Cognitive disorders: how to recognize and help a loved one in time?

Cognitive disorders: how to recognize and help a loved one in time?

Date of publication: 08.28.2020 From the life of the hospital

WHO recognizes dementia as a public health priority. The forecasts given by experts are alarming. Thus, according to the World Health Organization, in 2030 the total number of people with dementia in the world will be about 82 million, and by 2050 there may be about 152 million.

Dementia has become “younger”, and today it does not only affect the very elderly, but 9% occurs in people under the age of 65. There are many misconceptions associated with this disease. Not everyone knows that the cause of cognitive disorders can be not only heredity, but also poor lifestyle choices, bad habits, and excess weight. Previously, it was believed that the decline in cognitive functions with age is a normal process: a person ages, and therefore becomes forgetful, irritable, and confused. But today experts have come to a different opinion: the aging processes of the brain, which are irreversible, can be slowed down and help a loved one live longer in a clear mind.

Anastasia Vasilenko, a psychiatrist at the Stavropol Regional Psychiatric Hospital No. 1, Candidate of Psychological Sciences, spoke in detail about the causes and mechanisms of the appearance of cognitive disorders.

– What are cognitive disorders?

– Cognition is knowing. Cognitive means everything that relates to cognitive processes - perception, thinking, memory, attention, the ability to make plans and evaluate the consequences of one’s actions. Simply put, it is something that relates to the mind and intellect.

– What age people are at risk?

– If we talk about age dynamics, it is clear that we are always different. Every year we are different from who we were before. There is so-called healthy aging, and there are disorders and diseases. With healthy aging, a person does not have severe memory impairment, and he does not do anything absurd. When these disorders appear, we say that senile dementia or some other type of dementia begins to develop. Unfortunately, such cognitive impairments do not only occur in old age. In general, intellectual spectrum disorders can now begin after 40 years of age.

– Dementia or dementia: what is it and why does it begin to progress?

– Dementia is the loss of the ability to think, remember and remember correctly. When a person begins to develop intellectual spectrum disorders, the first thing that becomes noticeable is memory impairment. He becomes forgetful. Sometimes such disorders occur very early. In my practice, I have seen the development of dementia both at the age of 36 and at 27. If you notice that problems arise with memory, you should consult a doctor.

– Why does the brain start to work differently?

– There are two main forms of dementia. The first is due to genetic prerequisites. These are Alzheimer's disease, Parkinson's disease and some others. And there is dementia, which develops without such a genetic predisposition, but as a result of the fact that the brain suffers for other reasons. It never happens “suddenly”, it never starts suddenly. The development of dementia can be facilitated by lifestyle, the presence of diseases and negative environmental factors in which a person lives. Here it is appropriate to use such a concept as brain hygiene. At 17-20 years old, if there are no diseases, the brain is in excellent condition. And if a young man does not drink alcohol, does not smoke, does not use drugs, plays sports, is not overweight, and takes care of his health, his brain will remain in good shape for a long time. And there is a high probability of living to 70, 80, 90 years old with a clear mind.

Anastasia Vasilenko said that the cause of the development of dementia before the age of 30-40 can be chronic alcoholism, advanced endocrinological diseases, hypertension, smoking, a sedentary lifestyle, excess weight, and traumatic brain injuries. For these reasons, the blood supply to the brain is disrupted, and it gradually begins to die. If treatment is not started, dementia will develop catastrophically quickly.

The psychiatrist also recalled that against the background of a severe infection or some other disease, temporary memory loss and loss of attention may appear. But this happens due to the fact that the body is weakened. It’s worth healing, getting enough sleep, resting, and your intellectual abilities will be restored.

– What symptoms should alert you and make you go to the doctor?

– Even from a sedentary lifestyle, the brain suffers. The first symptoms to pay attention to are headaches, dizziness, and nausea. When they appear, you need to contact a neurologist. In this case, there are still no impairments in memory, attention, or cognitive functions, but the person feels heaviness in the head, gets tired quickly, has trouble thinking clearly at the end of the working day, and actively reacts to weather changes. This indicates insufficient blood supply to the brain.

