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Dementia

Table of contents
Dementia
Anamnesis of dementia
Physical inspection
Diagnostic approach
Diagnostic testings of dementia
Further laboratory inspection
Progressing of dementia
Separate types of dementia

Close concepts: dementivny illness, organic brain syndrome (OBS), chronic organic brain syndrome, degenerative disease of a brain (general term), senility (wrong term)

Dementia — the acquired decrease in mental capacities. The diffusion or disseminated damages of a brain are caused a clinical syndrome of reduction of mental abilities. The word "dementia" comes from the Latin roots de (from or from), ment (mind) and ia (morbid condition). This term assumes existence of a disease which negatively influences function of neurons of a brain: The main clinical signs of dementia are oppression of short-term memory and disorientation.

As the reasons of dementia consider numerous and very various diseases. Despite variety of the reasons, clinical displays of dementia are similar. Dementia is not the diagnosis of a disease, but a syndrome which demands establishment of the etiological reason and development of individual treatment planning. Contrary to a popular belief, some diseases which are followed by dementia are curable. At other diseases it is possible with the help of treatment to detain pathological process and to compensate clinical and mental symptomatology.

MAIN DATA

At patients with noted decrease in mental capacity first of all it is necessary to undertake search of potentially curable reasons of dementia. In certain cases early timely diagnosis of these reasons  significantly  improves the forecast. In spite of the fact that many chronic, progressing forms of dementia are incurable, the good forecast is in certain cases possible. Often sick old age with dementia doctors do not pay due attention. They are regarded as "incurable", "senile", "aterosklerotik" which cannot be helped already, and sent to nursing homes where patients are deprived of high-quality medical care. In these conditions incidence and mortality increases. This situation leads to the fact that potentially diagnosed and curable reasons of dementia remain unnoticed.

Dementia meets at geriatric patients (about 15%) more often, though is not an indispensable consequence of aging. Increase among the population of number of people of advanced and senile age increases probability of the address to the doctor of people with disturbances of thinking. About 12% of the population are made by aged people of 65 years and are more senior. From 1900 to 1985 the relative number of persons are more senior than 65 years trebled, and their absolute quantity increased by 7 — 8 times. The similar tendency will probably remain and in the future.

Dementia — the basic mental disease of senile age, is not norm. At healthy elderly people essential oppression of mental capacities usually is not observed. The term "high-quality senile forgetfulness" call only insignificant disturbances of memory which often occur at many people of old age. At dementia extent of disturbance of thinking is incomparable to norm. Functional capacities of a brain are kept at senile forgetfulness, but are lost at dementia.

Use of the term "senility" in relation to dementia at old men is wrong as masks pathology indistinct concept of age norm. Besides, this term assumes irreversibility of a state which is in certain cases curable. Dementia is not a synonym of mental retardation as assumes normal intellectual development during the period previous losses of mental functions. We do not use also the term "organic brain syndrome" as it is not specific. Division of dementia on "dosenilny" and "senile" on the basis of age at which the first symptoms (till 65 flyings appeared and is more senior than 65 years), it is any and senseless from the clinical point of view.

Increase in number of the population of old and senile age in modern society increases interest in geriatrics and the diseases which are followed by intellectual dysfunction. Is available at least 50 established somatic, neurologic and psychiatric  reasons  of dementivny states (tab). The Alzheimer's disease and states reminding it are the most common cause of dementia (for example, a depression, the residual phenomena of an alcoholism, the Peak illness). Besides, it is possible to call a set of other metabolic, traumatic, tumoral and infectious reasons.

 

Dementia reasons. Classification by a pathogeny and curability

 

Dementia reasons potentially curable at specific therapy

Dementia reasons which are a little giving in to treatment

Metabolic

Hypothyroidism and other endocrinopathies

Hypoglycemia and (or) anoxia

Wilson's illness

Traumatic

Subdural hematoma

Damage
brain

Hydrocephaly with normal likvorny pressure

Tumoral

 

Intracranial tumor, primary
or metastatic

Brain complications   of system
tumoral  diseases

Scarce

 

Malignant anemia

Effects of a syndrome  of Vernike —
Korsakova

Deficit of folates

Pellagra

Brain abscess

   Kreyttsfeldt's illness — Jacoba

Tertiary brain syphilis

Hydrocephaly with normal likvorny pressure

Effects    of meningitis and encephalitis  (for example,  herpetic encephalitis)

Meningitis and encephalitis

Subacute bacterial endocarditis

Vascular

 

Dementia because of brain heart attacks
(multiple repeated disturbances of cerebral circulation, on -
example, because of frequent embolisms)

 

Toxic

Alcoholism

 

 

Poisoning with salts of heavy metals

 

Degenerative

 

  Alzheimer's illness,     

Peak illness

Inborn

 

Illness of Gentington

* Such division is a little artificial, some states can go to both groups at the same time.

Approximately 15% of the patients inspected concerning dementia have a disease which potentially gives in to correction by means of pathogenetic therapy. There is a lot of such diseases: a hypothyroidism, pernicious anemia, deficit of folates, an emotional depression, intoxication, hydrocephaly with the normal pressure of liquor, a subdural hematoma, an intracranial tumor, vascular diseases and other forms of insufficiency of functions of bodies (for example, a heart, pulmonary, renal, liver failure). Besides, 74 patients with dementia have states which are partially giving in to drug treatment: syphilis, arterial hypertension (at the patients potentially subject to disturbances of brain (blood circulation) and alcoholism. Thus, more than at 1/3 patients with dementia pathogenetic therapy can be used even if these patients do not manage to be cured completely. Besides, at part of patients at whom it is impossible neither to cure an illness nor to suspend, it is possible to use symptomatic therapy. For example, at patients with multiple disturbances of cerebral circulation it is possible to use symptomatic therapy after the correct correction of diabetes and arterial hypertension. The adequate therapy appointed after correctly made diagnosis can significantly improve quality of life at this category of patients.

After establishment of a pathogeny of a disease the doctor has to inspect carefully the patient to find out an exact cause of illness. It is possible at a combination of careful collecting the anamnesis and clinical inspection using the most modern laboratory methods. Treatment of dementia completely depends on correctness of establishment of the reason of a state and, therefore, is directly connected with quality of diagnosis.



 
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