Neurological diseases: list, symptoms, causes and treatment features. Aging of the nervous system Diseases of the nervous system in older people

AGING AND MENTAL PROCESSES
DISORDERS IN THE OLD AND OLD AGE.

Aging is a natural physiological
The process itself is not a disease. Although human aging is
normal process, it is accompanied
a complex set of age-related changes in almost all organs and systems
organism. The skin gradually fades, the hair turns gray. Bones become brittle
joints lose their mobility. The work of the heart weakens, the vessels become smaller
elastic, slowing down the speed of blood flow. Changes in metabolism
cholesterol, lipids, blood sugar levels.
The activity of the respiratory system, digestion is disturbed. Decreases
activity of the immune system. Decreased vigilance, weakened hearing, reduced
sharpness of other senses. Weakens the activity of the endocrine and nervous
systems. Age-related changes in the body
although they are not a disease in the medical sense, they cause a feeling
sickness, uselessness, weakness.

In the process of aging, the psyche also suffers. Decreases
mental flexibility, the ability to adapt to changing conditions
life, activity and general tone fall, a feeling of weakness and general
malaise, mental processes slow down, wrinkle and attention worsen,
the ability to rejoice and emotionally respond to life events decreases,
there is a kind of senile conservatism. These mental changes
expressed to a greater or lesser extent
accompany the aging process
practically every person.

The aging process is extremely uneven. Signs of aging in different organs and systems
organisms do not appear simultaneously. In other words, some organs "age"
earlier and others later. For example, visual acuity begins to deteriorate already
after 20 years, changes in the musculoskeletal system appear after 30,
cardiovascular and muscular systems– after 40, hearing loss becomes
noticeable after 50. Once started, age-related changes gradually progress
throughout a person's life. In domestic science, the age of 45-60 is denoted
as a period of reverse development (involutional, climacteric), 60-75 years old - as an elderly
(presenile), 75-90 years old - as actually senile. People older than
90 years old are long-livers.

The aging process is individual.
People age differently. This applies not only to the age of appearance of the first
involutive changes in the body, not only the predominant defeat of some
organs and the relative safety of others, but also mental changes,
associated with the aging process. Many old people retain a high level of creativity.
activity and the ability to find the joy of life in changing conditions.
Accumulated life experience, maturity of judgments allow an aging person
reconsider past attitudes and views, form a new position in life, find a calm
contemplative attitude towards life. However, this is not always the case. In many cases, the very fact
aging and a number of related complex life situations create
conditions for violation of human adaptation.
Loss of loved ones and the problem of loneliness, retirement, end
professional activity, changing the stereotype of life and emerging
financial difficulties, the development of ailments and diseases that limit physical
opportunities and causing a feeling of weakness, inability to independently
cope with everyday problems, fear of the future, awareness of the inevitability
approaching death - that's far from complete list psychological problems
faced by the elderly.

Age-related biological changes in the body and
socio-psychological factors contribute to the development of mental illness in the elderly and senile age.

The most common manifestations of mental illness in the elderly and
old age - depression,
anxiety and hypochondria.

All old people periodically complain about a bad mood. IN
cases when the depressed mood becomes persistent, lasts for weeks,
especially months, we are talking about depression.
Sadness, sadness, gloom, joylessness, dreary or dreary-anxious
mood, a painful feeling of emptiness, a feeling of own uselessness,
senselessness of existence - this is the main context of the experiences of depressive
old man. With depression, activity decreases, interest in habitual
occupations and hobbies. A patient with depression often complains that "everything is done
through force." Often appear
various unpleasant sensations and pains, the general vitality decreases. violated
sleep, decreased appetite. Depressed old people don't always tell
others about their painful experiences. Often they are embarrassed or
consider their condition as a natural manifestation of old age. If elderly
a person becomes sad, silent, inactive, lies in bed for a long time
bed, often crying, avoiding communication - these changes in behavior can
indicate depression.

Depression is a serious illness. Without treatment
depression in the elderly and senile age can last for years, creating a mass
problems, both for the patient and his relatives. At the first suspicion of development
depression should see a doctor. The sooner treatment for depression is started
disorders - the faster it is achieved positive result. depression in
old age is curable. There are a wide range of medications and
psychotherapeutic techniques that allow you to save an elderly person from
depression and prevent its development in the future.

Many people become more anxious as they get older. simple life situations
with which a person used to cope without difficulty, cause a number of
unreasonable fears, excitement and anxiety. Going to the doctor, payment
utilities, meeting with friends, grocery shopping, cleaning and much more
the other becomes a source of endless fears and fears. In these cases
talk about the development of anxiety
(neurotic) disorder. Such patients are fussy, restless,
pester others with the incessant repetition of their fears. permanent
a feeling of inner tension with a sense of an impending catastrophe makes
the life of such people is unbearable. A common theme of fears in old age is one's own
health or health and life of loved ones. Such patients are afraid to stay in
loneliness, require that someone close to them constantly
accompanied, endlessly calling relatives with questions about their well-being. At times anxiety reaches
degree of panic. Patients cannot be at rest, rushing around the apartment,
groaning, crying, wringing their hands. Anxiety is often accompanied by various
unpleasant sensations in the body (pain, palpitations, internal trembling, spasms in
stomach, etc.), which further increases the excitement and gives rise to new fears. At
sleep is often disturbed by anxiety. Patients can not fall asleep for a long time, wake up at night.
Sleep disturbances, in turn, become a source of new fears and fears.

Anxiety neurosis is a serious disease that requires specialist treatment.
It is impossible to cope with this state by the effort of one's own will. Reception
sedatives provide only temporary relief. Meanwhile,
use of modern medical techniques allows you to completely get rid of
anxiety and fear.

