SENILE PSYCHOSIS (Senile Brain Disease, Senile Dementia)

A state of mental, emotional, and social deterioration resulting primarily from degeneration of the brain in old age; classified by the American Psychiatric Association (1952) as “Chronic Brain Syndrome associated with senile brain disease.”Due to increasing longevity, cases of senile brain disease have multiplied in the past thirty years, and in 1965 accounted for 4.4 per cent of first admissions to public mental hospitals. The average age at first admission is about seventy-five for both sexes, although the disorder may set in as early as sixty. Female patients outnumber male patients by about four to three because of their longer life span.The onset of senile brain disease (or senile dementia) is usually gradual, although it may be hastened by illness or stress. The first observable symptoms are generally a narrowing of interest, a dislike for change, and a reduction in alertness and adaptability. The patient grows increasingly self-centered and isolated from others; he is preoccupied with his own thoughts and bodily functions and begins to forget recent events. He may also become irritable and easily agitated, unsympathetic or even hostile, restless and insomniac.As the disorder progresses, the memory impairment increases to the point where the patient not only tells the same story over and over again, but may fabricate events, become confused about the time relationships, and forget the names of children or whether he has ever been married at all. Many patients become extremely untidy and careless about personal habits. They tend to forget where they placed objects and may accuse others of stealing them. Sometimes they wander off and become lost. They may also engage in sexual indecencies, such as exhibiting themselves or molesting children. As time goes on they become disoriented, incoherent, and develop delusions and hallucinations.Senile psychoses are classified into five clinical types: simple deterioration, paranoid, presbyophrenic, delirious and confused, and depressed and agitated. See these topics. There is much overlapping between these types, and the distinctions are often arbitrary.The symptom picture in senile psychosis is not thought to be due solely to cerebral atrophy, but to an interaction of organic and psychological factors. Evidence for this lies in the fact that brain changes are not proportionate to intellectual changes, and personality changes often seem to be related to “premorbid” attitudes and behavior patterns such as irritability, rigidity, and immaturity. Moreover, preventive measures are primarily psychological rather than physical.It is generally agreed that senile dementia can be prevented, or at least postponed or reduced in severity, by alleviating conditions that produce stress, anxiety, loneliness, feelings of helplessness and uselessness in aging individuals. Families should therefore help them find satisfying interests, new ways to be of service, and suitable companions to replace others they may have lost. The need for affection and emotional security, a sense of dignity and worth, recognition from others, and a sense of belonging does not diminish with age.It is usually considered advisable to care for milder forms of senile dementia in the home, where the patient has his emotional roots and does not have to revise his lifetime habits. If serious problems develop from intellectual, ethical, and emotional impairment, he usually has to be institutionalized. Treatment may include mild sedatives to encourage sleep, tranquilizers to combat agitation, restlessness, and confusion, a vitamin-enriched diet to slow down brain atrophy and prevent confused and delirious states, and electroshock therapy in cases of severe depression. A program of social and occupational activity should be maintained as long as possible. In spite of these measures, some patients gradually deteriorate until they become oblivious of their surroundings and sink to a vegetative level. See aging, deterioration, VEGETATIVE STATE.