The nature of agnosia in organic dementia is determined. Organic Dementia – Signs and Treatment

The term “dementia” in medicine usually refers to acquired dementia, characterized by a violation of the basic mental functions of a person: thinking, intelligence, attention, memory and others. The disease usually progresses slowly, but in some cases it occurs very quickly. The rapid development of pathology is observed, as a rule, with traumatic brain injuries or intoxication, in which brain cells die in short period time.

With dementia, a person loses the ability to understand the world, loses previously acquired skills, does not show emotions, forgets events that happened recently, while the patient is not aware of what is happening to him. Violations are usually so severe that a person cannot carry out his professional activities and experiences serious difficulties in Everyday life. Many people whose relatives have encountered this pathology wonder how many years patients with dementia live. It is very difficult to give a definite answer, as everything depends on many factors. If a person receives the necessary care and supportive treatment, they can live for many years. You should also take into account how quickly dementia develops and what causes it was caused.

According to statistics, dementia is most often diagnosed in older people over the age of sixty. In patients over eighty years of age, the disease is diagnosed in approximately 80% of cases.

Causes of the disease

Dementia develops as a result of severe damage to the central nervous system of an organic nature, therefore, the trigger for its onset can be any pathological condition leading to degenerative changes and death cellular structures cerebral cortex. Considering the most probable reasons Therefore, it is necessary to first identify those specific types of acquired dementia in which destruction of the cerebral cortex acts as an independent mechanism of pathology. In this case we are talking about Alzheimer's disease, Pick's disease, etc. Such pathologies are most often diagnosed in patients over the age of sixty-five years.

In other cases, dementia occurs due to secondary damage to the human brain. Often this pathology acts as a complication of injury, infectious lesions, vascular diseases occurring in chronic form, exposure to a variety of toxic substances. Most often, secondary organic brain damage occurs due to vascular pathologies, such as atherosclerosis, hypertension, etc.

It is possible that dementia can develop due to alcohol and drug abuse and tumor growths in the brain. Quite rarely, the development of the disease is facilitated by infections: meningitis, viral encephalitis, AIDS, neurosyphilis and others.

It is extremely difficult to say how many reasons there are that contribute to one degree or another to the development of acquired dementia. In some cases, dementia becomes a complication of hemodialysis, severe liver or kidney failure, and certain endocrinological and autoimmune diseases. In most cases, the disease occurs due to the influence of several provoking factors at once. A typical example of such a disorder is the so-called senile (senile) dementia.

It is worth noting that the risk of developing acquired dementia increases with age. If we rely on medical statistics, then among people under sixty years of age the percentage of patients with dementia is extremely small, while among older people over seventy to eighty years of age this figure reaches 75-80%.

Classification

In modern clinical practice, dementia is divided into the following functional and anatomical forms:

Dementia can occur in lacunar or total form. In the first case, the patient experiences localized lesions of those structures that are responsible for the function of the intellect. In this case, serious violations are usually observed short term memory, minor asthenic manifestations may also occur.

If observed complete destruction personality core, we're talking about about total dementia. Such patients experience not only deterioration of memory and intelligence, but also serious disorders emotional-volitional sphere. If the disease develops over several years, the patient may completely lose his previously characteristic interests and spiritual values. The person becomes completely socially maladapted.

Clinical picture

Depending on the stage of dementia, symptoms can be quite variable. This disease is characterized by a violation of all human cognitive functions. Behavioral and personality disorders can develop at any stage of the disease, as well as motor dysfunctions and other deficit syndromes.

Vascular dementia is usually characterized by the most rapid development, while, for example, in Alzheimer's disease, the pathology progresses at a slow pace. As temporary clinical manifestations, many patients experience various psychoses, characterized by manic, depressive, and paranoid states.

Early stage dementia may present with memory impairment. The patient is unable to remember and understand new information, and speech disorders may occur due to difficulties in finding words. Personality disorders and mood swings are also quite common early in the development of acquired dementia. Quite often, patients experience progressive difficulties in performing usual daily activities. It becomes difficult for them to find their way home, remember where they live, etc. Loss of independence often leads to outbursts of aggression and depressive disorders.

Other symptoms that characterize incipient dementia include apraxia, agnosia, and aphasia. Often early signs illnesses are noticed by close people of the sick person, complaining about his strange behavior and emotional instability.

At the intermediate stage of development of the pathology, patients are almost completely deprived of the ability to learn. Their memory does not disappear completely, but it is significantly reduced, especially for those events that happened relatively long ago, for example, a couple of years ago. It becomes increasingly difficult for patients to take care of themselves: dressing, washing, etc. At the same time, personal changes also progress: irritability appears, sometimes accompanied by outbursts of aggression, or complete passivity occurs with an absence of emotional manifestations and signs of depression.

Dementia at this stage of its development often leads to the patient losing an adequate sense of space and time. A person finds it difficult to answer basic questions, for example, how old is he, can get lost in his own apartment, and confuse day with night. Such disorders can eventually transform into psychosis, accompanied by hallucinations, mania and depression.

In the severe stage of the disease, patients lose the ability to move independently. Often the disease at this stage is accompanied by urinary incontinence and a complete lack of memory. The patient may forget how to eat and drink independently. These patients are at very high risk of developing bedsores and pneumonia. Patients are often placed in specialized medical facilities to ensure proper care.

Diagnostics

In case of cognitive impairment and suspected dementia, it is necessary to carry out comprehensive examination sick. As a rule, at the very beginning of the development of the disease, few people pay attention to minor changes, and therefore dementia is often diagnosed at a fairly advanced stage. Relatives need to be careful and consult a doctor if close person for some reason he began to confuse words, forget recent events, became uncommunicative and irritable.

To identify the disease, specialists use special psychometric tests. An examination by a neurologist and an ophthalmologist is required. In order to exclude infectious and metabolic diseases, a series of laboratory tests. This usually includes a blood test for sugar levels, hormonal analysis of blood serum and other studies.

Neurological examination of patients with dementia reveals slowing of psychomotor functions. The patient may expend a lot of effort, but not give correct answers. As one of the most informative tests for identifying acquired dementia, doctors often ask patients to evaluate their short-term memory. If you put three or four objects in front of the patient, and then remove them and ask them to name them after a few minutes, the person with dementia will not be able to do this.

In addition to identifying a memory disorder, when diagnosing acquired dementia, it is necessary to confirm the presence of aphasia, agnosia, apraxia and other characteristic signs of the disease in the patient. In addition to this, an assessment is carried out mental status sick.

Electrocardiography, vascular Dopplerography, magnetic resonance and computed tomography are required. Vascular dementia and Alzheimer's disease are detected using the Khachinsky ischemic scale. The verdict about the disease and its stage is made based on the patient’s score.

