Dementias represent a group of mental disorders in the etiopathogenesis of which neurodegenerative elements associated with the loss of metabolic, vascular and energetic support predominate.
The cognitive functions usually affected in dementia are: memory, attention, learning ability, orientation, language, calculation, thinking and judgment.
According to the DSM IV TR, the criteria for establishing the diagnosis of dementia are:
The development of several cognitive deficits, including:
– memory impairment (decreases the ability to assimilate new information or to evoke previously learned information).
– at least one of the following:
* aphasia (language disorder)
* apraxia (impairment of the ability to perform purposeful motor activities in a specific sequence in the absence of motor function impairment)
* agnosia (inability to recognize objects in the absence of sensory function impairment)
* disruption of executive functioning (planning, organization, abstraction, sequencing).
The cognitive deficits mentioned above represent a decline from the previous level of functioning. Memory impairment must be present, but sometimes it may not be the predominant symptom.
Alzheimer’s dementia is a degenerative disease with progressive evolution that associates non-cognitive psychiatric complications (anxiety, depression, insomnia, behavioral disorders, delusional ideas, etc.).
Two forms of the disease are distinguished:
Early-onset (under age 60) Late-onset (after age 65)
Among the risk factors involved in the development of Alzheimer’s disease are: genetic vulnerability (beta-amyloid, neurofibrils with abnormalities of chromosomes 4, 9, 14, 21), decrease in acetylcholine (the main neurotransmitter involved in cognition), amplification of glutamate activity, depressive disorder, glucocorticoid therapy, cerebral hypoxia, cerebral vascular alterations of ischemic type, metabolic dysfunction, diabetes mellitus, cardio-metabolic syndrome.
Alzheimer’s disease can present at the onset or during the evolution: apathy 50-70%, agitation 40-65%, anxiety 30-50%, irritability 30-45%, depression 40%, delusional ideas 20-40%, insomnia 20-25 %, hallucinations 5-15%.
Cerebral atrophy changes appear on brain imaging examinations.
The second most common form of dementia in the general population is Vascular Dementia caused by strokes.
Another common form of dementia (15-20%) is Dementia with Lewy bodies which combines the symptoms of Alzheimer’s disease with those of Parkinson’s disease.
Frontotemporal dementia is the 2nd form of dementia in middle-aged patients. The duration of evolution is similar to Alzheimer’s dementia (2-20 years). Clinically, there is a profound alteration of personality and social behavior, affective flattening and early loss of criticism of the disease and one’s own actions.
CT scan shows bilateral frontal and anterior temporal atrophy.
Dementia in Wilson’s disease is characterized by:
Liver damage – ranging from manifestations of acute hepatitis or liver cirrhosis to liver failure. Neurological manifestations: seizures, dystonia, pseudobulbarism, migraines. Psychiatric manifestations: cognitive impairment, depression, insomnia, psychotic spectrum disorders, personality changes. Multisystem manifestations: Kayser-Fleischer eye ring, cardiomyopathies, hypothyroidism, pancreatitis, skin spots, renal function disorders, menstrual disorders.
Detection of the disease is done by ophthalmological evaluation and testing of the copper plasma level, which in patients with manifest disease exceeds 25 μg/dl (the normal level is 10-15 μg/dl).
Dementia from Parkinson’s disease affects 1% of the population over the age of 60. Clinically, it is manifested by the alteration of executive functions, visual dysfunctions and dysfunctions of video-spatial coordination. Memory is relatively preserved in contrast to other forms of dementia. Neuroimaging evaluations reveal bilateral changes in the anterior cingulate cortex and the ventral part of the striatum and unilateral changes in the right caudate nucleus.
Dementia after TBI is rare. The symptomatology begins approximately 6 months after the CBT and associates neurological (hypertonia, paralogies, aphasia) and psychological (akinetic mutism, apalic syndrome, impulsive behavioral disinhibition) symptoms.
There are also partially or completely reversible dementias that occur in: intoxications (alcohol, carbon monoxide, pesticides, trihexyphenidyl, barbiturates, tricyclic antidepressants, lithium, lead, mercury, manganese, digitalis, cocaine), infections (meningitis, encephalitis, tuberculosis, neuroborreliosis , parasitosis), subdural hematoma, brain tumors, normotensive internal hydrocephalus, Wilson’s disease, metabolic disorders (chronic renal failure, dialysis dementia, chronic hypoglycemia, liver failure), endocrine disorders (hypothyroidism, Cushing’s syndrome), autoimmune disorders (systemic lupus erythematosus with associated vasculitis), deficiency conditions (Wernicke-Korsakov syndrome, pellagra, vitamin B12 and folate deficiency), paraneoplastic syndromes.
Informative material created by Dr. Lidia Șiuinea, primary psychiatry physician in the Psychiatry Department of the Târgu-Jiu County Emergency Hospital
2023-07-12 10:02:53
#degenerativedementia #disorders #Breaking #local #news #video #news #News #Gorjeanul.ro #Gorjeanul
