SENILE DEMENTIA (dementia senilis; synonym senile dementia) — the mental disease arising in old age; it is shown by total weak-mindedness with the dysmnesia developing as the progressing amnesia.
Among mental diseases of an old age of S. of page is one of the most frequent. From 12 to 34,4% of all cases of the mental diseases arising at this age are the share of its share, according to a number of researchers. In process of increase in average life expectancy S.'s frequency of page increases, i.e. the risk of developing of a disease increases with age. Occurs at S. women of page twice-three times more often than at men. By data A. V. Snezhnevsky, at most of patients the disease develops at the age of 60 — 85 years, most often between 68 — 76 years. According to Larsson (T. Larsson) et al., middle age, in Krom begins a disease, at men — 73,4, women have 75,3 years.
The clinical picture
S. of page has several forms — simple, konfabulyatorny, delirious and psychotic.
The simple form begins gradually with the mental disorders inherent to aging (see. Old age, aging, mental disorders ). First of all the personality changes. Gradually the majority inherent to an individual of interests disappears earlier. Events of reality draw attention less and quite often begin to be perceived with a shade of disappointment and even hostility, are regarded as small, passing, not worth mentioning. In the past patients see preferential positive, constantly to it are returned, eulogize. An outlook everything is more limited directly to that, as for the patient.
From the majority the prevailing value is gained by satisfaction of physiological requirements and care of somatic wellbeing: interests of patients concentrate on food, is frequent with aspiration to observance of a certain diet, treatment and self-treatment, departure fiziol. requirements. Former sympathies and affections for persons of the immediate environment weaken and disappear. There is a misunderstanding of the relations existing between people. Egoism develops. Quite often there are no feeling of a step and bashfulness. There is moral coarsening. Such lines, characteristic of an old age, as obstinacy, intractability, rigidity, tendency to contradictions, a capriciousness, are quite often combined with the increased suggestibility. At one patients the discontent, peevishness, peevishness, fault-finding, irony and even a causticity, at others — complacency, euphoria, carelessness, tendency to uniform jokes prevail. The prevailing affective background changes a little. Quite often there is a personal shift — a point of separate characterologic features (psikhopatization), as a rule, those, to-rye represented sthenic traits of character, napr, such as hardness and determination, thrift and economy, commitment and sequence earlier. These properties of the personality become exaggerated and even comical. In some cases there are a suspiciousness and disinhibition of the lowest inclinations — collecting and storage of stuff, vagrancy, the increased sexual excitability, etc. The senile psikhopatization is usually observed when in the past the patient had a psychopathic warehouse of character (see. Psychopathies ). Sometimes at development of senile insanity (see below) a psikhopatization takes the leading place in a wedge, to a picture C. of page and is followed by rather easy decrease in memory or shades its manifestations.
Over time changes of the personality everything more give way to actually mental disintegration, to-ry develops as the progressing amnesia (see) — from more late acquired and less strongly fixed to earlier acquired and strongly acquired, from more difficult (criticism, individual judgments, ability to abstraction etc.) to simpler and automated (last experience and representations, a lexicon etc.). Mental disintegration, by A. V. Snezhnevsky's definition, is followed by loss of ability to establish new connection on the basis of former experience and comes to an end with development of total weak-mindedness (see). The sequence of approach of weak-mindedness is reflected in features of development of disturbances of memory. In the beginning memory on the distracted and differentiated concepts — names, dates, names, terms suffers, i.e. the selective reproduction is broken. Further fixating amnesia joins (see). With its emergence there is an anamnestic disorientation in time in the beginning, including in hronol. the sequences of events of private and public life, and in the subsequent and in the place — patients cannot tell not only about where they are (the city, the home address, etc.), but are not guided also in surrounding directly (do not find the apartment, a bed, a toilet, kitchen etc.) — a space disorientation. Recognition of persons of the immediate environment is broken, them call by others names, usually names of the died relatives. In the most hard cases recognition of own appearance is broken. Such patients, looking at itself in a mirror, ask: «And it that else for the old woman?» can also begin a conversation with reflection, taking it for other person (a symptom of a mirror).