Differential diagnosis

In clinical practice, organic dementia must be differentiated from so-called depressive pseudodementia during the examination of the patient. Often severe depression accompanied by severe intellectual impairment, which can be taken as signs of dementia. Heavy psychological trauma and stress can also cause pseudodementia as a kind of protective reaction.

In some cases, intellectual impairment occurs due to metabolic disorders, for example, a lack of vitamin B12, folic acid or other substances necessary for the human body. In such cases, all symptoms of dementia disappear after proper correction of the disorders.

It is important to emphasize that differentiating pseudodementia from organic dementia can be very difficult even for experienced specialists. Most often the production correct diagnosis is possible only with constant and long-term monitoring of the patient’s condition. In addition, dementia must be differentiated from memory impairment, which is often found in older people, and cognitive disorders that occur against the background of depression.

Unfortunately, with organic dementia, treatment can almost always only be supportive. Therapy is prescribed to compensate for deficits in cognitive functions and improve cerebral circulation. To do this, the doctor prescribes appropriate medications, individually setting their dosage for each specific patient. Speaking about how long such treatment should last, it should be emphasized that maintenance therapy is necessary throughout life. As symptomatic treatment Sedatives and antidepressants may be prescribed. It is worth noting that dementia occurring against the background of depression does not disappear even when the latter is eliminated.

Dementia, or more simply put, senile dementia, is a severe disorder of higher nervous activity caused by brain damage. This disease, which mainly affects older people, manifests itself as a decrease in mental abilities and gradual degradation of personality. It is impossible to cure dementia, but it is quite possible to slow down the progression of the disease, the main thing is to know the cause that caused the brain damage and the principles of treating the disease.

Causes and types of dementia

Depending on the cause of the disease, dementia is divided into primary and secondary. Primary, or organic dementia, occurs when there is massive death of neurons in the brain or when blood vessels malfunction. This is caused by diseases such as Alzheimer's disease, Pick's disease or dementia with Lewy bodies. In 90% of cases, senile dementia is caused precisely by these reasons. The remaining 10% relate to secondary dementia, which can be caused by an infectious brain lesion, malignant neoplasm, metabolic problems, diseases thyroid gland, as well as brain injuries.

What is characteristic is secondary dementia, with timely treatment, is completely reversible, while organic or primary dementia is an irreversible process in which one can only slow down its development and relieve unpleasant symptoms, thereby prolonging the patient’s life.

Signs of dementia

Dementia of the organic type is characterized by manifestations of Alzheimer's disease. Initially, they are faintly noticeable, and therefore they can only be identified by closely observing the patient. In the early stages of dementia, a person's behavior changes - he becomes aggressive, irritable and impulsive, often suffers from forgetfulness, loses interest in his next activity and is unable to perform work in accordance with the norms.

A little later, absent-mindedness, a general decrease in understanding, an apathetic and depressive state are added to these signs. The patient may get lost in space and time, forget what happened to him a few hours ago, but remember in detail the events of many years ago. A characteristic feature dementia is sloppiness and lack of a critical attitude towards one's appearance. Approximately 20% of such patients experience psychosis, hallucinations and mania. It often seems to them that close people are preparing a conspiracy around them and are trying only for their lives.

Dementia affects not only the patient’s psyche and cognitive functions. In most cases, people with this condition have problems with speech, which becomes slow, inconsistent, and sometimes incoherent. Another sign of the disease is seizures, which occur at all stages of the disease.

Dementia treatment

The fight against the disease in question is aimed at stabilizing the pathological process, as well as reducing the severity of existing symptoms. Treatment is complex and must necessarily include the fight against diseases that aggravate dementia (atherosclerosis, hypertension, obesity, diabetes).

Organic dementia at an early stage is treated with the following drugs:

• nootropics (Cerebrolysin, Piracetam);
• homeopathic remedies (Ginkgo biloba);
• dopamine receptor stimulants (Piribedil);
• means for improving blood circulation in the brain (Nitsergoline);
• CNS mediators (Phosphatidylcholine);
• drugs that improve the utilization of glucose and oxygen by brain cells (Actovegin).

In the later stages of the fight against dementia, the patient is prescribed acetylcholinesterase inhibitors, which means the drug Donepezil and others. These funds help improve the social adaptation of patients, and therefore reduce the burden on people caring for such patients. Take care of yourself!

Dementia defines an acquired form of dementia, in which patients experience a loss of previously acquired practical skills and acquired knowledge (which can occur in varying degrees of intensity of manifestation), while at the same time a persistent decrease in their cognitive activity. Dementia, the symptoms of which, in other words, manifest themselves in the form of a breakdown of mental functions, is most often diagnosed in old age, but the possibility of its development at a young age cannot be ruled out.

general description

Dementia develops as a result of brain damage, against which a marked decline in mental functions occurs, which generally makes it possible to distinguish this disease from mental retardation, congenital or acquired forms of dementia. Mental retardation (also known as oligophrenia or dementia) implies a stop in personality development, which also occurs with brain damage as a result certain pathologies, but predominantly manifested in the form of damage to the mind, which corresponds to its name. Wherein mental retardation differs from dementia in that with it the intelligence of a person, physically adult, is up to normal indicators, corresponding to his age, never arrives. In addition, mental retardation is not a progressive process, but is the result of a disease suffered by a sick person. However, in both cases, both when considering dementia and when considering mental retardation, there is the development of a disorder of motor skills, speech and emotions.

As we have already noted, dementia overwhelmingly affects people in old age, which determines its type as senile dementia (this pathology is usually defined as senile insanity). However, dementia also appears in youth, often as a result of addictive behavior. Addiction means nothing more than dependence or bad habits- pathological attraction, in which there is a need to perform certain actions. Any type of pathological attraction increases the risk of developing mental illness in a person, and often this attraction is directly related to the existing problems for him. social problems or personal problems.

Addiction is often used in connection with such phenomena as drug addiction and drug dependence, but more recently another type of addiction has been defined for it - non-chemical addictions. Non-chemical addictions, in turn, define psychological addiction, which itself acts as an ambiguous term in psychology. The fact is that predominantly in the psychological literature this kind of dependence is considered in a single form - in the form of dependence on narcotic substances (or intoxicants).

However, if we consider this type of addiction at a deeper level, this phenomenon also arises in the everyday mental activity that a person encounters (hobbies, interests), which, thereby, defines the subject of this activity as an intoxicating substance, as a result of which he, in in turn, is considered as a substitute source that causes certain missing emotions. These include shopaholism, Internet addiction, fanaticism, psychogenic overeating, gambling addiction, etc. At the same time, addiction is also considered as a method of adaptation, through which a person adapts to conditions that are difficult for himself. The elementary agents of addiction are drugs, alcohol, and cigarettes, which create an imaginary and short-term atmosphere of “pleasant” conditions. A similar effect is achieved when performing relaxation exercises, while resting, as well as through actions and things that bring short-term joy. In any of these options, after their completion, a person has to return to reality and conditions from which he managed to “escape” in such ways, as a result of which addictive behavior is considered as a rather complex problem of internal conflict, based on the need to escape from specific conditions, against the background of which and there is a risk of developing mental illness.

