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Why do old people talk nonsense and say something inexplicable when they are old?
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The so-called Alzheimer's Harmo's disease, also known as Alzheimer's Harmo's disease (AD), is a kind of primary degenerative encephalopathy that occurs in old age and pre-old age. It refers to a persistent disorder of higher nervous function, that is, unconscious disorder of memory, thinking, analysis and judgment, visual space recognition, emotion and so on. Its characteristic pathological change is cerebral cortex atrophy, accompanied by β -amyloid protein (β-AP) deposition, neurofibrillary tangles (NFT), a large number of memory neurons decrease and senile plaque (SP) formation. At present, there is no specific medicine to treat or reverse the progress of the disease.
With the development of modern medicine, more and more elderly people become young and full of vitality. But please don't forget: in the near future, China will enter an aging society. At the same time, it is accompanied by a problem that cannot be ignored-the incidence of Alzheimer's Harmo's disease is increasing year by year.
The survey found that the average age of Alzheimer's disease in northern China was 75 and 76 years old, and the age of vascular dementia was about 68 years old. The rate of severe Alzheimer's disease in people over 65 years old is above 5%, and by the age of 80, the rate rises to 15-20%.
The ability of daily living of Alzheimer's patients is declining. They don't know their spouses and children, and they can't take care of themselves by dressing, eating and urinating. Some will also have auditory hallucinations, which will bring endless pain and trouble to themselves and the people around them. The average survival time of patients with Alzheimer's disease is 5.5 years. After cardiovascular and cerebrovascular diseases and cancer, Alzheimer's Harmo's disease has become the "fourth killer" of the health of the elderly.
Dementia is no longer a "patent" for the elderly, and the number of dementia patients in their forties and fifties is increasing year by year. Not only the elderly, the 50-year-old daughter accompanied her 80-year-old mother to see a doctor, and both of them were diagnosed with Alzheimer's disease; The forgetfulness of this 47-year-old woman is also caused by Alzheimer's disease ... All these indicate that the era of suffering from Alzheimer's disease has come ahead of time. With the gradual rejuvenation of Alzheimer's disease, vascular factors play an increasingly prominent role in the pathogenesis.
In fact, symptoms and reactions of Alzheimer's disease began in middle age. If it is not found and treated early, it will be incurable if it develops seriously. Dementia is no longer a "patent" for the elderly. Experts say that early dementia can be cured, but it can't be treated until the age of 60 or 70.
The first symptom begins with amnesia.
Although the cause of the most common Alzheimer's disease has not been found, all dementia has symptoms, and the initial symptom is amnesia. Middle-aged people, see if you have been particularly forgetful recently. It is normal to forget it only occasionally, but remember it slowly afterwards. But if you often forget things, some things are deliberately forgotten, and you can't remember them afterwards, which may even affect your work and life. You'd better go to the hospital for a checkup.
Suffering from amnesia, there are some obvious signs. Might as well do the following self-test for yourself. Once you feel wrong, don't be careless, or be afraid of others' jokes. Early symptoms can be cured. Don't wait for the diagnosis.
Three stages of Alzheimer's disease
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Generally speaking, Alzheimer's disease often occurs after the age of 50, and its onset is hidden and its development is slow. In the earliest days, it often began with increasing forgetfulness. If you don't pay attention, it is usually not easy to find. According to the development of the disease, it can be roughly divided into three stages:
The first stage is also called forgetting period.
The performance of this issue is obvious amnesia, such as forgetting what you said, what you did or important appointments, and slowly forgetting distant things. At the same time, thinking analysis, judgment ability, visual space discrimination function, calculation ability, etc. Also reduced, but sometimes they can keep their familiar jobs or skills.
The second stage is also called chaos.
At this time, in addition to the aggravation of symptoms in the first stage, the outstanding performance is that the visual space recognition obstacle is obviously aggravated and it is easy to get lost.
It is also difficult to dress, or wear pants as clothes; I don't know the faces of friends or relatives, I can't remember their names, and I can't talk to others, although I sometimes talk to myself.
The third stage is also called extreme dementia stage.
