Dementia is a progressive disease that affects the cognitive sphere and causes cortical neurological disorders. The disease is based on a progressive neurodegenerative process that destroys the brain every year. The disease ultimately leads to total dementia and deficit neurological symptoms. The core of personality is completely destroyed: patients forget their relatives, their name. At the terminal stage, the patient may not recognize his own face in the mirror.
At what age do they die: from the moment of diagnosis, life lasts another 7-15 years. For example, if the diagnosis was made at the age of 68, then approximately the patient will live until 75-83 years.
With proper symptomatic and pathogenetic therapy, the disease can be stopped for a limited period, but the process of progressive degeneration of cortical functions still remains. The prognosis of the disease is unfavorable.
The lifespan of a person with dementia depends on the following factors:
- Previous events and life history.
- Depending on how long neurodegeneration lasts.
- Compliance with doctor's orders.
- Other diseases of internal organs.
Stages
Dementia leads to deterioration of the nervous system. A person suffering from this pathology has decreased mental abilities. With dementia, memory deteriorates and self-care skills are lost.
Pathology occurs under the influence of causes such as brain injury, infectious diseases, alcohol addiction, and Alzheimer's disease.
The patient's life expectancy depends on the rate of disease progression. The most common cause of death is concomitant diseases.
In the early stages of dementia, symptoms such as absent-mindedness and sudden changes in mood occur. As the disease progresses, the patient forgets current information, but remembers previously occurring events. In the future, reading, self-care, and writing skills disappear. The patient ceases to adequately evaluate his actions and poorly recognizes other people's speech.
How long do people who have been diagnosed with dementia live? Much depends on the clinical picture of the disease, the location of the affected area of the brain, and the causes of dementia. The main symptoms characteristic of different stages of dementia are listed in the corresponding table.
| Stages of pathology | Main features |
| Light | Sleep disturbance, difficulty remembering information, short-term loss of orientation in space. |
| Early | A sharp change in character, difficulties in choosing words when conducting a dialogue. |
| Intermediate | Loss of self-care and spatial orientation, incoherence of speech. |
| Heavy | Loss of ability to move, memory loss, problems swallowing food, fecal incontinence. |
Senile insanity: Features of the disease
Age-related insanity is a pronounced mental disorder, which is characterized by complete or partial collapse of personality. This process of manifestation of dementia ultimately leads to the loss of opportunities to communicate with others. The person suffering from the disease loses basic life skills. The development of the disease gives rise to irreversible mental changes in the brain, which pose a danger to loved ones.
In this matter, timely diagnosis plays an important role. It is thanks to her that the process of personality disintegration can be stopped at the initial stage.
In women, the disease occurs much more often, has more pronounced symptoms and progresses faster than in older men. However, in the initial stages it is quite treatable.
Symptoms of the last stage
What symptoms characterize the last stage of dementia? The patient's appetite sharply worsens and exhaustion is observed.
In the last stage of dementia, the patient loses the ability to sit and hold his head up. Atrophy of the facial muscles occurs. Against the background of paralysis, the patient's chewing skills disappear.
Severe dementia can result in coma and death. The average life expectancy of patients with late stage dementia varies from six months to one and a half years.
Diagnosis
The diagnosis is based on the wedge data, pictures. Differential diagnosis is difficult when distinguishing the initial manifestations of S. s. and age-related mental changes, as well as S. s. and atherosclerotic dementia that occurs in old age. Often, diagnostic difficulties in the first case are resolved only by follow-up. S. s. should be distinguished from Alzheimer's disease, especially when it began after age 60, a psychotic form
S. s. - from pre-senile psychoses (see), senile functional psychoses; in some cases, differential diagnosis is carried out with schizophrenia, which manifests itself for the first time in old age.
Signs
Dementia causes many complications before death. The lethal outcome is accelerated by the following pathologies:
- circulatory disorders. Due to problems with blood circulation, the risk of blood clots increases;
- immobility. It provokes the appearance of bedsores. In a weakened body, the process of tissue regeneration is disrupted. When infection enters open wounds, sepsis occurs, which is fatal in approximately 90% of cases;
- long-term use of antipsychotic medications. The use of appropriate medications causes intestinal obstruction, liver pathologies, and dysfunction of the digestive tract. The listed ailments can also cause serious death.
One of the complications of senile dementia is pneumonia. This is one of the most common causes of death in patients with dementia. How do patients with pneumonia die? Due to stagnation of blood, pulmonary edema occurs, a sufficient amount of oxygen does not penetrate into the body, and brain function deteriorates. The consequence of these violations is the rapid death of the patient.
Heart attack is a relatively rare cause of death in patients with dementia. It develops due to mental abnormalities and hallucinations, which instill anxiety and panic in the patient.
Another relevant question is: at what age do patients with dementia die? Senile dementia affects patients aged 65 to 85 years. The earlier the main symptoms of the disease appear, the more intense dementia develops. When the first signs of the disease appear in a 65-year-old patient, it is quite difficult to stop the course of the disease. It is quite rare for a patient to survive the age of seventy. With a late onset of the disease, the symptoms of dementia are less pronounced - the patient's life expectancy is approximately 10 years.