Returning to dementia, we can highlight the current data provided by WHO, based on which it is known that global incidence rates number about 35.5 million people with this diagnosis. Moreover, it is expected that by 2030 this figure will reach 65.7 million, and by 2050 it will be 115.4 million.

With dementia, patients are not capable of realizing what is happening to them; the disease literally “erases” everything from their memory that accumulated in it during the previous years of life. Some patients experience the course of such a process at an accelerated pace, due to which they quickly develop total dementia, while other patients can linger for a long time at the stage of the disease within the framework of cognitive-mnestic disorders (intellectual-mnestic disorders) - that is, with disorders of mental performance, decreased perception, speech and memory. In any case, dementia not only determines the result for the patient in the form of problems of an intellectual scale, but also problems in which he loses many human personality traits. The severe stage of dementia determines for patients dependence on others, maladaptation, they lose the ability to perform simple actions related to hygiene and eating.

Causes of dementia

The main causes of dementia are the presence of Alzheimer's disease in patients, which is defined, respectively, as Alzheimer's type dementia, as well as with current vascular lesions to which the brain is exposed - the disease in this case is defined as vascular dementia. Less commonly, the causes of dementia are any neoplasms that develop directly in the brain; this also includes traumatic brain injuries ( non-progressive dementia ), diseases nervous system etc.

Etiological significance in considering the causes leading to dementia is assigned to arterial hypertension, disorders of the systemic circulation, lesions of the great vessels against the background of atherosclerosis, arrhythmias, hereditary angiopathy, repeated disorders relevant to cerebral circulation (vascular dementia).

The etiopathogenetic variants leading to the development of vascular dementia include its microangiopathic variant, macroangiopathic variant and mixed variant. This is accompanied by multi-infarct changes occurring in the brain substance and numerous lacunar lesions. In the macroangiopathic variant of the development of dementia, pathologies such as thrombosis, atherosclerosis and embolism are distinguished, against the background of which major artery brain occlusion develops (a process in which narrowing of the lumen and blockage of the vessel occurs). As a result of this course, a stroke develops with symptoms corresponding to the affected pool. As a result, vascular dementia subsequently develops.

As for the next, microangiopathic development option, here angiopathy and hypertension are considered as risk factors. The characteristics of the lesion in these pathologies lead in one case to demyelination of the white subcortical matter with the simultaneous development of leukoencephalopathy, in another case they provoke the development of lacunar lesion, against which Binswanger's disease develops, and because of which, in turn, dementia develops.

In about 20% of cases, dementia develops against the background of alcoholism, the appearance of tumor formations and the previously mentioned traumatic brain injuries. 1% of the incidence is due to dementia due to Parkinson's disease, infectious diseases, degenerative diseases of the central nervous system, infectious and metabolic pathologies, etc. Thus, a significant risk has been identified for the development of dementia due to actual diabetes mellitus, HIV, infectious diseases of the brain (meningitis, syphilis) , thyroid dysfunction, diseases internal organs(renal or liver failure).

Dementia in older people, by the nature of the process, is irreversible, even if the possible factors that provoked it are eliminated (for example, taking medications and stopping them).

Dementia: classification

Actually, based on a number of listed features, types of dementia are determined, namely senile dementia And vascular dementia . Depending on the degree of relevance for the patient social adaptation, as well as the need for supervision and outside help in combination with his ability to self-care, the corresponding forms of dementia are distinguished. So, in the general course, dementia can be mild, moderate or severe.

Mild dementia implies a condition in which a sick person is faced with degradation in terms of his existing professional skills; in addition, his social activity also decreases. Under social activity in particular, it means reducing the time spent on everyday communication, thereby extending to the immediate environment (colleagues, friends, relatives). In addition, in a state of mild dementia, patients also have a weakened interest in the conditions of the outside world, as a result of which it is important to abandon their usual options for spending free time and hobbies. Mild dementia is accompanied by the preservation of existing self-care skills, in addition, patients adequately navigate within the confines of their home.

Moderate dementia leads to a condition in which patients can no longer remain alone with themselves for a long period of time, which is caused by the loss of skills in using technology and devices surrounding them (remote control, telephone, stove, etc.), difficulties even using door locks. Constant monitoring and assistance from others is required. As part of this form of the disease, patients retain the skills to self-care and perform actions related to personal hygiene. All this, accordingly, makes life more difficult for those around the patients.

As for such a form of the disease as severe dementia then here we are talking about the absolute disadaptation of patients to what surrounds them with the simultaneous need to provide constant assistance and control, which are necessary even to perform the simplest actions (eating, dressing, hygiene measures, etc.).

Depending on the location of the brain damage, the following types of dementia are distinguished:

• cortical dementia - the lesion predominantly affects the cerebral cortex (which occurs against the background of such conditions as lobar (frontotemporal) degeneration, alcoholic encephalopathy, Alzheimer's disease);
• subcortical dementia - in this case, subcortical structures are predominantly affected (multi-infarct dementia with white matter lesions, supranuclear progressive palsy, Parkinson's disease);
• cortical-subcortical dementia (vascular dementia, cortical-basal form of degeneration);
• multifocal dementia - many focal lesions are formed.

The classification of the disease we are considering also takes into account dementia syndromes that determine the corresponding variant of its course. In particular this could be lacunar dementia , which implies a predominant memory loss, manifested in the form of a progressive and fixation form of amnesia. Compensation for such a defect by patients is possible due to important notes on paper, etc. The emotional-personal sphere in this case is slightly affected, because the core of the personality is not subject to damage. Meanwhile, it is not excluded that patients may develop emotional lability(instability and changeability of moods), tearfulness and sentimentality. An example of this type of disorder is Alzheimer's disease.

Alzheimer's type dementia , the symptoms of which appear after the age of 65 years, within the initial (initial) stage occurs in combination with cognitive-mnestic disorders with increasing impairments in the form of orientation in place and in time, delusional disorders, the appearance of neuropsychological disorders, subdepressive reactions in relation to one’s own incompetence. On initial stage patients are capable of critically assessing their condition and taking measures to correct it. Moderate dementia within this condition is characterized by the progression of the listed symptoms with a particularly severe violation of the inherent functions of the intellect (difficulties in conducting analytical and synthetic activities, a reduced level of judgment), loss of ability to perform professional duties, and the emergence of a need for care and support. All this is accompanied by the preservation of basic personal characteristics, a feeling of one’s own inferiority in adequately responding to an existing illness. In the severe stage of this form of dementia, memory decay occurs completely; support and care are needed in everything and at all times.

