Dementia - all about the types and forms of the disease

Dementia in women is more often associated with age, brain damage from tumors and injuries, rather than with alcohol and drug addiction. The condition is difficult to diagnose due to its similarity to the symptoms of various diseases. Many discover forgetfulness, the inability to distinguish between faces and events at a young age, and fear that this is irreversible dementia. But you shouldn’t get carried away with self-diagnosis, especially since the diagnosis is made only after a complete neurological and psychiatric examination.

Causes of dementia in women

What is dementia? It's not just dementia or memory loss. It is a complex process of cognitive degeneration. It can only be reversible if caused by injury or tumor. In other cases, a gradual decline in human consciousness occurs.

In women, there are general and hormonal causes. Common causes of dementia include:

1. Degeneration of the frontal, temporal regions of the brain, or hippocampus;
2. Toxic damage to the central nervous system due to alcohol or drug abuse;
3. Alzheimer's disease;
4. Brain damage by parasites.

A special case is that dementia is caused by a sharp change in hormonal levels during early menopause, caused by toxic damage to the body. False dementia is more common in women.

Women under 50 may experience a condition where extreme fatigue causes forgetfulness, loss of orientation in space, short-term mood swings, apathy, depression and reluctance to take care of oneself. The patient simply locks herself at home and does not pay attention to the world around her. This condition is clinical depression, and is caused not by disruption of the brain lobes, but by changes in hormonal levels due to fatigue. The condition is described in fiction. A classic example is Sue Townsend's book "The Woman Who Laid Bed for a Year"

“False dementia” is a diagnosis invented by journalists. In fact, it could be a mental disorder, depression, or the first signs of tumor growth. When such signs appear, the examination begins with a neurologist or endocrinologist, and continues, depending on the results.

Comparative characteristics of the main types of dementia

Difficulties often arise in the differential diagnosis of the type and cause of the disease. This is due not only to the variety of clinical forms, but also to the possible appearance of uncharacteristic symptoms. Particular diagnostic difficulties are caused by types of dementia that occur against the background of certain degenerative diseases of the nervous system: Pick's disease, Huntington's disease or Creutzfeldt-Jakob disease. Doctors are not alert to these diseases, so they are detected in late stages.

Dementia due to Alzheimer's disease

Dementia syndrome due to Alzheimer's disease is the most common type of acquired dementia. The statistics for dementia of the Alzheimer's type are disappointing - about 45 million people live on the planet, of which 97% die within 10 years of diagnosis.

The classification of dementia and its clinical manifestations depend on the age when the first symptoms of the disease began: early or late onset of the disease is distinguished (presenile and senile type, respectively). A mixed form is considered separately, which combines features of the vascular and Alzheimer's type.

Alzheimer's types of dementia, their characteristics and distinctive features

Criterion	Presenile type	Senile type
Onset of the disease	50-65 years	70 years and older
Hereditary burden	Genetic mutations are traced in the genes responsible for the formation of proteins: APP, presenilin 1 and 2	Absent
The degree of impairment of higher brain functions (attention, memory, thinking, etc.)	Sharply expressed	Moderate
Rate of progression	Fast	Slow
Forecast	Adverse	Relatively favorable

Another distinctive feature in the mechanism of development of the early type is the rapid formation of protein deposits in the brain in the form of plaques. This is due to genetic mutations in the synthesis of protein molecules: in early dementia, protein synthesis occurs faster.

Other forms of dementia

Dementia syndrome in Pick's disease has a malignant course. The patient's death occurs 5-7 years from the moment of diagnosis. Unlike Alzheimer's type, this form of dementia occurs in people 45-60 years old. What comes to the fore in the clinical picture is not a change in memory or thinking, but severe disturbances in behavior, emotions and the total degradation of a person as an individual.

Dementia syndrome in Creutzfeldt-Jakob disease is characterized by very rapid progression. Mild dementia becomes severe within 1-2 years. The disease differs from other types in the combination of cognitive and mental disorders with neurological symptoms (epileptic seizures, paralysis of various muscle groups, early speech disorders, etc.).

Acquired dementia in Huntington's disease begins in adulthood (35-45 years) and progresses very slowly. From the moment of diagnosis to pronounced clinical manifestations, 12-17 years pass. Unlike other types, this form is characterized by relative preservation of memory even in later stages. In the early phase, various types of behavior disorders predominate (depression, apathy, lack of self-criticism) and rapid erratic muscle movements that appear against the will of the person (chorea).