The patients are in a state of complete decline, and they can't take care of themselves. If they need someone to take care of them when they eat, dress and bathe, they will be incontinent.
Ten Warning Signs of Alzheimer's Disease
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First, memory loss affects daily activities.
Second, it is difficult to deal with familiar things.
Third, people are more and more confused about time, place and people.
Fourth, judgment is declining.
Five, often put things in the wrong place.
Six, abstract ideas began to appear problems.
Seven. Emotional instability, abnormal behavior.
Eight, personality changes
Nine, lose the initiative to do things
10. Ability to understand things and difficulties in language expression.
Prevention of Alzheimer's disease
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Due to the different causes of dementia, the prevention methods are also different, mainly in the following aspects:
1, improve the working environment.
2, avoid alcohol and quit smoking.
3. Diet regulation: To prevent high-fat foods from raising cholesterol, it is very important for the elderly to take in necessary nutrients, such as protein, inorganic salts, amino acids and various vitamins, especially vitamins B 1, B2 and B6, vitamin C and vitamin E.
4. Cheerfulness is conducive to longevity and mental health.
5. Arrange your life and study well: In your later years, you should persist in learning new knowledge and maintain extensive contact with society.
Before retiring, we should make all preparations ideologically and materially. Rich life content and extensive hobbies can promote mental activity and delay or alleviate the aging process.
7, regular physical examination, early treatment of physical diseases, not only pay attention to your body, but also do not pay too much attention or worry.
8. Regular outdoor activities: The elderly are suitable for more sustained competitive sports, such as walking, jogging, gymnastics, Tai Ji Chuan, Tai Ji Chuan and traditional dancing.
The treatment of AD is mainly the application of acetylcholinesterase (AchE), anti-inflammatory drugs, antioxidants and other symptomatic drugs to temporarily alleviate the cognitive decline of patients.
Principles and methods of preventing and treating Alzheimer's disease with traditional Chinese medicine
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According to the experiment of China Institute of Medicine of China Medical University, Gastrodia elata can improve learning and memory impairment, not only for health care, but also for preventing or treating Alzheimer's disease.
The study on the effect of gastrodia elata in Yuanlin Traditional Chinese Medicine Building on memory impairment found that gastrodia elata, the main active component of gastrodia elata, can increase the secretion of adrenal hormones, improve the utilization rate of blood sugar in the body, and then activate brain function. Lou Zhongliang pointed out that in addition to overcoming the memory disorder, in the treatment of Alzheimer's disease, the Chinese medical code has confirmed that Gastrodia elata can treat "speaking in a trance, being in shock, and being unconscious", which refers to the symptoms of the elderly speaking upside down. Through animal experiments, it is also found that Gastrodia elata is better than the prescriptions currently used in western medicine, and the hepatotoxicity of western medicine is greater, with side effects such as headache and gastrointestinal discomfort.
In terms of purchasing, he also pointed out that there are often unscrupulous medicine vendors replacing gastrodia elata with fake and shoddy products in the market. Consumers should choose a variety with solid and heavy texture, Ying Ge mouth, fine longitudinal wrinkles and bright cross section, which is the main obvious feature of Gastrodia elata.
Gastrodia elata prescription for treating senile dementia
Formula: take gastrodia elata 10g, pig brain 1g and japonica rice 250g.
Preparation method:
1, cut gastrodia elata into pieces.
2, glutinous rice washed clean, and gastrodia elata powder and pig brain into the pot at the same time, add water to cook porridge, with brain cooked as the degree.
How to eat: Take/kloc-0 every morning for 2-7 days. You can take it often.
Tianma recipe for treating apoplexy sequelae
Formula: gastrodia elata 10g, scorpion 3g.
Preparation method: * * Grind into fine powder and mix evenly.
How to eat: 2 grams each time, with hot wine. 1~ twice a day. 30 days is 1 course of treatment, and you can take it for two courses continuously.
Alzheimer's Harmo's disease is not only caused by physiological reasons, in fact, the lifestyle and loneliness of the elderly are also important reasons for Alzheimer's Harmo's disease. Giving the elderly a healthy living environment and a good attitude towards life is the best way to prevent Alzheimer's disease. I hope everyone can spend more time with their elderly parents and don't let them feel lonely.