The next syndrome is considered total dementia. It means the appearance of gross forms of disorders of the cognitive sphere (impaired abstract thinking, memory, perception and attention), as well as personality (here we already distinguish moral disorders, in which such forms as modesty, correctness, politeness, sense of duty, etc.) disappear. . In the case of total dementia, as opposed to lacunar dementia, the destruction of the core of the personality becomes relevant. Vascular and atrophic forms of damage to the frontal lobes of the brain are considered as the causes leading to the condition under consideration. An example of such a condition is Pick's disease .

This pathology is diagnosed less frequently than Alzheimer's disease, mainly among women. Among the main characteristics, current changes are noted within the emotional-personal sphere and the cognitive sphere. In the first case, the state implies rough forms personality disorder, complete lack of criticism, spontaneity, passivity and impulsiveness of behavior; hypersexuality, foul language and rudeness are relevant; the assessment of the situation is impaired, there are disorders of desires and will. In the second, with cognitive disorders, severe forms of thinking impairment are present, and automated skills are retained for a long time; Memory disorders are noted much later than personality changes; they are not as pronounced as in the case of Alzheimer's disease.

Both lacunar and total dementia are, in general terms, atrophic dementias, while there is also a variant of a mixed form of the disease (mixed dementia) , which implies a combination of primary degenerative disorders, which mainly manifests itself in the form of Alzheimer's disease, and vascular type brain lesions.

Dementia: symptoms

In this section we will look at a generalized view of the signs (symptoms) that characterize dementia. The most characteristic of them are considered disorders associated with cognitive functions, and this kind of impairment is the most pronounced in its own manifestations. Emotional disorders in combination with behavioral disorders are no less important clinical manifestations. The development of the disease occurs gradually (often), its detection most often occurs as part of an exacerbation of the patient’s condition, arising due to changes in the environment surrounding him, as well as during an exacerbation of a somatic disease that is relevant to him. In some cases, dementia can manifest itself in the form of aggressive behavior of the sick person or sexual disinhibition. In the event of personality changes or changes in the patient’s behavior, the question is raised about the relevance of dementia for him, which is especially important if he is over 40 years old and does not have a mental illness.

So, let’s take a closer look at the signs (symptoms) of the disease we are interested in.

• Disorders related to cognitive functions. In this case, disorders of memory, attention and higher functions are considered.
  • Memory disorders. Memory disorders in dementia involve damage to both short-term memory and long-term memory; in addition, confabulations are not excluded. Confabulations in particular involve false memories. Facts from them that occurred earlier in reality or facts that previously occurred but underwent a certain modification are transferred to the patient at another time (often in the near future) with their possible combination with events that were completely fictitious by them. Light form dementia is accompanied moderate impairments memory, they are mainly associated with events occurring in the recent past (forgetting conversations, phone numbers, events that occurred within a certain day). Cases more severe course Dementia is accompanied by retention in memory of only previously learned material while quickly forgetting newly received information. Final stages diseases may be accompanied by forgetting the names of relatives, one’s own occupation and name, this manifests itself in the form of personal disorientation.
  • Attention disorder. In the case of the disease we are interested in, this disorder implies a loss of the ability to respond to several relevant stimuli at once, as well as a loss of the ability to switch attention from one topic to another.
  • Disorders associated with higher functions. In this case, the manifestations of the disease are reduced to aphasia, apraxia and agnosia.
    • Aphasia implies a speech disorder in which the ability to use phrases and words as a means of expressing one’s own thoughts is lost, which is caused by actual damage to the brain in certain areas of its cortex.
    • Apraxia indicates a violation of the patient's ability to perform purposeful actions. In this case, the skills previously acquired by the patient are lost, and those skills that have been formed over many years (speech, household, motor, professional).
    • Agnosia determines a violation of various types of perception in the patient (tactile, auditory, visual) with the simultaneous preservation of consciousness and sensitivity.
• Disorientation. This type of disorder occurs over time, and mainly within the initial stage of development of the disease. In addition, disruption of orientation in temporal space precedes disruption of orientation on the scale of orientation in place, as well as within the framework of one’s own personality (here the difference between a symptom in dementia and delirium is manifested, the features of which determine the preservation of orientation within the framework of considering one’s own personality). The progressive form of the disease with advanced dementia and pronounced manifestations of disorientation on the scale of the surrounding space determines for the patient the likelihood that he can freely get lost even in an environment that is familiar to him.
• Behavioral disorders, personality changes. The onset of these manifestations is gradual. The main features characteristic of the individual gradually intensify, transforming into conditions inherent to this disease as a whole. Thus, energetic and cheerful people become restless and fussy, and people who are thrifty and neat, accordingly, become greedy. Transformations inherent in other traits are considered similarly. In addition, there is an increase in selfishness in patients, a disappearance of responsiveness and sensitivity to the environment, they become suspicious, conflictual and touchy. Sexual disinhibition is also determined; sometimes patients begin to wander and collect various rubbish. It also happens that patients, on the contrary, become extremely passive, they lose interest in communication. Untidyness is a symptom of dementia that occurs in accordance with the progression of the general picture of the course of this disease; it is combined with a reluctance to self-care (hygiene, etc.), with uncleanliness and a general lack of reaction to the presence of people next to you.
• Thinking disorders. There is a slowness in the pace of thinking, as well as a decrease in the ability to logical thinking and abstraction. Patients lose the ability to generalize and solve problems. Their speech is detailed and stereotypical in nature, its scarcity is noted, and as the disease progresses, it is completely absent. Dementia is also characterized possible appearance crazy ideas in patients, often with absurd and primitive content. So, for example, a woman with dementia with a thought disorder before the appearance of delusional ideas may claim that her mink coat was stolen, and such an action may go beyond her environment (i.e. family or friends). The crux of the nonsense in this idea is that she never had a mink coat at all. Dementia in men within this disorder often develops according to a scenario of delusion based on the jealousy and infidelity of the spouse.
• Decreased critical attitude. We are talking about the attitude of patients both to themselves and to the world around them. Stressful situations often lead to the appearance of acute forms anxiety-depressive disorders (defined as a “catastrophic reaction”), in which there is a subjective awareness of intellectual inferiority. Partially preserved criticism in patients determines the possibility for them to maintain their own intellectual defect, which may look like a sharp change in the topic of conversation, turning the conversation into humorous form or distraction in other ways from it.
• Emotional disorders. In this case, it is possible to determine the diversity of such disorders and their overall variability. Often this depressive states in patients combined with irritability and anxiety, anger, aggression, tearfulness or, conversely, a complete lack of emotions in relation to everything that surrounds them. Rare cases determine the possibility of development manic states combined with a monotonous form of carelessness, with gaiety.
• Perception disorders. In this case, the conditions of the appearance of illusions and hallucinations in patients are considered. For example, with dementia, a patient is sure that in the next room he hears the screams of children being killed in it.

