What are the common health concerns affecting seniors. How can excessive talking be linked to cognitive impairment in the elderly. Why is proper nutrition crucial for older adults. What role does exercise play in maintaining senior health. How do medications impact the well-being of older individuals. When should seniors seek medical evaluation for behavioral changes. How can families support their aging loved ones effectively.

Excessive Talking in the Elderly: A Potential Sign of Cognitive Impairment

As individuals age, changes in behavior can sometimes indicate underlying health issues. One such change that may raise concern is compulsive or excessive talking, also known as garrulity. This behavior, particularly when it represents a significant shift from a person’s usual communication patterns, can be associated with cognitive impairment or dementia.

Is excessive talking always a sign of dementia? While not all instances of increased verbosity indicate cognitive decline, it’s essential to pay attention to sudden or drastic changes in communication habits. In some cases, garrulity may be an early symptom of dementia or other neurological conditions affecting the elderly.

• Increased verbosity or inability to stop talking
• Significant change from previous communication patterns
• Potential indicator of cognitive impairment or dementia

For families noticing such changes in their elderly loved ones, seeking professional medical evaluation is crucial. A comprehensive assessment by a neurologist and psychologist can help determine if cognitive impairment is present and guide appropriate treatment options.

Energy Levels and Fatigue in Middle-Aged Adults: Exploring Causes and Solutions

Many individuals in their 50s and beyond experience a decline in energy levels, often feeling exhausted after a typical workday. This fatigue can be particularly challenging for those with sedentary jobs, as lack of physical activity throughout the day can contribute to low energy.

Can vitamins or supplements boost energy without increasing appetite? While some supplements may offer a temporary energy boost, it’s essential to address the root causes of fatigue rather than relying solely on quick fixes. Several factors can contribute to low energy levels in middle-aged adults:

1. Medication side effects
2. Underlying medical conditions (e.g., thyroid disorders)
3. Imbalanced diet
4. Lack of regular exercise
5. Poor sleep quality

To combat fatigue effectively, consider the following steps:

• Review medications with a healthcare provider to identify potential causes of fatigue
• Undergo a medical evaluation to rule out underlying health issues
• Assess and improve dietary habits to ensure balanced nutrition
• Incorporate regular physical activity into daily routines
• Prioritize good sleep hygiene

Counterintuitively, adding exercise to one’s routine often leads to increased energy levels and improved overall well-being. Starting with small, manageable amounts of physical activity and gradually increasing intensity and duration can help overcome initial resistance and fatigue.

Vascular Dementia: Diagnosis, Treatment, and Considerations for Seniors with Heart Conditions

Vascular dementia, the second most common type of dementia after Alzheimer’s disease, poses unique challenges in diagnosis and treatment, particularly for seniors with existing heart conditions. This form of cognitive impairment results from reduced blood flow to the brain, often due to a series of small strokes.

How does vascular dementia differ from Alzheimer’s disease? While both conditions affect cognitive function, vascular dementia tends to have a more “spotty” presentation, impacting specific areas of the brain corresponding to affected blood vessels. In contrast, Alzheimer’s disease typically causes more diffuse cognitive changes.

Diagnostic Challenges

Diagnosing vascular dementia can be complex, especially when medical devices such as pacemakers or defibrillators limit imaging options. In these cases, healthcare providers may rely more heavily on clinical observations, cognitive testing, and medical history to form a diagnosis.

Treatment Considerations

Medications commonly used to treat Alzheimer’s disease, such as Aricept (donepezil), are sometimes prescribed for vascular dementia. However, these drugs come with potential side effects and may not be suitable for all patients, particularly those with heart conditions.

Are cholinesterase inhibitors like Aricept safe for patients with heart devices? The use of these medications in patients with pacemakers or defibrillators requires careful consideration and monitoring. Potential side effects, including nausea, dizziness, and impacts on heart rate, should be closely observed and discussed with healthcare providers.

Managing Vascular Dementia

While treatment options for vascular dementia are limited, managing underlying risk factors is crucial:

• Control hypertension
• Manage diabetes
• Maintain healthy cholesterol levels
• Adopt a heart-healthy lifestyle

These steps can help reduce the risk of further vascular damage and potentially slow the progression of cognitive decline.

Nutrition and Weight Management in the Elderly: Striking a Healthy Balance

Proper nutrition plays a vital role in maintaining health and well-being for seniors. However, concerns about weight gain or loss can sometimes lead to overly restrictive diets that may do more harm than good.

Is a 900-calorie diet appropriate for a 94-year-old woman? In most cases, such a low-calorie diet is not recommended for elderly individuals, especially those who are already underweight or at risk of malnutrition. Severe calorie restriction can lead to:

• Muscle loss
• Weakened immune system
• Increased risk of falls and fractures
• Cognitive decline
• Poor wound healing

For seniors, maintaining a healthy weight often involves ensuring adequate calorie and nutrient intake rather than restrictive dieting. A balanced diet that includes a variety of nutrient-dense foods is crucial for supporting overall health and well-being in older adults.

Nutritional Considerations for Seniors

When addressing nutrition in the elderly, several factors should be considered:

1. Caloric needs: While calorie requirements may decrease with age, severe restriction is rarely beneficial.
2. Protein intake: Adequate protein is essential for maintaining muscle mass and strength.
3. Micronutrients: Ensuring sufficient intake of vitamins and minerals, particularly calcium, vitamin D, and B vitamins.
4. Hydration: Maintaining proper fluid intake to prevent dehydration.
5. Fiber: Including fiber-rich foods to support digestive health.

Encouraging a more balanced approach to nutrition can help seniors maintain a healthy weight while ensuring their bodies receive the necessary nutrients for optimal functioning.

The Impact of Medications on Senior Health: Balancing Benefits and Side Effects

As individuals age, they often find themselves managing multiple health conditions, which can lead to complex medication regimens. While these medications are often necessary for treating various ailments, they can also contribute to side effects that impact quality of life.

How can seniors and their caregivers manage medication-related side effects effectively? The key lies in regular communication with healthcare providers and a proactive approach to medication management:

• Maintain an up-to-date list of all medications, including over-the-counter drugs and supplements
• Regularly review medications with healthcare providers to assess necessity and potential interactions
• Be aware of common side effects associated with each medication
• Report any new or concerning symptoms to healthcare providers promptly
• Discuss potential alternatives or dosage adjustments if side effects are significant

In some cases, the cumulative effect of multiple medications can lead to symptoms such as fatigue, dizziness, or cognitive changes. A comprehensive medication review can help identify opportunities to streamline treatment regimens and reduce unnecessary medications.

Polypharmacy in the Elderly

Polypharmacy, the use of multiple medications concurrently, is a common concern among older adults. While often necessary to manage various health conditions, it can increase the risk of adverse drug interactions and side effects.

What strategies can help reduce the risks associated with polypharmacy? Healthcare providers and patients can work together to implement several approaches:

1. Regular medication reviews to assess the continued need for each drug
2. Deprescribing unnecessary or potentially harmful medications
3. Considering non-pharmacological alternatives when appropriate
4. Using the lowest effective dose of necessary medications
5. Monitoring for drug-drug interactions and adjusting regimens accordingly

By carefully managing medication use, seniors can often achieve better symptom control while minimizing the risk of adverse effects.

The Role of Exercise in Maintaining Senior Health and Vitality

Regular physical activity plays a crucial role in maintaining health, mobility, and independence as individuals age. Despite common misconceptions, exercise can be beneficial for seniors of all fitness levels and can contribute significantly to overall well-being.

How does exercise benefit older adults specifically? The advantages of regular physical activity for seniors are numerous:

• Improved cardiovascular health
• Increased muscle strength and bone density
• Enhanced balance and coordination, reducing fall risk
• Better cognitive function and mood
• Increased energy levels and improved sleep quality
• Management of chronic conditions such as diabetes and arthritis

For seniors who have been sedentary, starting an exercise routine may seem daunting. However, even small amounts of physical activity can yield significant benefits. The key is to start slowly and gradually increase activity levels over time.

Safe Exercise Options for Seniors

What types of exercises are most suitable for older adults? Several low-impact activities can provide excellent health benefits while minimizing the risk of injury:

1. Walking: A simple yet effective form of exercise that can be easily incorporated into daily routines
2. Swimming or water aerobics: Gentle on joints while providing a full-body workout
3. Tai Chi: Improves balance, flexibility, and mental focus
4. Chair exercises: Ideal for those with limited mobility or balance concerns
5. Resistance band workouts: Helps maintain muscle strength without heavy weights
6. Yoga: Enhances flexibility, balance, and relaxation

Before starting any new exercise program, seniors should consult with their healthcare providers to ensure the chosen activities are safe and appropriate for their individual health status.

Supporting Cognitive Health in Aging: Strategies for Seniors and Caregivers

Maintaining cognitive health is a primary concern for many seniors and their families. While some degree of cognitive change is normal with aging, there are steps that can be taken to support brain health and potentially reduce the risk of cognitive decline.

What activities can help seniors maintain cognitive function? Engaging in mentally stimulating activities is key to supporting brain health:

• Learning new skills or hobbies
• Solving puzzles and playing strategy games
• Reading and discussing books or current events
• Participating in social activities and maintaining connections with others
• Practicing mindfulness or meditation
• Engaging in regular physical exercise

In addition to these activities, lifestyle factors play a crucial role in cognitive health. A balanced diet rich in antioxidants, omega-3 fatty acids, and other brain-supporting nutrients can contribute to overall brain health.

Early Detection of Cognitive Changes

Recognizing early signs of cognitive decline is important for timely intervention and support. While some changes in memory and cognitive function are normal with age, certain symptoms may warrant further evaluation:

1. Difficulty performing familiar tasks
2. Problems with language or communication
3. Disorientation to time or place
4. Poor or decreased judgment
5. Misplacing things and inability to retrace steps
6. Changes in mood or behavior

If these symptoms are observed, it’s important to consult with a healthcare provider for a comprehensive evaluation. Early detection of cognitive issues can lead to better management and potentially slow the progression of cognitive decline.

Supporting Seniors with Cognitive Impairment

For seniors diagnosed with cognitive impairment or dementia, creating a supportive environment is crucial. Caregivers and family members can help by:

• Establishing routines to provide structure and reduce confusion
• Simplifying tasks and breaking them into manageable steps
• Using memory aids such as calendars, to-do lists, and reminders
• Ensuring a safe home environment to prevent accidents
• Encouraging social interaction and engagement in enjoyable activities
• Providing emotional support and patience during challenging moments

By implementing these strategies and working closely with healthcare providers, seniors and their caregivers can better navigate the challenges associated with cognitive changes and maintain quality of life.

Age Related Health Issues In Seniors

Q1. My father has always been a good talker, but as he’s aged (he’s now in his late 80s), he has become a compulsive talker, to the point that it seems like he literally cannot stop talking. Is there any help for such a compulsion? Have you seen this in other seniors?

Excessive talking, also known as garrulity, can be associated with dementia, or cognitive impairment. It is necessary that you take your father to a doctor who can recommend a neurologist and psychologist who can perform appropriate evaluations to determine if he might be suffering from some form of dementia. From there, you can find out if any treatment options are available to help your father with the garrulity, as well as any other dementia symptoms he might be exhibiting.

Q2. At my age (51), is there a vitamin or something I can take every day to give me energy without increasing my appetite? I have no energy at the end of my eight-hour workday. And I work at a desk all day, so I don’t get any exercise.