Diagnosis and differential diagnosis of Alzheimer's disease
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Alzheimer's disease refers to a group of acquired syndromes in which conscious patients suffer from persistent and comprehensive advanced neurological dysfunction due to various diseases, including memory, the ability to solve daily life problems, acquired skills, correct social skills and the ability to control emotions, which eventually leads to the decline of mental function. In the definition of dementia, the following concepts need to be clarified: 1. Dementia occurs in patients with clear consciousness, which is different from various conscious disorders; 2. Various physical diseases are the causes, which are different from pseudodementia caused by simple mental disorders; 3. Dementia lasts for at least 6 months, usually progressive, not transient or paroxysmal; 4. Dementia is a comprehensive disorder of higher nervous function, not a local dysfunction of the brain; 5. Dementia is acquired, which is different from congenital mental retardation; Dementia is a syndrome, which can be caused by different reasons, not just a special disease.
First, determine whether you have dementia.
1. Diagnostic criteria of dementia (DSM, Class I, R)
(1) There is evidence that there are short-term and long-term memory disorders.
(2) Meet at least one of the following conditions:
① abstract thinking disorder;
② Judgment obstacle;
(3) Other cortical higher functional impairments, such as aphasia, apraxia, agnosia, etc. ;
4 personality changes.
(3) The first and second types of obstacles affect work, daily social activities and interpersonal relationships;
(4) It doesn't just happen in delirium;
(5) Any of the following situations:
① Specific organic factors;
② It can't be explained by any non-organic mental illness.
. 2. Collect medical history in detail and compare it with previous intelligence and behavior.
3. Neuropsychological test
For a patient with suspected dementia, it is necessary to first evaluate whether there is cognitive impairment, what functions the impairment involves and the severity of the impairment, which requires neuropsychological testing. Including attention and concentration, sense of orientation, memory, calculation, language, abstract thinking, spatial perception, structural ability, application, cognitive flexibility and speed. In addition, there are changes in social adaptability, interpersonal relationship and life ability and personality, which is called behavior evaluation. Psychological test is an objective and standard measurement of the behavior samples shown by these psychological phenomena. It quantifies psychological phenomena, adopts a set of strictly designed questions or assignments (that is, standard procedures) to be answered or completed by the subjects, and then evaluates the answers. Its advantage is that data collection and interpretation are standard, which makes it possible to improve the accuracy of diagnosis. At the same time, it can learn from different sources, which is an essential tool to judge dementia. However, each test scale is not perfect and all-inclusive, which requires a variety of scale tests and comprehensive analysis and judgment combined with clinical findings.
Commonly used scales include the following:
(1) Short-term Mental Memory Scale (MMSE): the total score is 30. Illiteracy score X 17, primary school education level decreased by 20 points, middle school education level cluster by 24 points, which belongs to cognitive impairment.
(2) Hasegawa Simple Intelligent Measuring Table (HDS): the total score is 32.5. Illiteracy-15, primary school level, 19, middle school or above 23 is cognitive impairment.
(3) CCSE: The total score is 30, and 20 is cognitive impairment.
(4) Common sense-memory-attention test (1MCT): the total score is 36 points. Illiteracy-
(5) ADL: the total score of 20 is normal, and the total score is >; Extra points mean that there are different degrees of functional decline, loss of more than two functions or total score >; 26 people think that the ability of daily living is insufficient.
(6) Social Function Activity Survey (FAQ): The total score range is 0-20, the ability of this activity decreased 1, and the ability loss was 2. Losing two or more activities means social dysfunction. If the total score is calculated, more than 5 points is a social function defect.
(7) Hamilton Depression Scale (HRSD): the most commonly used scale to judge depression in clinic. Most projects are graded according to five grades, and a few projects are graded according to three grades. According to the comprehensive evaluation after mental state examination and clinical observation, the total score above 35 may be severe depression, above 20 may be mild or moderate depression, and below 8 may be no depression.
