Late-stage symptoms of dementia

Written by Zhang Hui
Neurology
Updated on September 01, 2024
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In the later stages of dementia, symptoms become very severe. Patients experience significant impairment in memory function, forgetting not only recent events but also events from the past. Additionally, patients show obvious impairments in visuospatial abilities, having trouble locating the bathroom in their own home, and often getting lost when they go out. There is also a noticeable change in behavior, with patients exhibiting aggression, cursing, and inappropriate actions like urinating or defecating in random places. Some patients may experience recurrent visual and auditory hallucinations. As the disease progresses, elderly patients may eventually become bedridden for life, not interacting with anyone, remaining silent, and refusing to eat. They ultimately may die from complications such as lung infections, urinary tract infections, malnutrition, and bedsores. Therefore, the symptoms of dementia in its later stages are quite severe, with cognitive impairments, abnormal mental and behavioral symptoms, and various infections all posing serious threats to the health of the elderly.

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Written by Zhang Hui
Neurology
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How is dementia diagnosed in the elderly?

Alzheimer's disease is a degenerative disease of the nervous system. The diagnosis of this disease mainly relies on the clinical manifestations of the patient, as well as some corresponding scales and some corresponding imaging examinations. In terms of examinations, it is necessary to check some neurofunctional scales, mainly cognitive function scales, common scales include some MMSE scales, and some MoCA scales. These scales are very important for diagnosing this disease. In addition, some imaging examinations need to be improved, mainly including cranial magnetic resonance imaging examinations. Cranial MRI can reveal atrophy in the patient's temporal lobe, hippocampus, and other areas, which also have an important reference value for the diagnosis of the disease. Moreover, an electroencephalogram can be performed to see some mild abnormalities, and lumbar puncture tests can also reveal some abnormally increased protein deposits.

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Written by Zhang Hui
Neurology
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progression of Alzheimer's disease in the elderly

The progression of dementia in the elderly mainly includes the following aspects. The first is the pre-stage of mild cognitive impairment, during which patients show no clinical symptoms. Some may only report slight memory impairment, with a possible slight decline in learning ability and a mild decrease in the capability to learn new things. As the disease progresses to the second stage, the period of mild cognitive impairment occurs, where patients will experience impaired memory, but it is not particularly obvious, and daily life is not affected at all. Then, entering the third stage, some periods of dementia occur, during which patients' memory, executive abilities, computational skills, and judgment are significantly impaired. Patients might even get lost or possibly forget their own names. As the disease further progresses into the later stages of dementia, the elderly may exhibit some psychiatric symptoms. They become delirious, talk to themselves, and may see things that do not exist. Eventually, the elderly may end up bedridden, with complications such as pulmonary infections and bedsores.

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Written by Zhang Hui
Neurology
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Causes of Alzheimer's Disease in the Elderly

The causes of dementia in the elderly are not currently completely clear. Dementia in the elderly is mainly divided into familial and sporadic types. Familial dementia shows autosomal dominant inheritance, which is caused by a gene mutation on chromosome 21 leading to the accumulation of some toxins, resulting in the death of neurons and causing dementia fundamentally due to genetic mutations. However, most cases of dementia are sporadic and do not have a clear family history. The mechanisms and reasons for disease onset are not particularly clear. Some believe that abnormalities in cerebral vascular function may lead to neuronal cell functional disorders, resulting in decreased ability to clear certain cell toxins, thus leading to neuronal apoptosis and death, and consequently impaired cognitive functions. In addition, factors such as oxidative stress, inflammatory mechanisms, excessive fatigue, and emergency stress may also cause cell death. Overall, the causes of dementia in the elderly are not particularly clear.

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Written by Zhang Hui
Neurology
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precursors of senile dementia

The diagnosis of senile dementia must first meet the diagnostic criteria for dementia, primarily characterized by impairment in multiple cognitive areas such as memory, language skills, executive function, and computational ability, and these impairments affect daily life; this is called senile dementia. Before dementia occurs, there are some precursory signs, mainly slight declines in memory. For example, patients might occasionally forget to bring keys when going out, or forget to turn off the stove while cooking. These mild memory impairments are some of the precursors to senile dementia. Additionally, there is a decline in learning ability, including the symptoms of learning new knowledge and mastering new skills; these declines are also precursors to senile dementia. Therefore, the precursors of senile dementia can primarily be summarized as a slight decline in memory function and some slight decline in learning ability.

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Written by Zhang Hui
Neurology
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How is Alzheimer's disease treated?

Firstly, attention must be paid to pharmacological treatment. In terms of pharmacological therapy, the main treatments include cholinesterase inhibitors, which can increase the amount of acetylcholine in the central nervous system and improve the patient’s cognitive level. Glutamate receptor antagonists can also be used, and they have a certain therapeutic effect on moderate to severe dementia. Secondly, patients with dementia may exhibit psychiatric symptoms in the later stages, such as hallucinations. Under a doctor's advice, appropriate amounts of antipsychotic drugs can be used for treatment. Thirdly, medications that protect brain cells and nourish nerves can be administered to the elderly. Additionally, close nursing care is necessary to prevent accidents. (Please undertake medication under the guidance of a professional physician.)