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Neurology symptoms of the disease in the elderly. Neurological diseases: list, symptoms, causes and treatment features

18.02.2021

AGING PROCESSES AND MENTAL DISORDERS IN THE ELDERLY AND OLD AGE.

Aging is a natural physiological process and is not a disease in itself.

Although human aging is a normal process, it is accompanied by a complex set of age-related changes in almost all organs and systems of the body. The skin gradually fades, the hair turns gray. Bones become fragile and joints lose mobility. The work of the heart weakens, the vessels become less elastic, the blood flow rate slows down. Metabolism changes, the level of cholesterol, lipids, blood sugar rises. The activity of the respiratory and digestive systems is disrupted. The activity of the immune system decreases. Vigilance decreases, hearing weakens, acuity of other sense organs decreases. The activity of the endocrine and nervous system weakens. Although age-related changes in the body are not a disease in the medical sense, they cause a feeling of soreness, uselessness, and weakness.

In the process of aging, the psyche also suffers. Mental flexibility, the ability to adapt to changing living conditions decreases, activity and general tone decrease, a feeling of weakness and general malaise appears, mental processes slow down, wrinkles and attention worsen, the ability to rejoice and emotionally respond to life events decreases, a kind of senile conservatism appears. These changes in the psyche, expressed to a greater or lesser extent, accompany the aging process in almost every person.

The aging process is extremely uneven. Signs of aging in different organs and systems of the body do not appear simultaneously. In other words, some organs "age" earlier, while others - later. For example, visual acuity begins to deteriorate after 20 years, changes in the musculoskeletal system appear after 30, cardiovascular and muscular systems - after 40, hearing impairment becomes noticeable after 50. Once started, age-related changes gradually progress throughout a person's life. In domestic science, age is designated as a period of reverse development (involutional, climacteric), years - as elderly (pre-senile), years - as actually senile. People over the age of 90 are considered centenarians.

The aging process is individual. People age in different ways. This concerns not only the age of the appearance of the first involutive changes in the body, not only the predominant damage to some organs and the relative safety of others, but also mental changes associated with the aging process. Many old people remain highly creative and able to find joy in life under changed conditions. The accumulated life experience, the maturity of judgments allow the aging person to reconsider past attitudes and views, to form a new life position, to find a calm contemplative attitude to life. However, this is not always the case. In many cases, the very fact of aging and a number of accompanying difficult life situations create conditions for a violation of human adaptation. The loss of loved ones and the problem of loneliness, retirement, the end of professional activity, a change in the stereotype of life and financial difficulties that have arisen, the development of ailments and diseases that limit physical capabilities and cause a feeling of weakness, inability to cope with everyday problems on their own, fear of the future, awareness of the inevitability of the approaching death - this is not a complete list of psychological problems faced by an elderly person.

Age-related biological changes in the body and socio-psychological factors contribute to the development of mental illness in old and old age.

The most common manifestations of mental illness in old and old age are depression, anxiety and hypochondria.

All old people periodically complain of a bad mood. In cases where the depressed mood becomes persistent, it lasts for weeks, especially months, we are talking about depression. Sadness, sadness, gloominess, joylessness, dreary or dreary-anxious mood, a painful feeling of emptiness, a feeling of one's own uselessness, meaninglessness of existence - this is the main context of the experiences of a depressed old man. With depression, activity decreases, interest in habitual activities and hobbies decreases. A person with depression often complains that “he does everything through force”. Often there are various unpleasant sensations and pains, the general vitality falls. Sleep is disturbed, appetite decreases. Depressed old people do not always tell others about their painful experiences. Often they are shy about them or consider their condition as a natural manifestation of old age. If an elderly person becomes sad, silent, inactive, lies in bed for a long time, cries often, avoids communication - these changes in behavior may indicate depression.

Depression is a serious medical condition. Without treatment, depression in old and old age can last for years, creating a lot of problems for both the patient himself and his relatives. At the first suspicion of the development of depression, you should consult a doctor. The earlier the treatment of depressive disorders is started, the faster the positive result is achieved. Depression in old age is curable. There are a number of medications and psychotherapeutic techniques that can help relieve an elderly person of depression and prevent its development in the future.

Many people become more anxious as they get older. Simple everyday situations that a person used to cope with without difficulty cause a number of unfounded fears, excitement and anxiety. Going to the doctor, paying utility bills, meeting friends, shopping for groceries, cleaning and much more become a source of endless fears and fears. In these cases, they talk about the development of an anxiety (neurotic) disorder. Such patients are fussy, restless, pester those around them with incessant repetition of their fears. The constant feeling of inner tension with a sense of impending catastrophe makes the life of such people unbearable. A common theme of fear in old age is your own health or the health and life of loved ones. Such patients are afraid of being left alone, demand that someone from their close people constantly accompany them, endlessly call their relatives with questions about their well-being. At times, anxiety reaches the degree of panic. Patients cannot be at rest, rushing about the apartment, moaning, crying, wringing their hands. Anxiety is often accompanied by a variety of unpleasant sensations in the body (pain, palpitations, internal tremors, abdominal cramps, etc.), which further increases the anxiety and generates new fears. Sleep is often disrupted with anxiety. Patients cannot sleep for a long time, they wake up at night. Sleep disturbances in turn become a source of new fears and fears.

Anxiety disorders are a serious medical condition that requires specialist treatment. It is impossible to cope with this state by an effort of one's own will. Taking anti-anxiety medications only provides temporary relief. Meanwhile, the use of modern medical techniques allows you to completely get rid of anxiety and fear.

Hypochondria - excessive fixation of a person on bodily sensations with the appearance of fears or beliefs in the presence of a severe physical illness, which is not confirmed by objective medical examinations. Old age itself, with the inevitable development of physical ailment and a variety of painful sensations, provides abundant food for the formation of hypochondriacal experiences. Hypochondria manifests itself, as a rule, in the form of new, unusual and extremely painful for a person bodily sensations. Burning, constriction, twisting, shooting or incessant aching pains, "electric shocks", a burning sensation in the body - this is not a complete list of complaints of patients with hypochondria. A thorough examination by a therapist or neurologist does not reveal the cause of these sensations, and the appointment of pain relievers is ineffective. Hypochondriacal feelings and ideas are usually accompanied by a depressed mood with a touch of irritability, discontent, grumbling. These patients are distrustful, often change doctors, insist on additional examinations. Constant fixation on painful sensations, an endless demand for help from relatives, significant financial costs for all new expensive examinations - this is the lifestyle of an old man with hypochondria. Meanwhile, mental disorders are the basis of painful bodily sensations in hypochondria.

Treating hypochondria is challenging. Only a comprehensive prescription of medications and psychotherapy, perseverance on the part of doctors and the help of close people will allow an elderly person to get rid of painful bodily sensations.

A relatively rare, but very dangerous mental disorder in old age is a manic state (mania). The main manifestation of mania is painfully elevated mood. Inadequate gaiety with flat, often ridiculous jokes, complacent euphoric mood with a tendency to boast and self-exaltation are easily replaced by outbursts of anger with aggression. These patients are tireless, sleep very little, are agitated, are constantly in motion, talkative, distracted. It is difficult for them to concentrate on any topic; they easily jump from one thought to another. In a manic state, a person looks for new acquaintances, spends money uncontrollably and often becomes a victim of scammers.

During the period of mania, a person is uncritical of his behavior and rarely goes to the doctor of his own free will. Meanwhile, active treatment is necessary not only in order to prevent inappropriate behavior during the period of manic excitement, but also because mania, as a rule, gives way to severe depression. Without adequate therapy in old age, there is often a continuous change of manic and depressive states.

Older people are often suspicious. They often complain about unfair treatment from others, oppression from relatives, and infringement of rights. In cases where these complaints have no real basis, we can talk about the development of delusional ideas - false, inaccurate judgments and inferences caused by a mental disorder. Delusional ideas are the main manifestation of chronic delusional disorder, a disease that often occurs in old age. Gradually, suspicion increases, any actions of others are interpreted as directed against the patient. The content of delusional ideas is diverse. Most often these are the ideas of theft, material or moral oppression, persecution for the purpose of taking possession of property, and poisoning. Patients say that ill-wishers want to "get rid of" them, evict them from the apartment, steal things, food, mock them in every possible way, secretly enter the room, leave garbage, dirt, add inedible objects to food, let gases into the apartment, scatter poisonous powders. Sometimes the content of delusion is jealousy. Delusional events usually take place within the apartment. The ill-wishers are usually neighbors or relatives. Less often strangers, representatives of the police, public utilities, and doctors are involved in the circle of persecutors.

In old age, delusions are often accompanied by false perceptions (hallucinations). Patients “hear” unusual sounds, knocking, steps, voices in the apartment. Sometimes they complain about unusual odors in the apartment, altered taste of food. Sometimes they "see" strangers in the apartment.

Delirium is always accompanied by anxiety, fear, often depressive feelings. The patients themselves suffer from their disease no less than the people around them. The delusional statements of old people are often perceived by the people around them as psychologically understandable. Often, relatives, wanting to protect the patient from unpleasant neighbors, change their apartment. When the situation changes, the delirium subsides for a while, but then resumes with the same force.

Delusional patients are not critical of the content of their experiences, they cannot be persuaded, logical arguments fail to prove them the falsehood of statements. They refuse psychiatric consultation and treatment. In the absence of persistence on the part of their relatives, these patients can be at home for years, and sometimes even decades without treatment. At the same time, starting treatment and feeling relief in the state (disappearance of anxiety, fear, deactualization of delusional experiences), patients subsequently begin to independently seek the help of a doctor.

Dementia (dementia) is a specific form of mental disorders in old age. The main manifestation of dementia is impaired memory and higher mental functions of a person. The most common forms of dementia in old age are vascular dementia and Alzheimer's disease.

