Pathological sloppiness. New discovery by scientists! Sloppiness is a disease. Pants that are too long and drag on the ground

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Carelessness and sloppiness can be a characterological personality trait that is formed during the period of a person’s upbringing, and this quality can be modeled from adults, even despite all the efforts of the parents to accustom the child to order.

If one of the parents is careless or sloppy, and the other, on the contrary, is neat, then the probability of the child acquiring a character trait will be about 50% of the probability. Since raising a child does not take place on the basis of moral teachings, but by example. The child will imitate the parent who is more authoritative in the family.

However, such characterological qualities as negligence and sloppiness may also be important when diagnosing the state of the brain, since they can be formed not only in early childhood and have an imitative essence, but also begin to manifest itself in adolescence or already in adulthood.

One of the most striking examples of the fact that sloppiness and negligence manifests itself as a result of changes in the biological processes of the brain can be the process of a person’s transition from childhood to an adult, mature state. This period is called “Puberty,” more commonly known as adolescence or adolescence.

During puberty, not only primary and secondary sexual characteristics begin to change, but also all metabolic biological processes of the body. These biological processes change just as a person grows. For one person, it can proceed calmly, gradually, but more often – in jumps and “distortions”. This is why the behavior of adolescents is so unpredictable and often a neat and diligent child suddenly shows negligence and sloppiness, defiant behavior, inconsistency, etc.

With age, as a rule, when puberty passes, both sloppiness and negligence go away, a person matures and his behavior becomes orderly.

An example of patient complaints about negligence and sloppiness:

Patient: Woman, 49 years old, has 2 higher educations, a talented musician, and a university teacher. Bad habits No. Lives with his daughter's family. Leads a healthy lifestyle. I came for a consultation with a psychiatrist, psychotherapist (psychiatrist-psychotherapist), accompanied by my daughter and son-in-law. He doesn’t notice any oddities or inappropriate behavior in himself. The condition is described by her daughter and son-in-law in her presence. The woman agrees, but finds her own excuses for this.

“Mom is a very kind and sympathetic person. At the same time, she is very lazy, avoids unnecessary movements, eats constantly, is ugly fat, wears dirty clothes, smells bad, and does not want to wash herself at all. Last time I washed myself two months ago. My grandmother, a powerful woman, raised her quite strictly, “pressed” her: they say, study, you’re not a beauty anyway, no one will marry you. My mother studied obediently, and then, against my grandmother’s will, she married my father and found herself in a bohemian environment, where neatness was not strictly observed. Then I was born. From that moment on, my mother was replaced. She became sloppy and was kicked out of all jobs.

I lived with my grandmother, because... there was a continuous endless party in our apartment, and my parents quarreled (and later divorced, and then my dad died). Mom was in a civil marriage for some time, and her second husband left her. She took it very hard. Since then, she has had virtually no personal life (she herself says: “Too much trouble”). She didn’t want to be attractive, she despised all feminine things, considering most women “hens” who could only talk about men and rags. It seems to me that my mother unconsciously turned me against men. (However, she loves my husband very much). When I got married, at first we lived with my mother-in-law for some time, and my mother was alone. During this time, she changed a lot: she gained a lot of weight, stopped taking care of herself, and the house was constantly in chaos and dirt. Then she gave us her apartment and went to live with her grandparents. There the grandmother again began to order her around (she scattered something, didn’t wash it, look at yourself, how you’re dressed, etc. However, this was fair).

Then my grandmother became seriously ill, and my mother literally spent the night under her bed in the hospital for almost a year. That is, complete self-denial in the name of loved ones. Now it's just creepy to look at her. I love her very much, but I am constantly ashamed of her - for her gluttony, sloppiness, and unwashliness.

She may leave dirty laundry all over the house and not clean her nails or wash her clothes for weeks. She cuts her hair very short, as if on purpose to make herself even uglier. Mom gets offended by the comments and screams. Despite the fact that she has stage 3 obesity, high pressure, diseased heart and lungs, she is not going to go to the doctor or lose weight. It seems that a person is deliberately punishing and killing himself. I'm scared for her, I'm afraid she'll leave too soon. I think - what could provoke such behavior? Maybe she is not mentally healthy? Maybe grandma’s “aggressive” upbringing is to blame? Maybe she misses my love? What can I do"?

After examining the patient, the psychotherapist stated the presence of an acute psychotic condition, which requires immediate treatment in a hospital. The psychotherapist explained the situation and recommended urgent hospitalization in mental asylum, to the acute department. The relatives understood the situation correctly and agreed to hospitalization, but the patient herself categorically refused any treatment, not believing that there were any problems. And if someone doesn’t like its smell, then let them buy deodorant for themselves and smell it. In the process of lengthy negotiations between the psychotherapist and the patient, an agreement was reached on treatment. Treatment in hospital lasted 28 days. She was discharged in satisfactory condition with a critical attitude towards herself and a determination to continue treatment on an outpatient basis. Observed for three years. She is socially adapted, takes care of herself independently, and helps with housework.

This situation quite clearly represents the symptoms of sloppiness and negligence, but cases are not uncommon when sloppiness in clothing and housekeeping, or negligence in performing any work does not manifest itself in such a vivid form. This indicates other mental changes in a person. These symptoms may relate to various types mental disorder. Therefore, a psychotherapist must take into account all aspects of personality and behavior, for this a complete pathopsychic diagnosis is carried out.

Negligence in business or sloppiness, which develops and begins to manifest itself in a person’s behavior, already in adulthood indicates some kind of biological changes occurring in the brain.

The same processes, but only in reverse, the processes of regression, can explain the appearance of sloppiness and negligence in old age.

The main task of a psychotherapist is to conduct an accurate pathopsychological diagnosis and establish the true mental state of a person. These biological processes must be correctly assessed and differentiated from characterological characteristics, skills acquired in the process of education, taking into account age characteristics development of the body.

If treatment is necessary, it should be selected rationally and be oriented towards the developmental characteristics of the nervous system and age criteria.

A sloppy wife needs a blind husband.

Proverb

If a man in your house throws dirty socks around, that's...

doesn't mean he's a slob, he's just marking his territory.

Observation

Sloppiness as a personality quality is a tendency to show extreme untidiness; inability to keep one’s body, clothing, home, or workplace clean.