Hypochondria is an excessive fixation of a person on
bodily sensations with the appearance of fears or beliefs in the presence of a severe
physical illness not supported by objective medical evidence
surveys. Old age itself, with the inevitable development of physical malaise and
a variety of painful sensations provides abundant food for the formation
hypochondriacal experiences. Hypochondria manifests itself, as a rule, in the form of new
unusual and extremely painful bodily sensations for a person. Burning,
constriction, twisting, shooting or incessant aching pains, "bumps
current”, a burning sensation in the body - this is not a complete list of complaints of patients with
hypochondria. A thorough examination by a therapist or neurologist does not allow
identify the cause of these sensations, and the appointment of painkillers is
ineffective. Hypochondriacal sensations and ideas are usually accompanied by decreased
mood with a touch of irritability, discontent, grumbling. These patients
differ in distrust, often change doctors, insist on additional
surveys. Constant fixation on painful sensations, endless
demand for help from relatives, significant financial costs for all
new expensive examinations - this is the lifestyle of a patient with hypochondria
old man. Meanwhile, the basis of painful bodily sensations in hypochondria are
mental disorders.

Treatment of hypochondria
- difficult task. Only the complex prescription of medications and
psychotherapy, perseverance on the part of doctors and the help of loved ones will allow
an elderly person to get rid of painful bodily sensations.

Relatively rare, but very dangerous mental disorder
in old age - a manic state
(mania). The main manifestation of mania is a painfully increased
mood. Inadequate gaiety with flat, often ridiculous jokes,
benevolent-euphoric mood with a tendency to boast and glorify
are easily replaced by outbursts of anger with aggression. These patients are tireless, sleep very little,
excited, always in motion, talkative, distracted. It's hard for them
focus on a topic, they easily jump from one thought to
another. In a manic state, a person is looking for new acquaintances, uncontrollably
spends money and often becomes a victim of scammers.

During the period of mania
a person is uncritical about his behavior and rarely gets to the doctor on his own
desire. Meanwhile, active treatment is necessary not only to
prevent inappropriate behavior during a period of manic excitement, but also
because mania tends to be replaced by severe depression. Without adequate
therapy in old age, there is often a continuous change of manic and
depressive states.

Older people are often suspicious. They often
complain about unfair treatment by others, harassment from
side of relatives, infringement of rights. In cases where these complaints are not subject to
real grounds, we can talk about the development of crazy ideas - false, not corresponding to reality
judgments and inferences based on
disorder of mental activity. Crazy ideas - basic
manifestation of chronic delusional disorder - a disease, often
found in old age. Gradually, suspicion increases, any
the actions of others are interpreted as directed against the patient. Content
delusional ideas varied. Most often these are ideas of theft, material or
moral oppression, persecution for the purpose of taking possession of property, poisoning.
Patients say that ill-wishers want to "get rid of" them, evict them from the apartment,
steal things, products, mock them in every possible way, secretly penetrate into
room, leave garbage, dirt, put inedible objects in food,
let gases into the apartment, scatter poisonous powders. Sometimes content
delirium is jealousy. Events that are the content of delusions, as a rule,
take place within the apartment. As ill-wishers usually act
neighbors or relatives. Less often, strangers are involved in the circle of pursuers.
people, representatives of the police, utilities, doctors.

In old age, delusions are often accompanied by false perceptions.
(hallucinations). Patients "hear" unusual sounds in the apartment, knocking, steps,
vote. Sometimes they complain about unusual smells in the apartment, the changed taste of food.
Sometimes they “see” strangers in the apartment.

Delirium is always accompanied by anxiety, fear,
often depressive experiences. Patients themselves suffer from
disease is no less than the people around them. Crazy sayings of old people
often perceived by others as psychologically understandable. Often
relatives, wishing to protect the patient from
unpleasant neighbors, changing apartments. When the situation changes, delirium for some
time subsides, but then resumes with the same force.

Patients with delusions are not critical to the content of their experiences, their
impossible to convince, logical arguments fail to prove them false
statements. They refuse psychiatric consultation and treatment. In the absence of perseverance
relatives, these patients can stay at home for years, and sometimes decades, without
treatment. At the same time, having started treatment and feeling relief in the state (disappearance of anxiety, fear, deactualization
delusional experiences) patients subsequently independently begin
seek the help of a doctor.

specific
form of mental disorders in old age
is dementia.
The main manifestation of dementia is a violation of memory and higher mental
human functions. The most common forms of dementia in old age are vascular dementia and Alzheimer's disease.

unsharp
memory loss
observed in normal mental aging. Decreases with age
the speed of mental processes, the ability to concentrate, appears
forgetfulness, difficulties arise when remembering names, names, worsens
the ability to remember new information. These memory impairments do not prevent
daily and social life of people of senile age, are preserved
all the personality traits of a person are unchanged.

A different picture is observed in dementia. Memory impairments are never isolated, but
are always accompanied by a change in other mental functions and behavior in
in general. Alzheimer's disease develops gradually. The first manifestation
diseases are memory disorders and memory loss for current and
past events. The person becomes forgetful, distracted, current events in
his experiences are replaced by the revival of memories of the past. Already in the early
stages of the disease suffers orientation in time. The idea of
time sequence of events. The character is changing
person, the previously inherent personality traits are erased. He becomes
rude, selfish, sometimes apathy and inactivity come to the fore.
In some cases, the first manifestations
Alzheimer's disease may be delusions or hallucinations, as well as prolonged
depression.