Forgetting the present and recent past, patients remember events of bygone years. At the same time there is a revival of the memoirs relating to long ago past. There is a shift of a situation in the past up to life in the past. Patients consider themselves young and even young. Report about the occupations those years, napr, about study, about in what their parents it are engaged. item. Among data on the facts which were earlier actually there can be fictional facts — ekmnestichesky confabulations (see. Konfabulez ); usually they arise at leading questions. Around and fussy efficiency the domestic psychiatrist S. G. Zhis-lin called a combination of life in the past with the raised speech otklikayemost on the events a senile delirium.
At S. of page there is a clear dissociation between expressed and even very deep weak-mindedness and safety of nek-ry external shapes of behavior, napr, a manner to behave, in particular at a conversation, the correct speech with a sufficient lexicon and live intonations, the pertinent use of ordinary expressions. At the same time hyper expressivity of a mimicry and gestures is often observed. In an onset of the illness there is a dissociation between deep extent of mental disintegration and rather insignificant physical aging. In the subsequent marasmus develops (see).
In nevrol. the status narrowing of pupils, weakening of reaction of pupils to light and convergence, decrease in an animal force, trembling of extremities, the senile gate (tripping, small steps) is noted. Grasp reflexes are quite often noted. Anamnestic aphasia (see) in a varying degree is constant. There can be reduced epileptic seizures reminding faints (see).
In nek-ry cases of far come mental disintegration at S. of page there are focal frustration reminding the frustration observed at Alzheimer's disease (see. Alzheimer disease ), napr, speech stereotypies — disintegration of grammatical structure of the speech, dominance of stereotypic turns, parenthesises, interjections, verbigeration (see. Depressive syndromes), an echolalia (see. Catatonic syndrome ); motor stereotypies — rhythmical percussions by hands, a potiraniye of hands or fingers, the chewing movements; constructive apraxia (see) and agraphia (see. Letter ), i.e. there is S.'s altsgeimerization
of page C. of page disturbances of a rhythm of a dream are inherent, its duration in separate days fluctuates from 2 — 4 to 20 hour; as a rule, it is superficial. Ability to long wakefulness is at the same time observed. The periods of a dream and wakefulness randomly alternate. In a final stage of S. of page there comes the drowsy state.
In an initial stage of S. of page develops cachexia (see). Patients lie in a pose of an embryo, do not react on surrounding, sometimes muffledly mutter something. Oral avtomatizm can be observed (see Reflexes pathological).
Frequency of a simple form C. of page, by data A. V. Snezhnevsky, makes apprx. 5,5% of cases of all diseases of an old age which are followed by weak-mindedness; according to D. Bothschild — about 50% of all cases of S.
of the village Konfabulyatornaya a form (a synonym: the chronic presbiofreniya of Vernike, a presbiofreniye) arises at a complication of a simple form C. of page atherosclerosis of vessels of a brain. The village of Klin is the most softly proceeding form C., the picture is defined is long the existing euphoria in combination with the increased speech activity, sufficient safety of a lexicon, irrepressible fussy efficiency and plentiful ekmnestichesky confabulations. At the same time «life in the past» is most expressed.
S.'s kind of the page complicated by atherosclerosis of small vessels of a cerebral cortex is a considerable part of cases of a disease of Gakkebush — Geyera — Geymanovich (see. Gakkebusha-Geyera-Geymanovicha syndrome ).
Delirious form (synonym: the senile delirium, senile confusion, an acute presbiofreniya) arises at a complication of a simple form C. of page various somatopathies and as a result of disturbances of exchange. It is most often shown by emergence of the reduced delirium poor in hallucinatory, illusory and crazy frustration, or its severe forms — a professional or mussitirutoshchy delirium (see. Delirious syndrome). Occasionally there are frustration inherent Delirium acutum (see).
