehensible quiet and quickly fading speech (up to mutism), and severe exhaustion. Patients have significantly reduced appetite, they do not control pelvic functions. This kind of confusion is prognostically less favorable and, in its extreme degree, essentially represents the so-called terminal (death) delirium. The older the person, the more likely it is to develop a hypoactive type of confusion.

Confusion in patients with dementia is modified in the direction of strengthening and greater persistence of signs of cognitive disorders proper, such as disorientation, impaired memory, attention, comprehension and speech, as well as regression of behavior (loss of self-service skills). Based on EEG and PET studies, it can be concluded that confusion is a clinical manifestation of reversible (unlike dementia) diffuse cerebral dysfunction with a predominant interest of cortical neurons. The most important prerequisite for the development of such a dysfunction is undoubtedly the limitation of the functional capabilities of the brain as an integral organ that arises and increases with aging. It occurs both as a result of structural regressive changes in the brain tissue, and due to the progressive deficiency of mediator systems associated with these changes. All these negative phenomena lead to the fact that in old age the threshold of sensitivity of the brain to the influence of various external and internal factors, which cause an acute disorder of the higher integrative function of the brain, clinically manifesting by the symptoms of confusion, steadily decreases.

The aging process is accompanied by changes in the human psyche. In the article, we will consider senile mental illnesses, learn how to prevent the appearance of deviations in the elderly using folk methods. Let's get acquainted with preventive methods that preserve clarity of mind and sobriety of memory.

Body aging

Such a physiological process is not a disease or a sentence. It is accompanied by changes in the human body. It makes no sense to label the age at which such changes occur, because the body of each person is individual and perceives everything that happens to him in his own way. Many manage to maintain clarity of mind, good memory and physical activity until the end of their days.

Violation in the psyche provokes retirement, the death of loved ones and acquaintances, a feeling of abandonment and insolvency, and illness. This and much more changes life stereotypes, provokes the emergence of chronic depression, which leads to more serious diseases.

Deviations in old age are difficult to characterize, because the mental state of a person depends on many factors. The occurrence of the disorder is provoked by negative thoughts, constant stress and anxiety. Prolonged stress affects the emotional and physical state of a person. The nervous system becomes vulnerable, hence neuroses and deviations.

Diseases of old age

Age-related changes are often accompanied by chronic diseases. Over the years, they become aggravated, gradually undermining health, affecting the mental state of a person. It is becoming increasingly difficult to resist external circumstances. Older people react more painfully to unforeseen situations.

Common diseases of old age:

Damage to blood vessels leads to atherosclerosis.
Psychosis and depression are frequent companions of the elderly.
Alzheimer's and Parkinson's diseases.
Dementia or dementia.
The loss of calcium provokes the appearance of osteoporosis.
Diuresis is a disease that provokes urinary incontinence, frequent urges.
epileptic seizures.

Changes in the brain of the elderly

According to scientists, old age is a disease that can be treated. Most diseases appear in the human body at a young age. Brain aging provokes the awakening of chronic diseases and the emergence of new ailments.

senile depression

Causes of depression in old age:

Unresolved issues.
genetic predisposition.
Changes in the neurological and hormonal sphere.
response to negative events.
Side effect of taking medications.
Bad habits.

Symptoms are: depression, bad mood, accompanied by tears and negative thoughts, loss of appetite, sleep disturbance, and so on. In some cases, depression causes dementia, accompanied by apathy, poor memory, confusion of thoughts, disruption of physiological processes.

If depression does not go away within 2 weeks, seek help from a specialist. Modern medicine offers a wide range of drugs for the treatment of depression at any age. Start treatment in a timely manner, this will increase the chances of recovery.

Women are more prone to mental illness than men.

Dementia

Dementia includes senile destruction of the psyche. Older people deny the presence of mental disorders. Even relatives are in no hurry to realize the problem, justifying the illogical behavior of a close elderly person with advanced age. People are mistaken when they say that insanity is a manifestation of character.

Causes of dementia:
Senile dementia occurs as a result of age-related changes.
Bad habits.
Game addiction.
The use of carbohydrates in large quantities.
Lack of useful elements in the body.
Thyroid disorders.

False dementia is treatable, while true dementia leading to Alzheimer's disease requires specialist supervision and constant monitoring of the patient's behavior.

