Generality
Senile dementia is a neurodegenerative disease of the brain, which affects elderly people and causes a gradual and irreversible reduction of the cognitive faculties.
There are various types of senile dementia. The main and most famous types are: Alzheimer's disease, vascular dementia and dementia with Lewy bodies.
Initially, it produces occasional personality problems, slight problems with memory, language and reasoning, etc.
At an intermediate stage, it is responsible for a worsening of memory problems, the decline of part of the cognitive faculties, etc.
Finally, at an advanced stage, it is a reason for: total loss of cognitive abilities, difficulty swallowing, inability to recognize loved ones, etc.
At present, senile dementia is an incurable disease. As a support to patients, only symptomatic therapies exist.
What is senile dementia?
Senile dementia is the medical term that indicates a group of neurodegenerative diseases of the brain, typical of old age and characterized by a gradual - and almost always irreversible - reduction of a person's cognitive faculties.
Senile dementia falls into the broader category of dementias .
Dementias are neurodegenerative diseases of the brain, which can affect older people and younger people, and which lead to a progressive decline of an individual's cognitive faculties.
A collection of general information on dementia is present here and here.
WHAT IS NOT?
Doctors are keen to point out that, although they determine very similar manifestations, senile dementia and the so-called cognitive decline linked to old age are two different medical conditions.
In fact, cognitive decline linked to advanced age - also known as cognitive impairment in old age - is a normal involution process that the brain encounters during aging.
This involution process involves: a gradual reduction in brain volume, the loss of several neurons and an inefficient transmission of nerve signals.
TYPES OF DENY SEED
The main neurodegenerative diseases of the brain, which refer to "senile dementia", are:
- Alzheimer's disease or Alzheimer's disease . Alzheimer's disease can also affect young, thirty-year-olds. In these situations, the disease is known as juvenile Alzheimer, probably has genetic causes and is not among the forms of senile dementia.
Readers who wish to learn more about the subject can click here, under "What is Alzheimer's disease?".
- Vascular dementia . For further information, we recommend the article presented here, by consulting the "What is vascular dementia?"
- Dementia with Lewy bodies . Readers interested in learning more can click here (referring to "What is dementia with Lewy bodies") and here (for the definition of Lewy bodies).
OLD MEANING OF DEEMENT IN SENILE
At one time senile dementia was an alternative term for Alzheimer's disease.
Subsequently, with the discovery of other forms of dementia typical of old age, and with the identification of a form of juvenile Alzheimer, the term senile dementia has taken on a slightly different meaning, reported in the initial definition.
Epidemiology
Epidemiological data relating specifically to senile dementia do not exist.
However, it is possible to draw some interesting conclusions from the numerous statistical studies concerning the broader category of dementias
According to these studies, dated 2010, there are about 36 million demented people around the world.
Of these 36 million:
- 3% are between 65 and 74 years old, 19% are between 75 and 84 years old and more than half are aged 85 or over.
- 6.8 million live in the United States. More than half of these people with dementia are over eighty.
- 750, 000-800, 000 live in the UK.
- 50-70% suffer from Alzheimer's disease, 25% vascular dementia, 15% dementia with Lewy bodies and the remaining percentage are affected by other forms of dementia.
As a result of the lengthening of the average life span of human beings, experts believe that the number of people with senile dementia will increase gradually.
As regards dementia in general, some forecasts state that, by 2020, the world number of dementia will reach around 48 million.
In Italy, people with a form of dementia are about 1.5% of the population over 65 and more than 30% of the population over 80 years.
SOME CURIOSITIES
Around the senile dementia there are various myths and false beliefs.
To have a clearer and more truthful idea of this neurodegenerative disease, the reader can consult the photo gallery present here.
Causes
The precise causes of senile dementia are still unclear. To make it difficult to study and understand is the structural complexity of the brain.
At the moment, the only certain data, with regards to the triggering factors, is that senile dementia is the consequence of two events: the death of brain nerve cells and / or their malfunctioning at the level of intercellular communication (ie the communication existing between the cell and cell).
HYPOTHETICAL CAUSES: PROTEIN AGGREGATES AND CEREBROVASCULAR PROBLEMS
Studying the various types of senile dementia mentioned above, the researchers have made some important findings and have hypothesized, for these, a possible causal role.
As far as Alzheimer's disease and dementia with Lewy bodies are concerned, these findings consist of the so-called protein aggregates, ie protein aggregates based outside and / or within brain neurons.
The idea of scholars is that these aggregates interfere with the normal functioning of neurons, causing, in some situations, even death.
Proteins making up the protein aggregates include: APP (or amyloid beta precursor protein), tau protein and alpha-synuclein . APP and tau protein characterize Alzheimer's disease, while alpha-synuclein distinguishes dementia with Lewy bodies.
As far as vascular dementia is concerned, the findings that could somehow explain the onset of the disease consist in vascular alterations (that is to say in the blood vessels), found in the brain.
According to scholars, these alterations would affect the normal cerebral blood flow, all with serious consequences for the nervous tissue of the brain.
At the origin of cerebral vascular alterations there may be episodes of stroke omini-stroke, the so-called small blood vessel disease or atherosclerosis .
Insights into the causes
To explore the causes and risk factors of the various types of senile dementia, the reader can consult the articles present here (by clicking on "Risk factors"), here (by clicking on "Causes of vascular dementia") and here (by clicking under the heading "Causes of dementia with Lewy bodies").
Symptoms
The symptoms and signs of senile dementia undergo gradual deterioration, which is strictly dependent on the progressive death of brain nerve cells.
Generally, the symptomatological evolution of senile dementia is a three-stage path: initial, intermediate and advanced.
