Organic Brain Disorders

Even when it does not precipitate a stroke, chronic hardening and thickening of the arteries in the brain in old age—cerebral arteriosclerosis—can lead to confusion, disorientation, incoherence, restlessness, and occasional hallucinations. The patient may complain of headaches, dizziness, and fatigue, and sometimes paralysis on one side of the body and/or seizures. Other psychological symptoms, such as anxiety and depression, may also occur as a result of the stress precipitated by the disorder. Organic brain damage in later life also produces symptoms of mental disorders, as in multi-infarct dementia and Alzheimer's disease. Both of these disorders are associated with the degeneration of cerebral neurons, leading to atrophy and related destruction of brain tissue. Becoming more apparent after age 65 and peaking around age 70, approximately one-third of the over-80 population and half of the nursing home population suffer from these disorders.

The symptoms of multi-infarct dementia, which is associated with hypertension and vascular damage, are related to localized areas of dying or dead cerebral tissue known as infarcts. These symptoms include memory defect, periods of confusion, and lowered work efficiency; abstract thinking, judgment, and impulse control can also be affected. The patient may complain of dizziness, weakness, confusion, and fatigue, and may experience episodes of sham emotion, difficulty swallowing, disorientation, and problems in assimilating new experience. As time passes, memory becomes worse, speech and the performance of routine tasks are affected, personal habits deteriorate, little interest is shown in external events, and the patient becomes preoccupied with eating, eliminating, and other body functions.

Less common than multi-infarct dementia but still a serious disorder in the older adult population is Alzheimer's disease. This disease is characterized by a gradual deterioration of memory and other cognitive abilities, disorientation, and disintegration of personality and behavior. Mental alertness, adaptability, sociability, and tolerance for new things or changes in routine all decline gradually. The individual becomes more self-centered in his or her thoughts and activities, untidy, agitated, and preoccupied with natural functions. Although Alzheimer's disease has stimulated a great deal of research and attention by the media, its exact cause is still unknown.

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