Dementia in the elderly: symptoms, treatment

Senile dementia is one of the most serious diseases affecting older people. Often a person exposed to it becomes dangerous to others and himself. Treatment of senile dementia involves maintaining the condition stable without deterioration; it is impossible to completely recover from this disease. This is why it is so important to notice the first signs in the early stages. Symptoms may gradually increase or appear suddenly. In any case, the patient needs constant monitoring. In this article we will look at the signs of senile dementia: early and late symptoms, different forms of the disease and concomitant age-related diseases.

Another name is dementia. This is a mental disorder with impaired cognitive activity, as well as the psycho-emotional sphere. People who are over 68 years old are susceptible to it; the first signs always make themselves felt before the age of 70.

What is dementia

Signs of dementia (dementia or senile dementia) are a phenomenon in which the patient develops deficits in several areas of life, such as memory, ability to concentrate and make decisions, and interaction with the environment.

The term dementia indicated that with age, the natural occurrence of increasingly intensified memory disorders, difficulties in performing complex activities or generally accepted independent functions.

Currently, views on this problem vary - it is noted that dementia is not directly related to old age itself, but when it becomes highly intense, it only indicates that the elderly person has problems with dementia.

Dementia is a relatively common problem and its prevalence in the population is expected to increase.

According to WHO, 50 million people suffer from senile dementia in the world, and, according to its estimates, by 2030 the number of people with dementia will reach over 80 million, and by 2050 - over 150 million!

What medications are prescribed

Medication therapy is considered the most effective and basic method in the treatment of dementia. Often it is this that helps correct the symptoms of the disease.

There are several groups of drugs for the treatment of dementia, including:

1. Antidepressants.
2. Sedatives.
3. Neuroleptics.

Antidepressants

Intended for the treatment of depression, panic, anxiety, impotence and apathy. They can be prescribed by a doctor at the initial stage of the disease.

The table provides a small list of possible drugs for the treatment of dementia in older people:

It is important to understand that these medications cannot be taken without a doctor’s recommendation , as they have a number of side effects and can also be dangerous for older people in delirious states.

Sedatives

Often the course of the disease is accompanied by sleep disturbances or its complete absence , the occurrence of phobias and fears, hallucinations and delusional states.

The drugs given in the table below will help correct or mitigate this situation:

Before using any of the listed drugs, consultation with a specialist is necessary .

Causes of dementia

The causes of senile dementia are very different - the most often mentioned among them are the following:

• Alzheimer's (this disease is the most common cause of dementia),
• Dementia with Lewy bodies,
• Vascular dementia
• Frontotemporal dementia,
• Mixed dementia (in which features of Alzheimer's dementia coexist with signs of vascular dementia).

Less common causes of dementia include Parkinson's disease, hydrocephalus, Creutzfeldt-Jakob disease, and central nervous system syphilis.

Dementia also has reversible causes - examples include:

• vitamin B12 deficiency,
• hypothyroidism,
• Lyme disease,
• depressive disorders,
• tumors of the central nervous system.

Risk factors

The main risk factor for senile dementia is age; the older the person, the higher the risk of developing dementia. However, other causes that contribute to senile dementia are also mentioned. The most common of them:

• smoking,
• alcohol consumption (excessive amounts),
• hypertension (especially untreated or insufficiently treated),
• unhealthy diet (poor nutrition),
• lipid disorders,
• lack of physical activity,
• overweight and obesity.

Symptoms of dementia

Dementia is usually an evolving process in which the patient gradually develops more and more signs of dementia, such as symptoms such as:

• memory impairment (for example, the patient may ask the same question several times, even if he has already received the answer),
• difficulties with learning new information,
• feeling of alienation (in places well known to the patient),
• forgetfulness of words
• progressive loss of interest and apathy.

Of course, symptoms of dementia become much more obvious later in life.

Among them may be:

• feeling of loss (even in your own home),
• difficulty remembering anything (this can even apply to family members),
• increasing difficulties in communicating with other people,
• a change in behavior consisting of increasingly frequent appearance, irritability or even aggression.

In the later stages of senile dementia, people actually become unable to live independently, which leads to:

• significant disorientation (the patient may not know where he is or what date it is),
• difficulties in performing various motor activities (for example, using cutlery, or walking),
• increased behavioral disorders.

It should be immediately emphasized that there is no single, specific pattern of symptoms of dementia - depending on its cause, patients may suffer from different diseases.