Vovochka sits down at the table. His mother, looking at his hands, asks: “Vovochka, why are your hands so dirty?” Vovochka: - Most likely it’s because I just washed my face with them...

Sloppiness is the lack of need for cleanliness. Sloppy man is under the influence of the energy of ignorance. Good people are characterized by purity of consciousness, which cannot appear in a person if there is no purity of the body. It doesn’t happen like that - the body is dirty, but the mind is pure. People in passion are forced to take care of their appearance, body hygiene, cleanliness of their home and workplace, otherwise they will become social outcasts, receive negative disrespectful assessments from others, and lose significance and importance in the eyes of people. Patchkulya will not be able to move along career ladder. They go up it well-groomed men- in impeccable suits, impeccable shoes, ties, clean shirts. Brushed, shaved, in a word, they look expensive.

Patchkulya does not take care of her appearance; she looks wrinkled and unkempt. He doesn't care about the opinions of others. He is a bright representative of the army of ignorance. Alcoholics, drug addicts, and homeless people don’t care what they look like. What will an alcoholic buy in the morning – a bottle or toothpaste? What would a drug addict prefer - to run for the next dose or to take a steam bath in a Russian bathhouse? People are volunteers in an ignorant environment and lose shame and conscience. Alcoholics themselves say that the first thing they lose is shame. You become no longer ashamed of your fall in front of your wife, children, colleagues and strangers.

Sloppiness is the child of ignorance. Pachkulya, having become an adherent of an ignorant environment, first loses shame, and then, in advanced cases, and conscience. Animals have no shame. Self-preservation instincts force them to monitor the hygiene of their bodies. They are close to nature and have not lost touch with it. Man, despite the fact that he considers himself the “crown” of creation, has lost touch with nature. He does not understand her signals and signs. The flesh is stupid. Having lost shame, Pachkula, unlike animals, does not see the need to take care of herself. He doesn’t understand why he should waste time on washing, bathing, washing and cleaning. And that will do.

There is a good old joke on the topic of slobs: “Parents look at their dirty, dirty child, and think: should they wash this one or make a new one?” N.N. Nosov in “Dunno on the Moon” created the image of Pachkuli, which will help us understand the essence of sloppiness: “Pachkuli Pestrenky usually walked in gray pants and the same gray jacket, and on his head he had a gray skullcap with patterns, which he called a skull cap. He believed that gray matter is the best matter in the world, since it gets dirty less. This, of course, is nonsense and untrue. Gray fabric gets dirty, like others, but for some reason the dirt on it is less noticeable. It is necessary to mention that Pachkula was a rather funny little guy. He had two rules: never wash your face and never be surprised by anything. It was much more difficult for him to observe the first rule than the second, because the short ones with whom he lived in the same house always forced him to wash his face before dinner. If he protested, he was simply not allowed to sit at the table. Thus, he still had to wash himself, but this did not matter much, since he had the tendency to quickly get dirty. Before he had time to wash himself, some dirty dots, spots and stripes would immediately appear on his face, his face would quickly lose its natural color and become somewhat quail-colored. For this they called him Pachkuley...

While the car was driving around the city, Knopochka started a conversation with Patchkulya: “You, Pestrenky, apparently haven’t washed your face today?” - I just washed my face! - Why is he so dirty? - So, I got dirty again. “You’ll have to wash your face again, because we can’t take something so dirty on the trip.” - How do you mean “we can’t”? We persuaded ourselves to go, but now suddenly “we can’t”! - Pestrenky was indignant. Meanwhile, Dunno left the city and, approaching the Cucumber River, turned onto the bridge. At the end of the bridge, Button said: Come on, stop the car. Now Motley will wash himself in the river. Dunno drove up to the shore and stopped the car. - I protest! - Motley lost his temper. “There is no such rule as to wash your face twice a day!”

Sloppiness is a signal of personality degradation. If a person was previously neat, but now walks around dirty and rumpled, you need to be wary. Maybe he is deeply depressed or has begun to deteriorate sharply under the influence of some external unpleasant circumstances. You can fall into the swamp of ignorance quickly, literally in one day. In the evening there was a successful businessman, he went to the casino and lost his entire business, his house, his wife and children. In the evening there was a respectable family man, but he got involved with a drunken company. As a result, in the morning I ended up in the hospital with beatings, lost important secret documents, but acquired AIDS. Often a person descends to the level of an animal in terms of lifestyle, but is inferior to him in the purity of his body. He was a prosperous man, but now he lives in a doghouse. Compassionate old women sometimes bring him food and moonshine. He smells like a skunk, but he himself looks like a devil.

“Bees don’t let a dirty person in,” says a Russian proverb. It is clear that society reacts negatively to the reluctance of its member to be like everyone else in the context of hygiene. The brilliant Russian writer Nikolai Vasilyevich Gogol was sloppy. He had an unattractive appearance. Gogol especially did not like his nose. “My God, what a long, sharp, birdlike nose he had! I couldn’t look at him directly, especially up close, thinking: he’ll take a bite and it’s out of the question,” a contemporary recalled about him. If you add to the “bird’s nose” long, not combed for a long time and not washed hair, a suit that is ugly in appearance and color, then the picture will be far from picturesque...

There were whole legends about Gogol's sloppiness, and it was precisely this that was the reason for all the sarcastic jokes about him. Gogol's biographers say that he rarely washed his face and hands in the morning, he always went to dirty laundry and a soiled dress. In his youth, while studying at the gymnasium, because of his slovenliness and scrofulous appearance (he was bleeding from his ears), many students were disdainful to give him a hand, refused to take his books - it was a real hell for normal person. “Gogol constantly looked askance at us, kept aloof, always looked with a frown...” From childhood, Gogol cultivated his loneliness, filling it with all sorts of oddities: in the choir he was out of tune most of all, he always walked along the streets on the opposite side, constantly colliding with passers-by, often not finished his sentences, combed his hair and cut his hair only on great holidays...

The great French writer Honore de Balzac was also known for his sloppiness. Contemporaries saw his sloppy clothes against the backdrop of a gloomy facial expression and a heavy, heavy figure as characteristic of his appearance. It was useless to reproach the writer for sloppiness. People came to the conclusion that if they ironed Balzac’s clothes, put them in perfect order, and dressed him to perfection, everything would be in vain: within an hour he would again be wrinkled, unbuttoned and sloppy.

