The average age of patients at the onset of the disease is 56 years, the average duration of the disease is 6 years. Atrophic changes are expressed mainly in the frontal and temporal lobes of the brain, mainly the upper layers of the cerebral cortex are affected.
The clinic of the initial stage of Peak’s disease is determined by the localization of the atrophic process. In cases of lesions of the frontal lobes, aspiration, lethargy, inactivity, apathy appear. Patients become indifferent to themselves, to how they look, stop caring for loved ones, do not cook food. However, when prompted from the outside, they may show some activity.
If the atrophic process is localized in the basal part of the frontal lobe, then pseudo-paralytic symptoms are observed: disinhibition, lack of a sense of distance, reduced criticism. With damage to the temporal or frontotemporal areas, stereotypes in speech, writing and movements come to the fore. E. Ya. Sternberg (1977) also describes more rare variants of the onset of Peak’s disease: asthenic, aphatic, psychotic, amnestic.
Dementia in Peak’s disease manifests itself initially as a violation of complex forms of intellectual activity – the ability to abstract, generalize and distract. Thinking productivity, judgment, and criticism are reduced. The memory remains insignificant for a long time, usually there are no confabulations. Speech disorders – stereotypes and echolalia develop. Dysarthria and logoclonia characteristic of Alzheimer’s disease are usually not observed. With the frontal variant of dementia, speech activity decreases, up to mutism, with the temporal lobe there is amnestic aphasia. The phenomena of echolalia develop gradually, at first the patients repeat the questions addressed to them with some grammatical changes, rearrangement of words, subsequently cease to understand the meaning of the speech of others and automatically repeat some of the heard words or phrases. In the initial stage, “standing turns” in speech are related in the sense of questions or the general content of the conversation, over time this connection is lost. Stereotypes in the letter join. Violations of praxis are less typical of Peak’s disease, constructive praxis is usually not disturbed, phenomena of ideomotor apraxia may be observed.
Psychoses develop less frequently than with Alzheimer’s disease, and are manifested by depressive, anxiety-depressive states, an influx of visual hallucinations.
In the terminal stage, dementia is accompanied by somatic insanity.
Differential diagnosis.
Neurasthenic and psychopathic symptoms during menopause may resemble a clinic of neurosis, psychopathy, or organic diseases: the effects of a traumatic brain injury, neuroinfection, and cerebrovascular disease. The climacteric genesis of these disorders is evidenced by the relationship between their occurrence and the onset of menopause, a combination with endocrine-diencephalic disorders typical for this age period, and the absence of signs of an organic brain pathology. Neuroses are usually observed in people of a younger age.
The clinical picture of involutional melancholy may resemble vascular depression, the depressive phase of manic-depressive psychosis, and reactive depression. Often it is necessary to differentiate involutional paranoid and vascular psychoses, reactive paranoids, schizophrenia.
With presenile depression, in contrast to the depressive phase of manic-depressive psychosis, anxiety rather than melancholy comes to the fore in the clinical picture, there is no slowdown in ideator and motor acts. In addition, patients with circular depression are uncommunicative, while patients with presenile depression are anxious, annoying, approaching patients or staff with complaints, looking for sympathy and help. The nature of crazy ideas is also different. While patients with circular depression often express ideas of self-accusation and self-abasement, say that they should be “deserved punishment,” people with presenile depression expect punishment for “past sins”, trying to justify themselves in the eyes of others, proving their innocence. With circular depression, patients usually feel better in the evening, with presenile depression, asthenia and anxiety increase in the evening, and mood worsens. For circular depression, the Protopopov triad is typical (increased heart rate, dilated pupils, tendency to constipation), indicating sympathicotonia. Presenile depression is accompanied by vagotonia.
For patients with reactive depression, astheno-depressive syndrome is typical, asthenia is more pronounced than with presenile depression. Experiences are associated with mental trauma, anxiety is less pronounced, patients are usually tearful, sometimes motor agitation develops. The severity of painful symptoms is enhanced in connection with the mention of an unfavorable situation and weakens when resolved. If reactive depression develops after strong, personally significant psycho-traumatic influences, then the appearance of presenile depression is often preceded by prolonged minor experiences associated with family or household troubles. The clinical picture of late schizophrenia has a number of features caused by age: delusions of small scope with a specific content, age-related topics of delirium (jealousy, damage, poisoning) are often noted. Patients with prenatal psychosis in the premorbid period are usually extroverted, emotionally vulnerable, anxious, some hypersociable; patients with schizophrenia in their youth are distinguished by an unusual, peculiar character, low sociability. With schizophrenia, there is a dissociation of thought processes, often mental automatism, delirium is political, is not associated with real life circumstances.
Sociable patients with presenile paranoid tend to attract more sympathizers and assistants to their side. For schizophrenia patients, an emotional decline is characteristic. With schizophrenia, delirium develops quickly and decreases under the influence of treatment. Presenile delirium develops slowly and is characterized by therapeutic resistance.
Reactive paraioids, unlike presenilliacs, develop acutely in connection with mental trauma, which is manifested by a delusional plot, deactivating after the elimination of psychological trauma. In people suffering from presenile paranoid, delusional plot only at the beginning of the disease can be associated with mental trauma, and the dynamics of psychopathological symptoms does not depend on the strengthening or weakening of traumatic effects.
In the differential diagnosis of preseil, sennial and vascular dementia, it is necessary to take into account age, the total nature of dementia (in contrast to vascular dementia), typical violations of higher cortical functions: writing, speech, praxis.