By
As Alzheimer's disease progresses, the symptoms of dementia become apparent.
The patient is disoriented in time,
space, environment. These patients cannot name the date, month
and a year, are often lost on the street, do not always understand where they are, do not recognize
acquaintances and close people. Orientation in one's own personality is also disturbed.
Patients cannot tell their age, they forget the key facts of life. Often
there is a “shift into the past”: they consider themselves children or young
people claim that their long-dead parents are alive. Habitual
skills: patients lose the ability to use household appliances, cannot
dress yourself, wash yourself. Conscious actions are replaced by stereotyped
wandering and mindlessly collecting things. Impaired ability to count
letter. Speech is changing. Significantly depleted at first lexicon. Current
events in the statements of the patient are replaced by false memories. Gradually
speech loses its meaning more and more, the statements of patients acquire the character
stereotypical phrases, fragmentary words and syllables. In the advanced stages of Alzheimer's disease, patients completely lose
the ability to exist without outside help, speech and motor activity
limited to meaningless cries and stereotyped movements within
bed.

At an early stage
Alzheimer's patients rarely see a doctor. As a rule, memory impairment and character changes
evaluated by others as manifestations
natural aging. Meanwhile, treatment started at an early stage of the disease
Alzheimer's, most effective. However, modern medicinal
drugs can slow down the progression of the disease, reduce the severity
memory impairment, facilitate patient care even later stages of the disease
Alzheimer's.

In vascular dementia, the severity of mental
disorders usually do not reach such a deep degree as in the disease
Alzheimer's. These patients are characterized by significant fluctuations in the severity
violations of memory, orientation, awareness of the surrounding reality sometimes
even during the day. The prognosis in these cases is better than with the disease
Alzheimer's. It is extremely important to clarify the diagnosis already in the early stages of the disease,
because therapeutic approaches
significantly different in different forms of dementia.

Mental illness in old age is not always on time
are recognized. Often the person himself, his relatives, and sometimes general practitioners
practitioners consider the violations that have arisen as a manifestation of the “natural”
aging. Often an older person
suffering for years from painful manifestations of mental disorders, is afraid to turn to
to a psychiatrist, fearing that he would be considered "crazy". These people especially need
help and support from relatives. Properly prescribed treatment allows the elderly
a person to get rid of painful experiences that darken the last stage of his
life, and achieve a peaceful and happy old age.

In gerontology (the science of old age)
distinguish between the concepts of "painful" and "happy" aging. At present, gerontopsychiatry
has great potential for
early diagnosis of mental disorders in old age and a wide arsenal
medical and psychotherapeutic methods
their effective treatment. Starting treatment as early as the first symptoms
mental disorders in old age - the key to success in therapy and improving the quality
life of elderly and senile people.

Any living organism from the moment of origin and throughout its life undergoes certain changes in structure, metabolism, function and behavior, successively passing through the stages of embryonic and postembryonic development, maturity and old age, inevitably ending in death. Old age and death inevitably occur even if the body is in the most favorable environmental conditions and is provided with good food. Despite the fact that, as is known, environmental influences can have some modifying effect on the rate and nature of age-related changes, no one has yet been able to significantly slow down the aging process, let alone reverse it, which rather indicates the internal nature of this process.

At present, no definitive conclusion can be made about the causes of aging. From the numerous hypotheses existing on this issue, two main groups can be distinguished. The hypotheses of the first group suggest that aging is a consequence of the accumulation of irreparable damage received by the body during life.

As damaging factors, radioactive radiation can act, including background radiation resulting from the decay of natural radioactive elements, cosmic radiation and other sources of radiation, as well as random fluctuations in pH and temperature in microvolumes of the environment.

In addition, free radicals and peroxides, which can be formed during the oxidation of substances in the body, have a strong damaging effect. As is known, these compounds are chemically extremely active and capable of causing damage to molecules by breaking them or forming intramolecular and intermolecular crosslinks. The accumulation of poorly soluble collagen and lipofuscin described during aging may be a consequence of such free radical oxidation.

The inevitability of senile changes and the fatality of death, the desire to delay the outgoing and return the past youth has long excited the human mind and awakened the imagination. There are no number of legends, fantastic attempts and unreasonable recommendations that came from the depths of centuries and do not disappear today, which promise a quick achievement of long-term youth, longevity and getting rid of diseases. Most often, these methods of "rejuvenation" are naive and, at best, worthy of attention. However, they can be potentially hazardous to health. Such recommendations should be based only on scientific understanding of the mechanisms of aging and comprehensive experimental verification.

The central nervous system is designed to adapt the body to existence in conditions external environment to provide mechanisms for it to increase life expectancy. Age-related changes occurring in the nervous system are one of the main causes of aging.

The work of the central nervous system is disrupted primarily due to the aging of receptors - the endings of sensitive nerve fibers and specialized cells that are the link between external stimuli and the central nervous system. This process continues throughout life and occurs in all parts of the central nervous system.

In the process of aging of the body, the psychomotor reaction slows down significantly. The time required for the activation of conditioned reflexes - vascular, motor, blinking and respiratory - noticeably increases. With age, the ability to simultaneously and successfully perform several activities deteriorates sharply.

This is due to a significant change in the processes of protein biosynthesis in the brain. Protein production becomes less active due to a decrease in the content of RNA in nerve cells, which is due to the fact that the process of producing this acid slows down. As a result, the excitability and reactivity of the cellular structures of the brain worsen. The main nervous processes - excitation and inhibition - become unstable.

