Nutrition in the terminal stage, with dementia or in a state of awake coma

Dementia is a serious and common disease caused by organic damage to the brain and leading to impaired intellectual function and personality disorder. The danger of the disease lies in its irreversible nature, clinical signs, and inappropriate behavior of patients, which affects the life expectancy of patients, so the prognosis of the disease is disappointing.

The experienced team of specialists at the Yusupov Hospital, thanks to their professionalism, can recognize pathology at any stage, determine the possible causes of the disease and draw up an individual treatment plan that prevents further development of the disease and improves the quality of life. Thanks to high-quality and rational treatment, it is possible to stop the progression of the disease and prevent the transition to a severe stage. Of course, it is impossible to completely restore lost functions and cure the patient, since the pathology is irreversible, but social adaptation and improving the quality of life are possible.

Development mechanism

The main cause of alcoholic dementia is the death of brain neurons caused by long-term intoxication with ethanol and its metabolite acetaldehyde (a Group 1 carcinogen). Both of these substances are able to penetrate the blood-brain barrier, as a result of which, with each consumption of alcohol, a certain number of neurons die irrevocably, which leads to the severing of existing neural connections and chaotic dysfunction of the brain.

In addition, long-term intoxication with acetaldehyde provokes atherosclerosis of cerebral vessels, which leads to cerebral circulation disorders, which accelerates the loss of neurons.

According to drug addiction statistics, people over 55 years of age are at greatest risk of developing alcoholic dementia, but over the past couple of decades this disease has become much younger.

Symptoms

The symptoms of alcoholic dementia are very diverse, but the most commonly observed signs traditionally include the following:

1. Depressive mood. One of the earliest symptoms is an unreasonable lack of positive mood, which slowly develops into severe depression, reaching apathetic states.
2. Surface of thinking. Patients stop thinking about the consequences of decisions made or actions taken. Their actions are increasingly reminiscent of the actions of 3-5 year old children who immediately do the first thing that comes to mind.
3. Emotional instability. Unmotivated and causeless emotional fluctuations are often observed, when a positive and complacent mood is abruptly and without clear reason replaced by irritability or indifference.
4. Sleep disorders. The usual pattern of sleep and wakefulness is disrupted - patients may sleep during the day and be awake at night. The duration of periods of rest and activity can also change - some patients begin to sleep 20 hours a day, and some, on the contrary, fall asleep only for 2-3 hours, remaining in unhealthy agitation the rest of the day.
5. Memory impairment. Disorders of long-term memory occur—patients cannot remember events that happened many years ago and forget important facts or dates. As the disease progresses, short-term memory also begins to suffer, when patients forget what happened in the morning or even a couple of hours ago.
6. Intellectual inhibition. Even the simplest logical conclusions, analytical activities or assessment of the general situation cause enormous difficulties in patients with dementia, up to the complete impossibility of completing the task (for example, solving a school logic problem).
7. Decreased attention. It becomes almost impossible to concentrate on something - the patients’ attention constantly deviates from the task at hand, and all volitional efforts to concentrate do not bring any results.
8. Loss of skills. Patients lose their skills and abilities - both related to professional activities and purely everyday ones (for example, washing dishes well). Moreover, in many cases, the patients themselves stubbornly do not notice the poor quality of the work they perform, which is an important diagnostic criterion.
9. Personality disorders. As a rule, they occur in the last stages of the disease and appear in the formation of previously absent aspirations and inclinations in patients (for example, some patients begin to engage in garbage collection).
10. Mental disorders. In the most advanced cases, obvious psychiatric disorders are observed: hallucinations, manic syndrome, delusions, schizophrenia.

What determines survival time?

How long people live with dementia depends, first of all, on the timeliness of diagnosis. For some types of pathology (dyscirculatory encephalopathy, senile form of asthma), a more benign course is possible if the disease is detected at an early stage and therapy is organized correctly. Treatment should consist of the following:

• improving quality of life;
• correction of cognitive impairment;
• relief of psychotic disorders;
• minimizing changes in the patient's personality.

How many people live with a diagnosis of senile dementia depends on how comprehensive the treatment is. Psychotherapy, sociotherapy, communication with relatives, and regular work with cognitive functions are very important for older people. We should not forget about regular speech therapy, massages, and occupational therapy - all this slows down the course of the disease and increases life expectancy. But the prescription of psychotropic drugs to such patients often leads to undesirable results, namely accelerated personality disintegration, increased excitability, aggression, and sleep disturbances.

Important! In senile dementia, loneliness and isolation are contraindicated. People who have regular communication live longer with a diagnosis of dementia.

Pharmacotherapy is of great importance for life expectancy. Early treatment of cerebrovascular pathologies can stop the progression of dementia. Improving cerebral perfusion, using neuroprotectors, and correcting risk factors leads to patients living with a diagnosis of vascular dementia much longer. The same applies to diseases with an established cause and pathogenesis.