A slight decrease in memory is also observed during normal mental aging. With aging, the speed of mental processes decreases, the ability to concentrate, forgetfulness appears, difficulties arise in remembering names, names, the ability to remember new information worsens. These memory impairments do not interfere with the daily and social life of people of old age, all personal characteristics of a person remain unchanged.

A different picture is observed in dementia. Memory impairments are never isolated, but are always accompanied by changes in other mental functions and behavior in general. Alzheimer's disease develops gradually. The first manifestations of the disease are memory disorders and decreased memory for current and past events. A person becomes forgetful, distracted, current events in his experiences are replaced by the revival of memories of the past. Already in the early stages of the disease, time orientation suffers. The idea of \u200b\u200bthe temporal sequence of events is violated. The character of a person also changes, the previously inherent personal characteristics are erased. He becomes rude, selfish, sometimes apathy and inactivity come to the fore. In some cases, the first manifestations of Alzheimer's disease may be delusions or hallucinations, as well as prolonged depression.

As Alzheimer's disease progresses, the symptoms of dementia become apparent. The patient is disoriented in time, space, environment. These patients cannot name the date, month and year, they often get lost on the street, do not always understand where they are, do not recognize their friends and relatives. The orientation in one's own personality is also violated. Patients cannot name their age, they forget key facts of life. Often there is a "shift in the past": they consider themselves children or young people, claim that their long-dead parents are alive. Habitual skills are violated: patients lose the ability to use household appliances, cannot dress and wash on their own. Conscious actions are replaced by stereotypical wandering and mindless gathering of things. Ability to count and write is impaired. Speech changes. In the beginning, vocabulary is significantly depleted. Current events in the patient's statements are replaced by false memories. Gradually, speech loses its meaning more and more, the statements of patients acquire the character of stereotyped phrases, fragmentary words and syllables. In the advanced stages of Alzheimer's disease, patients completely lose the ability to exist without assistance, speech and motor activity is limited to meaningless screams and stereotypical movements within the bed.

In the early stages of Alzheimer's disease, patients rarely see a doctor. As a rule, memory impairments and character changes are perceived by others as manifestations of natural aging. However, treatment started early in Alzheimer's disease is most effective. Nevertheless, modern medicines can slow down the progression of the disease, reduce the severity of memory impairments, and facilitate the care of patients even in the later stages of Alzheimer's disease.

In vascular dementia, the severity of mental disorders usually does not reach such a profound degree as in Alzheimer's disease. These patients are characterized by significant fluctuations in the severity of memory impairment, orientation, awareness of the surrounding reality, sometimes even during the day. The prognosis in these cases is better than in Alzheimer's disease. It is extremely important to clarify the diagnosis already in the early stages of the disease, since therapeutic approaches differ significantly for different forms of dementia.

Mental illness in old age is not always recognized in time. Quite often the person himself, his relatives, and sometimes general practitioners consider the arisen disorders as a manifestation of "natural" aging. Often an elderly person, suffering from painful manifestations of mental disorders for years, is afraid to go to a psychiatrist, fearing that he will be considered "crazy." These people especially need help and support from their relatives. Properly prescribed treatment allows an elderly person to get rid of painful experiences that darken the last stage of his life, and to find a calm and happy old age.

In gerontology (the science of old age), the concepts of "painful" and "happy" aging are distinguished. Currently, gerontopsychiatry has great opportunities for early diagnosis of mental disorders in old age and a wide arsenal of medication and psychotherapeutic methods for their effective treatment. The beginning of treatment already at the first manifestations of mental disorders in old age is the key to the success of therapy and an improvement in the quality of life of elderly and senile people.

Neurological diseases in the elderly

The proportion of older people in the world's population is growing rapidly, which could become a serious problem for health systems in the future. Many diseases of the elderly are precisely neurological disorders, therefore the aging of the population is likely to affect neurological practice to a much greater extent than other branches of medicine. However, there is a clear dearth of clinical trials in elderly people.

age - indeed, elderly patients are systematically excluded from many clinical trials. As we face the challenge of helping an ever-increasing number of elderly patients in the future, more quality clinical trials involving the elderly are needed to provide the information needed in clinical practice.

There are several reasons why older people are routinely excluded from clinical trials. First, older patients are more likely than younger patients to have comorbidities, which increases the risk of unexpected events. Second, older adults often take multiple drugs - in one study, two-thirds of people age 75 or older took at least five drugs a day, and more than a quarter took ten drugs or more - this increases the risk of drug interactions. Thirdly, due to age-related changes in physiological reactions and the composition of the human body, the pharmacodynamics of drugs in elderly patients may differ from that in younger patients, which leads to an increase in the frequency and severity of adverse side effects.

In addition, there may be misconceptions that it is pointless to struggle for extra years in older people and that the use of drugs or methods that have been effective in young patients may be in vain.

In addition, patient-related factors can be an obstacle to participation in clinical trials. There is a possibility that older people are not aware of the importance to them or the possibility of participating in clinical trials; some are intimidated by the complicated process of obtaining informed consent that is required to participate; Many elderly patients have cognitive impairments, the presence of which makes obtaining informed consent more difficult (but not impossible) task; a patient's reluctance to participate in a clinical trial may come from family members or caregivers; sometimes mobility and transportation issues are an obstacle. However, the difficulty of enrolling older patients in clinical trials means that information on the effectiveness of treatment must be extrapolated from clinical trials with significantly younger and healthier patients, which presents a real challenge for clinicians.

Old age is the period of life in which the likelihood of developing epilepsy is highest (the incidence increases from 85.9 new cases per 100 thousand people aged 65–69 years to 135 new cases per 100 thousand people aged 80 years and older; morbidity the same in the general population (all age groups) is 80.8 new cases per 100 thousand population). At the same time, only three qualitative clinical trials of potential treatment of elderly patients with newly diagnosed epilepsy have been carried out so far.

Similarly, with each subsequent decade of life beyond age 55, the incidence of new strokes doubles. However, as noted by the authors of the review on the prevention and treatment of stroke in elderly people, the average age of participants in one of the key clinical trials of alteplase in acute stroke, conducted by the National Institute of Neurological Disorders and Stroke of the United States - NINDS (National Institute of Neurological Disorders and Stroke) was 67 years old, and patients aged 80 years and older were specifically excluded from post-registration studies. Accordingly, the use of alteplase for the treatment of patients over 80 years of age has not been registered. An attempt to rectify this situation is being undertaken in the ongoing, currently, the third International Clinical Trial in Stroke (Third International Stroke Trial - IST-3), which has already included more than 800 patients over 80 years old.

Many serious, disabling diseases of elderly patients are neurological. Therefore, to explore promising neurological interventions in elderly patients, a new generation of clinical trials with less stringent inclusion-exclusion criteria, using dosages and regimens that are appropriate for the elderly, are needed. These clinical trials will inevitably include patients with comorbidities, but we need to capture and quantify a group of debilitated patients - just as we estimate other factors such as age, gender, or blood pressure. Researchers must be flexible, be creative, and thus facilitate the participation of older patients in clinical trials. In addition, research planning should use endpoints suitable for assessing the elderly population: outcomes such as mortality may not accurately reflect the elderly population. Social impairment caused by a physical defect, cognitive function or quality of life indicators are some of the possible endpoints that are more appropriate for a given age group.

The demographic aging of the world's population will cause an increase in the number of elderly patients with neurological diseases. Efforts should be made to ensure that clinical trial participants are consistent with the general population.

References are in edition

Neurology symptoms of the disease in the elderly

These are the most visible signs of aging. Gradually, the length of the steps decreases, the gait becomes slower, the person begins to slouch. An elderly person is less confident and more careful when walking, tries to hold onto the handrails when going downstairs so as not to stumble. All movements become less fluid. It is difficult for a person to take off his pants, standing alternately on one and the other leg. The handwriting changes, all movements of the arms and hands lose dexterity. Choking often begins. Very often, the elderly develop urinary incontinence. Undoubtedly, this complex of movement disorders is associated with the loss of neurons in the spinal cord, cerebellum and brain, as well as with the loss of muscle mass.

Common and subtle gait disturbances in a “normal” elderly person must be distinguished from rapidly growing and pronounced gait changes in a small part of elderly people who retain a relatively normal level of other functions. Despite the similarity, the latter disorders reflect an aging degenerative brain disease and in most cases, sooner or later, are accompanied by a decrease in mental abilities. When walking, the patient looks at his feet, it is difficult for him to walk and talk at the same time. A flexion pose appears. Gradually, as the steps are shortened, the feet practically do not come off the floor (mincing gait); later a shuffling gait appears. Later, the patient, getting up from a lying or sitting position, it is difficult to take the first step, even if he moves his legs without difficulty while lying in bed. At this stage, supporting the patient by the hand or accompanying him with a request to walk in a certain rhythm can help. In the later stages of this disease, the ability to stand and walk is lost, the patient lies in bed, cannot turn, and sometimes is in a posture characteristic of flexor cerebral paraplegia. An inexperienced doctor may suspect a mental disorder. The cause of the above-described gait disturbance may be a combination of degeneration of the frontal lobes and basal ganglia, the pathological changes in which are still not fully understood. Levodopa and other medicines are not effective.

In a significant part of cases, the disease develops against the background of a partially curable state of normotensive hydrocephalus. It is characterized by moderate ataxia, as well as symptoms of parkinsonism. Parkinson's disease can be another curable cause of walking disorder. When searching for the causes of gait disorders, it is necessary to exclude damage to the posterior columns of the spinal cord, vestibular disorders, cerebellar ataxia, spastic paresis with ataxia in cervical osteochondrosis, each of which can lead to instability of the patient.

Falls in old age. Falls are a significant threat to life in older people without overt neurologic symptoms. On average, 30% of these people living in their home fall one or more times a year; the incidence of falls rises to 40% in people over 80 and exceeds 50% in the elderly living in nursing homes.