In the process of aging, the structure and metabolic processes in nerve cells (neurons), in their long processes (axons), as well as in their branching processes (dendrites) change. This leads to the death of part of the neurons, which is an almost irreparable loss: in the course of recent discoveries, scientists have found that although nerve cells divide (this was previously denied), they recover extremely slowly. Meanwhile, throughout a person's life in the neural networks of the brain, all the necessary vital information is accumulated and stored, which is associated with memory, experience and the possibilities of their use.

Since the density of neurons in the cerebral cortex decreases in old age, the intensity of blood flow to the brain decreases. The weight of the brain also changes with aging. After 30 years, it begins to slowly decrease (in men, this process occurs faster). At the same time, the energy potential of the brain decreases, which is associated with a weakening of energy metabolism.

Aging processes are characterized by a series of manifestations that are the same for all organs and systems, which consist in the replacement of active cells of fat and connective tissue due to impaired blood supply due to atherosclerotic and involutive processes in the cardiovascular system.

These phenomena are also characteristic of the central nervous system. With age, the mass of the human brain decreases, there is a decrease in the number of neurons in the cerebral cortex, subcortical nuclear structures and the cerebellum, while the number of glial cells increases. First of all, neurons that occupy a polar position in relation to functional activity die, i.e. actively functioning cells and neurocytes that do not have a functional load (accelerated wear and atrophy of rest). The biochemistry of neuronal activity changes: the synthesis and metabolism of neurotransmitters decreases, intermediate metabolites and toxins accumulate, causing multiple prolonged DNA damage, which leads to the accumulation of mutations and slows down the course of reparative processes.

The described morphological changes in the brain tissue lead to functional consequences. The electrical activity of cortical neurons decreases and the efficiency of transmission of nerve impulses is impaired, the efficiency of brain metabolism decreases, a cascade of biochemical reactions is observed - a decrease in the concentration of dopamine, serotonin. Against the background of brain hypoperfusion, the accumulation of pro-inflammatory signaling molecules in it - tumor necrosis factor, pro-inflammatory interleukins, was noted, which aggravates the aging process of the brain and stimulates the clinical manifestations of this aging.

It should be noted that the initial manifestations of aging appear quite early, in the fourth decade of life, in which the process of reducing the number of neurons begins. However, the decrease in the number of nerve cells in itself does not have a decisive influence on the manifestations of aging. More important is the state of functional connections between neurons, which are carried out due to neurotransmitters that interact with the corresponding receptors. It has been proven that in the process of normal natural aging there is a gradual dissociation of the regulatory systems of brain neurons. First of all, this is manifested by a change in signal cascades at the level of the cell nucleus, then there is a violation of the structural and functional properties of synaptic membranes and their degradation.

Recently, the number of old people has increased significantly. This caused the need for scientists to turn to the study of gerontology. At the same time, clinicians still pay little attention to the peculiarities of the mental activity of people of the elderly and senile age.

The nervous system during a person's life, like all other systems of the body, undergoes changes. The brain is also changing (Table 15)

There is evidence that in old people there is a smoothing of twists and a thickening of the brain membrane. Changes in the nervous system during aging are reduced to a violation of the nuclear-plasma ratios, some authors point to the branching and hypertrophy of dendrites that occur in the brain of senile people, sometimes.

The deposition of yellow-brown lipoid and black metalloid pigments, considered characteristic of old age, begins at a very early age, and in old age these deposits only change color ((from yellow to brown), while unpigmented cells are observed.

It should also be taken into account that not all parts of the brain change uniformly, except for

. Table 15. Dynamics of the mass (in grams) of the brain due to age (IS. Vitenko, 1994)

Age, years	Men		Women
	Mass per Bischoff	Mass for Chernyshev	Mass per Bischoff	Mass for Chernyshev

In addition, there is still no clear abolition of its typically senile changes from those stipulated by vascular disorders. The importance of the vascular factor in the aging process. The central nervous system is also reflected in age-related changes in blood circulation in the brain, as can be seen from Table 1.6.

. Table 16. Age-related changes in blood circulation in the brain

It is impossible to clearly establish the beginning of the physiological decline in mental activity. There are only data that indicate that the ability to quickly switch mental activity begins to decline from the age of 25-35, the clarity of perception and memory training - from the age of 40. At the same time, along with an early decrease in some mental functions, a further improvement in others is noted.

The state of analyzers in the elderly and senile age

Along with psychological changes, the functioning of the sense organs also changes with age. In older people, the accommodative ability decreases over the years, senile farsightedness often develops, and the field of vision narrows. Hearing acuity is reduced, which can lead to the development of a mild form of hearing loss, in general, these changes do not reach sharp manifestations. Most characteristic feature hearing impairment in the elderly and old people is considered to be a weakening of the intelligible perception of the language. There is such a phenomenon when the one who listens does not see the face of the speaker; the background is normal. Audiometric cree vrivu.

The doctor should take this into account when talking with elderly patients.

Taste, smell, pain and tactile sensitivity also decrease with age, but remain within the lower normal range.

The function of the vestibular apparatus noticeably changes, it weakens and may be absent in very old people. Its decrease is associated with the unsteady gait of people and their motor skills in general.

At the age of 70-80, the number of neuromotor units decreases. This process in the calf muscles begins already at the age of 45-50, in other muscles - later, which affects facial expressions both at rest and when smiling. Changes in motor skills are closely related to changes in sensory systems.

When aging proceeds normally, at the later stages, a narrowing of the ranges of all sensory systems of the body, a decrease in the speed of impulse conduction are noted.

During his life, a person goes through a number of stages of his development - infancy, childhood, adolescence, transitional age, adulthood, maturity, old age and, finally, old age and extinction. At each stage, there are their own tasks and priorities, life problems and experiences associated with them, as well as some changes in the physiological plan. As for adulthood, here the main changes occur in the cerebral cortex and these changes affect memory.

