Treatment of dementia in older people. Symptoms of senile dementia

What is dementia in older people

The life of older people is often complicated by the appearance of senile dementia, which in Latin means “senile dementia.” The disease affects the brain and causes a severe disorder of higher nervous activity. Symptoms of the disease are a sudden decrease in mental abilities, loss of accumulated knowledge and practical skills, which a person cannot restore again.

The clinical picture of dementia in older people depends on the initial state of the body, the causes of brain damage, the extent and localization of pathological processes. All cases of the disease are characterized by clearly manifested and persistent disorders of the intellectual and emotional spheres, which most often lead to complete collapse of the personality.

Today, according to the World Health Organization, the number of people with dementia in the world is approximately 47.5 million people. The future forecast does not bode well: the number of patients with this diagnosis is expected to increase to 75 million by 2030, and up to 135 million people will need treatment by 2050.

Statistics show that about 60% of cases of the disease are registered in countries with an average or low level of social development. In advanced countries, the leading place among the types of dementia is occupied by Alzheimer's disease, the second most common is vascular dementia.

Types of dementia in the elderly

Senile dementia is divided into three main groups:

1. Alzheimer's (or atrophic) type. The disease is triggered by degenerative processes in the nervous system.
2. Vascular type. In this case, first there are gross disturbances in the circulatory system of the brain, against the background of which dementia occurs as a secondary disease in older people.
3. Mixed type. It is based on both mechanisms of disease development.

Depending on the location of the organic defect, several types of dementia are distinguished in elderly people:

• cortical, when the lesion involves the cerebral hemispheres (characteristic primarily of Alzheimer's disease or Pick's disease);
• subcortical, in which the subcortical structures of the brain are the first to be destroyed, which is manifested by neurological symptoms (Parkinson's disease);
• cortical-subcortical, characterized by a mixed type of pathology;
• multifocal, when multiple lesions are observed in all parts of the brain, leading to various pronounced neurological symptoms.

Dementia can be lacunar or total. With the first, the structures responsible for human intellectual activity are first affected.

Short-term memory suffers the most, but older people retain a critical attitude towards their condition. Violations in the emotional-volitional sphere manifest themselves minimally: in the form of tearfulness, heightened sensitivity. An example of a lacunar type is the initial stage of Alzheimer's disease.

Total dementia has catastrophic consequences for older people in the form of complete disintegration of personality with gross changes in emotional and volitional activity, and impairment of the intellectual sphere. As the disease progresses, spiritual values ​​are completely lost, the range of life interests is narrowed to a minimum, the feeling of shame disappears, the patient is in a state of complete disadaptation to the social environment.

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Stroke and heart disease

A sick heart and thick blood = poor circulation, atherosclerosis (blockage of blood vessels with fatty plaques) and blood clots that can break off, end up in the brain and cause a stroke. Many people who experience it die, and many more suffer lifelong limitations in mobility, memory loss, and disability. The worst thing is that stroke has become 20-25 years younger: now both 20- and 30-year-old people are at risk of ending up in intensive care, whereas previously this problem was faced only after 55 years.

Causes of dementia in older people

Senile dementia occurs due to damage to the central nervous system. As a rule, it is caused by diseases, the course of which leads to degeneration and death of brain cells. Alzheimer's disease, Pick's disease, dementia with Lewy bodies are an independent process of destruction of the cerebral cortex. But often the disease in older people does not act as a primary independent ailment, but as a complication in the following conditions:

• cerebral atherosclerosis;
• hypertension;
• alcoholism;
• stroke;
• tumor formations of the central nervous system;
• infections (AIDS, meningitis, viral encephalitis);
• traumatic brain injuries.

Also, the causes of the disease in older people can be complications after hemodialysis, endocrine pathologies, severe liver or kidney failure, autoimmune diseases (systemic lupus erythematosus, multiple sclerosis).

Additional risk factors for the development of pathology are:

• lack of active intellectual activity throughout life;
• overweight;
• diabetes;
• Having relatives with dementia, especially if the disease was diagnosed before the age of 65.