Clinical picture
S. s. has several forms - simple, confabulatory, delirious and psychotic.
The simple form begins gradually with mental disorders characteristic of aging (see Old age, aging, mental disorders). First of all, the personality changes. Most of the interests previously characteristic of the individual gradually disappear. Events of reality attract less and less attention and often begin to be perceived with a tinge of disappointment and even hostility, regarded as small, transitory, and not worthy of attention. In the past, patients see mostly positive things, constantly return to them, and praise them. The horizons are increasingly limited to what directly concerns the patient.
For the majority, satisfaction of physiological needs and concern for somatic well-being acquire predominant importance: the interests of patients are focused on food, often with the desire to adhere to a certain diet, treatment and self-medication, and administration of physiology. needs. Previous sympathies and attachments to people in the immediate environment weaken and disappear. There is a misunderstanding of the relationships that exist between people. Egoism develops. There is often a lack of tact and modesty. Moral coarsening arises. Such characteristic traits of old age as stubbornness, intractability, rigidity, a tendency to contradictions, and capriciousness are often combined with increased suggestibility. In some patients, dissatisfaction, grumpiness, grumpiness, pickiness, irony and even causticism predominate, in others - complacency, euphoria, carelessness, and a tendency to make monotonous jokes. The prevailing affective background changes little. Often a personal shift occurs - a sharpening of certain characterological characteristics (psychopathization), as a rule, those that were previously sthenic character traits, for example, such as firmness and determination, prudence and frugality, determination and consistency. These personality traits become exaggerated and even caricatured. In some cases, suspicion and disinhibition of lower drives appear - collecting and storing rubbish, vagrancy, increased sexual excitability, etc. Senile psychopathization is usually observed in cases where in the past the patient had a psychopathic character (see Psychopathy). Sometimes, with the development of senile insanity (see below), psychopathization takes a leading place in the wedge, S.’s picture of the village. and is accompanied by a relatively mild decrease in memory or obscures its manifestations.
Over time, personality changes increasingly give way to mental decay itself, which develops according to the type of progressive amnesia (see) - from later acquired and less firmly established to earlier acquired and firmly assimilated, from more complex (criticism, individual judgments , ability to abstract, etc.) to a simpler and more automated one (past experience and ideas, vocabulary, etc.). Mental decay, as defined by A.V. Snezhnevsky, is accompanied by a loss of the ability to establish new connections based on previous experience and ends with the development of total dementia (see). The sequence of onset of dementia is reflected in the development of memory impairment. At first, memory for abstract and differentiated concepts suffers - names, dates, titles, terms, i.e. selective reproduction is impaired. Next comes fixation amnesia (see). With its appearance, amnestic disorientation initially occurs in time, including in chronol. sequence of events in personal and social life, and subsequently in place - patients cannot say not only where they are (city, home address, etc.), but also cannot navigate their surroundings directly (they cannot find their apartment, bed, toilet, kitchen, etc.) - spatial disorientation. Recognition of people in the immediate environment is impaired; they are called by other people's names, usually the names of deceased relatives. In the most severe cases, recognition of one's own external appearance is impaired. Such patients, looking at themselves in the mirror, ask: “Who is this old woman?” and can start a conversation with the reflection, mistaking it for another person (mirror symptom).
Forgetting the present and recent past, patients remember events of long ago. At the same time, memories of the long past are revived. There is a shift of the situation into the past, up to living in the past. Patients consider themselves young and even youthful. They report on their activities in those years, for example, about studying, what their parents are doing, etc. n. Among information about facts that were previously in reality, there may be fictitious facts - ecmnestic confabulations (see Confabulosis); They usually arise with leading questions. The combination of living in the past with increased verbal responsiveness to what is happening around and fussy efficiency was called senile delirium by the domestic psychiatrist S. G. Zhislin.
With S. s. There is a clear dissociation between pronounced and even very profound dementia and the preservation of certain external forms of behavior, for example, demeanor, in particular during conversation, correct speech with sufficient vocabulary and lively intonations, appropriate use of common expressions. In this case, hyperexpressiveness of facial expressions and gestures is often observed. At the onset of the disease, there is a dissociation between a deep degree of mental decay and relatively minor physical decrepitude. Subsequently, insanity develops (see).
In neurol. status, there is constriction of the pupils, weakening of the reaction of the pupils to light and convergence, decreased muscle strength, trembling of the limbs, senile gait (mincing, with small steps). Grasping reflexes are often observed. Amnestic aphasia (see) is constant to varying degrees. Reduced epileptic seizures resembling fainting may occur (see).