The great Albert Einstein was distinguished by great sloppiness. He himself said: “Even in my youth, I discovered that my big toe sooner or later makes a hole in my sock. I haven't worn socks since then." Walking in boots on bare feet seemed much more pleasant to the scientist than wearing them at night. The genius greatly valued the comfort that he associated with the disorder and chaos of his home. Scattered things, books, papers did not interfere with his work at all. It seemed to Einstein that such things as ties, hats, and tuxedos were invented by fools to complicate their lives. He preferred old sweaters and open-necked shirts to elegant clothes. The genius did not like going to the hairdresser. His hair was always long and unkempt.

Socrates' wife, Xanthippe, was a sloppy bitch... Her favorite expression was: - If you are as smart as everyone says, then where is your money, Socrates. Friends, sympathizing with Socrates, asked him: “Why do you need her?” Such a woman? To which Socrates invariably answered: “You are afraid of yours.” posthumous fate, and I’m not afraid of anything. The great gods gave me such a wife that while living on Earth I would ALREADY experience all the torments of hell. I am no longer afraid of death.

Peter Kovalev

To wash hands , dishes and at least once a week, everyone is taught gender in childhood. But for some reason, only in adulthood it turns out that some people cannot go to bed without straightening the towel on the hanger, while others feel great, having completely forgotten when this very towel was washed, and do not see anything terrible in the fact that the mug with tea it barely comes off the sticky surface of the kitchen table.

CINDERELLA SYNDROME
I adore my friend Masha - she is a kind, sympathetic, smart and incredibly beautiful girl, but sometimes I want to kill her. Otherwise, her passion for cleanliness will kill me first. A perfectionist in everything, Masha tries to maintain perfect order in own apartment. I've never seen dirty dishes in her sink (because she washes them immediately after eating), shoe prints in the hallway (she wipes them right away), her bathroom mirror is never splattered with toothpaste (you'd think she never doesn’t brush her teeth), and the things in the closet are in such perfect order that it seems like she doesn’t get dressed at all. This “decent” behavior first delights, then amuses, and then begins to irritate. Well, really, how can you worry about the fact that your tablecloth is laid out asymmetrically, every five minutes you have to straighten a slightly tangled blanket from the sofa, while driving away the comfortably seated guests, and why can’t you just chat on the phone while lying in bed without while wiping away dust and not collecting crumbs!
The mania for cleanliness can reach catastrophic proportions. A person begins to see dirt and garbage even where there is none - constantly wipe his hands, wash the floors every day, take a shower 10 times a day, and end every preparation of dinner in the kitchen with almost general cleaning.

COMMENT BY A PSYCHOLOGIST
In its extreme manifestation, cleanliness syndrome is one of the most common variants of obsessive-compulsive syndrome, which even received a special name - mysophobia, or fear of pollution. In a less vivid manifestation, a person simply notices that he is experiencing discomfort from the fact that some thing is “not located as it should” or there is some kind of disorder around him (the dishes were not washed immediately after eating, a small a stain on the edge of the bathtub, etc.). In both cases, the cause is an unmet need for security. The correct order of things and events makes the world familiar and predictable, and therefore safe.
An important point in overcoming the neat syndrome is awareness the real reason desire for order and cleanliness. Gradually, you can develop a sense of trust in the world. Psychological training and consultation with a psychotherapist can help with this.

SELECTIVE APPROACH
Another category of people also suffers from a mania for cleanliness, but, unlike pathological Cinderellas, they love cleanliness extremely selectively. Such a person will not fall asleep if, God forbid, the floor is not washed, but at the same time he can quite calmly stack old boxes in the middle of the apartment, throw out socks and will not even bother to sort out the summer outerwear hanging in bunches in the hallway and occupying half the aisle.
For example, my sister is firmly convinced (and never tires of reminding me of this at every opportunity) that the floor should be so clean that you can’t be afraid to walk on it barefoot. But at the same time, she sees nothing wrong with eating in bed - and not only innocent cookies, but also stewed potatoes, goulash or even soup!
And my friend Vanka has already filled almost half of his already tiny apartment with all sorts of computer hardware (processors, motherboards and other IT components), but at the same time he sputters with indignation if you wash the dishes not according to his “technology”, you put plates in the dryer with the “wrong” side or mistakenly place your shoes on the second shelf instead of the third.

COMMENT BY A PSYCHOLOGIST
Mixed type people in relation to cleanliness also has a mixed nature of the reasons underlying the symptoms. Most often, a person’s vague position in relation to cleanliness is explained by the fear of social evaluation (primarily the evaluation of significant people) and the desire to avoid an unpleasant feeling of shame. In the personality of such a person, there is a certain conflict between his own “boundaries of sloppiness” and society’s ideas about the canons of cleanliness. Therefore, the solution to this conflict is a compromise option, in which “indicators of cleanliness” are simply designated - for example, a kitchen stove, sink, etc. The choice of indicator depends on the opinion of society - in some cases, a washed floor is a symbol of cleanliness, in others - a made bed, thirdly, washed dishes or something else.

COMPLETE IGNORE
But it is most convenient to relate to the third type - “ignorers” (psychologists call them indifferent, and pathological Cinderellas - nothing less than slobs), who feel equally comfortable in both a dirty and a clean apartment. They don’t see the difference between a dirty and clean floor, they wash dishes only when there are no clean ones left in the house, and they don’t even seem to suspect that dust can accumulate on the TV. They “don’t see” the mess because they really don’t notice, or because they’re just lazy. But in both cases, their houses are not distinguished by exemplary order, and only a good reason can motivate them to accomplish the feat of doing a little cleaning. Or a very good mood.
Here it’s time to remember again the story about my friend Masha. “Misha! - Masha says to her MCH. “Please wash the dishes after you!” “I washed yesterday,” Misha mutters and backs away from the kitchen. “Misha, I think it’s time to wash the floor, otherwise I’m already afraid to walk on it!” - Masha asks plaintively, kneading the dough with one hand and stirring the soup with the other. “Are you afraid? Gender has nothing to do with it. In my opinion, it just all depends on the degree of your courage!” - Mishka answers, covering himself with a pillow just in case. People like Misha do not become covered in dirt only because more “decent” citizens happen to be next to them. Who, through the power of love, patience or excellent teaching abilities, try (and sometimes quite successfully) to instill in such phlegmatic people a sense of beauty and purity.

