Dementia that occurs in persons of aresenyl age is characterized by a slow onset, progression, the development of total dementia with the decay of higher cortical functions (speech, writing, reading, praxis), the addition of subcortical disorders due to atrophic processes.
Alzheimer’s disease
Alzheimer’s disease usually begins at the age of 50 to 65 years, the average duration of the disease is 8-9 years. In the initial stage, there are impaired memory, fixative abilities, reproduction. Often there are phenomena of amnestic disorientation in place and time. Memory gaps are sometimes filled with coifabulation. E. Ya. Sternberg (1967) noted that amnestic syndrome in Alzheimer’s disease is not accompanied by a pathological revival of past experience. In patients, intelligence decreases, attention is disturbed early. Already in the initial stage of the disease, signs of the breakdown of motor skills and speech appear. First of all, the ability to subtle and complex movements mastered in recent years disappears, which is especially pronounced in the study of constructive-finger praxis. Speech disorders initially manifest difficulty in pronouncing words: speech becomes uncertain, patients cease to understand and differentiate the meaning of certain phrases, semantic relationships between words. Violations of the account (acalculia) are noted, the ability to understand the digit capacity of numbers, to compare numbers is lost. Over time, impaired speech, counting, praxis and optical perception. Amnestic aphasia and memory impairment are exacerbated. Patients cannot name objects, they remember their properties and purpose. Optical gnosis is disturbed. Vocabulary is depleted, nouns fall out of speech, patients miss words, break off phrases, leave them unfinished. The letter is broken – at first arbitrary, and then dictated: the handwriting suffers rudely, the patients rearrange and miss the letters. Primary alexia appears: at first, patients can still read aloud, but they don’t understand what they’ve read, they will no longer recognize the letters. The phenomena of apraxia are aggravated – the ability to perform habitual actions is lost, motor activity is reduced. In the initial stage of Alpheimer’s disease, depressive states, fragmentary delusions of damage, short-term episodes of impaired consciousness, psychomotor agitation, and influxes of hallucinations often occur. Usually these psychotic states are rudimentary and not persistent. Dementia in Alzheimer’s disease is accompanied by focal symptoms: epileptiform seizures, akinetohyperkinetic and extrapyramidal (parkinson-like) symptoms, chore-like hyperkinesias. In the initial stage, gross dementia develops, a complete breakdown of speech, praxis and recognition is observed, gait is disturbed, muscle tone is increased, grasping automatisms appear. Patients lie in an embryonic position, lead a vegetative lifestyle, cachexia is rapidly growing in them, despite increased appetite and the absence of diseases of internal organs. Alzheimer’s disease, according to E. Ya. Sternberg, occurs 3-4 times more often than Peak disease. The author highlighted a number of features inherent in Alzheimer’s disease: the frequency of family burden with endogenous psychoses or psychopathies, dissociation in the initial stage between memory impairments and the presence of a “facade” of the personality, an early tendency to develop individual components of dementia syndrome into focal disorders. Dementia in Alzheimer’s disease has the character of afato-and apracto-diagnostic.