Dementia – senile dementia

With age, the functions of the central nervous system, such as memory and intelligence (cognitive functions), weaken. This occurs both due to involutional processes in the brain, and due to dysfunction of organs and systems (such as cardiovascular, excretory, digestive). In most older people, these changes do not go beyond normal, generally accepted functioning. But approximately every tenth elderly person develops more severe disorders, which leads to a loss of working capacity, social and everyday independence. This condition is defined as dementia (or dementia).

In modern society, thanks to and development of science, medical knowledge and the general progress of civilization, human life expectancy has increased. So, according to some data, the average life expectancy in Russia in the 19th century was 32 years, in the USSR in the 30s – 44 years, in the 60s – 69 years, in the 80s – 70 years. Currently, the average life expectancy is about 65 years, while women live longer than men by an average of 12 years. In connection with the increase in life expectancy, the prevalence, severity and social significance of persistent cognitive impairment leading to disability is growing.

The development of dementia currently poses a challenge to the patient’s relatives, his immediate environment and social services, as well as the health care system. The progression of cognitive impairment leads to isolation of the patient from society and placement in specialized institutions (nursing homes, psychiatric clinics, neuropsychiatric boarding schools, etc.). An increase in the number of patients with dementia leads to a decrease in the proportion of the working population, which is most relevant in our country, since there is a tendency to reduce life expectancy (compared to developed countries) and increase mortality among middle-aged people.

Among the main causes of dementia, it is possible to identify not the aging of the brain, but many diseases that cause continuous, single or multifocal damage to the cortex and subcortical structures of the brain. There are several main causes of dementia: primary dementia is associated with degenerative diseases (for example, Alzheimer’s disease), secondary dementia is associated with complications of diseases such as stroke, infections, alcoholism, trauma, cancer, cardiovascular disease. There are also mixed forms of dementia.

Regardless of the causes of dementia, its manifestations consist in a global decrease in cognitive functions that disrupt social functioning (decreased attention, intelligence, memory, behavioral disorders in which episodes of aggression, anxiety, lack of self-service, etc.) are possible.

In our country, the diagnosis of dementia is at a low level, often violations are detected quite late, because either relatives try to compensate patients for lost social and household functions, or older people, living alone, are not of particular interest to others or become victims of criminal acts. Late diagnosis limits the ability of medicine to provide timely and sufficient assistance. You need to see a doctor at the first sign! There are modern drugs and algorithms for the treatment of patients with dementia, proven and verified in international studies.

As for individual families in which patients with dementia are identified, the situation sometimes comes to a standstill. So, for example, if an elderly person in the family falls ill, then the relatives face a difficult choice: to organize care at home, or to shift it onto the shoulders of the state. In the first option, organizational difficulties are possible, since relatives mainly work and it is impossible to organize assistance to the patient 24 hours a day.

In the second variant, the manifestation of kindred feelings does not allow sending an elderly person to a psychiatric hospital or psycho-neurological boarding school from the very first days. If we talk about state aid for dementia, then today it is in its infancy: there are huge queues for neuropsychiatric boarding schools, existing geriatric centers cannot cope with a large flow, and psychiatric hospitals are limited in the means for comprehensive care for such patients.

Dementia care is always based on the desire and interest of the patient’s relatives in creating the most comfortable conditions and the fastest help. Today, while maintaining certain conditions (absence of dangerous tendencies: severe aggression, suicidal behavior, decompensation of severe somatic pathology), competent and adequate outpatient care for patients with dementia is possible, including: diagnosis, selection of therapy, organization of qualified care, training of relatives of the patient, monitoring of mental and somatic state.