Vascular dementia

The second most common is vascular dementia; statistics in Russia have an unfavorable upward trend and account for 17-21% of the total number of patients with dementia. It predominantly occurs between the ages of 68-80 years.

Types of vascular dementia depending on the cause:

• occurring with atherosclerosis of the cerebral arteries (brain vessels);
• appeared after an acute cerebrovascular accident (ischemic-vascular form) - frequent transient ischemic attacks, hemorrhagic or ischemic form of stroke, complicated hypertensive crisis;
• arising against the background of arterial hypertension.

Ischemic-vascular types of organic dementia usually begin acutely, which is the main diagnostic criterion. Most often, cognitive and mental disorders develop suddenly after a series of ischemic episodes (for example, several strokes or a history of complicated hypertensive crises). The deterioration of the condition is not gradual, but wave-like or spasmodic: episodes of exacerbation alternate with the patient’s relatively stable condition.

Important! The diagnosis of “dementia of vascular origin” is formulated only after laboratory and instrumental confirmation of the disease that caused its development.

All types of senile dementia against the background of atherosclerosis and hypertension are characterized by slow and smooth development. In this case, dementia is a severe form of vascular disease, because in the early stages neither atherosclerosis nor hypertension lead to memory or thinking disorders. At first, nonspecific symptoms such as irritability, resentment, constant anxiety and mood swings predominate. In the later stages, cognitive and mental changes occur, mainly in the form of memory impairment.

First signs

Cognitive impairment occurs gradually. The patient begins to forget, first everyday moments and recent events, then deep childhood memories. She may forget the names of her children and grandchildren, or even what she did last week. Initial signs of this kind are confused with the natural decline of cognitive function in old age, and may not be taken into account. Relatives constantly observe forgetfulness in women after 70, but this should not be commonplace. Loss of reason is not a necessary accompaniment of old age.

A more alarming sign is a lack of understanding of what is happening on the street, loss of proprioception, and the function of spatial perception. An elderly woman tries not to go out without her family, and cannot move independently by bus, on foot, or in a car. Her perception of movement is impaired; it seems to her that transport has become slower, or vice versa, faster. Objects in the house may appear different and distort the perception of what is familiar.

Depression, reluctance to communicate with people, low mood, tearfulness and nagging towards relatives can also be regarded as signs of senile dementia. The patient feels social isolation, the inability to do the same things as before, and loses interest in life and events. It all starts in a “soft” form, the woman ceases to be interested in anything other than the TV, and goes out at home. Then social adaptation is lost, sloppiness arises, and the desire to take care of oneself and take care of the cleanliness of the body and home disappears.

Why should you contact a specialist? In the middle stage of dementia, a person is not able to care for himself, and when the disease progresses, he becomes dangerous to himself.

Mental retardation from birth

Congenital dementia (oligophrenia) is a series of diseases characterized by congenital or acquired mental underdevelopment during the first three years of life.

There are three degrees of oligophrenia:

1. Debility is a mild degree of illness. Such people are adequate, do simple work, and do not violate generally accepted rules. It is more difficult to diagnose, since there are no obvious symptoms. Patients are characterized by a lack of imagination and narrow thinking.

Imbecility is the middle stage of mental retardation. Capable of self-care, but need constant care. They understand when someone addresses them, they know people close to them. Poorly developed motor skills and coordination. The vocabulary is poor, thinking is primitive, memory and attention are underdeveloped.

Idiocy is a severe form of oligophrenia. People with this diagnosis require constant care and are not capable of self-care. They do not single out close people and often show aggression.

There is no speech, sometimes individual words and sounds are pronounced. They don't have the most basic skills. They do not control the functioning of the pelvic organs. Basic needs are food and sleep.

Causes:

• heredity,
• genetic disorders
• intrauterine infections of pregnant women (rubella, toxoplasmosis, syphilis),
• alcoholism, mother's drug addiction,
• consanguineous marriages,
• traumatic brain injuries during childbirth.

