The senile dementia Is a mental illness suffered by people over 65 years and characterized by loss of cognitive functions.
It is considered a disorder that begins gradually, progressively evolves and is chronic.
However, by properly detecting and intervening the disease, its evolution can be attenuated or slowed down and, thus, provide more years of Life to the old man who suffers it.
This article will be devoted to discussing the different types of senile dementia, explaining their characteristics and mentioning what therapeutic treatments Can be performed.
Characteristics of senile dementia
Senile dementia is a syndrome characterized by deterioration of cognitive functions, with a gradual and progressive onset, and that is capable of affecting Activities of the patient's daily life.
The"senile"specification in the term dementia was used to differentiate between those patients over 65 years of age suffering from a dementia syndrome and Those who present it more precociously.
This distinction between senile dementia and dementia is important because the risk of developing this disease increases as the Age, doubling by two from the age of 65.
Also, it should be noted that the term dementia does not refer to a single disease but to a syndrome that can be caused by many diseases Chronicles, such as Alzheimer disease , Parkinson's disease, vitamin deficiencies, etc.
However, dementias should not be classified as those disorders in which only memory loss is present, there are no other cognitive deficits and The daily activities of the patient are not affected.
Thus, dementia must be differentiated from age-related cognitive impairment (DECAE), which is a relatively benign phenomenon and is linked To the normal aging of the brain.
Thus, if in a person of about 80 years we observe that he has less memory than when he was young or that he is a little less agile mentally, this does not Means that you have to suffer from dementia, you can have a simple normal aging of your functions.
Similarly, senile dementia has to be differentiated from mild cognitive impairment (MCI).
The DCL would be an intermediate step between DEMAE and dementia, since there is a higher cognitive impairment than would be considered normal in the Aging, but lower than that in dementia.
Thus, in order to speak of dementia, at least two conditions must be present:
There must be multiple cognitive deficits, both in memory (memory and learning) and in other cognitive functions (language, attention, Problem solving, apraxia, agnosia, calculation, etc.).
These deficits have to cause a significant alteration in the social and work functioning of the patient, and they have to imply a deterioration Important of the previous cognitive level.
Cognitive symptoms of senile dementia
In senile dementia, a large number of cognitive deficits may appear.
In each case, depending on the type of dementia that is Part of the brain Affected, some functions will be better preserved and others will be Will be further deteriorated.
However, the development of senile dementia is progressive, so as time passes, dementia will spread through the brain as if Was an oil stain, so all functions will be affected sooner or later.
The cognitive functions that can be altered are:
1. Memory
It is usually the most common symptom in most dementia syndrome. You may start with difficulty learning new information and forgetting things Recent
As the disease progresses, memories of past events are also affected, to the point of forgetting important events and Nearest relatives
2. Orientation
It usually appears in the early stages of many types of dementia, and like all other functions, as time goes by they are losing Practically all orientation skills.
Usually start with problems to remember the day or the month in which you are. Later you may lose the ability to orient yourself on the street, Not remember the year in which you live or forget your own identity.
3. Attention
There are some types of dementia where attention deficits are very noticeable.
In them the person has many difficulties to concentrate or even attend something for just a few seconds.
4. Language
Patients with dementia may have problems speaking, such as anomia when they do not remember the name of certain words or Verbal fluency when they speak more slowly.
5. Gnosias
Dementia also alters the ability to recognize external stimuli through any stimulatory pathway: visual, tactile, auditory, olfactory... In Advanced stages, this difficulty may lead the patient not to recognize the face of their relatives or even theirs when reflected in a mirror.
6. Praxias
The ability to coordinate movements is altered. A person with dementia may not be able to move their hands properly to pick up scissors and Cut out a sheet of paper.
7. Executive Functions
Dementias also lose the ability to plan and organize activities. For example, to boil rice you have to take a pot, pour Water, boil it and pour the rice. A person with Dementia may not be able to perform this mental exercise.