— Margie, Texas

Feeling a lack of energy or fatigue is understandably a disturbing symptom. You have not provided your full history, but if you are on a variety of medications, they can cause fatigue. First, you should put all your medications in a bag and take them to your doctor to find out whether there are any that you can eliminate or reduce in dosage. Even if the combination of medicine is not related to your fatigue, this is a valuable exercise.

Second, you should check with you doctor to be certain you do not have a metabolic condition such as thyroid disease. Third, you should review your diet to be sure it is balanced, with appropriate representation of carbohydrates, fats, and proteins. Finally, you indicate that you don’t get any exercise. I understand completely that you feel tired and not inclined to exercise; however, it always surprises people to find that adding exercise to their lives actually adds zest and energy. Try it and see.

Q3. My husband was recently diagnosed with vascular dementia by a neuropsychiatrist, based on tests run by the doctor. His neurologist, though, doesn’t think that he has vascular dementia but is unable to confirm it because my husband has a pacemaker and defibrillator combo in his chest. They both prescribed Aricept for him. I have been doing some research on this medication and have learned of its many side effects. My husband had been nauseated and dizzy for the past two days (he’s taken five pills so far, 5 mg. each). I read that these pills can slow down your heartbeat, and he has the pacemaker and defibrillator to keep his heart functioning well. Isn’t it detrimental to his health to take the medication? Sorry I wrote so much, but this is a new Illness in our lives. Thank you.

— Judy, Arizona

This can definitely be confusing. Whenever possible, it is important to provide a clear diagnosis of vascular dementia, which is the second most common type of the dementias next to Alzheimer’s disease. In general, vascular dementia is more “spotty” since it affects specific blood vessels in the brain; on the other hand, Alzheimer’s disease is more diffuse in its effects. For that reason, intellectual insight and awareness is more apt to be preserved in vascular dementia. This condition results from repeated small strokes, which cause the death of tissues surrounding the affected blood vessels. There are suggestions of interrelationships between Alzheimer’s disease and vascular dementia. That is important and means it’s essential to control hypertension, diabetes, and cholesterol levels — all of which contribute to the risk of stroke. Thus, while your doctors were unable to confirm or eliminate vascular dementia as a diagnosis, some of the same protective steps should be taken with either form of dementia.

You are correct that Aricept has significant side effects, as do similar medications that are used to treat Alzheimer’s disease. These drugs are cholinesterase inhibitors, the purpose of which is to promote increased levels of acetylcholine, the “memory chemical,” which is depleted in Alzheimer’s disease. However, these agents have limited effectiveness and then only work for short periods of time. Therefore, it is necessary to monitor the adverse affects. If your husband’s quality of life is too impaired by the drugs, you can consider reducing or stopping their use. In short, and most unfortunately, we do not yet have major drugs to ameliorate either Alzheimer’s disease or vascular dementia.

Q4. My 94-year-old mother weighs 90 pounds and is stooped over. She stays on a 900-calorie-a-day diet because she is afraid to gain weight. She tries to rely on nonfat diet foods with no sugar. Is it dangerous for an elderly woman to be restricting her diet like this? I don’t think it’s healthy.

I would encourage your mother to increase her calorie intake if she can, but in particular, she should be eating a balanced diet. The usual formula is 30 percent protein, 50 percent carbohydrate, and 20 percent fat.

A growing body of literature suggests that caloric restriction can extend life, but only when part of a healthy, well-balanced diet. The data suggest this is true in a wide variety of species, but it hasn’t been demonstrated in human beings. Others would argue that in the later years a little added weight may be protective. It sounds as if your mother is going overboard in her decision to avoid sugar and to eat low-fat diet foods. On the other hand, she is 94, and I assume she has been on this restricted diet for some time. Sometimes, of course, people lose weight because of depression or some underlying physical condition. I assume she has been carefully evaluated for such a problem — if not, I suggest that you look into it.

Q5. Is dried fruit a good solution for constipation as I age? If so, how much is a healthy amount to take on a daily basis?

— Intesair, United Arab Emirates

Constipation is not as easily defined as one might think. It refers either to the need to strain in order to defecate or indicates infrequent or incomplete bowel movements. Constipation increases with age and may be related to many medical and surgical conditions as well as many medications. It can also come as a result of low fiber, caloric, and fluid intake. There are dietary approaches to treat constipation, which include increasing fluids and fiber: eating more vegetables, fruits (especially prunes), whole-grain breads, and high-fiber cereals. Physical activity is an important element in the treatment. Laxatives are widely overused and should be a last resort.

Q6. What do you recommend for problems in finding words?

— Nancy, Texas

Difficulty finding words is not uncommon as people grow older. Vocabulary actually grows with age but words can become difficult to retrieve. Our reaction speed also slows as we grow older. Moreover, it is difficult to deal with large amounts of information, and, of course, with age comes an accumulation of knowledge. Verbal fluency is therefore diminished, an effect that can be measured by the number of words one can recite in a particular category (for example, types of vegetables) in a fixed amount of time. Again, as we age, speed becomes an obstacle.

For someone who has a problem finding words, patience is necessary from both the person affected and his or her audience. Of course, this problem can be embarrassing at times, but there is no simple means of treatment or prevention other than quietly taking one’s time before speaking.

Q7. After MRIs, a PET scan, and neurocognitive/movement testing, my father was recently diagnosed with corticobasal degeneration. After researching the diagnosis, I’m still not sure how the doctor can be certain that it’s not Parkinson’s, Alzheimer’s, or Pick’s disease. What makes CBD unique?

— Theresa, Maryland

Corticobasal degeneration is a progressive neurological disorder of unknown cause associated with atrophy of many areas of the brain, including the cerebral cortex. This degeneration progresses gradually. Symptoms typically begin around age 60 and may first appear to affect one side of the brain, then eventually both sides. It can have symptoms similar to those of Parkinson’s disease, such as poor coordination; in addition, there can be visual impairments, muscular jerks, and difficulty swallowing. The patient may be unable to walk. Unfortunately, there is currently no successful treatment. The disease progresses slowly over six to eight years. It can be difficult to separate from Parkinson’s, Alzheimer’s, and Lou Gehrig’s disease, but I think what makes it unique is that some of its symptoms are not characteristic of Parkinson’s or Alzheimer’s, including hesitant or “halting” speech, dysphagia (difficulty swallowing), and myoclonus (muscular jerks). If your father has any of these symptoms, it may be the reason he’s been diagnosed with CBD rather than one of the other degenerative diseases.

Q8. How can I ensure that my mother gets the right nutrients now that she has such a small appetite as a senior?

— Gwen, United Kingdom

Emphasize a balanced diet of foods she enjoys, and have her eat four to five smaller meals each day. A very useful beverage product called Ensure comes in a variety of flavors and is packed with necessary vitamins. It could be very useful for your mother if she is having trouble eating complete meals. I suggest sprucing it up with whole milk, some chocolate ice cream, and chocolate syrup mixed in a blender. Such a milkshake early in the morning or at night, along with a regular diet, adds both calories and essential nutrients.

Q9. My mother is 76 years old and is losing her eyesight to glaucoma. We had always been a very close family, but my mother has become distant since we came back from a family cruise in January and has not attended any family function since then. My siblings and I are having a hard time with this: We can’t get her to a doctor (she probably hasn’t been for at least ten years), she won’t let us do anything for her, and she says some very hateful things to us. All four of us plus our children are wondering if this is a mental problem. We are all open to any feedback that you might have.

— Sue, Indiana

Loss of vision has strong emotional effects in itself and it is a marker, perhaps in your mother’s case, of increasing age and her fears about it. It is useful when a family is concerned about an older member to have a family meeting and carefully evaluate the personality of the person that is in trouble and devise a thoughtful approach. This family approach is especially useful to avoid individual conflict in approaching the parent, in this case your mother.

Once you have a consistent and comprehensive plan, I would sit down with your mother and strongly insist (you cannot use force) that she accept your help. Arrange for her to see a primary care physician to undertake an overall evaluation of her physical and emotional state. Some times a social worker, psychologist or psychiatrist can also be helpful following the discussion with the primary care doctor. It would be very useful to put any medicines your mother might be taking in a brown bag and take them to the doctor to see if any of them are having adverse effects that may contribute to her behavior. It would also be wise to visit her regularly but also to encourage her to participate in outside activities at a church or temple, senior center, whatever to help draw her out.

There are many behavior patterns in the later years. It has been said that “aging is not for sissies” and your mother’s adjustment may test all of your family’s capacities. But you are right to want to intervene now and not let the issue percolate further.

Learn more in the Everyday Health Senior Health Center.

How to deal with non-stop talking?

My grandmother fell right after Christmas, fractured her hip. She had previously been living alone and was doin everything in her own up until the fall. She is 88. After the fall it was apparent that she could no longer live alone. My father lives 4 hours away. He and my mother whom are in their late 60’s can not care for her. We decided that because of her physical issues and because of her moderate demintia she would come to live with us.

I am a stay at home mom to a 6 year old son with high functioning autism. My spouse of 15 years works from home. So because there are two of us at home most days it seemed like the best thing for my gran to come live with us.

We have a moderately sized home. We had to have a complete renovation of the bathroom before my gran could come home with us. We are currently in the process of remodeling the basement for extra space.

My issue is between caring for a special needs child, who has many “quirks,” my spouse, and now grandma I am at my breaking point!

One of the biggest challenges is my gran’s non-stop talking. She gets up every morning (we have established a routine to help with her memory) and then she sits by the front window and just talks and talks and talks!!!! She talks about every bird, squirrel, dog, cat, person. She will repeat the same thing every day. Then she will start with the same stories from the past.

She comments on every little house work thing that needs to be done. And what is on the agenda for today? — this is a particular sore point with me as I do all of the housework, I used to run my own business from home. I am a mental list maker so I know every little thing that needs to be done around the house. I just don’t have the energy most days. And when I am cleaning she constantly is pointing out things I miss or things I haven’t gotten to. For example when I am dusting she will start telling me about a piece of furniture that is waaaaaayyyyy across the room. One I haven’t even touched yet.

She asks non-stop questions about my son. Like really off the wall stuff, like will he get a drivers license, is he going to graduate high school, will he drink and do drugs; my son is six for frackin’ sake!?! Most days I feel like it is all I can do to get him out the door, dressed fully, teeth brushed, hair combed and a bite of food in his belly for school.

She is constantly asking if she “can help” but she can’t walk with out a cane, and when she does he is very off balance. In the last month she has fallen 3 times because she refuses to sit down while getting dresses. So now I have to watch her an help her get dressed. Reminding her to sit down while putting her shirt on. Then slide on her underwear, pants, socks and house shoes then stand up one time. I have to tell her sit at the end of the bed and then comb your hair.

I have tried giving her small things to do, like fold the laundry, or watch so the dog doesn’t run out the door. But she will constantly ask “can she help” And not just one time, repeatedly every 5 minutes or so.

When we watch TV she will just randomly start talking about things. Topics that are not related to the TV show. Or at dinner we will be talking about our sons day and she will then just interject with some random topic even if she was previously speaking about his day.

Riding in the car is a nightmare if you are the driver because she mentions every little thing she sees. Like tonight there was a plastic grocery sack on the side of the road and she asks if we saw the white dog.

Anytime I make her food or we go out to eat she constantly offers everyone at the table some of her food. No matter how many times we tell her no, she will offer again and again. She weighs about 100 lbs and is like a twig. I am overweight so that is frustrating.