Symptoms

Symptoms are usually classified by function:

• Cognitive - forgetfulness, inability to make inferences and conclusions, violation of the logic of thinking, loss of the ability to recognize people, determine place and time, disappearance of the sense of the passage of time.
• Behavioral – desire for social isolation, avoidance of friends, girlfriends, usual activities, mood swings from tearfulness to aggression, unmotivated outbursts of anger, loss of interest in favorite hobbies, people, profession, family, loved ones. In later stages - socially unacceptable behavior, Tourette's syndrome, aggression, inappropriate actions. The patient behaves like a child, can be naked in public, relieve herself, confuses people, “falls into childhood.” When he finds himself on the street, he cannot find his way home and falls into a stupor.
• Physiological – violation of the technique of habitual movements. The patient stops sewing, embroidering, cooking, and driving. She cannot do simple exercises, even if she has done exercises before. When dancing, it moves in its own rhythm. In the later stages, collisions with things, falls while swimming, movement, and the inability to go to the toilet on your own are possible. The condition may be accompanied by hypotension, atonic constipation and cachexia if the patient is not properly cared for.

It is not recommended to leave patients with dementia without care and supervision, as they may completely lose physiological functions.

Forecasts

What does dementia mean? What forecasts do doctors give and how long do people with this diagnosis live on average? These are important questions that interest every patient and his relatives.

The forecasts cannot be called optimistic, since, according to statistics, a person with dementia and intellectual impairment can live from 1 to 15 years. Dementia itself does not cause death; the patient dies from complications: sepsis, dehydration, malnutrition, pneumonia. Life expectancy depends on a number of factors, such as the patient’s age, location, and type of dementia.

Scientists have proven that dementia that manifests itself in old age is easier to tolerate and progresses more slowly, which means that the average life expectancy in this case is higher than that of those who become ill at a young age.

Provoking factors of development

In women over 60 years of age, the provoking factor is the gradual decline of hormonal levels. In the presence of brain damage, the process develops rapidly. Social isolation, loss of profession, and lack of need to engage in some complex work that requires intellectual work accelerate dementia.

Women who remain poor and alone are at risk because they cannot provide themselves with adequate nutrition. Research from the Mayo Clinic links the disease to a poor diet that is low in omega-3s and triggers multiple inflammations. “Treatment with folk remedies” for bronchitis and pneumonia, an unkempt oral cavity, and general exhaustion aggravate the situation.

The course of the disease is accelerated by a general depressive background, the need to care for sick people, the lack of opportunity to rest, and to do something outside the family circle.

Prevention of dementia includes a healthy lifestyle, intellectual hobbies, physical activity in the fresh air, and constant communication not only with loved ones, but also with people outside the family circle.

Where to turn to specialists

The district clinic has specialists who will monitor a patient with dementia. The local therapist will visit the patient at home or see him at an outpatient clinic. This doctor evaluates the nature of the pathological symptoms and makes a referral to other doctors.

A neurologist and a psychiatrist see patients in the district and city clinics. A dementia specialist advises patients at a regional clinical hospital or specialized clinics in large cities.

Inspection procedure

Dementia develops with a loss of self-criticism towards one’s condition, so the patient’s relatives should initiate a visit to the doctor

If you refuse to attend an appointment with a specialist, loved ones may focus on specific complaints about your well-being:

• headache;
• dizziness;
• noise in the head and ears;
• unsteadiness of gait.

It is undesirable to delay a visit to the doctor, because in the absence of therapeutic correction, the stages of dementia can develop rapidly. Only timely treatment begins makes it possible to retain practical skills and information for as long as possible.

Dispensary registration

Depending on the prevalence of symptoms, a patient with dementia is registered at a dispensary. Constant monitoring makes it possible to observe changes in the condition and timely diagnose the onset of the next stage. A clinical examination of an elderly person can be carried out by a neurologist, psychiatrist or local therapist.

Hospitalization

Referral to hospital is necessary in the following situations:

• acute mental and motor agitation;
• aggression towards others or self-injury;
• suicide attempts;
• impairment of consciousness with loss of ability to navigate in time and space.

The patient is hospitalized in a psychiatric hospital to relieve psychotic symptoms (delusions, hallucinations) and aggressive mood. After discharge, the issue of registration in a boarding school for elderly people with mental disorders or the elderly person staying at home under the supervision of relatives and medical workers is decided.

Forced treatment

According to the Regulations on Psychiatric Care, treatment of patients must be carried out with their voluntary consent. The exception is cases when a patient with dementia is declared incompetent and cannot independently decide on treatment.

A dementia specialist gives a referral for inpatient treatment if hallucinations, delusions, and aggression appear. In a situation that is dangerous for others, a decision is made on compulsory treatment. In extreme situations, relatives should call a specialized ambulance team, which will take the patient to a psychiatric hospital for treatment.