Each type of memory (sensory, short-term and long-term) from a functional point of view is provided by brain processes of varying complexity and mechanisms associated with the activity of various brain systems, which in turn are related both structurally and functionally. Memory acts either as a dynamic function that develops over time, or as a complexly organized material structure localized in the space of the brain. The characteristics of functional systems (“functional organs”, according to A.A. Ukhtomsky), which are formed from various brain formations in the process of engram fixation, the implementation of the memory function, form the structural and functional basis of memory and learning.

Revealing the topography of systems that implement the engram is associated with great difficulties due to dynamism and wide distribution. The formation of an engram is a complex dynamic structure, in which a wide range of brain formations participate, but each of them plays a special role in the implementation of certain types of nervous activity, making its own temporal and functional contribution. It is assumed that in the process of learning in the cortical-subcortical structures, a model of the spatial distribution of co-excited structures is formed, and when a trigger stimulus (conditioned, situational, motivational, verbal, etc.) is turned on, an engram of co-excited points is reproduced, which determines the final specific result of conditioned reflex activity.

The combination of various brain formations into certain functional memory systems may be based on different initial principles. One of the most global principles is the allocation of structures that are included in the actual memory system, i.e. involved in the storage of memorized information, and a system of structures that form a regulatory (modulating) memory system. In the implementation of this approach, significant difficulties are in identifying macrostructures in which the whole engram can be localized, rather than its individual components. This was pointed out in 1950 by K.S. Lashley in his famous work "In Search of the Engram". The problem of engram localization remains one of the most difficult and, in essence, far from being solved. The regulatory mechanisms of memory include those structures, interventions in the activity of which lead to a change in the function of memory. The memory regulation system includes two levels: nonspecific (“general brain”) and modal-specific (“regional”). The modal-specific level of memory modulation includes various parts of the neocortex, with the exception of the frontal cortex. The nonspecific level of regulation of memory processes includes the reticular formation (mesencephalic), hypothalamus, associative thalamus, hippocampus and frontal cortex. The close functional connection of the links of the non-specific and specific memory modulation systems, in essence, includes their separate functioning. This means that any form of memory modulation involves non-specific and specific components in their dynamic interaction.

Fixing the information of the events of the external world in their spatial and temporal interconnection requires a known time, i.e. is a multi-stage process. The first stage of engram formation is associated with the emergence of sensory traces that make up the content of sensory memory. They arise due to the activity of sensory systems, analyzers, the optimal level of functioning of which is provided by the activating systems of the brain. Simultaneously with the arrival of sensory information in the cortical zones, the second stage begins, which determines short-term memory. At this stage, the process of sorting sensory signals, extracting new information for the body from them, is carried out. This occurs through the activation of the mechanism of the orienting reflex, which mainly ensures the interaction of modal-specific (analyzer) systems with the hippocampal formation with its large and small limbic circles. According to the concept of O.S. Vinogradova, the hippocampal system plays the role of a special preliminary device that does not allow rigid fixation of all random traces and contributes to the best organization of the classification system for storing traces in long-term memory. In long-term memory (the third stage), events that are significant for the body are mainly recorded. The selection of significant events among the new ones identified by the hippocampal system is carried out by the reinforcement system, which is represented by a complex emotional and motivational apparatus. Long-term memory is formed with the indispensable participation of reinforcement systems, i.e. it has a conditioned reflex nature. Long-term memory is actively involved in the activity process during the period when the hippocampal system releases new signals focused in the current “field of consciousness”, and evaluates the significance of these signals in relation to their ability to meet the needs of the body. meaningful in a positive or negative respect is fixed in long-term memory. At this last stage, trace processes pass into a stable structure. In this link of engram fixation, molecular processes at the cellular and subcellular levels play a key role. Significance in the formation of memory has a key role.

With regard to the brain apparatus of memory, the idea has developed that, like other higher functions, memory is organized according to a polysystemic principle. N.P. Bekhtereva, summarizing numerous data on electrical stimulation of the human brain, comes to the fundamental conclusion that “although there are areas of the brain that are closely related to memory processes, the recording data of the physiological parameters of the brain and its electrical stimulation indicate an organization according to a distributed principle ... One gets the impression not just about the systemic nature of the organization of memory, but about the multitude of systems that provide different types and different phases for each memory, having links common to all and different for each of them. The basis for classifying a particular structure as a memory system is the degree of influence of this structure on the consolidation of learning outcomes in the same experience when it is turned off. In fact, significance, by controlling attention, i.e. opening certain areas of the brain, and ensures the relevance of fixing traces in them.

As most studies have shown, damage or removal of sections of the convexital cerebral cortex leads to the development of selective, modal-specific memory defects relating only to those types of stimuli that are perceived, processed, and possibly stored in the cortical field of the analyzer. With local lesions of the associative cortical zones, partial motor, visual, auditory and other amnesias are observed, which are based on the breakdown of previously strengthened conditioned reflex connections, i.e. long-term memory is impaired. It has been established that when the cortex is damaged, it is especially difficult to memorize and store more complex and less emotionally significant material. It is assumed that the temporal association cortex, whose neurons are characterized by gnostic characteristics (unitary perception), can take part in the formation and, possibly, storage of figurative memory. The phenomena of involuntary recollection of distant events by patients were demonstrated in the works of W. Penfield, which were carried out by electrical stimulation of the temporal lobe during neurosurgical treatment. It is noted that vivid memories arise during electrical stimulation of the epileptic brain, in which the excitability thresholds are lowered and therefore the activation of memory traces is facilitated.