WHAT TO DO TO NOT GET OVER WITH DIRT: Once a week, walk around your apartment with a garbage bag and throw out at least 50 unnecessary things (even small ones, but not less than 50!). Are you afraid of dirt? Mine is wearing gloves! To prevent your hands from smelling like rubber later, wear thin latex gloves under thick rubber gloves - buy them at a pharmacy or in the household chemicals department. Use good mops (for example, PVA) or microfiber rags to wash the floors - you will be surprised how different they are from dad's regular old sweatpants that mom uses. To give you an incentive to clean regularly, buy a whole arsenal of a wide variety of cleaning products, from floor shampoos to furniture polish - cleaning your home, like taking care of yourself, should be a pleasure.

• Are dementia and dementia the same thing? How does dementia occur in children? What is the difference between childhood dementia and mental retardation?
• Is unexpected untidiness the first sign of senile dementia? Are symptoms such as untidiness and sloppiness always present?
• What is mixed dementia? Does it always lead to disability? How to treat mixed dementia?
• Among my relatives there were patients with senile dementia. How likely am I to develop a mental disorder? What is the prevention of senile dementia? Are there any medications that can prevent the disease?

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What is dementia syndrome?

Dementia is a severe disorder of higher nervous activity caused by organic damage to the brain, and is manifested, first of all, by a sharp decrease in mental abilities (hence the name - dementia translated from Latin language means dementia).

The clinical picture of dementia depends on the cause that caused organic brain damage, on the localization and extent of the defect, as well as on the initial state of the body.

However, all cases of dementia are characterized by pronounced stable disorders of higher intellectual activity (memory deterioration, decreased ability to abstract thinking, creativity and learning), as well as more or less pronounced disturbances of the emotional-volitional sphere, from the accentuation of character traits (the so-called “caricature”) until the complete collapse of personality.

Causes and types of dementia

Since the morphological basis of dementia is severe organic damage to the central nervous system, the cause of this pathology can be any disease that can cause degeneration and death of cells in the cerebral cortex.

First of all, it should be highlighted specific types dementia, in which destruction of the cerebral cortex is independent and leading pathogenetic mechanism diseases:

• Alzheimer's disease;
• dementia with Lewy bodies;
• Pick's disease, etc.

In other cases, damage to the central nervous system is secondary, and is a complication of the underlying disease (chronic vascular pathology, infections, trauma, intoxication, systemic damage to nervous tissue, etc.).

Most common cause of secondary organic damage brain become vascular disorders, in particular cerebral atherosclerosis and hypertonic disease.

Common causes of dementia also include alcoholism, tumors of the central nervous system, and traumatic brain injury.

Less commonly, dementia is caused by infections - AIDS, viral encephalitis, neurosyphilis, chronic meningitis, etc.

In addition, dementia can develop:

• as a complication of hemodialysis;
• as a complication of severe renal and liver failure;
• for some endocrine pathologies (thyroid disease, Cushing's syndrome, pathology of the parathyroid glands);
• for severe autoimmune diseases (systemic lupus erythematosus, multiple sclerosis).

In some cases, dementia develops from multiple causes. A classic example of such a pathology is senile (senile) mixed dementia.

Functional and anatomical types of dementia

Depending on the predominant localization of the organic defect, which has become the morphological substrate of the pathology, four types of dementia are distinguished:
1. Cortical dementia is a predominant lesion of the cerebral cortex. This type is most characteristic of Alzheimer's disease, alcoholic dementia, Pick's disease.
2. Subcortical dementia. With this type of pathology, the subcortical structures are primarily affected, which causes neurological symptoms. A typical example is Parkinson’s disease with predominant damage to the neurons of the substantia nigra of the midbrain, and specific motor disorders: tremors, general muscle stiffness ("doll gait", mask-like face, etc.).
3. Cortical-subcortical dementia is a mixed type of lesion, characteristic of pathology caused by vascular disorders.
4. Multifocal dementia is a pathology characterized by multiple lesions in all parts of the central nervous system. Steadily progressing dementia is accompanied by severe and varied neurological symptoms.

Forms of dementia

Clinically, lacunar and total forms of dementia are distinguished.

Lacunarnaya

Lacunar dementia is characterized by peculiar isolated lesions of the structures responsible for intellectual activity. In this case, as a rule, the person who suffers the most is short term memory, so patients are forced to constantly take notes on paper. Based on its most pronounced symptom, this form of dementia is often called dysmnestic dementia (dysmenia literally means memory impairment).

However, a critical attitude towards one’s condition remains, and the emotional-volitional sphere suffers slightly (most often only asthenic symptoms are expressed - emotional lability, tearfulness, increased sensitivity).

A typical example of lacunar dementia is initial stages The most common form of dementia is Alzheimer's disease.

Total

Total dementia is characterized by complete disintegration of the core of personality. In addition to pronounced violations of the intellectual-cognitive sphere, gross changes in emotional-volitional activity are observed - a complete devaluation of all spiritual values ​​occurs, as a result of which vital interests become impoverished, the sense of duty and modesty disappears, and complete social disadaptation occurs.

The morphological substrate of total dementia are lesions frontal lobes cerebral cortex, which often occurs with vascular disorders, atrophic (Pick's disease) and volumetric processes of the corresponding localization (tumors, hematomas, abscesses).

Basic classification of presenile and senile dementias

The likelihood of developing dementia increases with age. So if in adulthood the proportion of patients with dementia is less than 1%, then in age group after 80 years it reaches 20%. Therefore, the classification of dementias that occur in late life is especially important.

There are three types of dementia that are most common in presenile and senile (presenile and senile) ages:
1. Alzheimer's (atrophic) type of dementia, which is based on primary degenerative processes in nerve cells.
2. Vascular type of dementia, in which degeneration of the central nervous system develops secondary gross violations blood circulation in the vessels of the brain.
3. Mixed type, which is characterized by both mechanisms of disease development.

Clinical course and prognosis

The clinical course and prognosis of dementia depend on the cause that caused the organic defect of the central nervous system.

In cases where the underlying pathology is not prone to development (for example, with post-traumatic dementia), with adequate treatment, significant improvement is possible due to the development of compensatory reactions (other areas of the cerebral cortex take on part of the functions of the affected area).