She crochets so I have her making a bunch of stuff or different family things like baby showers and weddings. But even then she is not always able to follow a pattern or complete even a small project. She is not able to do any new patterns with out the project going completely amok. I even learned how to crochet so at least she could talk to me about that.

I was taking her to a senior work-out class twice a week but because she couldn’t stand and was having a hard time doing the work-out she now refuses to go. I take her to the library once a week to get new books/magazines but she rarely finishes a book now. I take her with me for all the household errands. But she can’t walk for long periods so I have to bring her walker with a seat and then try and push her and drag the shopping cart.

The other thing is when she is walking she does not concentrate on walking but starts pointing out random things the will trip because she does not pick her feet.

She hated the rest home/rehab. Won’t entertain the idea of a facility at all. My spouse is getting more frustrated than I am and I spend more time with her. She won’t “join” in with groups.

Any suggestions?

Frontotemporal dementia – Symptoms – NHS

Frontotemporal dementia usually causes changes in behaviour or language problems at first.

These come on gradually and get worse slowly over time.

Eventually, most people will experience problems in both of these areas. Some people also develop physical problems and difficulties with their mental abilities.

Behaviour and personality changes

Many people with frontotemporal dementia develop a number of unusual behaviours they’re not aware of.

These can include:

• being insensitive or rude
• acting impulsively or rashly 
• loss of inhibitions
• seeming subdued
• losing interest in people and things
• losing drive and motivation
• inability to empathise with others, seeming cold and selfish
• repetitive behaviours, such as humming, hand-rubbing and foot-tapping, or routines such as walking exactly the same route repetitively
• a change in food preferences, such as suddenly liking sweet foods, and poor table manners
• compulsive eating, alcohol drinking and/or smoking
• neglecting personal hygiene

As the condition progresses, people with frontotemporal dementia may become socially isolated and withdrawn.

Language problems

Some people experience problems with speech and language, including:

• using words incorrectly – for example, calling a sheep a dog
• loss of vocabulary
• repeating a limited number of phrases
• forgetting the meaning of common words
• slow, hesitant speech
• difficulty making the right sounds to say words
• getting words in the wrong order
• automatically repeating things other people have said

Some people gradually lose the ability to speak, and can eventually become completely mute.

Problems with mental abilities

Problems with thinking do not tend to occur in the early stages of frontotemporal dementia, but these often develop as the condition progresses.

These can include:

• difficulty working things out and needing to be told what to do
• poor planning, judgement and organisation
• becoming easily distracted
• thinking in a rigid and inflexible way
• losing the ability to understand abstract ideas
• difficulty recognising familiar people or objects
• memory difficulties, although this is not common early on

Physical problems

In the later stages, some people with frontotemporal dementia develop physical problems and difficulties with movement.

These can include:

Some people have frontotemporal dementia overlapping with other neurological (nerve and brain) problems, including:

Getting medical advice

See a GP if you think you have early symptoms of dementia. If you’re worried about someone else, encourage them to make an appointment with a GP and perhaps suggest you go with them.

The GP can do some simple checks to try to find out the cause of your symptoms, and may refer you to a specialist for further tests.

It’s usually very helpful to have someone at the consultation who knows you well and can give the specialist another perspective on your symptoms.

Read more about:

Getting a dementia diagnosis

Tests used to diagnose dementia

Advice if you’re worried someone else could have dementia

Page last reviewed: 16 January 2020
Next review due: 16 January 2023

Long-winded speech could be early sign of Alzheimer’s disease, says study | Alzheimer’s

Rambling and long-winded anecdotes could be an early sign of Alzheimer’s disease, according to research that suggests subtle changes in speech style occur years before the more serious mental decline takes hold.

The scientists behind the work said it may be possible to detect these changes and predict if someone is at risk more than a decade before meeting the threshold for an Alzheimer’s diagnosis.

Janet Cohen Sherman, clinical director of the Psychology Assessment Center at Massachusetts General Hospital, said: “One of the greatest challenges right now in terms of Alzheimer’s disease is to detect changes very early on when they are still very subtle and to distinguish them from changes we know occur with normal ageing.”

Speaking at the American Association for the Advancement of Science in Boston, Sherman outlined new findings that revealed distinctive language deficits in people with mild cognitive impairment (MCI), a precursor to dementia.

“Many of the studies to date have looked at changes in memory, but we also know changes occur in language,” she said. “I’d hope in the next five years we’d have a new linguistic test.”

Sherman cites studies of the vocabulary in Iris Murdoch’s later works, which showed signs of Alzheimer’s years before her diagnosis, and the increasingly repetitive and vague phrasing in Agatha Christie’s final novels – although the crime writer was never diagnosed with dementia. Another study, based on White House press conference transcripts, found striking changes in Ronald Reagan’s speech over the course of his presidency, while George HW Bush, who was a similar age when president, showed no such decline.

“Ronald Reagan started to have a decline in the number of unique words with repetitions of statements over time,” said Sherman. “[He] started using more fillers, more empty phrases, like ‘thing’ or ‘something’ or things like ‘basically’ or ‘actually’ or ‘well’.”

Worsening “mental imprecision” was the key, rather than people simply being verbose, however. “Many individuals may be long-winded, that’s not a concern,” said Sherman.

Sherman and colleagues had initially set out to test the “regression hypothesis”, the idea that language is lost in a reverse trajectory to how it was acquired during childhood, with sophisticated vocabulary being the first thing to go.

The hypothesis turned out to be wrong, but the team did find that dementia is accompanied by characteristic language deficits. In a study, the scientists compared the language abilities of 22 healthy young individuals, 24 healthy older individuals and 22 people with MCI.

When given an exercise in which they had to join up three words, for instance “pen”, “ink” and “paper”, the healthy volunteers typically joined the three in a simple sentence, while the MCI group gave circuitous accounts of going to the shop and buying a pen.

“They were much less concise in conveying information, the sentences they produced were much longer, they had a hard time staying on point and I guess you could say they were much more roundabout in getting their point across,” said Sherman. “It was a very significant difference.”

In another test, people were asked to repeat phrases read out by the investigator. Complex vocabulary or grammar was not a problem, but those with MCI appeared to have a mental block when they were given phrases involving ambiguous pronouns, such as “Fred visited Bob after his graduation”, which the scientists said required more mental agility to assign a meaning.

The prospect of an effective treatment for Alzheimer’s has had knockbacks in the past year as a string of drugs designed to sweep away the amyloid plaques seen in the brains of patients have each been shown to make no difference to the rate of cognitive decline in trials. Between 2002 and 2012, 99.6% of drugs studies aimed at preventing, curing or improving Alzheimer’s symptoms were either halted or discontinued.

Some believe that these failures may be, in part, because by the time Alzheimer’s is diagnosed, the disease has already caused irreparable damage to the brain, making it too late for treatment to help.

“So we are trying to push the detection period back to the very subtle, early changes in in Alzheimer’s disease,” said Sherman.

There are 850,000 people with dementia in Britain and this figure is expected to reach 1 million by 2025. Last year, dementia overtook heart disease as the leading cause of death in England and Wales.

6 Diseases Linked to Communication Disorders in Seniors

Last Updated: December 26, 2018

Because our parents and senior loved ones are especially prone to ailments that can negatively impact awareness, hearing and speech, it is important to understand these issues as well as how medical professionals can treat them.

Learn more about six diseases that are linked to communication disorders in seniors.

6 Diseases Linked to Communication Disorders in Senior Loved Ones

If your parent or senior loved one is experiencing difficulty in hearing, speech or understanding, it may be worth researching theses diseases and speaking about them with your parent’s physician:

1. Alzheimer’s Disease

Alzheimer’s and related dementias can greatly hinder communication and understanding when areas of the brain responsible for comprehension and speech are damaged. While Alzheimer’s and most other common kinds of dementia are incurable and progressive, sometimes therapies can improve communication skills among people with the disease. Because Alzheimer’s is irreversible, however, people who are speaking with a loved one with the disease must be prepared to adapt their communication patterns to the situation. A recent article has a list of tips to help communicate with someone who is suffering from Alzheimer’s. For instance, nonverbal cues such as maintaining eye contact and smiling can be helpful when talking with a loved one with the disease.

2. Amyotrophic Lateral Sclerosis (ALS)

ALS, also commonly referred to as Lou Gehrig’s Disease, is a disabling, progressive disease that can cause difficulty speaking and swallowing, muscle atrophy and weakness. There is currently no cure for ALS and as the disease progresses, communication can become labored. Loved ones with ALS can work with occupational therapists and speech language-pathologists to mitigate speech problems, although they can they lose their ability to speak altogether.

3. Hearing Loss

According to the National Institute of Health (NIH), one in three people over age 60 experience hearing problems, and that figure increases to 50% in seniors over 80. Hearing loss can be most problematic when it’s not recognized. Recent studies have linked hearing loss to Alzheimer’s and according to the American Academy of Audiology, untreated hearing loss is also linked to depression and social isolation in seniors, so it’s important to watch out for signs of hearing difficulties. Signs of hearing loss can include avoiding social interactions, frequently asking conversation partners to repeat themselves and listening to the radio or television at unusually loud volumes. If you think that a senior loved one may be experiencing hearing loss, arrange a doctor’s visit right away. Audiologists are adept at diagnosing hearing problems and in recent years, hearing aids and other adaptive devices have become more powerful while decreasing in price.

4. Multiple Sclerosis (MS)

Multiple sclerosis can cause difficulty with both speech and understanding. While MS is typically diagnosed before old age, it is a condition that many seniors live with. Problems with the swallowing reflex which are prevalent among people with MS can cause difficulty speaking, while cognitive problems associated with MS can impede understanding. According to a study published on the NIH website, half of the people with MS have communication difficulty. The National MS Society has published an excellent guide to speech problems for MS patients and their loved ones, which includes a number of practical tips. For example, it suggests that people with MS who are struggling with their speech use a recorder to help themselves learn to correct their speech. The document also reminds family members to keep an eye out for communication problems in loved ones: “A person with MS may not notice his or her own speech problems. Many times a family member or physician brings it up.”

5. Parkinson’s Disease

Parkinson’s disease affects about 1% of seniors over 60 in the U.S. In people with Parkinson’s, damage to a region of the brain called the “basal ganglia” often causes speech problems. These problems can manifest themselves as problems with articulation, reduced fluency and voice changes; although it’s usually not until the later stages of the illness that these problems can cause the sufferer to become unintelligible.  An NIH document describes three general treatments strategies for the speech problems caused by Parkinson’s:

• “Communication-oriented strategies” involve educating and empowering the listener to better understand the person with Parkinson’s. For example, family members of people with Parkinson’s are taught active listening to help them understand their loved one.
• “Low-tech augmentative and alternative communication” (low-tech ACC) aims to help people with more advanced speech problems through a strategy known as alphabet supplementation, where “a speaker points to the first letter of each word on an alphabet soundboard as it is spoken.
• “Speaker-oriented” treatments help the person with Parkinson’s compensate for speech problems independently through instruction and practice.

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6. Stroke-Related Aphasia

Aphasia is a disorder that impairs one’s ability to use and understand language. The leading cause of aphasia is stroke and one in four people who have a stroke will develop aphasia, according to the National Stroke Association. There are several different categories of aphasia and no two person’s symptoms are completely the same. Many people do recover, at least somewhat, from aphasia, but the Stroke Association says that recovery is not likely when symptoms have persisted for more than six months after the stroke. Speech therapy is the primary treatment for aphasia, although other approaches have been tried as well. One interesting therapy is known as “melodic intonation therapy,” whereby patients are sometimes able to sing words and phrases that they cannot speak.