Geriatric facilities

In the last stages of dementia, patient care becomes of primary importance. In geriatric institutions, a doctor treating dementia prescribes medications to a bedridden patient to maintain vitality. Specialized care includes timely changing of diapers and feeding (from a spoon or through a tube).

Timely contact with a specialist makes it possible to adapt the patient to the changed living conditions as much as possible. A doctor treats dementia in older people according to its stage and symptoms. Diagnosing dementia and finding out its cause makes it possible to slow down the progression of the disease. Prescribed drug treatment and rehabilitation methods make it possible to stabilize the condition and preserve independence and capacity as much as possible.

Diagnostics

Identifying dementia is a complex process. Diagnosis is carried out by neurologists and psychiatrists. From the neurological side, the lobes of the brain are scanned, degenerative changes and tumors are detected. Next, behavioral and cognitive tests are performed to determine how deep the symptoms of the disease are. Testing is the job of a psychiatrist, not a neurologist. Only a medical commission can assess how serious the situation is.

When diagnosing, attention is paid to differentiating the condition from other diseases, in particular, Alzheimer's disease, severe depression, and alcohol dependence.

What causes dementia

What are the causes of dementia? Despite the variety of causes for the development of dementia, the disorder begins with a gradual deterioration in the functioning of certain areas of the brain .

The process of loss of nerve cells in the brain in the human body begins at the age of 20, so complaints of forgetfulness in older people are understandable, but if such age-related changes lead to discomfort in everyday life, then perhaps this is the beginning of the manifestation of symptoms of dementia.

Medical practice includes more than 200 pathological conditions that provoke the death of neurons and the destruction of connections between them, leading to dementia.

One of the main sources of acquired dementia is Alzheimer's disease , which covers more than half of the cases and is its specific variety, in which significant damage to the cerebral cortex is independent in the general mechanism of the disease.

A special risk group should include people who have problems with the circulatory system (atherosclerosis, hypertension, cerebral ischemia) caused by weak blood flow and saturation of parts of the brain with oxygen.

The likelihood of vascular dementia increases several times in people who have suffered a stroke , which is expressed by blockage of blood vessels with a blood clot or thrombus, as a result of which blood circulation in the brain is significantly affected and, if urgent measures are not taken, leads to hypoxia.

In such patients, the manifestation of this disorder is about ten times higher in the first few months after a stroke than in healthy people, especially for the group of patients whose age is 60 years and above.

Can dementia occur after a stroke? About preventing dementia after a stroke in the video:

Treatment

In severe stages of dementia, treatment is not possible. The patient is cared for and monitored so that he does not harm himself or others. At initial stages, cognitive and behavioral therapy and a set of measures aimed at improving the functioning of the brain lobes are possible. It includes exercise therapy, physiotherapy, and taking medications that improve cerebral circulation and nervous activity.

Dementia is irreversible, but its progress can be slowed down by giving the patient years of active life. Self-prescription of nootropics and drugs that improve cerebral circulation is not recommended.

Classification of dementia in neurology

In medicine, dementia is classified on the following basis:

• localization of the lesion;
• reason for appearance;
• the nature of the flow.

Based on the location of the lesion, the disease is divided into:

1. Subcortical dementia. The subcortical structures of the brain are affected.
2. Cortical dementia. Changes are recorded in the cortical medulla.
3. Mixed . Lesions occur in the cortical and subcortical layers.
4. Multifocal . All parts of the brain are affected. This is the most unfavorable type of disease with a progressive course.

Depending on the degree to which the patient’s intellect degrades, the following types of disease are distinguished:

1. Lacunar dementia. Memory and attention change, but the patient maintains a critical attitude towards himself.
2. Partial dementia. Develops as a result of illness or injury. Changes in the brain are superficial; a person understands that he is sick.
3. Total dementia. An extreme manifestation of Alzheimer's disease. Characterized by complete loss of all cognitive functions.

Based on the root cause, the following types of pathology are distinguished:

1. Vascular dementia (develops due to cerebrovascular accident).
2. Alcoholic.
3. Toxic (caused by prolonged exposure to chemicals).
4. Traumatic.
5. Epileptic.
6. Alzheimer's type dementia.
7. Dementia caused by multiple sclerosis.
8. Senile (appears due to natural age-related brain degeneration).
9. Idiopathic (arising for an unknown reason).