Anorexia, illiterate vegetarianism, diabetes mellitus, and any endocrinological diseases can also lead to disturbances in the nutrition of nervous tissue. Important! If you are physically healthy, if you lead an active lifestyle and consult a doctor on time, and not just mindlessly take pills, then your brain will be healthy. But this does not apply to Alzheimer's and Parkinson's diseases.

– How to notice the first symptoms of Alzheimer's disease?

– Memory disorders and intellectual disorders are growing very quickly, which are more pronounced in Alzheimer’s disease than in senile dementia. The person suddenly becomes confused, cannot understand what is happening, because he does not remember current events well. Literally, if he turns away from you and turns again, he will think that he saw you for the first time. Such patients always look surprised and confused. There are also disturbances in speech and usual order of actions. Patients confuse words and cannot, for example, perform a simple test: disassemble and reassemble a ballpoint pen.

As Anastasia Olegovna noted, up to a certain point a person can understand for himself that he is developing dementia. He complains of a short-term memory disorder and forgets what happened a day or an hour ago. Whether treatment will be prescribed on time, how the disorder will progress - all this depends on the patient’s environment. It is the loved ones who must sound the alarm in time and not ignore the symptoms.

– Dementia can be accompanied by psychotic disorders: with or without delusions, hallucinations, aggression, significant behavioral disturbances. It is clear that if a person suddenly expresses delusional ideas (for example, “you want to kill me and take my apartment”) and behaves aggressively, then the relatives turn to a psychiatrist. But when there are no such obvious violations, and memory and intelligence fade away gradually, unfortunately, it is very late to seek help. And often relatives say that everything was fine “literally until yesterday.” But when you start asking questions, it turns out that five years ago the patient had forgetfulness, and two years ago she got lost on the street, and for the last year she has been afraid to leave the house because she is not sure that she will find her way back. Then it becomes clear that the symptoms appeared a long time ago. Patients with dementia often remember events from the distant past to the smallest detail, but current ones are not fixed in memory. Many people say: yes, my grandmother has such a memory, no one in the family has such a memory, she recites “Eugene Onegin” by heart. But in fact, this is a formidable symptom that current events are already being erased from memory.

– These disorders cannot be cured, but is it possible to somehow prolong mental clarity?

“Both relatives, doctors, and patients themselves understand that the process is irreversible. And this sometimes makes them refuse treatment, which is wrong. The more attention is paid to the disease, the better the doctor’s prescriptions are followed, the longer the patient will remain independent in simple everyday situations.

Medicines exist, their action is effective, but they do not reverse the development, because the dead nervous tissue is not restored. Medicines help neurons start working more actively: they become less tired, and a person maintains a high level of functioning longer. Drug treatment is necessary, but it alone is not enough. Supportive social events are needed. A person with dementia needs to be able to navigate where they live. To do this, it is necessary to maintain order in his room (every thing has its own place), place a clock and a calendar on the walls. It is important to keep the pills in the pill box and monitor how the patient takes them. And the main thing is to train skills that are needed constantly: going to the store for bread, dressing yourself, brushing your teeth. It is important not to try to do what a person can still do himself.

– In order for the brain to continue to function longer, you need to train those functions that you want to preserve. The brain is good at what it does every day. In order for it to remain “fresh”, you need to constantly learn. Dance, learn foreign languages, learn poetry, read books. Constantly learning keeps your brain sharp!

The full version of the interview broadcast on the Svoe TV channel can be viewed at the link

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Diagnostic examination of patients

If you suspect a cognitive personality disorder, it is recommended to do the following:

• general clinical analysis of blood and urine;
• biochemical blood test, including electrolytes, calcium, glucose, liver and kidney function indicators, lipid spectrum;
• tests to assess the hormonal profile, levels of B vitamins and folic acid;
• CT or MRI of the brain;
• serological testing for markers of syphilis and HIV (if symptoms of the disease appear at a young or mature age);
• according to indications: ECG, chest x-ray, duplex scanning of cerebral vessels, study of cerebrospinal fluid to detect markers of Alzheimer's and dementia.