There are many causes of falls, some of which are mentioned above in the gait disturbance statement. An important provoking factor is age-related decline in vision and vestibular function. Postural instability inherent in aging contributes to falls during normal physical activity: walking, changing posture and descending stairs. Orthostatic hypotension is also an important cause of falls in the elderly, often due to the use of antihypertensive and sedative drugs. It should be noted that falls are characteristic symptoms of some neurological diseases of the elderly: stroke, Parkinson's disease, normotensive hydrocephalus, progressive supranuclear palsy, etc.

Neurological diseases of the elderly.

Among the degenerative diseases of the nervous system of the elderly, the most common and important is the non-hereditary form of Alzheimer's disease. Dementia as the main manifestation of brain diseases is discussed in our article. Our article is devoted to Alzheimer's disease and other degenerative diseases of the elderly.

Atherosclerotic lesion of cerebral vessels is often found in the elderly, but it does not develop in parallel with aging and is often significantly pronounced in some 30-40-year-olds and is almost not detected in some 80-year-olds. In addition to atherosclerotic lesions, with aging, the main arteries become larger, convoluted and dense.

Most neoplasms of the nervous system are observed at a young and middle age. In old age, their frequency decreases. Some endocrine tumors, apparently, develop during a period of increased functional demands - for example, in old age, pituitary adenomas begin to develop along with atrophy of the gonads and adrenal glands.

The high risk of side effects when taking medications in the elderly is associated with several factors: an increase in the duration and severity of drug action, frequent dose discrepancies with reduced body weight, a decrease in the level of hepatic metabolism and renal excretion of the drug, and especially the manifestation of latent dementia when taking certain drugs, mainly sedatives ...

Often in elderly people, the disease does not develop in a severe form due to the combined functional failure of several organs, none of which reaches the stage of clinical manifestations. This multiple organ failure is the clinical image of old age. The long list of diseases diagnosed in the elderly at autopsy reflects an individual's increased predisposition to disease with age. However, the contribution of the aging process is not obvious, so medical students often do not understand during autopsy what caused the death of an elderly person.

Mental illnesses arising in presenile (presenile, involutional) and senile age.

general characteristics

A decrease in mortality, an increase in average life expectancy led to a change in the age structure of the population: the number of elderly and senile people increased. This is due to the absolute increase in the number of all psychoses of late age, but the proportion of age-related psychoses proper did not increase. It is generally accepted to divide late age mental illnesses into "organic" ones, i.e. arising on the basis of a certain morphological, mainly destructive, process and leading to various forms of dementia, and "functional", i.e. not possessing a similar anatomical substrate, reversible and, as a rule, not leading to gross dementia. However, clinical and morphological studies have shown the proximity, if not all, then part of the so-called involutional psychoses to endogenous ones. During functional processes, there is no persistent organic decrease in the level of mental activity and morphological cerebral changes. In psychiatric practice, the designations "organic" and "inorganic" psychoses emphasize their significant differences.

Involutional (presenile, presenile) psychoses

Involutional psychoses unite a group of mental illnesses that manifest themselves in the involutionary period (45-60 years) and in old age (late variants of involutional psychoses), which do not lead to dementia, i.e. are functional.

The nosological independence of involutional psychoses remains controversial. Presenile psychoses include: 1) involutional depressions (melancholy), including a malignant variant (Kraepelin's disease); 2) involutional delusional psychoses; 3) late age catatonic and hallucinatory psychoses.

Due to the sharp discrepancy in the definition and diagnosis of involutional psychoses, there is practically no reliable data on their prevalence. Difficulties in diagnosis are associated with the fact that at a later age, the clinical manifestations of many psychoses lose their typicality and acquire common (age-related) features. In particular, special anxious-agitated and anxious-delusional syndromes characteristic of involutional psychoses can also be observed in other diseases that arise at a later age (schizophrenia, MDP, atherosclerotic and other organic psychoses). The diagnosis of involutional psychoses based on the clinical picture alone turned out to be inconsistent in many cases. Long-term follow-up observations have shown that many "involutional depressions" subsequently proceed periodically, with repeated phases becoming increasingly similar to typical depressive or manic phases. The study of catamnesis revealed paroxysmal forms with the complication of subsequent attacks, i.e. with the appearance in them of typical schizophrenic disorders, and at later stages - schizophrenic personality changes. The pre-manifest period of life of such patients and their families also sometimes has features characteristic of endogenous psychoses. In general, clinical studies of recent years have contributed to the narrowing of the concept of involutional psychoses and made it possible to classify their considerable part as endogenously or organically determined diseases.

Etiology and pathogenesis

The premorbid personality structure (rigidity, traits of anxious suspiciousness, etc.), situational and psychotraumatic factors preceding psychosis, are important; but somatic diseases that reduce the body's resistance, etc. The role of the listed factors in all mental diseases of late age is more significant than in psychosis of middle age. The assumption of the pathogenetic role of endocrine factors associated with involution has not been confirmed.

Depression and psychosis at an involutionary age

Involutionary depression (melancholy) is a prolonged anxious or anxious-delusional depression that first appeared in the involutionary age. The single (monophasic) nature of the disease is an essential diagnostic criterion. The clinical picture consists of a depressed mood, anxious excitement with fear, verbal illusions, delusions of condemnation and delusions of Cotard. The forms of the disease manifesting in old age are called "late depression". They are observed mainly in women. The onset of the disease in 80 - 90% of cases is preceded by harm, most often psychogenia. The initial period of psychosis can last from several weeks to a year and is defined by atypical depression with lethargy, dysphoria, and hypochondriacal disorders. Further exacerbation occurs: anxiety, agitation, ideomotor agitation. In older patients, anxiety-depressive affect is usually combined with irritability or anger. Depressive delusions of various forms (ideas of self-abasement, self-blame, condemnation, ruin, or hypochondriacal) quickly join. In the structure of psychosis, a picture of anxious-agitated depression with fear, motor agitation, anxious verbigeration and severe adaptation disorders (increased anxiety when changing places) can be observed. In a state of anxiety, patients can impulsively inflict severe damage on themselves and make serious suicidal attempts. Agitation may alternate with a state of numbness (depressive stupor). Psychosis is complicated by delusional symptoms, depressive ideas of immensity, hypochondriac-nihilistic delirium (various variants of Cotard's syndrome) arise. Verbal illusions or hallucinations corresponding to the dominant affect are often encountered. Such a complex depressive syndrome can last 2 to 3 years. Then the clinical picture stabilizes, becomes more and more monotonous. If it is not possible to induce therapeutic remission, then the intensity of affective disorders gradually decreases, anxiety and fear decrease, and all psychotic disorders are reduced. Sometimes, for many years, monotonous anxiety and phenomena of reduced motor restlessness are observed. There are signs of behavior regression (gluttony, slovenliness, etc.) and a decrease in the level of mental activity, including dysmnestic disorders.

Malignant presenile psychosis (Kraepelin's disease) - the disease proceeds with a sharp anxious agitation and confusion, incoherence of speech, oneiric confusion, sometimes with violent excitement, followed by cachexia and death. This severe form of anxious-agitated melancholy is now extremely rare.

Simple depression. The development and content of these depressions are closely related to situational and reactive moments. Although even with them the alarming coloration of a lowered mood prevails and hypochondriacal fears occupy a large place, persistent delusional disorders and agitation are usually absent. Their prognosis is generally favorable, but nevertheless they often turn into persistent subdepressive states with gloom and increased hypochondriacia. Involutional delusional psychoses. Hallucinatory-paranoid psychoses of late age with a clear tendency to syndromic complication, in particular to the development of mental automatism, during follow-up check in most cases turned out to be late manifesting or exacerbating forms of schizophrenia. The clinical and nosological independence of certain groups of late delusional psychoses remains controversial.

Involutionary paranoia. The course is chronic (up to several years) or undulating. The clinical picture is determined by a systematized monothematic paranoid delusion in the form of ideas of jealousy (mainly in men), then ideas of harm (more often in women) or persecution. Such psychoses are rich in argumentation and delusional interpretations; detailed delusions gradually develop. Delirium also spreads retrospectively (delusional rethinking of the facts of the past). Patients are distinguished by stenic, often uplifted, affect, optimism, and exhibit high delusional activity of the "persecuted persecutor" type. These psychoses are usually not accompanied by significant personality changes and do not translate into organic decline.

Involutionary paranoid ("late paranoid", paranoid of small scale or everyday relationships). It occurs more often in persons with features of paranoia and rigidity in premorbid. The course of such psychoses is protracted or wavy. The clinical picture of paranoid is determined by "small-scale" delusions of persecution (sabotage, oppression), poisoning and damage, which is designated in the same way as delusions of small scale or everyday relationships. Delirium is directed mainly against specific individuals from the patient's environment (family members, neighbors) or people with whom the "persecutors" may be associated (police officers, doctors, etc.). As a rule, delusions are systematized, although the delusional system remains simple and specific. Persecution is usually interpreted in terms of damage (attempts to deprive the patient of a room, damage to property, etc.). Separate verbal illusions, less often verbal hallucinations are noted.

Quite often, delirium of poisoning with olfactory deceptions (smells of gases, poisonous substances) and delusional interpretation of various somatic sensations is added. At the same time, revelatory ideas are developing against the persecutors (the same neighbors are doing “dark deeds”). The behavior of patients becomes more and more delusional, often with litigious struggle. The mood is at times anxious and depressed, but optimism prevails. After a change of residence, delusional production, as a rule, temporarily stops, but delusional correction does not occur. Outside the sphere of delirium, patients retain their usual social ties, serve themselves, and are fully oriented in everyday matters. Even with a long course of the disease, pronounced psychoorganic disorders do not develop. Personal changes are limited by growing suspicion and conflict.

Treatment of diseases

Organic deafening processes of late age

Mental diseases of late age, caused by organic processes, are subdivided, but predominantly morphological changes into atrophic-degenerative and vascular. Mental disorders in cerebral vascular diseases.

