SENILE DEMENTIA: SYMPTOMS, CAUSES, TYPES AND TREATMENTS - ECONOMÍA - 2025

The dementia is a mental illness suffered by people over 65 years and is characterized by loss of cognitive functions. It is considered a disorder that begins gradually, evolves progressively and is chronic in nature.

However, by detecting and appropriately intervening the disease, its evolution can be attenuated or slowed down and, in this way, provide more years of healthy life to the elderly who suffers from it.

Senile dementia is a syndrome characterized by the deterioration of cognitive functions, with a gradual and progressive onset, and which is capable of affecting the activities of daily living of the patient.

The "senile" specification in the term dementia was used to differentiate between patients over 65 years of age who suffer from a dementia syndrome and loss who present it earlier.

This distinction between senile dementia and presenile dementia is important, since the risk of suffering from this disease increases as age increases, doubling by two after 65 years.

Characteristics of senile dementia

The term dementia does not refer to a single disease but to a syndrome that can be caused by many chronic diseases, such as Alzheimer's disease, Parkinson's disease, vitamin deficiencies, etc.

However, those alterations in which only memory loss is present, there are no other cognitive deficits and the patient's daily activities are not affected, should not be classified as dementias.

Thus, dementia must be distinguished from age-related cognitive impairment (DECAE), which is a relatively benign phenomenon and is linked to normal aging of the brain.

In this way, if in a person of about 80 years we observe that they have less memory than when they were young or that they are a little less agile mentally, this does not mean that they have to suffer from dementia, they may have a simple normal aging of their functions.

Similarly, senile dementia has to be differentiated from mild cognitive impairment. This would be an intermediate step between the cognitive deterioration associated with age and dementia, since there is a higher cognitive deterioration than would be considered normal in aging, but less than that which occurs in dementia.

In order for us to speak of dementia, at least two conditions must be present:

1. There must be multiple cognitive deficits, both in memory (recall and learning) and in other cognitive functions (language, attention, problem solving, apraxia, agnosia, calculation, etc.).
2. These deficits must cause a significant alteration in the patient's social and occupational functioning, and must lead to a significant deterioration in the previous cognitive level.

Cognitive symptoms of senile dementia

In senile dementia, a large number of cognitive deficits can appear. In each case, depending on the type of dementia suffered and the part of the brain that is affected, some functions will be more preserved and others will be more impaired.

However, the evolution of senile dementia is progressive, so as time passes, the dementia will spread through the brain as if it were an oil stain, so that all functions will be affected sooner or later.

The cognitive functions that can be altered are:

Memory

It is usually the most frequent symptom in most dementia syndrome. It can start with difficulties learning new information and forgetting about recent things.

As the disease progresses, memories of past events are also affected, until important events and close family members are forgotten

Orientation

It usually appears already in the early stages of many types of dementia, and like the rest of the functions, as time passes, practically all orientation capacities are lost.

It usually starts with trouble remembering the day or month you are in. 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.

Attention

There are some types of dementia where attention deficits are very noticeable. In them, the person has great difficulty concentrating or even attending to something for just a few seconds.

Language

Patients with dementia may have problems when speaking, such as anomia when they do not remember the names of certain words or reduced verbal fluency when they speak more slowly.

Gnosias

Dementia also alters the ability to recognize external stimuli through any stimulating pathway: visual, tactile, auditory, olfactory… In advanced stages, this difficulty can lead the patient to not recognize the faces of their relatives or even their own when they see reflected in a mirror.

Praxias

The ability to coordinate movements is impaired. A person with dementia may not be able to move their hands properly to reach for scissors and cut out a sheet of paper.

Executive functions

In dementias, the ability to plan and organize activities is also lost. For example, to boil rice you have to take a pot, pour water, boil it and add the rice. A person with Dementia may not be able to perform this mental exercise.

Logic reasoning

Finally, one of the capacities that is usually lost in the middle phases of all types of dementia is the ability to build logical thoughts autonomously for any event or activity.

Psychological symptoms

Normally, cognitive deficits do not appear in isolation, and are accompanied by a series of psychological symptoms that cause a lot of discomfort both in the patient and in their caregivers.

As specific psychological symptomatology we can find:

Delusional ideas

It is present in between 10 and 73% of cases of Dementia. The most frequent idea is that of "someone steals things", which may be due to the

inability to remember precisely where they keep the objects.

Hallucinations

The frequency of this perceptual alteration is between 12 and 49% in patients with dementia. Visual hallucinations are the most frequent, especially in Lewy body dementia.

Identification errors

It is another perception disorder. In this case, the person with dementia may believe that people are living in their home who are not really there (ghost host syndrome) or may not recognize their own reflection in a mirror and believe that it is someone else.

Depressed mood

Depressive symptoms affect a not inconsiderable minority of patients with dementia at one point or another during the illness (20-50%).

Apathy

Lack of motivation develops in nearly half of dementia patients. These symptoms are often mistaken for depression.

Anxiety

A common manifestation of anxiety in dementias is "Godot syndrome." This is characterized by asking repeated questions about an upcoming event due to the inability to remember that you have already asked and have already been answered. The patient believes he never gets a response and increases his anxiety.

Likewise, in some cases of dementia, behavioral symptoms are also witnessed, such as: physical aggression, wandering, restlessness, agitation, screaming, crying or foul language.