Does a parent or senior loved one in your family have communication disorders? How have you persevered and overcome the challenge? We would like to hear your stories in the comments below.

Related Articles:

Have the conversation with an older person

For some older people, talking about personal matters might not come easily. They may have never really talked about how they feel; it wasn’t the thing to do when they were growing up. Others worry about what will happen as a result of sharing their experiences; they do not want to be seen as a burden and they don’t want to be treated differently. Some also worry that asking for help might be seen as a weakness. 

But the community and its understanding of mental health issues has come a long way.

Talking to an older person

If you’re concerned about an older person experiencing anxiety, depression, suicidal thoughts, or just not coping, then it is important to take the first step. Begin a conversation; your support and concern may make all the difference. 

Opening up the conversation with an older person about the way they are feeling can be tough. There is some more information available on this site to guide you through as well as some helpful conversation starters.

To further support you, we have produced a fact sheet that can guide you through the conversation and give you tips and strategies.

Download the fact sheet

Having a conversation with an older person

Finding the words and talking it through

If you haven’t been feeling yourself lately, if you’ve been down or anxious, talking about it is the first step to feeling better. We have a fact sheet to support you if you want to open up to someone as well as more information about finding the words and what to say to your GP if you choose to open up to him or her.

Having a conversation about the way you feel helps those around you to better understand and support you. To further support you we have produced a fact sheet to give you some more information and guidance.

Download the fact sheet

Talking is the way out: Older women

Finding the words: Older men

Anxiety and Obsessive Compulsive Disorder in the Elderly

by: Maria Licoudis, R.N. &amp Care Manager

“Why does my mother wash her hands three times because she feels it is a good luck number?” David asks. “Why does my dad ball up Kleenex and put them all over the house? I find them under the covers, on the chairs, and even in the fridge!” Randy asks.

We all experience anxiety. To some degree, it is normal and can even be constructive, but it can also become disruptive and disabling. Anxiety and OCD (Obsessive Compulsive Disorder) can come with persistent rituals or obsessive thoughts that start to control daily life. Seniors tend to experience more worrisome anxiety for many reasons. They often deal with multiple illnesses, have pain and chronic conditions, suffer losses of loved ones, have Alzheimer’s and/or Dementia, and manage poly pharmacy (multiple medications). Seniors can also have trouble expressing or addressing their troublesome issues or anxieties.

In OCD, the obsessions and rituals start to control people and their daily routines. For example, some may develop a ritual of washing their hands over and over again, or others may check that they have turned off the stove several times before being able to go to bed. Some may even lock, relock and constantly check their doors because they fear the outside world. Many are preoccupied with symmetry and order of furniture and household items. They may become hoarders and have trouble throwing anything out, even expired foods. When OCD becomes severe, it can prevent one from being able to carry on responsibilities and ADLs (activities of daily living), and the normal routine of life. The inability to control these rituals and compulsions causes decreased independence, satisfaction and quality of life and increases loneliness and depression.

According to helpguide.org, OCD behaviours can fall into five common categories:

• “Washers”: when someone is afraid of contamination
• “Checkers”: where someone repeatedly check doors and stoves
• “Doubters”: fear that things aren’t perfect
• “Counters”: obsessed with symmetry and order
• “Hoarders”: fear of getting rid of items or of any kind of change

OCD can be treated with therapy, antidepressants (or other medications) and family therapists. The goal is to try and break the pattern of the anxious thoughts that produce this anxiety and that can only be relieved by the ritual.

As caregivers, we can start by trying to help the elderly to maintain and retain a sense of self- worth, and control over their loss of independence. When their “ritual” strikes, don’t try to get them to stop, but rather ask them calmly why they are doing it. Often they may have a reason. For example, the person who balls up tissue and leaves it everywhere may have been embarrassed that they were drooling and didn’t have a tissue. In their mind, keeping the tissue available everywhere will prevent that embarrassment. It is important for to reassure the person and to gather some information about their anxiety, so as to slowly redirect and divert some of their rituals. Several things may help to reduce their stress and anxiety:

• Avoiding large and crowded settings
• Being careful when introducing new environments
• Decreasing caffeine intake
• Increasing exercise and walking (expends energy and refocuses the mind)
• Talking about their past fears and losses
• Allowing them to express themselves and to share their emotions (let them know if it’s ok to cry)
• Getting adequate sleep
• Eating a balanced diet
• Practicing deep breathing
• Refocusing their energies to an activity, an outing, a movie, a phone call, a puzzle, or a game of cards

Cognitive therapy may also assists in creating constructive ways to create a calm and supportive environment. It is important to never criticize, disapprove of or scold the person for their behaviours. By reacting with patience, kindness, caring and love, we can contribute to creating a more balanced and less stressful environment. Remember the problem is the OCD and the rituals, never the person.

Note: This article is for informative purposes only. Always check with a medical professional.

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With memory impairments

With memory impairments

Memory impairment is one of the manifestations of dementia.

Dementia (acquired dementia) is a disease caused by organic damage to the brain. Dementia is characterized by persistent disorders of the intellect (memory, thinking), emotional disturbances and a decrease in volitional qualities. The diagnosis is established on the basis of clinical criteria and instrumental studies (CT, MRI of the brain).The causes of dementia in old age are most often vascular diseases (hypertension, strokes, atherosclerosis of the cerebral vessels) and atrophic diseases (for example, Alzheimer’s disease).

Alzheimer’s disease – a disease that occurs due to brain damage associated with metabolic disorders. At the initial stages, memory is disturbed, patients forget what they recently said, why they left home, what they wanted to buy in a store, etc. As a result, they experience difficulties in housekeeping, in the workplace.Reminders don’t always help them. Often, patients attribute memory impairments to absent-mindedness or overwork and do not go to doctors, although it is at the first stage of the disease that effective drug therapy is possible. Patients can change their behavior, they can become irritable, show aggression. At this stage, patients can still perform daily self-care activities. In the future, the understanding of someone else’s speech is disturbed, gradually a person forgets everything – the place of birth, the names of his children, stops recognizing familiar people, household items, gets lost in public places.Patients do not find the right words, often replace them with others, sometimes close in meaning, sometimes not. Instead of words, scraps of them are often pronounced, syllables are rearranged, vocabulary is depleted. There comes a pronounced stage of the disease, when patients can no longer prepare their own food, do their usual homework, and make purchases. Personal traits are erased, patients differ from one another only in the severity of the disorders. Frequent symptoms are aimless wandering and vagrancy, more often at night (patients leaving home are often due to the fact that they are not understood).Misunderstanding of the patient by relatives can be expressed in patients in tears, malice, verbal or physical aggression. Short-term hallucinations, psychomotor agitation are possible. Patients become sloppy, unkempt. In the advanced stage, patients are inactive, completely dependent on the people caring for them. The patient cannot give his name, address, does not recognize relatives, familiar objects. Sometimes you may not even recognize yourself in the mirror. The patient experiences difficulties in nutrition, loses the ability to move, there is a sharp restriction or practical absence of speech, suffers from urinary and fecal incontinence.

Vascular dementia occurs as a result of vascular damage due to atherosclerosis and hypertension. There is “ischemia” – necrosis of a part of the nervous tissue (including microstrokes, which can proceed almost imperceptibly, manifest, for example, only with a severe headache). With vascular disorders, patients complain of dizziness, tinnitus, headaches, sensitivity to changes in atmospheric pressure. Initial manifestations can occur as early as 50 years old, sometimes even earlier.At the expanded stages, personality changes occur – distrustful people become intolerably suspicious, irritable people become frankly angry, careless people become thoughtlessly lightweight. The danger is excessive gullibility, when they can fall under the influence of others because of their gullibility, suggestibility. Those who in the past were stingy and suspicious may have delusions of persecution, delusions of damage – “they want to poison with gas”, “neighbors are robbing”, “relatives want to take over my apartment”.Persons who in the past are prone to anxious introspection, depressive reactions often develop depression. The patient becomes emotionally unstable – sometimes crying, and then laughing in conversation, often anxious, confused, sentimental. Sleep is often disturbed – it becomes shortened, the “sleep-wakefulness” rhythm is disturbed, at night the sleep becomes intermittent, and during the day the patients are in a semi-drowsy state. Patients can easily develop fears – fear of “stroke”, “cancer”, etc. In the future, a symptom such as “confusion” may arise, when the patient cannot understand where he is and even who he is.At night, motor restlessness is possible – he gets up, wanders around the apartment, touches sleeping people, touches objects that came to his hand, mutters something. In this state, he can open gas, front door, water. At advanced stages, people experience an almost complete loss of memory for the events that are happening to them now. Patients at this stage can say that they “went to work” yesterday, that their parents are alive, who “live with them,” that is, memories from the past replace the events that actually happened to them.Patients cease to recognize others, the meaning of speech is disturbed.

Here are some practical guidelines for communicating with a relative with dementia:

1. Try to tune in to a positive interaction with the patient: Talk to your sick relative in a pleasant and polite manner. Use facial expressions, voice timbre and tactile contacts to convey information and tender feelings.
2. Communicate with the patient in a caring but at the same time confident and clear tone.
3. When talking to a sick person, limit exposure to distractions and background noise. Before you speak, get the patient’s attention: refer to him by name, identify your personality and relationship (degree of relationship) with the patient, use non-verbal signs and touch to keep his attention.
4. State your message clearly. Use simple words and sentences. Speak slowly, clearly, in an encouraging tone.
5. Ask simple questions that are easy to answer.Ask one question at a time; the best answer is yes or no. Refrain from asking difficult questions or giving too many choices. If he is working on an answer, it is natural to give him a hint.
6. Be patient with the patient and give him time (perhaps a few minutes) to react or answer a question.
7. If necessary, repeat important information, possibly more than once.
8. Try to help the patient remember specific data (time, place, names of friends and relatives).
9. To be understanding, even if it is sometimes difficult, and try not to be angry with the patient if he cannot do something, or behaves incorrectly, since his behavior, like memory impairments, is a manifestation of his illness.
10. Try not to react to reproaches and reproaches.
11. Praise can accomplish more than criticism. With the correct behavior of the patient, praise can be expressed in words, a touch or a smile.
12. Respond with love and encouragement in your voice.People with dementia often feel embarrassed, anxious, and insecure. In addition, they often distortedly see the surrounding reality, in particular, they can remember things that never happened in real life. Avoid convincing them that you are wrong. Often times, nothing can help you establish contact as effectively as touching, shaking hands, hugging, and praising.
13. Break the action down into a chain of consecutive steps. You can inspire a person to complete a task within their power by gently reminding them what to do in the sequence of steps required to complete the task.Thus, you help him to do what he is no longer able to cope with on his own due to his condition. The use of visual cues can help a lot in this, for example, indicating with your hand where to put the soup bowl.
14. If reaching a goal becomes difficult, distract the patient and give him another goal. If the person is upset, try changing activities. For example, ask him for help or offer to go for a walk.
15. Remember the good old days.Memories of the past are often calming and life-affirming activities. Many people with dementia cannot remember what happened 45 minutes ago, but they clearly recall events forty-five years ago.
16. The patient needs stimuli for mental activity, which do not require excessive efforts from him, and especially he needs an interlocutor.
17. Take care of the unchanged daily routine of the patient.
18. Simple rules and strong habits are very helpful for all elderly people, and especially those with dementia.
19. Concomitant diseases (high blood pressure, diabetes mellitus, thyroid pathology, and others) must be diagnosed and treated in a timely manner – this is also the task of those caring for the patient.
20. Very important for older people: good nutrition and adequate fluid intake, and regular movement.