The view of the cerebral cortex as the main substrate of long-term memory is considered by most researchers to be quite reasonable. At the same time, memory defects that occur when cortical areas are damaged can be explained not only by the destruction of traces stored in them, but also by difficulty in reproduction. To a large extent, this remark applies to the temporal cortex and the frontal lobes of the brain. So, with the "frontal syndrome" there is a difficulty in the active organization of actions, the inertia of stereotypes, and easy distractibility. All this leads to the impossibility of selective reproduction of traces of the current event and past experience. Apparently, this is due to the fact that motivational excitation from the limbic system enters the frontal and frontal cortex. The frontal cortex selects highly significant signals, sifting out secondary stimuli for a given moment. After the removal of the frontal sections of the neocortex, the value of the signals (often and rarely reinforced) is balanced, all signals become equally effective. The frontal regions of the cortex have different functional involvement. The dorsal regions (connected anatomically with the hippocampus) are predominantly involved in the “information” systems of brain formations, and the ventral regions (connected with the amygdala) are more involved in the “motivational” system. The frontal cortex can influence the hippocampus involved in the selection of stimuli in the process of orienting-exploratory activity.

The hippocampus plays a significant role in providing memory and in the genesis of its disorders. There are two hypotheses. According to one of them, the hippocampus has an indirect effect on the mechanisms of learning by regulating wakefulness, focused attention, and emotional and motivational arousal. According to the second hypothesis, which was last years widely accepted, the hippocampus is directly related to the mechanisms of coding and classification of material, its temporal organization, i.e. The regulatory function of the hippocampus contributes to the intensification and lengthening of this process and, probably, protects memory traces from interfering influences, as a result, optimal conditions are created for the consolidation of these traces into long-term memory.

The hippocampal formation is of particular importance in the early stages of learning, conditioned reflex activity. During the development of food conditioned reflexes to sound, short-latency responses of neurons were recorded in the hippocampus, and long-latency responses, in the temporal cortex. It was in the hippocampus and the septum that neurons were found whose activity changed only upon presentation of paired stimuli. The hippocampus is the first point of convergence of conditioned and unconditioned stimuli. Being a structure where motivational excitation of the posterior and anterolateral hypothalamus is compared with information coming from the external environment (through the septum), as well as with traces of previously accumulated experience (from the cortex), the hippocampus, apparently, performs a dual function. First of all, it plays the role of a selective input filter that canalizes urgent stimuli to be registered in long-term memory and extinguishes reactions to extraneous stimuli in this moment. At the same time, the hippocampus is involved in retrieving traces from memory under the influence of motivational arousal. Traces can be retrieved from memory independently of external stimuli, and can also provide expectation of these stimuli by the tonic feedback mechanism. In other words, the hippocampus can participate not only in fixation, but also in the reproduction of learned information by storing the addresses stored in trace memory. But since the reproduction apparatus does not suffer completely when the hippocampus is damaged, it is assumed that the reproduction defect in amnesia may be due to a disorder of emotional and motivational processes, as well as a violation of the selection and organization of the material.

It is suggested that the ability to learn is associated with the level of functional activity of the hippocampus, which in turn is hereditarily determined. The development of the hippocampus in evolution, the completion of its maturation in ontogenesis will coincide with a critical period - the transition to independent establishment of contacts with the environment, to active orienting-exploratory behavior. In immaturely born hippocampal neurogenesis is completed at this time. Studies of cellular and synaptic activity have shown that the pyramidal fields CA1 and CA2 of the hippocampus, in addition to their usual properties, exhibit a unique ability to generate long-term, calculated for hours and weeks, potentiations of synaptic transmission. Long-acting post-tetanic potentiation (PTP) is considered as the basis for the formation of a memory trace. Long-term potentiation occurs in spiny synapses of hippocampal pyramidal cells after repeated presynaptic stimulation. It is similar to a conditioned reflex: stimulation repeated for 12 days leads to the preservation of potentiation for 37 days; a greater number of stimulations, acting as a reinforcer, ensures that the potentiation is maintained for many weeks; extensive areas of the cortex are responsible for the occurrence of potentiation in the hippocampus by generating their own long-acting potentiation.

Studies of the features of the topographic distribution of giant synapses of mossy fibers (or axons of granular cells of the dentate fascia), the so-called “memory synaptic endings” on hippocampal pyramidal neurons, were carried out on various genetic lines of mice and rats. Linear (genotypic) differences were established in the number and localization of giant synapses on the dendrites of hippocampal pyramidal neurons. Anatomical differences are in a certain connection with the rate of formation of a conditioned reflex. In animals selected for a high rate of formation of conditioned reflexes (avoidance reactions), mossy fiber terminals are most numerous on the apical dendrites of pyramidal cells, and in animals with low level avoidance reactions - on basal dendrites. The total area occupied by the fibers turned out to be equal. In rats with a high level of active avoidance, there was a large width of the motor cortex, large sizes of the dentate gyrus and corpus callosum. It is assumed that the distribution of mossy fibers is an inevitable final step in strengthening the pathway: cerebral cortex - entorhinal cortex - dentate fascia - field CA3 of the hippocampus. It is assumed that the increased size of the pyramidal neurons of the hippocampus serve as an indicator of its functional activity (the large surface of the neuron is able to receive more afferent impulses coming to the cell body both from the outside and from interneurons). It can be noted that animals with different genotypes differ in neuroanatomical features, learning ability, and excitability threshold. As already noted, the increase and complication of the dendritic tree of a neuron in phylogenesis is necessary not only for receiving a large number of incoming impulses, but also for their preliminary processing. It is known that the dendrites and synaptic connections of the pyramidal neurons of the neocortex and the hippocampus are formed during the ontogenetic development of the brain. Moreover, in young individuals, the ends of the dendrites, in particular the apical ones, remain free for some time to form new synaptic contacts. The parts of the dendrite located closer to the body of the neuron are associated with stronger and simpler natural reflexes, and the ends serve to form new selective connections and associations. In adulthood, the dendrites no longer have areas free from neuronal contacts, but with aging, it is the ends of the dendrites with later synapses that suffer first of all. Perhaps this is the morphological basis for such a widely known fact in neurology and in everyday life, when in old age it is difficult to digest new material, current events are forgotten, but past events are easily reproduced. In addition, there is every reason to assume that ontogenetic heterochronous maturation of specific synapses is a necessary adaptation for the spatiotemporal distribution of nerve impulses on a neuron, which ensures its involvement in a certain engram.

