Acquired impairments: types of dementia
Depending on the etiology and clinical picture, several variants of dementia are distinguished. Organic brain damage leads to the development of total or lacunar dementia.
- Total dementia is most often the result of degenerative processes affecting the frontal lobes.
- Lacunar dementia usually develops against the background of diffuse angiopathies. It is characterized by a specific personality change—an accentuation of character traits that were previously inherent to the person.
Concentric (epileptic) dementia
This is a specific variant of organic intellectual decline. Over time, patients experience impairments in memory and comprehension. Memory becomes selective: the individual perfectly retains details significant to them (pension amount, staff names) but fails to remember neutral information.
Thinking loses its flexibility and becomes viscous. The patient cannot isolate the main point, gets lost in details, and completely loses the ability to think abstractly (proverbs are understood only literally).
Speech changes: vocabulary drops sharply (oligophasia), abounding in filler words, clichés, and inappropriate diminutive suffixes. Behavior is dominated by egocentrism, pettiness, and pedantry. Such individuals are despotic toward close relatives and sycophantic toward superiors. Empathy is completely lost.
Schizophrenic (vesanic) dementia
From the Latin vesania — madness. This type of dementia is fundamentally different from organic dementia: here, the ability to remember and comprehend is formally unimpaired (patients, for example, solve arithmetic problems without difficulty). The problem lies in the secondary nature of the intellectual decline.
The basis of the disorder is apathetic-abulic syndrome (loss of emotions and volition). The patient is physically and intellectually capable of studying or working, but completely lacks any drive to do so. They become passive, indifferent, and stop caring about hygiene and appearance. Answers are reduced to a formal "I don't know," without attempting to comprehend the question.
Thinking becomes bizarre (overinclusive thinking), and strange associations appear (symbolism, neologisms). Speech may turn into a meaningless set of words (schizophasia). Over time, due to prolonged lack of intellectual activity, accumulated knowledge is lost.
Congenital impairments: Oligophrenia
Oligophrenia is most accurately described as intellectual underdevelopment. In such patients, the IQ level does not change significantly with age.
The degree of adaptation depends on the severity of the condition:
- Patients with imbecility are capable of basic self-care (for example, dressing themselves).
- Individuals with debility most often live and are raised in ordinary families rather than in specialized institutions.
Briefly: answers to topical questions
What degrees of severity of oligophrenia exist in the classification?
The ICD-10 classification distinguishes 4 degrees of mental retardation, replacing the traditional domestic classification (debility, imbecility, idiocy). The cited source fragment indicates the following categories: F70 — mild mental retardation, corresponding to debility; F71 — moderate mental retardation, corresponding to imbecility. IQ is recognized as the only generally accepted measure for assessing the degree of intellectual development.
What pathopsychological methods and tests are used to assess intelligence in adults?
Special test methods, including batteries of verbal and non-verbal tests, are used to assess intelligence in adults.
- Raven's Progressive Matrices — a pattern-recognition test consisting of 60 tables with figures arranged in a specific order.
- Wechsler Adult Intelligence Scale (WAIS) — a comprehensive method for adults and adolescents over 16 years of age. It includes 11 subtests (6 verbal, 5 non-verbal). It assesses general knowledge, arithmetic skills, memory, vocabulary, abstraction, and spatial visualization. The result is an IQ score.
Which groups of drugs are used to treat dementia?
Drugs acting on neurotransmitter systems and antipsychotics are used to treat dementia and manage concomitant symptoms.
- Acetylcholine precursors — choline alphoscerate.
- Cholinesterase inhibitors — non-selective (pilocarpine, neostigmine methylsulfate) and central nervous system-selective (ipidacrine, galantamine, rivastigmine, donepezil).
- Glutamate receptor blockers — memantine (has a nootropic effect by eliminating excitotoxicity).
- Antipsychotics — in low doses (quetiapine, chlorprothixene, haloperidol) are used to relieve anxiety and confusion in early-stage dementia.
Why should intelligence not be assessed during an acute psychosis with productive symptoms?
Intelligence should not be assessed during acute psychosis because productive symptoms distort the real picture of the patient's cognitive functions.
In a state of acute psychosis, pronounced agitation and confusion mask the patient's real abilities (for example, in logic or calculation). Temporary loss of function during this period does not always mean the destruction of brain structures; it may merely be their temporary inaction. There is a strict clinical rule: the depth of the intellectual defect and the severity of negative symptoms should be assessed exclusively after the acute episode of the illness has resolved.
To distinguish schizophrenic dementia from organic dementia, remember: in schizophrenia, "the brain can, but doesn't want to" (volition/emotions), while in organic pathology, "it wants to, but can't" (memory/comprehension).
Class and exam questions
Is it possible to assess intelligence during an acute psychosis with productive symptoms?
No, during an acute psychotic episode accompanied by delusions or hallucinations, intelligence must not be assessed.
What task is used to assess intelligence in adults?
One of the tasks is a request to compare two concepts. Also, concrete thinking is indicated by agreement with the statement that a kilogram of down is lighter than a kilogram of nails.
Does schizophrenic dementia belong to organic dementia?
No, schizophrenic dementia should not be classified as organic dementia.
What else to study on this topic
- Detailed analysis of apathetic-abulic syndrome
- Symbolism and paralogical thinking in schizophrenia
- Methods for testing IQ levels in adults
- Differential diagnosis of types of organic dementia
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