Alzheimer's type dementia is much less common in men than in women.

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Alzheimer's disease

Alzheimer's disease is a dementia in the elderly that occurs as a type of selective dementia (lacunary). This is a variant of atrophic senile dementia, the symptoms and signs of which may begin before age 60, but the peak incidence occurs between 65 and 75 years. The risk of developing Alzheimer's disease is inherited. You can reduce them by starting from childhood to study foreign languages ​​and play music. The reason for the development of this type of senile dementia can be the impetus for the beginning:

• injuries
• or oxygen starvation of the brain
• poisoning with neurotoxins.

The development of the disease is based on biochemical disturbances in glucose metabolism, leading to the formation of plaques deposited in the brain, consisting of poorly soluble protein and contributing to the degeneration of nerve cells. The result is focal lesions of the cerebral cortex. The outcome of the disease can be total dementia.

Alzheimer's begins with memory impairment. At first, slight absent-mindedness or everyday forgetfulness do not attract attention. As a rule, loss of memory of recent events, which becomes a habit, begins to disturb. At the same time, early memories (for example, children's poems or events of youth) are remembered very clearly. Later they are erased too. An elderly person becomes unable to remember the necessary information at the right time.

New information is also poorly absorbed. Old people suffer from problems with orientation in space and time. Increasingly, questions arise about what date it is, day of the week and year, which give way to the fact that a person is unable to understand where he is and does not recognize himself in the reflection in the mirror. At the same time, visual, auditory, and tactile sensitivity are impaired. Acquaintances, relatives, and objects in familiar surroundings are not recognized. The late stages of senile dementia do not allow a person to perceive himself normally.

The practical sphere is also gradually disappearing. First, complex professional skills are lost. Then it’s time for self-service.

If at the beginning of the disease patients are more often animated and fussy, then over time their fussiness develops into motor stereotypes such as simple monotonous movements. Speech is also reduced (see aphasia).

Emotional disorders begin with egocentrism and dissatisfaction with oneself for the inability to cope with difficulties in professional activities and education. At the initial stages, patients are fully aware of their defect and try to fight it. At further stages, criticism decreases. At the same time, the patient’s interests are significantly narrowed, and the complexity of his judgments decreases. A person becomes simpler before our eyes, and then sinks, becoming at first overly distrustful and touchy, and then indifferent.

Features of drug treatment of dementia in older people

To date, there are no uniform standards for the treatment of dementia in older people. Drugs are prescribed individually, often by trial and error. The patient’s age is taken into account, the causes of mental regression (for example, Alzheimer’s disease), the presence of concomitant diseases are identified, and the neglect of the pathology as a whole is assessed.

Important! Unfortunately, dementia cannot be cured, nor can completely lost skills be restored. At the current stage of medical development, it is possible to slow down the progression of pathology and make it easier for relatives to care for the patient.

Drugs for the treatment of dementia in older people are divided into the following types:

• Antidepressants. Relieves concomitant depression and chronic pain.
• Anticoagulants and antiplatelet agents. Serve to prevent hemorrhages in the vessels of the brain, prevent the formation of blood clots and embolisms.
• Neuroprotectors. Improves nutrition of brain cells.
• Calcium antagonists, nootropics. Normalize cognitive functions.

Also, medications that normalize blood pressure are additionally used in treatment.

Elderly sick people are recommended not only to undergo drug treatment, but also to adhere to a healthy lifestyle - stop smoking, exclude pickles, marinades, and heavy foods from the diet. At an early stage, it is better to reduce emotional and physical stress.

Prescribed drugs for mild dementia

With a mild form of the disease, older people develop minor memory problems, they cannot always choose the right words in a conversation, and they become emotionally unstable. Depression may also develop. But personality changes are still insignificant; self-service skills are preserved.