(8) Gross Aging Scale (GDS): To evaluate the severity of dementia, * * * is divided into seven grades, each with a detailed descriptive definition.
(9) Clinical Dementia Rating Scale (CDR): To evaluate the severity of dementia, only when the damage is due to cognitive impairment, it is recorded as CDR 0.5 (suspected dementia), CDR 1.0 (mild dementia), CDR 2.0 (moderate dementia) and CDR 3.0 (severe dementia).
(10) Huggins Ischemia Score (HIS): used to distinguish vascular dementia from non-vascular dementia, with a total score of 18. Seven is vascular dementia, and four is non-vascular dementia, mainly AD.
Rule out diseases that look like dementia
In the early stage of the disease, special attention should be paid to the differentiation from pseudodementia. Pseudodementia refers to patients with depression, and some people use it as a broad term, including all patients with obvious cognitive impairment secondary to mental illness, which is called pseudodementia.
(1) Symptomatic pseudodementia (Ganser syndrome): Usually, the onset is sudden, and the patient can understand the questions raised, but gives an extremely embarrassing answer, giving people the impression of deliberately joking, and may also have functional neurological symptoms, which are more common in strong mental trauma or stress and are suggestive.
(2) Childhood dementia: full of childlike innocence, imitating the tone of children's speech, claiming to be only 5 years old, calling everyone "uncle" and "aunt" is seen in addiction.
(3) Depression: It is difficult to distinguish pseudodementia from early dementia, especially when dementia is accompanied by depression. The basic symptoms are decreased working ability, decreased interest, indifference to others, depression, regret, despair and other emotions. But listening carefully to the patient's conversation, we can find that the patient remembers the details of the disease clearly, and the examination process can show good memory, attention and calculation ability in a short time through encouragement. Depression is characterized by rapid onset, small progress in the course of disease and obvious pre-illness incentives. It can be determined by the Hamilton Depression Scale (HRSD) test.
(4) Delirium: The elderly are often injured by physical diseases, and delirium occurs after surgery. The disorder of memory and orientation seems to be dementia, but delirium suddenly appears, and the symptoms at night are serious, and the response to environmental stimuli or hallucinations is rapid and strong, which is different from the indifference and dullness of dementia.
(5) Benign senile amnesia or physiological brain aging: it is a physiological aging process, not progressive. Have the ability of self-evaluation of memory loss and forgetting, be able to fulfill the obligations and responsibilities of family members who live together, maintain professional work ability, maintain the original characteristics without outstanding changes in personality, maintain the integrity of mental activities, adhere to ethical concepts, and seek perfection of themselves and the environment.
(6) Aphasia: Patients with aphasia may show incoherent speech, anxiety and depression, but after examination, patients have no abnormal behavior and judgment except language dysfunction, and most of them are accompanied by focal neurological signs.
Step 5 Determine the extent of dementia
Dementia can be divided into mild, moderate and severe. It can be determined according to the General Aging Scale (GDS), Clinical Dementia Rating Scale (CDR) and the diagnostic criteria of the World Health Organization International Classification of Diseases (ICD- 10).
Second, identify the diseases that cause dementia.
1. Dementia is a group of syndromes. The common diseases that cause dementia are as follows:
(1) Nervous system diseases with dementia as the main symptom.
① Alzheimer's disease.
② Diffuse I-ewy body disease or Izwy body dementia.
3 Pick's disease (brain lobe atrophy).
(2) Dementia is a part of other nervous system diseases.
① Cerebrovascular diseases: multiple cerebral infarction, subcortical arteriosclerosis encephalopathy (Binswanger's disease), amyloid cerebrovascular disease, collagen cerebrovascular disease, subarachnoid hemorrhage, cerebral hemorrhage, etc.
② Infectious diseases of the brain: encephalitis, meningitis, brain abscess, brain parasitic diseases, paralytic dementia, progressive multifocal leukoencephalopathy, acute sclerosing panencephalitis, CJD disease (cortical-basal ganglia-spinal degeneration), AIDS dementia syndrome (AIDS subacute encephalitis), etc.
③ Extrapyramidal diseases: Parkinson's disease, Huntington's disease, etc.