Types

Dementia is like an oil stain, it begins by affecting a part of the brain, causing certain symptoms, and later it spreads throughout all brain 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. In addition, each one of them seems to have different mechanisms of appearance and evolution.

Depending on the brain area affected by each dementia, they can be divided into two groups: those dementias that affect the upper parts of the brain (cortical dementias) and those that affect the deeper parts (subcortical dementias).

-Cortical senile dementias

Alzheimer's type dementia (DSTA)

It is the dementia syndrome par excellence, the one that affects a greater number of people and the one that has originated a greater number of investigations. It is considered the prototype of cortical dementias.

DSTA is characterized by beginning with memory impairment, decreasing learning capacity, and presenting frequent forgetfulness and orientation problems.

Later, other cortical symptoms appear, such as agnosia, aphasia, apraxia, and impaired executive functions.

The onset of this dementia is very gradual and its evolution is slow and progressive.

Lewy body dementia (MCI)

It is a type of dementia very similar to Alzheimer's, the cognitive deficits are practically traced to those of the DSTA and it has a very similar beginning and evolution.

It is basically differentiated by 3 aspects: presenting a greater alteration of attention and fluctuations in cognitive deficits, suffering from parkinsonian symptoms of tremor and slowness of movements, and suffering frequent hallucinations.

Frontotemporal degeneration (FTD)

It is a particular dementia that predominantly affects the frontal lobe, a fact that causes its first symptoms to be extravagant behavioral changes, amnesia and early apraxia, and severe speech and movement disorders.

-Subcortical senile dementias

Parkinson's disease (PD)

The main characteristic of Parkinson's is the progressive death of dopaminergic neurons, which causes dysfunction in movement, causing tremor, bradykinesia and rigidity.

Likewise, it can cause cognitive deficits such as slowing down of thought and movement, dysfunction of the ability to execute and impaired recall memory (inability to retrieve stored information).

Vascular dementia (DV)

DV is a complex disorder in which the symptoms of dementia are the result of vascular problems that affect the blood supply to the brain.

Its symptoms can be of any type, depending on the area of ​​the brain that has been damaged by vascular diseases.

AIDS dementia complex

It is suffered by about 30% of people affected by HIV. There are serious deficits in attention and concentration, difficulties in acquiring and remembering information, and alterations in naming and verbal fluency.

Apart from these mentioned, there are other less frequent dementias such as: corticobasal degeneration, Huntington's disease, progressive supranuclear palsy, normotensive hydrocephalus, dementias of endocrinometabolic origin, etc.

Statistics

The global prevalence of Dementia varies between 5% and 14.9% in the entire Spanish population. From 65 years of age the prevalence increases to practically 20% and at 85 years it reaches 40%, so that cases of dementia increase with age.

Of all the types, the most prevalent is Alzheimer's, followed by vascular dementia and Lewy body dementia.

Treatments

Today, the treatment of senile dementias does not eradicate the disease, but it does reduce cognitive deterioration and provide patients with the highest possible quality of life.

Pharmacotherapy

There is no drug capable of curing a dementia syndrome; however, accelycolinesterase inhibitor drugs such as tarcin, galantamine or rivastigmine can have a neuroprotective effect and contribute to slowing down 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 and anxiolytics.

Psychological treatment

Therapies have been proposed in 4 different areas:

• Cognitive area: to maintain the patient's abilities and stop the evolution of deficits, it is very important to carry out cognitive stimulation activities in which memory, attention, language, executive functions, etc. are worked.
• Psychosocial area: it is important that the patient keep hobbies, perform activities such as animal-assisted therapy or music therapy to increase their well-being.
• Functional: to maintain its functionality, it is advisable to carry out Trainings in meaningful activities and daily life.
• Motor: people with dementia usually suffer a deterioration of their physical abilities. Keeping them in shape with passive gymnastics, physical therapy or psychomotor activities is essential.

Thus, senile dementia is a disorder that gradually shuts down the brain of the person who suffers from it, however, work can be done to provide the greatest possible well-being during the course of the disease.

References

1. Baquero, M., Blasco, R., Campos-García, A., Garcés, M., Fages, EM, Andreu-Català, M. (2004). Descriptive study of behavioral disorders in mild cognitive impairment. Rev neurol; (38) 4: 323-326.
2. 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, Deus, Dementias and Alzheimer's disease: a practical and interdisciplinary approach (559-587). Barcelona: Higher Institute of Psychological Studies.
3. Martín, M. (2004). Antipsychotic drugs in the treatment of psychiatric symptoms of dementias. Psychiatric Information, 176.
4. Martíenz-Lage, P. (2001) Cognitive impairment and dementias of vascular origin In A. Robles and JM Martinez, Alzheimer 2001: theory and practice (pp. 159-179). Madrid: Medical Classroom.
5. 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.
6. Obeso JA, Rodríguez-Oroz MC, Lera G. Evolution of Parkinson's disease. (1999). Actual problems. In: "Neuronal death and Parkinson's disease". JA Obeso, CW Olanow, AHV Schapira, E. Tolosa (editors). Goodbye Madrid, 1999; chap. 2, pp. 21-38.
7. Rodríguez M, Sánchez, JL (2004). Cognitive reserve and dementia. Annals of Psychology, 20:12.
8. Slachevsky, A., Oyarzo, F. (2008). Dementias: history, concept, classification and clinical approach. In E, Labos., A, Slachevsky., P, Fuentes., E, Manes., Treatise on Clinical Neuropsychology. Buenos Aires: Akadia.