However, the most common types of dementia - Alzheimer's disease and vascular dementia - have a tendency to progress, therefore, when they talk about treatment, for these diseases we are only talking about slowing down the process, social and personal adaptation of the patient, prolonging his life, removing unpleasant symptoms and so on.

And finally, in cases where the disease that causes dementia progresses rapidly, the prognosis is extremely unfavorable: the patient’s death occurs several years or even months after the first signs of the disease appear. Reason fatal outcome As a rule, various concomitant diseases (pneumonia, sepsis) develop against the background of disturbances in the central regulation of all organs and systems of the body.

Severity (stage) of dementia

In accordance with the patient’s social adaptation capabilities, three degrees of dementia are distinguished. In cases where the disease that causes dementia has a steadily progressive course, we often speak of the stage of dementia.

Mild degree

With mild dementia, despite significant impairments in the intellectual sphere, the patient remains critical of his own condition. So the patient can easily live independently, performing familiar household activities (cleaning, cooking, etc.).

Moderate degree

With moderate dementia, there are more severe intellectual impairments and a reduced critical perception of the disease. At the same time, patients experience difficulty using conventional household appliances(stove, washing machine, TV), as well as telephone, door locks and latches, so under no circumstances should the patient be completely left to his own devices.

Severe dementia

In severe dementia there is complete collapse personality. Such patients often cannot eat on their own, observe basic hygiene rules, etc.

Therefore, in the case of severe dementia, hourly monitoring of the patient is necessary (at home or in a specialized institution).

Diagnostics

To date, clear criteria for diagnosing dementia have been developed:
1. Signs of memory impairment – ​​both long-term and short-term (subjective data from a survey of the patient and his relatives are supplemented by an objective study).
2. The presence of at least one of the following disorders characteristic of organic dementia:

• signs of decreased ability for abstract thinking (according to objective research);
• symptoms of decreased criticality of perception (discovered when making real plans for the next period of life in relation to oneself and others);
• triple A syndrome:
  • aphasia – various kinds violations of already formed speech;
  • apraxia (literally “inactivity”) – difficulties in performing purposeful actions while maintaining the ability to move;
  • Agnosia – various disturbances of perception while maintaining consciousness and sensitivity. For example, the patient hears sounds, but does not understand the speech addressed to him (auditory-verbal agnosia), or ignores a part of the body (does not wash or put on one foot - somatoagnosia), or does not recognize certain objects or faces of people with intact vision (visual agnosia). and so on.;
• personal changes (rudeness, irritability, disappearance of shame, sense of duty, unmotivated attacks aggression, etc.).

3. Violation of social interactions in the family and at work.
4. Absence of manifestations of delirious changes in consciousness at the time of diagnosis (no signs of hallucinations, the patient is oriented in time, space and his own personality, as far as his condition allows).
5. A certain organic defect (results of special studies in the patient’s medical history).

It should be noted that in order to make a reliable diagnosis of dementia, it is necessary that all of the above symptoms be observed for at least 6 months. Otherwise, we can only talk about a presumptive diagnosis.

Differential diagnosis of organic dementia

Differential diagnosis of organic dementia must be carried out, first of all, with depressive pseudodementia. With deep depression, the severity of mental disorders can reach a very high degree, and make it difficult for the patient to adapt to Everyday life, simulating the social manifestations of organic dementia.

Pseudo-dementia also often develops after severe psychological shock. Some psychologists explain this kind of sharp decline in all cognitive functions (memory, attention, ability to perceive and meaningfully analyze information, speech, etc.) as defensive reaction for stress.

Another type of pseudodementia is a weakening of mental abilities with metabolic disorders(vitaminosis B12, lack of thiamine, folic acid, pellagra). With timely correction of disorders, signs of dementia are completely eliminated.

Differential diagnosis organic dementia and functional pseudodementia are quite complex. According to international researchers, about 5% of dementias are completely reversible. Therefore, the only guarantee of a correct diagnosis is long-term observation of the patient.

Alzheimer's type dementia

Concept of dementia in Alzheimer's disease

Dementia of the Alzheimer's type (Alzheimer's disease) received its name from the name of the doctor who first described the pathology clinic in a 56-year-old woman. The doctor was alarmed early manifestation signs of senile dementia. Post-mortem examination showed peculiar degenerative changes in the cells of the patient’s cerebral cortex.

Subsequently, this kind of violation was discovered in cases where the disease manifested itself much later. This was a revolution in views on the nature of senile dementia - previously it was believed that senile dementia was a consequence of atherosclerotic damage to the blood vessels of the brain.

Dementia of the Alzheimer's type is the most common type of senile dementia today, and, according to various sources, accounts for 35 to 60% of all cases of organic dementia.

Risk factors for developing the disease

There are the following risk factors for developing dementia of the Alzheimer's type (arranged in descending order of importance):

• age (the most dangerous limit is 80 years);
• the presence of relatives suffering from Alzheimer's disease (the risk increases many times if the relatives develop the pathology before the age of 65);
• hypertonic disease;
• atherosclerosis;
• increased level lipids in blood plasma;
• obesity;
• sedentary lifestyle;
• diseases occurring with chronic hypoxia ( respiratory failure, severe anemia, etc.);
• traumatic brain injuries;
• low level of education;
• lack of active intellectual activity throughout life;
• female.

First signs

It should be noted that degenerative processes in Alzheimer's disease begin years, even decades before the first clinical manifestations. The first signs of Alzheimer's type dementia are very characteristic: patients begin to notice a sharp decline in memory for recent events. At the same time, a critical perception of their condition persists for a long time, so that patients often feel understandable anxiety and confusion, and consult a doctor.

Memory impairment in dementia of the Alzheimer's type is characterized by the so-called Ribot's law: first short-term memory is impaired, then recent events are gradually erased from memory. Memories from distant times (childhood, adolescence) are retained the longest.

Characteristics of the advanced stage of progressive dementia of the Alzheimer's type

At the advanced stage of dementia of the Alzheimer's type, memory impairment progresses, so that in some cases only the most significant events are remembered.

Gaps in memory are often replaced by fictitious events (the so-called confabulation– false memories). The criticality of perception of one's own state is gradually lost.

At the advanced stage of progressive dementia, disorders of the emotional-volitional sphere begin to appear. Most typical for senile dementia Alzheimer's type the following disorders:

• egocentrism;
• grouchiness;
• suspicion;
• conflict.