For example, in patients with Alzheimer's disease, memory impairment is the most obvious, while in the case of frontotemporal dementia, its main symptoms are changes in behavior and difficulties in communicating with the environment.

Late manifestations

They are expressed more clearly and are very noticeable to others.

Amnestic phenomena

Memory impairment can manifest itself in different ways. Someone forgets why they came into the room or the kitchen, but attributes this to simple forgetfulness, without attaching serious importance. Some people have a severely impaired sense of time and orientation; people cannot remember what date it is today, and they do not recognize places that have been familiar to them since childhood. Later, they stop remembering new faces or forget the faces of those with whom they communicate every day. In some cases, the patient does not recognize his own face when he sees it in the mirror. It is important to note that it usually takes 15-20 years from mild memory loss to complete memory loss. If you notice the first signs and consult a doctor who will prescribe medications for senile dementia, this will help you avoid severe changes.

Depression of mental activity

Dementia is always accompanied by speech and cognitive disorders. They also progress gradually, at first the affected person gets confused in his thoughts, then forgets how to hold a pen and write with it, and cannot add simple numbers in his head. There is a learning disability, disturbances in the order of habitual actions, and then an inability to perform basic everyday manipulations. Often people are embarrassed by this and hide it from others, as a result of which loved ones mistake a dangerous disease for simple absent-mindedness.

Emotional changes

Emotional disorders manifest themselves individually, largely depending on the patient’s psychotype. Depression and apathy are associated with the fact that people understand the inevitability of change and realize the complexity of their situation. They strive to protect themselves from others so as not to get into awkward situations and not be a burden. Unreasonable outbursts of aggression often occur. As a rule, all previously inherent features are enhanced. For example, if frugality was characteristic, dementia increases it to stinginess. Indifference becomes a common symptom; it is against this background that loved ones begin to notice other symptoms and signs of senile dementia in older men and women.

Physical aspects

A decrease in neural connections in the brain leads to a decrease in physical activity, the explanation being that the coordination centers of motor activity are affected. Patients cannot make precise movements and often fall and get injured. They can no longer move long distances, as the body is exhausted and weakened. Physical weakness only increases emotional deviations.

Social life

The need to communicate with people begins to weaken after early signs appear. In later stages, people completely refuse to contact anyone. If they somehow express their thoughts, this does not mean that they are communicating. Most often this is simply self-expression, not aimed at third parties. With dementia, a person can talk to non-existent characters, react emotionally to them, ask himself questions and answer them. They often talk calmly about death, even expressing their desire to die in order to get rid of the difficulties that have arisen. During this period, a person susceptible to dementia becomes dangerous to himself and those around him.

Accompanying illnesses

If it is possible to notice late symptoms of senile dementia, treatment and how long they live with such deviations depend on the presence of concomitant diseases. This mental disorder is rarely the only one; the conditions that usually accompany it are listed below.

Alzheimer's disease

It affects more than 60% of patients with dementia. The condition worsens gradually; on average, thought processes slow down by 5% every year. The most significant manifestations are observed in memory; it can deteriorate rapidly, with true memories being replaced by false ones. A characteristic feature of Alzheimer's: while storing new memories, old ones are repressed, and later new ones are also forgotten.

An additional symptom that follows from the others is speech impairment, arbitrary pronunciation of words and phrases, repetition of the endings of the interlocutor’s phrases, or the inability to correctly reproduce a complex phrase. Problems arise with coordination of movements, this is a characteristic sign. With this form, life expectancy is reduced by at least several years.

Vascular dementia

Develops due to discirculatory encephalopathy in patients over 60 years of age. The same manifestations are present as in classical dementia, such as loss of orientation in space and memory, inability to care for oneself, and isolation. Physiological ailments are added, such as dizziness, headaches, nausea and vomiting. Increased meteosensitivity and short-term memory loss are possible, all of this is caused by vascular dysfunction.

With Lewy bodies

It is rare and has features that are not typical for other forms. The first sign is the appearance of colorful dreams; they can be pleasant or scary. Behavior changes in the first phase of sleep, patients make sudden movements and may fall out of bed. After awakening, they do not understand where they are and who surrounds them, how they got to this place. When awake, slowness and severe fatigue become noticeable after performing simple tasks. The phase of loss of strength may be replaced by increased activity, but it does not last long. Usually, apathy and indifference return by evening.

Parkinson's disease

It is also associated with senile dementia; in approximately 5% of cases it is accompanied by Parkinson's disease. Symptoms develop after 70 years of age in patients who have a genetic predisposition. Manifests itself in limb tremors during activity and at rest, muscle tension. Muscle tissue can be so tight that it makes it difficult to perform activities. Due to coordination problems, gait changes.