Senile dementia: symptoms

In this case, a similar definition of the state of senile dementia is the previously mentioned senile dementia, senile insanity or senile dementia, the symptoms of which arise against the background of age-related changes occurring in the structure of the brain. Such changes occur within neurons; they arise as a result of insufficient blood supply to the brain, the impact on it caused by acute infections, chronic diseases and other pathologies discussed by us in the corresponding section of our article. Let us also repeat that senile dementia is an irreversible disorder that affects each of the areas of the cognitive psyche (attention, memory, speech, thinking). As the disease progresses, all skills and abilities are lost; It is extremely difficult, if not impossible, to acquire new knowledge during senile dementia.

Senile dementia, being among the mental illnesses, is the most common disease among older people. Senile dementia occurs almost three times more often in women than in men. In most cases, the age of patients is 65-75 years, on average, in women the disease develops at 75 years, in men - at 74 years.
Senile dementia manifests itself in several varieties of forms, manifesting itself in a simple form, in a presbyophrenic form and in a psychotic form. The specific form is determined by the current rate of atrophic processes in the brain, somatic diseases associated with dementia, as well as factors of a constitutional-genetic scale.

Simple form characterized by inconspicuousness, occurring in the form of disorders generally inherent in aging. In acute onset, there is reason to believe that pre-existing mental disorders were aggravated by one or another somatic disease. There is a decrease in mental activity in patients, which is manifested in a slowdown in the pace of mental activity, in its quantitative and qualitative deterioration (implying a violation of the ability to concentrate attention and switch it, its volume is narrowed; the ability to generalize and analyze, to abstract and in general weakens imagination is impaired; the ability to be inventive and resourceful in solving problems that arise in everyday life is lost).

All in to a greater extent a sick person adheres to conservatism in terms of his own judgments, worldview and actions. What happens in the present tense is viewed as unimportant and not worth attention, and is often completely rejected. Returning to the past, the patient primarily perceives it as a positive and worthy example in certain life situations. Characteristic feature becomes a tendency to edify, intractability bordering on stubbornness and increased irritability arising from contradictions or disagreement on the part of the opponent. Interests that previously existed are significantly narrowed, especially if they are in one way or another connected with general questions. Increasingly, patients focus their own attention on their physical condition, in particular this applies to physiological functions (i.e. bowel movements, urination).

Patients also have a decrease in affective resonance, which is manifested in an increase in complete indifference to what does not directly affect them. In addition, attachments weaken (this even applies to relatives), and in general, understanding of the essence of relationships between people is lost. Many people lose their modesty and sense of tact, and the range of shades of mood is also subject to narrowing. Some patients may show carelessness and general complacency, sticking to monotonous jokes and a general tendency to joke, while other patients are dominated by dissatisfaction, pickiness, capriciousness and pettiness. In any case, the patient’s past characterological traits become scarce, and awareness of the personality changes that have arisen either disappears early or does not occur at all.

The presence of pronounced forms of psychopathic traits before the disease (especially those that are sthenic, this concerns power, greed, categoricalness, etc.) leads to their aggravation in manifestation at the initial stage of the disease, often to a caricatured form (which is defined as senile psychopathization ). Patients become stingy, begin to accumulate rubbish, and they increasingly make various reproaches towards their immediate environment, especially regarding irrationality, in their opinion, of expenses. Also subject to censure on their part are the morals that have developed in public life, especially with regard to marital relations, intimate life etc.
Initial psychological changes, combined with the personal changes that occur with them, are accompanied by memory deterioration, in particular this applies to current events. They are usually noticed by those around the patients later than the changes that have occurred in their character. The reason for this is the revival of past memories, which is perceived by the environment as a good memory. Its decay actually corresponds to the patterns that are relevant for a progressive form of amnesia.

So, first, memory associated with differentiated and abstract topics (terminology, dates, titles, names, etc.) comes under attack, then a fixation form of amnesia is added here, manifesting itself in the form of an inability to remember current events. Amnestic disorientation regarding time also develops (i.e., patients are unable to indicate a specific date and month, day of the week), and chronological disorientation also develops (the inability to determine important dates and events, linking them to a specific date, regardless of whether such dates relate to personal life or public life). To top it off, spatial disorientation develops (manifests itself, for example, in a situation where, when leaving home, patients cannot return back, etc.).

The development of total dementia leads to impairment of self-recognition (for example, when viewing oneself in reflection). Forgetting the events of the present is replaced by the revival of memories relating to the past, often this can concern youth or even childhood. Often, such a substitution of time leads to the fact that patients begin to “live in the past,” while considering themselves young or children, depending on the time in which such memories occur. Stories about the past in this case are reproduced as events relating to the present time, while it is not excluded that these memories are generally fiction.

The initial periods of the course of the disease can determine the mobility of patients, the accuracy and speed of performing certain actions, motivated by random necessity or, conversely, by habitual performance. Physical insanity is observed already within the framework of an advanced disease (complete collapse of behavior patterns, mental functions, speech skills, often with relative preservation of somatic function skills).

In severe forms of dementia, the previously discussed states of apraxia, aphasia and agnosia are noted. Sometimes these disorders manifest themselves in a sharp form, which may resemble the course of Alzheimer's disease. Possible few and isolated epileptic seizures, similar to fainting. Sleep disorders appear, in which patients fall asleep and get up at an unspecified time, and the duration of their sleep ranges from 2-4 hours, reaching an upper limit of about 20 hours. In parallel with this, periods of prolonged wakefulness may develop (regardless of the time of day).

The final stage of the disease determines for patients the achievement of a state of cachexia, in which an extreme form of exhaustion occurs, in which there is a sharp weight loss and weakness, decreased activity in terms of physiological processes with accompanying changes in the psyche. In this case, the characteristic feature is the adoption of the fetal position when the patients are in a drowsy state, there is no reaction to surrounding events, and sometimes muttering is possible.

Vascular dementia: symptoms

Vascular dementia develops against the background of previously mentioned disorders that are relevant for cerebral circulation. In addition, as a result of studying the brain structures of patients after their death, it was revealed that vascular dementia often develops after a heart attack. To be more precise, the point is not so much in the transfer of this condition, but in the fact that because of it a cyst is formed, which determines the subsequent likelihood of developing dementia. This probability is determined, in turn, not by the size of the cerebral artery that has been damaged, but by the total volume of the cerebral arteries that have undergone necrosis.

Vascular dementia is accompanied by a decrease in indicators relevant for cerebral circulation in combination with metabolism, otherwise the symptoms correspond to general flow dementia. When the disease is combined with a lesion in the form of laminar necrosis, in which glial tissue grows and neurons die, serious complications may develop (vascular blockage (embolism), cardiac arrest).