These signs are called senile (senile) personality restructuring. In the future, against their background, a very specific type of Alzheimer’s dementia may develop. delirium of damage: the patient accuses relatives and neighbors of constantly robbing him, wishing for his death, etc.

Other types of disturbances in normal behavior often develop:

• sexual incontinence;
• gluttony with a special penchant for sweets;
• craving for vagrancy;
• fussy, disorderly activity (walking from corner to corner, shifting things, etc.).

At the stage of severe dementia, the delusional system disintegrates, and behavioral disorders disappear due to extreme weakness of mental activity. Patients plunge into complete apathy and do not experience hunger or thirst. Movement disorders soon develop, so that patients cannot walk or chew food normally. Death occurs from complications due to complete immobility, or from concomitant diseases.

Diagnosis of Alzheimer's type dementia

The diagnosis of dementia of the Alzheimer's type is made on the basis of the characteristic clinical picture of the disease, and is always probabilistic. Differential diagnosis between Alzheimer's disease and vascular dementia is quite difficult, so often a final diagnosis can only be made posthumously.

Treatment

Treatment of dementia of the Alzheimer's type is aimed at stabilizing the process and reducing the severity existing symptoms. It should be comprehensive and include therapy for diseases that aggravate dementia (hypertension, atherosclerosis, diabetes, obesity).

In the early stages good effect The following drugs were shown:

• homeopathic remedy ginkgo biloba extract;
• nootropics (piracetam, cerebrolysin);
• drugs that improve blood circulation in the vessels of the brain (nicergoline);
• stimulator of dopamine receptors in the central nervous system (piribedil);
• phosphatidylcholine (part of acetylcholine, a neurotransmitter of the central nervous system, therefore improves the functioning of neurons in the cerebral cortex);
• actovegin (improves the utilization of oxygen and glucose by brain cells, and thereby increases their energy potential).

At the stage of advanced manifestations, drugs from the group of acetylcholinesterase inhibitors (donepezil, etc.) are prescribed. Clinical researches have shown that the administration of such drugs significantly improves social adaptation patients and reduces the burden on caregivers.

Forecast

Dementia of the Alzheimer's type is a steadily progressive disease that inevitably leads to severe disability and death of the patient. The process of disease development, from the appearance of the first symptoms to development senility, usually takes about 10 years.

The earlier Alzheimer's disease develops, the faster dementia progresses. In patients under 65 years of age (early senile dementia or presenile dementia) they develop early neurological disorders(apraxia, agnosia, aphasia).

Vascular dementia

Dementia due to cerebral vascular lesions

Dementia of vascular origin ranks second in prevalence after dementia of the Alzheimer's type, and accounts for about 20% of all types of dementia.

In this case, as a rule, dementia that develops after vascular accidents, such as:
1. Hemorrhagic stroke (vascular rupture).
2. Ischemic stroke(blockage of a vessel with cessation or deterioration of blood circulation in a certain area).

In such cases, massive death of brain cells occurs, and the so-called focal symptoms, depending on the location of the affected area (spastic paralysis, aphasia, agnosia, apraxia, etc.), come to the fore.

So clinical picture post-stroke dementia is very heterogeneous, and depends on the degree of damage to the vessel, area blood supply area brain, compensatory capabilities of the body, as well as the timeliness and adequacy of medical care provided in case of a vascular accident.

Dementias that occur with chronic failure blood circulation, develop, as a rule, in old age, and demonstrate a more uniform clinical picture.

What disease can cause vascular type dementia?

The most common causes of vascular type dementia are hypertension and atherosclerosis - common pathologies characterized by the development of chronic cerebrovascular insufficiency.

The second large group of diseases leading to chronic hypoxia of brain cells is vascular damage in diabetes mellitus ( diabetic angiopathy) and systemic vasculitis, as well as congenital disorders of the structure of cerebral vessels.

Acute cerebral circulatory failure can develop due to thrombosis or embolism (blockage) of a vessel, which often occurs with atrial fibrillation, heart defects, and diseases with an increased tendency to thrombus formation.

Risk factors

The most significant risk factors for the development of dementia of vascular origin:

• hypertension, or symptomatic arterial hypertension;
• increased levels of lipids in blood plasma;
• systemic atherosclerosis;
• cardiac pathologies (coronary heart disease, arrhythmias, heart valve damage);
• sedentary lifestyle;
• overweight;
• diabetes;
• tendency to thrombosis;
• systemic vasculitis (vascular diseases).

Symptoms and course of senile vascular dementia

The first warning signs of vascular dementia are difficulty concentrating. Patients complain of fatigue and have difficulty concentrating for long periods of time. At the same time, it is difficult for them to switch from one type of activity to another.

Another harbinger of developing vascular dementia is slowness of intellectual activity, so for early diagnosis For cerebrovascular accidents, tests are used to measure the speed of completing simple tasks.

TO early signs developed dementia of vascular origin includes violations of goal setting - patients complain of difficulties in organizing elementary activities (making plans, etc.).

In addition, already in the early stages, patients experience difficulties in analyzing information: it is difficult for them to identify the main and secondary, to find the common and different between similar concepts.

Unlike dementia of the Alzheimer's type, memory impairment in dementia of vascular origin is not as pronounced. They are associated with difficulties in reproducing perceived and accumulated information, so that the patient easily remembers “forgotten” when asking leading questions, or chooses the correct answer from several alternative ones. At the same time, the memory is important events persists for quite a long time.

For vascular dementia, disturbances in the emotional sphere are specific in the form of a general decrease in mood, up to the development of depression, which occurs in 25-30% of patients, and severe emotional lability, so that patients can cry bitterly, and a minute later move on to completely sincere joy.

Signs of vascular dementia include the presence of characteristic neurological symptoms, such as:
1. Pseudobulbar syndrome, which includes impaired articulation (dysarthria), changes in voice timbre (dysphonia), less often - impaired swallowing (dysphagia), forced laughter and crying.
2. Gait disturbances (shuffling, mincing gait, “skier’s gait”, etc.).
3. Decreased motor activity, so-called “vascular parkinsonism” (poor facial expressions and gestures, slowness of movements).