Prognosis and prevention

The prognosis depends on the degree of damage to the brain and central nervous system. The early stages leave the patient with several years of normal life. In the middle and late stages, the process accelerates and special care is required. Alcohol-induced dementia is rare among women, but once it occurs, the consequences can be catastrophic. The patient “skips” the middle stage, quickly falling into a critical state.

Prevention of dementia is an active social and intellectual life, and compliance with the rules of a healthy lifestyle. In addition to mental exercise and socializing, you need to eat right, monitor your diet for vitamins D3, E, K, as well as calcium and selenium, drink enough water, eat more green vegetables and sources of omega-three fats, and limit alcohol to two drinks per week .

Dementia - symptoms

The severity of symptoms directly depends on the degree of mental retardation.
The first signs appear in the form of a somatovegetative reaction at the age of 0–3 years. The child is characterized by increased excitability of the autonomic nervous system. This is accompanied by sleep disturbances, appetite disturbances, and gastrointestinal disorders. This is accompanied by vomiting, temperature fluctuations, loss of appetite, flatulence, and increased sweating. As the child gets older, the symptoms become more pronounced. Thus, dementia in children aged 4–10 years is accompanied by psychomotor impairment. They are expressed in hyperdynamic disorders of various origins: psychomotor type excitability, stuttering, tics. All this is due to more pronounced differentiation of the cortical sections of the motor analyzer.

The first signs of dementia

In practice, mental retardation in children cannot always be detected: symptoms of the disorder in the early stages are subtle. One of the first signs may be a child’s emotional instability:

• frequent mood changes;
• lack of self-control;
• difficult adaptation to new conditions;
• behavioral disorders;
• fussiness;
• shyness;
• uncertainty.

In addition, there is a violation of the properties of attention. It is unstable, concentration is insufficient, the child is constantly distracted even when performing a simple task. Preschool children may experience the following symptoms:

1. Impaired perception
   – it is difficult for children to form a coherent image.
2. Problems with speech
   – there is a delay in mental development in speech, it can be either systemic or partial.

Mild mental retardation

Mild mental retardation is designated by doctors as debility. This form of disorder is characterized by good mechanical memory. Children can acquire a certain amount of knowledge and basic skills in writing, reading, and counting. In some cases, a rich vocabulary masks a lack of mental activity.

Such children do not show initiative or independence. The transition to mental tasks causes certain difficulties. Mental retardation of this form is manifested by insufficient ability to self-control, impulsiveness and suppression of impulses. Children show a craving for imitation and suggestibility. They adapt well to life, so they undergo socialization well.

Moderate mental retardation

Moderate mental retardation is called imbecility. Children with this disorder are capable of accumulating a certain amount of knowledge and have good mechanical memory. The vocabulary is small, the very understanding and use of speech is limited. Such children are self-centered and require increased attention to themselves. They constantly need positive assessment of their actions: they show joy when they are praised and are offended when reproached.

Such children are not accustomed to difficulties. When tension is required, their favorite answers are: “I can’t,” “I don’t want,” “I don’t know.” Such signs of dementia are missed by parents. Constant work with such children allows one to acquire a number of basic skills and abilities, but the amount of material learned is small. Children need constant care, and education is carried out in specialized educational institutions.

Severe mental retardation

Severe and profound mental retardation is characterized by a complete lack of reaction to what is happening around or an inadequate response to stimuli. There is no articulate, intelligible speech. Patients with this degree of mental retardation perceive speech intonation, but do not understand the meaning of what is said. Left alone with themselves, many of them remain motionless, others are in constant motion: crawling, grabbing all surrounding objects. They often show aggression, which can be directed both at themselves and at others.

Causes of this syndrome

The main reason for the development of senile insanity is organic damage to brain cells. Factors that provoke this condition are:

1. Alzheimer's disease.
2. Atherosclerosis.
3. Arterial hypertension.
4. Injuries.
5. Stroke.
6. Chemical poisoning.
7. Brain tumor.
8. Infectious diseases (meningitis, encephalitis, syphilis, polio).
9. Endocrine pathologies.
10. Hereditary predisposition.

Patients at risk for dementia are those with the following problems:

• hypertension;
• high cholesterol;
• obesity;
• hormonal disorders;
• lack of physical and intellectual activity;
• the presence of close relatives suffering from mental disorders.

Find out more about dementia:

• symptoms and treatment of the condition in older people;
• signs of dementia in men and women, children and adolescents;
• acquired and congenital dementia, as well as connections with other diseases;
• features of early dementia;
• receiving disability and needing nursing care;
• Read about tips for communicating with someone with dementia.