Frontotemporal degeneration

This deviation is characterized by early onset of symptoms, at the age of under 50 years. The cause is genetic predisposition. The symptoms are: rudeness in speech and attitude towards others, antisocial behavior, the appearance of riskiness and uncompromisingness, a complete lack of feelings of shame and embarrassment. Eating habits may change greatly; a desire to eat or chew something inedible may appear.

In this case, there are no movement disorders, and normal orientation in space is maintained. Those susceptible to frontotemporal degeneration move freely and continue to do their work, remember people’s faces, remember dates and some facts, and do not experience high fatigue. This is a significant difference from the classical form. The frontal lobe of the brain is characterized by damage, while vascular dementia creates numerous lesions in different parts.

Huntington's disease

It appears at an earlier age, up to 30 years. It develops very rapidly, memory and orientation are impaired, but these are not the main signs. First, the manner of movement changes, all actions become more abrupt, difficulties appear in maintaining a stationary position, involuntary muscle contractions lead to the appearance of grimaces on the face. Then aggression or apathy towards everything may appear, the most dangerous of the manifestations being hallucinations. An accurate diagnosis can only be made after a genetic examination.

Diagnosis of the disease

Tools used as screening tests for the diagnosis of dementia are the MMSE (Mini-Mental State Examination) and the Clock Drawing Test.

The first is basically a short 30-item questionnaire used to screen for dementia. Once completed, the patient's score is added—when the MMSE score is below 24, which may indicate the patient has dementia, suggesting a more definitive diagnosis is needed.

The clock drawing test involves asking the patient to draw a clock face on a piece of paper, write the numbers corresponding to the following hours on it, and finally mark the time on the clock. In this case, many factors are important, such as the shape of the dial itself, the placement of numbers on it, and how the subject marks the time.

In situations where screening tests and their results indicate that a patient may have dementia, additional tests are usually ordered. In this case, first of all, an analysis should be carried out that will confirm or exclude the presence of certain pathologies in the patient that are reversible causes of dementia.

In this case, laboratory tests (for example, to determine the level of thyroid hormones or vitamin B12) can be ordered or privately performed.

Computed tomography or magnetic resonance imaging is also important for diagnosing dementia - they can not only detect other reversible causes of dementia (for example, brain tumors), but also find abnormalities characteristic of other causes of this pathology (an example is frontotemporal dementia , where atrophy may occur in the frontal and temporal lobes of the brain).

As a rule, a patient who discovers signs of dementia consults a neurologist, but sometimes he needs to consult with other specialists.

This need arises because ultimately not only neurological symptoms, but also those considered by other specialists, can lead to senile dementia. An example is depression, which is a psychiatric problem. Its development can also cause symptoms of dementia.

Aggression in patients with dementia

Dementia refers primarily to cognitive impairment: problems with memory, self-care, and thinking. However, dementia often leads to the development of psychiatric disorders, one of which is aggression. Aggression in patients with dementia can occur at any stage and manifest itself in a variety of forms.

Reasons for aggression

Long before the first manifestations of aggression, symptoms of inappropriate behavior arise:

• ordinary frugality turns into stinginess, the patient hides money, can destroy it, not trust loved ones and at the same time easily succumb to the deception of scammers;
• suspicion, the formation of obsessions and delusions;
• fear, fear of intrigue, conspiracies of others aimed at causing harm to the health and life of the patient, which is often accompanied by refusal to take medications and food (fear of poisoning);
• excessive and inappropriate sexual activity.

From a medical point of view, aggressiveness in dementia develops due to the massive death of neurons, the loss of neuronal connections, leading to a gradual change and disintegration of the personality. Individual character traits are erased, fear and negativism appear, accompanied by emotional outbursts.

The frequency of manifestation of a particular psychotic disorder often depends on the type of dementia. Atherosclerotic cerebrovascular disease and psychosis, for example, are considered related. One of the pathologies in which aggression occurs most often is Alzheimer's disease.

Aggression in the structure of psychotic disorders in Alzheimer's disease Type of psychotic disorder Prevalence among patients, % Time before/after diagnosis, months.

Aggression in dementia can take a verbal form: swearing, cursing, threats, raising the voice to the point of screaming, or it can be expressed physically - an increased tendency to get into fights, biting, scratching, etc.