Mental disorders in cerebral atrophic diseases of late age. The combination of various psychoses of late age into one group on the basis of a morphological criterion (cerebral atrophy of late age) is well argued. Variants of the atrophic process, determined macroscopically and histologically, to a certain extent correspond to the clinical features of the nosological forms of the group under consideration. Cerebral atrophic diseases are usually united by subtle initial symptoms, slow, gradual, but chronically progressive, irreversible development. Dementia progresses in the overwhelming majority of cases from a slight decrease in the level of personality to a deep disintegration of mental activity, that is, to total (global) dementia. At different stages of the disease, neurological symptoms gradually join mental disorders: epileptic seizures, cortical and other neurological disorders. The process is predominantly endogenous, various exogenous factors often play a subordinate (provoking, weighting) role. Even with some rare forms (Creutzfeldt-Jakob disease), in the etiology of which the significance of exogenous influences (viral infection) is very likely, the participation of a genetic factor is not excluded. The modern classification of atrophic processes with mental disorders includes: 1) presenile dementia: a) systemic atrophies - Pick's disease, Huntington's chorea, Parkinson's disease, Creutzfeldt-Jakob disease and other rare diseases; b) Alzheimer's disease close to senile dementia; 2) senile dementia: the main form and its variants.

Pick's disease

PEAK'S DISEASE (Pikovskaya atrophy of the brain) is an impaired organic process accompanied by various focal disorders. Most often it manifests in the presenile age and is caused by limited atrophy of certain areas of the cortex and subcortical formations of the brain. There are no reliable data on the prevalence of Pick's disease; it has been found, however, that it occurs approximately 4 to 5 times less frequently than Alzheimer's disease.

Etiology and pathogenesis. Pick's disease belongs to the so-called systemic atrophies, that is, to a group of endogenous degenerative-atrophic processes with different localization in the nervous system. Many authors classify Peak's atrophy as a hereditary disease; verified family cases of this disease have been described many times. Families with other forms of systemic atrophy besides Pick's disease have been observed. However, it is often not possible to establish hereditary burdened.

Computed tomography of the brain. A pronounced expansion of the ventricular system and a sharp expansion of the grooves of the cerebral hemispheres, especially in the anterior sections, are determined.

The clinical picture. The average age at onset is approximately 55 years; both earlier and later manifestations are possible. The average duration of the disease does not exceed 6 years, in some cases - up to 8 years. Women get sick more often, but the gender distribution differences are less significant than in other atrophic processes. In addition to the general clinical properties of late atrophic processes, Pick's disease has a number of characteristic features. In the early stages, deep and progressive personality changes are clearly visible. Disorders of memory and other "instrumental" functions of the intellect can remain blurred for a long time. Mental activity is struck as if "from above": the productivity of thinking, criticism and the ability to comprehend, the level of judgments and inferences decrease. The type of personality changes correlates with the predominant localization of atrophy. Specifically, the correlation between the initial disorders and the localization of atrophy is as follows. Atrophy of the convexital surfaces of the frontal lobes: spontaneity, passivity, inactivity, indifference and emotional dullness; the impoverishment of speech, thinking and motor skills is growing. Atrophy of the orbital (basal) areas of the frontal lobes: euphoria, a sharp decrease in criticism, loss of moral attitudes, disinhibition of drives, i.e. pseudo-paralytic syndrome. Frontal-temporal atrophy; various stereotypes, at the beginning of behavior and actions, later - speech and writing.

Other initial disorders are much less common. In some cases, at the onset of the disease, patients experience a certain feeling of change and present complaints that resemble those of patients with cerebral vascular lesions. There are rare forms in which, in the clinical picture, limited focal disorders are much ahead of the development of dementia, so that in the early stages of the disease there is an assumption of a vascular or tumor process. Sometimes, on the contrary, focal symptomatology "lags behind", and the severity of personality changes, in particular aspontaneity, or stereotyping leads to the diagnosis of schizophrenia. The misdiagnosis becomes apparent later. As the process progresses, typical violations that were noted already in the initial stage intensify. Spontaneity, indifference and indifference reach an extreme degree, pseudo-paralytic features become more and more coarse and absurd, and stereotypes of behavior can completely determine the clinical picture. The mental capacity for work and the intellectual activity of patients are steadily decreasing, then all types of memory are reduced and destroyed. A deep dementia of the globular type develops with an extreme impoverishment of all types of mental activity.

In Pick's disease, more often in the initial stage, mental disorders are also possible, usually short-term and rudimentary: hallucinatory and hallucinatory-paranoid episodes, individual delusional statements (ideas of harm, jealousy or petty oppression), undeveloped stereotypical confabulations, states of confusion and psychomotor agitation.

Focal cortical disorders are obligatory manifestations of Pick's disease. In almost all cases, speech decay is observed, total aphasia develops. There is a gradual vocabulary, semantic and grammatical impoverishment of speech, speech stereotypes appear. In cases of predominance of atrophy of the frontal lobes, patients show a peculiar "unwillingness" to speak: a decrease in speech activity reaches full speech aspontaneity, expressive speech gradually fades away (a state of "initiative", seeming dumbness). With combined frontotemporal atrophies, amnestic aphasia and impaired understanding of speech are observed, when semantic understanding becomes worse with relative preservation of phonemic, i.e., repeated, speech. Complete sensory aphasia occurs in later stages. Echolalia (repetition of heard words, cues, sounds) - a characteristic feature of speech decay in Pick's disease - can be partial or complete, softened (mitigated) and automated. Over time, stereotypes ("standing turns") are more and more often revealed; in the later stages of the disease, they often constitute the only form of the patient's speech activity. There are also violations of reading, writing (including "standing turns" writing) and counting; apractical symptoms are usually mild. With the transition of atrophy to the subcortical ganglia (in approximately 1/4 of patients), extrapyramidal disorders are observed, more often amiostatic syndromes, less often various hyperkinesis. The transition of atrophy to the precentral area with the appearance of spastic hemisyndrome is a rare occurrence in Pick's disease.

The outcome of the disease is global dementia, a total decay of speech, activity and recognition, as well as insanity and complete helplessness. The prognosis is unfavorable.

Treatment for Pick's disease

There are no effective means capable of limiting the progression of the process. Patients, especially in the later stages of the atrophic process, need hospitalization in a psychiatric hospital. The device is shown in a boarding school for the chronically mentally ill.

Chorea of \u200b\u200bHuntington

PROGRESSIVE CHRONIC HEREDITARY CHOREA (GENTINGTON CHOREA) is one of the forms of cerebral atrophy; manifests in middle or old age with hyperkinesis of the chorea type, psychopathic, psychotic disorders and a kind of dementia. There are known cases of early onset of the disease - up to 20 years (about 5% of all cases) - the juvenile form. In Europe, patients with a juvenile form make up 4%, in some peoples of the South African Republic - 15.7% of all patients with Huntington's chorea. In general, Huntington's chorea is a relatively rare disease. Information about its prevalence is scarce and contradictory, since due to the relatively mild severity of dementia, not all patients fall into the field of vision of a psychiatrist. There is reason to assume geographic differences in the prevalence of this suffering. Roughly the incidence of the disease in the population ranges from 3 to 7 or more. Cases of Huntington's chorea account for 0.1 to 1% of those admitted to psychiatric hospitals.

Etiology and pathogenesis. Established not only hereditary nature, but also the type of inheritance (dominant) of the disease. Huntington's chorea is directly transmitted through a large number of subsequent generations; the ratio of sick and healthy in quite numerous generations is close to 1: 1; marked 100% concordance in monozygotic twins, cases of illness in half-brothers and sisters, absence of diseases in the offspring of the remaining healthy family members. However, along with hereditary forms, there is a small group of "non-hereditary" cases that do not differ from the bulk of diseases either clinically or pathoanatomically. At the heart of Huntington's chorea is an atrophic process. The systemic nature of atrophic changes, the hereditary nature of the disease and its frequent combination with other atrophic-degenerative processes make it possible to classify Huntington's chorea as systemic atrophy.

The clinical picture. The average age at which the disease begins is somewhat lower than with other presenile atrophies (45 - 47 years). The average duration of the disease is much longer (12 - 15 years, sometimes several decades). The distribution of patients by sex does not differ from that in the population.

In at least half of the cases, Huntington's chorea develops against the background of premorbid abnormalities, intellectual disability, psychopathic anomalies, a kind of clumsiness, and undifferentiated motor skills. It often remains unclear whether these are premorbid features (congenital inferiority) or the initial manifestations of the disease. Among the pronounced premorbid characterological anomalies, it is conditionally possible to distinguish excitable, explosive, hysterical, withdrawn, emotionally cold (schizoid) psychopathies. The disease more often manifests as choreatic hyperkinesis, in fewer cases, intellectual decline or other psychopathological disorders. Dementia developing in chronic chorea has a relatively low progression and often also a relatively small depth, as a result of which patients are hospitalized late or generally remain outside the hospital, retaining a certain ability to work. At the same time, they turn out to be untenable in creative, mental work that is unusual for them and to some extent. The intellectual performance of patients is subject to significant fluctuations. Revealed gross disorders of memorization and reproductive memory also fluctuate. The devastation of memory that occurs in the later stages usually does not reach the extreme degree observed in other atrophic processes; very rarely is the orientation in one's own personality or chronological sequence of events grossly disturbed. From the very beginning of the disease, as a rule, there are defects in conceptual thinking, a progressive decrease in the level of available generalizations, abstraction and judgments, narrowing and impoverishment of all mental activity. In some patients, dementia continues to develop in this direction; in others, extreme instability of attention, increased distraction, inconsistency of thinking, inconsistency of attitudes and goals of intellectual work and the associated extreme unevenness of its results are in the foreground, which gives the clinical picture the appearance of "choreatic dementia ".