The list of drugs is determined by the reasons that caused changes in brain tissue:

1. Medicines for the treatment of Alzheimer's disease.
   An example of a typical representative of the group is Rivastigmine. The drug serves to suppress the activity of the neurotransmitters acetylcholinesterase and butyrylcholinesterase. Thanks to taking the drug, cognitive functions improve in sick people during treatment - the active substance of the drug reduces the rate of degradation of acetylcholine.

   Taking the drug begins with a minimum volume (the dosage is selected individually), which is gradually increased until the therapeutic effect of the treatment is achieved. Capsules must be taken twice a day.

2. Neuroprotectors.

   Representative of the group of drugs is “Cortexin”. The main active ingredient is the amino acid glycine, which has an antioxidant effect; it regulates the processes of excitation and inhibition. Available in powder form, from which a solution for intramuscular injection is made.

   The therapeutic dose of the drug is administered once a day. Treatment can last up to 20 days; if necessary, a repeat course is prescribed after a month.

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3. Antidepressants or tranquilizers.

   For patients with mild dementia, such drugs are prescribed only for the treatment of pronounced symptoms of depression and sleep disorders. The best option is to take herbal-based sedatives.

4. For the treatment of impaired speech function - "Akatinol".

   The drug improves the transmission of nerve impulses, helps to activate the motor and mental functions of sick people. Available in tablet form.

   The dosage of the drug is selected individually. The volume is gradually increased in 7-day increments until the desired effect is achieved. Sick people in the initial stages of the disease are prescribed a small amount of drugs for treatment, but the patient must take them for life. As a rule, the list of drugs consists of one leading drug and a number of auxiliary drugs - based on glycine and vitamin complexes.

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Roots of the disease

Gerontophilia is a disease that manifests itself as excessive tenderness and warmth towards teachers, falling in love with your school teacher or a popular star. This is especially true for girls. The causes of gerontophilia may be the following:

1. Unsatisfactory relationship with mother or father.
2. Lack of attention in childhood and adolescence.
3. Unsuccessful or painful experiences of close relationships with peers.
4. Inability to build relationships with guys or girls, frequent breakups.
5. Low self-esteem and lack of self-confidence.

Medications for moderate dementia in older people

At this stage of the disease, older people lose skills in handling technology, and they cannot cope with opening doors or locks. Therefore, they require constant supervision from relatives. Hygienic self-care skills are still retained. At this stage, the following drugs are used to treat dementia in older people:

• Acetylcholinesterase inhibitors.

A representative of this group is Exelon, which is an analogue of Rivastigmine. This inexpensive drug is available in the form of a transdermal patch, which greatly facilitates patient care.

The dosage is prescribed individually. The used patch should be removed and only then a new one should be applied.

• NMDA receptor antagonist.

The representative of the group is Memantine. Available in tablet form.

When building a treatment strategy for sick people with moderate dementia, the doctor prescribes medications from two groups, for example, Exelon and Memantine. Additional medications include sleeping pills and sedatives.

If there is no visible improvement in the patient’s condition, treatment is stopped, and the doctor selects drugs that have a similar previous effect, but with other active substances.

Majori and Michael

There is a lot of talk about this couple online. The fact is that the guy is good enough for his partner, frankly speaking, to be his grandchildren. He is only 30, and his “girlfriend” is already over 90. Moreover, the guy is proud of his elderly girlfriend. He claims that he likes all the “charms” of a mature figure, which women most often try to hide. He is delighted with Majori’s wrinkles and, according to his own statement, likes her gray hair, although he calls it “platinum” or natural. According to the couple, they rarely go out, spending most of their time in bed. For those who have little faith in such sincerity of feelings, it seems that this is not a matter of love, but of the legacy that Majori will leave behind. However, she claims that she has no savings at all. In fairness, it is worth noting the fact that Michael has several older girlfriends. According to Majori, at first she was jealous of her boyfriend towards other women, but now she easily forgives him, because he returns to her every time and calls her the best.

The couple met 9 years ago in a bookstore. As the woman admitted, she divorced her husband 37 years ago and she really lacked male attention and care. Mike himself calls their relationship “very physical.”