As for the predominant category of people who develop vascular form dementia, then in this case the data indicate that this predominantly includes persons aged 60 to 75 years, and one and a half times more often these are men.

Dementia in children: symptoms

In this case, the disease, as a rule, appears as a symptom of certain diseases in children, which may include mental retardation, schizophrenia and other types of mental disorders. This disease develops in children with a characteristic decrease in mental abilities, which manifests itself in impaired memorization, and in severe cases, difficulties arise even with remembering one’s own name. The first symptoms of dementia in children are diagnosed early, in the form of prolapse certain information from memory. Further, the course of the disease determines the appearance of disorientation within the framework of time and space. Dementia in children early age manifests itself in the form of loss of skills previously acquired by them and in the form of speech impairment (up to its complete loss). The final stage, similar to the general course, is accompanied by the fact that patients stop taking care of themselves; they also lack control over the processes of defecation and urination.

Within childhood dementia is inextricably linked with oligophrenia. Oligophrenia, or, as we previously defined it, mental retardation, is characterized by the relevance of two features relating to intellectual defect. One of them is that mental underdevelopment is total, that is, both the child’s thinking and his mental activity. The second feature is that with general mental underdevelopment, the “young” functions of thinking are most affected (young - when considering them on a phylo- and ontogenetic scale); insufficient development is determined for them, which makes it possible to associate the disease with oligophrenia.

Intellectual disability of a persistent type, developing in children after the age of 2-3 years against the background of trauma and infections, is defined as organic dementia, the symptoms of which manifest themselves due to the collapse of relatively formed intellectual functions. Such symptoms, due to which it is possible to differentiate of this disease from oligophrenia, include:

• lack of mental activity in its purposeful form, lack of criticism;
• pronounced type of memory and attention impairment;
• emotional disturbances in a more pronounced form, not correlating (i.e. not associated) with the actual degree of decline in intellectual abilities for the patient;
• frequent development of disorders relating to instincts (perverted or increased forms of desire, performance of actions under the influence of increased impulsiveness, weakening of existing instincts (instinct of self-preservation, lack of fear, etc.) is not excluded);
• Often the behavior of a sick child does not adequately correspond to a specific situation, which also happens if a pronounced form of intellectual disability is irrelevant for him;
• in many cases, the differentiation of emotions is also subject to weakening, there is a lack of attachment in relation to close people, and the child’s complete indifference is noted.

Diagnosis and treatment of dementia

Diagnosis of the patient’s condition is based on a comparison of the symptoms that are relevant to them, as well as on the recognition of atrophic processes in the brain, which is achieved through computed tomography(CT).

Regarding the issue of treating dementia, now effective way There is no cure, particularly when considering cases of senile dementia, which, as we have noted, is irreversible. Meanwhile, proper care and the use of therapeutic measures aimed at suppressing symptoms can, in some cases, seriously alleviate the patient’s condition. The need for treatment is also discussed here. concomitant diseases(with vascular dementia in particular), such as atherosclerosis, arterial hypertension etc.

Treatment of dementia is recommended within the home environment, hospitalization or psychiatric department relevant for severe disease development. It is also recommended to create a daily routine so that it includes a maximum active work when periodically performing household duties (with an acceptable form of load). Purpose psychotropic drugs is performed only in case of hallucinations and insomnia; in the early stages it is advisable to use nootropic drugs, then - nootropic drugs in combination with tranquilizers.

Prevention of dementia (vascular or senile form its currents), as well as effective treatment of this disease is currently excluded due to the practical absence of appropriate measures. If symptoms indicating dementia appear, it is necessary to visit specialists such as a psychiatrist and a neurologist.

– acquired dementia caused by organic brain damage. It may be a consequence of one disease or be of a polyetiological nature (senile or senile dementia). Develops in vascular diseases, Alzheimer's disease, trauma, brain tumors, alcoholism, drug addiction, central nervous system infections and some other diseases. Persistent intellectual disorders, affective disorders and decreased volitional qualities are observed. The diagnosis is made based on clinical criteria And instrumental studies(CT, MRI of the brain). Treatment is carried out taking into account the etiological form of dementia.

General information

Dementia is a persistent disorder of higher nervous activity, accompanied by the loss of acquired knowledge and skills and a decrease in learning ability. There are currently more than 35 million people suffering from dementia worldwide. The prevalence of the disease increases with age. According to statistics, severe dementia is detected in 5%, mild – in 16% of people over 65 years of age. Doctors assume that the number of patients will increase in the future. This is due to increased life expectancy and improved quality medical care, which makes it possible to prevent death even in cases of severe injuries and diseases of the brain.

In most cases, acquired dementia is irreversible, so the most important task of doctors is timely diagnosis and treatment of diseases that can cause dementia, as well as stabilization of the pathological process in patients with acquired dementia. Treatment of dementia is carried out by specialists in the field of psychiatry in collaboration with neurologists, cardiologists and doctors of other specialties.

Causes of dementia

Dementia occurs when there is organic damage to the brain as a result of injury or disease. Currently there are more than 200 pathological conditions that can provoke the development of dementia. The most common cause of acquired dementia is Alzheimer's disease, accounting for 60-70% of total number cases of dementia. In second place (about 20%) are vascular dementias caused by hypertension, atherosclerosis and other similar diseases. In patients suffering from senile dementia, several diseases that provoke acquired dementia are often detected at once.

In young and middle age, dementia can occur with alcoholism, drug addiction, traumatic brain injury, benign or malignant neoplasms. In some patients, acquired dementia is detected due to infectious diseases: AIDS, neurosyphilis, chronic meningitis or viral encephalitis. Sometimes dementia develops when serious illnesses internal organs, endocrine pathology and autoimmune diseases.

Classification of dementia

Taking into account the predominant damage to certain areas of the brain, four types of dementia are distinguished:

• Cortical dementia. The cortex is predominantly affected cerebral hemispheres. It is observed in alcoholism, Alzheimer's disease and Pick's disease (frontotemporal dementia).
• Subcortical dementia. Subcortical structures suffer. Accompanied by neurological disorders (trembling limbs, muscle stiffness, gait disorders, etc.). Occurs in Parkinson's disease, Huntington's disease and white matter hemorrhages.
• Cortical-subcortical dementia. Both the cortex and subcortical structures are affected. Observed in vascular pathology.
• Multifocal dementia. Multiple areas of necrosis and degeneration form in various parts of the central nervous system. Neurological disorders are very diverse and depend on the location of the lesions.

Depending on the extent of the lesion, two forms of dementia are distinguished: total and lacunar. In lacunar dementia, the structures responsible for certain types intellectual activity. Short-term memory disorders usually play a leading role in the clinical picture. Patients forget where they are, what they planned to do, what they agreed on just a few minutes ago. Criticism of one’s condition is preserved, emotional and volitional disturbances are weakly expressed. Signs of asthenia may be detected: tearfulness, emotional instability. Lacunar dementia is observed in many diseases, including initial stage Alzheimer's disease.