At the initial stage, the most characteristic manifestations consist of:
- Small short-term memory problems (usually amnesia);
- Sporadic personality changes;
- Occasional lack of judgment;
- Slight difficulties in language, calculation, reasoning and understanding of new concepts;
- Tendency to passivity and lack of initiative.
In the intermediate stage, the most common symptoms and signs are:
- Clear loss of part of cognitive skills, from reasoning and learning skills to judgment skills;
- Worsening of short-term memory problems;
- Long-term memory problems;
- Aggravation of language difficulties;
- Visual problems, from the inability to recognize colors and read to that of quantifying approximately a distance;
- Space-time confusion (or disorientation), with the patient struggling to realize where he is, to say with certainty the day of the week etc;
- Difficulties in daily life, even in the most trivial activities;
- Mild emotional instability.
Finally, at an advanced stage, the typical disorders consist of:
- Total or almost total loss of cognitive abilities;
- Inability to care for one's own person, therefore problems with eating, washing, etc .;
- Inability to recognize loved ones;
- Difficulty swallowing;
- Loss of control of bowel and bladder function (incontinence);
- Loss of motor control, with the patient walking less and less.
It is important to point out that each type of senile dementia has some specific symptomatology.
For example, those suffering from Alzheimer's disease may also manifest: unusual aggression, agitation, depression, insomnia and / or disappointment.
Those with vascular dementia may experience hallucinations and a series of disorders depending on the brain area affected by vascular changes.
Finally, patients with dementia with Lewy bodies can highlight problems similar to those with Parkinson's disease (ie curved gait, shuffling steps, etc.).
Insights
More information on the symptomatology of the various types of senile dementia are present here (under "Symptoms"), here (under "Symptoms, signs and complications") and here (under "Symptoms, signs and complications").
CAUSES OF DEATH
If dementia is the cause of death, in most cases swallowing disorders are fatal . In fact, these disorders contribute to the development of inhalation (or aspiration) pneumonia .
DURATION OF THE COGNITIVE DECLINE
The duration of gradual cognitive decline depends on the type of senile dementia in place.
For example, Alzheimer's disease typically takes between 7 and 10 years to completely impair cognitive abilities; after which it causes death.
Vascular dementia acts differently from patient to patient: in some subjects, the decline is very rapid (a few years); in other subjects, however, it is decidedly slower.
Finally, dementia with Lewy bodies shows a cognitive decline that reaches its peak within 7 years.
Diagnosis
Not being able to count on a specific test to diagnose dementia, doctors resort to a long series of very different tests that evaluate the conditions in which the patient is exposed and allow the exclusion of different diseases with similar symptoms (NB: this way of proceeding, by exclusion, is known as differential diagnosis).
The diagnostic evaluations used include:
- A thorough physical examination .
It consists in the analysis of symptoms and signs reported or manifested by the patient. Although it does not provide any certain data, it represents an obligatory and often rich passage of useful diagnostic information.
- Analysis of clinical history .
It consists in investigating: how and when the symptoms made their first appearance; if the patient suffers or has suffered in the past from other particular pathologies; if the patient takes drugs, etc.
- A complete neurological examination .
It consists of the analysis of tendon reflexes, motor skills (balance, etc.) and sensory functions.
- A cognitive and neuropsychological examination .
It consists of the study of behavior, memory skills, language skills and the faculty of reasoning.
- Nuclear magnetic resonance (NMR) and computerized axial tomography (CT), both referred to the brain.
They are two diagnostic imaging procedures that allow us to assess the health of the brain. In fact, they are able to highlight any processes of atrophy of the cerebral cortex (typical of Alzheimer's disease) or possible cerebrovascular alterations (typical of vascular dementia).
- Laboratory tests .
They consist of: blood tests, blood glucose measurements, urine tests, toxicological tests, cerebrospinal fluid analysis and, finally, measurement of thyroid hormones.
Their execution is important from the point of view of differential diagnosis.
Treatment
At present, senile dementia is a condition that doctors can only treat from the point of view of symptoms, as they have not yet discovered a specific treatment, able to stop neurodegeneration and regress its consequences (ie the reduction of the cognitive faculties).
The various types of symptomatic therapy available to patients with senile dementia include:
- Drugs . The best known and prescribed are acetylcholinesterase inhibitors and memantine, a pharmacological preparation that acts on the glutaminergic system.
The administration of other medicines depends on the type of senile dementia in place.
For example, vascular dementia involves the use of antihypertensives and anticoagulants (to cope with cerebrovascular problems), while dementia with Lewy bodies involves the use of levodopa (to counteract problems of a Parkinsonian nature).
Other potentially useful drugs and pharmaceutical preparations are: antidepressants, antipsychotics and antioxidant vitamins.
For further details on some drugs to be taken in the presence of senile dementia, the reader is advised to click here (Alzheimer's drugs).
- Physiotherapy
- Occupational therapy
- Behavioral therapy
- Language therapy
- Cognitive stimulation.
To learn more about the aforementioned treatments, the reader can consult the articles presented here and here and click, in both cases, under "Therapy".
DIET AND STYLE OF LIFE
Several research teams are trying to figure out if diet and lifestyle affect senile dementia.
In this case, they are testing whether, in some way, the type of diet and regular physical activity are able to slow down the neurodegenerative process induced by Alzheimer's disease, etc.
To know some details of this research, readers should be redirected to the dedicated articles, present here (diet and physical activity) and here (physical activity).
Prognosis
Given the impossibility of treating it specifically and the inexorable neurodegeneration it causes, senile dementia inevitably has a negative prognosis.
Prevention
Several scientific studies have shown that there are some strategies to postpone the appearance of senile dementia. Relevant information can be found here under "Prevention".