Paranoia

Psychosis, accompanied by unthinkable ideas. An elderly person with such a diagnosis suffers himself and involuntarily makes others suffer. The paranoid is suspicious, irritable, prone to exaggeration, does not trust close people, accuses them of all sins.

Only a psychotherapist will make the correct diagnosis and prescribe the appropriate treatment.

Parkinson's disease

This is a disease of the brain, manifested by impaired coordination of movements, trembling of the hands, chin, legs, stiffness, slow action, and a frozen look.

Unreasonable fear, insomnia, confusion, reduced intellectual function appear.

Causes of Parkinson's disease:

body aging;
genetic predisposition,
bad ecology,
lack of vitamin D
oncological diseases.

Early diagnosis allows you to remain active for a long time, to remain a professionally active person. Ignoring the disease leads to its progression.

The disease is also called "trembling paralysis", it often manifests itself in people over 70 years old.

Alzheimer's disease

Symptoms of the disease of the central nervous system are extensive. It flows differently for everyone. The loss of short-term memory, ill-considered actions, mental disorders are alarming, gradually a person becomes helpless.

At the last stage, the patient completely relies on the help of others, he is not able to take care of himself on his own. His health noticeably worsens, hallucinations appear, memory loss, inability to move independently, and in some cases convulsions.

Factors affecting the development of the disease:

Improper diet, consumption of alcoholic beverages, sausages.
Passion for salt, white sugar, flour products.
Low brain and physical activity.
Low level of education.
Lack of oxygen.
Obesity.
Incomplete sleep.

The disease is considered incurable, although there are drugs that improve the patient's condition, albeit not for long. Recently, more and more older people are faced with such a diagnosis.

Treatment of the psyche with folk remedies

Alternative methods are effective only in combination with therapy prescribed by a doctor.

The use of herbal preparations is advisable in the initial stages of the development of senile psychoses.

Fighting senile insomnia

Ingredients:

Dry leaves and flowers of hawthorn - 2 tablespoons.
Water - 500 ml.

How to cook: Pour boiling water over dry grass, leave to infuse for 2 hours. Strain.

How to use: Take 3 times a day, 50 ml.

Result: Soothes, relieves senile neurosis, promotes sound sleep.

For senile dementia

Ingredients:

Nettle - 200 g.
Cognac - 500 ml.

How to cook: Fill the nettle with cognac. Leave for a day. Remove for 5 days in a dark place.

How to use: Take the tincture twice a day before meals, a teaspoonful.

Recipe: Prevention of mental disorders.

With aggressive behavior

Ingredients:

Melissa.
Motherwort.
Blueberry leaves.
Chamomile.
Mint.
Water - 700 ml.

How to cook: Take herbs, 10 g each, pour boiling water.

How to use: Cooled infusion (200 ml) take before bedtime.

Result: Soothes, restores clarity to thoughts.

Regular consumption of walnuts, dried fruits, buckwheat and sauerkraut improves memory. The development of dementia can be prevented by solving crossword puzzles, leading an active lifestyle, monitoring nutrition, and resisting a depressive mood.

Proper nutrition and adequate sleep

Omega-3 acids have a positive effect on the structure of the brain. They are found in:

asparagus,
fish oil,
red caviar,
olive oil,
broccoli.

Include fish in your diet, which improves brain activity and slows down the development of dementia.

You need to go to bed before 11 pm. Sleep duration should be 8 hours. During this time, the brain will rest, restore energy potential. The sleep hormone is called melatonin. You can fill its deficiency with meat and dairy products, eggs, poultry, buckwheat, bananas, walnuts, B vitamins.

Physical activity and mental work

Sport improves brain function and protects it from aging. Jogging, brisk walking, dancing, roller skating, cycling and other types of cardio are considered effective.

Constantly develop, read books every day, learn a new language. Studies have shown that memory does not fail people who read and write a lot by hand. This will preserve the functions of brain activity, but is not a panacea for developing pathologies.

Busy is the best medicine

It is much easier to cope with mental illness if you accept your age and the changes that accompany it. This will help a real assessment of behavior and attitude. Optimism will keep your composure and peace of mind. The wisdom accumulated over the years of life will solve any problems.