Vascular dementia, which develops as a result of chronic circulatory failure, usually progresses gradually, so the prognosis largely depends on the cause of the disease (hypertension, systemic atherosclerosis, diabetes mellitus, etc.).

Treatment

Treatment of vascular dementia is primarily aimed at improving cerebral circulation - and, consequently, at stabilizing the process that caused dementia (hypertension, atherosclerosis, diabetes, etc.).

In addition, it is standard to prescribe pathogenetic treatment: piracetam, cerebrolysin, actovegin, donepezil. The regimens for taking these drugs are the same as for Alzheimer's type dementia.

Senile dementia with Lewy bodies

Senile dementia with Lewy bodies is an atrophic-degenerative process with the accumulation of specific intracellular inclusions – Lewy bodies – in the cortex and subcortical structures of the brain.

The causes and mechanisms of development of senile dementia with Lewy bodies are not fully understood. Just like with Alzheimer's disease, great importance has a hereditary factor.

According to theoretical data, senile dementia with Lewy bodies ranks second in prevalence, and accounts for about 15-20% of all senile dementias. However, during life such a diagnosis is made relatively rarely. As a rule, such patients are misdiagnosed vascular dementia or Parkinson's disease with dementia.

The fact is that many symptoms of dementia with Lewy bodies are similar to the listed diseases. Just as with the vascular form, the first symptoms of this pathology are a decrease in the ability to concentrate, slowness and weakness of intellectual activity. Subsequently, depression, decreased motor activity similar to parkinsonism, and walking disorders develop.

At the advanced stage, the clinical picture of dementia with Lewy bodies is in many ways reminiscent of Alzheimer's disease, since delusions of damage, delusions of persecution, and delusions of doubles develop. As the disease progresses, delusional symptoms disappear due to complete exhaustion of mental activity.

However, senile dementia with Lewy bodies has some specific symptoms. It is characterized by so-called small and large fluctuations - sharp, partially reversible disturbances in intellectual activity.

With small fluctuations, patients complain of temporary impairments in the ability to concentrate and perform some task. With large fluctuations, patients note impaired recognition of objects, people, terrain, etc. Often the disorders reach the point of complete spatial disorientation and even confusion.

Other characteristic dementia with Lewy bodies – presence visual illusions and hallucinations. Illusions are associated with a violation of orientation in space and intensify in dark time days, when patients often mistake inanimate objects for people.

A specific feature of visual hallucinations in dementia with Lewy bodies is their disappearance when the patient tries to interact with them. Often visual hallucinations are accompanied by auditory hallucinations (speaking hallucinations), but in pure form auditory hallucinations do not occur.

As a rule, visual hallucinations are accompanied by large fluctuations. Such attacks are often provoked by a general deterioration in the patient’s condition (infectious diseases, fatigue, etc.). When coming out of a large fluctuation, patients partially amnesize what happened, intellectual activity is partially restored, however, as a rule, the state of mental functions becomes worse than the original one.

Another characteristic symptom Dementia with Lewy bodies is a behavior disorder during sleep: patients can make sudden movements, and even injure themselves or others.

In addition, with this disease, as a rule, a complex of autonomic disorders develops:

• orthostatic hypotension (a sharp decrease in blood pressure when moving from a horizontal to a vertical position);
• arrhythmias;
• disruption digestive tract with a tendency to constipation;
• urinary retention, etc.

Treatment of senile dementia with Lewy bodies similar to the treatment of dementia of the Alzheimer's type.

In case of confusion, acetylcholinesterase inhibitors (donepezil, etc.) are prescribed, in as a last resort– atypical antipsychotics (clozapine). The use of standard antipsychotics is contraindicated due to the possibility of developing severe movement disorders. Non-frightening hallucinations with adequate criticism to special drug elimination are not subject to

To treat the symptoms of parkinsonism, small doses of the drug levodopa are used (being very careful not to cause an attack of hallucinations).

The course of dementia with Lewy bodies is rapidly and steadily progressive, so the prognosis is much more serious than for other types of senile dementia. The period from the appearance of the first signs of dementia to the development of complete insanity usually takes no more than four to five years.

Alcoholic dementia

Alcohol-induced dementia develops as a result of long-term (15-20 years or more) toxic effects of alcohol on the brain. In addition to the direct influence of alcohol, indirect effects (endotoxin poisoning during alcohol impairment liver, vascular disorders, etc.).

Almost all alcoholics at the stage of development of alcoholic personality degradation (third, last stage alcoholism) reveal atrophic changes in the brain (expansion of the ventricles of the brain and furrows of the cerebral cortex).

Clinically alcoholic dementia represents a diffuse decrease in intellectual abilities (deterioration of memory, concentration, ability for abstract thinking, etc.) against the background of personal degradation (coarsening of the emotional sphere, destruction of social connections, primitivism of thinking, total loss value guidelines).

At this stage of development alcohol addiction It is very difficult to find incentives to encourage the patient to treat the underlying disease. However, in cases where it is possible to achieve complete abstinence for 6-12 months, the signs of alcoholic dementia begin to regress. Moreover, instrumental studies also show some smoothing of the organic defect.

Epileptic dementia

The development of epileptic (concentric) dementia is associated with a severe course of the underlying disease (frequent seizures with transition to status epilepticus). Indirect factors may take part in the genesis of epileptic dementia ( long-term use antiepileptic drugs, injuries from falls during seizures, hypoxic damage to neurons in status epilepticus, etc.).

Epileptic dementia is characterized by slowness of thought processes, the so-called viscosity of thinking (the patient cannot distinguish the main from the secondary, and gets fixated on describing unnecessary details), decreased memory, and impoverished vocabulary.

A decrease in intellectual abilities occurs against the background of a specific change in personality traits. Such patients are characterized by extreme selfishness, malice, vindictiveness, hypocrisy, quarrelsomeness, suspiciousness, accuracy, even pedantry.

The course of epileptic dementia is steadily progressive. With severe dementia, malice disappears, but hypocrisy and servility remain, and lethargy and indifference to the environment increases.

How to prevent dementia - video

Answers to the most popular questions about causes, symptoms and
dementia treatment

Are dementia and dementia the same thing? How does dementia occur in children? What is the difference between childhood dementia and mental retardation?

The terms “dementia” and “dementia” are often used interchangeably. However, in medicine, dementia is understood as irreversible dementia that has developed in a mature person with normally formed mental abilities. Thus, the term “childhood dementia” is inappropriate, since in children higher nervous activity is at a developmental stage.