The results of morphological and physiological studies led to the idea of ​​the existence of a ring system: hippocampus - hypothalamus - reticular formation. This phylogenetically ancient system is united by direct and feedback connections, through which the new cortex carries out self-regulation and regulation of other brain systems. When exposed to an external stimulus, previously formed corticofugal selectively facilitating or inhibitory effects are formed or switched on in the neocortex, which are directed to reticular interneurons that perceive afferent impulses. Corticofugal impulses, pre-processed by physical and biological parameters, are directed to reticular neurons to minimize and selectively subcortical influences on the cortex.

The activating reticular formation has not only a general activating effect on the process of engram formation, but is also directly included in its structure. During the period of action of narcotic and other neuropharmacological agents that inhibit the function of the reticular formation, the memorization of new material of any modality is impaired, regardless of its complexity and emotional significance. This is due primarily to the suppression of activating reticulocortical influences, and this worsens the consolidation of traces. In contrast, stimulation of the reticular formation facilitates learning and accelerates the fixation of the engram.

An increase in the activity of the thalamocortical system with the help of electrical stimulation or neuropharmacological drugs is accompanied by an improvement in short-term memory, in particular its most primitive form, the so-called "echo memory", i.e. the volume of directly reproduced material increases after its presentation at a fast pace. With the destruction (destruction) of some thalamic nuclei (dorsomedial and ventrolateral), it may be difficult to assimilate new material or retain previously memorized information, and memory defects for distant events are also detected. However, since these phenomena are transient, it is assumed that such memory impairments are associated with a weakening of the activating influences of these nuclei on the frontal cortex.

The interaction of two streams of impulses, their processing and comparison underlie the specific integrative function of the frontal lobes, which form general programs of behavior and commands for the nearest subcortical structures, in particular for the neostriatum, where two streams of impulses are also compared, which is important for the formation of all types of motor movements. reactions. For the formation and implementation of conditioned reflex forms of behavior, the cortical level of signal processing is more important than the neostriatal one. This shows a certain hierarchy of the two systems of integration.

Thus, the conditioned reflex (engram) is a highly integrated phenomenon in which various cortical and subcortical formations of the brain take part, which are involved in the integrative process with different functional and temporal contributions. Recognizing the neurophysiological specificity of brain formations, due to the peculiarities of processing the flow of information carriers afferent for these formations (for example, nerve impulses), we can talk about a wide brain topography of functional aggregates involved in the learning process.

But, as for mature age, it is precisely for him that it is characteristic that at this age, as already mentioned above, various kinds of changes occur, and often these changes lead to certain diseases. These diseases primarily include: vegetative-vascular dystonia, cervicalgia, atherosclerosis, multiple sclerosis, Parkinson's disease.

Vegetative-vascular dystonia is a fairly common diagnosis, especially in young and adulthood. It is characterized by autonomic disorders of the nervous system: nervousness, irritability, headaches, decreased ability to work, which is often regarded by doctors as neurasthenia. Particularly characteristic attacks of headaches, accompanied by nausea, vomiting, sharp pains in the heart, increased blood pressure, trembling in the body. Often such patients are taken to the hospital with a diagnosis of myocardial infarction. Patients have a feeling of fear, but no serious consequences. This disease does not end, and with proper diagnosis and qualified treatment, full recovery can be achieved.

Cervicalgia: pain in the neck. They can be benign (osteochondrosis), or a manifestation of a serious pathology (tumor). Most often, doctors and patients themselves associate pain in the neck with osteochondrosis, but pain in the neck does not always depend on osteochondrosis. They can be the cause of other, more serious diseases against the background of osteochondrosis.

Currently, acute cerebrovascular accident is a common pathology, and not only in the elderly, but also at a fairly young age (the so-called strokes). They can be of the ischemic type (transient cerebrovascular accident, or ischemic infarction) and hemorrhagic stroke with cerebral hemorrhage. Their prevention is an urgent problem in medicine; avoid risk factors (hypercholesterolemia, hypertension, diabetes mellitus, cardiovascular diseases). Manifestations of a stroke: impaired speech, paresis and paralysis, loss of consciousness and other symptoms. Timely and correct diagnosis and, of course, the use of modern methods of treatment and further rehabilitation under the guidance of qualified specialists are very important, which is often not carried out by patients after discharge from the hospital, which can lead to the complete disappearance of all symptoms of the disease.

The most common complaint of patients in the clinical practice of a doctor with diseases of the nervous system is frequent headaches. There are many reasons: there may be tension headaches, with migraine, after a traumatic brain injury, with vascular pathology (atherosclerosis, vascular aneurysms), brain tumors. In men, more often at the age of 30-40 years there are so-called. cluster pains, which are manifested by paroxysmal sharp pains, can be periodically repeated, or chronic. Causes: pituitary tumors, hormonal imbalance, vascular aneurysms, ethmoiditis. Such pains always serve as a signal of danger and require a thorough examination.