Please note that in the initial stages of a disease associated with memory impairment, for example, when a diagnosis of Alzheimer’s disease is made, people may feel some discomfort due to excessive family care.Therefore, care should be consistent with the needs of the patient and be aimed at maintaining the patient’s activity and independence.

Tips for loved ones of a patient with Alzheimer’s disease:

1. Create the feeling that you are always there. Call, come to visit – it means a lot to the patient
2. Avoid situations that contribute to a decrease in self-esteem. Focus the person’s attention on those actions that he can do on his own.
3. Take care of the little things. Bring something tasty, go to the post office, etc.
4. Be very clear and precise in your offers of assistance. Distribute responsibilities in the family, make a list with areas of responsibility for each of its members.
5. Strive to know more about Alzheimer’s disease, what the manifestations of the disease are, and how you should respond to them.
6. Make sure everyone in the family is involved in joint activities.Formulate feasible responsibilities for the patient when organizing joint activities.
7. Be a careful listener. Try to understand and accept what the patient is saying.
8. Encourage a healthy lifestyle. Give practical advice on daily routine, wellness exercise, and proper nutrition.

With high risk factors for vascular dementia (atherosclerosis, stroke, hypertension), it is necessary to pay attention to the implementation of doctors’ recommendations, control of blood pressure levels, and regular preventive courses of treatment.See also guidelines for hypertensive patients .

For consultation at the “ Memory Center ” you must make an appointment with a psychotherapist.

All patients who apply to the “Memory Center” undergo an initial appointment with a psychotherapist, who carries out primary diagnostics, prescribing medications, if necessary, and consulting a psychologist.

You can sign up by calling the registry (812) 575-27-63 or through the form on the main page of the site .

90,000 Obsessive-compulsive disorder

Syndromes (complexes of symptoms), united in the group of obsessive-compulsive disorder (OCD), which got its name from the Latin terms obsessio and compulsio, play a noticeable role among mental illnesses.

Obsession (Latin obsessio – taxation, siege, blockade).

Compulsions (lat.compello – I force). 1. Obsessive drives, a kind of obsessions (obsessions). Irresistible drives that arise in spite of reason, will, feelings are characteristic. Often they turn out to be unacceptable for the patient, contradict his moral and ethical properties. Unlike impulsive drives, compulsions are not realized. These drives are recognized by the patient as wrong and are painfully experienced by him, especially since their very appearance, due to its incomprehensibility, often gives rise to a feeling of fear in the patient 2.The term compulsion is also used in a broader sense to refer to any obsessions in the motor sphere, including obsessive rituals.

In Russian psychiatry, obsessive states were understood as psychopathological phenomena characterized by the fact that phenomena of a certain content repeatedly appear in the patient’s mind, accompanied by a painful feeling of coercion [Zinoviev PM, 193I]. For N. with. characterized by involuntary, even against the will, the emergence of obsessions with clear consciousness.Although obsessions are alien, outsiders in relation to the patient’s psyche, the patient is not able to get rid of them. They are closely related to the emotional sphere, accompanied by depressive reactions, feelings of anxiety. Being symptomatic, according to S.L. Sukhanov [1912], “parasitic”, they do not affect the course of intellectual activity in general, remain alien to thinking, do not lead to a decrease in its level, although they worsen the working capacity and productivity of the patient’s mental activity. Throughout the course of the disease, a critical attitude remains towards obsessions.NS. are conventionally divided into obsessions in the intellectual-affective (phobia) and motor (compulsion) spheres, but most often several types of obsessions are combined in the structure of the disease of obsessions. Isolation of abstract obsessions, affectively indifferent, indifferent in their content, for example, arrhythmania, is rarely justified; analysis of the psychogenesis of neurosis often allows us to see a pronounced affective (depressive) background at the basis of obsessive counting. Along with elementary obsessions, the connection of which with psychogeny is obvious, there are “cryptogenic” ones, when the cause of the onset of painful experiences is hidden [Svyadosch L.M., 1959]. NS. observed mainly in individuals with a psychasthenic character. Obsessive fears are especially common here. In addition, N.S. are found in the framework of neurosis-like states with sluggish schizophrenia, endogenous depression, epilepsy, the consequences of traumatic brain injury, somatic diseases, mainly hypochondriacal-phobic or nosophobic syndrome. Some researchers distinguish the so-called. “Obsessive-compulsive disorder”, which is characterized by the predominance of obsessive states in the clinical picture – memories that reproduce a psychogenic-traumatic situation, thoughts, fears, actions.In genesis play a role: mental trauma; conditioned reflex stimuli, which have become pathogenic due to their coincidence with others, which previously caused a feeling of fear; situations that have become psychogenic due to the confrontation of opposite tendencies [Svyadosch A.M., 1982]. It should be noted that the same authors emphasize that the scientific researcher occurs with various character traits, but most often in psychosthenic personalities.

At present, almost all obsessive-compulsive disorders are combined in the International Classification of Diseases under the concept of “obsessive-compulsive disorder”.

ROC concepts have undergone a fundamental reassessment over the past 15 years. During this time, the clinical and epidemiological implications of OCD have been completely revised. If it was previously thought that this is a rare condition observed in a small number of people, now it is known that OCD is common and gives a high incidence rate, which requires urgent attention of psychiatrists around the world. In parallel, our understanding of the etiology of OCD has expanded: the fuzzy psychoanalytic definition of the past two decades has been replaced by a neurochemical paradigm exploring the neurotransmitter disorders underlying OCD.Most significantly, pharmacological interventions specifically targeting serotonergic neurotransmission have revolutionized the recovery prospects of millions of OCD sufferers worldwide.

The discovery that intense serotonin reuptake inhibition (SSRI) is the key to effective treatment for OCD was the first stage of a revolution and stimulated clinical research that showed the effectiveness of such selective inhibitors.

As described in ICD-10, the main features of OCD are repetitive obsessive thoughts and compulsive actions (rituals).

In a broad sense, the core of OCD is obsessional syndrome, which is a condition with a predominance in the clinical picture of feelings, thoughts, fears, memories that arise apart from the desire of patients, but with awareness of their pain and a critical attitude towards them. Despite the understanding of the unnaturalness, illogicality of obsessions and states, patients are powerless in their attempts to overcome them. Obsessive motives or ideas are recognized as alien to the person, but as if coming from within.Obsessive behaviors can be rituals designed to ease anxiety, such as hand washing to combat “contamination” and to prevent “contamination.” Trying to drive away unwelcome thoughts or urges can lead to intense internal struggles accompanied by intense anxiety.

Obsessions in ICD-10 are included in the group of neurotic disorders.

The prevalence of OCD in the population is quite high. According to some data, it is determined by an indicator of 1.5% (meaning “fresh” cases of diseases) or 2-3% if episodes of exacerbations observed throughout life are taken into account.Obsessive-compulsive disorder sufferers account for 1% of all patients receiving treatment in psychiatric institutions. It is believed that men and women are affected approximately equally.

CLINICAL PICTURE

The problem of obsessive compulsions attracted the attention of clinicians already at the beginning of the 17th century. They were first described by Platter in 1617. In 1621 E. Barton described the obsessive fear of death. Obsessions are mentioned in the works of F.Pinel (1829). I. Balinsky proposed the term “obsessive representations”, which took root in Russian psychiatric literature. In 1871 Westphal coined the term agoraphobia to denote the fear of being in public. M. Legrand de Sol [1875], analyzing the features of the dynamics of OCD in the form of “the insanity of doubts with delusions of touch, points to a gradually complicating clinical picture – obsessive doubts are replaced by absurd fears of” touching “surrounding objects, motor rituals are added, the implementation of which obeys the whole life sick.However, only at the turn of the XIX-XX centuries. the researchers managed to more or less clearly describe the clinical picture and give a syndromic description of obsessive-compulsive disorders. The onset of the disease, as a rule, occurs in adolescence and adolescence. The maximum of clinically outlined manifestations of obsessive-compulsive disorder is observed in the age range of 10 – 25 years.

Major clinical manifestations of OCD:

Obsessive thoughts – painful, arising without will, but recognized by the patient as his own, ideas, beliefs, images that in a stereotyped form forcibly invade the patient’s consciousness and which he tries to resist in some way.It is this combination of an inner feeling of compulsive urge and efforts to resist it that characterizes obsessive symptoms, but of the two, the degree of effort is more variable. Obsessive thoughts can take the form of single words, phrases, or lines of poetry; they are usually unpleasant to the patient and can be obscene, blasphemous, or even shocking.

Obsessive imagery is vividly presented scenes that are often violent or disgusting, including, for example, sexual perversion.

Obsessive impulses are urges to take actions, usually destructive, dangerous or capable of dishonoring; for example, jumping out into the road in front of a moving vehicle, injuring a child, or shouting obscene words in public.

Obsessive rituals include both mental activity (for example, repetitive counting in some special way, or the repetition of certain words), and repetitive but meaningless acts (for example, washing hands twenty or more times a day).Some of them have an understandable connection with previous obsessive thoughts, for example, repeated hand washing – with thoughts of infection. Other rituals (for example, regularly unfolding clothes according to some complex system before putting them on) do not have such a connection. Some sufferers feel an irresistible urge to repeat these actions a certain number of times; if this does not work, they have to start all over again. Patients are invariably aware that their rituals are illogical, and they usually try to hide them.Some fear that these symptoms are signs of incipient insanity. Both obsessive thoughts and rituals inevitably lead to problems in daily activities.

Obsessive ruminations (“mental gum”) are internal debates that endlessly revise the arguments for and against even the simplest of everyday activities. Some obsessive doubts concern actions that may have been improperly performed or not completed, such as turning off the gas stove tap or locking the door; others relate to activities that could harm other people (for example, being able to drive past a cyclist and run over him).Sometimes doubts are associated with a possible violation of religious precepts and rituals – “remorse.”

Compulsive actions – repetitive stereotyped actions, sometimes acquiring the character of protective rituals. The latter are aimed at preventing any objectively unlikely events dangerous to the patient or his relatives.

In addition to the above, in the series of obsessive-compulsive disorders, a number of outlined symptom complexes stand out, and among them obsessive doubts, contrasting obsessions, obsessive fears – phobias (from the Greek.phobos).

Obsessive thoughts and compulsive rituals may intensify in certain situations; for example, obsessive thoughts about harming other people often become more persistent in the kitchen or some other place where knives are stored. Because patients often avoid such situations, there may be superficial similarities with the characteristic avoidance pattern found in phobic anxiety disorder. Anxiety is an important component of obsessive-compulsive disorder.Some rituals reduce anxiety, while others increase it. Obsessions often develop in the context of depression. In some patients, this looks like a psychologically understandable response to obsessive-compulsive symptoms, but in others, there are recurrent episodes of depressive mood that occur independently.

Obsessions (obsessions) are subdivided into figurative, or sensual, accompanied by the development of affect (often painful) and obsession with affectively neutral content.

Sensory compulsions include obsessive doubts, memories, ideas, drives, actions, fears, obsessive feelings of antipathy, obsessive fear of habitual actions.

