Tuesday, June 23, 2020

Nine disease signals of senile dementia

1. Memory impairment

The memory impairment of Alzheimer's disease is characterized by impaired ability to remember new knowledge and difficulty in recalling long-term knowledge. Memory impairment occurs early, and is almost the first intellectual impairment found by the patient's family or colleagues, especially near-memory impairment-forgetting, and even if the near-memory impairment is not one of the earliest symptoms, the diagnosis is Alzheimer's disease. Very suspicious. Neuropsychological studies of memory deficits have shown that these patients have difficulties in inputting listening information, information quickly disappears from short-term memory, and information storage and remote memory are also impaired, suggesting that it is not helpful to patients.

Memory impairment is the first symptom of Alzheimer's disease. It is both amnestic (ie, difficult to remember new knowledge, related to cerebral cortical function, and forgetful (ie, far memory deficit, difficult to recall information that has been remembered in the past, and subcortical function Impaired). First, near memory is impaired, and then far memory is also impaired. Eventually, both near and near memory are impaired, which affects daily life. The patient can also have fictitious phenomena, which is related to his learning and memory abilities. Patients cannot monitor their own answers or cannot correct their own mistakes.

The patient's daily performance is "throwing away", "forgetting to say", and asking the same question repeatedly. For example, in a clinical examination, the patient can’t remember the doctor’s surname, and even denied having told him. However, patients with near-memory disorders are often considered to be often forgetful and neglected by healthy elderly people, especially when early forgetting is obvious, far memory is relatively retained, so relatives often think that the patient's memory is not bad, or even very good. The reason is that things that are more than ten years or even decades ago are clearly remembered, although they do not deny that "the current affairs will be forgotten". The situation described above deserves the attention of relatives.

Similarly, memory loss is also a core symptom of cerebrovascular dementia in the early stage. The earliest occurrence is near-memory defect, and far-memory dysfunction appears mostly in the later stage.

2. Visual space skill barrier

In the early stages of Alzheimer's disease, there is impairment of visual skills. The position of the item cannot be accurately judged; when reaching for the item, the item is not reached and the object is caught empty, or the hand is reached too far and the item is knocked over. When placing items, you cannot correctly determine where to put it. For example, you cannot accurately place the pot or kettle on the fire eye of the stove, and the pot or kettle will fall to the ground due to the deviation. Getting lost in a familiar environment can also be seen in the early days. By the middle of the day, disorientation occurred even in his own home, unable to find his own room, and wondering which bed was his own. On the simple drawing test, the patient cannot accurately copy the stereogram, and even the simple plan is difficult to draw after the middle period. In daily life, there are obvious difficulties in dressing. You cannot judge the up, down, left and right of the clothes when you pick them up.

3. Language barrier

Language disorder is a sensitive indicator of advanced brain dysfunction. In self-speech, the obvious difficulty in finding words is the language disorder that manifests first. Because of the lack of substantive words in spoken language, it becomes empty words that cannot express meaning; or when it is difficult to find words, it is redundant to use too many explanations to express words that cannot be spoken. Although it is difficult to find words in the early stage, the naming of the items may be normal, and the impairment of the listing is a sensitive indicator of early dementia. With the development of the disease, since the speech becomes more and more empty, the naming cannot become more obvious. Firstly, the naming ability of less used nouns is impaired, and then the names of commonly used items and relatives are also unable to be named.

The pronunciation, intonation and grammatical structure of speech in Alzheimer's patients are relatively retained until the late stage, while the semantic aspects are progressively impaired. With the development of dementia, the practical content of the language gradually decreases, and irrelevant vocabulary and changing themes are inappropriately added. Family members often refer to it as "speaking and talking", so that despite the chatter, the listener can not understand his coherent thinking from his conversation, or even express any information, which is the characteristic of the self-speaking of Alzheimer's patients. At the same time, listening to comprehension is severely impaired, often unanswered, and the ability to talk declines, making it impossible to talk, which leads to imitating language and stress disorder. In the end, the patient can only make incomprehensible voices, and finally silence. During most of the disease, the mechanical part that produces speech is still normal, and the pronunciation is not damaged as in other primary movements. Stuttering and/or vague grunting occurs as the disease progresses to a later stage.

4. Difficulty writing

Difficulty writing often occurs early in Alzheimer's disease. The content words that are written because of difficulty in writing are not satisfactory, which may be the first symptom of family members' attention (such as letter writing). Research suggests that writing errors or missed writing are related to distant memory impairment. With the development of the disease, there are a lot of wrong writing (the strokes are like Chinese characters, but the strokes are wrong, or even new words that do not exist). By the middle and late stages of the disease, the patient did not even know his name, nor could he write his own name.

5. Misuse and recognition

It is very difficult to check for the uselessness and misrecognition of Alzheimer's patients. It is difficult to distinguish their uselessness and misrecognition from the incompetence caused by aphasia, visual space skills disorder and amnesia. About one-third of patients have blindness. Those who can't recognize faces, don't know their relatives and familiar friends. Impaired self-cognition can produce mirror signs. The patient sits in front of the mirror and speaks with his image in the mirror, and even asks his image "Who are you?"

