an article of Carlos Martin LawrenceGeriatrician
Medical Director of the
He cognitive decline consists of the alteration of the most genuinely human higher mental functions, the progression of which leads to the syndrome of dementia. The most common type of dementia is degenerative, especially Alzheimer disease, followed by vascular and mixed dementia. Median survival is currently estimated at 8-12 years.
The dementia It is a disease whose prevalence increases with age, of a chronic and disabling nature, ultimately fatal, with a complex course, great inter-individual variability and a large number of complications throughout its evolution. Has a important family repercussionespecially on the main caregiver, and social due to the significant consumption of specific socio-sanitary resources for their care.
Dementia can be defined as the loss of intellectual faculties (cognitive impairment) of sufficient intensity to determine a social maladjustment in relation to the patient’s previous functioning. It is an acquired global syndrome, persistent over time and presenting with a normal level of consciousness. The dementia syndrome develops fundamentally in three spheres: cognitive, behavioral and physical.
- In the cognitive spherethe earliest symptom is usually memory impairment, especially recent and short-term memory, with relative preservation of long-term memory. Added to this is the inability to learn new data, which is why they have a reluctance to face unknown situations.
- The disorientation initially it is temporary, to later become spatial, with a serious risk of loss; in the last phases of the disease, the orientation regarding the person himself is lost.
- The aphasia Dementia itself manifests itself as a progressive inability to understand and make oneself understood, with an impoverishment of language consistent with the progression of the disease.
- The apraxia It manifests as a difficulty in carrying out movements in a fine and coordinated manner, even though the ability to carry out the movement is intact; As an example, in the initial phase we have impaired writing and at the end of the disease motor akinesia is appreciated.
- The agnosia It supposes the loss of the ability to recognize common objects and familiar people, despite the fact that the sense organs are intact.
- The difficulty with intellectual functioning It is also manifested as the loss of calculation capacity, abstract thought, critical judgment and planning capacity.
All these symptoms can be classified into different degrees depending on the patient’s ability to live independently at home (mild), if they require some supervision (moderate) or if they require continuous supervision (severe).
The study candidates of cognitive deterioration would be those people who complain of memory alterations, older people in whom there are incompetence problems, anxious or depressed people with cognitive complaints and, in general, all those people in whom their family or caregiver suspects cognitive deterioration , although they do not complain. People with obvious changes in the cognitive sphere, older people with psychiatric problems, or families with a high risk of suffering from dementia should be followed up at a scheduled consultation every 6 months.
Once we have a clinical suspicion of the existence of cognitive impairment, the study objectives They would be to verify the progression to dementia, look for treatable causes and diagnose possible associated diseases. In people who have developed dementia, we can perform a follow-up that allows to document the cognitive decline, identify the preserved capacities that can be strengthened and prevent factors of social and family maladjustment.