Obsessive doubts – an intrusive uncertainty arising contrary to logic and reason in the correctness of the performed and committed actions. The content of doubts is different: obsessive everyday fears (whether the door is locked, whether the windows or water taps are tightly closed enough, whether the gas or electricity is turned off), doubts related to official activities (whether this or that document is written correctly, whether the addresses on business papers are confused , whether inaccurate numbers are indicated, whether the orders are formulated or executed correctly), etc.Despite the repeated verification of the action taken, doubts, as a rule, do not disappear, causing psychological discomfort in the person suffering from this kind of obsession.

Obsessive memories include persistent, irresistible painful memories of any sad, unpleasant or shameful events for the patient, accompanied by a feeling of shame, remorse. They dominate the mind of the patient, despite efforts and efforts not to think about them.

Obsessive drives – urges to commit one or another harsh or extremely dangerous action, accompanied by a feeling of horror, fear, confusion with the inability to get rid of it.The patient is seized, for example, by the desire to throw himself under a passing train or push a loved one under him, to kill his wife or child in an extremely cruel way. At the same time, patients are painfully afraid that this or that action will be implemented.

Manifestations of obsessive representations can be different. In some cases, it is – a vivid “vision” of the results of obsessive drives, when patients imagine the result of a committed cruel act. In other cases, obsessive notions, often called overwhelming, appear in the form of implausible, sometimes absurd situations that patients take for real.An example of obsessive notions is the patient’s conviction that the buried relative was alive, and the patient painfully imagines and experiences the suffering of the deceased in the grave. At the height of obsessive ideas, the consciousness of their absurdity, implausibility disappears and, on the contrary, confidence in their reality appears. As a result, obsessions acquire the character of overvalued formations (dominant ideas that do not correspond to their true meaning), and sometimes delirium.

An obsessive feeling of antipathy (as well as obsessive blasphemous and blasphemous thoughts) – an unjustified antipathy driven away by the patient from himself to a certain, often close person, cynical, unworthy thoughts and ideas in relation to respected people, among religious persons – in relation to saints or ministers churches.

Obsessive actions are actions performed against the wishes of the sick, despite efforts made to restrain them. Some of the compulsive actions weigh on the patients until they are realized, others are not noticed by the patients themselves. Obsessive actions are painful for patients, especially in those cases when they become the object of attention of others.

Obsessive fears, or phobias, include obsessive and meaningless fear of heights, large streets, open or confined spaces, large crowds of people, fear of sudden death, fear of contracting one or another incurable disease.Some patients may experience a wide variety of phobias, sometimes acquiring the character of a fear of everything (panphobia). And finally, obsessive fear of the emergence of fears (phobophobia) is possible.

Hypochondriacal phobias (nosophobia) – obsessive fear of any serious illness. Most often, cardio, stroke, syphilo and AIDS phobia are observed, as well as the development of malignant tumors. At the peak of anxiety, patients sometimes lose a critical attitude to their condition – they turn to doctors of the appropriate profile, require examination and treatment.The implementation of hypochondriac phobias occurs both in connection with psycho- and somatogenic (general non-mental diseases) provocations, and spontaneously. As a rule, as a result, hypochondriacal neurosis develops, accompanied by frequent visits to doctors and inappropriate medication.

Specific (isolated) phobias – obsessive fears limited to a strictly defined situation – fear of heights, nausea, thunderstorms, pets, dental treatment, etc. Since contact with situations that cause fear is accompanied by intense anxiety, the desire of patients to avoid them is characteristic.

Obsessive fears are often accompanied by the development of rituals – actions that have the meaning of “magic” spells, which are performed, despite the patient’s critical attitude to the obsession, in order to protect against one or another imaginary misfortune: before starting any important business, the patient must perform some then a specific action to exclude the possibility of failure. Rituals can, for example, be expressed in clicking fingers, playing a melody by the patient, or in repeating certain phrases, etc.In these cases, even those close to you are not aware of the existence of such disorders. Rituals combined with obsessions represent a fairly stable system that usually exists for many years or even decades.

Obsessions with affective-neutral content – obsessive philosophizing, obsessive counting, remembering neutral events, terms, formulations, etc. Despite their neutral content, they burden the patient, interfere with his intellectual activity.

Contrasting obsessions (“aggressive obsessions”) – blasphemous, blasphemous thoughts, fear of harming oneself and others. Psychopathological formations of this group relate mainly to figurative obsessions with a pronounced affective saturation and ideas that take possession of the consciousness of patients. They are distinguished by a sense of alienation, the absolute lack of motivation of the content, as well as a close combination with obsessive drives and actions. Patients with contrasting obsessions and complain of an irresistible desire to add endings to the remarks just heard that give the said an unpleasant or threatening meaning, repeat after others, but with a touch of irony or anger, phrases of religious content, shout out cynical words that contradict their own attitudes and generally accepted morality , they may feel fear of losing control over themselves and possible committing dangerous or ridiculous actions, injuring themselves or their loved ones.In the latter cases, obsessions are often combined with phobias of objects (fear of sharp objects – knives, forks, axes, etc.). The contrast group also includes obsessions with sexual content (obsessions of the type of forbidden ideas about perverted sexual acts, the objects of which are children, representatives of the same sex, animals).

Obsessions with pollution (misophobia). This group of obsessions includes both the fear of pollution (earth, dust, urine, feces and other sewage) and the fear of the penetration of harmful and poisonous substances into the body (cement, fertilizers, toxic waste), small objects (shards of glass, needles, specific species dust), microorganisms.In some cases, the fear of contamination can be limited, remain for many years at the preclinical level, manifesting itself only in certain features of personal hygiene (frequent change of linen, repeated washing of hands) or in housekeeping (careful handling of food, daily washing of floors , “Taboo” on pets). This kind of monophobia does not significantly affect the quality of life and is evaluated by others as habits (exaggerated cleanliness, excessive disgust).Clinically manifested variants of misophobia belong to the group of severe obsessions. In these cases, progressively more complicated protective rituals come to the fore: avoiding sources of pollution and touching “unclean” objects, processing things that could get dirt, a certain sequence in the use of detergents and towels, which allows maintaining “sterility” in the bathroom. The stay outside the apartment is also furnished with a series of protective measures: going out into the street in special clothes that cover the body as much as possible, special handling of worn items upon returning home.In the later stages of the disease, patients, avoiding pollution, not only do not go outside, but do not even leave their own room. In order to avoid dangerous contacts and contacts in terms of contamination, patients do not even admit their closest relatives. Misophobia is also associated with the fear of contracting any disease that does not belong to the categories of hypochondriacal phobias, since it is not determined by the fear of the person suffering from OCD with one or another disease. In the foreground is the fear of a threat from the outside: the fear of pathogenic bacteria entering the body.Hence the development of appropriate protective actions.

A special place in the series of obsessions is occupied by obsessive actions in the form of isolated, monosymptomatic movement disorders. Among them, especially in childhood, tics predominate, which, in contrast to organically conditioned involuntary movements, are much more complex motor acts that have lost their original meaning. Tics sometimes give the impression of exaggerated physiological movements. This is a kind of caricature of certain motor acts, natural gestures.Patients suffering from tics can shake their heads (as if checking whether the hat is sitting well), make hand movements (as if throwing away interfering hair), blink their eyes (as if getting rid of a speck). Along with obsessive tics, pathological habitual actions (biting the lips, grinding teeth, spitting, etc.) are often observed, which differ from the intrusive actions themselves by the absence of a subjectively painful feeling of obsession and experiencing them as alien, painful. Neurotic conditions characterized only by obsessive tics usually have a favorable prognosis.Appearing most often in preschool and primary school age, tics usually subside by the end of puberty. However, such disorders may turn out to be more persistent, persist for many years and only partially change in manifestations.

Course of obsessive-compulsive disorder.

Unfortunately, it is necessary to indicate chronization as the most characteristic trend in the dynamics of OCD. Cases of episodic manifestations of the disease and complete recovery are relatively rare.However, in many patients, especially with the development and preservation of one type of manifestation (agoraphobia, compulsive counting, ritual hand washing, etc.), long-term stabilization of the state is possible. In these cases, there is a gradual (usually in the second half of life) mitigation of psychopathological symptoms and social readaptation. For example, patients who have experienced fear of traveling by certain types of transport or public speaking cease to feel inferior and work alongside healthy ones.In milder forms of OCD, the disease is usually benign (on an outpatient basis). The reverse development of symptoms occurs after 1 – 5 years from the moment of manifestation.

More severe and complex OCD, such as phobias of contamination, pollution, sharp objects, contrasting representations, numerous rituals, on the contrary, can become resistant, resistant to treatment, or show a tendency to relapse with disorders that persist despite active therapy.Further negative dynamics of these conditions indicates a gradual complication of the clinical picture of the disease as a whole.

DIFFERENTIAL DIAGNOSIS

It is necessary to distinguish OCD from other disorders in which obsessions and rituals occur. In some cases, obsessive-compulsive disorder must be differentiated from schizophrenia, especially when obsessive thoughts are unusual in content (for example, mixed sexual and blasphemous topics) or rituals are extremely eccentric.The development of a sluggish schizophrenic process cannot be ruled out even with the growth of ritual formations, their persistence, the emergence of antagonistic tendencies in mental activity (inconsistency of thinking and actions), monotony of emotional manifestations. Protracted obsessive states of a complex structure must be distinguished from the manifestations of paroxysmal schizophrenia. In contrast to neurotic obsessive states, they are usually accompanied by a sharply growing anxiety, a significant expansion and systematization of the circle of obsessive associations that acquire the character of obsessions of “special significance”: previously indifferent objects, events, random remarks from others remind patients of the content of phobias, offensive thoughts and thereby acquire in their view, a special, threatening meaning.In such cases, it is necessary to consult a psychiatrist in order to exclude schizophrenia. Differentiation between OCD and generalized disorders, known as Gilles de la Tourette’s syndrome, may also pose a challenge. Tics in such cases are localized in the face, neck, upper and lower extremities and are accompanied by grimaces, mouth opening, tongue protruding, and intense gestures. In these cases, this syndrome is excluded by the coarseness of movement disorders characteristic of it and more complex in structure and more severe mental disorders.

Genetic factors

Speaking about a hereditary predisposition to OCD, it should be noted that obsessive-compulsive disorders are found in about 5-7% of parents of patients with such disorders. Although this rate is low, it is higher than that of the general population. While the evidence for a hereditary predisposition to OCD is uncertain, the psychasthenic personality traits can be largely attributed to genetic factors.

FORECAST

About two-thirds of OCD patients improve within a year, more often by the end of that period.If the disease lasts more than a year, fluctuations are observed during its course – periods of exacerbations are interspersed with periods of improvement in health, lasting from several months to several years. The prognosis is worse if we are talking about a psychasthenic personality with severe symptoms of the disease, or if there are continuous stressful events in the patient’s life. Severe cases can be extremely persistent; for example, a study of hospitalized OCD patients found that three-quarters of them remained symptomatic after 13–20 years.