Dementia in Huntington's chorea is far from being extreme in all cases. The depth of dementia is different and does not correlate with the severity of hyperkinesis. The development of dementia is usually accompanied by an increase in affective and psychopathic changes. In particular, excitability and explosiveness, emotional instability, a tendency to hypochondriac and teary-depressive reactions, hysterical moodiness, etc., increase. As dementia progresses, however, these changes are usually smoothed out and emotional-volitional dullness and dull euphoria come to the fore. Speech changes are mainly explained by the influence of hyperkinesis on the speech muscles. However, sometimes there are also signs of a general impoverishment of speech and vague amnestic-aphatic disorders. Various psychotic syndromes occur relatively often. As with other atrophic diseases, they usually remain undeveloped or rudimentary. In the early stages of the disease, reactive states with hysterical or pseudodement coloring, depending on premorbid abnormalities, or depressive syndromes usually with a special gloomy, dysphoric, irritable or apathetic tinge of affect prevail. Poor, poorly systematized paranoia disorders, in particular delusions of jealousy, and expansive delusional syndromes with paralytic, ridiculous ideas of greatness and omnipotence are relatively common. There are also hallucinosis with a predominance of tactile and visceral deceptions of perception, with sharply negative efficiency, or acute psychotic episodes with indiscriminate psychomotor agitation. Along with pronounced forms in the families of patients with Huntington's chorea, a number of clinical variants of the disease are also observed: neurological (typical choreatic hyperkinesis without severe dementia; cases with a predominance of akinetic-hypertensive syndrome, reminiscent of Wilson's disease); psychopathic (so-called choreopathy); a variant of progressive dementia with rudimentary movement disorders. In patients with late onset of the disease, "status subchoreaticus" has been described - a variant with mild manifestations of Huntington's chorea. The options do not change throughout the course of the disease.

The clinical picture of the juvenile variant. The juvenile variant of Huntington's chorea differs from the corresponding disease in adults by the originality of motor disorders, greater progression, the appearance of symptomatic epilepsy and cerebellar disorders. Choreic movements are the first manifestation of the disease. They are overlapped by progressive muscle rigidity, which later prevails among motor disorders.

In all patients, intellectual activity deteriorates. They cannot continue their studies at school, they note difficulty concentrating. Psychoses are possible. Convulsive seizures develop in 30-50% of patients with juvenile variant in the late, late stages of the disease. Both large convulsive seizures and seizures of the petit mal type are possible. Anticonvulsants are ineffective.

In some patients with a juvenile variant, disorders of cerebellar functions occur - dysmetria, diadochokinesia and intentional tremor. Less commonly, nystagmus is observed. The disease progresses rapidly and ends in death.

Treatment for Huntington's chorea

They tried to treat Huntington's chorea with neuroleptic drugs (reserpine, chlorpromazine, ethaperazine, thioridazine, mazheptil, etc.). In some cases, hyperkinesis is noticeably reduced, and sometimes affective tension and psychopathic behavior disorders are smoothed out. For psychotic disorders, chlorpromazine is indicated. However, the effect of psychotropic therapy is usually short-lived; even with supportive treatment, there are no significant changes in the course of the disease. Attempts have been made for neurosurgical treatment. After stereotaxic operations, hyperkinesis often softened or disappeared, but due to the progression of mental changes, this treatment can hardly find widespread use. Due to the relatively low progression of mental disorders in Huntington's chorea, hospitalization in a psychiatric hospital is not necessary in all cases. Most of the sick can stay for a long time or always in a family or homes for the disabled. In the prevention of the disease, a certain place is occupied by medical and genetic counseling.

Questions From Readers

Hello, my wife's leg started to hurt 18 October 2013 Hello, my wife's leg started to hurt. There were all signs of a pinched nerve. According to the results of MRI of the lumbosacral spine: At the level of L1-L2 - left posterior paramedial disc protrusion up to 3.5 mm, width - 10.1 mm; At the L3-L4 level - posterior central protrusion up to 4.5 mm on the left, width - 17.5 mm level L4-L5 - posterior paramedial hernia on the left up to 5.1 mm, width - 17.0 mm; At the level L5-S1 - posterior paramedial hernia on the right with elements of hernia sequestration up to 7.2 mm, width 18.1 mm. Hernias cause compression of the dural sac and nerve roots. In one clinic, it is advised to start manual therapy, while others say that with hernias with such dimensions, this is absolutely contraindicated. Tell me how to proceed more correctly - to start a course of man.therapy, or is it still with medication and a neurosurgeon? Thank.

References are in edition

Nervous system... The most important manifestations of human aging are associated with age-related changes in c.s. However, this often retains a high level of intellectual activity, the ability to generalize, to concentrate. In addition, long-term maintenance of intellectual activity is based on the ability to cope with a wide range of tasks based on rich life experience.

I.P. Pavlov and colleagues showed that the mobility of the processes of excitation and inhibition is weakened first of all, the strength of the nervous processes and the protective function of inhibition are reduced, and conditioned reflexes are more difficult to develop.

The nature of unconditioned reflexes also changes, reflex reactions often become protracted. Changes in the activity of analyzers are increasing, vibration, tactile, temperature and pain sensitivity, sense of smell, visual acuity and eye accommodation power decrease, presbyopia progresses, the rate of dark adaptation changes, the upper limit of hearing gradually decreases. A number of changes in the electroencephalogram are found, in particular, a slowdown in the alpha rhythm. There are shifts in the regulation of the internal environment of the body, more often it breaks down. In connection with the weakening of the influence of the nervous system on tissues, associated with the destruction of nerve endings and a decrease in the synthesis of mediators in them, there are violations of tissue trophism. An important adaptive mechanism under these conditions is an increase in the sensitivity of cells to mediators.

Mental disorders... Among the mental changes caused by aging, the most important and permanent is the decrease in mental activity. The pace of mental activity slows down, its "stiffness" arises (difficulties in solving problems that require resourcefulness, imagination, ingenuity, finding new, "workaround" solutions), the perception of the environment worsens and its volume narrows, the ability to abstract and integrate various perceptions into one whole, the ability to assimilate new things decreases, in particular, not only new information, but also new skills. The latter are especially difficult when they do not agree with those that existed before. Slowdowns and declines in mental productivity often entail dissociation between the tempo of thinking and speaking. The depletion of mental activity and, as a result, a decrease in the communicative function of speech may be accompanied by an increase in speech activity, depleted of semantic content ("senile chatter"). There is a close relationship between signs of mental aging and changes in motor skills, manifested by impaired pace, fluency, accuracy and coordination of movements. Disautomation of motor functions occurs. Therefore, in old age, the role of visual perception increases when performing fast and accurate movements. In situations requiring quick and clear motor responses, for example when crossing streets, old people can easily develop states of "motor confusion" with unpredictable movements.

In the mental changes observed with aging, memory changes are not leading for a long time. Experimental psychological studies have shown that memorization of words and numbers noticeably worsens only after 70 years. What is often taken for memory loss is actually a manifestation of a weakening of the possibility of forming new connections, a decrease in mental activity or attitudes for remembering.

In the process of aging, a person's character changes. Initially, there is a certain sharpening of the former characterological features. It is usually more pronounced in persons of a psychopathic disposition and accentuated personalities. Along with this, there are also personal shifts common for old people - conservatism in judgments and actions expressed to varying degrees, one or another degree of misunderstanding and rejection of the new with its opposition to the past, which, as a rule, is regarded positively or simply praised. There is a tendency towards teaching and moralizing. Objections lead to irritation to the point of hostility. Easily arising stubbornness is often combined with selective sublime suggestibility. In all cases, affectivity changes. The resonance for current events is reduced, as well as for many events affecting personal life. So, very often an old person who loses a spouse with whom a long life has been lived is only at the first moment capable of giving a violent affective reaction (grief, despair, etc., in women, often with hysterical components), and then quickly calms down and subsequently noticeably is not burdened by the loss that befell him. The majority of old people are characterized by the appearance of such traits as fear or anxiety about their personal future, stinginess, distrust and especially increased attention to their health and various physiological functions. The latter is determined, apparently, by the fact that in the overwhelming number of aging people, this process is reflected in consciousness primarily as a physical illness. As a rule, it is precisely the negatively colored experience of one's physical distress that is the main reason for the corresponding negative attitude of the majority of people towards the fact of aging. There are direct correlations between age and suicide rates. Older people are the most likely to commit suicide. The ratio of men and women in this period of life is 2: 1. With an increase in the number of completed suicides in old age, there is a simultaneous decrease in the frequency of incomplete suicides - suicidal attempts.

There are a number of factors that slow down the time of onset and the rate of mental changes that occur in old age. These include, first of all, the high level of intellectual development achieved by old age and dependent on natural talent or professional activity. The signs of age-related decline in the psyche are usually less pronounced in those cases when a person continues to lead an active lifestyle in old age, doing physical or intellectual work. There are indications that lighter mental changes during aging are observed in people who are sociable, livable, active, and have good adaptive capabilities.

Preexisting mental illnesses arising in old age or aggravated in this age period are often accompanied by certain psychopathological disorders inherent only in this contingent of patients.

Asthenia predominates among neurotic or neurosis-like disorders. A weak manifestation of autonomic disorders is characteristic. Very often asthenia is accompanied by anxious hypochondria. In patients with depression, a melancholy mood is often poorly expressed or even absent. Depression with lethargy, weakness, or depression with anxiety affect predominate. Usually there is no ideomotor inhibition, which allows us to speak of the predominance of mixed states. Depression often occurs with irritability, grumpiness, discontent. The content of depressive delirium is dominated by ideas of ruin, impoverishment, hypochondriacal character or ideas of self-deprecation. Kotard's delirium is often observed, more often his hypochondriacal variant. In hypomanic and manic states, either unproductive efficiency or fussiness prevails, or states with fragmentary expansive delusions (mania with pseudo-paralytic syndrome).