The term used to denote childhood dementia is " mental retardation", or oligophrenia. This name is retained when the patient reaches adulthood, and this is fair, since dementia that occurs in adulthood (for example, post-traumatic dementia) and oligophrenia proceed differently. In the first case, we are talking about the degradation of an already formed personality, in the second - about underdevelopment.

Is unexpected untidiness the first sign of senile dementia? Are symptoms such as untidiness and sloppiness always present?

Sudden untidiness and untidiness are symptoms of disturbances in the emotional-volitional sphere. These signs are very nonspecific and are found in many pathologies, such as: deep depression, severe asthenia (exhaustion) of the nervous system, psychotic disorders (for example, apathy in schizophrenia), various types of addictions (alcoholism, drug addiction), etc.

At the same time, patients with dementia in the early stages of the disease can be quite independent and neat in their usual everyday environment. Sloppiness can be the first sign of dementia only when the development of dementia in the early stages is accompanied by depression, exhaustion of the nervous system or psychotic disorders. This kind of debut is more typical for vascular and mixed dementias.

What is mixed dementia? Does it always lead to disability? How to treat mixed dementia?

Mixed dementia is called dementia, the development of which involves both a vascular factor and the mechanism of primary degeneration of brain neurons.

It is believed that circulatory disorders in the blood vessels of the brain can trigger or intensify the primary degenerative processes characteristic of Alzheimer's disease and dementia with Lewy bodies.

Since the development of mixed dementia is caused by two mechanisms at once, the prognosis for this disease is always worse than for the “pure” vascular or degenerative form of the disease.

The mixed form is prone to steady progression, therefore inevitably leading to disability and significantly shortening the patient's life.
Treatment of mixed dementia is aimed at stabilizing the process, and therefore includes combating vascular disorders and mitigating the developed symptoms of dementia. Therapy, as a rule, is carried out with the same drugs and according to the same regimens as for vascular dementia.

Timely and adequate treatment for mixed dementia can significantly prolong the patient’s life and improve its quality.

Among my relatives there were patients with senile dementia. How likely am I to develop a mental disorder? What is the prevention of senile dementia? Are there any medications that can prevent the disease?

Senile dementias are diseases with a hereditary predisposition, especially Alzheimer's disease and dementia with Lewy bodies.

The risk of developing the disease increases if senile dementia in relatives developed in a relatively early age(up to 60-65 years old).

However, it should be remembered that hereditary predisposition is only the presence of conditions for the development of a particular disease, therefore even an extremely unfavorable family history is not a death sentence.

Unfortunately, today there is no consensus on the possibility of specific drug prevention of the development of this pathology.

Since risk factors for developing senile dementia are known, measures to prevent mental disorder, are primarily aimed at eliminating them, and include:
1. Prevention and timely treatment diseases leading to circulatory disorders in the brain and hypoxia (hypertension, atherosclerosis, diabetes mellitus).
2. Dosed physical activity.
3. Constantly engaged in intellectual activity (you can make crosswords, solve puzzles, etc.).
4. Quitting smoking and alcohol.
5. Prevention of obesity.

Before use, you should consult a specialist. >>>> Sloppiness is a sign of what?

Sloppiness is a sign of what?

What is behind the term " sloppiness"Many people know. This is a disregard for order in the environment around a person and/or a violation of body hygiene standards. A person’s indifference to his own appearance causes, at a minimum, bewilderment, and sometimes just a feeling of disgust among those around him. Chaotic, cluttered environment surrounding a person, may suggest a catastrophic lack of time, carelessness with things, or a simple reluctance to spend time on cleaning.

Usually signs of sloppiness refers to cases of lack of upbringing in childhood, lack of discipline, laziness or lack of aesthetic taste. But sloppiness can also act as a symptom mental disorder. And if, in the case of sloppiness, which has become a character trait, a person can be influenced by persuasion, own examples, impose on him an algorithm, subject to which he will be able to achieve certain success in changing his cluttered world and appearance, then in the case of a mental disorder it is very difficult to cope with the phenomenon of sloppiness. Mental disorder and self-esteem are often incompatible things, so convince a person to look at himself from the outside and evaluate his appearance or the state of housing (workplace) is not possible.

Usually so painful phenomena of sloppiness occur during puberty in adolescents, when some biochemical processes in the body change, which can affect the functioning of the brain. Most often, upon leaving puberty, the phenomena of sloppiness gradually disappear. But this does not always happen, since a careless attitude towards one’s body and a sloppy attitude towards things can be learned from childhood as a result of imitation of one or both parents, despite educational process, spent by them with the child.

A person is somewhat different from an animal in terms of instincts, and if in animals the need for cleanliness of their own body is associated with the instinct of self-preservation, then in a person the love for cleanliness is fixed in the form of a habit (developed independently or copied in childhood from the behavior of people around him, in particular, parental behavior).

A careless attitude towards oneself and the environment can be the result of depression, when a person, who is always neat and collected in everyday life, loving order, cleanliness and neatness, gradually begins to slide into the abyss of indifference and chaos, ceases to notice the inconveniences and clutter around him, begins to partially neglect or completely your own hygiene. Upon recovery from depression, such a person will pull himself together and begin to observe, as before, own rules hygiene and order, but in case of untreated depression and inability independent exit from it, sloppiness can take on catastrophic proportions.

Sloppiness can become a sign of personality degradation when certain diseases: alcoholism, drug addiction.

Frequent cases of sloppiness are observed in older people during the period of degradation of brain cells. Such people require the attentive attention of their relatives and the help of a psychiatrist who will select the optimal treatment for each specific case. You won’t be able to cope on your own or with the help of relatives who have no experience in this matter.

There is a type of sloppiness associated with an irresistible desire to accumulate things, as a result of which the home turns into a cluttered warehouse or trash heap. Foreign scientists have come up with a term for this state of sloppiness: “Messy syndrome” (messy - translated from English, dirty, disorderly). This condition has other names in medical literature: “Diogenes Syndrome”, “Plyushkin Syndrome”, “Syllogomania”. As it turned out, this condition can be caused not only by diseases that affect brain cells, but also by deep psychological trauma (loss of loved one, ruined personal life). In the case of “Messy Syndrome”, the help of a psychiatrist is required.