8. Logical reasoning
Finally, one of the skills that is often lost in the middle phases of all types of dementia is the ability to construct logical thoughts Autonomously for any event or activity.
Psychological symptoms
Usually cognitive deficits do not appear in isolation, and are accompanied by a series of psychological symptoms that cause much discomfort both in The patient as in their caregivers.
As a specific psychological symptomatology we can find:
1. Delirious Ideas: It is present in 10% and 73% of cases of Dementia. The most common idea is that of"someone steals things,"which may be due to
Inability to remember precisely where objects are stored.
2. Hallucinations The frequency of this perceptual alteration is between 12 and 49% in patients with dementia. The Visual hallucinations Are the most frequent, Especially in the Dementia by Lewy bodies .
3. Errors of identification: Is another perception disorder. In this case, the person with dementia may believe that people living in the home live who are not Of the ghostly guest) or not recognize their own reflection in a mirror and believe that it is someone else's.
4. Depressive mood: Depressive symptoms affect a not insignificant minority of patients with dementia at one time or another of the disease (20-50%).
5. Apathy The lack of motivation develops in practically half of the patients with dementia. These symptoms are often confused with depression.
6. Anxiety: A common manifestation of anxiety in dementia is"Godot's syndrome." This is characterized by asking repeated questions about an event Coming due to the inability to remember that you have already asked and have already answered. The patient believes he never gets a response and increases his anxiety.
Likewise, in some cases of dementia, behavioral symptoms are also observed, such as: physical aggression, vagrancy, restlessness, agitation, Crying, crying or foul language.
What types of dementia are there?
Dementia is like an oil spot, begins to affect a part of the brain, causing certain symptoms, and then spreads By all the cerebral areas, causing a greater number of deficits and eliminating all the capacities of the person.
However, there are different types of dementia. Each type begins by affecting a different area of the brain and causes particular deficits. Further, Each of them seems to have different mechanisms of appearance and evolution.
Depending on the brain area that affects each dementia, they can be divided into two groups: those dementias that affect the upper parts of the brain (Cortical dementias) and those affecting the deeper parts (subcortical dementias).
Senile Cortical Dementias
1. Alzheimer's Dementia (DSTA)
It is the demential syndrome par excellence, which affects a greater number of people and the one that has originated a greater number of investigations. Is Considered the prototype of cortical dementias.
DSTA is characterized by the beginning of a deterioration of memory, diminishing the capacity of learning, and presenting frequent forgetfulness and problems of orientation.
Later, other cortical symptoms appear, such as agnosia, aphasia , Apraxia and deterioration of executive functions.
The onset of this dementia is very gradual and the evolution is slow and progressive.
2. Dementia by Lewy bodies (DCL)
It is a type of dementia very similar to Alzheimer's , Cognitive deficits are practically matched to those of the DSTA and have a very early onset and evolution similar.
It differs basically by 3 aspects: to present a greater alteration of the attention and fluctuations in the cognitive deficits, to suffer symptoms Parkinson's of tremor and slow movements, and frequent hallucinations.
3. Frontotemporal degeneration (FFT)
It is a particular dementia that predominantly affects the frontal lobe, a fact that makes its first symptoms are extravagant behavioral changes, Amnesia and early apraxia, and severe alterations in speech and movement.
Subcortical senile dementias
1. Parkinson's disease (PD)
The main feature of the Parkinson's Is the progressive death of dopaminergic neurons, which causes dysfunction in the movement, causing tremor, bradykinesia And stiffness.
Likewise, it can cause cognitive deficits such as thought and movement impairment, dysfunction of the ability to perform and deterioration of the Evocation memory (inability to retrieve stored information).
2. Vascular Dementia (DV)
DV is a complex disorder in which the symptoms of dementia result from vascular problems affecting the blood supply brain.
Its symptoms can be of any type, depending on the area of the brain that have damaged vascular diseases.
3. AIDS dementia complex
It is affected by about 30% of people affected by HIV . Serious deficits in attention and concentration, difficulties in acquiring and remembering Information, and alterations in denomination and verbal fluency.