With dementia, even previously calm and non-aggressive people exhibit aggressive behavior. The reason for this is unmet needs or unsuccessful attempts to express one’s thoughts and desires.

Patients with dementia, along with healthy members of society, need emotional communication and comfort.

Aggressive dementia can occur for biological, social, and psychological reasons. The first include:

• pain syndrome;
• disease;
• physical discomfort (hunger, constipation, forced posture);
• the appearance of external sound and visual stimuli (noise, light);
• taking certain medications, side effects of therapy;
• hallucinations, delusions requiring an aggressive response;
• visual and auditory disturbances, loss of spatial orientation, when a person is unable to independently realize his desires.

The second group includes forced loneliness, cessation of social connections, inaction, attempts to hide symptoms from others, lack of trust in loved ones, and sensory deprivation.

Psychological factors that provoke aggression include ignoring the patient’s opinion, violation of his rights, incorrect assessment on the part of the patient of the actions of caregivers, the threat of invasion of personal space (help from strangers in performing hygiene procedures).

Strangers and unknown environments also provoke aggression.

Attacks of aggression during dementia can also appear because a person lives in his own reality: he believes that he must perform certain actions (pick up a child from kindergarten, take a walk in the park, make tea), but they try to interfere with him or do the work for him.

Dementia, depression and psychosis are also inextricably linked. Feelings of loneliness and abandonment often push the patient to act aggressively.

How to deal with aggression with dementia

Psychiatric symptoms are stable: in most cases, appearing at an early stage of the disease, they persist for at least three years. Therefore, caregivers need to know how to prevent and deal with aggression.

It is important to understand here that aggression in older people with dementia is not a manifestation of the patient’s character, but a natural consequence of the disease. Aggressive actions are directed at others only because they are the ones nearby.

It is not the patient’s attitude towards people that changes, but his reaction to reality. The patient is unable to control himself, since aggression arises due to irreversible changes in the brain matter.

Learning to work with this is difficult at first, so caregivers are advised to remember the following, already proven techniques.

Prevention of aggressive behavior

Typically, aggressive behavior is preceded by the same situations. It is important to identify a pattern here - this will help you learn to predict the occurrence of aggression. Often the patient begins to become irritated under the following conditions:

• stress or fear when unable to perform normal activities;
• the need to accept outside help when performing intimate procedures;
• dissatisfaction of loved ones with respect to mistakes and blunders that the patient makes when performing simple everyday tasks;
• disorientation (in a noisy public place, when guests arrive) also causes excessive nervousness;
• physical discomfort, including fatigue.

The sooner relatives understand what exactly the patient is reacting to aggressively, the faster and more effectively they will be able to prevent psychosis in dementia.

It is necessary to come to terms with the fact that a person is no longer able to cope with everyday life and ordinary affairs. Even the most obvious things now require a lot of thought for him due to a change in perception, and this should also be responded to calmly. The less negativity the patient feels, the less aggression will manifest itself.

Senile dementia and psychosis require delicate assistance in everyday life and in the implementation of hygiene procedures. You cannot criticize a person with dementia; you should, if possible, avoid situations that indicate his weakness. When the first signs of irritability, restlessness, fear, or anxiety appear, you should immediately distract the person with his favorite activity.

Relatives of a person with dementia must also take care of themselves: defiant behavior negatively affects caregivers, devastates them, and encourages depressive thoughts.

This, in turn, is felt by the patient and reacts to the patients’ dissatisfaction with another emotional outburst.

A vicious circle is formed, from which you can only get out of it by regularly restoring your strength after each incident and not holding back stress within yourself. This can be realized by visiting a psychologist or even just talking with friends.

During an attack of aggression

The response of a caregiver or loved one must be thought out and rehearsed in advance, so that the symptoms of aggression in older people with dementia will not take them by surprise.

If the attack turns out to be a surprise, you should not give in to the first impulse to respond. You need to take a deep breath, take a few steps away from the person and slowly count to ten.

Often by this moment the patient has already forgotten about what is happening or calms down.

Important! Any appropriate response only makes the situation worse. You cannot make accusations, lose your temper, or show resentment or negativity.

It is advisable to distract the patient from the situation and move the conversation to another topic. Since dementia is accompanied by attention problems, this maneuver is often successful. You should demonstrate friendliness, understanding, acceptance of the patient’s condition, and a willingness to help.

Restriction of mobility during a surge of aggression often leads to tension in the situation, increased negative emotions, and aggravation of the condition. Therefore, this measure should be carried out only in extreme cases, when rampant dementia goes too far and the patient is capable of causing harm to himself or others.

