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Psycology » Psychiatry and psychotherapy » Late-onset psychosis » Alzheimer disease

ContentPsychosis later age:
- Presenile (involution) psychoses atrophic brain diseases: - Senile dementia of Alzheimer's type - Alzheimer's Disease - Pick's disease - Parkinson's disease and Huntington's chorea borderline disorders in later life

Alzheimer's disease - primary degenerative dementia endogenous starting at presenile age and is characterized by progressive memory impairment, speech, intelligence with the outcome in the total gross disorders dementia higher cortical functions (speech, praxis, optical spatial perception) - Afat-aprakto-agnostic dementia.

The first description of the disease was given by Alzheimer (1906). Woman, aged, diseased '51, detect memory impairment observed in further violation of orientation in space, speech disorders and the growing loss of skills. Gradually developed total dementia: the patient became helpless, untidy, she formed contracture, and four and a half years the death occurred. In the study of the brain A. Alzheimer first discovered except abundant senile plaques characteristic neurofibrillary changes, and later became known as Alzheimer's neurofibrillary changes.

In accordance with modern neuromorphological data at an early stage of the disease characteristic neurohistological changes are found only in the hippocampus, amygdala and adjacent cortex of the temporal lobes. In moderate dementia in the next step celebrated defeat posterotemporal and parietal cortex, the angular gyrus rear. In the final stage of severe dementia in the painful process involved and the frontal lobes of the brain (A. Brun, I. Gustafson, 1976, 1993).

Prevalence. According to a multicenter study indicators for age groups 60-69 years, 70-79 years, 80-89 years, female population in the UES were respectively 0.4, 3.6, 11.2%, and male - 0.3, 2, 5, 10%. In Moscow (data SI Gavrilova, 1995), the frequency of Alzheimer's disease is 4.4%. The ratio of female patients to male patients is on different data from 3:1 to 5:1.

Clinical manifestations. In most cases, the disease begins between the ages of 45 to 65 years, rarely celebrated debut earlier (about 40 years) or higher (over 65 years). The initial symptoms are signs of a gradual development of memory impairment. Appear absent-mindedness, forgetfulness, patients forget to put this or that thing, sometimes not immediately recall the name of this or that subject. In the early years of the disease is characterized senilnopodobnye features: stupidity, restlessness, excessive talkativeness. Memory disorders progress from a more complex and abstract to a more simple, concrete, from later acquired and weakly attached to the previously acquired and more permanent fixture material. Lost the ability to form new connections. Violations due to memorization fixation amnesia resemble picture Korsakov syndrome, but develop against incremental dementia. This leads to difficulties fixing past experience and amnestic disorientation phenomena in the environment, the time sequence of events. Simultaneously suffers ability to selective reproduction of the desired material at the moment. Materials memory, its reserves are destroyed in the sequence of more new connections to the old. Patients forget your address, place of residence, calling his previous address, etc. In advanced cases, they can not give any information about yourself.

With the progression of mental disorders occur in parallel disorders of attention and perception. Visual, auditory, tactile perception is becoming less clear, obscure, remain scattered, unconnected to one. Instead of a real recognition of the situation appear more often false recognition, although there is no such express "shift the situation in the past," as in senile dementia. Only at the final stage of the disease false recognition reach an extreme degree, so that patients do not recognize themselves in the mirror, take their picture for a stranger can communicate with him, argue ("symptom mirror"). Unlike senile dementia amnestic syndrome in Alzheimer's disease is not accompanied by such a marked revival of past experience, these phenomena do not occur, and there are always scarce, fragmented, and there are no manifestations of "senile delirium." Very rarely occur confabulation (only slowly progressing cases). The main clinical feature - is the leading role of memory disorders. Characterized by the appearance of special loss, affective disorders (confused and depressed affect). Typical of early Alzheimer's disorder orientation as manifest violation of praxis. Patients like "unlearn" sew, cut, cook meals, wash and iron. Loss of skills is a harbinger of future apraxia, as well as violations of orientation - the future agnosia. Symptoms that in the early stages of the disease are special, but typical symptoms of dementia, psychotic symptoms, and then develop into more specific neurological, ie focal symptoms. Early orientation disorder turn into distinct optically-agnostic disorders. Loss of skills, general stupidity are then transformed into more specific aprakticheskuyu symptoms. Such dynamics is observed in the motility and behavior of patients. Motor recovery and fussiness in the future become the basis for the development of more monotonous activities, acquire the character of monotony, made rhythmic, something patients tinder crumple rhythmically nod, bend and unbend hand, etc. (Go to the simpler forms of movement disorders with neurological basis in pathology).

At the same time, many patients have long-lasting feeling of well-known changes (sometimes surprising statements of patients, "no memory", "brains are not", etc.).

Disintegration of speech. Features of dynamics coincide with the pathology of memory. Disintegration of speech is as of a higher and less attached to the sides of the speech function more simple primitive. In the early stages of the disease is marked by speaking the fuzziness of individual words (dysarthria), then the decay process leads to the appearance of sensory aphasia (88%), with almost the same frequency found aphemia (78%).

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