With total dementia, there is a gradual disintegration of the personality. Intelligence decreases, learning abilities are lost, and the emotional-volitional sphere suffers. The circle of interests narrows, shame disappears, former moral and moral standards. Total dementia develops with space-occupying formations and circulatory disorders in the frontal lobes.

The high prevalence of dementia in the elderly led to the creation of a classification of senile dementias:

• Atrophic (Alzheimer's) type– provoked by primary degeneration of brain neurons.
• Vascular type– defeat nerve cells occurs secondarily due to impaired blood supply to the brain due to vascular pathology.
• Mixed type– mixed dementia - is a combination of atrophic and vascular dementia.

Symptoms of dementia

The clinical manifestations of dementia are determined by the cause of acquired dementia and the size and location of the affected area. Taking into account the severity of symptoms and the patient’s ability to socially adapt, three stages of dementia are distinguished. For dementia mild degree the patient remains critical of what is happening and of his own condition. He retains the ability to self-service (can do laundry, cook, clean, wash dishes).

With moderate dementia, criticism of one's condition is partially impaired. When communicating with the patient, a clear decrease in intelligence is noticeable. The patient has difficulty caring for himself and has difficulty using household appliances and mechanisms: cannot answer the phone, open or close the door. Care and supervision required. Severe dementia is accompanied by a complete collapse of personality. The patient cannot dress, wash, eat, or go to the toilet. Constant monitoring is required.

Clinical variants of dementia

Alzheimer's type dementia

Alzheimer's disease was described in 1906 by the German psychiatrist Alois Alzheimer. Until 1977, this diagnosis was made only in cases of dementia praecox (aged 45-65 years), and when symptoms appeared after the age of 65 years, senile dementia was diagnosed. It was then found that the pathogenesis and clinical manifestations diseases are the same regardless of age. Currently, the diagnosis of Alzheimer's disease is made regardless of the time of appearance of the first clinical signs of acquired dementia. Risk factors include age, the presence of relatives suffering from this disease, atherosclerosis, hypertension, excess weight, diabetes mellitus, low motor activity, chronic hypoxia, traumatic brain injury and lack of mental activity throughout life. Women get sick more often than men.

The first symptom is a pronounced impairment of short-term memory while maintaining criticism of one’s own condition. Subsequently, memory disorders worsen, and a “movement back in time” is observed - the patient first forgets recent events, then what happened in the past. The patient ceases to recognize his children, mistakes them for long-dead relatives, does not know what he did this morning, but can talk in detail about the events of his childhood, as if they had happened quite recently. Confabulations may occur in place of lost memories. Criticism of one's condition decreases.

In the advanced stage of Alzheimer's disease, the clinical picture is complemented by emotional and volitional disorders. Patients become grumpy and quarrelsome, often demonstrate dissatisfaction with the words and actions of others, and become irritated by every little thing. Subsequently, delirium of damage may occur. Patients claim that loved ones deliberately leave them in dangerous situations, add poison to their food in order to poison them and take over the apartment, say nasty things about them in order to ruin their reputation and leave them without public protection, etc. Not only family members are involved in the delusional system, but also neighbors social workers and other people interacting with patients. Other behavioral disorders may also be detected: vagrancy, intemperance and indiscriminateness in food and sex, meaningless erratic actions (for example, shifting objects from place to place). Speech becomes simplified and impoverished, paraphasia occurs (the use of other words instead of forgotten ones).

At the final stage of Alzheimer's disease, delusions and behavioral disorders are leveled out due to a pronounced decrease in intelligence. Patients become passive and inactive. The need to take fluids and food disappears. Speech is almost completely lost. As the disease worsens, the ability to chew food and walk independently is gradually lost. Due to complete helplessness, patients require constant professional care. Death occurs as a result of typical complications (pneumonia, bedsores, etc.) or the progression of concomitant somatic pathology.

The diagnosis of Alzheimer's disease is based on clinical symptoms. Treatment is symptomatic. Does not currently exist medicines and non-drug methods that can cure patients with Alzheimer's disease. Dementia progresses steadily and ends with complete collapse of mental functions. The average life expectancy after diagnosis is less than 7 years. The earlier the first symptoms appear, the faster the dementia worsens.

Vascular dementia

There are two types of vascular dementia - those that arose after a stroke and those that developed as a result of chronic insufficiency of blood supply to the brain. With post-stroke acquired dementia, the clinical picture is usually dominated by focal disorders (speech disorders, paresis and paralysis). The nature of neurological disorders depends on the location and size of the hemorrhage or area with impaired blood supply, the quality of treatment in the first hours after a stroke and some other factors. At chronic disorders blood supply, symptoms of dementia predominate, and neurological symptoms quite monotonous and less pronounced.

Most often, vascular dementia occurs with atherosclerosis and hypertension, less often with severe diabetes mellitus and some rheumatic diseases, even less often - with embolism and thrombosis due to skeletal injuries, increased blood clotting and diseases of peripheral veins. The likelihood of developing acquired dementia increases with illness of cardio-vascular system, smoking and excess weight.

The first sign of the disease is difficulty trying to concentrate, distracted attention, fatigue, some rigidity of mental activity, difficulty planning and decreased ability to analyze. Memory disorders are less severe than in Alzheimer's disease. Some forgetfulness is noted, but when given a “push” in the form of a leading question or offered several answer options, the patient easily recalls the necessary information. Many patients exhibit emotional instability, low mood, depression and subdepression are possible.

Neurological disorders include dysarthria, dysphonia, gait changes (shuffling, decreased step length, “sticking” of the soles to the surface), slowing of movements, impoverishment of gestures and facial expressions. The diagnosis is made based on clinical picture, USDG and MRA of cerebral vessels and other studies. To assess the severity of the underlying pathology and draw up a pathogenetic therapy regimen, patients are referred for consultation to the appropriate specialists: therapist, endocrinologist, cardiologist, phlebologist. Treatment - symptomatic therapy, therapy of the underlying disease. The rate of development of dementia is determined by the characteristics of the leading pathology.

Alcoholic dementia

The cause of alcoholic dementia is long-term (over 15 years or more) abuse of alcoholic beverages. Along with the direct destructive effect of alcohol on brain cells, the development of dementia is caused by impaired activity various organs and systems, gross metabolic disorders and vascular pathology. Characteristics of alcoholic dementia typical changes personality (coarsening, loss of moral values, social degradation) combined with a total decrease in mental abilities (distracted attention, decreased ability to analyze, plan and abstract thinking, memory disorders).