In some cases of far-advanced mental disintegration with S. s. focal disorders arise that resemble the disorders observed in Alzheimer's disease (see Alzheimer's disease), for example, speech stereotypies - the collapse of the grammatical structure of speech, the predominance of stereotypical phrases, introductory words, interjections, verbigeration (see Depressive syndromes), echolalia (see Catatonic syndrome); motor stereotypies - rhythmic tapping of hands, rubbing of hands or fingers, chewing movements; constructive apraxia (see) and agraphia (see Letter), i.e. alzheimerization of S. occurs.
S. s. sleep rhythm disturbances are typical; its duration on any given day ranges from 2-4 to 20 hours; as a rule, it is shallow. At the same time, the ability to remain awake for a long time is observed. The periods of sleep and wakefulness alternate randomly. In the final stage of S. s. a drowsy state ensues.
In the initial stage of S. s. cachexia develops (see). Patients lie in the fetal position, do not react to their surroundings, sometimes mutter something inaudibly. Oral automatisms may be observed (see Pathological reflexes).
The frequency of the simple form of S. s., according to A. V. Snezhnevsky, is approx. 5.5% of cases of all diseases of old age accompanied by dementia; according to Rothschild (D. Bothschild), - approximately 50% of all cases of S. s.
The confabulatory form (syn.: Wernicke's chronic presbyophrenia, presbyophrenia) occurs as a complication of the simple form of S. s. atherosclerosis of cerebral vessels. It is the mildest form of S. s. Wedge, the picture is determined by long-term euphoria in combination with increased speech activity, sufficient preservation of vocabulary, indefatigable fussy efficiency and abundant ecmnestic confabulations. At the same time, “life in the past” is most pronounced.
A type of S. of the page, complicated by atherosclerosis of small vessels of the cerebral cortex, is a significant part of cases of Hackebusch-Geyer-Heimanovich disease (see Hackebusch-Geyer-Heimanovich syndrome).
The delirious form (syn.: senile delirium, senile confusion, acute presbyophrenia) occurs as a complication of the simple form of S. s. various somatic diseases and as a result of metabolic disorders. Most often it is manifested by the occurrence of reduced delirium, poor in hallucinatory, illusory and delusional disorders, or its severe forms - professional or musculoskeletal delirium (see Delirious syndrome). Occasionally, disorders characteristic of Delirium acutum (see).
The psychotic form (syn. senile insanity) can occur during S.s. in the form of affective, delusional and hallucinatory-delusional disorders (see Senile psychoses). The frequency of this form, according to A.V. Snezhnevsky, is 8.4% of all cases of S. s.
Terminal state
How are the last days before the patient's death? At a late stage of the disease, a person experiences complete indifference to surrounding events.
The terminal condition may be accompanied by the following manifestations:
- prolonged suspended animation sleep;
- urinary disturbance;
- small volume of urine excreted;
- lack of stool;
- coldness of the extremities due to a decrease in the volume of circulating blood;
- the appearance of dark spots on the skin;
- dark coloration of urine;
- metabolic deterioration;
- constriction of the pupils.
The terminal state is followed by preagonia - the slow decline of the body. A person’s blood pressure may drop sharply, tachycardia occurs, and oxygen delivery to the brain becomes difficult.
During the agony, people with dementia can gain lucidity. In science, this state is called “death clarification.” It is observed quite rarely. In most cases, a person dies insane.
The agony lasts on average 5-60 minutes. This condition is accompanied by disturbances in breathing rhythm and muscle cramps. After this, first clinical and then biological death occurs.
Providing assistance
Death from a stroke occurs gradually, so family and friends are advised to make efforts to alleviate his condition. During the pathological process, patients experience pain that intensifies before death. To block these unpleasant near-death sensations, the attending physician prescribes medications with an analgesic effect.
Most strong pain relievers can only be purchased with a doctor's prescription. To avoid the development of addiction, regular monitoring of the patient’s health is carried out. If there is an improvement in the condition, the doctor adjusts the dosage or discontinues the medication.
If a person has a sound mind before death, then he needs communication. Relatives should treat even the most ridiculous requests and speeches of the patient with understanding. No one knows how long a bedridden patient will live after a stroke.
That is why it is recommended that someone from his family and friends be with him at all times. To alleviate the patient’s condition and care, it is recommended to use special means - mattresses, beds and diapers. A TV or computer is placed near the patient, which will distract him.
In case of excessive weakness, it is recommended to provide comfortable conditions for the person lying down. If a patient is diagnosed with breathing problems, a pillow is placed under the patient's head. If there is coldness in the lower and upper extremities, the patient should be covered.
Stroke is a severe pathological process characterized by brain damage. In severe cases of the disease, the patient is immobilized. If the patient is in a supine position, it is recommended that he be provided with full care. The symptoms of a pre-death state are pronounced, which allows relatives to determine it on their own. When pathology occurs, the patient’s environment should provide him with support and care.
How to prolong the life of a patient suffering from dementia?
Timely initiation of treatment will help prolong the patient's life. The patient is advised to take appropriate medications and attend classes that stimulate brain activity.
At a late stage of the disease, the patient’s death can be delayed with proper care. In some cases, it is recommended to place the patient in a specialized medical institution, where he will be under the supervision of specialists.