After the attack

The most pointless thing to do after an attack of aggression is to show dissatisfaction, refuse communication, or try to “put” the patient in his place. As a rule, the latter already forgets about what happened and does not understand the demonstration of resentment.

Therefore, you should pretend that nothing special happened. If attacks occur too often, cause concern, or have excessively violent manifestations, you need to contact a psychiatrist who deals with dementia patients.

Important! Aggression often occurs as a side effect of certain medications used to treat symptoms of dementia. Therefore, you need to think about whether the sudden increase in attacks is a consequence of the use of medications.

Drug treatment

Since aggression often occurs due to illness, pain, or physical discomfort, a patient with dementia should regularly visit doctors in order to prevent chronic diseases. If caregivers cannot independently understand what triggers the attack, they should consult a psychiatrist.

The main drugs used to treat aggression in dementia are risperidone and aripiprazole.

The use of antipsychotics to relieve attacks of aggression in dementia Characteristics of the drug Risperidone Aripiprazole

Senile dementia and aggression require attention and care from others.

Drug treatment is not always the best way out of this situation, since sedatives solve the consequences, but not the problem, and often affect the patient’s consciousness, aggravating other symptoms.

You should resort to pharmacological therapy only if all other methods of correcting aggressive behavior have already been exhausted. But even in this case, it is necessary to constantly monitor the development of dementia and, if possible, use more gentle methods.

High-quality treatment of the underlying disease reduces the risk of psychosis. Treatment of aggression in dementia with antipsychotics worsens the course of dementia, especially cognitive status. Among people using antipsychotics, the mortality rate is a quarter higher than among patients using other drugs.

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Source: https://demenciya.ru/demenciya/agressiya-pri-dementsii/

Dementia treatment

Accurate diagnosis in cases of suspected dementia is important, first of all, because the treatment of senile dementia can vary greatly depending on what exactly is responsible for its occurrence.

Sometimes it is found that leveling out existing abnormalities leads to the disappearance of dementia disorders - this is the case in patients with hypothyroidism or vitamin B12 deficiency, in whom adding and leveling out the deficiencies of the substances they are missing can lead to the disappearance of symptoms of dementia.

Surgery is sometimes used for people with Hakim-Adams syndrome, in whom the use of a ventricular valve, which drains excess cerebrospinal fluid inside the skull, can lead to partial resolution of the disease's symptoms.

For the most common forms of dementia, such as Alzheimer's disease, pharmacological treatment is used. With this disease, patients are recommended to use drugs from the group of acetylcholinesterase inhibitors, which can improve their condition by increasing the amount of one of the neurotransmitters - acetylcholine.

However, it should be emphasized here that this type of treatment does not cancel existing changes and disorders, but only slows down the rate of progression of the disease. For this reason, it is important that a patient who is suspected of having dementia consults a doctor as soon as possible. The earlier treatment is started, the greater the chance that the patient will be able to function independently for as long as possible.

Caring for older people with dementia

In the early stages, it is enough to remind older people of the need to perform hygiene procedures and other routine actions, and monitor the quality of food. Later, assistance in performing these actions and complete control over their lives is required. It is necessary to create safe conditions, keep the patient away from potentially dangerous areas and objects: the balcony, the kitchen, the gas stove, knives, household chemicals. It is equally important to monitor the intake of prescribed medications for the treatment of senile dementia. Medicines should not be left freely available; a person may forget to take them or take them several times and end up with an overdose.

In the later stages, loved ones are forced to take on all the care, since it is no longer possible to independently meet the needs. With quality care and proper treatment, you can live up to 20 years with senile dementia. The prognosis depends on concomitant pathologies and compliance with doctor’s recommendations.

Prevention

Is it possible to prevent the development of dementia, Alzheimer's disease, etc.? This is one of the most difficult questions that many scientists constantly face. It is believed that protective factors may include following a Mediterranean diet, eating fish, nuts, or regular and frequent exercise. However, there is no complete certainty that this will be enough.

It is simply impossible to completely prevent dementia - there is nothing we can do about the main risk factor for its occurrence, which is old age. However, it is emphasized that maintaining a generally healthy lifestyle can minimize the chances of developing dementia.

In this case, it is important to avoid stimulants such as cigarettes or large amounts of alcohol. You can also reduce the risk of senile dementia with the help of a balanced diet that provides us with all the necessary nutrients, as well as regular physical activity. It is also worth maintaining the correct, optimal weight.