Predementia Neurocognitive Disorders in the Elderly
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Predementia Neurocognitive Disorders in the Elderly O. S. Levin
Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 119, No. 9, Iss. 2, pp. 10–17, September, 2019. Original article submitted June 7, 2019. Accepted June 27, 2019. Impairments to neurocognitive functions are among the main signs of brain damage, and are particularly manifest in the elderly. A significant proportion of elderly people consistently show “age-related” changes in cognitive functions within the age norm and not leading to social maladaptation, while other cases show increasing cognitive deficit resulting in loss of the ability to work, followed by domestic dependence – this is dementia. However, loss of mental faculty does not develop instantaneously – it is preceded by a longer or shorter transitional period, during which cognitive disorders are beyond age norms but have not yet reached the extent generally associated with the concept of dementia. Nonetheless, the onset of signs of dementia over prolonged periods of time provides a criterion for the main illness predominantly apparent as cognitive impairments. The need for earlier diagnosis led to the concept of “moderate cognitive disorder” (MoCD). Studies to date allow MoCD to be regarded as a constituent part of the complex structure of overlapping syndromes (“pre-dementia cognitive disorders”), whose identification may have not only theoretical, but also purely pragmatic relevance, on the one hand allowing series of clinical trials with different therapeutic targets to be planned and, on the other, rational approaches to the management of patients in clinical practice to be constructed. Keywords: pre-dementia neurocognitive impairments, subjective cognitive impairments, moderate cognitive disorder, dementia, memantine, cholinesterase inhibitors.
Introduction. Impairments to neurocognitive functions constitute one of the basic manifestations of brain damage, appearing particularly frequently in the elderly. In connection with increases in longevity and changes in civilization occurring in recent decades, the prevalence and social significance of cognitive impairments has grown inexorably in recent decades. Cognitive functions weaken with age, which is linked with involutionary changes in the brain. However, in most elderly people these are consistent changes and, although they may raise concerns, they do not go beyond the boundaries of age norms and do not lead to social maladaptation. Nonetheless, a significant proportion of elderly people develop severe cognitive deficit over time, such that the patient, as described by the famous Swiss psychiatrist E. Bleuler, “stops coping with life”: the patient loses the ability to
work and then domestic independence. This state is designated by the term “dementia.” Although the risk of dementia increases exponentially with age, this state is not an inevitable attribute of aging and is not linked exclusively with age-related changes in the brain. In addition, dementia is always based on pathological processes (degenerat
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