What is used for severe dementia

The last stage of the disease is characterized by an extremely severe condition. Elderly people cannot perform even simple actions, control physiological needs, and become immobilized. Consciousness is destroyed, the person begins to delirium.

At this stage, active treatment is not carried out. The patient is prescribed psychotropic drugs to prevent senile delirium and the development of hallucinations. Symptomatic manifestations of concomitant diseases are eliminated, for which painkillers and antibiotics are used (in the presence of sepsis).

Other drugs to treat dementia in older people

In addition to the main drugs for the treatment of dementia in older people, additional drugs are also used. The choice of medications depends on what type of brain disorder the patient has.

1. Neuroleptics and vascular drugs.

The task of this group of antipsychotic drugs is to relieve psychosis, excessive agitation, and delirium. There is also a stimulating type of antipsychotics, which serve to eliminate the patient’s severe inhibition.

The medicine is prescribed by the doctor depending on how exactly senile dementia manifests itself in a particular patient. Typical representatives:

• "Eglonil";
• "Haloperidol";
• "Tizercin";
• "Fluanxol."

The drugs are available in both injection and tablet form. Treatment may cause side effects - drowsiness, lethargy.

2. Sedatives and sleeping pills.

Medicines in this group are used as adjuvant therapy - senile dementia is associated with sleep disturbances and the appearance of phobic disorders.

When the disease begins to progress, the following are used for treatment:

• "Phenazepam." Refers to emergency therapy, used to relieve psychosis. Continuous use is not recommended.
• "Phenibut." A drug that improves blood flow to the brain. Over time, while taking the medication, the patient's reaction rate increases, anxiety decreases, and sleep normalizes.
• "Sonapax". A complex medicine that has a sedative and hypnotic effect.

The dosage of these drugs in the treatment of dementia in older people should be selected strictly individually. It is not allowed to increase the prescribed dose and frequency of administration without permission.

3. Correctors of emotional disorders.

In order to improve the emotional state of sick elderly people, in addition to sedatives (Sonapax, Phenibut), antidepressants are prescribed:

• "Amitriptyline";
• "Miaser";
• "Fluoxetine."

The dosage of drugs for the treatment of elderly people is determined individually; the choice of such medications is solely the prerogative of the doctor. Medicines have a hypnotic and sedative effect.

4. For the treatment of psychotic disorders.

Irritability and psychosis, aggressive behavior, tendency to wander - all these conditions are manifestations of psychotic disorders. Treatment of sick people in this case must be carried out under the mandatory supervision of a doctor, who, if the medications are ineffective, will cancel them and prescribe new ones.

The drug of choice may be benzodiazepines, valproic acid salts, or Haloperidol.

Very often, relatives caring for elderly patients also experience depression. In this case, it is recommended to undergo psychotherapeutic treatment and take sedative medications.

5. Vitamins.

Vitamin complexes are a means of additional therapy. Elderly people with dementia are prescribed B vitamins - Neurovitan, Neurobion, Neovitam. These medications prevent aging and demyelination of nerve fibers and increase stress resistance.

In order to prevent strokes, immunomodulators and antioxidants - vitamins C and E - are prescribed.

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For girls

Of course, gerontophilia is a disease, but in this psychological disorder a certain symbiosis occurs. For a girl, a mature lover is the key to solving many problems. He is attentive, knows how to worry, surrounds her with care and affection, which he may have really lacked in childhood, and can take on some of the problems. In addition, a mature man is not selfish in terms of close relationships and pays more attention to his partner. In turn, a mature man is pleased by the attention of a young girl, it raises self-esteem and gives him confidence that he is not yet as old as his passport says. Another reason for gerontophilia in young girls may be caused by the fact that relationships with young people of the same age have failed over and over again for seemingly no apparent reason. The friends got married a long time ago, and the very fact of their marriage is perceived by the girl as proof of her imperfection, insolvency and failure. A mature partner is able to see charm even in the whims and quarrels of his young lover.