Plasticity of the nervous system - the ability to functional brain restructuring in response to the action of significant external and internal factors. Nervous structures have a special plasticity in early ontogenesis, due to which a significant restructuring of their structure and connections is possible in case of various injuries. With age, plasticity decreases. For a mature brain, the property of functional plasticity can manifest itself both at the neuronal and systemic levels.



1.1. What morphological, metabolic and functional changes occur in the nervous system during aging?

The leading mechanism of integral aging of the body is age-related changes in the mechanisms of neurohumoral regulation. They determine the main changes in thinking, psyche, memory, emotions, performance, reproductive ability, regulation of physiological functions.

The number of nerve cells decreases from 10-20% in 60-year-olds to 50% in the elderly. Dystrophic changes in the cells of the nervous tissue increase: lipofuscin (a product of fatty acid oxidation) accumulates in neurons, senile amyloidosis develops (accumulation of a special protein, amyloid, in the brain tissue). Focal demyelination of nerve fibers develops, which leads to a slowdown in the conduction of excitation along the nerve fiber and an increase in the time of the reflex. There are atrophic changes in the convolutions, the expansion of the furrows (mainly in the frontal and temporal lobes).

With aging, the functional capacity of the brain decreases. The inhibitory effects of the cerebral cortex on the activity of subcortical formations are reduced. Old conditioned reflexes slowly fade away and new ones are difficult to develop. Alpha rhythms slow down, slow fluctuations intensify, the excitability of brain structures changes unevenly, which leads to disruption of the integrative activity of the brain and contributes to the development of inadequate reactions.

In various parts of the nervous system, the metabolism of brain neurotransmitters (dopamine, norepinephrine, serotonin, acetylcholine) is disturbed, which determines the development of aging and increases the risk of developing aging diseases - Parkinson's disease, depression, etc.

An important role in the development of aging is played by dysfunctions of the hypothalamic-pituitary system, which causes disturbances in adaptive (adaptive) reactions.

1.2. What clinical manifestations of neuropsychiatric disorders are characteristic of aging?

· Asthenic syndrome: weakness, decreased performance, increased fatigue, sleep disturbances

Weakening of attention, concentration, ability to assimilate new information, learning, including self-care

Decreased memory, often develops " retrograde amnesia"- such a memory disorder when memory is lost for what has recently happened and old events are restored in memory (it is possible for a person to immerse himself in memories, "return to the past" and indifference to real life)

· Increasing "mental rigidity"- conservatism in judgments, a negative attitude towards the new, praising the past, a tendency to teach and edify, overestimate one's own personality

The appearance of inadequate emotional and behavioral reactions is possible: explosiveness, aggressive forms of behavior

Changes in the emotional sphere are characteristic: a decrease in mood, emotional lability(mood instability), increased touchiness, tearfulness

Pessimism, grumbling, grouchiness, self-centeredness, suspicion, pettiness, distrust, callousness

Characteristic “sharpening” of character traits, especially negative ones: thrifty people become stingy (Box from “ dead souls”), the shy and incredulous become hypochondriacs, fixated on painful sensations.

If life is bleak, then the emotional sphere drastically fades, a person ceases to be interested in the surrounding life, family, and politics. His feelings are closed on physiological processes: food and sleep.

Intelligence tends to be preserved with aging, but changes in intelligence are very individual. In people who had high intelligence in their youth, a decrease in intellectual function occurs later and is slightly expressed. In people with limited intelligence, the decline in mental abilities is faster and more intense. In such cases, testing is necessary to rule out mental illness. Different intellectual functions also change in different ways. There are abilities that can increase with age: life experience, range of knowledge, practical insight, the ability to find a way out of a difficult situation, knowledge of foreign languages. Other intellectual functions are more prone to fading: memory loss (retrograde amnesia), weakening of the ability to assimilate new information. However, often the difficulties of mastering new material are compensated by the ability for associative thinking, the ability to use rich life experience. Ways to preserve intelligence: a wide range of knowledge, life experience, practical ingenuity, the ability to find a way out of a difficult situation, knowledge of foreign languages.

Psychomotor ability: The elderly and old people work more slowly, but more attentively. More attention is needed to assess the situation. The abundance of information puts older people in a difficult position. Caution in behavior is characteristic.

Personal changes in behavior are largely determined by the state of health, the impact of the disease on the psyche, as well as a critical period in a person's life: retirement, loss of loved ones, loneliness, etc.

1.3. What signs of aging as a result of dysfunctions of the central and peripheral nervous system is important for a nurse to consider when caring for elderly and senile patients? :

Reduced sensitivity (with atrophy of the receptor apparatus): tactile, temperature and pain

Decreased tolerance to temperature changes, risk of hypothermia or hyperthermia

Decreased feeling of thirst and desire to drink liquids, the risk of developing significant dehydration (dehydration)

Dysregulation of the cardiovascular system, high risk of developing orthostatic hypotension - decrease in blood pressure with a rapid transition to a vertical position, accompanied by dizziness, fainting and falls, a high risk of injury

Slowness of movements, impaired coordination and correction of body position, instability, frequent staggering when walking, falls, high risk of injury

The above violations, as well as problems of hearing and vision loss, can lead to accidents with the elderly and the elderly on the streets, crossings, when entering and exiting transport, in rooms with an unusual environment - the wards of hospitals and boarding houses, in bathrooms and toilets. Therefore, the prevention of domestic injuries is an important task in ensuring the safety of the elderly and senile.

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