Among the states of dimmed consciousness in old age, delirium and deafening of consciousness are most often noted. Expanded delirious pictures are rather an exception. Hypnagogic, abortive, occupational, and exaggerating deliriums are common. With delirium, distinct autonomic disorders are rare. Oneiric syndrome occurs only in the form of separate episodes, that is, it is fragmentary. It is observed only in exogenous organic psychoses (vascular, alcoholic, in the debuts of senile dementia, etc.) and sometimes in schizophrenia. Twilight clouding of consciousness usually proceeds without pronounced hallucinatory, delusional and affective disorders. Chaotic motor excitement may be noted. Complete amnesia is often observed after delirium and oneyroid. With incomplete amnesia, transient Vic's syndromes can occur in the form of confabulosis, residual delirium. After severe and especially long-lasting states of dull consciousness (pronounced degrees of stunning, professional and exaggerating delirium, dim dimness of consciousness), a psychoorganic syndrome develops, often pronounced, prolonged and in some cases reversible.

When psychopathological disorders occur, it is possible to state the presence of disorders of various severity inherent in the psychoorganic syndrome. The existence of the latter often entails the appearance of reactive and especially symptomatic lability. Reactive lability is the development of mental reactions under the influence of mental trauma, which in old people may be insignificant. In the presence of symptomatic lability, various intercurrent diseases easily provoke the appearance of states of clouded consciousness. The presence of symptomatic lability is associated with such an important fact as the debut in old age of a relatively gradually developing somatic illness of mental disorders.

In old age, there is often a modification of the manifestations and development of mental illnesses that began in the previous age periods. This pathomorphosis of pre-existing mental illnesses is due to age-related changes in mental activity and shifts in the response of the brain altered by aging.

In old age, mental illness occurs that is characteristic only of this period of life, that is, diseases in which aging in certain cases is an etiological factor - senile dementia, Alzheimer's disease, Peak disease, etc.

When treating mental disorders in an elderly patient, one should always take into account his somatic state. Due to the low and even poor tolerance in old age, treatment with psychopharmacological agents, their use requires caution: a slow increase in doses, a decrease in the maximum doses used (approximately twice or even three times compared with the doses used in the treatment of young and middle-aged patients), mandatory simultaneous use correctors (cyclodol, etc.) due to the ease of development of neurological complications that are difficult to correct. Tranquilizers should be prescribed very carefully due to their pronounced muscle relaxant effect and sharply increasing movement coordination disorder. For this reason, it is better not to use a tranquilizer like Relanium (Seduxen) at all.

In the treatment of depressive conditions, electroconvulsive therapy is widely used. Many patients are indicated for treatment with nootropic drugs (piracetam, pyriditol, etc.). These funds have, among other things, a mild stimulating effect, so they should be prescribed only in the morning and at noon. In addition, the use of nootropic drugs often leads to the appearance of severe irritability. Of the psychotherapeutic methods, family psychotherapy is of great importance.

Insomnia problem ... Elderly patients often complain of insomnia, their sleep patterns change - they often sleep more during the day, and at night lead a more active lifestyle (eating, walking around the room, reading). In this case, sleeping pills often used by patients can quickly become addictive. In addition, against the background of taking sleeping pills, weakness, headaches, a feeling of morning "weakness", and constipation may appear. If necessary, sleeping pills are prescribed by a doctor. The nurse can recommend the patient to take medicinal herbs (for example, motherwort decoction, 10-15 ml 40 minutes before bedtime), 10-20 drops of Valocordin, a glass of warm milk with honey dissolved in it (1 tablespoon) and etc.

How the nervous system ages

When I was in medical school, we were taught that the central nervous system, the central nervous system, cannot repair the damage done to it, such as a trauma, head injury, or Alzheimer's - it cannot regenerate dead brain cells. We are accustomed to the idea that the brain ages with age. But, fortunately, this general opinion has literally turned upside down lately. We now know that brain cells and nerve cells have the ability to regenerate. This is fantastic news because it means that we are not condemned to the ages of the brain and nervous system, such as loss of memory, loss of the ability to reason well. And even dementia.

But, of course, many cells undergo changes with age, and we'll talk about them first. First, the nerve cells in your brain and spine tend to contract and can no longer send signals at the same speed. When nerve cells degenerate, waste products accumulate. This threatens Alzheimer's disease and other serious problems.

All your senses suffer, such as hearing. I advise my patients to have their hearing checked annually so that they can take action in time, including wearing a hearing aid if needed.

This degeneration process disturbs the balance because the vestibular apparatus is poorly regulated. Age-related hearing loss is called presbycusis. Ringing in the ears occurs. This is an incessant, sometimes loud, piercing ringing. If you have similar symptoms, see your doctor and he will find the best solution.

Vision weakens with age. Almost every patient of mine over 55 needs reading glasses, plain or bifocal.

Problems start when you can't focus on the text, called presbyopia. Some people see poorly in the dark, while others, on the contrary, in bright light. But problems can sometimes be solved simply with the help of glasses, so visit an ophthalmologist every year to know everything about your vision.

With nerve damage, your taste experiences change. And how sad it is when you no longer feel the taste of your favorite food or wine - with age, the number of taste buds located on the tongue decreases. And those that remain are reduced in size. Between the ages of 40 and 60, the disappearance of your taste buds increases and you lose the ability to taste salty and sweet.

And in conclusion, there is a decrease in saliva secretion, then dry mouth occurs, which makes it difficult to swallow. Saliva is an important component of digestion, which it promotes.

With age, a person ceases to distinguish between smells. Most often, a deterioration in the sense of smell occurs after 70 years. This is due to the loss of nerve endings in the nose or from the use of medications. Many older people are taking more and more medications, some of which can have harmful effects on the sense of smell. Such as estrogens, long-term runny nose drops and zinc supplements. There is no cardinal cure for this problem, so we can only try to prevent it while you can still smell.

Now about the memory. Nobody wants to lose their memory. Even young people often forget one thing or the other. For example, how many of you have not forgotten your computer password? Did you leave your keys in your parked car? With age, memory weakens, especially if you have not paid attention to your brain and nervous system for a long time. One of the reasons is the natural shrinking of the brain and nerve cells. By the age of 90, their number reaches 10 percent. This is a normal, natural process. But sometimes the process accelerates, and then the threat of dementia is imminent, seizures and a condition called aphasia - speech disorder occur.

Reading, you thought - what a horror this old age is. But wait. There is much in your power to prevent or at least slow down the aging process.

The risk of stroke increases the more the older we get. It is ischemic, when the blockage of blood vessels stops the supply of oxygen to the brain, and hemorrhagic when they rupture. Both are very serious and need immediate medical attention. Delaying it has irreversible consequences and leads to brain damage. It is possible to prevent stroke, even if you are genetically predisposed, by lowering cholesterol levels, maintaining a healthy weight, quitting smoking and preventing diabetes.

Supplements that support the nervous system:

Vitamin C:1000 mg per day

Vitamin E:200 units

Fish fat:3 g per day

Vitamin complex:

Folic acid:4 mg

AT 12:2.4 mg

AT 6:1,3 mg

Selenium:2 mg

Turmeric:750 mg per day

In 2004, Dr. John Hopkins presented the following data: 4,700 elderly people participated in the experiment. It turned out that those who took the vitamins avoided Alzheimer's disease. Omega-3 fatty acids, which are rich in fish oil, help to maintain a youthful brain. Moreover, if you do not eat seafood, you should make up for the lack of these acids with fish oil.

Turmeric is found in Indian spices. Its effect was studied at the University of California at Los Angeles on mice, and it was found that it is not only an antioxidant, but also an anti-inflammatory agent, prevents clogging of blood vessels with protein plaques in mice, the same occurs in Alzheimer's disease. In India, according to researchers, the lowest incidence of this disease is probably due to the use of curcumin and other spices, and it tastes great. I recommend adding it as a curry or in capsules. B vitamins work together as a nervous system support group. Folic acid works as a coenzyme in the presence of a certain level of vitamins B-6 and B-12; a lack of folic acid has been associated with the onset of Alzheimer's disease.

Another antioxidant that helps the brain is selenium. French researchers have found that it can inhibit mental decline. And long-term studies in this area indicate that when the level of selenium in the blood of older people decreases, brain performance decreases.

RELATIONSHIP OF DENTAL AND MENTAL ABILITY

Recent research suggests that people who do not monitor their oral health are more likely to have mental problems such as memory problems. The experiment involved 2000 people over the age of 60, all with periodontal disease, chronic inflammation of the gums. Scientists have found that the more bacteria that cause gum disease in a person, the worse his memory tests. And vice versa.

So advice: take good care of your teeth and brush for at least two minutes a day.

From the book Atlas: Human Anatomy and Physiology. Complete practical guide author Elena Yurievna Zigalova

From the book The Psychology of Schizophrenia author Anton Kempinsky

by Mike Moreno

From the book How to Stop Aging and Get Younger. Result in 17 days by Mike Moreno

author Alexey Viktorovich Sadov

From the book Wellness according to B.V. Bolotov: Five rules of health from the founder of medicine of the future author Yulia Sergeevna Popova

From the book of 100 Chinese Healing Exercises. Cure yourself! author Xing Soo Neurological and mental disorders in old age are very diverse and their origin is different. In the second half of life, the compensatory-adaptive capabilities of the organism begin to decrease more and more clearly, and the connections of individual nerve nodes and cells become less strong and reliable.
In elderly people, there is always a narrowing of the vessels of the brain due to atherosclerotic changes in them. Therefore, with age, the higher nervous activity of a person also changes, the strength, mobility and balance of the main nervous processes decrease. Clinically, this is manifested by an asthenic symptom, characterized by a drop in performance, sleep disturbance, emotional instability, and a weakening of attention and memory. Changes in the emotional sphere of a person are especially demonstrative.

