Dementia is a global deterioration of mental functions in both intellectual,
cognitive, emotional and affective aspects, resulting in a global disintegration
of the personality that manifests itself both intellectually and behaviorally
with the reduction and loss of the ability to learn and therefore to adapt to
changes. environment. It is still characterized by emotional disorders, with the
impairment of memory especially for recent events. In about 10% of elderly
people are detectable signs of significant deterioration; over 80 years the
frequency reaches 20%
The clinical picture in general is characterized by the following undesirable symptoms:
1) Attention and concentration disorders.
2) Memory impairment, with reduced ability to learn, memorize and re-evoke
recent and past events. Confabulation.
3) Reduction of the ideational patrimony, poverty of the ideical contents,
repetitiveness, compromise of the thought.
4) Disorders of thought, loss of ability to adhere to reality with suspicion,
perspiration, hypochondria and jealousy.
5) Loss of critical skills and judgment.
6) Increased reactivity, extreme selectivity of stimuli. Inability to evaluate,
integrate and analyze the information received. Tendency towards catastrophic
reactions.
7) Lack of initiative and spontaneity, apathy, detachment, mutacy, indifference,
stereotypy and automatism.
8) Excitement, clamor, hyper-realistic and inconclusive hyperactivity
9) Disturbances of affectivity, emotional superficiality. Reduction of general
interests and awareness of one's illness. Affective dullness, euphoria,
affective lability, increased irritability.
10) Consciousness disorders, narrowing and obfuscation of the field of
consciousness, onirism, temporo-spatial disorientation.
11) Disorders of symbolism (language, graphics, expression).
12) Subversion of fundamental instincts, loss of control of the sphincters.
13) Progressive decay of the physical state.
14) Anatomopathological alterations, characterized by reduction of the
cerebellar mass with deepening of the grooves and fissures, thinning of the
convolutions, dilatation of the ventricles, neuronal depopulation and with
slightly different histopathological aspects in the various forms.
The onset is often accompanied by anxiety, depression, referable to the
patient's experience in the face of the growing difficulty of learning and
remembering. They are frequent at this stage: an easy worry with complaints
about vague somatic disorders (hypochondria); a tendency towards isolation and
depression, for which the patient finds solace only in the family environment;
exaggerated emotional responses, affective indifference, periods of easy
irritability and excitability. Thus the typical symptomatology of the impairment
of memory, in the state of mental confusion with serious decay of the psychic
conditions up to mental breakdown, makes its way. From the etiopathogenetic
point of view, the s. dementia can be divided into two main groups: primary
dementias, supported by an abiotrophic-degenerative process whose genesis is
still obscure, including Alzheimer's disease, of Pick, of Creutzfeldt-Jakob, and
senile and other dementias and dementias secondary ones in which the
degenerative and atrophic process starts from different noxae and from different
morbid processes with various anatomical alterations at the CNS, (v. Toxicitis,
vasculopathies, neoplasia, trauma, etc.).
Primary dementias
- Presence dementias: a) Alzheimer-Perusini disease: b) Pick disease
- Senile dementia
- Creutzfeldt-Jakob disease
- Huntington's Korea
- Others: Parkinson's disease, supranuclear paralysis progress., Degeneracy.
spinocerebell., dementia-Parkinson complex of Guam, Hallovorden-Spatz disease.
- Arteriopathic dementias (see cerebral arteriosclerosis, Búrger, etc.)
- Cerebral hypoxia
- Metabolic diseases: mixedema, hypoglycemia, mal. chronic hepatics, uremia,mal. of Wilson, etc.
- Nutritional diseases: Wernicke-Korsakoff syndrome, vitamin deficiency B12, pellagra, mal. of Marchiafava-Bignami (see Alcoholism)
- Heavy metal poisoning (lead, mercury, manganese)
- Drug poisoning
- Normotensive hydrocephalus
- Neoplasms
- Trauma
- Brain infections (bacterial, fungal, luetic).