TREATMENT: BASIC METHODS AND APPROACHES

Despite the fact that OCD is a complex group of symptom complexes, the principles of treatment for them are the same. The most reliable and effective method of treating OCD is drug therapy, during which a strictly individual approach to each patient should be manifested, taking into account the characteristics of the manifestation of OCD, age, gender, and the presence of a history of other diseases. In this regard, we must warn patients and their relatives against self-medication.If any disorders similar to mental ones appear, it is necessary, first of all, to contact the specialists of the psycho-neurological dispensary at the place of residence or other medical institutions of the psychiatric profile to establish the correct diagnosis and prescribe competent adequate treatment. It should be remembered that at present a visit to a psychiatrist does not threaten any negative consequences – the notorious “registration” was canceled more than 10 years ago and replaced by the concepts of counseling and medical care and dispensary observation.

When treating, it should be borne in mind that obsessive-compulsive disorders often have a fluctuating course with long periods of remission (improvement in the condition). The apparent suffering of the patient often seems to require vigorous and effective treatment, but the natural course of the condition should be kept in mind to avoid the typical mistake of overly intensive therapy. It is also important to consider that depression is often associated with OCD, and that depression is often associated with amelioration of obsessive symptoms when effectively treated.

Treatment of OCD begins with explaining the symptoms to the patient and, if necessary, with the belief that they are the initial manifestation of insanity (a common cause for concern in obsessive-compulsive patients). Sufferers of these or those obsessions often involve other family members in their rituals, so relatives need to treat the patient firmly but sympathetically, mitigating the symptomatology if possible, and not aggravating it by excessive indulgence of the sick fantasies.

Drug therapy

The following therapeutic approaches exist for the currently identified types of OCD. Of the pharmacological drugs for OCD, the most commonly used are serotonergic antidepressants, anxiolytics (mainly of the benzodiazepine series), beta-blockers (for the relief of autonomic manifestations), MAO inhibitors (reversible), and triazole benzodiazepines (alprazolam). Anxiolytic drugs provide some short-term relief of symptoms, but they should not be prescribed for more than a few weeks at a time.If treatment with anxiolytics is required for more than one to two months, small doses of tricyclic antidepressants or minor antipsychotics sometimes help. The main link in the OCD treatment regimen, overlapping with negative symptoms or with ritualized obsessions, is atypical antipsychotics – risperidone, olanzapine, quetiapine, in combination with either SSRI antidepressants, or with other antidepressants – moclobemodiene, thianopentizene alprazolam, clonazepam, bromazepam).

Any comorbid depressive disorder is treated with an adequate dose of antidepressant medication. There is evidence that one of the tricyclic antidepressants, clomipramine, has a specific effect on obsessive symptoms, but the results of a controlled clinical trial showed that the effect of this drug is insignificant and manifests itself only in patients with distinct depressive symptoms.

In cases where obsessive-phobic symptoms are observed in schizophrenia, intensive psychopharmacotherapy with proportional use of high doses of serotonergic antidepressants (fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram) has the greatest effect.In some cases, it is advisable to use traditional antipsychotics (small doses of haloperidol, trifluoperazine, fluanksol) and parenteral administration of benzodiazepine derivatives.

Psychotherapy

Behavioral psychotherapy

One of the main tasks of the specialist in the treatment of OCD is to establish a fruitful collaboration with the patient. It is necessary to instill in the patient faith in the possibility of recovery, overcome his prejudice against the “harm” caused by psychotropic drugs, convey his conviction in the effectiveness of treatment, subject to systematic adherence to prescribed prescriptions.The patient’s faith in the possibility of healing must be supported in every possible way by the relatives of the sufferer of OCD. If the patient has rituals, it must be remembered that improvement usually occurs when using a combination of the method of preventing the reaction with placing the patient in conditions that aggravate these rituals. Significant, but not complete, improvement can be expected in about two-thirds of patients with moderately severe rituals. If, as a result of such treatment, the severity of rituals decreases, then, as a rule, the accompanying obsessive thoughts also recede.With panphobia, behavioral techniques are used primarily to reduce sensitivity to phobic stimuli, supplemented by elements of emotionally supportive psychotherapy. In cases where ritualized phobias predominate, along with desensitization, behavioral training is actively used to help overcome avoidant behavior. Behavioral therapy is significantly less effective for obsessive thoughts that are not accompanied by rituals. Some experts have been using the method of “stopping thoughts” for many years, but its specific effect has not been convincingly proven.

Social rehabilitation

We have already noted that obsessive-compulsive disorder has a fluctuating (fluctuating) course and over time the patient’s condition can improve, regardless of what treatment methods were used. Until they recover, sufferers can benefit from supportive conversations that provide ongoing hope of recovery. Psychotherapy in the complex of therapeutic and rehabilitation measures in patients with OCD is aimed at both correcting avoidant behavior and reducing sensitivity to phobic situations (behavioral therapy), as well as family psychotherapy with the aim of correcting behavioral disorders and improving family relations.If marital problems exacerbate symptoms, spouse interviews are indicated. Patients with panphobia (at the stage of the active course of the disease), due to the intensity and pathological persistence of symptoms, require both medical and social and labor rehabilitation. In this regard, it is important to determine the adequate terms of treatment – long-term (at least 2 months) therapy in a hospital, followed by continuation of the course on an outpatient basis, as well as measures to restore social ties, professional skills, and intra-family relationships.Social rehabilitation is a set of programs for teaching patients with OCD methods of rational behavior both in everyday life and in a hospital setting. Rehabilitation focuses on teaching social skills to properly interact with other people, vocational training, as well as skills needed in everyday life. Psychotherapy helps patients, especially those experiencing a sense of their own inferiority, to better and correctly relate to themselves, master ways to solve everyday problems, and gain faith in their own strength.

All these methods, if used judiciously, can increase the effectiveness of drug therapy, but are not able to completely replace drugs. It should be noted that explanatory psychotherapy is not always helpful, and some patients with OCD may even get worse, as such procedures induce painful and unproductive reflections on the subjects discussed in the course of treatment. Unfortunately, until now, science has not known ways to heal mental ailments once and for all.OCD often tends to recur, requiring long-term prophylactic medication.

A person aging: about what happens to us with age

A person aging: about what happens to us with age

What is an aging person and what is a developing person? The article focuses not on biochemical and morphological aspects, but on the personality – on the process of individual development of a person, because he never stops.One should not think that after adolescence a person reaches a plateau, as scientists call “acme”, the highest point of development, and then degrades. Aging is not degradation. This is a very peculiar process of continuing development.

Normal aging, according to our psychological school, is a process of continuous, progressive, uneven, complex growth of various limitations. There are purely physiological ones: hearing decreases, specific forms of diseases appear, which in fact are not diseases, but there are normal symptoms of aging associated with movements, muscles, sensory systems, psychology, and so on, and, of course, social restrictions arise, which in the individual consciousness an aging person is refracted and transformed into existential.The unevenness of the process gives rise to individual differences. Modern methods of scientific research, prone to statistical processing and quantitative analysis of data, unfortunately, do not help to reveal the essence of the mechanisms that lie behind it, because aging is highly individual.

Why? Roughly speaking, here’s a child. As soon as he is born, he immediately enters the society, where he is looked after, but nature is arranged in such a way that a certain program is laid in the genetics of a new person that gives him a minimum range so that he survives.Therefore, early ontogenesis, that is, early individual differences from birth to preschool age, are sufficiently programmed. We know the standards: when a child must be able to hold his head, say the first word, what kind these words should be, when he should have phrasal speech, when he should start walking, crawling, and so on. If there are deviations in the standards, we say that this is abnormal, pathological, something needs to be done about it – the correction must be medical, because these programs are biological.In adulthood, development is already more directed, social: a person shows his own activity, and so on. He reaches the third age, that is, the age of aging, with a very serious baggage – knowledge, experience, experiences, trauma, views, meanings, values. All this colossal baggage, of course, very much noises the natural biological program. Therefore, aging is individual precisely because of individual experience. Thus, we are not very good at finding biological causes using natural science methods.Therefore, all the data on individual differences that I will cite are clinical. That is, collected not for patients, but through long, many years of observation – including by our department and me.

Nevertheless, it is possible to distinguish individual differences, which we call style, variant or type, that is, to distinguish a certain typology of normal aging based on how the brain works. In the 1930s and 1950s, a prominent Soviet researcher, psychologist Alexander Romanovich Luria, opened the world to a science he called neuropsychology.She was born in the Soviet Union and is accepted all over the world. Indeed, this is our achievement, one of the few that is definitely ours. Luria studies patients with local brain lesions, presenting various kinds of tests, shows that when certain structures are damaged, certain symptoms of disorders of higher mental functions, such as memory, thinking, attention, speech, and so on, arise. He concluded that if a patient is given a specific test that will demonstrate certain disorders of mental functions, then these zones are responsible for the implementation of these mental functions.

In the 70s and 80s, Natalya Konstantinovna Korsakova, a student of Alexander Romanovich Luria, began working at the Scientific Center for Mental Health, where she was offered to use the methods developed by Luria for diagnosing Alzheimer’s disease in order to understand exactly how the brain is affected. And indeed, presenting these tests, Luria’s methods that were developed for people with brain tumors, she shows that patients with Alzheimer’s disease develop very similar symptoms, similar to those that occur in patients with tumors of the parietal, frontal lobes. , temporal, subcortical structures of the brain.Korsakova concludes that in Alzheimer’s disease and other forms of senile dementia, severe mental disorders of old age, specific cognitive impairments are observed. This means that this pathological process, not neoplastic, but atrophic, spreads in each individual case with a different disease to certain areas of the brain. This is how the science of neurogerontopsychology was born. Scientists wondered what happens in old age normally. Having studied more than 300 healthy people from 50 to 100 years old who have never consulted doctors for mental health and neurological problems, Korsakova singles out various neurocognitive styles, a typology of normal aging.It shows how we and our psyche are aging in connection with the work of the brain. These data are indirectly confirmed by Western studies using neuroimaging, functional tomography, positron emission tomography, and so on.

What is aging phenomenologically?

First, of course, there is a slowdown in the pace of activity. Latency grows, people in the third age start to work slower. This slowness becomes especially evident at the initial stage of activity.It becomes especially difficult to quickly extract information, to connect it. You need to be able to negotiate with your memory after 55 years, so that it gives out what you need.

Secondly, a person begins to work as a one-channel system. If he reads a newspaper, then the TV no longer hears and does not think about things unrelated to this newspaper.

As for the speech sphere, an elderly person needs to speak not only slowly, but also in a low voice. Not necessarily loudly, although age-related hearing loss can also occur, but a velvety baritone or even bass will be learned better than tenor and falsetto.This is a scientifically proven sensory thing.

Fourth, tempo characteristics. Speech information can be absorbed more slowly than non-speech information. There is a certain imbalance, stealing from the right hemisphere in favor of the left. The left hemisphere begins to work more intensely due to the fact that it may lose some right hemisphere functions. But nevertheless, not always and rather fragmentarily, therefore, for example, music is absorbed well, and listening to songs of youth actualizes the deep layers of memories.

The tactile sphere literally comes to life, that is why people love to sort out things, wipe the dust, so it is better for the elderly to give textured gifts, textured ones – this also actualizes the thresholds of memory layers.

About memory. Access to direct memories of what happened now is becoming more closed. Access to early memories of youth, adolescence and even childhood is opened. They become brighter and more distinct. Traces of memory are not erased: we remember everything, it is just that we do not always have access to this.

And finally, this is a decrease in the ability to learn new things and difficulty in setting creative tasks. Not because the person becomes feeble-minded, but because there is not enough energy to support the creative process, which, as you know from all the metaphors, should gush.