After complete cessation of alcohol and treatment of alcoholism, partial recovery is possible, however, such cases are very rare. Due to the pronounced pathological cravings to alcoholic beverages, decreased volitional qualities and lack of motivation, most patients fail to stop taking ethanol-containing liquids. The prognosis is unfavorable, the cause of death is usually somatic diseases caused by alcohol consumption. Often such patients die as a result of criminal incidents or accidents.

Diagnosis of dementia

The diagnosis of dementia is made when five mandatory features. The first is memory impairment, which is identified based on a conversation with the patient, special research and interviews with relatives. The second is at least one symptom indicating organic brain damage. These symptoms include the “three A” syndrome: aphasia (speech disorders), apraxia (loss of the ability to perform purposeful actions while maintaining the ability to perform elementary motor acts), agnosia (perceptual disorders, loss of the ability to recognize words, people and objects while maintaining the sense of touch , hearing and vision); reducing criticism of one’s own condition and the surrounding reality; personality disorders (unreasonable aggressiveness, rudeness, lack of shame).

The third diagnostic sign of dementia is a violation of family and social adaptation. The fourth is the absence of symptoms characteristic of delirium (loss of orientation in place and time, visual hallucinations and delirium). Fifth – the presence of an organic defect, confirmed by instrumental studies (CT and MRI of the brain). The diagnosis of dementia is made only if all listed signs for six months or more.

Dementia most often has to be differentiated from depressive pseudodementia and functional pseudodementia resulting from vitamin deficiency. If a depressive disorder is suspected, the psychiatrist takes into account the severity and nature of affective disorders, the presence or absence of daily mood swings and feelings of “painful insensibility.” If vitamin deficiency is suspected, the doctor examines the medical history (malnutrition, severe lesions intestines with prolonged diarrhea) and eliminates symptoms characteristic of a deficiency of certain vitamins (anemia with a lack of folic acid, polyneuritis with a lack of thiamine, etc.).

Prognosis for dementia

The prognosis for dementia is determined by the underlying disease. With acquired dementia resulting from traumatic brain injury or space-occupying processes (hematomas), the process does not progress. Often there is a partial, less often a complete reduction of symptoms due to the compensatory capabilities of the brain. In the acute period, it is very difficult to predict the degree of recovery; the outcome of extensive damage can be good compensation with preservation of work ability, and the outcome of minor damage can be severe dementia leading to disability and vice versa.

In dementia caused by progressive diseases, there is a steady worsening of symptoms. Doctors can only slow down the process by providing adequate treatment of the underlying pathology. The main goals of therapy in such cases are maintaining self-care skills and adaptability, prolonging life, providing proper care and eliminating unpleasant manifestations of the disease. Death occurs as a result of a serious impairment of vital functions associated with the patient's immobility, his inability to perform basic self-care and the development of complications characteristic of bedridden patients.

A distinction is made between so-called dementia (from the Latin de - a prefix meaning decline, lowering, downward movement, + mens - mind, reason) - acquired dementia and mental retardation (from the Greek oligos - small in the sense of quantity + phren - thought, mind) - congenital dementia.

Based on the characteristics of the clinical picture, the following types of dementia are distinguished.

Organic dementia- dementia caused primarily vascular diseases brain, syphilitic and senile psychoses, brain injuries. Organic dementia is usually divided into two groups: total (diffuse, global) and partial (dysmnestic, partial, lacunar).

Total dementia is characterized by a persistent decline in all intellectual functions, weakness of judgment, and lack of criticism of one’s condition. An example of this is the so-called senile dementia (see “Psychoses old age”, as well as dementia with progressive paralysis (paralytic dementia - see).

The patient, in the past a very educated and cultured person, without being embarrassed by those present, walks naked around the ward, then approaches the young doctor and invites her to “marry him immediately.” He does not remember the dates of his life, known historical dates. He regards his condition without any criticism, considers himself to be quite healthy, and explains the fact of his stay in the department of a psychiatric hospital with the desire to “take a break from business in this nice environment.”

Partial (dysmnestic) dementia characterized, as the name itself shows, pronounced violations memory. The remaining intellectual functions suffer mainly secondarily, since the “entrance gate of the intellect,” as memory is sometimes called, is disrupted. Such patients retain the ability to judge and have a critical attitude towards their condition. It is difficult for them to learn new things, but old knowledge, especially professional, well-established knowledge, can be retained for quite a long time. Due to their critical attitude towards themselves, such patients understand their situation, try to avoid conversation in which they could detect memory disorders, constantly use a notebook, and write in advance what they need to say or do.

A typical picture of such partial dementia can be observed with cerebral atherosclerosis or syphilis of the brain.

By International classification diseases (10th revision) the following types of dementia are distinguished: dementia due to Alzheimer's disease; vascular dementia; dementia in Pick's disease, Huntington's disease, Parkinson's disease, AIDS, etc.; unspecified dementia.

Acquired dementia also includes schizophrenic and epileptic dementia.

Schizophrenic dementia, also called apathetic or atactic, is characterized by intellectual inactivity, lack of initiative, while the prerequisites for mental activity are still long time may be preserved. That is why the intelligence of such patients is compared to a closet, full of books that no one uses, or with a musical instrument that is locked and never opened.

A 22-year-old young man lies motionless in bed all day long, showing no interest in anything and doing nothing. He doesn’t pick up books and is completely indifferent to the most interesting television program. At the same time, one day he unexpectedly walked up to the chess table and beat a very strong chess player. Subsequently, he continued to do nothing, and was indifferent to numerous offers to play chess.

Epileptic dementia is expressed not only in a significant decrease in memory, but also in a peculiar change in thinking, when a person begins to lose the ability to distinguish between the main and the secondary; everything seems important to him, all the little things seem significant. Thinking becomes viscous, unproductive, pathologically detailed, the patient cannot express his thoughts in any way (it is not for nothing that epileptic thinking is sometimes called labyrinthine). Also characteristic is a narrowing of the range of interests, focusing exclusively on one’s condition (concentric dementia).

A 36-year-old patient, suffering from epilepsy since childhood, reports in detail, with many details, about her condition: “So, then I went, walked, and in front of me was a door, well, I grabbed the handle, grabbed it and pushed, and there was another the grandmother was standing, she had woolen socks and size forty shoes...”, etc. The patient made this entire long speech in order to inform the doctor about the appearance of seizures after hitting her head with a door. Memory is sharply reduced, the woman uses a small number of words, often using stereotyped expressions and rhymes, willingly uses diminutive words: “little eyes”, “little hands”, “sister”, “little bed”. She is completely occupied with herself, interested in those around her insofar as it has something to do with her.

Oligophrenia is a hereditary, congenital or acquired dementia in the first years of life, expressed in general mental underdevelopment with a predominance primarily of an intellectual defect and, as a result, difficulty in social adaptation.