Once a diagnosis of dementia is made, life expectancy prognosis also depends on the following factors:

1. Physical activity. At the initial stages, the patient must have a sufficient level of physical activity: walks in the park, simple work in the country, exercise therapy. Regular movement can help delay the loss of fine motor skills and the progression of the disease.
2. Daily routine and lifestyle. How do people with dementia live? A familiar environment, quiet, calm communication, the same circle of people for communication reduces the frequency of exacerbations of the disease and stops its course. New familiar, unusual situations that require the use of lost cognitive skills, cause excitement and anxiety, negatively affect the general condition, provoke exacerbation and accelerate the development of pathology. Therefore, dementia patients must have a clear daily routine and sufficient time to sleep. This significantly increases life expectancy.
3. Nutrition. How long people live with dementia also depends on proper nutrition. The diet has a particularly strong effect on the course of vascular ischemia. In case of chronic cerebral ischemia, the diet should include:

• nuts;
• legumes;
• vegetable oils;
• berries, fruits;
• dried fruits;
• seafood.

In the later stages of dementia, it is imperative to monitor how the patient is fed, since a lack of food and water leads to cachexia and dehydration, rapid exhaustion and shortened life expectancy. If all medical recommendations are followed, patients with dementia live, on average, several years longer.

Stages of the disease

The rate of development of alcoholic dementia depends on many factors: the amount of alcohol consumed, concomitant diseases, genetic inheritance, drug use. This means that dementia can develop differently in different patients, but still, as a rule, the disease goes through four main stages:

1. Stage one: initial. The only external sign is emotional disorders - the appearance of isolation, the predominance of depressive moods, the loss of previous interests and hobbies.
2. Stage two: easy. Mild dysfunctions of memory, attention and logical thinking are observed: patients find it difficult to remember or concentrate, and any intellectual stress comes at the cost of noticeable effort.
3. Stage three: middle. Symptomatically repeats the second stage, but the disturbances are much more pronounced: patients clearly do not control their attention, cannot remember anything, have difficulty remembering past events, and intellectually demonstrate violations of logical coherence, consistency of judgments or inferences.
4. Stage four: severe. There is a complete disintegration of the personality with disruption of all mental functions, loss of moral principles and the development of various mental disorders.

Diagnostics

The disease is quite difficult to determine in young people. It is important for patients to undergo a set of diagnostic measures when the disease manifests itself. The main thing is to find out the reason that launched the destructive processes. Lost time will irrevocably change the patient’s condition.

At the first signs indicating pathology (deterioration of cognitive abilities), you should urgently consult a doctor. Timely diagnosis will help the patient stop the rapid development of the disease and extend the period of self-care (personal hygiene, ability to solve household problems, prepare food, eat food).

The attending doctor gives a referral for examination by a neurologist and psychiatrist. Experts draw conclusions based on the results:

• personal conversation;
• magnetic resonance and computed tomography;
• blood tests for hormones;
• general and biochemical blood analysis.

It is not recommended to ignore emerging forgetfulness, absent-mindedness or excessive fatigue. It is important to understand that timely consultation with a doctor will prolong independent life.

Treatment methods

There is no specific treatment for alcoholic dementia. At the first and second stages, the main efforts of narcologists are aimed at improving blood circulation in the brain and maximizing the restoration of impaired functions of brain neurons.

Particular attention is paid to the vascular system, as it plays a key role in the nutrition of brain cells. For this purpose, patients regulate blood pressure and normalize blood sugar (glucose) levels. To improve the general condition, physiotherapy, dietary nutrition and therapeutic exercises are prescribed.

At the third and fourth stages, especially when signs of paranoia or schizophrenia are already observed, treatment is possible only in a hospital setting, with the use of antipsychotic drugs.

At-risk groups

Every person (young and middle-aged) has a fairly high risk of contracting this terrible disease.

People with Down syndrome or those who have a history of acquired or congenital dementia in their family are most at risk.

The following factors pose a serious threat:

• smoking;
• excessive alcohol consumption;
• high cholesterol;
• obesity;
• severe depression;
• atherosclerosis;
• diabetes;
• hypertension or hypotension;
• high levels of estrogen and homocysteine ​​in the blood.

Any of these factors can lead to early dementia, so it is necessary to take all tests in advance and change your usual lifestyle.

Find out more about dementia:

• how it is related to other neurological diseases;
• what are the symptoms and signs of dementia in older people, how is it treated;
• does dementia occur in children and adolescents, are such patients given disability;
• is there a difference in the manifestation of the disease in men and women;
• what tests can be taken to identify the disease;
• what is the patient’s life expectancy and how relatives and friends should behave with him.

Clinical prognosis

Overall extremely unfavorable. As mentioned above, lost neurons cannot be restored, and, therefore, with significant death of brain cells, restoration to the full extent of previous mental functions also becomes impossible.

Clinical prognosis for alcoholic dementia improves significantly with early medical help, when the loss of neurons is not yet critical, and the remaining brain cells can take over the functions of the lost ones, which partially or even completely compensates for the damage caused to the brain.