The psychotic form (a synonym senile insanity) can arise during S. of page in the form of affective, crazy and hallucinatory-dilision frustration (see. Senile psychoses). Frequency of this form, by data A. V. Snezhnev-sky, makes 8,4% of all cases of S. of page
the Aetiology and a pathogeny
Among the reasons causing quick-aging, a certain value belongs to a genetic factor. According to Larsson et al., the risk of a disease of S. of page is 4,3 times higher in families where this disease, in comparison with the general population is observed. For emergence the game-fabulyatornoy of a form C. of page matters existence of cycloid character (see. Psychopathies ). In cases of senile insanity in families of patients patients with endogenous diseases, first of all schizophrenia (see), and persons with a psychopathic warehouse of character, both among probands, and among their relatives come to light. Accession of the acute somatopathy causing exogenous type of reaction (see Bongeffer exogenous types of reactions, t. 10, additional materials), age decrease in intelligence in patol is capable to transform. state, inherent S. of page. The basis of development of S. of page is made by the age involution (aging) of a brain developing in earlier terms and proceeding in more accelerated, than at usual aging. The point of view gains ground, according to S.'s cut of page is natural end fiziol. aging at a dozhivaniye to a certain age; still Shpilmeyer (W, Spielmeyer, 1912) said that each person can have senile dementia if it lives up to the corresponding age. This argument is spoken well by the fact of increase of frequency of S. of page in process of increase in age: up to 65 years the risk of a disease makes 0,12%, from 65 to 75 years — 1,62%, from 75 to 80 years — 2,5%.
At a macroscopic research find opacification and a thickening of covers of a brain, thinning of its crinkles and expansion of furrows, an edema of a brain. The weight of a brain is reduced till 1100 and less. The atrophy takes all brain, but especially gray matter of big hemispheres, is preferential in frontal, temporal and parietal lobes.
At microscopic examination dystrophy of ganglionic cells, their congestion by lipofuscin and fatty regeneration is observed. Sclerous change of nervous cells during the coloring them across Nissl is noted (see. Nisslya method ), wrinkling and their transformation into cells shadows. The depression of cells arising at the same time is most expressed in the third, is more rare in the second and first layers of a cerebral cortex. Existence of senile plaques, quantity is characteristic to-rykh fluctuates from 20 to 60 and more under review. Most often they are found in bark of frontal lobes, an ammonovy horn and subcrustal areas — a thalamus, subthalamic kernels. Quite often at S. of page altsgeymerovsky regeneration of neurofibrilla meets.
the Diagnosis is based on data a wedge, pictures. Differential diagnosis is complicated at differentiation of initial manifestations of S. of page and age mental changes, and also S. of page and the atherosclerotic weak-mindedness arising in old age. Quite often diagnostic difficulties in the first case are allowed only by a catamnesis. The village of the village should distinguish from Alzheimer's disease, especially when it began after 60 years, a psychotic
form C. of page — from before senile psychoses (see), senile functional psychoses; in nek-ry cases carry out differential diagnosis with the schizophrenia demonstrating for the first time in old age.
Sick S. should provide to page leaving and supervision first of all. Use psikhofarmakol. means (for improvement of a dream, elimination of motive concern, is more rare such psikhopatol. frustration as nonsense, depressive affect) shall be limited because such patients easily have lacks of coordination of movements and an obezdvizhennost that worsens S.'s forecast of page. The prevention and timely treatment of intercurrent diseases is necessary.
the Disease steadily progresses and comes to an end with death in a condition of marasmus. The forecast depends on age, in Krom the disease developed. So, if S. of page arose aged apprx. 60 years, then the forecast the worst. After 75 years the disease develops at slow speed. Drift is noted also at senile insanity. S.'s duration of page fluctuates from 7 months to 11 years and more, depends on a form and attending conditions (accession of intercurrent diseases, leaving, a rhythm of life etc.).
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