④ Hereditary diseases of nervous system: hepatolenticular degeneration, olivopoccipital atrophy (OPCA), hereditary spastic paraplegia, Freiedreich*** ataxia, myoclonic epilepsy (Unverricht -Lundborg disease), tuberous sclerosis, Hallervorden-Spatz disease, metachromatic leukodystrophy, globoidal leukodystrophy, adrenal gland.
Pick's disease, familial amaurotic dementia syndrome, mucopolysaccharide storage disease, etc.
⑤ Neurodegenerative diseases: progressive supranuclear paralysis (PSP), thalamic degeneration, etc.
⑥ Hydrocephalus: Communicative hydrocephalus (normal intracranial pressure hydrocephalus) and obstructive hydrocephalus.
⑦ Brain tumors: tumors common in frontal lobe, glume lobe, omphalocele and the third ventricle.
8 hypoxic encephalopathy: brain hypoxia caused by various reasons. Pet-name ruby brain injury: brain contusion, chronic subdural hematoma, boxing, home beating dementia, etc.
Indications for demyelinating diseases: multiple sclerosis, disseminated encephalomyelitis, etc.
(8) Nutritional diseases: hemorrhagic poliomyelitis, vitamin 13 12 deficiency, omphalocele demyelinating disease (Marchiafava Bigami disease), etc.
(3) Dementia is a part of systemic diseases.
Endocrine system diseases: hypothyroidism, adrenocortical hypofunction, hypoparathyroidism, etc.
② Metabolic diseases: hypoglycemia, hypercalcemia or hypocalcemia, hypernatremia or hyponatremia, etc.
③ Digestive system diseases: hepatic encephalopathy, malabsorption syndrome, etc.
④ Urinary system diseases: uremia, progressive dialysis encephalopathy, etc.
⑤ Respiratory diseases: pulmonary encephalopathy, etc.
Connective tissue diseases: disseminated lupus erythematosus, Behcet's disease, etc.
⑦ Hematological diseases: leukemia, etc.
8 circulatory system diseases: heart failure after cardiac arrest and resuscitation.
Pet-name ruby all kinds of malignant tumors: brain and meningeal metastases and non-metastatic cancerous encephalopathy.
2. Determine the cause of dementia
(1) Determine whether dementia is part of a systemic disease.
(1) Detailed medical history, past history, comprehensive physical examination and routine laboratory examination.
(2) According to the results obtained in (1), put forward targeted further inspection items to be determined or excluded.
(2) Determine whether dementia is a part of nervous system diseases.
① Ask about medical history and past history in detail, and conduct comprehensive mental state, nervous system physical examination and routine laboratory examination.
(2) According to the results obtained in (1), it is planned to further examine the nervous system diseases to be determined or excluded, and the following examination items can be selected:
Dynamic observation of EEG, evoked potential, hundreds of t CD, brain MRI, SPECT, PET, special biochemical tests such as tau protein in cerebrospinal fluid and serum, brain and peripheral nerve biopsy, as well as pathological, immunohistochemical and molecular biological tests.
3. The main points of etiological diagnosis of common dementia
(1) Alzheimer's disease
Diagnostic criteria of Alzheimer's disease in Lonicds-ADHD: possible Alzheimer's disease, possible Alzheimer's disease and definite Alzheimer's disease. .
② The following points are helpful for the clinical diagnosis of AD: the neuropsychological test confirmed dementia; Slowly onset, gradually aggravating, no history of stroke; The neuropsychological disorder is serious, and the neurological function defect is light; Head CT and MRI showed diffuse brain atrophy without focal lesions; Huggins scored less than 4 points; SPECT showed that the blood flow in bilateral glume, parietal lobe and occipital lobe decreased symmetrically. The final diagnosis also needs pathological examination.
(2) vascular dementia
① Judgment of dementia; There must be evidence of cerebrovascular disease (medical history, signs, imaging evidence); Dementia and cerebrovascular disease are definitely related.