With age, the risk of vascular diseases of the brain increases sharply. Cerebral frequencystroke in persons aged 60 years and older, 17 times higher than in persons of younger age. There is always a direct connection between age-related changes in the nervous, cardiovascular systems and lipid metabolism with atherosclerotic pathology in the elderly and old people. This relationship determines both the mechanisms of development of vascular pathology of the brain and the clinical manifestation of the main neurological symptoms of old age.
The progressive development of cerebral pathology begins with a failure of cerebral circulation, and with a deterioration in the supply of oxygen to the brain due to narrowing of the cerebral vessels, the phenomena of cerebral encephalopathy often develop in the elderly.
The functional capabilities of the central nervous system in old and senile age are sharply limited. This is a natural phenomenon to which the body gradually adapts. But the adaptive capacity of the organism at this age decreases.
Neurological and mental disorders in old age are diverse, their course depends only on the individual characteristics of each individual person, on the conditions of his existence, habits, etc. The way a person lived his life, how he treated his health for many years, depend in many ways, and the changes that occur to him in old age

Demographics and statistics
Some data for thought and action:
In 2000, there were 590 million people over 60 years old; by 2010 there will be 1 billion 100 million. There are now about 30 million elderly people in Russia: 4.3% of them are people over 75 years old. 3-4 million elderly people need constant medical and social assistance, and only 216-220 thousand people stay in boarding schools. According to statistics:

50% of the elderly have difficulty walking and climbing stairs;

15% of people aged 65-74 suffer from a clear limitation of mobility, and after 75 years this figure increases to 30%;

from 17 to 41% cannot visit medical institutions on their own;

31% have difficulty in self-service (dressing, bathing, eating, taking care of their natural needs);

8% do not leave their apartments;

5% do not leave bed;

4 to 5 diseases occur for every elderly person; in the future, 1 - 2 diseases are added for every 10 years;

74% regularly take medication;

58% rate their health as "bad" and 10% - as "very bad";

33% of people over 60 years old fall at least once a year, and half of the falls lead to injuries, 25% of patients with femoral fractures die within the first 6 months, only 25% return to their previous mobility;

30% have hearing impairments;

26% - visual impairment;

10-15% of 60-year-olds and 31-40% of 80-year-olds have dementia (dementia);

15% suffer from urinary incontinence;

11% call an ambulance more often 2-3 times a month;

more than 20% of older people live alone;

25% of older people periodically do not want to live or want to commit suicide ...

In old age, the anatomical and physiological systems of a person undergo more or less significant changes. With aging, a person's social position and lifestyle change, and their health and state of health deteriorate. A person has difficulty adapting to age restrictions. In order to help an older person cope with the upcoming changes, it is necessary to know well what happens to the aging body.
In this section, we will try to talk about the main problems of older people and give practical recommendations for solving each problem. For convenience, we will describe the changes occurring in the body of an elderly person, moving along the anatomical and physiological systems, and the problems that arise in this case will be conditionally divided into 3 groups: medical, psychological and social. It must be remembered that all problems are closely related and the solution of one of them can give a positive result in solving the other, and vice versa. For example, the awakening of creative activity can lead to the disappearance of depression, and this, in turn, will lead to the healing of pressure ulcers and the rapid restoration of motor activity. Otherwise, if hope for recovery is lost as a result of being hospitalized for a hip fracture, when a 75-year-old patient is denied surgical treatment, and no one is involved in care, depression develops, accompanied by refusal to eat and drink. The pressure sores that quickly arise from this lead to the development of sepsis and ... the patient dies.

Skin and subcutaneous tissue
The skin of older people becomes very thin, especially on the hands, feet, in the area of \u200b\u200blarge joints and in places of bony protrusions. By reducing perspiration and sebum production, loss of elasticity, the skin becomes dry, wrinkled and wrinkled. The amount of subcutaneous fat decreases. Because of this, the skin is easily displaced, becomes flabby. It is easily injured, cracked, torn, ulcerated, and does not heal well. In a bedridden elderly, even rough or heavy bedding can injure the skin and lead to the development of pressure sores. For more information on the prevention of pressure sores and the dangers of prolonged bed rest, see the "Bed patient" section.
Due to the age-related characteristics of the skin, heat exchange is disturbed, the elderly easily give off heat and therefore they often freeze and chill, need warm clothes, heating the bed. It must be remembered that you can use electric heating pads to heat the bed only if you are sure that the elderly person will not fall asleep next to the heating pad. Otherwise, if involuntary urination occurs during sleep, the heating pad will get wet and this will lead to electrical injury. Elderly people find it difficult to tolerate high temperatures and humidity. On the other hand, in a poorly heated room, especially in combination with low mobility, hypothermia develops even at a positive temperature, which can lead to illness or death of the patient. The optimum indoor temperature should be around 21 ° C.
Diaper rash often appears on the skin of older people, especially in places of natural folds (inguinal, axillary, under the mammary glands in women, on the palms - with a prolonged stay of the hands in a compressed state). Cancer of the skin often develops. Therefore, regular examination of the entire skin surface is necessary.

Age-related hair changes
Hair during life changes under the influence of genetic, immune, hormonal factors and exogenous influences (heat and cold, chemical agents and mechanical trauma, etc.). Atrophic and dystrophic changes occur in hair follicles and hair follicles, hair loses pigment, thinns, becomes brittle.
Most often, older women are worried about hirsutism - an increase in the growth of hard facial hair during menopause. This growth is enhanced by attempts to shave, pull out hair. The growth of hair on the head, the skin of the trunk, the pubis, and in the armpits of both sexes decreases with age. The formation of bald patches on the temples, on the crown of the head, baldness (mainly in men) is more often hereditary. In addition to heredity and dermatoses leading to baldness, stress, hormonal disorders, vitamin and microelement deficiencies, occupational hazards and intoxication are recognized as pathogenetic factors. Sometimes it is necessary to eliminate external causes (systematic negative effects of hydrogen peroxide and chemical dyes, trauma with metal combs, mechanical tension of hair when combing, systematic use of heavy hats, etc.). The experience of geriatricians shows that often elderly patients are very worried about hair loss on the head, become depressed or anxious. In such cases, it should be suggested to use a suitable wig. If you have the opportunity and desire, you can conduct a comprehensive course of treatment.
Hair care of an elderly person, their frequent washing, careful combing, haircut, everyday combing create a good mood, increase self-esteem, and prevent depression.

Musculoskeletal system
The total amount of bone tissue decreases with age. The articular cartilage, including the intervertebral discs, becomes thinner, which leads to the development of pain syndrome, changes in posture, and curvature of the spine. Gymnastics is of great importance for the prevention of such conditions. The elderly often suffer from severe pain in the spine, hip, knee, shoulder joints with any movement. Pain is accompanied by severe deformity and limited mobility. This leads to a decrease in the motor activity of the elderly, his isolation, depression, the desire to stay in bed all the time.
Due to osteoporosis - bone loss - bones become fragile. They break easily even with minor bruises. In addition to osteoporosis, the causes of frequent bone fractures in the elderly can be loss of muscle mass as a result of weight loss, as well as pathology of the joints.
The amount of muscle tissue decreases, which leads to a weakening of activity and ability to work. The rapid onset of fatigue does not make it possible to do the usual things, to finish the work begun to the end. Exercise not only stops the loss of muscle mass, but also contributes to an increase in strength even in very elderly people, an increase in their physical activity. It is known that after persistent physical education for 1-2 months, many elderly people abandoned canes and walkers. Therefore, physical activity, despite the pain syndrome, physical exercises with a dosed load help to maintain mobility and physical strength at any age. For patients with painful articular syndrome, isometric exercises.
The gait is disturbed. She becomes slow, unstable, with a shortened step, shuffling. The period of support on both legs increases. An elderly person turns slowly, awkwardly, at different speeds in different parts of the body. Such gait disturbances often lead to falls, and falls lead to bone fractures. When walking, there should be good support in the form of a strong cane, walkers, handrails along the walls, etc. The soles of boots must be equipped with devices that prevent slipping (plaster, etc.).
The floors in rooms, kitchens, corridors, bathrooms and toilets must be dry and non-slip, covered with anti-slip rubber mats.
You should not rush the elderly, force them to walk fast, make them nervous about being late somewhere. It must be remembered that, according to scientists, 2/3 of falls in older people can be prevented!

Respiratory system
The lung tissue of the elderly loses its elasticity. The mobility of the chest and diaphragm decreases. The lungs cannot fully expand when inhaling. Is developing dyspnea... Reduced bronchial patency, impaired drainage "cleansing" function of the bronchi. Poor ventilation of the lungs contributes to the development of pneumonia.
In the elderly, the cough reflex decreases. Due to a decrease in the blood filling of the lungs and the adhesion of the walls of the alveoli, normal gas exchange is disrupted, as a result of which air oxygen poorly penetrates through the alveoli into the blood, and carbon dioxide from the blood. Is developing hypoxia - a condition accompanied by a low oxygen content in the blood, which leads to rapid fatigue, drowsiness. Hypoxia causes sleep disturbances. Therefore, the elderly need to be more often in the fresh air, to do breathing exercises, especially those who are forced to spend a lot of time in bed or an armchair.
The head end of the bed in older people should be raised to improve pulmonary ventilation and promote deeper breathing. In case of pulmonary diseases, it is necessary to promote in every possible way an increase in physical activity. The doctor should only prescribe bed rest when absolutely necessary. In the treatment should be used, of course, according to the doctor's prescription, expectorants in combination with agents that thin phlegm and drugs that dilate the bronchi. Elderly people with pulmonary disease need therapeutic breathing exercises and massage. If the patient is still in bed, then he should move in it as much as possible, turn, sit down.