Patients with Alzheimer's disease can present with two types of apraxia: conceptual apraxia is the inability to correctly make continuous and complex movements with gestures, such as pipe fitting, matchmaking, and cigarette lighting. Intentional exercise apraxia is the inability to make actions that can be made spontaneously as instructed. For example, patients who get up early every day will brush their teeth with a toothbrush, but cannot do toothbrushing actions as instructed. Apraxia is common in the medium term, that is, after memory and language impairments have clearly appeared and before exercise has not been obvious. The patient showed a loss of the skills he had mastered. If he used to ride a bicycle or swim, he would not be sick after the illness. In severe cases, he would not use any tools, even chopsticks or spoon.

6. Computing obstacles

Dyscalculia often occurs in the middle of Alzheimer's disease, but it may be manifested in the early stages, such as shopping will not account or miscalculate. The dyscalculia may be due to visual dysfunction (cannot formulate the formula correctly); or due to aphasia, and does not understand the requirements of arithmetic operations; or it may be that the primary calculation cannot. In severe cases, even simple addition and subtraction will not be calculated, and even if they do not know the numbers and arithmetic symbols, they will not be able to answer how many fingers the examiner extended.

7. Poor judgment and distracted attention

Alzheimer's patients can have poor judgment, loss of generalization ability, distracted attention, unrecognition, and involuntary consciousness at an early stage. In the early stages of dementia, it is not uncommon for patients to continue to work despite the obvious memory impairments, language voids, generalization and computational abilities. This situation is due to a very skilled work, which is simply repeated daily, but if a new situation occurs, or when a new request is made to it, his work is incompetent; or his memory is reduced, although the work has The error continued to work due to the understanding of colleagues around.

With memory loss, patients with vascular dementia will gradually have inattention, and the calculation, orientation, and comprehension of the degree will decrease to varying degrees. Compared with Alzheimer's disease, patients with Alzheimer's dementia can have a complete decline in intelligence until they are completely lost, while the decline in intelligence in patients with vascular dementia is "patchy". Some people observe that the most common is time orientation The decline in power, computing power, near memory, spontaneous writing and copying ability is not comprehensive. The brain damage caused by vascular lesions can occur in various neuropsychiatric symptoms depending on the location: Generally speaking, lesions located in the left cerebral hemisphere cortex may have symptoms such as aphasia, aphasia, misreading, loss of books, and miscalculation. ; Cortical lesions located in the right cerebral hemisphere may have visual spatial disturbances; lesions located in the subcortical nerve nucleus and its conduction beam may have corresponding motor, sensory and extrapyramidal disorders, and may also have strong laughs and crying Symptoms, sometimes hallucinations, self-talk, numbness, silence, indifference and other mental symptoms.

8. Mental functional disorder

In the early stages of senile dementia, despite the recessive intelligence decline, personality and social behavior may still be significantly intact. Because these behaviors are preserved, patients can still effectively engage in social activities, often making others underestimate or forgive the patients' incompetence. Emotional indifference often occurs early, and patients often have a stupid image of the face. In fact, mental functional psychiatric symptoms can also be seen in the early stage, and the patient exhibits mania, hallucinations, delusions, depression, personality changes, delirium, etc. In the past, more attention was paid to cognitive dysfunction in patients with senile dementia, while ignoring psychotic symptoms. In fact, mental disorders may be more prominent. The presence or absence of psychiatric symptoms and the psychiatric symptoms may reflect different subtypes of Alzheimer's disease, or may indirectly reflect genetic differences in Alzheimer's disease. These circumstances suggest that the elderly are mainly mental functional psychiatric disorders and those with a short course of disease should be considered as the possibility of senile dementia, and avoid the elderly patients with depression, mania, and behavioral disorders (attack, running) as the manifestation of senile dementia. Miscarried into a mental hospital for treatment.

9. Dyskinesia

Patients with Alzheimer's disease often perform normally in the early stages of exercise, but in the mid-term they appear to be overactive. If you walk around indoors aimlessly, or get up in the middle of the night, touch around everywhere, open the door, close the door, move things, etc. With the loss of instinctive activity, incontinence of urination and urination (urination is difficult to control may occur earlier), life can not take care of themselves. Although patients with senile dementia do not develop dyskinesia until late, increased muscle tone is not uncommon. Even patients with mild and moderate dementia can show signs of extrapyramidal systems: such as muscle rigidity involving the upper and lower limbs and neck , Decreased movement, tremor, abnormal flexion posture. When the patient's intellectual decline is not prominent or ignored and extrapyramidal signs have appeared, it is easy to be confused with the diagnosis of Parkinson's disease. To the late stage of the disease, the symptoms and signs of pyramidal system and the symptoms and signs of extrapyramidal system gradually appeared, or the original signs of extrapyramidal system were aggravated, and finally showed ankylosing or flexural quadriplegia. Intelligence declines completely, without any conscious response to external stimuli, which is manifested as immobile silence.

According to the above disease signals, clinical diagnosis also requires physical examination, especially advanced neurological function examination, often combined with dementia scale. Commonly used scales are the Mental State Mini Test (MMSE) and the Hasegawa Simple Intelligence Scale (HDS) to determine the degree of mental retardation of patients, and then use the Hachinski Ischemia Scale to identify the type of dementia. In addition, supplemented with necessary laboratory tests such as electroencephalogram, head CT and MRI, cerebral blood flow measurement (r-CBT\SPECT) and blood biochemical detection to further strengthen clinical diagnosis and differential diagnosis. With a view to treating dementia as soon as possible, correctly and actively, especially those with treatable dementia.

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