The disease usually develops in people over 70 years old. The frequency of senile dementia among mental diseases of senile age is from 12 to 25%. Clinical and epidemiological examination of patients conducted at the Moscow Psychoneurological Dispensary No. 2 showed senile dementia in 4.3% of them; in the population, these patients accounted for 5.4% (E. Ya. Sternberg, 1977).
The development of senile dementia is based on a progressive atrophic process that occurs in the cerebral cortex, mainly in the frontal and temporal lobes. In the etiology of senile dementia, the hereditary factor and the burden of exogenous harmfulness are of great importance.
Senile dementia develops slowly. In its course, three stages are distinguished: initial, developed dementia and senility. Initially, character traits are sharpened, up to a kind of “cartooning” of the personality. Previously thrifty people become greedy, mean, some playfulness, coquetry, inadequate age increase. In the past, tidy people require petty-pedantic fulfillment of sanitary norms from relatives, sociable people become annoying. The circle of interests is gradually narrowing, personal well-being and material well-being are becoming most important, social and ethical coarsening, self-centeredness are developing. Patients become grouchy, stubborn, suspicious, insensitive to loved ones and, along with this, easily suggestible. These personality traits often lead to conflicts in the family or with neighbors, and patients do not critically evaluate their behavior. Their sense of modesty disappears, instincts are disinhibited. Patients become gluttonous, sexually licentious, prone to sexual perversions, which in some cases leads to the commission of socially dangerous acts. Sometimes patients leave home, roam the streets, collect various trash.
Patients have impaired memory. In the initial stage of senile dementia, the process of memorization suffers. This leads to an amnestic disorientation, which is especially pronounced if patients fall into an unusual environment for them (moving to a new place of residence, hospitalization in a hospital). They cannot go to their room, room, or toilet. Having left the entrance of the house, they cannot independently find the way back. Having difficulty remembering names, dates, item names. Gradually, life events in the reverse chronological order fall out of memory – progressive amnesia develops. At first, patients forget the names of their grandchildren, then their children, while they recall some events of their youth with small details.
In the third stage of senile dementia, patients cannot remember their age, surnames, addresses, completely lose their knowledge acquired in life. Intelligence decreases gradually. At first, attention suffers, and distractibility increases. The ability to generalize is reduced, the vocabulary will decrease.
It should be noted that in the initial stage, patients are obese, not happy, angry. Over time, the mood becomes complacent, there is euphoria, carelessness. In the stage of insanity, emotional devastation develops. Despite the gross violation of memory and intelligence, patients for a long time remain talkative, contact.
A feature of senile dementia is its total nature: the absence of a critical attitude to a defect in intelligence and its behavior, the collapse of the “core” of the personality.
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n the final stage, patients completely lose their speech, the ability to distinguish edible from inedible, self-care skills disappear. Usually at this stage, patients constantly lie in bed, recovering for themselves. Mental insanity is accompanied by physical: patients lose weight, atrophic changes develop in the internal organs. Death occurs 5-10 years after the onset of the disease.
The confabulatory form of senile dementia (presbyophrenia) is manifested by high spirits, increased motor activity, fussiness, combined with abundant pseudo-reminiscences and confabulations.
With senile delirium, patients are disoriented in the place, time, and consciousness, a shift in the situation to the past occurs. Memories are often associated with their profession. Fear and motor agitation in senile delirium are usually not noted.
Against the background of total dementia, hypochondriacal delusions sometimes arise in the form of Kotar’s delirium, delirium of robbery, impoverishment. At night, patients usually stay awake, walk around the apartment or ward, looking for missing things, looking in the bed of other patients; they are grouchy, unhappy, cursing if they put them to bed. With Kotar’s delirium, patients claim that their entrails have disappeared, their stomach has disappeared, food falls “directly into the stomach,” some say that they died.
With a depressive form of senile dementia, the mood in patients is reduced, they are uncommunicative, gloomy, gloomy, they have ideas of self-accusation.
Differentiate senile dementia and vascular, presenile dementia, brain tumors.
With senile dementia, macroscopically reveal a decrease in the size of the brain, a decrease in its mass, a thickening of the dura mater, microscopically – foci of desolation, proliferation of senile druze (stellate glial formations).
Treatment of patients with senile dementia is reduced mainly to the organization of care for them, often it is necessary to use symptomatic, cardiac, vascular drugs. To stop psychotic conditions, antipsychotics are prescribed. In the initial stage of the disease, it is advisable to use nootropic drugs.
If patients with senile dementia commit unlawful acts, they are recognized as insane.