The cardiovascular system
With age, the work of the heart muscle worsens. During physical exertion, the heart poorly supplies the body with blood, tissues are not provided with adequate oxygen, because of this, the physical capabilities of a person are significantly reduced, and fatigue quickly sets in. You should organize regular "breaks" when working with older people, even if they don't ask you to. Their body is poorly prepared for the upcoming physical work, poorly worked out and then poorly recovered. You cannot force them right away, do something quickly, for example, go quickly right away or start dressing quickly. If you feel that you have already rested, this does not mean that an elderly person who was doing physical work with you had time to rest.
In addition, as a result of a decrease in the elasticity of blood vessels during physical work, blood pressure rises sharply.
Elderly people often complain of shortness of breath, irregular heart rhythm when performing physical work or during a night's sleep.
If an elderly person is forced to spend a lot of time sitting or standing, he develops swelling of the legs, varicose veins of the lower extremities. In this case, you can use elastic stockings or bandages, periodically (5-10 minutes every 2-3 hours) lie down and raise your legs so that they are higher than the body, while it is very good to make movements reminiscent of twisting the pedals of a bicycle.
Blood pressure usually rises with age. It is important to remember that in older people, in sudden situations, such as fear, stress, blood pressure can rise sharply or, conversely, fall sharply. This happens, for example, with orthostatic collapse, when, during a rapid transition from a horizontal position to a vertical position, blood pressure drops sharply, which may be accompanied by loss of consciousness. This happens especially often in patients receiving drugs that lower blood pressure, diuretics, etc. Elderly people should not get up suddenly. It is dangerous to rise and sit up suddenly in bed after a night's sleep or after lying for a long time. This often results in falling from a bed or chair, especially if it is deep. If possible, it is best to help the patient to get up. This should be done slowly, in stages, so that the heart and blood vessels can compensate for the change in position. An elderly person's bed or chair should be comfortable for a slow rise (for more details, see the "Bed" section), since, in most cases, the patient is forced to jerk out of an uncomfortable chair or bed.

Digestive system
Elderly people often suffer from poor appetite. This may be due to a loss of smell, taste, and a decrease in the amount of saliva secreted and digestive juices. At the same time, nutrients are poorly absorbed.
Even with their own teeth, the elderly often have impaired biting and chewing function, and the mechanical processing of food in the mouth worsens. However, older people are more likely to have problems with chewing due to poor oral health. In this regard, they may refuse to eat and lose weight. More details can be found in the section "Problems" - "Appetite disorders".
Check for teeth in your mouth and their condition. Food prepared by the elderly should not be too hard. Little saliva is produced, and therefore the elderly often complain of dry mouth, cracks in the lips and tongue. Due to the small amount of saliva, which has a bactericidal effect, in the oral cavity, especially with poor care and the presence of dentures, under which food particles always remain, putrefactive processes develop rapidly. Elderly people need careful oral care, frequent wetting with water or juice.
We must not forget that old people may simply not have money to buy food or have no opportunity to purchase it, if, for example, due to weakness or illness, they cannot leave the house or prepare food for themselves, etc.
Elderly people always eat poorly alone and much better in company. It is with difficulty and often reluctance to prepare their own food and at the same time eat well if the food is prepared by someone who is nearby and who, having laid the table, can share the meal with them.
Due to age-related changes, the elderly often develop hernias and diverticula (protrusion of the wall) of the esophagus. Food passes through the esophagus "sluggishly", there is a feeling of a lump behind the breastbone, especially when the elderly eats in a horizontal position. Often there is a gastroesophageal reflex - the backflow of food from the stomach into the esophagus, which leads to symptoms such as chest pain, heartburn. To prevent this complication, it is necessary to eat in an upright position in small portions, more often; after eating, stay upright for at least 1 hour. Food should be homogeneous, mushy, not too liquid. The last meal must be taken no later than 3-4 hours before bedtime.
The gastric mucosa of the elderly is very easily vulnerable. The risk of developing stomach ulcers is high. Special care must be taken when taking anti-inflammatory drugs that are often prescribed to patients for joint pain, such as aspirin or ibuprofen.
Constipation is a big problem. They are explained by a slowdown in intestinal motility, a decrease in the tone of the colon and a violation of the movement of feces along it, a weakening of the muscles of the anterior abdominal wall and pelvis, a sedentary lifestyle, malnutrition, concomitant diseases, such as hemorrhoids. For the prevention of constipation, you can advise to lead an active lifestyle, take daily walks, do gymnastics, massage the anterior abdominal wall of the abdomen, consume a sufficient amount of liquid, vegetables and fruits.
The pancreas undergoes degenerative changes with age. Diabetes mellitus often develops. To prevent the disease, you should limit the consumption of flour products, sweet and fatty foods, alcohol.
In old age, the liver takes longer for the decomposition of toxic substances and drugs, the production of proteins - albumin decreases, which causes poor wound healing.

urinary system
With age, the number of nephrons, the working cells of the kidneys, decreases. Diuresis, i.e. the daily amount of urine decreases (in an 80-90-year-old person, it is only half of the urine output of a young person). Urine is excreted in small amounts, in high concentration. Drugs are poorly excreted from the body, so drug overdose can easily occur. The bladder wall thickens and the elasticity and capacity decrease. The frequency of the urge to urinate increases. Violation of the closure function of the sphincters of the bladder causes urine leakage, i.e., its non-continence when filling the bladder. Due to the decrease in the functions of the higher nerve centers that control the urinary reflex, older people do not tolerate when the bladder is full of urine. When the urge to urinate occurs, they feel the need to urinate immediately. With this in mind, when caring for the elderly, it is necessary to reduce the interval between urination, to force patients to go to the toilet more often, or use a boat or duck.

Vision
In older people, refractive errors occur, cataracts often develop, which leads to a decrease in visual acuity, especially peripheral. Elderly people fix their gaze poorly on objects, often or do not see at all what is to the side of them. Therefore, when communicating with them, entering a room or approaching from the side, you should somehow attract their attention so as not to scare. Do not approach a person with poor vision against the light. Knock on the door in advance or let me know that you are nearby, for example, say hello so loudly that he hears you and answers you or gives a sign that he has noticed you. However, do not start a conversation loudly or abruptly when you are around an elderly person.
If the patient wears glasses, then it is necessary to ensure that the lenses of the glasses are clean, not scratched (plastic lenses are especially easy to deteriorate if glasses are often placed on hard surfaces with the lenses down). The glasses must be correctly fitted. It is important to periodically consult an ophthalmologist for older people, as vision loss can occur quite quickly. Glasses should always be close to the patient. It is necessary to provide good lighting in the room. It is dangerous to be in the twilight. During the day, you need to open the curtains on the window, in the evening turn on the lamps on time.
Do not unnecessarily rearrange objects in the room without notifying the elderly person about it, otherwise he, not seeing them very well in a new place, out of habit, will follow his usual route and stumble or hit. By changing the usual place of a glass with spoons on the dining table, you doom the patient to a fruitless search for a spoon during tea drinking, which will be very unpleasant for him, especially if he understands that everyone is looking at him. When new people or objects appear in the room, they must be described to the patient so that he has the opportunity to imagine them. For example, "Today is a sunny day, I opened the door to the balcony." "I brought you red carnations. They are on the coffee table in your favorite vase." Comment on your next steps: "We need to take medicine. I will now bring a glass of water." "Time for lunch. First we have mushroom soup. We have sour cream with it." It is convenient to explain the arrangement of objects on the table using a comparison with an hour dial: a sugar bowl is at 12 o'clock, a bread box with white bread is at 3 o'clock, a glass of tea is in front of you at 6 o'clock. When moving together, hold your companion by the hand, preferably the forearm. Tell him what you will meet on your way: "Now we will get off the sidewalk" or "Now we will start climbing the stairs to the second floor."
When eating, an elderly person should not have many objects. It is useful to use light contrasts so that you can better see objects, for example, place a dark non-slip support on a light table, a dark plate and a spoon on it. In this color combination, your patient will see everything well.
In an elderly person, the eyes poorly and slowly adapt to conditions of insufficient or excessive illumination, especially with a rapid transition from light to dark and vice versa. Therefore, your ward may not see anything under his feet if he just looked from the window into the room where he is.
When entering from the street into the entrance or into the transport, an elderly person becomes extremely vulnerable. He does not clearly distinguish insufficiently consecrated objects, for example, the steps of a staircase on which a shadow falls. It is advisable that additional lamps be installed in such dangerous places as stairs, corridors, front doors. The steps of the stairs or their edges, thresholds (if it is not possible to remove them at all!) Should be painted in contrasting (light) colors. There are twice as many switches in such places than usual, so that you can turn on the light at the beginning of your journey and turn it off at the end.

Hearing
If your client wears a hearing aid, make sure that he / she is using it correctly according to the included technical manual; periodically check how the device works, whether it is broken, whether the batteries are dead, or whether earwax has clogged the headphones.
When talking, make sure that the device is working and turned on. Your interlocutor will be able to understand you better if he focuses on facial expressions and lip movements. Therefore, when talking, it is better to sit so that your faces are on the same level. It is impossible for the interlocutor to look at you against the light. One should speak not loudly (!), But also not quietly, clearly, distinctly, somewhat slowly, but without exaggerating or emphasizing individual syllables (without chanting!), Accompanying speech with lively facial expressions and a small number of expressive gestures.
When speaking, try not to turn your face away, look at the floor, or cover your mouth or face with your hands. Firstly, you thereby impair the clarity of sounds, and secondly, people with poor hearing often read lips well. Speak in short phrases, small blocks of meaning; finishing each of them, make sure that the other person heard you correctly. In especially important cases, ask to repeat the meaning of the words you said. If the ward does not understand you, repeat using other words, but in no case raise your voice, do not shout, do not get irritated and do not rush.
Elderly people with hearing impairment perceive low tones better and worse - high tones; high female and squeaky children's voices are hard to hear. People with hearing impairments are very disturbed by background noise, for example when several people are talking at the same time or when you are talking to them in a room where the TV is on. In this case, a hard of hearing person may think that other people who are speaking with him are whispering, saying something about him that he himself should not know. If they laugh at the same time, then he thinks that they are laughing at him. If a person has poor hearing in one ear, then it is necessary to speak from the side of the other ear. If the situation does not allow creating such conditions for your interlocutor to hear you well, write him the necessary information on paper.
Be kind to him, make an effort to establish good contact, otherwise, feeling your irritation, he will withdraw into himself.
etc.................

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