Apart from these commented, there are other less frequent dementias such as corticobasal degeneration, Huntington's disease , Supranuclear palsy Progressive, normotensive hydrocephalus, dementias of endocrinometabolic origin, etc.
How many people have dementia?
The overall prevalence of Dementia ranges from 5% to 14.9% in the entire Spanish population
From the age of 65 the prevalence increases to almost 20% and at 85 years it reaches 40%, so that the cases of dementia increase with the age.
Of all types the most prevalent is Alzheimer's followed by vascular dementia and dementia by Lewy bodies.
How can they be treated?
Nowadays, the treatment of senile dementias does not allow to eradicate the disease but to reduce the cognitive deterioration and to provide the maximum Quality of life to patients.
Pharmacotherapy
There is no drug capable of curing a dementia syndrome, however, drugs accelicolinesterase inhibitors such as tarcine, Galantamine or the Rivastigmine Can have a neuroprotective effect and contribute in the slowing of the evolution of the disease.
Likewise, psychological symptoms such as hallucinations, depression or anxiety can be treated with different psychotropic drugs such as Antipsychotics , Antidepressants Y Anxiolytics .
Psychological treatment
Therapies have been proposed in 4 different areas:
1. Cognitive area : In order to maintain the patient's abilities and to curb the evolution of the deficits, it is very important to carry out cognitive stimulation activities in the To work memory, attention, language, executive functions, etc.
2. Psychosocial area: It is important that the patient conserve hobbies, perform activities such as assisted therapy with animals or music therapy to increase their well-being.
3. Functional: P To maintain its functionality, it is advisable to carry out trainings in meaningful and daily activities.
4. Motor: People with dementia often suffer from deterioration of their physical abilities. Keep them in shape with passive gymnastics, physical therapy or Psychomotricity is fundamental.
Thus, senile dementia is a disorder that gradually fades the brain of the person who suffers it, however, one can work for Provide you with the greatest possible comfort during the course of the illness.
References
- Baquero, M., Blasco, R., Campos-García, A., Garces, M., Fages, E. M., Andreu-Català, M. (2004). Descriptive study of behavioral disorders in mild cognitive impairment. Rev neurol; (38) 4: 323-326 .
- Martí, P., Mercadal, M., Cardona, J., Ruiz, I., Sagristá, M., Mañós, Q. (2004). Non-pharmacological intervention in dementias and Alzheimer's disease: miscellaneous. In J, Deví., J, God, Dementias and Alzheimer's disease: a practical and interdisciplinary approach (559-587). Barcelona: Higher Institute of Psychological Studies.
- Martín, M. (2004). Antipsychotic drugs in the treatment of psychiatric symptoms of dementias. Psychiatric Information, 176.
- Martínez-Lage, P. (2001) Cognitive impairment and dementias of vascular origin In A. Robles and J. M. Martinez, Alzheimer's 2001: theory and practice (Pp. 159-179). Madrid: Aula Médica.
- McKeith I, Del-Ser T, Spano PF, et al (2000). Efficacy of rivastigmine in dementia with Lewy bodies: a randomized, double-blind, placebo-controlled international study. Lancet ; 356: 2031-36.
- Obeso J.A., Rodríguez-Oroz M.C., G. Evolution of Parkinson's disease. (1999). Actual problems. In:"Neuronal death and Parkinson's disease". J.A. Obeso, C.W. Olanow, A.H.V. Schapira, E. Tolosa (editors). Adis. Madrid, 1999; Chap. 2, pp. 21-38.
- Rodríguez M, Sánchez, JL (2004). Cognitive reserve and dementia. Annals of Psychology, 20: 12.
- Slachevsky, A., Oyarzo, F. (2008). Dementias: history, concept, classification and clinical approach. In E, Labos., A, Slachevsky., P, Fuentes., E, Manes., Treaty of Clinical Neuropsychology. Buenos Aires: Akadia.