Normal aging types

This typology is based on the concept of Alexander Romanovich Luria about the structures of the functional blocks of the brain. On the basis of his numerous studies, he divided the brain into three blocks, not according to morphological structure, but according to the roles that the structures of the brain play for the realization of higher mental functions.

Energetic neurocognitive aging style

The most common, universal. It is associated with a decrease in the functions of the energy supply of mental activity: people become slower, they have the phenomenon of “on-off” – “on-off”. That is, a person begins to read a book, it’s difficult, it’s gone, closes it, goes to the kitchen and helps his wife cook borsch, that is, it is activated. These fluctuations can be observed rather mildly, they should not disrupt adaptation.With vascular lesions of the brain, this effect can disrupt it. That is, a person may not be able to cope with the task in the “off” state, and in the “on” state, he may become too agitated. He cries, then laughs. There are such clinical examples.

In addition, this is a narrowing of the volume of activity, a single-channel system of perception, inhibition of memory traces and fatigue – nonspecific characteristics of aging, not risk factors. Most importantly, the cerebral cortex is working well.That is, a person can come up with himself, learn from past experience, plan, for example, that it will take him so long to get to the clinic, and to visit his grandchildren, such operations are needed; he can plan the day in a specific way. The inhibition, the inaccessibility of the memories that are needed right now, means that you need to write down, and the person understands all this. The risk factor that can lead a person to maladjustment is, of course, stress. Since the subcortical structures are emotions, stress resistance, there are not enough ways to regulate your emotions.That is, emotional problems can come up here.

This is also an aggravation of bodily ailments. The most malignant one that really unsettles a person and introduces him into a state of maladjustment, anxiety, depression is the hip neck. Such a person needs special attention; possibly professional psychological support. I’m not talking about cataracts and other purely age-related things – they, of course, also require special attention.

Spatial neurocognitive aging style

The second type is a decrease in the ability to orientate in real and internal space.Already a specific type of aging, in which it becomes very difficult to perceive different things holistically. Reading even a short story and understanding what the point is can already be a problem. You must first read one paragraph, comprehend it, remember it, take a break, then the second, and so on. Technically, you can read the story, the person will not be exhausted, but he will not understand it. And the most important thing is “disadaptation” in the new space. Please note this is not a spelling error. That is, the person is not completely lost, but it is difficult for him in the new space, he begins to grab his right hand, thinking: “Right hand means I need to go to the right.”They have a marker that is really programmed: “I write with my right hand,” which means you need to orient yourself to the right. They can wander for a very long time, but not in the sense that they are really lost, but because they have such difficulties in the new space. In the old familiar space, everything can be quite safe.

That is, the risk factors here are a change in the habitat, for example, emigration. Our colleagues, Russian psychologists abroad, at one time published articles in magazines dedicated to Russian emigrants in France and the USA.They describe these phenomena on a very large scale, also in connection with the linguistic side. For example, the phenomenon of “pathological nostalgia”: an emigrant woman believed that she was in her Moscow apartment, saw people from that life. These were not hallucinations due to mental illness, but a temporary condition, stress, culture shock. It is associated with the right hemisphere.

The important thing to understand here is that these kinds of things can be very similar to Alzheimer’s, but they need to be distinguished. Here are the statistics.Schizophrenia – 1%, but 10% is Alzheimer’s disease, where 4% is early Alzheimer’s. In our clinic, these are all women of 40 years old. I remember the last case: 40 years old, a nurse and really serious symptoms associated with deep memory impairment. If you want to understand what it is, watch the striking Still Alice movie about early Alzheimer’s. What is happening with a person is shown with maximum reliability, with deep psychologism, insight into the essence of this painful state.After 55-60 years – this is already a classic Alzheimer, and the late one is called senile (lat. “Senile”). Scientists say it’s genetically programmed. Unfortunately, there is no way to identify a person’s risk of developing this disease before the disease occurs. The genetic constellation leads to an imbalance of acetylcholine and other neuropeptides, which leads to the formation of Alzheimer’s cells, that is, atrophy of nerve cells in certain regions, which leads to the fact that these cells do not work and the brain does not function well.

There is no cure for Alzheimer’s disease: all drugs that are prescribed are symptomatic and do not greatly improve the state of mental functions. And even more so, unfortunately, they do not prevent further malignant development (after the onset of the disease, a person lives no more than 10 years). This is gross exhaustion, that is, a person cannot work actively for 45 minutes, gross memory impairments, inability to remember material, disorientation in space, confusion, that is, a person may not understand where he is, on the street or at home.You could once observe on the street a grandfather in slippers with an absolutely confused expression on his face, who sometimes screams, tries to call for help. Of course, this is not yet a reason to diagnose him with Alzheimer’s disease, but this is a pathological condition that very often accompanies it. Spatial disturbances come to the fore, that is, people cannot remember where the toilet is, where the kitchen is. But it is worth noting that their personality facade is preserved, they experience this state, they are critical of it.Probably, the whole tragedy lies in the fact that they understand that they are losing what constitutes their personality. Because, according to one of the founders of Russian psychology, Sergei Leonidovich Rubinstein, one of the central functions of memory is the structuring of the personality. If memory disintegrates, all our experience disintegrates, the experience of communication with our personality, that is, the personality leaves.

Regulatory neurocognitive aging style

This is not a pathology yet, but already a really risky option, when the anterior cerebral hemispheres are aging in the first place.This is where self-control decreases. This is the most central symptom because the frontal lobes are involved. Luria calls the third functional block of the brain a block of programming, regulation and control of mental activity, therefore, regulation and control suffer here first of all. When they weaken a little, this is still the norm – what we in everyday life call “gray hair in a beard, a demon in a rib”: a person is more than 60, and he believes that he, as a young man, can do his job, behave like a young man, dress in torn jeans, walk with a player, say: “I’m listening to Dima Bilan, I won’t listen to Shulzhenko and Utesov, I’m not that old yet.”There may be a sexualization of behavior.

In activity there may be problems with making plans, getting stuck at some points, inflexibility. Apathy, impairment and decreased motivation, which still needs to be maintained. Including motivation to pass on the semantic value experience to other generations: “Well, that I’m going to call my grandson, he doesn’t need me. That I will get him. ” Experiencing failure, loneliness, changing living conditions can all be a risk factor. Emotional, brutal reactions may follow.Against the background of stress, an elderly person may think: “What is it, my son came, he stole my passport. I can’t find my passport because he came, he wants to do something with me. ” That is, delusional ideas arise, but against the background of some kind of stress.

An extreme case, the pathological prototype here is Pick’s disease – also such a classic disease, a pole of Alzheimer’s disease. If the facade of the personality is preserved there, and the person is aware of and suffers from growing cognitive impairments, then with Pick’s disease (or, as it is now customary to say according to the new-fashioned psychiatric classification, with frontotemporal dementia), the anterior parts of the cerebral cortex are dysfunctional.Such patients are emotionally dull, passive, indifferent, inactive, lying down, doing nothing. They are poor in motor skills, writing, reading, counting and are not critical of what is happening, but they have euphoria, they are complacent, they can laugh. At the same time, they are absolutely inactive, empty, moral and ethical attitudes are lost. There may be stereotypes, perseverations, that is, obsessive actions, and gross cognitive impairments, that is, violations of speech, grammatical structure, impoverishment of speech production, unwillingness to speak, build a detailed statement, and so on.First of all, and at the beginning, this emotional-personal dysfunction appears, at a later stage, some kind of cognitive impairment is added. This is already maladjustment.

What prevents pathological aging?

People who have been engaged in intellectual work throughout their lives have less dementia at a later age. Gymnastics technologies for the brain have been developed separately, that is, if there are already any limitations in the cognitive sphere, then you can turn to psychologists who will develop an individual training program.Of course, I know old people who study poetry themselves. It’s like a separate activity: we got up, had breakfast, walked the dog, then a couple of hours to learn a new poem, called a friend in the Moscow region, read it by heart, played chess on the phone, which is also good, you can see how e2-e4 relate, then you can eat again, then take a walk with the dog again. That is, this is a planned activity, where there is a cognitive and intellectual component to maintain tone. The tone is maintained in this way – through intellectual activity.

In people who constantly maintained physical activity, the risk of dementia in later age is reduced due to the fact that the metabolism works better, which means that atherosclerotic plaques are not formed, sugar is normalized, and so on. That is, things related purely to the vessels no longer make a pathological contribution.

Mode. It has been shown that people who consume alcohol are more likely to develop dementia at a later age. The so-called Mediterranean diet is useful: proteins, seafood, phosphorus, fresh vegetables.Those who have a clear sleep and wakefulness schedule get sick less.

And then – pure psychology. People who have experienced trauma and with these traumas did not go to a specialist, did not get rid of them, suffer more often. People who experienced a lot, but mini-stress, that is, who had vigorous activity, who lived in constant stress, are less sick with Alzheimer’s disease and other dementia.

Reflexive people (who reflect on their inherent neurocognitive style) can use this.As in the example with borscht. If he has a spatial option, but he remembers well what ingredients need to be put. And she has the first option, she does not remember this, but her frontal lobes are preserved, that is, she remembers the procedure: first you need to pass it, then lay it out, and so on. And so they cook borscht together, because they understand that it is impossible to cook it together. That is, they really bring freshness to their relationship, because they go to the next level. They are developing joint activities that did not exist.

And finally, the possibility of implementing development tasks. Of course, you perfectly understand: those old people who have grandchildren are happy. Loneliness gives rise to all these forms of maladjustment. Even if we are faced with a lonely representative of the third age, but he has all this (that is, he was intellectually active, he reflects on what is happening to him), then he will be able to find compensation strategies through purely social things like clubs or social programs.

90,000 Help the right way: what a volunteer needs to know about the characteristics of elderly people

Source: Evening Moscow

General self-isolation has been declared in Moscow.Everyone should stay at home, but the coronavirus is especially dangerous for people over 65. The elderly, many of whom are lonely, find it difficult to adapt to new conditions. Social workers and volunteers help them cope with this situation. What the volunteers need to know about the peculiarities of the elderly, Bayrta Ochirova, a social work specialist at the Kutuzovsky family center, told Vechernyaya Moskva.

A characteristic relationship to time and events

People in old age often exaggerate the significance of this or that event.For example, a telephone conversation or a trip to the store seems to be commonplace for us, but not for a 65+ person. For him, this can be the plan of the whole day. Your sudden arrival can be a source of stress, so it is important to agree in advance about the day and time of the visit or the phone call. This will give them time to prepare and tune in.

Need to speak out

A peculiarity of the psychology of the elderly is the desire to return to the time when they were young and energetic.As a rule, in conversation they indulge in memories and get hung up on one topic. It is difficult for them to switch to another until they speak out. The volunteer is advised to listen to the elderly person and then smoothly change the direction of the conversation.

Anxious feelings

Deterioration of health and the inability to independently perform some actions most often cause in the elderly a feeling of inferiority and the feeling that they are superfluous, a burden. The task of the volunteer is to help them avoid stressful situations, to try to increase their self-esteem.Talk to an older person calmly, in any case do not remind of his age. Moreover, try to praise any achievements. This will make him feel confident and able to do something useful, even if you think it is insignificant.

Aggression

No need to argue and prove your case – another recommendation in working with the elderly. This behavior can provoke aggression in your ward. If this does happen, rest assured.Do not try to resolve a conflict when the older person is angry. You should wait for the aggression to subside.

Sensitivity

People at this age can be not only aggressive, but also overly touchy.