② The following points are helpful for the clinical diagnosis of vascular dementia: having a history of dementia-related stroke; Symptoms and signs of neurological deficit; Brain CT and MRI showed the damage of cerebrovascular diseases; Chacinski score > 7 points; SPECT showed a focal cerebral blood flow decrease.
(3) Mixed dementia
Mixed dementia is vascular dementia and AD. Whether these two diseases exist at the same time is undoubtedly difficult to determine. The following points are helpful for its clinical diagnosis: (1) there are clinical characteristics of VD and AD in the course of dementia; Brain CT and MRI have focal cerebrovascular injury, which can cause dementia, moderate and severe leukoaraiosis with diffuse brain atrophy. The final diagnosis requires pathological examination.
The pathogen of dementia
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A few days ago, scientists discovered the cause of Alzheimer's disease. The cause of Alzheimer's disease is that a certain protein in brain cells is cut off by an enzyme and a toxic substance is accumulated.
The enzyme that causes Alzheimer's Harmo's disease was called "β-secretase" more than ten years ago, but it was not until a few days ago that scientists confirmed the enzyme that causes Alzheimer's Harmo's disease. It is predicted that the onset of Alzheimer's Harmo's disease can be prevented or delayed by developing drugs that can hinder its function in the future.
How to care for Alzheimer's patients
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Some patients with Alzheimer's disease are at home, while others receive treatment and care in hospitals and welfare homes for the elderly. So how can nursing be scientific?
First of all, we should prevent the elderly from bedridden. For patients with Alzheimer's disease, family members are often easily overprotected, which is the biggest cause of bedridden patients. Once the patient is bedridden, there will be many complications, which will aggravate the symptoms of dementia and shorten the life span. Therefore, patients with early dementia should be allowed to do what they can under the care and guidance of their families. In addition, family members should also understand the patient's psychological state, never alienate the patient, and help the patient eliminate psychological and behavioral obstacles and help the patient recover his memory. This is a very important link for the prevention and treatment of early patients.
Pay attention to diet and nutrition. Alzheimer's patients generally have different degrees of eating disorders and swallowing disorders. Moreover, the elderly's own renal function, digestive and absorption functions are low, basal metabolism and physical activity are reduced, which is easy to hinder the body's utilization and absorption of nutrients, leading to malnutrition and even anemia. Therefore, we should consider the balance of quantity and quality in the diet of dementia patients, choose foods that are easy to digest and swallow, and don't have to limit the intake of protein and fat. Poor nutrition will further promote the development of diseases.
Maintain daily hygiene habits. For patients with early dementia, we should try our best to help them maintain their daily habits and hygiene habits. Living, dressing, brushing your teeth, washing your face, etc. Even if it is not standardized, try to let him do it. Because this is also a link that cannot be ignored to prevent the further development of the disease. For bedridden patients, care should be given, oral cavity should be cleaned regularly, and people should take a bath and wash their hair, and change clothes frequently. Dementia patients often have urinary incontinence, and once urinary incontinence occurs, the condition has reached a quite serious period. However, defecation should be handled and cleaned in time to keep the skin clean and dry to prevent infection.
Prevent infection. The incidence of pneumonia in dementia patients is very high, and the mortality rate is also very high. According to foreign survey data, more than 90% of the deaths of dementia patients are due to pneumonia. Once complicated, the course of disease progresses rapidly, especially for patients in bed, whose body functions decline in all aspects, such as respiratory system function decline, body infection defense ability decline, as well as consciousness disorder, malnutrition, incontinence, bedsore, etc., which are prone to pneumonia. Therefore, the above situation should be avoided as far as possible, and once complicated with infection, it should be treated in time.
Prevent bedsores. The so-called bedsore refers to the necrosis of skin and subcutaneous tissue caused by local circulation disorder. To prevent the occurrence of bedsore, we should first manage the bedridden patients systematically and locally. System management includes treating primary disease, improving general condition, keeping water and electrolyte balance in the body and preventing infection. Local management: Bedridden patients change their body position every 2-3 hours, pay attention to observe the skin and keep it clean. It is best to wash with warm water, not alcohol or disinfectant. You can use local cotton pads, pillows, foam pads, etc. to rest in hip, rib and other prone parts.
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