To assess the severity of the pathology, psychological testing is carried out, which consists of the following points:

• orientation in place, in time and one’s own personality: the patient is asked to name the date and place of birth, say where he is, etc.;
• a test for repeating the names of objects (sometimes it is necessary to explain their meaning), individual numbers in order or randomly;
• Praxis assessment: they are asked to perform several conscious actions, for example, fasten buttons, fold clothes;
• tests of visual-spatial perception: the patient is asked to draw simple or three-dimensional geometric figures, depict a dial and mark a certain time with arrows;
• pay attention to the peculiarities of speech, the ability to maintain a conversation;
• assessing intelligence by searching for logical associations (for example, they suggest finding something in common between a plum and an apricot).

Principles of treatment

Therapy is prescribed only after receiving the results of a diagnostic examination. But usually treatment is aimed at:

• normalization of cerebral circulation, improvement of energy metabolism in brain cells, prevention of hypoxia;
• prevention of neurodegenerative changes;
• compensation for deficiency of B vitamins and other macro- and microelements, essential amino acids;
• therapy for concomitant disorders (use of antihypertensive and antiarrhythmic drugs, hepatoprotectors, etc.).

If the cause is not eliminated, cognitive personality disorder will progress: if in a mild form of the syndrome the patient only needs help managing finances and paying for utilities, at the stage of severe dementia the patient is completely dependent on others. In such cases, we offer hospitalization in our hospital, where the person will be under round-the-clock supervision by qualified and experienced medical personnel.

You can call a doctor or make an appointment at a clinic with our operators using a 24-hour anonymous phone number 8(969)060-93-93.

Possible complications

Progressive MCI without timely effective therapy can develop into dementia, which leads to the loss of self-care skills and the ability to solve everyday problems. This gives rise to problems of socialization - the circle of contacts narrows, the ability to work is lost, and the desire to attend public events disappears. With a fluctuating course, patients have difficulty performing intense mental tasks, while correct correction of the daily routine and reduction of stress allows them to maintain their usual lifestyle.

General information about the disease

Translated from Latin, “cognitive” means “familiarization, cognitive.” Consequently, mild cognitive disorder (MCI) is a slight deterioration of a whole complex of intellectual abilities: concentration, memory, reproduction and processing of information, the ability to abstract and solve logical problems. However, such a disorder does not reach the level of dementia, mental retardation or amnestic syndrome. Its development is provoked by an organic or infectious disease, and MCI can occur before, during or after the underlying disease. It most often occurs in people with a low level of education. Among the patients, about 10% are elderly people over 65 years of age; it is worth noting that the majority begin to develop a symptomatic picture characteristic of Alzheimer’s within a year.

Diagnostic methods

To make a diagnosis, consultation with a psychiatrist, neurologist, or clinical psychologist is required. In this case, criteria are applied taking into account the emphasis on the state of the cognitive sphere and memory. It is necessary to distinguish between mild cognitive impairment and mental retardation, dementia and psychoorganic syndrome. For this use:

• Psychological testing, this may include pathopsychological or neuropsychological examination. There is a mild degree of impairment of short-term memory, slight instability of attention, fluctuations in dynamic mental activity. Possibly, but not necessarily, a decrease in abstract-logical function. The result is determined taking into account the patient’s level of education, age, and field of activity;
• A conversation with a psychiatrist and neurologist allows you to establish an anamnesis and identify symptoms. Characteristic complaints include general confusion, increased fatigue, difficulty concentrating and remembering. Patients working in the mental sphere note difficulty in formulating logical conclusions and abstract ideas;
• A physical examination by a neurologist is intended to establish the causes and differentiate diseases from other pathologies. Small but persistent neurological disorders may be observed: discoordination phenomena, anisoreflexia, symptoms of oral automatism and oculomotor failure. In this case, no clear syndromes can be traced.

When is the best time to develop cognitive abilities?

Previously, it was believed that cognitive abilities develop in a person until the age of 20–25, and after 40 they begin to slowly fade away; there is even a phrase “Nerve cells do not recover.” However, recent studies have proven that this is not so, nerve cells are replaced with new ones, like everything else in the body, and the development of cognitive abilities is possible at any age. The brain, which systematically performs certain mental work, develops its potential. Remember how children learn to read, how hard mental work tires them at first, but very soon, without thinking, they put syllables into words, and words into sentences.

Cognitive functions are divided into:

• memory;
• attention;
• speech;
• praxis (purposeful activity);
• gnosis (orientation, recognition of place and time);
• thinking.

All of them can be developed at any age, but it is better to start from the earliest, preschool years.